Presented at the 2013 City MatCH Conference in Savannah, Georgia.

1. Collaborative Innovation to Address
Social Determinants of Health: The
Medical-Legal Partnership Model
Shannon Mace Heller, JD, MPH
Public Health Specialist, Health, Education & Legal
assistance Project: A Medical-Legal Partnership
City MatCH Conference
Savannah, Georgia
24 September 2013

2. What is Medical-Legal Partnership?
MLP is a healthcare delivery model that integrates legal
assistance as a vital component of patient care.
MLP’s 3 key activities
transform the delivery of
health and legal services
and
improve health and well-
being for America’s most
vulnerable

3. Where we work, live, and play…
…determines our health status.

4. MLP Connection to Health
¤ Improved physical
environment
¤ Increased access to
health care
¤ Increased access to
basic necessities
¤ Decreased stress
¤ Increased access to
educational services

5. Unmet Legal Need
Source: Legal Services Corporation, Documenting the Justice Gap in America: The Current Unmet
Civil Legal Needs of Low-Income Americans (September 2009).

6. Health, Education and Legal Assistance
Project: A Medical-Legal Partnership
(HELP: MLP)
¤ Partners:
¤ Crozer-Keystone Healthy
Start
¤ Crozer-Keystone Nurse
Family Partnership
¤ Widener University School
of Law
¤ One of three national
Healthy Start project
demonstration grantees
(HRSA’s MCH Bureau)

7. Referral Process
} Education: Trainings provided
about potential legal issues of
participants
} Screening: An integrated legal
needs screening tool identifies
unmet legal needs of participants
} Referral: When a legal need is
identified the participant is
referred to HELP: MLP attorneys
} Action: Attorney contacts the
participant within 24 hours to
begin addressing the problem
} Follow-Up: Evaluation staff
contact participant for follow up
interview after obtaining informed
consent
Education
Screening
ReferralAction
Follow-Up

8. I-HELP Legal Screening Tool
¤ Developed by the
National Center for
Medical-Legal Partnership
¤ Integrated into Healthy
Start Participant Profile
electronic case record
¤ Identifies common legal
issues that impact health
and well-being
I Income Supports
H Housing & Utilities
E Education
L Legal (immigration)
Status
P Personal & Family
Stability

9. Evaluation Methods
¤ Program Participants:
¤ Collected data through telephone interviews 3-4
weeks after cases closed and review of case notes
¤ Measured: satisfaction, stress, health, and self-
efficacy
¤ At time data was collected 21 participants had
closed cases; 13 completed follow up interviews
¤ Healthy Start Staff:
¤ Conducted pre and post tests during trainings and
follow up interviews at end of grant period
¤ Measured: satisfaction, knowledge and beliefs

10. Healthy Start Project Results
(June 2012-May 2013)
¤ 29 Healthy Start Program
participants received services
benefiting over 100 individuals
¤ 70 Legal cases were
addressed
¤ 59 Case consultations
occurred with CKHS case
managers & staff
¤ 12 Students from multiple
disciplines educated
¤ 9 Trainings were conducted
for CKHS staff & community
partners
More than
100
Individuals
Helped
70
Legal
issues
addressed
59
Case
Consults
9
Trainings
conducted
with CKHS
12
Students
educated
at WUSL

11. Legal Issues Resolved
(May 2012- June 2013)
50%
14%
10%
6%
4% 6%
10% Public Benefits
Disability
benefits
Housing
Utilities
Custody
Consumer issues
OtherN=70

12. 50%
33%
17%
Change in Overall Health Following Services
Improved
Same
Worsened
n=12

13. Impact on Stress (May 2012-June 2013)
8.7
3.6
0
1
2
3
4
5
6
7
8
9
10
Prior to Services After services
Client Average Overall Level of Stress
Client Average
Overall Level of Stress
N=13

14. 8.3
1.375
0
1
2
3
4
5
6
7
8
9
Prior to services After services
Average Level of Stress for Clients with
Public Benefit Matters
Average Level of
Stress for Clients with
Public Benefit
Matters
N=8

15. 50%
33%
17%
Change in Overall Health Following
Services
Improved
Same
Worsened
N=12

16. Prior to Services After Services
Poor 5 2
Fair 5 2
Good 0 1
Very Good 3 2
Excellent 0 4
0
1
2
3
4
5
6Numberofresponses
Quality of Sleep
N=11

17. Always
Most of
the time
Half of
the time
Rarely Never
Prior to Services 3 5 4 0 0
After Services 0 1 1 8 2
0
1
2
3
4
5
6
7
8
9
#ofResponses
How often do you feel you are facing a
problem you cannot handle or ask for help
with?
n=12

18. Impact on CKHS Staff
¤ MLP integration has
resulted in:
¤ Increased knowledge
¤ Increased capacity to
serve clients
¤ Increased advocacy
capacity
¤ Decreased stress
¤ Increased ability to
identify and refer legal
needs

19. Challenges
¤ Sustainability
¤ Evaluation
¤ IRB approval
¤ Lost to follow up
¤ Demonstrating ROI
¤ Longitudinal health
outcomes
¤ Health system
investment

20. Client Quotations
¤ I didn't know I could even get help like that. I didn't know
where to turn. It made a big difference and I'm very
grateful. She still keeps in contact with me.
¤ Having a lawyer really changes everything. Being able to
say, "my lawyer will call you" gets results. I now know that if
anything happens I can call my lawyer, Laura.
¤ “Laura was a big help, she has been beyond a blessing. I
didn’t have a state ID or any other documents because of
my personal problems and she was able to help me apply
for benefits anyway.”
¤ The issue she worked on I was working on for more than a
year. No one knows how hard it was. She just stepped in
and in a month everything was done.

21. sm.helpmlp@gmail.com
helpmlp.org | @HELPmlp
Thank you!