Tapping medical-legal partnerships to boost children’s health

People who face utility shutoffs are more likely to also experience poor health, hospitalization, and concerns about their children’s development. And these strains worsen as energy prices rise.

In a new study, Yale researchers set out to better understand what other stressors families experiencing energy insecurity encounter — and make the case for the value of a model known as medical-legal partnerships in addressing them.

Most U.S. states have laws that protect people from the shutoff of utilities — such as water, sewer, and electricity — when these services are deemed necessary to prevent life-threatening medical conditions, often requiring a certificate signed by a physician. For the study, published Oct. 13 in the journal Pediatrics, the researchers surveyed families with children who had received such a certificate about other health-related social needs.

They found that most families surveyed also faced food, housing, and financial insecurity. Most owed arrearages for utility bills, ranging from less than $500 to more than $20,000. Nearly all said their utility shutoff certificates were helpful.

Understanding how often these stressors co-occur, the researchers said, is key to ensuring they can be addressed. And medical-legal partnerships — which situate legal services within health care settings and provide essential legal support for meeting health-related social needs — can play a big role in that effort.

Study authors Julia Rosenberg, an assistant professor of pediatrics at Yale School of Medicine, and Alice Rosenthal, an attorney with nonprofit law firm the Center for Children’s Advocacy and head of its medical legal partnership at Yale New Haven Hospital, sat down with Yale News to discuss the challenge, the benefit of medical-legal partnerships, and the importance of understanding health-related social needs.

This interview has been edited and condensed.

What are medical-legal partnerships and what services do they provide?

Alice Rosenthal: The model of a medical-legal partnership fully embeds legal services for low-income families into a medical setting. So the lawyer is part of the health care clinic, and with that, providers, nurses, doctors, social workers, everybody in the clinic thinks of legal health as part of health care. That leads them to think about and screen for the legal aspects that impact someone’s health and introduce patients to the lawyer so they can address any legal issues.

How prevalent are medical-legal partnerships?

Rosenthal: It’s more likely that a patient will not have access to one in their health care facility. There are very few lawyers in the country for low-income families and most civil legal matters go unaddressed. In the medical-legal partnership world, it’s very hard to find funding to support a lawyer in a health care setting.

Why is it important to have a better understanding of health-related social needs?

Julia Rosenberg: I think as health providers, addressing health from a holistic perspective and understanding all of the contextual factors that can affect health are incredibly important. In pediatrics, we’re often focused on prevention. We have preventative visits where we’re able to guide families and patients and counsel them on all sorts of ways to help children thrive in the future. One of the biggest ways to set children up for success is to make sure all aspects that affect health, including housing, food, electricity, equal access to education, are considered.

One of the benefits of having the Center for Children’s Advocacy embedded in our health care setting is that when we see certain aspects of health-related social needs that can be affected by legal support, we already have a solution available. It’s through this ongoing collaboration that we start to learn how to identify those needs more acutely and are able to intervene.

What did your new study reveal about the stresses these families face?

Rosenberg: We looked at families who had received utility shutoff protection through our medical-legal partnership and found that most had co-occurring health-related social needs relating to housing insecurity, food insecurity, and financial insecurity.

The percentage of families experiencing these insecurities were higher than previous studies have found for adults. Why do you think that was?

Rosenberg: We only have hypotheses right now, but one thought is that when there are stressors, there’s a greater impact on families with children. We’ve seen this trend in other situations, like the COVID-19 pandemic, for example.

Rosenthal: Families with children are particularly vulnerable to these sorts of stressors because of the high cost of raising children. The pandemic laid that bare for all of us to see. Further, as Dr. Rosenberg pointed out, pediatricians are doing a lot of preventative medicine and working with families to identify stressors and alleviate them before they become real problems. That kind of preventative care might not always happen in adult settings.

What do you hope people take away from these findings?

Rosenberg: We have shown that there are health-related social needs occurring at relatively high rates — addressing them is very important. Another important takeaway is the value of interdisciplinary initiatives like medical-legal partnerships. When we’re able to address one of a family’s needs — whether that’s medical, mental health, or health-related social needs — we have this opportunity to provide holistic care and address other needs. And that’s what we can do in a medical facility that has a medical-legal partnership.

Rosenthal: A lot of families we work with are skeptical as to why they would tell their child’s pediatrician about their housing or food insecurity. But when we train providers to think about social determinants of health as part of health care, families feel more comfortable sharing that information and consequently their kids are healthier.

So I would say everyone should have a medical-legal partnership or an interdisciplinary, holistic way of providing care, so that even if you don’t have a lawyer in the clinic, providers know what community resources are available to patients and their families.