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Cincinnati Children's reduced hospital admissions 38% by offering legal help to remedy poor living situations

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A Cincinnati Children’s Hospital Medical Center partnership with the Legal Aid Society has been so successful it’s keeping children out of the hospital. A study published Monday in Health Affairs shows the alliance has reduced admissions by 38% for those referred to the program.

Launched in 2008, the Child HeLP program (Cincinnati Child Health-Law Partnership) connects pediatric primary care patients and their families to advocates from the Legal Aid Society of Greater Cincinnati.

One success story involved forcing a large Cincinnati landlord to correct toxic housing conditions in Avondale. Situations like these can cause breathing problems. Legal Aid attorneys have also contested eviction notices that can leave sick kids out on the street. They have resolved benefits disputes where families have been unlawfully denied government programs like SNAP or WIC.

“If this were a pill that demonstrated a 38% reduction across so many kids in terms of hospitalization, every pharmaceutical company in the country would be going after it, and every health care payer would be figuring out how to cover it,” says Robert Kahn, MD, MPH, associate chair of Community Health at Cincinnati Children’s and the University of Cincinnati, and a co-author of the study.

Child HeLP | A Cincinnati Children's Partnership

To study the impact the partnership is having, researchers “compared outcomes for 2,203 children referred to Child HeLP over several years to 100 randomly selected control groups drawn from a pool of 34,235 children who were seen concurrently but not referred,” says the hospital.

“This is a terrific study,” says Laura Gottlieb, MD, MPH, a professor at the University of California in San Francisco and founding co-director of the Social Interventions Research and Evaluation Network (SIREN), a national research network that studies health care strategies to improve social conditions.

“This work could only be done in a place like a Cincinnati Children’s that has had such a long term dual commitment to addressing families’ social/legal and medical needs and to rigorously evaluating their programs," she adds. "The study adds substantively to the literature in this area, in this case demonstrating that a strong medical-legal partnership can contribute to decreasing costly and avoidable health care utilization in children.”

Study author Andrew Beck, MD, MPH, of the Division of General and Community Pediatrics at Children’s, worked to resolve that 2009 case in Avondale were one family faced eviction over installing an air conditioner to help a child with asthma. Exposing the problems at this building led to improvements at 19 buildings controlled by the same management group.

The study’s authors say work like this needs to be expanded. According to the National Center for Medical-Legal Partnership, 450 such medical-legal partnerships have formed.