UW News

January 15, 2009

New medical-legal partnership focuses on families

“The mold in my house is making my child sicker, but my landlord would kick me out if I said anything about it.”

“I don’t sleep because I’m worried about immigration officials all the time. And, when I don’t sleep, that means that I don’t treat my family members as well as I should.”

“My husband has a disability and he’s not getting the support that he needs. He used to be our breadwinner—-that’s what’s affecting our family.”

“My son has a felony, and now my landlord wants to kick us out. And, I have three other kids who are now going to be homeless because of that. Is that legal?”

Social, economic and legal problems significantly impact the health and well-being of families, especially their most vulnerable members — children. Many low-income families live from one crisis to the next. Issues like domestic violence, abuse, access to social services, housing, immigration and family law, and special-needs education compound the burdens of families with children. These families often turn to their health care providers for help.

“Sometimes in a trusted environment like a clinic, they’re often more likely to talk about the social, economic and legal issues that concern them,” said Dr. Benjamin Danielson, UW associate clinical professor in the Department of Pediatrics and medical director of the Odessa Brown Children’s Clinic. “However, as health care providers, we’re not necessarily equipped to deal with these issues.”

Now, instead of referring patient families to outside legal and social services agencies that operate in silos, Odessa Brown, Harborview Children and Teens Clinic, and the Northwest Justice Project, with the support of Seattle Children’s, have launched a three-year pilot program to bring advocacy and legal resources directly to families when and where they need them — in the medical clinic. Northwest Justice Project, a legal services organization, will support an attorney to provide legal advocacy and education to medical providers and social workers at the clinics. Davis Wright Tremaine, a local private law firm, also provided considerable support in the formation of the partnership.

The Medical-Legal Partnership for Children (MLPC) will help strengthen the safety net for low-income patient populations at both clinics by providing access to legal counsel, as well as health care. The Partnership, modeled after the Family Advocacy Program in Boston, is the first program of its kind in the Pacific Northwest. It was launched with a $380,000 three-year grant from the Robert Wood Johnson Foundation.

“This grant enables us to serve our young low-income patients facing various social, housing, immigration, economic and legal problems that can negatively affect their health,” Danielson said. “For example, a child with asthma living in substandard housing may make repeated trips to the Emergency Room. Intervention by a social worker and a lawyer that results in improving the family’s living conditions may have a significant, positive impact on the health of that child.”

The MPLC will improve the health and well-being of vulnerable families by addressing the social determinants of health. The Partnership will train health care workers on advocacy issues affecting vulnerable families, including how to screen for, identify, triage, and when appropriate resolve legal issues; case consultation with providers and direct legal services to pediatric patient families to improve access to health care and benefits; and systemic advocacy to promote child health.

“This is a new way to look at the health needs of low-income families seeking medical treatment. Many of these families have at least one significant legal need impacting their health,” said Dr. Brian Johnston, associate professor and chief of pediatrics at Harborview. “It makes sense to have front line primary care providers serving this population learn how to identify legal issues affecting these families, and be able to provide resources to address them.”

The project grant funds an attorney and a social worker. The attorney from the Northwest Justice Project will train physicians and social workers to recognize legal problems that may affect a child’s health. The attorney will also provide legal services and referrals for patient families at both clinics. A social worker will provide program coordination, liaison services between partners, family support and assistance with training and evaluation activities. An evaluation of  the project will be completed in partnership with the UW School of Social Work.

“More than a referral process, this is a new service model where lawyers and physicians can collaborate and advocate to improve the health of our most vulnerable populations,” said Scott Crain, the MLPC staff attorney provided through the Northwest Justice Project. “We’ll’ be able to offer advice and counsel including full representation in court, as well as educate doctors and social workers so that together we can address legal issues and rights violations that negatively impact health.”

Danielson said that the MLPC is a powerful example of how systems can collaborate to improve the quality of health for the region’s most vulnerable. “There are lots of ways our systems can work better. And, it’s nice to have the capacity to develop programs that help cross barriers and bridge gaps. It’s amazing to be able to do that in clinics like these.”

Danielson, Johnston, and Carol Jenkins, manager of the Protection Program at Seattle Children’s, are co-directors of the Medical-Legal Partnership for Children. For more information about the partnership, contact Jennie Richey, project coordinator, at 206-987-5942 or e-mail mlpc@seattlechildrens.org.