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Partnering Across Professions to Improve Family Health

Children’s health care shouldn’t stop outside the pediatrician’s door.

A big part of every parent or caregiver’s job is watching over kids’ diets and sleep and making sure they’re getting enough exercise and taking needed medications. But what if they’re doing all that, but also coping with a violent spouse? What if their child is taking asthma medication but still having trouble breathing in a moldy bedroom? What if they’re facing eviction and homelessness? What if they can’t get health insurance?

Such problems may seem personal — or perhaps purely financial. Yet they can seriously influence a family’s health. Researchers have found that 60% of maintaining good health depends on factors such as family income, quality of housing, employment and emotional stability.

Partners in Health

At Nemours Children’s, we understand the critical importance of these factors, known as “social determinants of health,” and we’ve stepped up to help.

In a community center in Wilmington, Del., we’ve partnered with the office of Delaware First Lady Tracey Quillen Carney, Casey Family Programs, community organizations and local lawyers to help our patients improve their health by resolving their legal challenges. We have similar team efforts afoot in Florida and Pennsylvania.

In all the places we serve, low-income residents are struggling to make ends meet while often fighting housing and job discrimination and other challenges. In Wilmington, the median annual income of our patients is below the federal poverty level. 

A National Need

Throughout the United States, recognition is growing of the value of medical-legal cooperation. Such teamwork not only improves patients’ health but can reduce homelessness, missed days of work and school, and the high costs of emergency room visits.

National associations including the American Academy of Pediatrics have called on their members to engage in more of these partnerships. At last count, more than 450 U.S. hospitals and health centers were offering on-site legal aid. 

At Nemours, we’ve developed screening tools with which parents of our patients, if they’re willing, can answer questions about financial, legal and other needs. During the appointment, our providers may also ask about living conditions, including the adequacy of their food and housing. “Having a lawyer as a partner on the health care team can really increase the amount of advocacy we’re able to do on behalf of families,” says Nemours Pediatric Hospitalist Abby Nerlinger, an in-house advocate of the medical-legal partnership.

Changing the System

Having witnessed the value of this teamwork, we want to broaden our impact. “As we recognize patterns of legal needs that impact health outcomes, we can work with legal aid attorneys to help pass legislation to improve conditions for whole communities,” Nerlinger says.

In Delaware, for instance, concerns about lead exposure in schools have prompted efforts by state lawmakers to require landlords to test for and  eliminate lead exposure in housing. Nemours is supporting this effort and others like it, to make a positive impact on the health of communities we serve.