Collaborative Innovation to Address Social Determinants of Health: The Medical-Legal Partnership Model

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Presented at the 2013 City MatCH Conference in Savannah, Georgia.

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Collaborative Innovation to Address Social Determinants of Health: The Medical-Legal Partnership Model

  1. 1. Collaborative Innovation to Address Social Determinants of Health: The Medical-Legal Partnership Model Shannon Mace Heller, JD, MPH Public Health Specialist, Health, Education & Legal assistance Project: A Medical-Legal Partnership City MatCH Conference Savannah, Georgia 24 September 2013
  2. 2. What is Medical-Legal Partnership? MLP is a healthcare delivery model that integrates legal assistance as a vital component of patient care. MLP’s 3 key activities transform the delivery of health and legal services and improve health and well- being for America’s most vulnerable
  3. 3. Where we work, live, and play… …determines our health status.
  4. 4. MLP Connection to Health ¤  Improved physical environment ¤  Increased access to health care ¤  Increased access to basic necessities ¤  Decreased stress ¤  Increased access to educational services
  5. 5. Unmet Legal Need Source: Legal Services Corporation, Documenting the Justice Gap in America: The Current Unmet Civil Legal Needs of Low-Income Americans (September 2009).
  6. 6. Health, Education and Legal Assistance Project: A Medical-Legal Partnership (HELP: MLP) ¤ Partners: ¤ Crozer-Keystone Healthy Start ¤ Crozer-Keystone Nurse Family Partnership ¤ Widener University School of Law ¤ One of three national Healthy Start project demonstration grantees (HRSA’s MCH Bureau)
  7. 7. Referral Process }  Education: Trainings provided about potential legal issues of participants }  Screening: An integrated legal needs screening tool identifies unmet legal needs of participants }  Referral: When a legal need is identified the participant is referred to HELP: MLP attorneys }  Action: Attorney contacts the participant within 24 hours to begin addressing the problem }  Follow-Up: Evaluation staff contact participant for follow up interview after obtaining informed consent Education Screening ReferralAction Follow-Up
  8. 8. I-HELP Legal Screening Tool ¤ Developed by the National Center for Medical-Legal Partnership ¤ Integrated into Healthy Start Participant Profile electronic case record ¤ Identifies common legal issues that impact health and well-being I Income Supports H Housing & Utilities E Education L Legal (immigration) Status P Personal & Family Stability
  9. 9. Evaluation Methods ¤ Program Participants: ¤ Collected data through telephone interviews 3-4 weeks after cases closed and review of case notes ¤ Measured: satisfaction, stress, health, and self- efficacy ¤ At time data was collected 21 participants had closed cases; 13 completed follow up interviews ¤ Healthy Start Staff: ¤ Conducted pre and post tests during trainings and follow up interviews at end of grant period ¤ Measured: satisfaction, knowledge and beliefs
  10. 10. Healthy Start Project Results (June 2012-May 2013) ¤  29 Healthy Start Program participants received services benefiting over 100 individuals ¤  70 Legal cases were addressed ¤  59 Case consultations occurred with CKHS case managers & staff ¤  12 Students from multiple disciplines educated ¤  9 Trainings were conducted for CKHS staff & community partners More than 100 Individuals Helped 70 Legal issues addressed 59 Case Consults 9 Trainings conducted with CKHS 12 Students educated at WUSL
  11. 11. Legal Issues Resolved (May 2012- June 2013) 50% 14% 10% 6% 4% 6% 10% Public Benefits Disability benefits Housing Utilities Custody Consumer issues OtherN=70
  12. 12. 50% 33% 17% Change in Overall Health Following Services Improved Same Worsened n=12
  13. 13. Impact on Stress (May 2012-June 2013) 8.7 3.6 0 1 2 3 4 5 6 7 8 9 10 Prior to Services After services Client Average Overall Level of Stress Client Average Overall Level of Stress N=13
  14. 14. 8.3 1.375 0 1 2 3 4 5 6 7 8 9 Prior to services After services Average Level of Stress for Clients with Public Benefit Matters Average Level of Stress for Clients with Public Benefit Matters N=8
  15. 15. 50% 33% 17% Change in Overall Health Following Services Improved Same Worsened N=12
  16. 16. Prior to Services After Services Poor 5 2 Fair 5 2 Good 0 1 Very Good 3 2 Excellent 0 4 0 1 2 3 4 5 6Numberofresponses Quality of Sleep N=11
  17. 17. Always Most of the time Half of the time Rarely Never Prior to Services 3 5 4 0 0 After Services 0 1 1 8 2 0 1 2 3 4 5 6 7 8 9 #ofResponses How often do you feel you are facing a problem you cannot handle or ask for help with? n=12
  18. 18. Impact on CKHS Staff ¤ MLP integration has resulted in: ¤ Increased knowledge ¤ Increased capacity to serve clients ¤ Increased advocacy capacity ¤ Decreased stress ¤ Increased ability to identify and refer legal needs
  19. 19. Challenges ¤ Sustainability ¤ Evaluation ¤ IRB approval ¤ Lost to follow up ¤ Demonstrating ROI ¤ Longitudinal health outcomes ¤ Health system investment
  20. 20. Client Quotations ¤  I didn't know I could even get help like that. I didn't know where to turn. It made a big difference and I'm very grateful. She still keeps in contact with me. ¤  Having a lawyer really changes everything. Being able to say, "my lawyer will call you" gets results. I now know that if anything happens I can call my lawyer, Laura. ¤  “Laura was a big help, she has been beyond a blessing. I didn’t have a state ID or any other documents because of my personal problems and she was able to help me apply for benefits anyway.” ¤  The issue she worked on I was working on for more than a year. No one knows how hard it was. She just stepped in and in a month everything was done.
  21. 21. sm.helpmlp@gmail.com helpmlp.org | @HELPmlp Thank you!

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