Tipping the scales: A lawyer joins the health care team
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.062 |
| Meta-epidemiology (narrow) | 0.001 | 0.002 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.025 | 0.009 |
| Scholarly communication | 0.012 | 0.015 |
| Open science | 0.004 | 0.020 |
| Research integrity | 0.008 | 0.026 |
| Insufficient payload (model declined to judge) | 0.051 | 0.018 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".