title: Medical-Legal Strategies to Improve Infant Health Care: A Randomized Trial.
abstract: BACKGROUND
  Changes in health care delivery create opportunities to improve systems to better meet the needs of low-income families while achieving quality benchmarks.
  
  
  METHODS
  Families of healthy newborns receiving primary care at a single large urban safety-net hospital participated. Intervention families were randomly assigned a family specialist who provided support until the 6-month routine health care visit. The Developmental Understanding and Legal Collaboration for Everyone (DULCE) intervention is based on the Strengthening Families approach and incorporated components of the Healthy Steps and Medical-Legal Partnership models. Medical record reviews determined use of preventive and emergency care. Surveys conducted at baseline, postintervention (6 months), and follow-up (12 months) were used to determine hardship and attainment of concrete supports.
  
  
  RESULTS
  Three hundred thirty families participated in the study. At baseline, 73% of families reported economic hardships. Intervention parents had an average of 14 contacts with the family specialist, and 5 hours of total contact time. Intervention infants were more likely to have completed their 6-month immunization schedule by age 7 months (77% vs 63%, P < .005) and by 8 months (88% vs 77%, P < .01). Intervention infants were more likely to have 5 or more routine preventive care visits by age 1 year (78% vs 67%, P < .01) and were less likely to have visited the emergency department by age 6 months (37% vs 49.7%, P < .03). The DULCE intervention accelerated access to concrete resources (P = .029).
  
  
  CONCLUSIONS
  Assignment to the Project DULCE intervention led to improvements in preventive health care delivery and utilization and accelerated access to concrete supports among low-income families.
authors.affiliation: Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, rsege@hria.org.
authors.forename: Robert
authors.initials: R
authors.lastname: Sege
authors.affiliation: Department of Pediatrics, Boston Medical Center and Boston University School of Medicine.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Preer
authors.affiliation: Medical-Legal Partnership | Boston, Boston, Massachusetts; and.
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Morton
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts;
authors.forename: Howard
authors.initials: H
authors.lastname: Cabral
authors.affiliation: Department of Pediatrics, Boston Medical Center and Boston University School of Medicine.
authors.forename: Oluwatomisin
authors.initials: O
authors.lastname: Morakinyo
authors.affiliation: Department of Pediatrics, Boston Medical Center and Boston University School of Medicine.
authors.forename: Vonne
authors.initials: V
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Boston Medical Center and Boston University School of Medicine.
authors.forename: Catarina
authors.initials: C
authors.lastname: Abreu
authors.affiliation: William James College (formerly the Massachusetts School of Professional Psychology), Newton, Massachusetts.
authors.forename: Edward
authors.initials: E
authors.lastname: De Vos
authors.affiliation: Department of Pediatrics, Boston Medical Center and Boston University School of Medicine.
authors.forename: Margot
authors.initials: M
authors.lastname: Kaplan-Sanoff
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000379:methods* / Q000706:statistics & numerical data; D007229:Infant Welfare; D007231:Infant, Newborn; D008297:Male; D010290:Parents; D011203:Poverty; D011320:Primary Health Care; D055815:Young Adult