Medical-Legal Strategies to Improve Infant Health Care: A Randomized Trial

Abstract

Background: Changes in health care delivery create opportunities to improve systems to better meet the needs of low-income families while achieving quality benchmarks.

Methods: Families of healthy newborns receiving primary care at a single large urban safety-net hospital participated. Intervention families were randomly assigned a family specialist who provided support until the 6-month routine health care visit. The Developmental Understanding and Legal Collaboration for Everyone (DULCE) intervention is based on the Strengthening Families approach and incorporated components of the Healthy Steps and Medical-Legal Partnership models. Medical record reviews determined use of preventive and emergency care. Surveys conducted at baseline, postintervention (6 months), and follow-up (12 months) were used to determine hardship and attainment of concrete supports.

Results: Three hundred thirty families participated in the study. At baseline, 73% of families reported economic hardships. Intervention parents had an average of 14 contacts with the family specialist, and 5 hours of total contact time. Intervention infants were more likely to have completed their 6-month immunization schedule by age 7 months (77% vs 63%, P < .005) and by 8 months (88% vs 77%, P < .01). Intervention infants were more likely to have 5 or more routine preventive care visits by age 1 year (78% vs 67%, P < .01) and were less likely to have visited the emergency department by age 6 months (37% vs 49.7%, P < .03). The DULCE intervention accelerated access to concrete resources (P = .029).

Conclusions: Assignment to the Project DULCE intervention led to improvements in preventive health care delivery and utilization and accelerated access to concrete supports among low-income families.

Trial registration: ClinicalTrials.gov NCT01343940.

Conflict of interest statement

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

Copyright © 2015 by the American Academy of Pediatrics.

Figures

FIGURE 1

Theoretical framework. Adapted from Barnett, DULCE leveraged support from MLP | Boston to address upstream factors: food, housing, and utilities hardship, and to identify and support other family legal needs. This intervention was designed to reduce overall family economic pressure and the resultant downstream results.

FIGURE 2

DULCE Consolidated Standards of Reporting Trials diagram showing flow of participants from initial assessment through data analysis. Please see text for detailed explanation.