Tipping the scales: A lawyer joins the health care team
Notice bibliographique
Résumé
The social determinants of health are well understood in paediatric medicine. Social conditions have a profound impact on child health, both directly and indirectly. Many health and social issues can be addressed by specialists in the legal profession. Problems associated with substandard housing, access to health care, immigration status and school support often have legal remedies. Legal aid assistance is available in many jurisdictions; however, many ‘working poor’ are either ineligible but cannot afford to hire a lawyer, or their specific issues are not covered by these programs. Lawyers have been an underused ally in Canadian clinical care issues despite their clear potential for assisting patients with complex socioeconomic problems. Pro Bono Law Ontario (PBLO) at SickKids was established in March 2009 at The Hospital for Sick Children, a 370-bed urban Canadian paediatric centre in Toronto, Ontario, with nearly 300,000 clinic and emergency patient visits per year. The goal of PBLO at SickKids was to provide free legal assistance to low-income families, whose children were treated at the hospital, pertaining to issues that impact child health or family stability. The delivery of this program was based on similar work at several paediatric institutions in the United States – called medical-legal partnerships (MLPs) for children. MLPs originated in 1993 at Boston Medical Center (Massachusetts, USA), and were serving hundreds of patient-families by 2005. In addition to direct advocacy work, MLPs have helped draft social policy changes and policy recommendations, and have expanded to more than 80 medical-legal partnerships across the United States. PBLO at SickKids was the first of its kind in Canada, and was an interdisciplinary initiative, linking public and private legal partners across Toronto with patients in the hospital. Information gathered from the first 12-month pilot period is reported. Over a 12-month period (May to April 2010), 360 patient and family consultations occurred, for a total of 419 legal issues. The most commonly cited issues were family law (domestic violence, child support and custody: n=76 [18.1%]), immigration law (n=69 [16.5%]), social services (disability and family welfare: n=51 [12.2%]) and health insurance (coverage without legal provincial status: n=36 [8.6%]) Other legal issues included access to education, consent law (capacity and power of attorney), housing/tenancy concerns, employment, social benefits and taxation. Provision of legal information (information provided by the triage lawyer regarding available legal options) was the most frequent outcome of consultation (n=136 [37.8%]), followed by legal advice (n=105 [29.2%]), referral to external pro bono legal services (n=99 [27.5%]) and brief legal representation by the program's triage lawyer (n=75 [20.8%]). Social workers referred patients to the program most frequently (n=145 [85.8%]), followed by physicians (n=8 [4.7%]) and nurses (n=6 [3.6%]) (May to October 2009). There were a median of 31 (range 24 to 37) consultations involving 35 (range 25 to 48) legal issues per month. Utilization data from the 12-month pilot program suggest that a significant population of low-income families seek legal counsel regarding issues directly or indirectly affecting their child's health, and that the majority of issues can be addressed through an onsite legal specialist. A hospital-based partnership with a qualified triage lawyer and access to specialized volunteer lawyers – at no cost to the family – can assist families with complex social issues. Although additional work is required to evaluate patient outcomes resulting from PBLO at SickKids, the program has been recognized as a valuable service at The Hospital for Sick Children. The authors appreciate the support of Pro Bono Law Ontario for creating the PBLO at SickKids, the Law Foundation of Ontario for pilot funding, and The Hospital for Sick Children for embracing innovative approaches to improving child health.
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Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,014 | 0,062 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,002 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,025 | 0,009 |
| Communication savante | 0,012 | 0,015 |
| Science ouverte | 0,004 | 0,020 |
| Intégrité de la recherche | 0,008 | 0,026 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,051 | 0,018 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
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Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».