General and Community Pediatrics

The primary care centers at Cincinnati Children’s serve an almost entirely low-income, urban patient population. Of the more than 60,000 clinical visits a year, 90 percent are covered by Medicaid, and 5 percent are not covered by any type of insurance. In the neighborhoods served by Cincinnati Children’s clinics, 47 percent of children live in poverty, and of those children, 26 percent live in extreme poverty. Within this population:

• 36 percent of families lack safe places to play outside or adequate childcare
• 69 percent lack funds to buy needed medications, provide sufficient food or avoid living in substandard housing
• 9 percent of families experience adult physical violence in the home

The Child HeLP program draws on the strengths of two powerful professions to help break the link between poverty and poor child health. We accomplish this in two ways:

• We train and educate to increase physician knowledge and ability to screen for legal and social issues that their low-income patients may experience.
• We provide information, advice and advocacy to resolve legal issues that may affect the health and well-being of children and families.

Since August 2008, Legal Aid has operated an on-site Child HeLP office in the PPCC staffed by a Legal Aid attorney or paralegal five days a week. Doctors and social workers at Cincinnati Children’s Hopple Street and Fairfield primary care clinics also refer patients to Child HeLP for legal assistance. Legal Aid has over 60 attorneys and paralegals who represent clients in seven counties.

The sharing of relevant information between the respective medical and legal teams is a critical component of the program. Legal Aid communicates with physicians and social workers so that they know what happened to the patient they referred and are able to follow up with the family during subsequent visits.

The Child HeLP team has created a “culture of advocacy” that promotes the adoption of regular screening, identification, triage and referral for social and legal issues affecting health. All first-year residents participate in:

• Visits to Hamilton County Job & Family Services and the Freestore Foodbank to learn about their services through tours, meetings with staff and observations of families being served
• Lectures and interactive sessions on Social Determinants of Health, Budgeting, Public Benefits, Housing, and Education
• Noon conferences to review Child HeLP cases and outcomes
• Brief meetings during the residents’ continuity clinic to discuss relevant topics including housing, family law, education and public benefits

Download more information about our resident training on social and legal issues:

• Resident Confidence Addressing Social History: Is It Influenced by Availability of Social and Legal Resources?
• Teaching social determinants of child health in a pediatric advocacy rotation: Small intervention, big impact
• Training in Social Determinants of Health in Primary Care: Does it Change Resident Behavior?

Since its inception in 2008, Child HeLP has received more than 500 referrals each year. Child HeLP keeps children healthy and families stable by achieving the following outcomes:

• Health hazards are eliminated from children’s homes
• Children and families obtain adequate nutrition by establishing eligibility for and securing food stamps and cash assistance
• Children obtain health insurance coverage
• Working parents get help with transportation and daycare
• Children are enrolled in school and get the special education support they need
• Child custody disputes are resolved
• Parents obtain relief from domestic violence
• Families avoid homelessness

Improving Housing Conditions

Six-month-old Maya was born prematurely and has Down syndrome. When Maya visited the PPCC, she had recently been hospitalized for a lung infection that appeared to be triggered or worsened by flooding and mold in her home. Maya’s doctor referred Maya’s family to Child HeLP. The Legal Aid attorney learned that other residents in Maya’s building were experiencing similar problems.

The landlord for the building where Maya lives refused to make repairs. Legal Aid filed court papers asking that the landlord be required to meet his legal obligations as a property owner. A judge ordered the owner of the building to make emergency repairs to all five apartments, beginning with elimination of the mold and flooding problems in Maya’s family’s bathroom. The repairs have been completed and Maya now lives in a healthier environment.

Securing Special Education Services

Beverly was not sure how to support her child, because the principal of her son’s school and her doctor at Cincinnati Children’s had different responses to the child’s preschool behaviors. Beverly’s 3-year-old son Caldwell was having behavior problems, and the school principal wanted him on medication to control his behavior as a condition of school attendance. Caldwell’s doctor did not support putting the child on medication, and the doctor referred him to Child HeLP for assistance.

The Legal Aid attorney worked with Beverly, the school and the child’s therapist to line up behavior supports and special education services for Caldwell. The attorney worked with the school to monitor and make changes as needed in his educational services. With appropriate services and supports in place, Caldwell did not need medication to make great progress and successfully complete the school year.