Medical legal partnership and health informatics impacting child health: Interprofessional innovations

Abstract

Dramatic differences in health are closely related to degrees of social and economic disadvantage. Poverty-induced hardships such as food insecurity, utility shut-offs, and substandard housing, all have the potential to negatively impact the health of families. In an effort to better address social determinants of health in pediatric primary health care settings using the Medical Legal Partnership (MLP) model of health care delivery, an interprofessional team of investigators came together to design an innovative process for using computerized clinical decision support to identify health-harming legal and social needs, improve the delivery of appropriate physician counseling, and streamline access to legal and social service professionals when non-medical remedies are required. This article describes the interprofessional nature of the MLP model itself, illustrates the work that was done to craft this innovative health informatics approach to implementing MLP, and demonstrates how pediatricians, social workers and attorneys may work together to improve child health outcomes.

An Integrative Review of Social Determinants of Health Assessment and Screening Tools Used in Pediatrics

“…In this way, nurses can have a vital role in appropriately directing patients and families towards relevant community resources. Second, interventions addressing SDOH risks demonstrate positive effects on child and family health and well-being (Gilbert et al, 2015) and are cost effective (Beck et al, 2016). Employing a system of routine screening of youth and family SDOH by pediatric nurses upon first clinic encounter or during admission intake, and again at regular follow-up intervals, would be an initial step in assessing population needs to tailor resource interventions.…”

“…Despite consistent research and knowledge documenting the negative impact that SDOH have on youth health outcomes and the positive effects addressing SDOH has on reducing health disparities (Gilbert & Downs, 2015), clinicians rarely screen for, or address, SDOH in pediatric clinical care settings (Kogan et al, 2014). This is due in part to healthcare provider behaviors, attitudes and perceptions.…”

“…Across all studies, only 30% (4) included community members in the initial development of the screening tool (i.e. through focus groups, home interviews, or cognitive interviews) (Gilbert et al, 2015; Keller et al, 2008; Orr et al, 1989; Page-Reeves et al, 2016). In contrast, 38% (5) relied on using a limited sampling of questions from various previously validated single domain SDOH measures and assessment tools (Beck et al, 2012; Fleegler et al, 2007; Garg et al, 2007; Gottlieb et al, 2014; Hassan et al, 2013).…”

Segurança Alimentar e Nutricional na Atenção Primária à Saúde: um olhar a partir dos direitos humanos

“…O segundo estilo de pensamento mais presente é o da SAN como um determinante social da saúde (daqui em diante designado apenas como estilo de pensamento dos determinantes sociais) [1,2,3,4,7,12,15,21,22,26,33,39,41,49]. Neste caso, os autores das 14 publicações argumentam, em diferentes graus de profundidade, que é necessário abordar a SAN na APS porque ela faz parte das condições ou circunstâncias de nascimento, crescimento, vida e/ou trabalho que impactam a saúde.…”

“…Neste caso, os autores das 14 publicações argumentam, em diferentes graus de profundidade, que é necessário abordar a SAN na APS porque ela faz parte das condições ou circunstâncias de nascimento, crescimento, vida e/ou trabalho que impactam a saúde. A noção de necessidades está abordada todas as publicações, sendo que em metade é usada especificamente a expressão necessidades sociais [7,15,21,22,26,33,41]. Na maior parte da produção deste estilo de pensamento, 11 publicações, são mencionados mecanismos da gênese dos desfechos de saúde e da IA.…”