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. Several jurisdictions across the United States implemented statewide and local right-to-counsel (RTC) programs in recent years to mitigate housing insecurity, a key challenge among people who use drugs (PWUD). While preliminary evidence suggests RTC policies improve housing and health outcomes, less is known about their implementation across multiple jurisdictions and implications for PWUD.

Purpose. We aimed to elicit perspectives on the initial impacts of RTC policies, implementation challenges, and barriers to access for PWUD from service providers and policy officials in housing and behavioral health sectors (affiliates).

Data. From October to May 2024, we conducted in-depth, semi-structured interviews with 39 affiliates located in three U.S. Mid-Atlantic states with RTC programs. Participants were recruited from three Mid-Atlantic states with RTC programs and interviews were conducted via Zoom or Google Voice. 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. Broadly, RTC was seen as addressing the power asymmetry in landlord-tenant relationships and helping tenants avoid wrongful eviction. Affiliates highlighted benefits of RTC for PWUD who may be uniquely disadvantaged in the legal system due to stigma and marginalization. However, interviews also revealed numerous barriers to accessing RTC for PWUD, including fear of legal involvement, limited access to technology, financial constraints, and lack of documents (e.g., signed retainer agreement). Affiliates emphasized the need for a holistic program to meet tenant needs beyond the legal system. Finally, affiliates discussed implementation challenges in all three jurisdictions. Funding and workforce constraints remained the most salient issues, leading to geographic disparities in access and engagement.

Conclusion. Emerging evidence suggests that RTC improves housing outcomes, but funding challenges, workforce shortages, and barriers to access for marginalized populations may limit the reach of RTC programs. 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