A Comparison of Family Legal Needs Between Children Referred Within an Academic Health System versus Those Referred Through a Maternal Substance Use Treatment Program

Background: Medical-legal partnerships (MLP) assist patient-clients with health-harming legal needs. The MLP at University of Kentucky recently began assisting families at the Beyond Birth (BB) Clinic, a comprehensive substance use disorder treatment program for mothers of young children, many of whom are trying to regain custody.

Methods: Data on all MLP referrals were collected between January 1, 2020 and April 30, 2021. After deidentification, the legal team provided researchers with data on client’s age group (0-5, 6-10, 11-15, 16-21, and over 21 years), race/ethnicity, referral source (BB or Academic Health System/AHS), and category of legal problem. The ten referral categories used in this analysis were: contract, criminal, education, employment, estate planning, family law, housing, immigration, medical billing, and public benefits. Frequencies and chi-square tests were used to examine differences in referral types by site and demographics.

Results: Eighty-one cases were referred to the MLP during the study time frame, 59 from the previously served AHS and 22 from BB. Education, family law, and benefits referrals were most common across both sites, accounting for two thirds of the total cases. Among BB clients, 57.9% of cases involved family law while 15.8% involved a criminal matter (primarily referrals for expungement). In contrast, among AHS clients, most referrals were for education (39%), family law (17%), and public benefits (17%). Most MLP referrals made were for clients under 11 years of age (88.9%), however, much of the age data were missing for BB clients preventing a true comparison.

Referral category also varied by age group (p = 0.002) with education referrals being most common among 6-21 year olds, and criminal referrals only occurring for those over 16. Nearly all family law referrals (92.3%) were for children under 11 years old. There were no significant differences in client race/ethnicity between referral sites, however, referral type did vary by client race (p=0.04). White clients were more likely to be referred for cases involving education or family law and Black clients were more likely to be referred for housing-related concerns compared to those of other races.

Conclusion: These data highlight some differences in the legal needs of women in recovery and their families compared to clients in an ACS. Some of these differences may be driven by BB’s mission to serve both mother and child, particularly children under 5. Many of these children are not yet in school, so education cases would be expected to be lower. The much higher need for assistance with expungement (criminal) and family reunification (family law) among BB clients likely reflects the legal consequences related to substance use. Recommendations are made concerning the capacity and specialization areas to be considered when providing MLP services to mothers in substance use disorder treatment.