Home visiting has been shown to be an effective support for families with young children. However, intensive in-home models often face persistent challenges with engagement and retention, which may limit their effectiveness for some families. A light-touch home visiting model—offering fewer visits over a shorter duration—delivered in a virtual setting presents an alternative opportunity for families to participate in home visiting and receive needed support with lower expectations for engagement. This paper explores the benefits of a light-touch home visiting program offered virtually to families with newborns through 9 months of age. Using administrative data from the Welcome Baby program, the study found increased enrollment and completion rates after the program’s transition to virtual implementation. The study also surveyed 910 families with new babies in Los Angeles County when their babies were 10 months and 18 months old. Those who had received Welcome Baby virtual visits demonstrated greater parenting confidence and parent-child interactions and had babies with stronger social and emotional development than families who did not receive Welcome Baby virtual visits. Differences were not observed for other measures of parenting behaviors. Families in Welcome Baby also were more likely to have consistent access to medical care, though this did not translate into greater use of well-care services. Findings suggest that virtual visits may make home visiting more accessible and offer important benefits for families.

Infant and Early Childhood Mental Health Consultation (IECMHC) is a capacity-building, prevention-focused service that supports early childhood professionals and families in promoting young children's social-emotional development. This conceptual analysis addressed the research question: How can IECMHC programs systematically and efficiently measure fidelity using existing documentation systems? The study examined data from a large, government-sponsored IECMHC program in a mid-Atlantic U.S. metropolitan region, involving 17 consultants (50% Black or African American, 36% other racial minority) serving 102 early childhood education centers with mostly racial minority staff and families. Through an iterative process with program leadership, 15 fidelity metrics were developed and operationalized at the programmatic, classroom, and child-specific levels using consultants' electronic documentation. The resulting fidelity database enables programs to assess consultant adherence to core consultation activities, identify areas for quality improvement, and facilitate reflective supervision. This approach offers a practical, replicable strategy for other IECMHC programs to adopt or adapt to enhance implementation fidelity and, ultimately, the equity, quality and effectiveness of mental health consultation services for infants, young children, and their caregivers.

The medical-legal partnership (MLP) model is a multidisciplinary intervention with demonstrated success in addressing health-harming legal needs. We analyzed initial data from the Georgetown University Health Justice Alliance's Cancer Legal Assistance and Well-being Project (Cancer LAW), an MLP between Georgetown University and MedStar Health serving cancer patients receiving care at an urban, safety-net hospital in Washington, D.C. The sample included 81 patients, who had an average of two legal issues, most commonly in the areas of Social Security, estate planning, housing, and health insurance. Data collected during legal representation captured both financial and non-financial benefits to patients. Patients who responded to a post-legal services survey reported reduced stress, and nearly 75% of survey respondents reported that legal services helped them maintain their treatment regimen. Further research, including on the impact of legal services on health outcomes, may be helpful in efforts to incorporate legal services as an accepted best practice in cancer care.

HealthySteps is an evidence-based, prevention program for families of children ages 0 to 3 integrated into pediatric primary care. Our objective was to synthesize feedback on local implementation of an enhanced HealthySteps+ program from various stakeholder viewpoints to improve implementation. Qualitative data were gathered from HealthySteps+ team members (n = 14), current clinic staff (n = 15), and a focus group of parents serving on the program's advisory committee (n = 7). Responses indicate that the core features of the HealthySteps+ program are consultations about typical and atypical child development, facilitated connections to resources, and parent mental health support. Key challenges to implementing the program include retention of skilled staff to sustain trusting relationships with parents and other providers. Based on these findings, the HealthySteps+ implementation team has increased communication with clinic staff at daily huddles, developed orientation materials for new pediatricians, and offered families additional peer support opportunities.

A growing body of research suggests that infant and early childhood mental health consultation (IECMHC) is effective in improving child outcomes and classroom quality in early care and education (ECE) settings. However, there is limited research regarding the provision of IECMHC virtually (e.g., by phone or video conferencing platform), and the transition to virtual services in the context of the COVID-19 pandemic provided an opportunity to learn more. This study focuses on mental health consultants' (MHCs) perceptions of the feasibility and effectiveness of providing IECMHC virtually. Using a purposive sampling method, we gathered survey data from 94 MHCs providing IECMHC in 15 states in the United States. More than two-thirds of MHCs reported consultation was as effective or more effective virtually (compared to in-person) when it involved adult or programmatic consultation, while one-third of MHCs viewed child-focused consultation as being as or more effective virtually. There was wide variation in the extent to which MHCs viewed specific consultation activities as feasible and effective when delivered virtually. Furthermore, one-third of consultants reported that the ECE programs they served experienced major barriers related to equipment and technology. We explore how these findings can inform future planning for the provision of virtual services.

ABSTRACT Introduction Maternal harm disproportionately affects Black birthing individuals, with systemic and provider‐related factors contributing significantly to preventable severe maternal morbidity (SMM) and maternal mortality. Despite the severity of the crisis, traditional maternal safety approaches, which typically exclude patient voices, narrowly focus on severe harm events rather than conducting full‐spectrum safety surveillance, which limits proactive intervention strategies. Methods This study applied the National Academies of Medicine's Learning Health System (LHS) principles to develop a comprehensive maternal safety framework. We employed a mixed‐methods approach integrating patient‐reported experiences of cases (patients experiencing severe maternal morbidity and/or postpartum readmission) and controls, provider perspectives, clinical informatics, natural language processing of clinical notes, and chart reviews to identify factors contributing to and mitigating maternal harm. We convened an interdisciplinary expert panel to synthesize findings into actionable recommendations for a Perinatal Safety Framework and a Perinatal Strategy Guide. Results The Perinatal Maternal Safety Framework was developed to define the maternal safety continuum. Six key features emerged, including: (1) three distinct starting points (pregnancy, birth, postpartum), (2) variability in baseline circumstances, (3) a broad definition of maternal harm encompassing physical, emotional, and psychological factors, (4) adaptation of established safety models, (5) six categories of contributing and mitigating factors, and (6) status factors influencing maternal safety outcomes. The Perinatal Strategy Guide outlines evidence‐based strategies addressing structural and systemic factors affecting maternal safety. Conclusions A comprehensive maternal safety framework integrating full‐spectrum safety surveillance and patient‐centered reporting is critical to addressing maternal health disparities. By applying LHS principles, this study provides a data‐driven, equity‐focused approach to improving maternal safety. Implementation of the Perinatal Strategy Guide will require interdisciplinary collaboration and engagement of individuals with lived experience to drive systemic change.

BACKGROUND Violent injury among trauma surgery patients is strongly associated with exposure to harmful social determinants of health and negative long-term health outcomes. Medical-legal partnerships in other settings successfully provide patients with legal services to address similar health-harming legal needs and may offer a promising model for the care of violently injured patients. STUDY DESIGN An electronic survey tool was distributed to clinicians and staff affiliated with the hospital-based violence intervention program at a single urban level one trauma center. Semistructured follow-up interviews were conducted with participants, and interviews were coded using thematic analysis and grounded theory. RESULTS Participants reported many health-harming legal needs among their violently injured patients. The most commonly identified needs were: health insurance denials (62.5%); difficulty accessing crime victims compensation funds (56.3%); trouble accessing official documents (50%); and problems with non-SSDI public benefits (50%). Participants reported inconsistent methods for learning about and responding to patients' health-harming legal needs. The most common barriers to addressing these needs included the following: lack of awareness that a lawyer could help with the issue (68.8%); prioritization of other needs (68.8%); previous negative legal experiences (62.5%); and cost (62.5%). Identified needs encompass issues traditionally addressed by MLPs as well as more novel challenges faced by violent injury survivors. CONCLUSION This survey and interview-based study identifies complex health-harming legal needs present among violently injured trauma surgery patients. Medical-legal partnerships specially designed for the setting of violent injury appear well-suited to meet these needs, potentially reducing risk of violent reinjury, long-term negative health outcomes, and health care system costs. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.

Medical-legal partnerships (MLPs) try to mitigate health inequity by uniting legal and health professionals to respond to legal determinants of patients' health. While there is a long tradition of "patients-to-policy" work in MLPs, the current empirical evidence base has evaluated MLP effectiveness by assessing benefits to individual patients, clinicians, and hospital and legal systems. This article calls for future research to measure how community power, which includes shifting power to impacted communities to develop and lead equity-focused agendas, is built as both a process and an outcome of MLPs.

Summary: The Georgetown University's Cancer Legal Assistance and Well-being Project launched in 2020 as a medical-legal partnership that works with health care providers at a Washington, D.C. safety-net hospital to treat the health-harming legal needs of historically and intentionally marginalized patients with cancer.

Exclusionary discipline practices differentially harm young children of color. As early childhood education systems seek to close these gaps to ensure all young children have access to high quality early learning experiences, the field requires more evidence-based approaches that can be scaled and replicated. Infant and early childhood mental health consultation (IECMHC) has been associated with lower rates of preschool expulsion; but the field lacks clear guidance on the essential elements of high quality IECMHC. Without such guidance, researchers cannot build a credible evidence base for the causal link between IECMHC and exclusionary discipline. An interdisciplinary research team, with support from the national Center for Excellence in IECMHC, led a consensus-building process to identify the essential activities of IECMHC as implemented across settings. The three-stage Delphi Process resulted in a list of five essential elements and 26 activities that define IECMHC and make concrete its emphasis on relationships and equity. This greater clarity around the activities of IECMHC can help inform future research and evaluation, as well as workforce and professional development.

Unmet legal needs contribute to housing, income, and food insecurity, along with other conditions that harm health and drive health inequity. Addressing health injustice requires new tools for the next generations of lawyers, doctors, and other healthcare professionals. An interprofessional group of co-authors argue that law and medical schools and other university partners should develop and cultivate Academic Medical-Legal Partnerships (A-MLPs), which are uniquely positioned to leverage service, education, and research resources, to advance health justice.

Purpose: There is a Black maternal health crisis in America, with significant racial disparities in birth outcomes for Black women in Washington, DC. Programs designed to reduce these inequities must intentionally address the role of systemic racism and the ongoing legacy of oppression that is endemic to traditional perinatal care services. This article describes the findings from the quantitative analysis of an innovative perinatal program (Mothers Rising) designed by and for Black women in the Washington, DC, metropolitan area that was part of a larger mixed methods study.Methods: Using data provided by a Medicaid managed care organization that insured program participants and women who did not receive Mothers Rising, program participants (n = 102) were matched with a group of Black women who did not receive the program (n = 102) using propensity scores matching. Perinatal outcomes were extracted from electronic health records from the managed care dataset, including birth weight and gestational age.Results: Statistical analyses of the differences in birth outcomes between program participants and their matched peers demonstrated small but statistically significant differences in gestational age, favoring the Mothers Rising group.Conclusions: This study adds to the evidence base for the effectiveness of culturally tailored interventions to successfully address persistent racial disparities in Black women's perinatal health outcomes that result from persistent racism. Hyperlocal, community-developed home-visiting programs, such as Mothers Rising, should be funded to sustain impact and optimize maternal health outcomes.

Evidence-based home visiting services (EBHV) are available in states and localities nationwide through the federally-funded Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. Nevertheless, the anticipated benefits of EBHV, such as improved child developmental outcomes and increased positive parenting practices, may be undermined by the fact that most families withdraw from services earlier than the model developers planned. Prior studies have linked family attrition with staff turnover. The current study used a mixed methods design to investigate the conditions under which families remained active in the home visiting program after their assigned home visitor resigned. Coincidence Analysis revealed that giving families advance notice (at least 1 month) prior to the home visitors’ upcoming resignation or developing a strong positive working alliance with the inheriting home visitor appears to independently make a difference for ongoing family engagement at 3 and 6 months following a staff transition. These findings suggest that emphasizing how staff turnover is managed may mitigate the risk of family withdrawal during these transitions.

This Report from the Field chronicles the establishment of Georgetown University's Perinatal Legal Assistance and Wellbeing Project, a medical-legal partnership in Washington, D.C. It describes foundational steps, implementation strategies, and lessons learned, and reflects on impacts of addressing the unmet legal needs of birthing individuals.

INTRODUCTION: Health-harming legal needs (HHLNs), social determinants of health that have a legal remedy, are drivers of poor health outcomes for Black women and children. HHLNs include inadequate access to safe housing, employment accommodations, and income supports. A medical–legal partnership (MLP) adds an attorney to the health care team to address patients’ HHLNs in a variety of health care settings. The Perinatal LAW Project (P-LAW), an MLP between the Georgetown University Health Justice Alliance and MedStar Washington Hospital Center Women’s & Infants’ Services, addresses perinatal patients’ HHLNs in an obstetrics and gynecology practice. METHODS: Perinatal LAW Project attorneys record client and case data in a legal case management system. The research team analyzed data for the first 18 months of the program (March 2021 to September 2022). RESULTS: One hundred thirty-one patients were referred for legal assistance, primarily by social workers and health navigators. Most patients were in their second and third trimesters. The majority of patients were Black or African American, aged 20–34, and lived under 200% FPL. The most common legal issues were in the areas of employment (parental leave, discrimination), housing (conditions, eviction), public benefits (food stamps, disability benefits), and family law (child support, domestic violence). The P-LAW addressed 150 legal issues and served 117 patients. CONCLUSION: Medical–legal partnership is a novel approach to addressing maternal health disparities. In our experience, legal services have a high utilization rate and patients often have more than one legal need. Future efforts to measure patient outcomes, including reduced maternal stress and medical appointment attendance, will build the evidence base for MLP in the perinatal context.

Abstract: Medical-legal partnerships (MLPs) integrate lawyers into medical teams to address patients' unmet legal needs that create barriers to good health and well-being (i.e., health-harming legal needs). This systematic review of the peer-reviewed literature focused on measuring 1) cancer patients' legal needs and 2) outcomes for cancer patients after receiving MLP services. Literature was searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for the period 2006–2022. Four articles met the inclusion criteria for objective one: three articles met the criteria for objective two. While limited, the literature provides data that when screened, cancer patients regularly struggle with health-harming legal needs. Preliminary evidence suggests that while MLPs can help resolve legal needs, measuring outcomes of MLP intervention is complex. Further peer-reviewed research is needed to better understand the unmet legal needs of cancer patients and the impact of MLPs on their health.

Perinatal depression is a serious public health issue among African American adolescents who experience significant racial health disparities in addition to age-related mental and physical health risks. Perinatal depression prevention interventions that specifically target the needs of African American adolescents are warranted. The current study presents the development and preliminary results of an intervention designed to prevent perinatal depression among African American adolescents using the heuristic framework for cultural adaptations. Adaptations were applied to an existing evidence-based cognitive behavioral group intervention to develop the Mothers and Babies Course for African American Adolescents. Adaptations were guided by qualitative data collected from a focus group and individual interviews, and by existing research on specific risk and protective factors that drive engagement with and barriers to interventions for this population. The adapted intervention was piloted with 7 pregnant and 21 postpartum African American adolescent students at four different public high schools in an urban city in the United States. The Edinburgh Postnatal Depression Scale was used to assess pre- and post-intervention perinatal depression scores. Accessibility and feasibility were assessed using participant and observer evaluations, respectively. Results indicated reductions in pre- to post-intervention depression scores and high acceptability and feasibility of the pilot study. Additional adaptations of the intervention based on qualitative feedback from study participants are discussed. Future development and implementation of the intervention provides an opportunity to reduce a mental health disparity that disproportionately affects African American adolescents.

Infant and Early Childhood Mental Health Consultation (IECMHC) is an evidence-based service in which consultants build capacity for early childhood professionals and programs to promote the social-emotional development of infants and young children. This paper describes the current state of the evidence for IECMHC, mapping the evidence to a new theory of change from the Center of Excellence (CoE) for IECMHC. There is a substantial literature base regarding the effects of consultation on outcomes for infants and young children; yet the evidence for consultation’s specific mechanisms of change, moderators of impact, and reductions in disparities have been understudied. The authors identify gaps in the scholarly literature, articulate next steps for research, and conclude with a call to action for IECMHC researchers to expand rigorous studies to the range of settings in which IECMHC is implemented and to center social justice in the research questions, methods, and dissemination.

The mechanisms by which high quality, two-generation early childhood services promote healthy child development remain unclear. This research examined how participation in Early Head Start (EHS), a U.S. two-generation programme for children under 3, was associated with healthy child development to age 5 through parenting processes. Using four time points of data from the Early Head Start Research and Evaluation Project, we tested a theory-driven model of direct and indirect pathways from EHS to children's language, social-emotional, and behavioural skills from age 1 to age 5 via parenting stress and practices. Results from longitudinal structural equation models for 2,555 mother-child dyads indicated that EHS participation was associated with increased responsive parenting during the very early years, improvements in children's language during the toddler years and, in turn, sustained language improvements through age 5. Long-term impacts of two-generation programmes may promote positive child outcomes in part by facilitating responsive parenting.

The Problem: Marginalized populations experience health-harming legal needs-barriers to good health that require legal advocacy to overcome. Medical-legal partnerships (MLPs) embed lawyers into the healthcare team to resolve these issues, but identifying patients with health-harming legal needs is complex, and screening practices vary across MLPs. Purpose of Article: Academic and community partners who collaborate in an MLP at a school-based health center (SBHC) share their process of co-creating a two-stage legal check-up for adolescents. Key Points: Screening adolescents for health-harming legal needs is challenging. It took ongoing collaboration to refine the process to fit the needs of adolescents and meet the partners' goals. Conclusion: Social determinants of health play a significant role in health disparities, and there is a need for innovative solutions to screen and address these in vulnerable populations. Other partners can learn from our experiences to cocreate their own approach to addressing health-harming legal needs.