Child HeLP (Legal Aid)

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:

• Cincinnati Children’s and the Legal Aid Society educate physicians to increase their knowledge and ability to identify legal and social issues that their low-income patients may experience and refer families to Child HeLP when needed.
• The Legal Aid Society provides information, advice and advocacy to clinic families to resolve legal issues that may affect the health and well-being of children and families.

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:

• 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 2,450 referrals. 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 day care.
• 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.

Finding a Voice

Watch Shaiheim’s story to see how Child HeLP makes a difference for families.

Improving Housing Conditions

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.

Securing Special Education Services

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.