Medical-Legal Strategies to Improve Infant Health Care: A Randomized Trial
Open accessAbstract
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.
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A separate RCT showed no difference in food resource interest or use between control group participants (as needed social work referrals) and intervention group participants (additional navigation support with referrals, including to food resources) (SMD = 0.18, 95% CI, -0.08 to 0.43).
“A separate RCT showed no difference in food resource interest or use between control group participants (patients who received as needed social work referrals) compared with intervention group participants (patients who received additional navigation support with referrals, including to food resources) (SMD = 0.18, 95% CI, -0.08 to 0.43). 21”
From Interventions Addressing Food Insecurity in Health Care Settings: A Systematic Review (2019) · cites this paper as [21]
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- Authors
- Sege, R., Preer, G., Morton, S. J., Cabral, H., Morakinyo, O., Lee, V., Abreu, C., De Vos, E., & Kaplan-Sanoff, M.
- Affiliations
- Boston University (US)
- Medical-Legal Partnership | Boston, Boston, Massachusetts; and
- William James College (formerly the Massachusetts School of Professional Psychology), Newton, Massachusetts
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2015-07-01
- Volume
- 136
- Issue
- 1
- Pages
- 97-106
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- PMC
- PMC9923600
- OpenAlex
- W1942593987
- Cited by
- 126
- References
- 49
- Citations by year
- 2026: 8 · 2025: 19 · 2024: 20 · 2023: 17 · 2022: 12 · 2021: 16 · 2020: 11 · 2019: 5 · 2018: 7 · 2017: 8 · 2016: 3
- FWCI
- 10.97
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- PEDIATRICS (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (90CA1763)
- Topics
- Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Keywords
- medical-legal partnerships, infant health care, low-income households, preventive medicine, immunization, emergency department visits, economic hardship, concrete support, safety-net hospitals, primary care
- MeSH terms
- Adolescent, Adult, Child, Child Health Services, Delivery of Health Care, Female, Health Promotion, Health Services Needs and Demand, Humans, Infant, Infant Care, Infant Welfare, Infant, Newborn, Male, Parents, Poverty, Primary Health Care, Young Adult
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