| Course | D396 Evidence-Based Practice for Health and Human Services |
|---|---|
| Task | Task 1 |
| Paper type | Annotated bibliography and evidence essay |
| Length | About 1,000 words, 4 pages |
| Format | APA 7 |
| School | Western Governors University (WGU) |
| Program | BS Health and Human Services |
| Updated | September 2026 |
Free sample paper for D396 Task 1
Can a Lawyer Help a Child Breathe? An Annotated Bibliography and Evidence-Based Practice Essay on Medical-Legal Partnerships for Families With Asthma in Substandard Rental Housing
Student Name
Leavitt School of Health, Western Governors University
D396: Evidence-Based Practice for Health and Human Services, Task 1
Course Instructor
Month Day, Year
Can a Lawyer Help a Child Breathe? An Annotated Bibliography and Evidence-Based Practice Essay on Medical-Legal Partnerships for Families With Asthma in Substandard Rental Housing
The Practice Question
Community health workers at a composite pediatric clinic in a mid-sized city see the same pattern every winter: children with asthma whose symptoms worsen in apartments with mold, leaks and cockroaches, whose parents have asked landlords for repairs without success, and who return to the emergency department (ED) again and again. The clinic's staff can teach inhaler technique and trigger avoidance, but they cannot fix a leaking roof. Some cities attach lawyers to health clinics through medical-legal partnerships, which address legal problems that affect health, such as a landlord's failure to repair unsafe housing. The question for this review, framed in PICO form, is: for low-income families of children with asthma living in substandard rental housing (population), does referral to a medical-legal partnership (intervention), compared with usual clinical care alone (comparison), improve housing conditions and reduce urgent asthma care (outcomes)?
Annotated Bibliography
Full references appear in the reference list; each entry below is headed by author and year.
Beck et al. (2012): a medical-legal partnership case series in pediatric primary care
Summary. A pediatric primary care clinic in Cincinnati and its legal partner traced a single referral for poor housing to 15 more cases in buildings owned by the same landlord. Pest infestation was the most common problem. Repairs were completed in 10 of 14 units with outcome data, and 11 of the owner's 19 building complexes received major systemic repairs. Of the 45 children living in the affected units, 36% had asthma, a higher rate than the clinic population. Appraisal. This is a descriptive case series without a comparison group, so it shows what a partnership can achieve rather than proving that it works better than usual care. Its strength for this question is that it measures housing outcomes directly and shows how one referral can improve conditions for many families. Level of evidence: low.
Krieger et al. (2005): randomized comparison of two intensities of home visiting by community health workers
Summary. Low-income families of children with asthma were randomly assigned to high-intensity or low-intensity home visits by community health workers, who assessed homes, provided education and supplies and helped families reduce triggers. The high-intensity group improved more in caregiver quality of life and in urgent health service use, and projected four-year savings per participant ranged from $189 to $721. Appraisal. A randomized trial is strong evidence, but the intervention was home visiting, not legal help. It is relevant because it shows that reducing home triggers reduces urgent care, and because landlord repairs are one thing community health workers cannot provide on their own. Level of evidence: high for home visiting; indirect for this question.
O'Sullivan et al. (2012): a proof-of-concept study of legal help for adults with asthma
Summary. Adults with poorly controlled asthma and home allergen exposures received legal assistance to fix leaks, remove pests or move to another apartment. Among 12 patients with data, ED visits and admissions fell from 22 and 11 before the intervention to 2 and 1 after, peak flow improved and most needed fewer medications. Appraisal. The sample is very small, adult rather than pediatric, and there is no comparison group, so improvement could reflect other changes over time. The direction of effect is consistent with the question, and the outcomes are exactly the ones this clinic cares about. Level of evidence: low.
Sandel et al. (2010): a policy analysis of the partnership model
Summary. This policy paper describes medical-legal partnerships, which at the time operated in more than 200 clinical sites, and explains how they integrate lawyers into health care to address legal problems that create and perpetuate poor health, including substandard housing. It describes system changes such as adding legal form letters to electronic records. Appraisal. This is expert opinion rather than research, but it explains how the model works and how a clinic could implement it. Level of evidence: expert opinion.
Acquiring the Evidence
Sources were found by searching PubMed and CINAHL with combinations of "medical-legal partnership," "housing," "asthma" and "community health worker," limited to English-language studies in the United States. Reference lists of relevant articles were checked for further sources. Research that directly compared families referred to a partnership with families receiving usual care was scarce, which is itself an important finding.
Appraising the Body of Evidence
Taken together, the evidence is consistent but not strong. The two studies of legal intervention (Beck et al., 2012; O'Sullivan et al., 2012) both report large improvements, one in housing conditions and one in urgent asthma care, but neither has a comparison group and one is very small. The strongest study (Krieger et al., 2005) is a randomized trial showing that reducing home triggers reduces urgent care, which supports the mechanism by which legal help would work. The policy paper (Sandel et al., 2010) explains implementation but provides no outcome data. The evidence is therefore enough to justify trying the approach with careful measurement, but not enough to claim it is proven.
Applying the Evidence
A reasonable decision for the clinic is to pilot a partnership with the local legal aid society for one year, combined with existing community health worker home visits. Community health workers would use a short housing checklist during visits; families with unresolved repair problems would be referred, with consent, to a legal aid attorney who holds office hours at the clinic twice a month. The combination addresses both sides of the problem: the worker reduces triggers the family can control, and the attorney addresses those only the landlord can fix.
Families' values matter here. Some parents fear retaliation or eviction if they complain, and some are undocumented and wary of legal systems. The referral must be voluntary, explained clearly and paired with information about tenants' legal protections.
Assessing the Outcome
The pilot should measure what the evidence could not settle: the percentage of referred families whose repairs are completed within 90 days, asthma-related ED visits and admissions during the twelve months on either side of referral, and family-reported asthma control, compared with families who were eligible but declined referral. These results will tell the clinic whether to continue, expand or stop.
References
Beck, A. F., Klein, M. D., Schaffzin, J. K., Tallent, V., Gillam, M., & Kahn, R. S. (2012). Identifying and treating a substandard housing cluster using a medical-legal partnership. Pediatrics, 130(5), 831-838. https://doi.org/10.1542/peds.2012-0769
Krieger, J. W., Takaro, T. K., Song, L., & Weaver, M. (2005). The Seattle-King County Healthy Homes Project: A randomized, controlled trial of a community health worker intervention to decrease exposure to indoor asthma triggers. American Journal of Public Health, 95(4), 652-659. https://doi.org/10.2105/AJPH.2004.042994
O'Sullivan, M. M., Brandfield, J., Hoskote, S. S., Segal, S. N., Chug, L., Modrykamien, A., & Eden, E. (2012). Environmental improvements brought by the legal interventions in the homes of poorly controlled inner-city adult asthmatic patients: A proof-of-concept study. Journal of Asthma, 49(9), 911-917. https://doi.org/10.3109/02770903.2012.724131
Sandel, M., Hansen, M., Kahn, R., Lawton, E., Paul, E., Parker, V., Morton, S., & Zuckerman, B. (2010). Medical-legal partnerships: Transforming primary care by addressing the legal needs of vulnerable populations. Health Affairs, 29(9), 1697-1705. https://doi.org/10.1377/hlthaff.2010.0038
What the D396 Task 1 instructions ask
The first D396 task asks you to apply the steps of evidence-based practice to a question from human services work. Most versions ask for a practice question, an annotated bibliography of relevant sources, a description of how evidence was acquired, an appraisal of the body of evidence, how the evidence would be applied and how outcomes would be assessed. Sources may include research studies and other credible evidence, depending on your instructions. Evaluators look for a clear question, annotations that summarize and evaluate each source, a search described well enough to repeat, and an appraisal that weighs strength and consistency before recommending action. Many versions also ask how the evidence was located.
How this D396 Task 1 example is built
The essay opens with the practice question as community health workers experience it, which grounds the search. The annotated bibliography gives each source a short summary, a note on design and a sentence on relevance. The acquisition section names databases, search terms and inclusion criteria, so the search could be repeated. The appraisal section weighs the sources together, noting consistent direction but small samples and limited designs. The application section recommends a pilot rather than full adoption, matched to the strength of the evidence. The outcome section lists what the pilot must measure, such as repairs completed and emergency visits, to fill gaps the evidence left. Each annotation ends with a line on relevance.
Where the D396 Task 1 rubric puts the marks
D396 Task 1 aspects are marked competent, approaching competence or not evident. A question aspect checks for a clear, answerable practice question. An annotation aspect rewards summaries with evaluation of each source. An acquisition aspect looks for a search strategy described clearly. An appraisal aspect wants the body of evidence weighed for strength and consistency. Application and assessment aspects ask how evidence becomes action and how outcomes will be measured. Evaluators notice when the recommendation matches the strength of the evidence and expect references in correct APA format. Evaluators also look for the appraisal to name the weakest part of the evidence, since recognizing limits is part of evidence-based practice. A recommendation sized to that strength, such as a pilot, earns credit.
D396 Task 1 help: what sends it back
Evidence essays come back most often when annotations only summarize. Add a sentence on each source's design, strength and relevance. Second, the search is described vaguely, such as I searched online. Name databases, terms and criteria. Third, appraisal lists sources one at a time. Weigh them together and state how strong the combined evidence is. Fourth, the recommendation overreaches. If evidence is modest, recommend a pilot with measures. Finally, keep the practice question in view. Each section should return to whether the evidence answers it, since drift is common in longer papers. Keep a search log as you go so the acquisition section is easy to write.
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D396 Task 1 questions, answered
What format should D396 annotations use?
Each annotation should give the reference, a short summary of purpose and findings, and an evaluation of design and relevance. The sample adds a line on how each source informs the decision.
Must D396 sources be research studies?
Not always; check your instructions. Research studies carry the most weight, but credible reports and guidelines can add context. The sample relies mainly on peer-reviewed studies. Note the type of each source in its annotation.
What are the evidence-based practice steps in D396?
Ask a question, acquire evidence, appraise it, apply it and assess the outcome. The sample follows each step as a section of the essay. Many courses use the five-step ask, acquire, appraise, apply and assess sequence.
Is the D396 pediatric clinic real?
No. The clinic and the families it serves were made up to frame the question. The studies on medical-legal partnerships and home asthma interventions are published and cited. Its families' stories are illustrative only.
Where can I find a free D396 Task 1 sample paper?
The complete bibliography and essay are on this page with commentary. Share your D396 task and practice question, and your first tailored paper is written at no cost.