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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how providing legal help can improve health outcomes for people in underserved communities. Specifically, it examines whether having a lawyer available in health centers can address legal issues affecting health, such as housing or employment problems. Participants will either receive basic legal information or meet with a lawyer for direct assistance. This approach is part of the Critical Time Medical-Legal Partnership Intervention. Individuals with pressing legal issues impacting their health and who are willing to participate in surveys over the next year might be a good fit for this trial. As an unphased trial, this study offers a unique opportunity to contribute to innovative solutions that could transform healthcare support in underserved communities.

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 prior data suggests that this intervention is safe for patients?

Research shows that Medical-Legal Partnerships (MLPs) are generally safe and can positively affect health. Studies indicate that addressing social factors, such as legal issues, can improve health outcomes. Smaller studies have found that MLPs effectively tackle these social factors, leading to better health results.

MLPs have previously been linked to improvements in both physical and mental health, as well as more effective use of healthcare services. No major negative effects have been reported in these studies, suggesting that this approach is well-tolerated.

This trial examines how legal help can improve health in underserved communities, a new method. Since it involves legal services instead of medical treatments, traditional safety concerns like side effects do not apply. Therefore, based on the available data, participating in this type of trial is expected to be safe. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Critical Time Medical-Legal Partnership Intervention because it addresses health-harming legal needs directly, which is a fresh approach compared to typical healthcare treatments that often overlook legal issues impacting health. Unlike standard care that might refer patients to legal aid, this intervention provides direct legal representation, helping patients navigate legal challenges that can affect their health outcomes. This method not only aims to resolve legal problems but also tracks and potentially improves health outcomes, offering a comprehensive way to enhance patient well-being by integrating legal and medical support.

What evidence suggests that the Critical Time Medical-Legal Partnership Intervention is effective for improving primary care outcomes?

Research has shown that Medical-Legal Partnerships (MLPs) can enhance health and community outcomes by addressing legal issues affecting health. In this trial, participants in the Critical Time Medical-Legal Partnership Intervention arm will undergo screening for health-harming legal needs and receive direct legal representation to address these issues. One study found that MLPs helped by identifying patients' legal problems that could harm their health and providing legal assistance to resolve them. Over 18 months, 29,268 patients were screened for such legal needs, and 492 received legal referrals. Other studies have found that MLPs significantly reduced social and legal problems, although results varied. These findings suggest that MLPs can effectively improve the well-being of vulnerable groups by addressing legal challenges related to health. ^{1 2 4 6 7}

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

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 (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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8729181/

Evaluating the Efficacy of Medical-Legal Partnerships that ... The MLP approach has been shown to improve patient and community outcomes for vulnerable populations by screening for and addressing legal needs as they relate ...

2. withpower.com withpower.com/trial/phase-health-harming-legal-needs-2025-29b9b

Medical-Legal Partnership for Social Determinants of Health Over an 18-month period, care coordinators screened 29,268 patients for health-harming legal needs, successfully referring 492 patients (1.7%) for legal ...

3. medical-legalpartnership.org medical-legalpartnership.org/wp-content/uploads/2016/12/Screening-for-Health-Harming-Legal-Needs.pdf

SCREENING FOR HEALTH-HARMING LEGAL NEEDS Medical-legal partnerships use a variety of informal and formal methods to screen patients for health-harming legal needs, at times employing a mix of ...

4. sciencedirect.com sciencedirect.com/science/article/pii/S2688115225000207

Prevalence of Health Harming Legal Needs of Patients ... Medical–legal partnerships (MLPs) have been shown to positively impact social and legal needs of patients yet few ED–MLPs exist. The goal of this study was to ...

5. publications.aap.org publications.aap.org/pediatrics/article/156/1/e2024069940/202046/Medical-Legal-Partnerships-and-Child-Health-and

Medical-Legal Partnerships and Child Health and Family ... Overall, there were significant reductions in social and legal needs across studies following the intervention, although outcomes varied.

6. medical-legalpartnership.org medical-legalpartnership.org/wp-content/uploads/2014/03/Medical-Legal-Partnership-Literature-Review-February-2013.pdf

A Review of the Evidence This review of the evidence will present the need for legal and health services integration, describe the essential components of the MLP model as well as the ...

7. medicine.yale.edu medicine.yale.edu/news/yale-medicine-magazine/article/social-determinants/

Beyond the clinic - Yale School of Medicine The Medical-Legal Partnership (MLP) places attorneys on site at health care clinics and hospitals to address the social determinants of health.