Health Impacts of Right to Counsel: Evidence from Early Implementers

• In Event: Before, During, and After: Lessons from State and Local Eviction Prevention Policies

Abstract

Evictions are associated with wide-ranging health harms. Tenant right to counsel (RTC) programs offer universal legal assistance to low-income tenants facing eviction. Several studies have shown that RTC improves case outcomes for tenants. In doing so, RTC might also support tenants’ physical and mental health. In this paper, we will review early evidence of the potential population health benefits of RTC programs through an in-depth examination of the nation’s first citywide RTC program in New York City (NYC) and the first statewide RTC program in Washington. Studies include two quasi-experimental studies from NYC and three mixed-methods studies from Washington State.

NYC studies leverage birth certificate data from NYC Vital Statistics and encounter-level emergency department (ED) claims from the Healthcare Cost and Utilization Project’s State Emergency Department Database. Data include all live births and ED encounters for Medicaid-insured New Yorkers from January 2016 through February 2020 (n=260,493 live births; 8,800 ZIP-months). Difference-in-difference analyses leverage staggered rollout of RTC by ZIP code to estimate treatment effects, finding that RTC was associated with a significant reduction in the probability of adverse birth outcomes (preterm birth or low birthweight) but not with all-cause ED visits.

The three Washington studies use mixed methods to explore tenants’ experiences with the RTC program. A qualitative study describes the health-related challenges that tenants face during eviction proceedings, and demonstrates the mechanisms and potentially relevant case outcomes that future research could use to examine health impacts of RTC. A cross-sectional quantitative study of case outcomes shows that – when compared with unrepresented tenants – tenants who receive support from the RTC program experience more positive case outcomes, but also documents a substantial take-up gap that has received limited attention in prior RTC research. Finally, a randomized controlled trial of an informational intervention targeting evicted tenants will measure the potential of a community-based “nudge” to increase program take-up and improve outcomes that relate to physical and mental health.

Jointly, quantitative and qualitative findings from NYC and Washington demonstrate that legal assistance reduces tenant mental distress by providing navigation services and promoting short and long-term housing stability. RTC is associated with improvements in stress-sensitive health outcomes such as preterm birth, but does not appear to significantly reduce ED visits. Housing and health impacts of right to counsel are limited by program uptake, but behaviorally informed informational interventions could increase access to legal aid. These results suggest that reducing administrative burdens in eviction procedures and right to counsel programs could improve access to civil justice and further promote population health.

Authors

• Will von Geldern, University of Washington
  Presenting Author

• Kathryn M Leifheit, University of California - Los Angeles
  Non-Presenting Co-Author