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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine whether veterans with housing-related legal problems benefit more from a special legal partnership involving healthcare providers or from regular legal aid. The study will compare two groups: one receiving assistance from a medical-legal partnership (a collaboration between legal and healthcare services) and the other from pro-bono lawyers. Researchers seek to identify differences in housing stability and mental health between these two groups after a year. Veterans with housing legal issues who are already involved in VA mental health or homeless programs might be suitable candidates for this trial. As an unphased trial, this study offers veterans a unique opportunity to contribute to research that could enhance the integration of legal and healthcare services.

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.

What prior data suggests that this medical-legal partnership intervention is safe for veterans?

Research has shown that medical-legal partnerships (MLPs) can improve veterans' housing and mental health without negative effects. In a 2-year study, veterans who used MLP services experienced significant improvements in these areas. These partnerships integrate legal experts into healthcare settings to address legal issues affecting health.

No reports of negative side effects from these services exist. Available studies suggest that MLPs are safe and beneficial for veterans facing housing challenges. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the medical-legal partnership (MLP) intervention because it offers a comprehensive approach to preventing veteran homelessness that goes beyond traditional legal aid. Unlike standard options, which typically involve referrals to pro-bono lawyers for legal issues, this treatment integrates legal assistance directly with healthcare services through a partnership between the Connecticut Veterans Legal Center and the VA Connecticut Healthcare System. This holistic method not only addresses immediate legal challenges but also considers broader factors affecting veterans' well-being, potentially leading to more sustainable outcomes in preventing homelessness. By combining legal and healthcare resources, the MLP intervention provides a more personalized and effective support system for veterans.

What evidence suggests that this trial's treatments could be effective for preventing veteran homelessness?

Research has shown that medical-legal partnerships (MLPs), one of the interventions in this trial, can greatly improve housing and mental health for veterans. In one study, veterans who used MLP services had better housing, more income, and improved mental health. Another study found that MLPs, which integrate legal help into healthcare settings, effectively solve legal issues affecting veterans' health. Additionally, an 18-month study reported positive changes in veterans' overall well-being after they received MLP services. These findings suggest that MLPs can significantly benefit veterans dealing with legal problems related to housing. Meanwhile, the trial will also evaluate the effectiveness of referring veterans to pro-bono lawyers, another intervention under study. ^{1 2 4 5 6}

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 (CVLC) 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

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]

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]

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]

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]

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]

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 (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]

Citations

1. reporter.nih.gov reporter.nih.gov/project-details/10938026

Medical-legal partnerships to prevent evictions and ... Our group completed a 2-year uncontrolled study of VA MLPs and found that veterans showed significant improvements in housing, income, and mental health after ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT04924088

Medical-legal Partnerships to Prevent Evictions and ... The investigators have already conducted a funded uncontrolled observational study and found that MLPs improve housing and mental health outcomes of Veterans.

3. medical-legalpartnership.org medical-legalpartnership.org/wp-content/uploads/2020/04/Leveraging-Legal-Services-on-H-PACT.pdf

LEVERAGING LEGAL SERVICES ON THE HOMELESS ... Medical-legal partnerships (MLPs) embed civil legal aid attorneys into the health care setting to address the unmet legal needs that can af- fect Veterans' ...

4. medical-legalpartnership.org medical-legalpartnership.org/wp-content/uploads/2019/05/MLPs-Serving-Veterans-History-Growth-and-Progress.pdf

MLPs-Serving-Veterans-History-Growth-and-Progress. ... VA MEDICAL-LEGAL. PARTNERSHIP. RESEARCH AND. OUTCOMES. A recent 18-month study30 by Tsai et al. examined the health and wellbeing outcomes of MLP services on ...

5. withpower.com withpower.com/trial/phase-2-2022-b91df

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

6. medical-legalpartnership.org medical-legalpartnership.org/wp-content/uploads/2020/10/BWF-VA-Transitions-Issue-Brief-FINAL.pdf

BWF-VA-Transitions-Issue-Brief-FINAL.pdf Medical-legal partnerships (MLPs) embed legal professionals into the health care setting to address unmet civil legal needs that can impact Veterans' health and ...