Collective Impact through Medical-Legal Partnerships Mary Asbury, JD Lee Ault Carter Robert S. Kahn, MD, MPH Angela M. Lloyd, JD Philanthropy Forward ‘15 Philanthropy Ohio September 18, 2015
Medical-Legal Partnerships Legal and health care teams together identify, address and prevent social and civil legal needs that impact patient families’ health and well -being
How MLPs work • Train health care providers to identify social and legal needs of patients • Provide legal care to patient families through information, advice and legal advocacy • Improve population health through system-level advocacy
The Need Variation in asthma admission rates by neighborhood All admissions 9/10-8/11 Red patients >5x more likely to lack transportation, live in poverty, be exposed to bad housing, have a depressed parent compared to green patients
National MLP • 1993: First MLP founded at Boston Medical Center • 2006: Kellogg and Robert Wood Johnson Foundations invested in national arm of Boston MLP • 2009: Renamed National Center for Medical-Legal Partnership established • 2013: National Center moves to George Washington University’s School of Public Health • Today: MLPs in 276 healthcare institutions in 36 states
Ohio MLPs
Cincinnati Child Health-Law Partnership (Child HeLP) • Partnership between Cincinnati Children’s Hospital Medical Center and Legal Aid Society of Greater Cincinnati • Referrals made in three primary care clinics; onsite office in largest clinic staffed by attorneys and paralegals • Assists clients with housing concerns, public benefit denials/delays, education services, family/custody issues • Interdisciplinary child advocacy training teaches residents to screen, identify and refer www.cincinnatichildrens.org/childhelp
Screening in Electronic Health Record
Data Sharing EPIC-Legal Referral Order By MRN to Match to LAS file (For Excel Output) EPIC Go-Live occurred on 5/24/11 Count of Orders on this report: 25 For Referrals made: 04/27/2014 to 05/03/2014 For Week Starting on: 4/27/2014 Count of Orders for this week: 25 MRN Pt Name Order Date Prov Name DOB OrderNum Race SEX ICD9_CODE Description Clinical Comments Address1 Address2 City ST Zip Work Phone HOME_PHONE DEPT_ABBREVIATION Child HeLP Date range: 4/1/14 - 4/30/14 Total records:130 Child Name Date Created in PIKA Date Opened 1st Contact Date Client name File # Area Intake Code Status Date Closed/Declined Closing Code Declined Code Notes (from CH Page) MRN
Monthly Outcomes Reports Last 12 Last 12 Month Current Month Last Month Last 12 Month Month Monthly Average Referrals Referrals Referrals Monthly Rate of Referrals per June 2015 May 2015 July 2014 - June 2015 Average 1000 Well Child Visits SITES All 55 78 823 69 24 PPC 30 52 584 49 30 Fairfield 20 18 159 13 22 Hopple 5 8 80 7 11 PROVIDERS All 55 78 823 69 Resident 14 28 270 23 Attending/Other 35 44 499 42 6 6 54 5 Social Worker (Direct) 18 24 337 28 Social Worker (Facilitated)* Last 12 Current Month Last Month Last 12 Month Month Opened Cases Opened Cases Opened Cases Monthly % of Last 12 Month June 2015 May 2015 July 2014 - June 2015 Average Monthly Average CASE TYPE All 48 35 583 49 Health/Income 11 11 159 13 27% Housing 25 14 270 23 46% Family 4 3 42 4 7% Education 8 6 105 9 18% Misc. Legal 0 1 7 1 1% CY2015 to date *Referral preceded 403 referrals within 72 hours by physician visit 281 cases opened
Results Since August 2008: • Referred over 4,400 patient families • Helped 8,300 children and 4,200 adults • Recovered $300,000 in back public benefits • Trained 400 residents and social workers
System-Level Advocacy • Sixteen Child HeLP referrals for similar complaints: • Pests, mold, no A/C • High rates of asthma, developmental delay, ↑ lead • Families lived in apt. complex: • Single developer • Foreclosure • Outstanding code violations • Tenant association formed, repairs facilitated 1 family → 16 families → 19 buildings/677 units
National and Regional Recognition
Publicatio Joint Publications ns • “Doctors and Lawyers Collaborating to HeLP Children – Outcomes from a Successful Partnership between Professions” , Melissa D. Klein, MD, MEd; Andrew F. Beck, MD, MPH; Adrienne W. Henize, JD; Donita S. Parrish, JD; Elaine E. Fink, JD; Robert S. Kahn, MD, MPH, Journal of Health Care for the Poor and Underserved , August 2013. • “ Identifying and Treating a Substandard Housing Cluster Using a Medical-Legal Partnership ”, Andrew F. Beck, MD, MPH, Melissa D. Klein, MD, MEd, Joshua K. Schaffzin, MD, PhD, FAP, Virginia Tallent, JD, Marcheta Gillam, JD, and Robert S. Kahn, MD, MPH, Pediatrics , November 2012. • “ Training in Social Determinants of Health in Primary Care: Does it Change Resident Behavior? ”, Melissa D. Klein, MD; Robert S. Kahn, MD, MPH; Raymond C. Baker, MD, MEd; Elaine E. Fink, JD; Donita S. Parrish, JD; and Deanna C. White, Academic Pediatrics, September – October 2011.
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