This document discusses medical-legal partnerships (MLPs), which integrate legal assistance into patient care to address social determinants of health. It provides examples of how MLPs have helped patients experiencing issues like difficulties accessing public benefits, housing problems, and education barriers. The Health, Education and Legal Assistance Project MLP improved patients' health, reduced stress, and resolved issues like gaining disability benefits or public housing for over 100 individuals. MLPs help healthcare providers identify legal needs and improve health outcomes, but challenges include sustainability, evaluation, and gaining long-term health data.

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. 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. Where we work, live, and play…
…determines our health status.

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. 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. 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. 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. 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. 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. 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. 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. 50%
33%
17%
Change in Overall Health Following Services
Improved
Same
Worsened
n=12

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. 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. 50%
33%
17%
Change in Overall Health Following
Services
Improved
Same
Worsened
N=12

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. 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. 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. Challenges
¤ Sustainability
¤ Evaluation
¤ IRB approval
¤ Lost to follow up
¤ Demonstrating ROI
¤ Longitudinal health
outcomes
¤ Health system
investment

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. sm.helpmlp@gmail.com
helpmlp.org | @HELPmlp
Thank you!