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Edwards ER, Fortuna A, Holliday R, Addison H, Tsai J. Prevalence of mental health conditions, substance use disorders, suicidal ideation and attempts, and experiences of homelessness among Veterans with criminal-legal involvement: A meta-analysis. Clin Psychol Rev 2025; 115:102533. [PMID: 39740354 DOI: 10.1016/j.cpr.2024.102533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 12/11/2024] [Accepted: 12/19/2024] [Indexed: 01/02/2025]
Abstract
Veterans with histories of criminal-legal system involvement are considered high-priority within Veterans Health Administration (VHA) and criminal-legal settings. Over several decades, a large literature has accumulated to study these Veterans' needs. To consolidate findings, this meta-analysis provides aggregated prevalence estimates of common mental health conditions, substance use disorders, suicidal thoughts and behaviors, and experiences of homelessness among Veterans with current or prior involvement with the United States criminal-legal system. A total of 79 samples encompassing over 1.2 million Veterans were analyzed. Results estimate 8 in 10 Veterans with criminal-legal involvement experience a mental health condition, 7 in 10 a substance use disorder, 1 in 10 a history of suicidal ideation, and 4 in 10 a history of homelessness. Veterans with current (versus prior) criminal-legal involvement had higher rates of alcohol use, drug use, and current homelessness. Samples consisting of Veterans with a history of incarceration and samples collected in non-VHA settings tended to have lower rates of psychosocial difficulty relative to samples consisting of Veterans with other forms of criminal-legal involvement or collected in VHA settings, respectively. Remaining gaps in the literature include research on criminal-legal involved Veterans under community supervision, and/or from demographic minority groups.
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Affiliation(s)
- Emily R Edwards
- VISN 2 Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs, Bronx, NY, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Anthony Fortuna
- VISN 2 Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs, Bronx, NY, USA; Department of Psychology, Fordham University, Bronx, NY, USA
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs, Aurora, CO, USA; Departments of Psychiatry and Physical Medicine & Rehabilitation, University of Colorado, Denver, CO, USA
| | - Helena Addison
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jack Tsai
- National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Washington, DC, USA; Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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2
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Lee J, Higashi RT, Hogan TP, Marcus JL, Repasky EC, Torres MB, Krakower D, Nijhawan AE. Linking Criminal Justice-Involved Individuals to HIV Preexposure Prophylaxis: A Qualitative Analysis of Multiple Stakeholder Perspectives. J Int Assoc Provid AIDS Care 2025; 24:23259582251341940. [PMID: 40350581 PMCID: PMC12066857 DOI: 10.1177/23259582251341940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Revised: 04/09/2025] [Accepted: 04/27/2025] [Indexed: 05/14/2025] Open
Abstract
ObjectiveAlthough incarcerated individuals are at disproportionately higher HIV risk compared to the general US population, few jails offer linkage to preexposure prophylaxis (PrEP). We explored stakeholder perspectives about barriers and facilitators to PrEP for justice-involved individuals.MethodsSemi-structured interviews were conducted with three stakeholder groups in Dallas County, Texas: justice-involved individuals (n = 8), County Jail staff (n = 9), and employees of local community organizations that provide PrEP services (n = 9). Transcripts were analyzed using a combined deductive and inductive approach.ResultsBarriers to PrEP linkage included: limited provider knowledge of and capacity for PrEP care, stigma around incarceration and PrEP, and mistrust in healthcare and criminal justice systems among justice-involved individuals. Perceived facilitators included addressing competing priorities, partnering with community organizations, and providers' cultural competency training.ConclusionFuture research should focus on adapting successful implementation strategies to the needs of justice-involved populations to improve HIV prevention and health outcomes in high-burden regions like the Southern USA.
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Affiliation(s)
- Jessica Lee
- UT Southwestern Medical Center, Department of Medicine, Dallas, TX, USA
| | - Robin T. Higashi
- UT Southwestern Medical Center, O’Donnell School of Public Health, Dallas, TX, USA
| | - Timothy P. Hogan
- UT Southwestern Medical Center, O’Donnell School of Public Health, Dallas, TX, USA
- Center for Health Optimization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Julia L. Marcus
- Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, MA, USA
| | - Emily C. Repasky
- UT Southwestern Medical Center, O’Donnell School of Public Health, Dallas, TX, USA
| | - M. Brynn Torres
- UT Southwestern Medical Center, Department of Medicine, Dallas, TX, USA
| | - Douglas Krakower
- Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, MA, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ank E. Nijhawan
- UT Southwestern Medical Center, Department of Medicine, Dallas, TX, USA
- UT Southwestern Medical Center, O’Donnell School of Public Health, Dallas, TX, USA
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Jaén J, Frankel A, French A, Davison R, Munoz-Laboy M, Martinez O. Medical-Legal Partnerships: a promising approach for addressing health-harming legal needs among people with HIV. FRONTIERS IN SOCIOLOGY 2024; 9:1422783. [PMID: 39045387 PMCID: PMC11264305 DOI: 10.3389/fsoc.2024.1422783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/25/2024] [Indexed: 07/25/2024]
Abstract
Introduction People with HIV (PWH), particularly those at the intersection of sexual and gender identities, face enduring obstacles to accessing HIV care, including structural stigma, structural racism and discrimination, housing instability, and limited access to health insurance. To address these challenges, Medical-Legal Partnerships (MLPs) in HIV care offer an innovative approach that integrates medical and legal services. By targeting health-harming legal needs (HHLN), MLPs aim to enhance the HIV care continuum outcomes for PWH. Methods This study examines the benefits and challenges of MLPs within organizations serving PWH through the social-ecological model. MLP providers (n=111) identified organizational-level challenges such as funding limitations, resource integration issues, and staffing constraints. Results MLPs demonstrated numerous benefits, including patient impact and benefits, comprehensive service provision, enhanced staff support and capacity, and potential for policy influence. Discussion These results underscore the feasibility of MLPs while offering valuable insights into their efficacy and challenges, guiding the implementation of MLPs to address health-harming legal needs, including discrimination, and thereby improving HIV care outcomes.
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Affiliation(s)
- Julia Jaén
- Social and Behavioral Sciences, Temple University, Philadelphia, PA, United States
| | - Anne Frankel
- Social and Behavioral Sciences, Temple University, Philadelphia, PA, United States
| | - Ashley French
- College of Medicine, University of Central Florida, Orlando, FL, United States
| | - Robin Davison
- College of Medicine, University of Central Florida, Orlando, FL, United States
| | - Miguel Munoz-Laboy
- School of Social Work, Stony Brook University, New York, NY, United States
| | - Omar Martinez
- College of Medicine, University of Central Florida, Orlando, FL, United States
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Johnson DY, Asay S, Keegan G, Wu L, Zietowski ML, Zakrison TL, Muntz N, Pillai R, Tung EL. US Medical-Legal Partnerships to Address Health-Harming Legal Needs: Closing the Health Injustice Gap. J Gen Intern Med 2024; 39:1204-1213. [PMID: 38191972 PMCID: PMC11116287 DOI: 10.1007/s11606-023-08546-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/20/2023] [Indexed: 01/10/2024]
Abstract
The medical-legal partnership (MLP) model is emerging across the USA as a powerful tool to address the adverse social conditions underlying health injustice. MLPs embed legal experts into healthcare teams to address health-harming legal needs with civil legal remedies. We conducted a narrative review of peer-reviewed articles published between 2007 and 2022 to characterize the structure and impacts of US MLPs on patients, providers, and healthcare systems. We found that MLPs largely serve vulnerable patient populations by integrating legal experts into community-based clinical settings or children's hospitals, although patient populations and settings varied widely. In most models, healthcare providers were trained to screen patients for legal needs and refer them to legal experts. MLPs provided a wide range of services, such as assistance accessing public benefits (e.g., Social Security, Medicaid, cash assistance) and legal representation for immigration and family law matters. Patients and their families also benefited from increased knowledge about legal rights and systems. Though the evidence base remains nascent, available studies show MLPs to be associated with greater access to care, fewer hospitalizations, and improved physical and mental health outcomes. Medical and legal providers who were engaged in MLPs reported interdisciplinary learning, and healthcare systems often experienced high returns on investment through cost savings and increased Medicaid reimbursement. Many MLPs also conducted advocacy and education to effect broader policy changes related to population health and social needs. To optimize the MLP model, more rigorous research, systematic implementation practices, evaluation metrics, and sustainable funding mechanisms are recommended. Broader integration of MLPs into healthcare systems could help address root causes of health inequity among historically marginalized populations in the USA.
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Affiliation(s)
- Daniel Y Johnson
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Spencer Asay
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Grace Keegan
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Lisa Wu
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Tanya L Zakrison
- Section of Trauma & Acute Care Surgery, Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Nathan Muntz
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Rhea Pillai
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Elizabeth L Tung
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.
- Center for Health and The Social Sciences, University of Chicago, Chicago, IL, USA.
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Kim B, Petrakis BA, Griesemer I, Sliwinski SK, Midboe AM, Raciborski RA, Byrne TH, Gingell MB, Blue-Howells J, Clark SC, Tsai J, Harvey KLL, McInnes DK. Legal Services for Veterans (LSV): Protocol for evaluating the grant-based LSV initiative supporting community organizations' delivery of legal services to veterans. PLoS One 2024; 19:e0297424. [PMID: 38625878 PMCID: PMC11020365 DOI: 10.1371/journal.pone.0297424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/05/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND 1.8 million Veterans are estimated to need legal services, such as for housing eviction prevention, discharge upgrades, and state and federal Veterans benefits. While having one's legal needs met is known to improve one's health and its social determinants, many Veterans' legal needs remain unmet. Public Law 116-315 enacted in 2021 authorizes VA to fund legal services for Veterans (LSV) by awarding grants to legal service providers including nonprofit organizations and law schools' legal assistance programs. This congressionally mandated LSV initiative will award grants to about 75 competitively selected entities providing legal services. This paper describes the protocol for evaluating the initiative. The evaluation will fulfill congressional reporting requirements, and inform continued implementation and sustainment of LSV over time. METHODS Our protocol calls for a prospective, mixed-methods observational study with a repeated measures design, aligning to the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) and Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) frameworks. In 2023, competitively selected legal services-providing organizations will be awarded grants to implement LSV. The primary outcome will be the number of Veterans served by LSV in the 12 months after the awarding of the grant. The evaluation has three Aims. Aim 1 will focus on measuring primary and secondary LSV implementation outcomes aligned to RE-AIM. Aim 2 will apply the mixed quantitative-qualitative Matrixed Multiple Case Study method to identify patterns in implementation barriers, enablers, and other i-PARIHS-aligned factors that relate to observed outcomes. Aim 3 involves a mixed-methods economic evaluation to understand the costs and benefits of LSV implementation. DISCUSSION The LSV initiative is a new program that VA is implementing to help Veterans who need legal assistance. To optimize ongoing and future implementation of this program, it is important to rigorously evaluate LSV's outcomes, barriers and enablers, and costs and benefits. We have outlined the protocol for such an evaluation, which will lead to recommending strategies and resource allocation for VA's LSV implementation.
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Affiliation(s)
- Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
| | - Ida Griesemer
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Samantha K. Sliwinski
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Amanda M. Midboe
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, United States of America
- University of California at Davis School of Medicine, Sacramento, California, United States of America
| | - Rebecca A. Raciborski
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, United States of America
- Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, United States of America
| | - Thomas H. Byrne
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Boston University School of Social Work, Boston, Massachusetts, United States of America
| | - Madolyn B. Gingell
- Veterans Health Administration Homeless Programs Office, Washington, District of Columbia, United States of America
| | - Jessica Blue-Howells
- Veterans Health Administration Homeless Programs Office, Washington, District of Columbia, United States of America
| | - Sean C. Clark
- Veterans Health Administration Homeless Programs Office, Washington, District of Columbia, United States of America
| | - Jack Tsai
- Veterans Health Administration Homeless Programs Office, Washington, District of Columbia, United States of America
- University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Kim L. L. Harvey
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - D. Keith McInnes
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Boston University School of Public Health, Boston, Massachusetts, United States of America
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Tsai J, Montgomery AE, Szymkowiak D. Preventing Homelessness Through the National Call Center for Homeless Veterans: Analysis of Calls and Service Referrals. Psychiatr Serv 2023; 74:316-319. [PMID: 35855621 DOI: 10.1176/appi.ps.20220124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study was the first to examine the characteristics and referral outcomes for veterans calling the National Call Center for Homeless Veterans (NCCHV). METHODS The authors analyzed data from NCCHV and U.S. Department of Veterans Affairs (VA) health care records. RESULTS Between December 2018 and October 2020, the NCCHV received 266,100 messages, with no major increase in the first 6 months of the COVID-19 pandemic. Of 110,197 veterans who contacted NCCHV, 69.6% were at risk for homelessness, and 20.1% were homeless. Most contacts (90.2%) resulted in a referral or transfer to a local resource. About 59.5% of NCCHV veterans had a medical record in the Veterans Health Administration; their use of homeless programs increased from 25.9% to 81.3%. Uses of mental health services, substance use treatment, and medical services showed small-to-moderate increases after NCCHV contacts. CONCLUSION NCCHV is important for linking veterans to health and social care. Additional work is needed to assess veterans' outcomes after an NCCHV contact.
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Affiliation(s)
- Jack Tsai
- National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs (VA) (Tsai, Szymkowiak); School of Public Health, University of Texas Health Science Center, Houston (Tsai); School of Public Health, University of Alabama at Birmingham, and Birmingham VA Health Care System, Birmingham (Montgomery)
| | - Ann Elizabeth Montgomery
- National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs (VA) (Tsai, Szymkowiak); School of Public Health, University of Texas Health Science Center, Houston (Tsai); School of Public Health, University of Alabama at Birmingham, and Birmingham VA Health Care System, Birmingham (Montgomery)
| | - Dorota Szymkowiak
- National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs (VA) (Tsai, Szymkowiak); School of Public Health, University of Texas Health Science Center, Houston (Tsai); School of Public Health, University of Alabama at Birmingham, and Birmingham VA Health Care System, Birmingham (Montgomery)
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7
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Mainardi AS, Harris D, Rosenthal A, Redlich CA, Hu B, Fenick AM. Reducing asthma exacerbations in vulnerable children through a medical-legal partnership. J Asthma 2023; 60:262-269. [PMID: 35188437 DOI: 10.1080/02770903.2022.2045307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Asthma health disparities are widely recognized, with worse outcomes in children from low income families. In a Medical-Legal Partnership (MLP), an attorney is embedded in a healthcare setting to address social determinants of health. We studied whether an MLP could impact asthma exacerbation rates in a vulnerable urban population at an academic children's hospital. METHODS The study population comprised children with asthma who were referred to the MLP between 2013 and 2017. We compared healthcare utilization for asthma exacerbations managed in primary care, emergency department and inpatient settings in the year before and year after MLP intervention. RESULTS 98 children with asthma were included in the study. The mean total encounters per person per year decreased from 1.16 to 0.66 (relative reduction 44.2%, p < 0.01). The largest effect was on hospitalizations, with a reduction from 0.33 to 0.10 hospitalizations per patient per year (relative reduction 69.7%, p < 0.01). Encounters for asthma exacerbations in the primary care office and emergency department also decreased but these changes did not meet statistical significance. CONCLUSION In a pediatric population with asthma, an MLP intervention was associated with a significant reduction in asthma exacerbation encounters and hospitalizations comparing the year before and after MLP intervention. Further studies are needed to better understand which interventions are most effective, and for which patient groups MLP referral would be particularly useful. MLPs may be an important way to reduce health disparities in patients with asthma and other chronic illnesses.
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Affiliation(s)
- Anne S Mainardi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of MedicineNew Haven, CT
| | - Drew Harris
- Division of Pulmonary and Critical Care, University of Virginia School of Medicine, Charlottesville, VR
| | - Alice Rosenthal
- Center for Children's Advocacy at Yale, New Haven Hospital, New Haven, CT
| | - Carrie A Redlich
- Occupational and Environmental Medicine Program, Yale University School of MedicineNew HavenCT
| | - Buqu Hu
- Division of Pulmonary and Critical Care, Yale University School of Medicine, New Haven, CT
| | - Ada M Fenick
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
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Fan Q, Keene DE, Banegas MP, Gehlert S, Gottlieb LM, Yabroff KR, Pollack CE. Housing Insecurity Among Patients With Cancer. J Natl Cancer Inst 2022; 114:1584-1592. [PMID: 36130291 PMCID: PMC9949594 DOI: 10.1093/jnci/djac136] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 01/11/2023] Open
Abstract
Social determinants of health are the economic and environmental conditions under which people are born, live, work, and age that affect health. These structural factors underlie many of the long-standing inequities in cancer care and outcomes that vary by geography, socioeconomic status, and race and ethnicity in the United States. Housing insecurity, including lack of safe, affordable, and stable housing, is a key social determinant of health that can influence-and be influenced by-cancer care across the continuum, from prevention to screening, diagnosis, treatment, and survivorship. During 2021, the National Cancer Policy Forum of the National Academies of Science, Engineering, and Medicine sponsored a series of webinars addressing social determinants of health, including food, housing, and transportation insecurity, and their associations with cancer care and patient outcomes. This dissemination commentary summarizes the formal presentations and panel discussions from the webinar devoted to housing insecurity. It provides an overview of housing insecurity and health care across the cancer control continuum, describes health system interventions to minimize the impact of housing insecurity on patients with cancer, and identifies challenges and opportunities for addressing housing insecurity and improving health equity. Systematically identifying and addressing housing insecurity to ensure equitable access to cancer care and reduce health disparities will require ongoing investment at the practice, systems, and broader policy levels.
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Affiliation(s)
- Qinjin Fan
- Correspondence to: Qinjin Fan, PhD, Surveillance & Health Equity Science Department, American Cancer Society, 3380 Chastain Meadows Pkwy, NW Suite 200, Kennesaw, GA 30144, USA (e-mail: )
| | - Danya E Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Matthew P Banegas
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA, USA
| | - Sarah Gehlert
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Laura M Gottlieb
- Social Interventions Research and Evaluation Network, University of California, San Francisco, CA, USA
| | - K Robin Yabroff
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Craig E Pollack
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
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Hoffmann JA, Alegría M, Alvarez K, Anosike A, Shah PP, Simon KM, Lee LK. Disparities in Pediatric Mental and Behavioral Health Conditions. Pediatrics 2022; 150:e2022058227. [PMID: 36106466 PMCID: PMC9800023 DOI: 10.1542/peds.2022-058227] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 12/31/2022] Open
Abstract
Mental and behavioral health conditions are common among children and adolescents in the United States. The purpose of this state-of the-art review article is to describe inequities in mental and behavioral health care access and outcomes for children and adolescents, characterize mechanisms behind the inequities, and discuss strategies to decrease them. Understanding the mechanisms underlying these inequities is essential to inform strategies to mitigate these health disparities. Half of United States children with a treatable mental health disorder do not receive treatment from a mental health professional. Children and adolescents in racial, ethnic, sexual, sex, and other minority groups experience inequities in access to care and disparities in outcomes for mental and behavioral health conditions. Suicide rates are nearly twice as high in Black compared to White boys 5 to 11 years old and have been increasing disproportionately among adolescent Black girls 12 to 17 years old. Children identifying as a sexual minority have >3 times increased odds of attempting suicide compared to heterosexual peers. Adverse experiences of children living as part of a minority group, including racism and discrimination, have immediate and lasting effects on mental health. Poverty and an uneven geographic distribution of resources also contribute to inequities in access and disparities in outcomes for mental and behavioral health conditions. Strategies to address inequities in mental and behavioral health among United States children include investing in a diverse workforce of mental health professionals, improving access to school-based services, ensuring equitable access to telehealth, and conducting quality improvement with rigorous attention to equity.
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Affiliation(s)
- Jennifer A. Hoffmann
- . Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine; Chicago, IL
| | - Margarita Alegría
- . Disparities Research Unit, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Kiara Alvarez
- . Disparities Research Unit, Massachusetts General Hospital, Department of Medicine, Harvard Medical School, Boston, MA
| | - Amara Anosike
- . Office of Government Relations, Boston Children’s Hospital, Boston, MA
| | | | - Kevin M. Simon
- . Adolescent Substance use and Addiction Program, Boston Children’s Hospital, Boston, Massachusetts; Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts; Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, MA, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lois K. Lee
- . Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA
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Battaglia TA, Gunn CM, Bak SM, Flacks J, Nelson KP, Wang N, Ko NY, Morton SJ. Patient navigation to address sociolegal barriers for patients with cancer: A comparative-effectiveness study. Cancer 2022; 128 Suppl 13:2623-2635. [PMID: 35699610 PMCID: PMC10152516 DOI: 10.1002/cncr.33965] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Sociolegal barriers to cancer care are defined as health-related social needs like affordable healthy housing, stable utility service, and food security that may be remedied by public policy, law, regulation, or programming. Legal support has not been studied in cancer care. METHODS The authors conducted a randomized controlled trial of patients who had newly diagnosed cancer at a safety-net medical center in Boston from 2014 through 2017, comparing standard patient navigation versus enhanced navigation partnered with legal advocates to identify and address sociolegal barriers. English-speaking, Spanish-speaking, or Haitian Creole-speaking patients with breast and lung cancer were eligible within 30 days of diagnosis. The primary outcome was timely treatment within 90 days of diagnosis. Secondary outcomes included patient-reported outcomes (distress, cancer-related needs, and satisfaction with navigation) at baseline and at 6 months. RESULTS In total, 201 patients with breast cancer and 19 with lung cancer enrolled (response rate, 78%). The mean patient age was 55 years, 51% of patients were Black and 22% were Hispanic, 20% spoke Spanish and 8% spoke Haitian Creole, 73% had public health insurance, 77% reported 1 or more perceived sociolegal barrier, and the most common were barriers to housing and employment. Ninety-six percent of participants with breast cancer and 73% of those with lung cancer initiated treatment within 90 days. No significant effect of enhanced navigation was observed on the receipt of timely treatment among participants with breast cancer (odds ratio, 0.88; 95% CI, 0.17-4.52) or among those with lung cancer (odds ratio, 4.00; 95% CI, 0.35-45.4). No differences in patient-reported outcomes were observed between treatment groups. CONCLUSIONS Navigation enhanced by access to legal consultation and support had no impact on timely treatment, patient distress, or patient needs. Although most patients reported sociolegal barriers, few required intensive legal services that could not be addressed by navigators. LAY SUMMARY In patients with cancer, the experience of sociolegal barriers to care, such as unstable housing, utility services, or food insecurity, is discussed. Addressing these barriers through legal information and assistance may improve care. This study compares standard patient navigation versus enhanced navigation partnered with legal advocates for patients with breast and lung cancers. Almost all patients in both navigation groups received timely care and also reported the same levels of distress, needs, and satisfaction with navigation. Although 75% of patients in the study had at least 1 sociolegal barrier identified, few required legal advocacy beyond what a navigator who received legal information and coaching could provide.
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Affiliation(s)
- Tracy A Battaglia
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - Christine M Gunn
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Sharon M Bak
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - JoHanna Flacks
- Medical-Legal Partnership, Boston (MLPB), Boston, Massachusetts
| | - Kerrie P Nelson
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Na Wang
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Naomi Y Ko
- Department of Medicine, Hematology, and Medical Oncology, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
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The Impact of a Pediatric Medical-Legal Partnership on Pediatric Providers: A Qualitative Study. Acad Pediatr 2022; 22:447-453. [PMID: 34271085 DOI: 10.1016/j.acap.2021.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/10/2021] [Accepted: 06/20/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Medical-Legal Partnerships (MLPs) integrate medical and legal care to address prevalent health-harming legal needs (HHLN) among socioeconomically marginalized populations. MLPs address a diverse array of social determinants of health (SDOH) and have been shown to positively impact children's health. Less is known, however, about how MLPs affect health care providers. MLPs may affect child health by changing clinical practice and provider behavior, and transforming providers' relationships with their patients and patients' families. Examining and understanding how MLPs affect providers is thus critical to elucidating how MLPs may ultimately impact child health. METHODS We examined one pediatric MLP at an academic medical center in New Haven, Connecticut. We conducted semi-structured interviews with 20 pediatric providers who had engaged with the MLP and 20 parents/guardians who had interacted with the MLP. We analyzed the qualitative data using inductive coding, primarily drawing upon provider interviews. RESULTS The MLP affected providers in five major ways. The MLP 1) improved provider awareness of SDOH and HHLN, 2) expanded provider perceptions of their role and responsibilities as clinicians, 3) improved provider efficacy in addressing SDOH and HHLN, 4) empowered providers to engage in systemic advocacy, and 5) improved providers' relationships with patients' families. CONCLUSION Our study identifies multiple ways that a pediatric MLP affects providers. Our findings suggest that MLPs can improve patient and population health by equipping providers with the knowledge and tools needed to assist patients with HHLN and SDOH, improving provider-family relationships, and encouraging providers to engage in systemic and institutional advocacy.
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12
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A care coordinator screening strategy to address health harming legal needs. BMC Health Serv Res 2022; 22:210. [PMID: 35172814 PMCID: PMC8848941 DOI: 10.1186/s12913-021-07440-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Medical legal partnerships provide an opportunity to help address various social determinants of health; however, the traditional practice of screening patients during clinical encounters is limited by the capacity of busy clinicians. Our medical legal partnership utilized care coordinators trained by the legal service attorneys to screen patients outside of clinical encounters for health harming legal needs. The goal of our study was to demonstrate that our novel model could successfully identify and refer patients of a safety-net healthcare system to appropriate legal services. Methods We conducted a mixed methods evaluation of the program. Data was collected during the implementation period of the program from March 2017 to August 2018. Operational data collected included number of patients screened, number of referrals to the legal partner, source and reason for referrals. Return on investment was calculated by subtracting program costs from the total reimbursement to the health system from clients’ insurance benefits secured through legal services. Results During the 18-month study, 29,268 patients were screened by care coordinators for health harming legal needs, with 492 patients (1.7%) referred for legal assistance. Of the 133 cases closed in 2017, all clients were invited to participate in a telephone interview; 63 pre-consented to contact, 33 were successfully contacted and 23 completed the interview. The majority (57%) reported a satisfactory resolution of their legal barrier to health. This was accompanied by an improvement in self-reported health with a decrease of patients reporting less than optimal health from 16 (89%) prior to intervention to 8 (44%) after intervention [risk ratio (95% confidence interval): 0.20 (0.04, 0.91)]. Patients also reported improvements in general well-being for themselves and their family. The healthcare system recorded a 263% return on investment. Conclusions In our medical legal partnership, screening for health harming legal needs by care coordinators outside of a clinical encounter allowed for efficient screening in a high risk population. The legal services intervention was associated with improvements in self-reported health and family well-being when compared to previous models. The return on investment was substantial.
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13
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Tsai J, Huang M, Daniels K, Harteveld C, Jackson D. Legal, mental health and psychosocial outcomes of the RePresent Games: a quasi-experimental study. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2022; 30:133-143. [PMID: 36950187 PMCID: PMC10026769 DOI: 10.1080/13218719.2021.2003266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This study evaluated a pair of video games called the RePresent games that taught users how to represent themselves in civil court. A quasi-experimental study was conducted that compared 69 RePresent game users and 78 non-game users with civil legal issues across four U.S. states on legal, mental health and psychosocial outcomes over 3 months. The results revealed that RePresent game users reported greater legal knowledge, better mental health and higher quality of life than non-game users across time, and a greater rate of improvement in legal knowledge than non-game users over time. These findings suggest that gamifying education about legal procedures for the general public holds great potential in helping individuals obtain self-help legal assistance although some formal mental health treatment may be needed for many seeking legal aid.
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Affiliation(s)
- Jack Tsai
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- U.S. Department of Veterans Affairs, National Center on Homelessness Among Veterans, West Haven, CT, USA
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Minda Huang
- Department of Psychology, University of Hartford, Hartford, CT, USA
| | | | - Casper Harteveld
- College of Arts, Media and Design, Northeastern University, Boston, MA, USA
| | - Dan Jackson
- NuLawLab, Northeastern University School of Law, Boston, MA, USA
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14
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Being uninsured is associated with clinical depression. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-021-02602-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Pulitzer Z, Box M, Hansen L, Tiruneh YM, Nijhawan AE. Patient, medical and legal perspectives on reentry: the need for a low-barrier, collaborative, patient-centered approach. HEALTH & JUSTICE 2021; 9:37. [PMID: 34855029 PMCID: PMC8638478 DOI: 10.1186/s40352-021-00161-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Worldwide, the United States has the highest incarceration rate per capita. Thousands of people are released from US correctional facilities each year, including many who are impacted by HIV infection and substance use disorder (SUD), two frequently comorbid conditions that present multiple challenges upon reentry. Reentry and care engagement research involving justice-involved people with HIV (PWH) with comorbid SUD has been largely limited to the perspective of those released. To formulate effective interventions for this population aimed at maintaining health and reducing recidivism, it is crucial to collect data from formerly incarcerated individuals with firsthand experience of the reentry process as well as other actors within the reentry framework. Insights from medical and legal service providers working in reentry systems have the potential to address key implementation concerns. To inform an intervention aimed at helping recently-released individuals PWH and SUD, we conducted a qualitative study to assess barriers and facilitators to community reentry from the perspectives of diverse consumers and providers of medical, legal, and reentry services. RESULTS Fifteen stakeholders within XXX County participated in in-person interviews. Results indicated that 1) Patients/clients emphasized psychosocial support and individual attitude more than medical and legal participants, who chiefly focused on logistical factors such as finances, housing, and transportation; 2) Patients/clients expressed both medical and legal needs during the reentry period, though medical providers and participants from legal entities mainly expressed concerns limited to their respective scopes of work; 3) All three participant groups underscored the need for a low-barrier, collaborative, patient-centered approach to reentry with the goal of achieving self-sufficiency. CONCLUSIONS Findings support and extend existing literature detailing the barriers and facilitators to successful reentry. Our findings underscore the notion that an effective reentry intervention addresses both medical and legal needs, includes an individualized approach that incorporates psychosocial needs, and focuses on establishing self-sufficiency.
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Affiliation(s)
- Zoe Pulitzer
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Maria Box
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Laura Hansen
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Yordanos M Tiruneh
- University of Texas Health Sciences Center at Tyler, 11937 US-271, Tyler, TX, 75708-3154, USA
| | - Ank E Nijhawan
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
- Parkland Health and Hospital Systems, Correctional Health, Dallas, TX, 75235, USA.
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16
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Eder M, Henninger M, Durbin S, Iacocca MO, Martin A, Gottlieb LM, Lin JS. Screening and Interventions for Social Risk Factors: Technical Brief to Support the US Preventive Services Task Force. JAMA 2021; 326:1416-1428. [PMID: 34468710 DOI: 10.1001/jama.2021.12825] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Evidence-based guidance is limited on how clinicians should screen for social risk factors and which interventions related to these risk factors improve health outcomes. OBJECTIVE To describe research on screening and interventions for social risk factors to inform US Preventive Services Task Force considerations of the implications for its portfolio of recommendations. DATA SOURCES Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Sociological Abstracts, and Social Services Abstracts (through 2018); Social Interventions Research and Evaluation Network evidence library (January 2019 through May 2021); surveillance through May 21, 2021; interviews with 17 key informants. STUDY SELECTION Individual-level and health care system-level interventions with a link to the health care system that addressed at least 1 of 7 social risk domains: housing instability, food insecurity, transportation difficulties, utility needs, interpersonal safety, education, and financial strain. DATA EXTRACTION AND SYNTHESIS One investigator abstracted data from studies and a second investigator evaluated data abstractions for completeness and accuracy; key informant interviews were recorded, transcribed, summarized, and integrated with evidence from the literature; narrative synthesis with supporting tables and figures. MAIN OUTCOMES AND MEASURES Validity of multidomain social risk screening tools; all outcomes reported for social risk-related interventions; challenges or unintended consequences of screening and interventions. RESULTS Many multidomain social risk screening tools have been developed, but they vary widely in their assessment of social risk and few have been validated. This technical brief identified 106 social risk intervention studies (N = 5 978 596). Of the interventions studied, 73 (69%; n = 127 598) addressed multiple social risk domains. The most frequently addressed domains were food insecurity (67/106 studies [63%], n = 141 797), financial strain (52/106 studies [49%], n = 111 962), and housing instability (63/106 studies [59%], n = 5 881 222). Food insecurity, housing instability, and transportation difficulties were identified by key informants as the most important social risk factors to identify in health care. Thirty-eight studies (36%, n = 5 850 669) used an observational design with no comparator, and 19 studies (18%, n = 15 205) were randomized clinical trials. Health care utilization measures were the most commonly reported outcomes in the 68 studies with a comparator (38 studies [56%], n = 111 102). The literature and key informants described many perceived or potential challenges to implementation of social risk screening and interventions in health care. CONCLUSIONS AND RELEVANCE Many interventions to address food insecurity, financial strain, and housing instability have been studied, but more randomized clinical trials that report health outcomes from social risk screening and intervention are needed to guide widespread implementation in health care.
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Affiliation(s)
- Michelle Eder
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Michelle Henninger
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Shauna Durbin
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
| | - Megan O Iacocca
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Allea Martin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Laura M Gottlieb
- Department of Family and Community Medicine, University of California, San Francisco
| | - Jennifer S Lin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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17
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Koeman J, Mehdipanah R. Prescribing Housing: A Scoping Review of Health System Efforts to Address Housing as a Social Determinant of Health. Popul Health Manag 2021; 24:316-321. [PMID: 32808870 DOI: 10.1089/pop.2020.0154] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
US health systems have begun to address housing instability within a larger effort to address social determinants of health. To explore existing themes within efforts by health systems to reduce housing instability and improve health, the authors conducted a scoping review supplemented with key informant interviews. Twenty-two articles were analyzed and 7 participants from 6 health systems were interviewed. Themes identified from the literature and interviews included intervention strategies and funding, access, coordination, and administrative processes and evaluation. As more health systems integrate housing-related interventions, findings from this study highlight the need for more upstream focus, consistent funding, and reliable evaluation strategies.
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Affiliation(s)
- Jamison Koeman
- Health Policy and Management and University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Roshanak Mehdipanah
- Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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18
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Beardon S, Woodhead C, Cooper S, Ingram E, Genn H, Raine R. International Evidence on the Impact of Health-Justice Partnerships: A Systematic Scoping Review. Public Health Rev 2021; 42:1603976. [PMID: 34168897 PMCID: PMC8113986 DOI: 10.3389/phrs.2021.1603976] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Health-justice partnerships (HJPs) are collaborations between healthcare and legal services which support patients with social welfare issues such as welfare benefits, debt, housing, education and employment. HJPs exist across the world in a variety of forms and with diverse objectives. This review synthesizes the international evidence on the impacts of HJPs. Methods: A systematic scoping review of international literature was undertaken. A wide-ranging search was conducted across academic databases and grey literature sources, covering OECD countries from January 1995 to December 2018. Data from included publications were extracted and research quality was assessed. A narrative synthesis approach was used to analyze and present the results. Results: Reported objectives of HJPs related to: prevention of health and legal problems; access to legal assistance; health improvement; resolution of legal problems; improvement of patient care; support for healthcare services; addressing inequalities; and catalyzing systemic change. There is strong evidence that HJPs: improve access to legal assistance for people at risk of social and health disadvantage; positively influence material and social circumstances through resolution of legal problems; and improve mental wellbeing. A wide range of other positive impacts were identified for individuals, services and communities; the strength of evidence for each is summarized and discussed. Conclusion: HJPs are effective in tackling social welfare issues that affect the health of disadvantaged groups in society and can therefore form a key part of public health strategies to address inequalities.
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Affiliation(s)
- Sarah Beardon
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Charlotte Woodhead
- Department of Psychological Medicine, King’s College London, London, United Kingdom
| | - Silvie Cooper
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Elizabeth Ingram
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Hazel Genn
- Faculty of Laws, University College London, London, United Kingdom
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, United Kingdom
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19
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Girard VW, Cannon Y, Bhatnagar P, Coleman S. How medical-legal partnerships help address the social determinants of mental health. Arch Psychiatr Nurs 2021; 35:123-126. [PMID: 33593506 DOI: 10.1016/j.apnu.2020.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Vicki W Girard
- Georgetown University Law Center, United States of America.
| | - Yael Cannon
- Georgetown University Law Center, United States of America
| | - Prashasti Bhatnagar
- Georgetown University Law Center, United States of America; MPH Johns Hopkins University, United States of America
| | - Susan Coleman
- Georgetown University School of Nursing and Health Studies, United States of America
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20
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Blosnich JR, Dichter ME, Gurewich D, Montgomery AE, Kressin NR, Lee R, Hester CM, Hausmann LRM. Health Services Research and Social Determinants of Health in the Nation's Largest Integrated Health Care System: Steps and Leaps in the Veterans Health Administration. Mil Med 2020; 185:e1353-e1356. [PMID: 32592393 DOI: 10.1093/milmed/usaa067] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/16/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- John R Blosnich
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion (CHERP), 151 University Drive C, Building 30, Pittsburgh, PA 15240.,Suzanne Dworak-Peck School of Social Work, University of Southern California, Montgomery Ross Fisher Building, 669 W 34th St, Los Angeles, CA 90089-0411
| | - Melissa E Dichter
- Corporal Michael J. Crescenz VA Medical Center, CHERP, 21 S University Ave, Philadelphia, PA 19104.,School of Social Work, Temple University, 1301 Cecil B. Moore Ave., Philadelphia, PA 19122
| | - Deborah Gurewich
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), 150 South Huntington Avenue (152M), Jamaica Plain Campus, Building 9, Boston, MA 02130
| | - Ann Elizabeth Montgomery
- Birmingham VA Medical Center, 700 19th St S, Birmingham, AL 35233.,School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL 35233
| | - Nancy R Kressin
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), 150 South Huntington Avenue (152M), Jamaica Plain Campus, Building 9, Boston, MA 02130.,Department of Medicine, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118
| | - Richard Lee
- Veterans Rural Health Resource Center, 163 Veterans Dr, White River Junction, VT 05009
| | - Christina M Hester
- American Academy of Family Physicians, 11400 Tomahawk Creek Pkwy, Leawood, KS 66211
| | - Leslie R M Hausmann
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion (CHERP), 151 University Drive C, Building 30, Pittsburgh, PA 15240.,Suzanne Dworak-Peck School of Social Work, University of Southern California, Montgomery Ross Fisher Building, 669 W 34th St, Los Angeles, CA 90089-0411.,Division of General Internal Medicine, University of Pittsburgh School of Medicine, 1218 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 1526
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21
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Lawton R, Whitehead M, Henize A, Fink E, Salamon M, Kahn R, Beck AF, Klein M. Medical-Legal-Psychology Partnerships - Innovation in Addressing Social Determinants of Health in Pediatric Primary Care. Acad Pediatr 2020; 20:902-904. [PMID: 32565317 DOI: 10.1016/j.acap.2020.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/04/2020] [Accepted: 06/13/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Rachel Lawton
- Behavioral Medicine & Clinical Psychology (R Lawton and M Whitehead), Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio.
| | - Monica Whitehead
- Behavioral Medicine & Clinical Psychology (R Lawton and M Whitehead), Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio
| | - Adrienne Henize
- Division of General & Community Pediatrics (A Henize, R Kahn, AF Beck and M Klein), Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio
| | - Elaine Fink
- Legal Aid Society of Southwest Ohio, LLC (E Fink and M Salamon), Cincinnati, Ohio
| | - Melissa Salamon
- Legal Aid Society of Southwest Ohio, LLC (E Fink and M Salamon), Cincinnati, Ohio
| | - Robert Kahn
- Division of General & Community Pediatrics (A Henize, R Kahn, AF Beck and M Klein), Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio
| | - Andrew F Beck
- Division of General & Community Pediatrics (A Henize, R Kahn, AF Beck and M Klein), Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio
| | - Melissa Klein
- Division of General & Community Pediatrics (A Henize, R Kahn, AF Beck and M Klein), Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, Ohio
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22
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Timko C, Tsai J, Taylor E, Smelson D, Blonigen D, Nash A, Finlay A. Clients of VA-Housed Legal Clinics: Legal and Psychosocial Needs When Seeking Services and Two Months Later. JOURNAL OF VETERANS STUDIES 2020; 6:239-249. [PMID: 34466762 PMCID: PMC8404205 DOI: 10.21061/jvs.v6i1.167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Veterans often need civil legal services, yet little is known about veterans’ use and consequences of these services. This study examined veterans seeking legal services at VA-housed legal clinics. Baseline data from 61 clients of two VA-housed legal clinics were used to identify clients’ legal needs and psychosocial characteristics. Data collected from 49 (80%) of the same clients two months later were used to address clients’ improvement and satisfaction after receiving legal services. At baseline, clients reported a mean of 6.0 (SD = 4.2) legal needs, with the most common being help obtaining VA benefits (87%). Clients represented a vulnerable population in that most had an extensive criminal history (e.g., had been arrested, charged, and incarcerated) and multiple health care needs (had a chronic medical condition, had recently received treatment in an emergency department, and had received psychological treatment due to significant psychological symptoms). At follow-up, clients reported a mean of 4.4 (SD = 3.8) legal needs. Tests to identify changes between baseline and follow-up on legal needs, housing arrangement, psychological symptoms, and substance use yielded few significant results. Most participants did not receive additional help with their legal matters after the baseline appointment. At follow-up, clients reported that few of their legal needs were met but also that they were mostly satisfied with the legal services they received. Findings suggest that because clients may need more intensive legal intervention of longer duration to resolve their legal needs and achieve better housing and health status, VA-housed legal clinics require greater resources and expansion.
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23
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Timko C, Taylor E, Nash A, Blonigen D, Smelson D, Tsai J, Finlay AK. National Survey of Legal Clinics Housed by the Department of Veterans Affairs to Inform Partnerships with Health and Community Services. J Health Care Poor Underserved 2020; 31:1440-1456. [PMID: 33416704 PMCID: PMC8215811 DOI: 10.1353/hpu.2020.0104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Legal clinics housed by the Department of Veterans Affairs (VA) help veterans eliminate service access barriers. In this survey of 95 VA-housed legal clinics (70% of clinics), clients' legal problems were mainly estate planning, family, obtaining VA benefits, and housing (14-17% of clients). Most clinics rarely interacted with VA health care providers, did not have access to clients' VA health care records, and did not track clients' VA health care access (58-81% of clinics); 32% did not have dedicated and adequate space. Most clinic staff members were unpaid. Survey findings-that most VA-housed legal clinics do not interact with VA health care or directly address clients' mental health and substance use needs, and lack funds to serve fully all veterans seeking services-suggest that VA and community agencies should enact policies that expand and fund veterans' legal services and health system interactions to address health inequities and improve health outcomes.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Emmeline Taylor
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA
| | - Amia Nash
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA
| | - Daniel Blonigen
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Palo Alto University, Palo Alto, CA, 94304, USA
- National Center on Homelessness Among Veterans, Department of Veterans Affairs, Menlo Park, CA, 94305 USA
| | - David Smelson
- National Center on Homelessness among Veterans, Department of Veterans Affairs, Bedford, MA 01730 USA
- VA Center for Healthcare Organization and Implementation Research, Bedford, MA 01730 USA
- Department of Psychiatry, University of Massachusetts Medical School, 55 N. Lake Avenue, Worcester, MA 01655 USA
| | - Jack Tsai
- National Center on Homelessness Among Veterans, Department of Veterans Affairs, 950 Campbell Ave., 151D, West Haven, CT 06516, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Andrea K Finlay
- Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA
- National Center on Homelessness Among Veterans, Department of Veterans Affairs, Menlo Park, CA, 94305 USA
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24
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Clary KM, Shaffer PM, Gaba A, Pinals DA, Smelson D. Comparing the treatment needs of participants with co-occurring mental health and substance use disorders in drug and veterans treatment courts. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1683905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Kelsey M. Clary
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Paige M. Shaffer
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ayorkor Gaba
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Debra A. Pinals
- Department of Psychiatry, Law, and Ethics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - David Smelson
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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25
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Tsai J, Huang M. Systematic review of psychosocial factors associated with evictions. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e1-e9. [PMID: 30014532 DOI: 10.1111/hsc.12619] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/17/2018] [Accepted: 06/21/2018] [Indexed: 06/08/2023]
Abstract
Evictions from rented accommodations are a common pathway to homelessness and can negatively impact the lives of individuals and communities worldwide. There have been only few interventions developed to address evictions, and it is important to first understand factors associated with evictions. This systematic review included all available peer-reviewed articles on the topic published in the international literature from 1900 to 2017 and identified 10 peer-reviewed studies of evictions conducted in the United States, Canada, Amsterdam and Britain. From these studies, four categories of factors associated with evictions were identified. These factors were financial hardships, sociodemographic characteristics, substance use and other health problems. While many studies had large sample sizes, the majority of studies were cross-sectional. Together, our review found that there were several salient factors known to be associated with evictions which may benefit from intervention. However, more prospective studies on evictions and development of interventions are needed.
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Affiliation(s)
- Jack Tsai
- U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale Univesrity School of Medicine, New Haven, Connecticut
| | - Minda Huang
- Graduate Institute of Professional Psychology, University of Hartford, West Haven, Connecticut
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Finlay AK, Owens MD, Taylor E, Nash A, Capdarest-Arest N, Rosenthal J, Blue-Howells J, Clark S, Timko C. A scoping review of military veterans involved in the criminal justice system and their health and healthcare. HEALTH & JUSTICE 2019; 7:6. [PMID: 30963311 PMCID: PMC6718001 DOI: 10.1186/s40352-019-0086-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/18/2019] [Indexed: 05/08/2023]
Abstract
BACKGROUND In the criminal justice system, special populations, such as older adults or patients with infectious diseases, have been identified as particularly vulnerable to poor health outcomes. Military veterans involved in the criminal justice system are also a vulnerable population warranting attention because of their unique healthcare needs. This review aims to provide an overview of existing literature on justice-involved veterans' health and healthcare to identify research gaps and inform policy and practice. METHODS A systematic search was conducted to identify research articles related to justice-involved veterans' health and healthcare that were published prior to December 2017. Study characteristics including healthcare category, study design, sample size, and funding source were extracted and summarized with the aim of providing an overview of extant literature. RESULTS The search strategy initially identified 1830 unique abstracts with 1387 abstracts then excluded. Full-text review of 443 articles was conducted with 252 excluded. There were 191 articles included, most related to veterans' mental health (130/191, 68%) or homelessness (24/191, 13%). Most studies used an observational design (173/191, 91%). CONCLUSIONS Knowledge gaps identified from the review provide guidance on future areas of research. Studies on different sociodemographic groups, medical conditions, and the management of multiple conditions and psychosocial challenges are needed. Developing and testing interventions, especially randomized trials, to address justice-involved veterans care needs will help to improve their health and healthcare. Finally, an integrated conceptual framework that draws from diverse disciplines, such as criminology, health services, psychology, and implementation science is needed to inform research, policy and practice focused on justice-involved veterans.
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Affiliation(s)
- Andrea K. Finlay
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025 USA
- Department of Veterans Affairs, National Center on Homelessness Among Veterans, 795 Willow Road, Menlo Park, CA 94025 USA
| | - Mandy D. Owens
- Department of Veterans Affairs Health Care System, Center of Innovation for Veteran-Centered and Value-Driven Care, 1660 S. Columbian Way, Seattle, WA 98108 USA
- Department of Health Services, University of Washington, 1959 NE Pacific St, Magnuson Health Sciences Center, Room H-680, Box 357660, Seattle, WA 98195-7660 USA
| | - Emmeline Taylor
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025 USA
| | - Amia Nash
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025 USA
| | - Nicole Capdarest-Arest
- Blaisdell Medical Library, University of California, Davis, 4610 X St, Sacramento, CA 95817 USA
| | - Joel Rosenthal
- Veterans Justice Programs, Department of Veterans Affairs, 795 Willow Road, Menlo Park, CA 94025 USA
| | - Jessica Blue-Howells
- Veterans Justice Programs, Department of Veterans Affairs, 11301 Wilshire Blvd, Los Angeles, CA 90073 USA
| | - Sean Clark
- Veterans Justice Programs, Department of Veterans Affairs, 2250 Leestown Road, Lexington, KY 40511 USA
| | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025 USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717 USA
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Hsu C, Hertel E, Johnson E, Cahill C, Lozano P, Ross TR, Ehrlich K, Coleman K, BlueSpruce J, Cheadle A, Matthys J, Chapdelaine M, Gray M, Tufte J, Robbins M. Evaluation of the Learning to Integrate Neighborhoods and Clinical Care Project: Findings from Implementing a New Lay Role into Primary Care Teams to Address Social Determinants of Health. Perm J 2018; 22:18-101. [PMID: 32392126 DOI: 10.7812/tpp/18-101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Health systems increasingly recognize the impact of social determinants of health such as access to housing, transportation, and nutritious food. Lay health workers have been used to address patients' social determinants of health through resource referral and goal setting in targeted populations, such as individuals with diabetes. However, we know of no studies that evaluate this type of role for a general primary care population. OBJECTIVE To assess the implementation and impact of the Community Resource Specialist (CRS) role in Kaiser Permanente Washington. METHODS We analyzed data from staff interviews, patient focus groups, clinic site visits, patient surveys, the electronic health record, and administrative sources. RESULTS Satisfaction with CRSs was high, with 92% of survey respondents choosing "very satisfied" or "somewhat satisfied." Of patients with a resource referral and follow-up encounter, 45% reported using the resource (n = 229) and 86% who set a goal and had a follow-up encounter (n = 218) progressed toward their goal. Primary care teams reported workload easing. Patients who used CRSs and participated in focus groups reported behavior changes and improved health, although no changes were detected from electronic health records or patient survey data. Key learnings include the need to clearly define the CRS role, ensure high visibility to clinical staff, and facilitate personal introductions of patients (warm handoffs). CONCLUSION Adding an individual to the primary care team with expertise in community resources can increase patient satisfaction, support clinicians, and improve patients' perceptions of their health and well-being.
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Affiliation(s)
- Clarissa Hsu
- Assistant Investigator at the Center for Community Health and Evaluation at the Group Health Research Institute in Seattle, WA
| | - Erin Hertel
- Senior Research Associate at the Center for Community Health & Evaluation, Kaiser Permanente Washington Health Research Institute in Seattle
| | - Eric Johnson
- Biostatistician at the Center for Community Health & Evaluation, Kaiser Permanente Washington Health Research Institute in Seattle
| | - Carol Cahill
- Communication and Analytics Consultant at the Center for Community Health & Evaluation, Kaiser Permanente Washington Health Research Institute in Seattle
| | - Paula Lozano
- Senior Investigator at Group Health Research Institute and Assistant Medical Director of Preventive Care at Group Health in Seattle, WA
| | - Tyler R Ross
- Director of Information Technology at the Kaiser Permanente Washington Health Research Institute in Seattle
| | - Kelly Ehrlich
- Project Manager at the Kaiser Permanente Washington Health Research Institute in Seattle
| | - Katie Coleman
- Assistant Investigator at the Kaiser Permanente Washington Health Research Institute in Seattle
| | - June BlueSpruce
- Project Manager at the Kaiser Permanente Washington Health Research Institute in Seattle
| | - Allen Cheadle
- Director of the Center for Community Health and Evaluation for the Group Health Research Institute in Seattle, WA
| | - Juno Matthys
- Research Associate at the Center for Community Health & Evaluation, Kaiser Permanente Washington Health Research Institute in Seattle
| | - Michelle Chapdelaine
- Research Associate in the Center for Community Health & Evaluation, Kaiser Permanente Washington Health Research Institute in Seattle
| | - Marlaine Gray
- Acting Assistant Investigator at the Kaiser Permanente Washington Health Research Institute in Seattle
| | - Janice Tufte
- Patient Co-Investigator at the Group Health Research Institute in Seattle, WA
| | - Michele Robbins
- Patient Co-Investigator at the Group Health Research Institute in Seattle, WA
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Schickedanz A, Chung PJ. Addressing Family Homelessness in Pediatrics: Progress and Possibility. Pediatrics 2018; 142:peds.2018-2328. [PMID: 30177512 PMCID: PMC6702124 DOI: 10.1542/peds.2018-2328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2018] [Indexed: 01/31/2023] Open
Affiliation(s)
- Adam Schickedanz
- Department of Pediatrics, David Geffen School of Medicine at UCLA and
| | - Paul J. Chung
- Department of Pediatrics, David Geffen School of Medicine
at UCLA, Los Angeles, CA,Department of Health Policy & Management, UCLA Fielding
School of Public Health, Los Angeles, CA
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29
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Benfer EA, Gluck AR, Kraschel KL. Medical-Legal Partnership: Lessons from Five Diverse MLPs in New Haven, Connecticut. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2018; 46:602-609. [PMID: 30336104 DOI: 10.1177/1073110518804210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This article examines five different Medical-Legal Partnerships (MLPs) associated with Yale Law School in New Haven, Connecticut to illustrate how MLP addresses the social determinants of poor health. These MLPs address varied and distinct health and legal needs of unique patient populations, including: 1) children; 2) immigrants; 3) formerly incarcerated individuals; 4) patients with cancer in palliative care; and 5) veterans. The article charts a research agenda to create the evidence base for quality and evaluation metrics, capacity building, sustainability, and best practices; it also focuses specifically on a research agenda that identifies the value of the lawyers in MLP. Such a focus on the "L" has been lacking and is overdue.
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Affiliation(s)
- Emily A Benfer
- Emily A. Benfer, J.D., LL.M., is a Distinguished Visiting Scholar and Senior Fellow, Solomon Center for Health Law and Policy, Yale Law School. Abbe R. Gluck, J.D., is a Professor of Law and Faculty Director, Solomon Center for Health Law and Policy, Yale Law School; Katherine L. Kraschel, J.D., is Executive Director, Solomon Center for Health Law and Policy and Lecturer in Law, Yale Law School
| | - Abbe R Gluck
- Emily A. Benfer, J.D., LL.M., is a Distinguished Visiting Scholar and Senior Fellow, Solomon Center for Health Law and Policy, Yale Law School. Abbe R. Gluck, J.D., is a Professor of Law and Faculty Director, Solomon Center for Health Law and Policy, Yale Law School; Katherine L. Kraschel, J.D., is Executive Director, Solomon Center for Health Law and Policy and Lecturer in Law, Yale Law School
| | - Katherine L Kraschel
- Emily A. Benfer, J.D., LL.M., is a Distinguished Visiting Scholar and Senior Fellow, Solomon Center for Health Law and Policy, Yale Law School. Abbe R. Gluck, J.D., is a Professor of Law and Faculty Director, Solomon Center for Health Law and Policy, Yale Law School; Katherine L. Kraschel, J.D., is Executive Director, Solomon Center for Health Law and Policy and Lecturer in Law, Yale Law School
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Tsai J, Blue-Howells J, Nakashima J. Needs of homeless veterans: 5 years of the CHALENG Survey 2012–16. J Public Health (Oxf) 2018; 41:e16-e24. [DOI: 10.1093/pubmed/fdy076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 04/03/2018] [Accepted: 04/15/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jack Tsai
- Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | | | - John Nakashima
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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