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Child HeLP is an innovative medical-legal partnership between the Cincinnati Children’s primary care centers and the Legal Aid Society of Greater Cincinnati to help patient families resolve legal and social issues that often undermine the health and well-being of their children. Doctors and social workers screen clinic families for problems that can be improved through legal assistance, including hunger, poor housing conditions, domestic violence and inadequate special education services. Once problems are identified, patients are referred to Child HeLP.
Our medical-legal partnership helps patient families navigate complex systems and gain the assistance they need to keep their children safe and healthy. Often, the resolution or management of legal and social problems contributes to improved health and well-being of the patient and family.
The primary care clinics at Cincinnati Children’s – Pediatric Primary Care Center (PPC) at the Burnet Campus, Hopple Street Health Center and Fairfield Primary Care Center – serve as the medical home for 25,000 vulnerable children in Greater Cincinnati, 90 percent of whom are on Medicaid.
Our clinic population mirrors the local low-income population. According to 2010 US Census Bureau estimates, Cincinnati’s childhood poverty rate is estimated at 48 percent, third among major US cities. One in five children in the 15-county region of Greater Cincinnati and Northern Kentucky lives in poverty.
Child HeLP draws on the strengths of two powerful professions, medicine and law, to help break the link between poverty and poor child health. We accomplish this in two ways:
Legal Aid operates an on-site Child HeLP office in the PPC 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 centers also refer patients to Child HeLP for legal assistance. Legal Aid has approximately 60 attorneys and paralegals who represent clients in Child HeLP cases.
The sharing of relevant information between the medical and legal teams is a critical component of Child HeLP. Following the parent or guardian’s written consent, the physician or social worker generates a Child HeLP referral in the electronic medical record that is automatically transmitted to the Child HeLP office. Legal Aid communicates back to the providers so that they know what happened to the patient they referred and are able to follow up with the family during subsequent clinic 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.
Resident physician training includes 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; and interactive learning sessions on social determinants of health, budgeting, public benefits, domestic violence, housing, and education.
Download more information about our resident training on social and legal issues:
Since its inception in 2008, Child HeLP has received more than 2,450 referrals. Child HeLP keeps children healthy and families stable by achieving the following outcomes:
Watch Shaiheim’s story to see how Child HeLP makes a difference for families.
Joseph was referred to Child HeLP because of appalling conditions in his apartment, including cockroach infestation and water damage. The entire apartment building was in disrepair, and Joseph was exposed to asthma triggers such as mold and dust on a daily basis.
Joseph’s referral to Child HeLP uncovered a much larger problem in his neighborhood. Together, Cincinnati Children’s and the Legal Aid Society discovered that a total of 16 families (45 children) had been referred to Legal Aid due to housing complaints from a cluster of 19 buildings that were all owned by a single absentee landlord. More than a third of the referrals involved patients with asthma.
Legal Aid learned that the Cincinnati Health and Building Departments had cited each of the 19 buildings for prior code violations and that the existing orders had not been complied with by the owner. The attorneys worked with the Building Department to help identify code violations in these buildings and to reissue orders for repairs.
Armed with powerful photographs of leaky ceilings, moldy pipes and insect infestations – all asthma triggers – Legal Aid also helped tenants form a tenants’ association. Legal Aid worked with the tenants to identify and prioritize repairs and force the landlord to remediate problems. The referrals to Child HeLP among these 19 buildings resulted in clean up and repair in nearly 80 percent of the cases, and major infrastructure repair (new roof, integrated pest management, improved electrical systems) in more than half of the buildings.
Since the improvement in living and building conditions, the number of cases of emergency department admissions for asthma from Joseph’s neighborhood has now decreased.
> Read more about Child HeLP’s work to improve housing conditions for families: Identifying and Treating a Substandard Housing Cluster Using a Medical-Legal Partnership.
Jeremiah is a junior high student with ADHD referred to Child HeLP because he was recommended for expulsion for misbehavior which put him at risk of being out of school for up to 80 school days. Much of Jeremiah’s behavior was related to ADHD, of which the school was aware. Although the school had agreed to complete a special education evaluation for Jeremiah over a year earlier, in fact the school never evaluated Jeremiah or provided interventions or accommodations to support his success.
Legal Aid represented Jeremiah’s mom and persuaded the school to withdraw the proposal for expulsion and allow Jeremiah to return to school immediately. In addition, the school agreed to provide accommodations for his disability. Cincinnati Children’s social workers provided the attorney with documentation of Jeremiah’s current condition, which was very helpful in resolving the discipline issue and increasing the likelihood of school success for Jeremiah.
The issues in this case raised questions about the possibility that this school district was engaged in a pattern of improper school removal for behavior issues of students who actually had special education disabilities and were entitled to interventions and supports – not punishment. As a result, Legal Aid attorneys are monitoring cases and data coming out of this district to identify systemic issues that should be addressed.
Child HeLP developed an innovative social history video curriculum to teach providers how to screen for social and legal issues affecting their low-income patient families.
> See Video Curriculum on Screening for the Social Determinants of Health. You will have to sign in to MedEdPORTAL to access the materials.
Child HeLP and other community partnerships are improving the health and well-being of low-income patient families:
> Vital Signs, Research Horizons> When Children Don’t Have Enough to Eat, Young & Healthy> Hope in a Grocery Cart, Young & Healthy
Learn how Cincinnati Children’s and other experts are using medical-legal partnerships to remove barriers to care and improve the lives of patients.
> When Poverty Makes You Sick, a Lawyer Can Be the Cure | New York Times Column
> Forbes Profiles in Innovation interview
> Institute for Healthcare Improvement audio broadcast
> Robert Wood Johnson Foundation | NewPublicHealth Q&A with Robert Kahn, MD
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