5/21/2018 1 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 Medical-Legal Partnership Background 2 A highly flexible, practical intervention to address social determinants of 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 operate 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 1
5/21/2018 Research Design 3 • 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) Eight Core Elements of Medical-Legal Partnership 4 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 2
5/21/2018 Three Models of Medical-Legal Partnership 5 Referred for legal services in 2016 Health Care Legal Partner Number Percent Primary site of Patient Most common legal Organization Organization of of patient legal services population needs in order of patients populat- served by prevalence ion partnership General Population Model Cincinnati Legal Aid 825 3 3 primary care Children and 1. Housing Children’s Society of clinics at families 2. Public benefits Hospital Med Greater nonprofit ped- 3. Education Center (OH) Cincinnati iatric hospital Special Population Model Delaware Community 181 0.5* Maternal and Pregnant/ 1. Family law Division of Legal Aid child health postpartum 2. Immigration Public Health Society, Inc. program women 3. Housing Alternative Legal Services Model Whitman-Walker No legal 1,546 10 Ambulatory HIV-positive, 1. Public benefits Health (DC) partner care/behavior-al LGBTQ, and 2. Transgender organization health sites of health center identity legal doc FQHC patients 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. Medical-Legal Partnership as a Health Equity 6 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 organization 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 3
5/21/2018 Contact Information 7 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 4
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