Article2012

Identifying and Treating a Substandard Housing Cluster Using a Medical-Legal Partnership

Andrew F. Beck · Melissa D. Klein · Joshua K. Schaffzin · Virginia Tallent · Marcheta Gillam · Robert S. Kahn

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Urban and Rural Development Challenges Indoor Air Quality and Microbial Exposure Environmental Justice and Health Disparities

Abstract

BACKGROUND AND OBJECTIVE: There is a documented connection between the home environment and health. Medical-legal partnerships (MLPs) can address social and environmental determinants of health. Our objective was to describe a cluster of substandard housing identified and treated by an MLP based in a pediatric primary care setting. METHODS: Potential cases of poor-quality housing were identified during outpatient primary care. A case was defined as any rented housing unit with a reported unaddressed housing risk within a defined building portfolio (owned by a single developer) in which ≥ 1 child lived. An on-site MLP offered affected families legal services including ordinance enforcement and connection to resources. They also initiated portfolio-wide advocacy. Legal advocates reported case outcomes. Medical history and household demographics were collected from the medical record and compared with clinic-wide data by using Fisher's exact test or χ(2) statistics. RESULTS: After identification of a single case, an additional 15 cases were identified. Pest infestation was the most common initial risk identified. Of 14 units with outcome data, repairs were completed in 10 (71%). Of the 19 building complexes with the same owner, 11 received significant systemic repairs. Of the 45 children living within the 16 identified case units, 36% had asthma, 33% had developmental delay or behavioral disorder, and 9% had an elevated lead level. Affected children were more likely to have one of these diagnoses than the general clinic population (all P < .01). CONCLUSIONS: An MLP identified and improved home environmental conditions for children living in a cluster of substandard housing.

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References

2002Housing and Health: Time Again for Public Health Action 2008Moving Upstream 2006Cumulative Social Disadvantage and Child Health 2002Home Is Where the Harm Is: Inadequate Housing as a Public Health Crisis 2001THE BUILT ENVIRONMENT AND CHILDREN'S HEALTH 2010Medical-Legal Partnerships: Transforming Primary Care By Addressing The Legal Needs Of Vulnerable Populations 2010Pilot Study of Medical-Legal Partnership to Address Social and Legal Needs of Patients

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