Advertisement

The Impact of a Pediatric Medical-Legal Partnership on Pediatric Providers: A Qualitative Study

      Abstract

      Objective

      Medical-Legal Partnerships (MLPs) integrate medical and legal care to address prevalent health-harming legal needs (HHLN) among socioeconomically marginalized populations. MLPs address a diverse array of social determinants of health (SDOH) and have been shown to positively impact children's health. Less is known, however, about how MLPs affect health care providers. MLPs may affect child health by changing clinical practice and provider behavior, and transforming providers’ relationships with their patients and patients’ families. Examining and understanding how MLPs affect providers is thus critical to elucidating how MLPs may ultimately impact child health.

      Methods

      We examined one pediatric MLP at an academic medical center in New Haven, Connecticut. We conducted semi-structured interviews with 20 pediatric providers who had engaged with the MLP and 20 parents/guardians who had interacted with the MLP. We analyzed the qualitative data using inductive coding, primarily drawing upon provider interviews.

      Results

      The MLP affected providers in five major ways. The MLP 1) improved provider awareness of SDOH and HHLN, 2) expanded provider perceptions of their role and responsibilities as clinicians, 3) improved provider efficacy in addressing SDOH and HHLN, 4) empowered providers to engage in systemic advocacy, and 5) improved providers’ relationships with patients’ families.

      Conclusion

      Our study identifies multiple ways that a pediatric MLP affects providers. Our findings suggest that MLPs can improve patient and population health by equipping providers with the knowledge and tools needed to assist patients with HHLN and SDOH, improving provider-family relationships, and encouraging providers to engage in systemic and institutional advocacy.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Adler NE
        • Rehkopf DH
        U.S. disparities in health: descriptions, causes, and mechanisms.
        Annu Rev Public Health. 2008; 29: 235-252
        • Link BG
        • Phelan JC
        • Miech R
        • et al.
        The resources that matter: fundamental social causes of health disparities and the challenge of intelligence.
        J Health Soc Behav. 2008; 49: 72-91
        • AAP Council On Community Pediatrics
        Poverty and child health in the United States.
        Pediatrics. 2016; 137e20160339
        • Huang KY
        • Cheng S
        • Theise R.
        School contexts as social determinants of child health: current practices and implications for future public health practice.
        Public Health Rep. 2013; 128: 21-28
        • Coley RL
        • Leventhal T
        • Lynch AD
        • et al.
        Relations between housing characteristics and the well-being of low-income children and adolescents.
        Dev Psychol. 2013; 49: 1775-1789
        • Leventhal T
        • Newman S.
        Housing and child development.
        Child Youth Serv Rev. 2010; 32: 1165-1174
        • American Academy of Pediatrics
        Integrating social determinants of health into health supervision visits.
        (Pediatrics)in: Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed. American Academy of Pediatrics, Itasca, IL2019
        • Beeson T
        • Mcallister BD
        • Regenstein M.
        Making the Case for Medical-Legal Partnerships: A Review of the Evidence.
        National Center for Medical-Legal Partnership, 2013
        • Taylor DR
        • Bernstein BA
        • Carroll E
        • et al.
        Keeping the heat on for children's health: a successful medical-legal partnership initiative to prevent utility shutoffs in vulnerable children.
        J Health Care Poor Underserved. 2015; 26: 676-685
        • O'Sullivan MM
        • Brandfield J
        • Hoskote SS
        • et al.
        Environmental improvements brought by the legal interventions in the homes of poorly controlled inner-city adult asthmatic patients: a proof-of-concept study.
        J Asthma. 2012; 49: 911-917
        • Conover CJ
        • Whetten-Goldstein K.
        The impact of ancillary services on primary care use and outcomes for HIV/AIDS patients with public insurance coverage.
        AIDS Care. 2002; 14: S59-S71
        • Sege R
        • Preer G
        • Morton SJ
        • et al.
        Medical-legal strategies to improve infant health care: a randomized trial.
        Pediatrics. 2015; 136: 97-106
        • Tsai J
        • Middleton M
        • Villegas J
        • et al.
        Medical-legal partnerships at Veterans Affairs medical centers improved housing and psychosocial outcomes for vets.
        Health Aff (Millwood). 2017; 36: 2195-2203
        • Ryan AM
        • Kutob RM
        • Suther E
        • et al.
        Pilot study of impact of medical-legal partnership services on patients' perceived stress and wellbeing.
        J Health Care Poor Underserved. 2012; 23: 1536-1546
        • Rodabaugh KJ
        • Hammond M
        • Myszka D
        • et al.
        A medical-legal partnership as a component of a palliative care model.
        J Palliat Med. 2010; 13: 15-18
        • Lawton R
        • Whitehead M
        • Henize A
        • et al.
        Medical-legal-psychology partnerships - innovation in addressing social determinants of health in pediatric primary care.
        Acad Pediatr. 2020; 20: 902-904
        • Keene DE
        • Murillo S
        • Benfer EA
        • et al.
        Reducing the justice gap and improving health through medical-legal partnerships.
        J Leg Med. 2020; 40: 229-245
        • Corbin J
        • Strauss A.
        Grounded theory research - procedures, canons and evaluative criteria.
        Z Soziol. 1990; 19: 418-427
        • Cohen E
        • Fullerton DF
        • Retkin R
        • et al.
        Medical-legal partnership: collaborating with lawyers to identify and address health disparities.
        J Gen Intern Med. 2010; 25: S136-S139
        • Regenstein M
        • Trott J
        • Williamson A.
        The State of the Medical-Legal Partnership Field: Findings From the 2016 National Center for Medical-Legal Partnership Surveys.
        National Center for Medical-Legal Partnership, 2017
        • O'Toole JK
        • Burkhardt MC
        • Solan LG
        • et al.
        Resident confidence addressing social history: is it influenced by availability of social and legal resources?.
        Clin Pediatr (Phila). 2012; 51: 625-631
        • Paul EG
        • Curran M
        • Tobin Tyler E
        The medical-legal partnership approach to teaching social determinants of health and structural competency in residency programs.
        Acad Med. 2017; 92: 292-298
        • Paul E
        • Fullerton DF
        • Cohen E
        • et al.
        Medical-legal partnerships: addressing competency needs through lawyers.
        J Grad Med Educ. 2009; 1: 304-309
        • Long T
        • Bosu O
        • Chaiyachati KH
        • et al.
        Why aren’t more primary care residents going into primary care? Studying program factors through qualitative interviews with primary care residents.
        J Gen Intern Med. 2014; 29: S258
        • De Marchis E
        • Knox M
        • Hessler D
        • et al.
        Physician burnout and higher clinic capacity to address patients' social needs.
        J Am Board Fam Med. 2019; 32: 69-78
        • Trott J
        • Regenstein M
        • Peterson A
        • et al.
        Clinician Perspectives of Medical-Legal Partnerships: Lessons for Adopting Social Determinants of Health Interventions in Health Care Settings.
        National Center for Medical-Legal Partnerships, 2019
        • Anderson-Carpenter KD
        • Collie-Akers V
        • Colvin JD
        • et al.
        The role of advocacy in occasioning community and organizational change in a medical-legal partnership.
        J Prev Interv Community. 2013; 41: 167-175
        • Allen H
        • Wright BJ
        • Harding K
        • et al.
        The role of stigma in access to health care for the poor.
        Milbank Q. 2014; 92: 289-318
        • Knowles M
        • Khan S
        • Palakshappa D
        • et al.
        Successes, challenges, and considerations for integrating referral into food insecurity screening in pediatric settings.
        J Health Care Poor U. 2018; 29: 181-191
        • Trott J
        • Peterson A
        • Regenstein M.
        Financing Medical-Legal Partnerships: View From the Field.
        National Center for Medical Legal Partnership, 2019