Medical-Legal Partnership for Social Determinants of Health

Overseen By Miguel A Munoz-Laboy, DrPH

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: Stony Brook University

Disqualifiers: State or federal custody, others

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

Compensation: Varies

Number of Visits: 8

1140 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What data supports the effectiveness of the treatment Critical Time Medical-Legal Partnership Intervention?

Medical-legal partnerships, which integrate lawyers into healthcare to address legal issues affecting health, have shown positive changes in clinical systems and health outcomes by addressing social determinants like housing and food insecurity. These partnerships have been associated with improved health and wellness in vulnerable populations by resolving legal problems that contribute to poor health. ^{1 2 3 4 5}

How is the Critical Time Medical-Legal Partnership Intervention treatment different from other treatments?

The Critical Time Medical-Legal Partnership Intervention is unique because it integrates legal professionals into healthcare settings to address social issues like housing and employment that affect health, unlike traditional treatments that focus solely on medical care. ^{2 3 4 5 6}

What is the purpose of this trial?

This clinical trial will examine the effects of legal services on primary care outcomes for medically underserved communities. The aims of the study are: 1. To test the effectiveness and cost-benefits of a critical-time intervention Medical-Legal Partnership (CTI-MLP) on patient outcomes. 2. To determine the most efficient mechanisms for CTI-MLP delivery. 3. To develop innovative community engagement strategies for addressing health-harming legal needs within community health centers. Eligible patients will be asked to complete a questionnaire 4 times, first when they join the study and then at 3 months, 6 months, and 12 months. In the survey, they will be asked to provide information about themselves, their health care, aspects of their daily life, and hardships they face. They will also allow researchers to access their electronic health record information housed in the community-based organization and attorney notes. Patient information will be completely confidential and de-identified, meaning, the research team will not know the identity of the person who answered the questions. Participating community health centers will be randomized (assigned by chance) to provide basic legal information and referral to legal aid; or have an attorney on-site to provide legal aid to those who screen for legal needs.

Eligibility Criteria

This trial is for individuals aged 13 or older from medically underserved Latinx and migrant communities who face acute health-harming legal needs. Participants must be willing to consent, allow access to their electronic health records, and not plan to relocate within a year after joining the study.

Inclusion Criteria

* Patients will be included in the trial if they meet all the following criteria: 1) ages 13 or older, 2) impacted by acute health-harming legal needs or risks (confirmed by screening developed in preparation for this proposal); 3) willing and able to consent to participate in the trial (including accessing EHR at the FQHC); and, 4) do not intend to relocate within the 12 months following their enrollment in the study.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive legal services within primary care to address health-harming legal needs

12 months

4 visits (in-person or virtual) at baseline, 3 months, 6 months, and 12 months

Follow-up

Participants are monitored for health and legal outcomes after the intervention

12 months

4 visits (in-person or virtual) at baseline, 3 months, 6 months, and 12 months

Treatment Details

Interventions

• Critical Time Medical-Legal Partnership Intervention

Trial Overview The trial tests how effective providing legal services through a Medical-Legal Partnership (CTI-MLP) is in improving primary care outcomes. It will compare two approaches: basic legal information with referrals versus on-site attorneys offering direct aid.

Participant Groups

Group I: Critical Time Medical-Legal Partnership Intervention Experimental Treatment 1 Intervention

Patients receiving care at an intervention health center will (a) be screened for health-harming legal needs. Those who meet eligibility criteria will be offered the opportunity to meet with a lawyer to review and explain their legal risks, rights, and remedies, (b) will be provided direct legal representation to mitigate or eliminate those legal needs, and (c) will consent to tracking of legal case management activity and outcomes and health outcomes in ways that accord with patient autonomy/consent, study expectation.

Group II: Control Active Control 1 Intervention

Patients receiving care at a health center in the control arm of the study in the control or "no intervention" arm of the study will (a) be screened for health-harming legal needs. Those who meet eligibility criteria will (b) be provided basic legal information and referral to legal aid, and (c) will consent to tracking of legal and health outcomes in ways that accord with patient autonomy/consent, study expectation.

Who Is Running the Clinical Trial?

Stony Brook University

Lead Sponsor

Trials

225

Recruited

41,700+

Boston University

Collaborator

Trials

494

Recruited

9,998,000+

University of Puerto Rico

Collaborator

Trials

69

Recruited

22,300+

University of Central Florida

Collaborator

Trials

101

Recruited

1,191,000+

Findings from Research

The Medical-Legal Partnership at Legal Aid of Western Missouri successfully provided free legal services to low-income individuals, addressing legal issues that impact their health and wellness.

Advocacy efforts by the medical-legal partnership personnel were linked to significant changes in healthcare organizations, highlighting the importance of integrating legal support into healthcare to improve health outcomes for disadvantaged populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of advocacy in occasioning community and organizational change in a medical-legal partnership. Anderson-Carpenter, KD., Collie-Akers, V., Colvin, JD., et al.[2013]

Over an 18-month period, care coordinators screened 29,268 patients for health-harming legal needs, successfully referring 492 patients (1.7%) for legal assistance, demonstrating the effectiveness of this model in identifying legal issues impacting health.

Patients who received legal assistance reported significant improvements in self-reported health and well-being, with a 263% return on investment for the healthcare system, indicating both efficacy and financial benefits of the intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A care coordinator screening strategy to address health harming legal needs. Berg, D., Setrini, A., Chan, K., et al.[2022]

Medical-legal partnerships, which integrate civil legal aid professionals into healthcare settings, are effective tools for addressing social issues like food insecurity and housing that contribute to health inequities.

Over 300 healthcare organizations have adopted these partnerships, and their success relies on strong financing and commitment from healthcare providers to sustain and expand these interventions for better health outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Addressing Social Determinants Of Health Through Medical-Legal Partnerships. Regenstein, M., Trott, J., Williamson, A., et al.[2019]

Medical-legal partnerships (MLPs) can effectively improve health outcomes by integrating legal staff into healthcare clinics, helping to address social determinants of health that are often rooted in legal issues.

By directly working with patients to identify and resolve legal needs, MLPs can provide valuable insights and solutions that benefit children and families, demonstrating a positive impact on clinical systems.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Legal Care as Part of Health Care: The Benefits of Medical-Legal Partnership. Murphy, JS., Lawton, EM., Sandel, M.[2015]

Medical-legal partnerships, present in over 200 clinical sites in the U.S., effectively address social determinants of health by integrating legal support into healthcare, helping patients tackle legal issues that affect their health.

These partnerships can improve clinical systems, such as by incorporating legal form letters into electronic health records, which assist low-income patients in resolving issues like substandard housing conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Medical-legal partnerships: transforming primary care by addressing the legal needs of vulnerable populations. Sandel, M., Hansen, M., Kahn, R., et al.[2010]

Social determinants of health (SDH) significantly impact individual and population health, prompting a transformation in the healthcare system to better address these factors.

Medical-legal partnerships, which integrate civil legal services into healthcare for vulnerable populations, represent an innovative approach to team-based care and are being considered for inclusion in medical education reforms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Training the 21st-Century Health Care Team: Maximizing Interprofessional Education Through Medical-Legal Partnership. Tobin-Tyler, E., Teitelbaum, J.[2018]

References

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

The role of advocacy in occasioning community and organizational change in a medical-legal partnership. [2013]

2. England pubmed.ncbi.nlm.nih.gov

A care coordinator screening strategy to address health harming legal needs. [2022]

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

Addressing Social Determinants Of Health Through Medical-Legal Partnerships. [2019]

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

Legal Care as Part of Health Care: The Benefits of Medical-Legal Partnership. [2015]

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

Medical-legal partnerships: transforming primary care by addressing the legal needs of vulnerable populations. [2010]

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

Training the 21st-Century Health Care Team: Maximizing Interprofessional Education Through Medical-Legal Partnership. [2018]