Cited by 126Child and Adolescent HealthMaternal and Neonatal HealthcareInfant Development and Preterm Care

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

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Sege, Robert, Preer, Genevieve, Morton, Samantha J., Cabral, Howard, Morakinyo, Oluwatomisin, Lee, Vonne, Abreu, Catarina, De Vos, Edward, Kaplan-Sanoff, Margot·2015·Pediatrics

DOI 10.1542/peds.2014-2955PMC PMC9923600

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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.

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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
ORCID: Sege, Robert
Preer, Genevieve
Morton, Samantha J.
Cabral, Howard
Kaplan-Sanoff, Margot
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
DOI: 10.1542/peds.2014-2955
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 › Medicine › Pediatrics, Perinatology and Child Health › Child and Adolescent Health
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › 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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Medical-Legal Strategies to Improve Infant Health Care: A Randomized Trial

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