National Center for Medical-Legal Partnership (NCMLP), GWU Milken Institute School of Public Health, George Washington University (GWU)
February 1, 2013
This covers 49 published articles written between 1977 – 2012 available on the MEDLINE, Scopus, and Google Scholar databases. Researchers also scanned the Center's “Academic Articles” page.
Department of Health Policy, School of Public Health and Health Services (note: the school was renamed the Milken Institute School of Public Health in 2014)
This report reviews the current literature discussing medical-legal partnerships (MLPs), which are integrative and collaborative models that bring legal services into the health care setting to address health inequities among vulnerable populations. By creating partnerships between health care and legal teams, MLPs are positioned to address social and legal needs in a familiar clinical setting. The report defines a legal need as a “health-related social problem that is better addressed through legal assistance than traditional medical care,” such as seeking protection from domestic violence, receiving disability benefits, or gaining access to food subsidies.
The research team reviewed articles written between 1977 – 2012 that were available on the MEDLINE, Scopus, and Google Scholar databases. They also scanned the National Center for Medical-Legal Partnership’s “Academic Articles” page. The team reviewed 49 published results.
The report found that while each MLP varied in structure, MLPs all focused on three components: providing legal assistance to clients, transforming health and legal institutions, and achieving policy change. The report also identified key activities MLPs should undertake, including providing legal assistance in the health care setting, educating health professionals about the relationship between social determinants and health, and working toward policy change by addressing laws preventing good public health.
Though there was much literature available on MLPs, the report found that there had been no systematic assessment of MLPs’ impact. Literature studying empirical outcomes focused on three categories:
- A MLP targeting the needs of cancer patients generated $1 million by resolving previously denied claims. (Rodabaugh 2010)
- An Illinois MLP demonstrated a 319 percent return on an initial investment of $116,250 between 2007-2009 while helping relieve $4 million in patients’ health care debt and claiming $2 million in additional awarded Social Security benefits. (Teufel 2012)
Impact on Health and Well-being
- A home visit/nurse-based intervention program for pre-natal and postpartum patients resulted in better prenatal behaviors, better pregnancy outcomes, lower rate of child abuse and neglect, and higher rates of maternal employment. (Williams 2008)
- A study of inner-city asthmatic adults saw a 91 percent reduction in emergency department visits and hospital admissions after a medical-legal intervention. 91 percent of patients also dropped 2 or more classes in asthmatic severity. (O’Sullivan 2012)
- A study of cancer patients supported by a MLP saw a stress reduction for 75 percent of patients, 30 percent increase in treatment adherence, and greater ease of keeping appointments for 25 percent of the patients. (Fleishman 2006)
Impact on Knowledge and Training of Health Providers
- Residents in clinics with social/legal resources were more confident in their knowledge regarding health benefits, were more likely to ask patients about their social history and situation regarding housing and public benefits, and were found to screen for social determinants of health more frequently. (O’Toole 2012)
The research found that there were four areas where more research should be done:
- Assessing Patient Need – The report found that a standardized tool assessing legal needs was needed to collect patient need data, inform legal and health providers, and provide for MLP growth and expansion. The report also found no common benchmark for what constituted a legal need across all MLPs, and claimed that defining legal need would help MLPs improve their service, helping them identify unmet legal needs and helping them organize their services to reach more patients.
- Evaluation MLP Service Quality – The report found no existing metrics of quality for MLPs that could guide clinicians and lawyers in their work and provide a standard to evaluate improvements.
- Advancing System-Level and Policy-Level Change through MLPs – The report recommended that MLPs must embrace a systemic approach to changing policy factors impacting vulnerable patients, but found no studies focusing on impact at the policy or regulatory level.
- Scaling the MLP Model to Improve Population Health – The report stated that empirical evidence must be developed to support MLP expansion and factors that contribute to their success, and specifically that large scale studies should be conducted to appraise the impact MLPs have on the population as a whole.
PUBLICATION DETAILSFormat: Research
Publication Type: Literature Review
Geographic coverage, US: NATIONAL
Topics: Legal Needs | Benefits of Legal Aid: Economic & Social Return on Investment | Benefits of Legal Aid: Other | Research Agenda | Medical-Legal Partnerships
Case type: Health
Practice Area: Health
How Provided: Delivery Systems e.g., MLPs
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Literature matrix PDF
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