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Breaking Barriers to Care

Many children and families face legal barriers when it comes to health care. In South Carolina, a new statewide effort aims to improve health outcomes by eliminating those daunting challenges.

Supported by a $1 million grant from The Duke Endowment, the work connects two medical-legal partnerships in the state: CHAMPS (a partnership of the University of South Carolina Schools of Law and Medicine, Prisma Health Midlands and Prisma Children’s Hospital) and the Greenville Medical-Legal Partnership, which includes Prisma Health Upstate, South Carolina Legal Services and Furman University.

In medical-legal partnerships, known as MLPs, doctors and lawyers work together to address the underlying causes of poor health. The holistic process starts at the doctor’s office, where screening questions cover housing, the availability of nutritious food, and other social and environmental determinants of health. If a pediatrician learns that substandard housing is aggravating a child’s asthma, for example, the MLP will contact the landlord.

“What’s more, if we see 10 children with health problems and discover they all live in the same apartment complex, we can begin to think about policy-level changes,” says Eli Hestermann, executive director of Furman’s Institute for the Advancement of Community Health. “We’re not just bailing out the boat as it’s leaking, but patching it.”

The free legal services might also address access to government-provided benefits or guardianship issues.

CHAMPS and the Greenville MLP serve pediatric patients and their families through a care team comprised of lawyers, health providers and students. One objective of the new effort is to study how MLPs benefit communities by lowering health care costs and reducing health disparities. Another goal is to study how two distinct MLP models can work together.

Furman, which has been involved with the Greenville MLP since 2016, will help manage the evaluation.

“Physicians must rethink the concept of preventive health, especially now that we know the long-term impacts of toxic stress and adverse childhood experiences on the developing brain,” says Dr. Kerry Sease of Prisma Health Children’s Hospital-Upstate, which helped pioneer MLPs in Greenville. “Routine screening for vulnerability is only useful if collaborative relationships exist to address these needs.”