The Impact of COVID-19 on Medical Legal Partnerships and Their Pediatric Patient-clients

Background: Medical Legal Partnerships (MLPs) help address the social determinants of health or health-harming legal needs impacting the health and wellbeing of vulnerable pediatric patients and families.

Methods: To examine the impact of COVID-19 on MLPs and the children and families they serve, we conducted 96 semi-structured interviews with 18 clients and 78 MLP staff including legal aid staff, attorneys, health and social workers, and health administrators from programs in 10 states representing 5 U.S. regions. Six of these MLPs have a children’s hospital as a medical partner. Interviews were collected between March and November 2020, capturing the initial and long-term impact of COVID-19.

Results: Initially, MLP partner clinics had reduced patient volumes in response to the pandemic resulting in decreased MLP referrals. Later in the pandemic, however, MLP’s saw an increase in demand for assistance with employment, housing, education, food insecurity and access to healthcare. Of 81 interviews with statements related to the impact of COVID 19 on clients, over half identified employment issues due to COVID exposure and increased evictions as problems for their patient-clients. Nearly one third of the 81 interviews discussed how children’s educational needs were impacted by COVID. They cited families experiencing difficulties accessing educational resources at home, trouble receiving IEP services, and behavioral problems related to the transition to non-traditional education. MLPs also noted increased food insecurity, inequities in internet access and subsequent educational outcomes, and an increased time to resolve issues due to closed schools and courts. Furthermore, several MLP sites were challenged with the shift to remote work. No longer being at the clinical site made it more difficult to coordinate referral intake and consults with medical partners and trainings had to become virtual. Programs also noted there were fewer resources available during the pandemic to help families meet their needs. A few MLPs also experience reduced funding in their own programs which sometimes resulted in a decrease in legal personnel to provide services.

Conclusion: The COVID 19 pandemic exacerbated the need for civil legal services to address social determinants of health for low-income families while simultaneously creating new barriers to resolution of those legal needs and reducing access to resources for children and their families.