Medical-Legal Partnership Background 2 A highly flexible, practical - - PDF document

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Medical-Legal Partnership

A Promising Intervention to Address Social Determinants of Health through Cross-Sector Collaboration

Alanna Williamson Milken Institute School of Public Health The George Washington University June 26, 2018

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Medical-Legal Partnership Background

A highly flexible, practical intervention to address social determinants

• f health and improve health equity
• Began in 1990s in children’s hospitals
• More than 300 health care sites with MLPs today
• General/children’s hospitals, health centers, VA clinics and more
• perate MLPs in collaboration with civil legal aid organizations

and/or law schools

• Need for clear definition of core elements of high-performing and

sustainable MLPs and the organization models that they employ

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Research Design

• Research team from the National Center for Medical-Legal Partnership, The

George Washington University Milken Institute School of Public Health

• Synthesis of findings from two 2016 national surveys of the field:
• 275 Health Care Organizations (47% response rate)
• 150 Legal Organizations (69% response rate)
• 4 site visits and 10 structured phone interviews with key staff at health care and

legal aid organizations operating medical-legal partnerships

• Interviews with lawyers, paralegals, physicians, NPs, PAs, social workers, health

care administrators, leadership, and others

• Sites selected based on survey data that indicated sufficient MLP activity for

analysis (>100 legal referrals annually)

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Eight Core Elements of Medical-Legal Partnership

1. Formal agreement 2. Defined patient population 3. Screening 4. Civil legal services staffing 5. “Lawyer in residence” 6. Training in SDOH 7. Information-sharing 8. Designated resources

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Three Models of Medical-Legal Partnership

Referred for legal services in 2016 Health Care Organization Legal Partner Organization Number

• f

patients Percent

• f patient

populat- ion Primary site of legal services Patient population served by partnership Most common legal needs in order of prevalence General Population Model Cincinnati Children’s Hospital Med Center (OH) Legal Aid Society of Greater Cincinnati 825 3 3 primary care clinics at nonprofit ped- iatric hospital Children and families

• 1. Housing
• 2. Public benefits
• 3. Education

Special Population Model Delaware Division of Public Health Community Legal Aid Society, Inc. 181 0.5* Maternal and child health program Pregnant/ postpartum women

• 1. Family law
• 2. Immigration
• 3. Housing

Alternative Legal Services Model Whitman-Walker Health (DC) No legal partner

• rganization

1,546 10 Ambulatory care/behavior-al health sites of FQHC HIV-positive, LGBTQ, and health center patients

• 1. Public benefits
• 2. Transgender

identity legal doc changes

Notes: *Legal services were not offered to the total patient population. Therefore, the share of patients served at this organization underrepresents patient need for these services. 6

Medical-Legal Partnership as a Health Equity Intervention

• Enables health care organizations to navigate systemic barriers

that patients face outside of their walls

• Highly adaptable to the patient population and clinical initiatives
• Need for alignment with other SDOH efforts in the health care
• rganization to maximize benefits
• Federal support (HRSA and VA) and some innovative financing

models emerging, but need for wise, intentional investment from health care organizations, health systems and payers

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Contact Information

Alanna Williamson Senior Research Assistant Milken Institute School of Public Health The George Washington University Email: awilliamson@email.gwu.edu Phone: (202) 994-4102 Website: http://medical-legalpartnership.org