title: Development of a brief questionnaire to identify families in need of legal advocacy to improve child health.
abstract: OBJECTIVE
  To determine whether the medical-legal advocacy screening questionnaire (MASQ), a simple 10-item questionnaire, is able to screen families in a primary care setting for possible referral to legal services more effectively than the clinical interview alone.
  
  
  METHODS
  Family Advocates of Central Massachusetts (FACM) is a medical-legal collaboration that assists low-income families with legal issues that affect child health. A convenience sample of parents seen at each of 5 medical practices associated with FACM was recruited to complete the MASQ prior to a routine child health care visit. Physicians blinded to the result assessed family need for referral to FACM after their usual clinical encounter. The sensitivity and specificity of both the MASQ and provider assessment were calculated.
  
  
  RESULTS
  Two hundred fifty-five parents from 5 practices participated in the study. The MASQ identified 85 patients in need of legal services. Prior to reviewing the MASQ, the primary care providers identified 35 families in need of referral to the FACM. After completion of both the MASQ and the medical encounter, 37 families agreed to referral. The MASQ had sensitivity of 0.81 and specificity of 0.75 in predicting program referral. Provider assessment had sensitivity of 0.65 and specificity of 0.95 of predicting program referral.
  
  
  CONCLUSIONS
  Routine use of the MASQ would likely identify more patients in pediatric practices who would accept referral to legal assistance than reliance on provider impression alone after a routine clinical encounter.
authors.affiliation: Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA. kellerd@ummhc.org
authors.forename: David
authors.initials: D
authors.lastname: Keller
authors.forename: Nathan
authors.initials: N
authors.lastname: Jones
authors.forename: Judith A
authors.initials: JA
authors.lastname: Savageau
authors.forename: Suzanne B
authors.initials: SB
authors.lastname: Cashman
mesh_terms: D000328:Adult; D002651:Child Advocacy / Q000331:legislation & jurisprudence*; D002669:Child Welfare / Q000331:legislation & jurisprudence*; D002675:Child, Preschool; D006801:Humans; D008404:Massachusetts; D020380:Needs Assessment; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000379:methods*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires