Teaching through Medical-Legal Partnership (M-LP): Impacting the Social Determinants of Health
David Keller MD, Valerie Zolezzi-Wyndham JD, Pat Flanagan MD, Rebecca Kislak JD, Pamela Tames JD, Kathleen Conroy MD Family Advocates of Central Massachusetts, UMass Medical School and Legal Assistance Corporation of Central Massachusetts, Worcester MA, Medical-Legal Partnership for Children of Rhode Island, Hasbro Childrend’s Hospital and Rhode Island Legal Services, Providence, RI, and Medical-Legal Partnership/Boston, Boston University Medical Center, Boston MA.
Children’s medical centers throughout the US have developed collaborative relationships with legal assistance attorneys to advocate for children and families on issues related to housing, education, immigration, domestic violence, financial support and access to services; social issues which are likely to affect child health. Attorneys and physicians involved in M-LPs are often used to teach medical students, residents, allied health students, faculty and clinical staff about the social determinants of health. Models of training include: 1) Medical students at the Warren Alpert Medical School at Brown University and law students at Roger Williams University School of Law in Rhode Island can enroll in a joint course on Poverty, Health and Law. Topics covered include the relationship between childhood asthma and poor housing; lead paint issues; and the impact of domestic violence on all members of the family. 2) Medical students and nursing students at UMass Medical School in Worcester, MA participate in a two week Community Clerkship in which they shadow doctors and attorneys in a variety of clinical settings and participate in court proceeding involving families served by the M-LP. 3) Residents at Boston University Medical Center and Hasbro Children's Hospital work with attorneys within their primary care continuity practice, as members of the interdisciplinary team addressing the social determinants of health in low income families. 4) Individual students at all three programs have conducted independent research projects under interdisciplinary supervision, resulting in local, regional and national presentations and publication in a peer-reviewed journal. 5) Participation in M-LPs by clinical faculty has led to the integration of health equity into the clinical teaching paradigms of all three institutions. In a society with growing social and health disparities, teaching through M-LP enables medical faculty to address the social determinants of health while addressing the needs of low income families.
I admit that part of the appeal of submitting the abstract was a desire to travel to Cuba (I was there in 1995, as part of a group of pediatricians looking at the impact of the Blockade/Embargo on the health of children after the collapse of the Soviet Union, and though that is was a fascinating place). It was a beautiful country, with amazingly smart doctors and a truly wonderful health care system built with no access to Western resources, and I have been curious to see how they are faring in the waning days of the Castros. Arranging this travel has made me realize that this really is one of the last Iron Curtains; it will have to fall sometime. I suspect that when it does, we will see some really creative collaborations in the areas of medicine.
From a mental health perspective, however, I am curious to here more of their approach to mental illness. When we were there last time, we got the sense that their approach to child development and mental illness was very different than ours, based a lot more on family taking care of family and less on pharmaceuticals (although, given the Embargo, that may have been making a virtue out of necessity)
I am not sure how much I will be able to learn; under US Law, I am allowed to travel to Cuba because of my participation in the conference, and I may not have a lot of free time. Still, I expect to meet some Cubans and hear about their child health system. I'll try to blog it from the Island; but I may need to wait until my return to post. So stay tuned.
PS Interesting piece in the Milford Daily News this weekend, on early diagnosis. See what you think- it is hard to explain this stuff in lay language.