Medical-Legal Partnership Intervention for Preventing Veteran Homelessness

Overseen By Christina M Lazar, MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Conservator assigned, Moving away, Others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 5

Duration: 12 months

300 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

The legal team in medical-legal partnerships works with healthcare providers to improve their clients' lives. It is unknown whether this approach is better than providing usual legal services, with no special emphasis on non-legal matters and no particular collaboration with healthcare providers. The investigators propose to randomly assign 300 Veterans with housing-related legal problems to either legal help from a medical-legal partnership or help from lawyers in the community. The investigators will follow the randomized Veterans in this study for one year to determine if there is a difference between the two groups of Veterans in their housing situations and their mental health. The investigators will also interview Veterans in both groups about their experience of the legal services they have received.

Will I have to stop taking my current medications?

The trial protocol does not specify whether participants must stop taking their current medications. It seems unlikely that you would need to stop, as the study focuses on legal services rather than medical treatment.

How is the Medical-legal partnership treatment different from other treatments for preventing veteran homelessness?

Medical-legal partnerships (MLPs) are unique because they integrate lawyers into healthcare teams to address legal issues that affect health, such as housing and benefits, which are not typically addressed by traditional medical treatments. This approach focuses on the social factors that contribute to health problems, offering a comprehensive solution that combines legal and medical support. ^{1 2 3 4 5}

What data supports the effectiveness of the treatment Medical-legal partnership for preventing veteran homelessness?

Research shows that Medical-legal partnerships (MLPs) can improve health outcomes by addressing legal issues that affect health, such as housing and income. In Colorado, MLPs led to improvements in health care experiences and reduced stress, while in North Carolina, they successfully resolved legal cases that contributed to better health and financial outcomes. ^{1 3 5 6 7}

Who Is on the Research Team?

Marc I. Rosen, MD

Principal Investigator

VA Connecticut Healthcare System West Haven Campus, West Haven, CT

Are You a Good Fit for This Trial?

This trial is for Veterans engaged in VA mental health or homeless programs, with an income at or below 200% of the federal poverty level, and facing housing-related legal issues. It's not for those under conservatorship, already getting help from Connecticut Veterans Legal Program, or unable to complete follow-up assessments.

Inclusion Criteria

Able to provide informed consent

Engaged in a VA mental health or homeless program

Has a legal problem related to housing (e.g., eviction, rent arrears, housing violation)

Exclusion Criteria

Already receiving civil legal aid from Connecticut Veterans Legal Program

I can attend all required follow-up assessments.

I have a legal guardian assigned to make decisions for me.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either the MLP intervention or referral to pro-bono lawyers for housing-related legal issues

12 months

Initial in-person and subsequent in-person interviews, phone discussions, and formal hearings

Follow-up

Participants are monitored for housing status and mental health outcomes

12 months

Interviews at 3-month and 6-month follow-ups

Qualitative Interviews

Participants are interviewed about their experiences with the legal interventions

6 months

2 interviews per participant

What Are the Treatments Tested in This Trial?

Interventions

• Medical-legal partnership
• Referral to pro-bono lawyer

Trial Overview The study compares two types of legal assistance: one through a medical-legal partnership that collaborates with healthcare providers and another through usual community lawyers. The goal is to see which better improves housing stability and mental health over a year.

How Is the Trial Designed?

Group I: Medical-legal partnership Experimental Treatment 1 Intervention

Treatment group will receive the MLP intervention through the Connecticut Veterans Legal Center in partnership with the VA Connecticut Healthcare System. The MLP intervention can be categorized into seven activity components: initial in-person and subsequent in-person interviews; discussions with clients by phone; research and review of relevant documents; consultations with clinicians or other attorneys; interactions with opposing parties; time appearing at formal hearings; and travel time.

Group II: Referral to pro-bono lawyer Active Control 1 Intervention

Control group will receive outside legal aid, i.e., control participants will be referred to pro-bono lawyers in the state.

Medical-legal partnership is already approved in United States for the following indications:

Approved in United States as Medical-legal partnerships for:

• Preventing evictions and homelessness among veterans
• Addressing housing-related legal issues
• Improving mental health outcomes

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Connecticut Veterans Legal Center

Collaborator

Trials

1

Recruited

300+

Published Research Related to This Trial

The Medical-Legal Partnership (MLP) in Colorado significantly improved health care experiences for clients, with 61.4% reporting great or moderate improvements, particularly in physical and mental health.

Clients experienced a reduction in missed appointments after engaging with the MLP, highlighting its potential to enhance health outcomes and reduce healthcare utilization, such as emergency department visits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving Health Outcomes in Vulnerable Populations: The Medical-Legal Partnership-Colorado's Experience. Sauaia, A., Santos, G., Scanlon, M., et al.[2022]

Over a 24-month period, a medical-legal partnership (MLP) in rural North Carolina successfully addressed 629 cases related to health-harming social needs, with a resolution rate of 98% for cases investigated by a lawyer.

The MLP not only provided legal support for issues like domestic violence and housing but also generated significant monetary benefits for patients, totaling over $484,000, demonstrating the effectiveness of integrating legal services into healthcare to improve patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Better Together: A Descriptive Analysis of a Medical-Legal Partnership in Western North Carolina. Cené, CW., Buys, E., Clark, JW., et al.[2023]

Medical-Legal Partnerships (MLPs) at Yale Law School effectively address the social determinants of health for diverse patient populations, including children, immigrants, and veterans, by integrating legal support with healthcare services.

The article emphasizes the need for a research agenda to evaluate the impact of lawyers in MLPs, aiming to establish quality metrics and best practices for these partnerships, which have been underexplored in previous studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Medical-Legal Partnership: Lessons from Five Diverse MLPs in New Haven, Connecticut. Benfer, EA., Gluck, AR., Kraschel, KL.[2020]

Medical-legal partnerships (MLPs) effectively integrate legal services into healthcare teams, helping vulnerable populations, particularly low-income and disabled veterans, address legal issues that impact their health.

From 2014 to 2016, MLPs at four Veterans Health Administration centers served 700 veterans, demonstrating the potential of these partnerships to enhance care by addressing social determinants of health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Partnerships Between Health Care and Legal Providers in the Veterans Health Administration. Tsai, J., Middleton, M., Retkin, R., et al.[2022]

In a pilot project involving 67 patients referred to a medical-legal partnership, the average perceived stress level decreased significantly by 8.1 points after receiving legal services.

Participants also reported an improvement in wellbeing scores by 1.8 points, indicating that addressing legal concerns can positively impact patients' mental health and stress levels.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pilot study of impact of medical-legal partnership services on patients' perceived stress and wellbeing. Ryan, AM., Kutob, RM., Suther, E., et al.[2013]

Medical-legal partnerships (MLP) are effective in addressing legal issues that contribute to health inequities, but health providers often feel uncomfortable accessing these services and need more training.

A review of 21 articles identified key components of MLP training, emphasizing skill acquisition, adaptability, and trauma-informed care, primarily led by lawyers and focused on didactic educational approaches.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Interprofessional Education in Medical-Legal Partnerships (MLPs) to Address Social Determinants of Health. Gard, LA., Bartell, T., Shah, AK., et al.[2021]

Medical-legal partnerships (MLPs) are effective in addressing health-harming legal needs, which can help reduce health inequities in communities.

The AHEAD Initiative successfully developed standardized evaluation tools to assess the impact of MLPs on community health, health system savings, and educational outcomes, providing a framework that can be adapted for various community health partnerships.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluating the Efficacy of Medical-Legal Partnerships that Address Social Determinants of Health. Nerlinger, AL., Alberti, PM., Gilbert, AL., et al.[2022]

Citations

1. United States pubmed.ncbi.nlm.nih.gov

Improving Health Outcomes in Vulnerable Populations: The Medical-Legal Partnership-Colorado's Experience. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Better Together: A Descriptive Analysis of a Medical-Legal Partnership in Western North Carolina. [2023]

3. England pubmed.ncbi.nlm.nih.gov

Medical-Legal Partnership: Lessons from Five Diverse MLPs in New Haven, Connecticut. [2020]

4. United States pubmed.ncbi.nlm.nih.gov

Partnerships Between Health Care and Legal Providers in the Veterans Health Administration. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Pilot study of impact of medical-legal partnership services on patients' perceived stress and wellbeing. [2013]

6. United States pubmed.ncbi.nlm.nih.gov

Interprofessional Education in Medical-Legal Partnerships (MLPs) to Address Social Determinants of Health. [2021]

7. United States pubmed.ncbi.nlm.nih.gov

Evaluating the Efficacy of Medical-Legal Partnerships that Address Social Determinants of Health. [2022]