Medical-legal partnership and healthy start: Integrating civil legal aid services into public health advocacy

Journal of Legal Medicine

Volumn 35, Issue 1, 2014, Pages 195-209

  Atkins, Daniel ^a   Heller, Shannon MacE ^a,b   Debartolo, Elena ^c   Sandel, Megan ^d  

^a WIDENER UNIVERSITY   (United States)

^b Department of Behavioral Health   (United States)

^c BOSTON MEDICAL CENTER   (United States)

^d BOSTON UNIVERSITY SCHOOL OF PUBLIC HEALTH   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; CASE MANAGEMENT; COOPERATION; FEMALE; HEALTH CARE DELIVERY; HEALTH CENTER; HEALTH PROMOTION; HUMAN; INFANT; INTEGRATED HEALTH CARE SYSTEM; INTERDISCIPLINARY COMMUNICATION; LEGISLATION AND JURISPRUDENCE; MALE; NEWBORN; OUTCOME ASSESSMENT; PREGNANCY; PUBLIC HEALTH; UNITED STATES; VULNERABLE POPULATION;

ADULT; CASE MANAGEMENT; COOPERATIVE BEHAVIOR; DELIVERY OF HEALTH CARE, INTEGRATED; FEMALE; HEALTH PROMOTION; HEALTH SERVICES ACCESSIBILITY; HEALTHY PEOPLE PROGRAMS; HUMANS; INFANT; INFANT, NEWBORN; INTERDISCIPLINARY COMMUNICATION; MALE; MATERNAL-CHILD HEALTH CENTERS; OUTCOME ASSESSMENT (HEALTH CARE); PREGNANCY; PUBLIC HEALTH; UNITED STATES; VULNERABLE POPULATIONS;

EID: 84897450139     PISSN: 01947648     EISSN: 1521057X     Source Type: Journal    
DOI: 10.1080/01947648.2014.885333     Document Type: Article

References (62)

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2. LSC updated the report in 2009 and concluded that only a small fraction of the legal problems experienced by low-income people (less than one in five) are addressed with the assistance of either a private attorney (pro bono or paid) or a legal aid lawyer
3. On the average, only one legal aid attorney is available for every 6,415 lowincome people.
4. By comparison, there is one private attorney providing personal legal services (those meeting the legal needs of private individuals and families) for every 429 people in the general population who are above the LSC poverty threshold.
5. Documenting the Justice Gap in America: The Current Unmet Civil Legal Needs of Low-Income Americans, LEGAL SERVS.
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13. Nancy Adler et al., Reaching for a Healthier Life: Facts on Socioeconomic Status and Health in the US, JOHN D. AND CATHERINE T. MCARTHUR FOUND. RES. NETWORK ON SOCIOECONOMIC STATUS AND HEALTH 1, 4 (2007), http://www.macses.ucsf. edu/downloads/ReachingforaHealthierLife.pdf.
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22. Stress is commonly defined as a person's response to any real or perceived threat (i.e., the stressor).
23. Allostasis (allo, meaning other, and stasis, meaning stability and taken from the Greek "to stand") refers to the body's ability to adapt to stress, through the output of hormones, to maintain or return to homeostasis.
24. Bruce S. McEwen & Eliot Stellar, Stress and the Individual:Mechanisms Leading to Disease, 153 ARCH. INTERNALMED. 2093, 2094-95 (1993). Daily life requires the constant adjustment of physiologic systems in response to stressors.
25. McEwen and Stellar initially put forth the theory of allostatic load in which a person is exposed to chronic stress and is unable to return to a state of homeostasis. Id.
26. Over long periods of time, this can accelerate disease processes and impair the body's ability to adapt to future stressors.
27. Multiple studies have shown that people in lower socioeconomic groups experience greater exposure to chronic stress than their more advantaged peers
28. And allostatic load may help to explain some of the health disparities that exist. See id. at 2095.
29. Lu & Halfon, supra note 18, at 13.
30. Pies et al., supra note 17, at 10.
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32. Megan Sandel et al., Medical-Legal Partnerships: Transforming Primary Care by Addressing the Legal Needs of Vulnerable Populations, 29 HEALTH AFF. 1697-1698 (Sept. 2010), http://www.medicallegalpartnership.org/sites/default/ files/page/MLP%20Transforming%20Primary%20Care.pdf.
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40. See generally Jeanette Zelhof & Sara J. Fulton, MFY Legal Services' Mental Health-Legal Partnership, 44 J. POVERTY L. & POL'Y 535 (Mar. 2011), http://www.mfy.org/wp-content/uploads/MFY-Legal-Services-Mental-Health-Legal- Partnership.pdf.
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44. David R. Williams et al., Moving Upstream: How Interventions that Address the Social Determinants of Health Can Improve Heath and Reduce Disparities, 14
45. J. PUB. HEALTH MGMT. PRAC. S8-S11 (2008), http://www.medical- legalpartnership.org/sites/default/files/news story file/Moving%20Upstream.pdf.
46. See generally Preventive Medicine: A Ready Solution for a Health Care System in Crisis, 13 POPULATION HEALTH MGMT. S3, S3-S11 (2010), http://www.uspreventivemedicine.com/Files/PDFs/In-Line/Supplemental-Article- Population-Health-Management-.aspx.
47. Chester (City), Pennsylvania, U.S. CENSUS BUREAU, http://quickfacts. census.gov/qfd/states/42/4213208. html (last updated June 27, 2103).
48. Our MLP, HELP: MLP, http://www.helpmlp.org/our-mlp.html (last visited Oct. 29, 2013).
49. quoting the results of a 2010 Needs Assessment Survey of participants in Chester, Pennsylvania).
50. See id.
51. See SavingOur Nation's Babies: The Impact of the FederalHealthy Start Initiative, NAT'LHEALTHY START ASS'N (2013), http://www.nationalhealthystart. org/site/assets/docs/NHSASavingBabiesPub2ndED.pdf.
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54. See Health, Education, & Legal-Assistance Project: A Medical Legal Partnership, HELP: MLP, http://www.helpmlp.org/(last visited Oct. 23, 2013).
55. I-HELP is a screening tool developed by the National Center forMedical Legal Partnership as a practical method for clinicians to elicit a history of social.
56. Circumstances from their patients. It helps focus the history on specific domains vital to health and well-being that are amenable to direct intervention.
57. IHELP is a mnemonic for: income supports and health coverage (I); housing and utilities (H)
58. Education and employment (E); legal (immigration) status (L); and personal and family stability and safety (P).
59. It is easily remembered by clinicians, and empowers them to screen for unmet needs and address issues, each of which directly impacts health.
60. Screening can be done during a series of healthcare visits or in a more focused manner if one of these issues is identified as a significant contributor to or risk factor for poor health.
61. See Ch́en Kenyon et al., Revisiting the Social History for Child Health, 120 PEDIATRICS e734-38 (2007).
62. See generally Robert Pettignano et al., The Health Law Partnership: Adding a Lawyer to the Health Care Team Reduces System Costs and Improves Provider Satisfaction, 18 J. PUB. HEALTHMGMT. & PRAC. 1 (2012); Locke et al., supra note 27.