Right-to-Counsel: Impacts, Implementation Challenges, and Implications for People Who Use Drugs

• In Event: Civil Legal Assistance as a Health Intervention: Evidence, Access, and Measurement

Abstract

Introduction. Three Mid-Atlantic jurisdictions implemented statewide and local right-to-counsel (RTC) programs during the COVID-19 pandemic to mitigate housing insecurity. Housing instability is especially consequential for people who use drugs (PWUD), a high-need population for whom eviction risk can exacerbate overdose, treatment disruption, and health vulnerability. While preliminary evidence suggests RTC policies improve housing and health outcomes, less is known about their implications for PWUD.

Purpose. We aimed to elicit perspectives on the initial impacts of RTC policies, implementation challenges, and barriers to access, among service providers and policy officials from housing and behavioral health sectors (stakeholders), and among people with lived and living experience with housing instability and substance use disorder (PWLE).

Data. We conducted in-depth, semi-structured, 60-minute interviews with 44 stakeholders, as well as two PWLE who accessed RTC. Participants were recruited from three Mid-Atlantic states and interviews were conducted via Zoom or Google Voice between October and May 2024 for service providers, and between January and July 2024 for PWLE. Interviews were recorded and audio recordings were transcribed.

Research design and methods. We utilized the constant comparison method to identify themes. A hybrid deductive and inductive approach was used; we developed a codebook that was initially informed by the World Health Organization Social Determinants of Health Framework and our study’s in-depth interview guide. Emergent codes were inductively added. Two analysts coded initial transcripts and the analytic team met to resolve coding conflicts, after which one analyst coded remaining transcripts.

Results. Findings were grouped into three broad themes: (1) Positive impacts of RTC, (2) Implementation challenges, and (3) Implications for PWUD. Broadly, RTC addressed the power asymmetry in landlord-tenant relationships. RTC also granted tenants the ability to be able to navigate the legal system and avoid wrongful eviction. Stakeholders and PWLE also recognized the benefits of RTC for PWUD who are uniquely disadvantaged in the legal system and at elevated risk of health-related harm when facing eviction. Still, stakeholders described implementation challenges in all three jurisdictions. Funding and workforce constraints remained the most salient issues, leading to geographic disparities in access. Finally, stakeholders described numerous barriers to accessing RTC, specifically for PWUD. Fear and stigma were described as discouraging PWUD from seeking legal aid; even among those who did seek help, limited access to technology, financial constraints, and lack of documents limited their sustainedengagement with legal aid. In consideration of these challenges, stakeholders and PWLE emphasized the need for a holistic program to meet tenant needs beyond the legal system.Conclusion. Emerging evidence suggests that RTC improves housing outcomes, but its specific impacts for PWUD remain poorly understood. Stakeholder interviews point to distinct barriers that limit uptake among this already hard-to-reach population. While RTC has the potential to benefit individuals facing the intertwined challenges of housing insecurity and substance use, important questions remain about how to expand these already constrained programs. There is a need to ensure that expansion efforts effectively reach and serve tenant populations who are both most in need and least likely to access services.

Author

• Hridika Shah, Johns Hopkins University
  Presenting Author