What Is MLP?

              

What is Medical-Legal Partnership?

Medical-legal partnership (MLP) is a health and legal services delivery model that aims to help vulnerable populations navigate the complex legal systems that hold solutions to many problems associated with social determinants of health.  By integrating legal assistance into the medical setting, MLP helps children, the elderly, adults with disabilities and other underserved communities mitigate the social stressors that affect their health so that they can get and stay healthy.

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Need and Opportunity

Recent healthcare reform measures seek to improve the lives of millions of low-income Americans by providing access to healthcare, adequate nutrition, safe housing and other basic needs.  These efforts reflect a growing recognition by policymakers, healthcare providers and advocates that social factors have a significant influence on health and well-being, and that medicine alone cannot solve the problems of those who struggle daily with material hardships like hunger and safety.

For our nation’s most vulnerable populations, these hardships come in many shapes and forms. Poor housing conditions, food and energy insecurity, educational and employment factors are just a few examples of non-medical problems that present significant barriers to health. A child with asthma living in a moldy apartment will never breathe symptom-free, no matter how much medicine is administered. A chronically ill patient will never get healthier if she does not have adequate nutrition, or the means to keep her medical appointments.

A variety of government programs are designed to address such problems; however, many low-income individuals and families across the country continue to lack the basic benefits that these programs afford.

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Together, Law and Medicine Can Improve Health and Well-Being

MLP brings together healthcare and legal professionals who share overlapping missions: to promote the health and well-being of vulnerable populations.  By leveraging the resources and expertise of two powerful professions, MLPs can offer a holistic kind of care to our nation’s neediest individuals and families.

Traditional medicine and law have treated vulnerable populations in isolation, despite the strong links between social stressors and health.  Studies have shown that adverse social conditions, such as substandard housing and insufficient heat, make people vulnerable to poor health.  At the same time, research also reveals that poor health makes people vulnerable to adverse social conditions.  The “cycle of vulnerability” often consigns our nation’s most disadvantaged households to a lifetime of poverty, poor health and other negative conditions.

MLP breaks this cycle by encouraging healthcare and legal providers to recognize the inextricable link between unmet basic needs and health, and by giving them the tools to address the social issues that perpetuate poor health in underserved communities. MLP is founded on the principle that early legal intervention can prevent social stressors from exacerbating health problems, in the same way that early detection can prevent the spread of disease.  By bringing doctors, lawyers and other professionals together, MLP helps patients and families escape the cycle of vulnerability and puts them on a track toward better health and well-being.

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MLP and the Landscape of Law and Healthcare

Medical-legal partnership works to improve the health and well-being of vulnerable populations, in part, by shifting the service delivery services of both law and healthcare.

Traditional legal aid operates in an “emergency room” model, providing crises-driven service to clients who are able to 1) identify their needs as having legal remedies and 2) connect with a local legal services agency.  By the time someone reaches legal aid, s/he is likely to have an acute legal need, such as an imminent eviction.  MLP engages and trains healthcare providers to recognize and refer these problems earlier so that legal staff can intervene further upstream, in a preventive, “primary care” model.

Traditional healthcare acknowledges the effect of social stressors on patient-health, but stops short of recognizing the role legal remedies play in curbing poor health.  Identified social problems are referred to other professionals and advocacy is considered secondary to the practice of healthcare.  MLP not only places an emphasis on the role legal intervention can play in promoting better health, but helps to re-orient healthcare providers to view advocacy as a key component in the delivery of healthcare.

Traditional Legal and Healthcare Services vs. MLP Services

Medical-legal partnership trains the next generation of lawyers and healthcare providers to work alongside each other as allies and to integrate their services to more effectively address the comprehensive needs of their patient-clients. MLP is currently incorporated into curriculum at 37 law schools, 24 medical schools and 55 residency programs.

More and more, medical-legal partnership is being recognized by professional health and legal organizations as an important means to serve vulnerable patient-clients and for its contributions to the health and legal professions. The American Medical Association (AMA), the American Bar Association (ABA) and the American Academy of Pediatrics (AAP) passed resolutions in support of medical-legal partnership, and the ABA developed an in-house support center dedicated to engaging the private bar in MLP. The Agency for Healthcare Research and Quality did an Innovations Exchange Profile on MLP, and the American Hospital Association recognized MLP with its NOVA Award.

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Basics of the MLP Model

Core Activities

Medical-legal partnerships support health and well-being through three core functions.

1. Legal Advice and Assistance to Patients: Doctors and other healthcare providers see vulnerable patients on a regular basis in the clinical setting.  MLPs train healthcare providers to understand the social causes of their patients’ problems and identify those patients whose stressors may be ameliorated or resolved by legal intervention. Healthcare providers refer these patients to on-site MLP attorneys for legal advice and assistance, and thus provide patients with a higher and more holistic level of care in a one-stop shopping context.
2. Internal Process and Professional Improvement: By observing the legal needs of a diverse patient population, MLP physicians, attorneys and other professionals are able to identify patterns of need and develop the necessary tools, techniques and approaches to resolve these within their institutions. For instance, MLPs have developed income support letters and guardianship documentation templates to help medical providers address their patients’ legal needs in the clinical setting. MLPs also have an impact on the professional development of healthcare and legal providers through a reorientation of service delivery and an expansion of traditional professional roles.
3. External System Change: MLPs operate at the intersection of public policy and patient care and are uniquely positioned to identify areas for regulatory and legislative change that affect patient health. MLPs unite the health and legal professions into one powerful voice to pursue systemic change, pushing to promote legislation and public policies that favors the health and well-being of patients and families. For example, MLP physicians and attorneys have provided joint testimony to improve the application process for chronically ill patients needing utility shut-off protections in the winter months. MLPs encourage a culture of advocacy among health and legal providers, and efforts towards systemic change account for one-third of MLP staff time and resources.

Structure of a Partnership

Medical-legal partnerships are comprised of at least one legal partner institution and one healthcare partner institution, and vary in size and scope. Primary legal partner organizations include Legal Services Corporation (LSC)-funded legal aid offices, non-LSC-funded legal aid offices and law schools, as well as significant support from private attorneys, law firms and bar associations.  Primary healthcare partner organizations include hospitals and community health centers, with significant support from medical schools, state health departments, and healthcare associations and societies.

MLP is more than a referral mechanism for patients to reach legal intake services (an undeniably scarce resource). It creates deep and meaningful integration between healthcare and legal partners to maximize the positive impact on both individual and systemic levels. MLP integration is demonstrated by the following core components of MLP:

1. Provision of direct legal assistance to patient-clients at a healthcare institution;
2. An established referral process and feedback referral loop between healthcare and legal providers;
3. Jointly created and led trainings for healthcare providers at a health institution;
4. An on-site legal provider presence at the health institution at least part-time every week;
5. Active engagement by both clinical and administrative staff and leadership at a healthcare institution;
6. Jointly developed metrics and mandated data collection/sharing;
7. Joint medical and legal funding strategies to sustain MLP activity; and
8. An aim toward jointly developed and led external systemic change efforts.

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MLP Across the U.S.

Legal providers and front-line healthcare staff are now partnered in nearly 200 hospitals and health centers serving vulnerable communities in 37 states nationwide. These partnerships operate in a variety of clinical settings, including geriatrics, pediatrics, oncology, family medicine, internal medicine and others. They form the MLP Network, an association of partnerships that signals participation in a variety of activities, including annual conferences, project-based initiatives, regional collaborations and information sharing.

In 2009, partnerships in the MLP Network provided legal assistance to more than 13,000 individuals and families, and trained 10,000 healthcare providers on the connections between health and unmet basic needs.

MLPs have been featured in The New York Times, The Los Angeles Times, The Washington Post, The Boston Globe and numerous other publications.

The National Center for Medical-Legal Partnership (NCMLP) was founded in 2005 in response to a growing demand for MLP from health and legal institutions across the country. NCMLP supports the expansion and advancement of MLP through a range of activities, including technical assistance for partnership sites, leadership and project support, hosting of the annual MLP Summit, and coordination of national research and policy activities related to health disparities and vulnerable populations.

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