Public-private partnership connects medical and legal sectors for healthier housing

blogimage_AsthmaThe connection between housing and health is not always immediately apparent. But for many children with asthma, substandard housing conditions can affect their well-being, as mold, pest infestations, and utility shut-offs can trigger asthma attacks. Worcester’s Medical-Legal Partnership (MLP) provides an approach to managing chronic illnesses, such as asthma, that are exacerbated by poverty-related instability, using cross-sector collaboration to reach more affected children in their area.

Last year, Worcester’s MLP, a non-profit partnership between Community Legal Aid and UMass Memorial Medical Center, carried out a successful neighborhood-wide pilot program with funds from the Massachusetts Medical Society. Valerie Zolezzi-Wyndham, Worcester MLP Co-Founder; Ted Kremer, Director of Pediatric Pulmonary Medicine at UMAss Memorial Medical Center; and Monica Lowell, Vice President of Community Relations at UMAss Memorial Health Care, report the pilot program “gave community health workers, UMass Memorial providers, and civil legal aid partners an opportunity to build strong relationships and hone service delivery, from referral mechanisms to case feedback loops.”

Zolezzi-Wyndham, Lowell, and Kramer recently presented the story of one child who is representative of the value of collaboration in this program: “Mary was one of the first asthma patients enrolled in Worcester’s new asthma program. Her community health worker connected Mary’s mom with Community Legal Aid. An attorney interviewed Mary’s mother to identify her healthy housing goals and represented her in court. As a result of the legal intervention, the eviction was dismissed, her subsidized housing voucher was protected, and the poor conditions were addressed. Through a combination of asthma education, medicine, and better housing, the team stabilized Mary’s asthma.”

“The City’s Division of Public Health and its partners in the medical and legal communities use a multi-sector approach to address housing and health needs for children at high-risk for asthma.”

The pilot program’s success was due in large part to the integration of delivery of services, which was made possible by leveraging the resources of various partners. “The driving idea behind this program is that these various interventions — medicine provided by clinicians, housing laws and conditions enforced by lawyers, and empowerment-focused asthma education provided by community health workers — can be more effective if their delivery is integrated,” said Zolezzi-Wyndham, Kramer, and Lowell explain said.

The program was later scaled to the city level, bringing in new partners such as the City of Worcester Division of Public Health and two federally qualified community health centers. As the program expands to reach its target population of 700 low-income children in Worcester, the public sector will play an increasingly larger role in integrating the delivery of services from various partners: “The City’s Division of Public Health and its partners in the medical and legal communities use a multi-sector approach to address housing and health needs for children at high-risk for asthma.”

The City of Worcester serves an important convening role in this collaborative project, promoting cross-sector dialogue and providing a space for clinical, community, and legal aid partners to share their challenges and successes through a forum. Partners discuss issues that are key to the success of the program, such as how to improve home visits. Zolezzi-Wyndham, Kramer, and Lowell also point out that, “If health care, public health, and legal aid organizations share their data around asthma and housing, they may identify common patients/clients and common goals.” The public sector is crucial in this aspect of the collaboration, as public health departments can ensure that decision-making is informed by city public health data.

“City leadership understood that innovations in healthy living and clinical care require collaboration and dialogue across sectors.”

Our case study of the Cardiac Arrest Registry to Enhance Survival (CARES) presents another successful cross-sector collaboration improving the delivery of health care. Dr. Bryan McNally, Associate Professor of Emergency Medicine at Emory University, worked with Atlanta hospitals, emergency medical technicians, medical software providers, and a network of medical experts, to develop , design, and implement CARES. This collaboration among Grady Memorial Hospital and Emergency Medical Services, medical software provider Sansio, and Emory University helped Atlanta track and measure improvement in cardiac arrest survival rates throughout the City of Atlanta, which rose from less than 3 percent in 2005 to 15 percent in 2007.