title: Identifying and treating a substandard housing cluster using a medical-legal partnership.
abstract: OBJECTIVE
  There is a documented connection between the home environment and health. Medical-legal partnerships (MLPs) can address social and environmental determinants of health. Our objective was to describe a cluster of substandard housing identified and treated by an MLP based in a pediatric primary care setting.
  
  
  METHODS
  Potential cases of poor-quality housing were identified during outpatient primary care. A case was defined as any rented housing unit with a reported unaddressed housing risk within a defined building portfolio (owned by a single developer) in which ≥ 1 child lived. An on-site MLP offered affected families legal services including ordinance enforcement and connection to resources. They also initiated portfolio-wide advocacy. Legal advocates reported case outcomes. Medical history and household demographics were collected from the medical record and compared with clinic-wide data by using Fisher's exact test or χ(2) statistics.
  
  
  RESULTS
  After identification of a single case, an additional 15 cases were identified. Pest infestation was the most common initial risk identified. Of 14 units with outcome data, repairs were completed in 10 (71%). Of the 19 building complexes with the same owner, 11 received significant systemic repairs. Of the 45 children living within the 16 identified case units, 36% had asthma, 33% had developmental delay or behavioral disorder, and 9% had an elevated lead level. Affected children were more likely to have one of these diagnoses than the general clinic population (all P < .01).
  
  
  CONCLUSIONS
  An MLP identified and improved home environmental conditions for children living in a cluster of substandard housing.
authors.affiliation: Division of General and Community Pediatrics and Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229, USA. andrew.beck1@cchmc.org
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Beck
authors.forename: Melissa D
authors.initials: MD
authors.lastname: Klein
authors.forename: Joshua K
authors.initials: JK
authors.lastname: Schaffzin
authors.forename: Virginia
authors.initials: V
authors.lastname: Tallent
authors.forename: Marcheta
authors.initials: M
authors.lastname: Gillam
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kahn
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006798:Housing / Q000592:standards*; D006801:Humans; D007223:Infant; D007603:Jurisprudence; D008297:Male; D009820:Ohio; D010317:Partnership Practice; D010372:Pediatrics; D058996:Quality Improvement; D011795:Surveys and Questionnaires