Computer-Supported Management of Medical-Legal Issues Impacting Child Health

Poverty-induced hardships, such as food insecurity, utility shut-offs, and substandard housing, have the potential to negatively impact health. In the United States, laws and policies exist to address such issues, but access to legal aid is often limited by social and economic disadvantages. A child’s health status may be negatively affected when they do not receive the benefit of laws designed to address such disparities. This study expanded upon the medical-legal partnership (MLP) concept to mitigate health disparities. MLP is a healthcare delivery model that seeks to improve the health and wellbeing of vulnerable populations by identifying social problems that may impede health and contribute to existing disparities.

The Child Health Improvement through Computer Automation (CHICA) system is a pediatric primary care computer-based clinical decision support system that is used to screen families for potential health problems in the clinic waiting room based on age-appropriate clinical guidelines and data already contained in the patient’s electronic health record. This study integrated CHICA and the MLP and incorporated legal service providers into the healthcare team to help facilitate solutions.

The specific aims of the project were as follows:

• Expand and modify an existing computer-based decision support system, CHICA, to assist pediatricians with the identification and management of four common medical-legal problems that have the potential to adversely impact child health. 
• Evaluate the effect of the CHICA medical-legal module on the identification and mitigation of medical-legal problems in four pediatric practices. 
• Evaluate physician and patient caregiver satisfaction with the CHICA medical-legal module. 
• Evaluate the impact of the CHICA medical-legal module on healthcare utilization. 

This randomized controlled study was conducted in five urban community health centers, focusing on common medical-legal issues including food insecurity, utility insecurity, housing instability, and substandard housing. Intervention clinics had access to the CHICA system and the full MLP module, while control clinics had access to CHICA and a modified MLP module that did not provide follow-up prompts or informational handouts. Caregivers of children up to 24 months of age and their physicians were interviewed regarding their satisfaction with the intervention process. They were also asked about any measures they had taken to mitigate identified medical-legal issues.

Initial results found that, of the four types of unmet legal needs, unmet food needs were the greatest, followed by substandard housing, housing instability, and lastly unmet utility needs. Analysis found that among intervention site caregivers interviewed, the proportion reporting that they were given written information about how to get help ranged from 72-82 percent by issue type, and the proportion reporting the same in control sites ranged from 64-81 percent by issue type. Researchers are currently reviewing the full dataset, completing the analyses, and plan to publish the full results in peer reviewed publications.