Addressing the Needs of a Vulnerable Population: A Medical, Legal and Mental Health Interdisciplinary Model
Authors: Mallory Legg, Esq.; Joyce Wong, MD; Darius Sanders, MSW; Amy Kordek, MSN Contributing author: Mary Leppert, MB, BCh
Background
In the United States, 17% of children have a disability,1 and 11–20% have a disorder of behavior.2 In Baltimore, Maryland, 21% of residents are children younger than 18 years, 62.4% of whom are Black and/or African American, and 21% live in poverty.3
Providing medical care to children with developmental or behavioral disorders in this urban setting has presented challenges that exceed the capacity and expertise of the clinicians rendering care within Kennedy Krieger Institute’s Medication Management Clinic (MMC), which serves primarily low-income patients with developmental and behavioral disorders from urban settings who have Medicaid insurance.
Barriers to Care
During equity, diversity and inclusion discussions, clinical staff members of the MMC determined that while the children they serve receive equitable medical care, educational and psychosocial barriers remain obstacles to the success of this vulnerable population. Management of developmental and behavioral disorders is confounded by a high rate of adverse childhood experiences and suboptimal supports in educational settings. The clinicians concluded that integrating legal consultation and mental health counseling services could better meet the needs of this clinic’s patients and families.
Genesis of the Clinic
MMC clinicians proffered a variation on the interdisciplinary approach employed by many medical clinics to improve access to appropriate supportive care for the clinic’s children and families. In the fall of 2020, the MMC initiated a novel interdisciplinary program offering legal consultation and counseling services. The legal consultation is provided by a staff attorney at Project HEAL (Health, Education, Advocacy, and Law), a community-based program of the Maryland Center for Developmental Disabilities at Kennedy Krieger Institute, and counseling services are provided by a clinical social worker from Kennedy Krieger’s Psychiatric Mental Health Program (PMHP).
Interdisciplinary Model
Clinic Structure
The attorney and social worker are integrated into the clinic in a variety of ways. Before each clinic day, clinicians indicate which patients on the schedule may require attorney and/or social worker consultation. Patients and families are offered the consultation, and with their consent, clinicians request that the appropriate consultant join the visit. The social worker meets with the patient to evaluate the patient, provide targeted treatment or screen the patient for ongoing individual or group social work services. The attorney conducts an intake to screen for civil legal issues and provide representation or limited representation (e.g., brief advice, document review, referrals, information and resources) for the patient and their family. The attorney may also provide case consultation services by providing advice to the faculty or staff member working with the family about a specific legal issue that the family is facing.
The clinic team also holds a monthly case discussion so that the clinicians, social worker and attorney can discuss cases in an all-teach, all-learn format.
Results - First Six Months
Discussion
This novel interdisciplinary team of medical, legal and behavioral health personnel is a model of comprehensive care for similar clinical settings. The clinicians, social worker and attorney feel they are improving access to appropriate care for the MMC’s patients and their families. One limitation is that the program was started virtually during the COVID-19 pandemic, which limited the attorney’s and social worker’s abilities to attend clinic appointments in person. This model should be replicated in other healthcare clinics serving low-income patients who face educational and psychosocial barriers.
References
- Zablotsky, B., Black, L.I., Maenner, M.J., et al. (2019). Prevalence and Trends of Developmental Disabilities among Children in the United States: 2009–2017. Pediatrics, 144(4), e20190811. doi:10.1542/peds.2019-0811
- Weitzman, C., Wegner, L. (2015). Section on Developmental and Behavioral Pediatrics; Promoting optimal development: screening for behavioral and emotional problems. Pediatrics, 135(2), 384–395. [Published correction appears in Pediatrics, 135(5), 946.] doi:10.1542/peds.2014-3716
- United States Census Bureau. QuickFacts: Baltimore city, Maryland; Baltimore Highlands CDP, Maryland; Maryland. Retrieved from https://www.census.gov/quickfacts/fact/table/baltimorecitymaryland,baltimorehighlandscdpmaryland,MD/PST045219 (accessed 5/29/2021)