Research & Evaluation

The Landscape of Medical-Legal Partnership
Research and Evaluation

Conceptual Model Development
Legal Needs Assessment
Medical-Legal Partnership Outcomes
Medical-Legal Partnership Cost-Benefit

Conceptual Model Development

NCMLP is developing a framework for conceptualizing how unmet legal needs affect health and developmental outcomes for children and families.  The framework will provide an adaptable logic model that links program activities to the mechanisms through which disparities may develop and through which the program can effect positive change. The emerging framework draws on a variety of efforts including a 2007 concept mapping project by Cornell University and MLP | Boston and related localized projects and academic papers.

Ongoing training evaluations have tended to concentrate on providers’ knowledge and self-reported behaviors regarding unmet needs.  Current efforts in development are exploring potential attitudinal and organizational barriers and facilitators to addressing unmet needs.

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Legal Needs Assessment

Medical-legal Advocacy screen questionnaire (MASQ)

The Family Advocates of Central Massachusetts in Worcester, MA developed a 10-item Medical-Legal Advocacy Screen Questionnaire (MASQ) used to screen families in a primary care setting for possible referral to legal services.  Their study found that the MASQ would more likely identify patients for referral to legal services than provider impression alone after a routine clinical encounter.  An article on the study appeared in the Ambulatory Pediatrics journal.

pediatric Emergency department study

In March 2008, NCMLP and MLP | Boston conducted a legal needs assessment in Boston Medical Center's pediatric emergency department.  This was one of the first studies to conduct an assessment of legal needs of a hospital-based population in which factors that may affect access to or utilization of legal assistance are also measured.  The IRB approved study included a two part-survey -- a self-administered survey in the waiting room and a follow-up phone interview.  Read the report

local legal needs assessments

Multiple local legal needs assessments are underway, including in Seattle and Iowa, to determine baseline data in anticipation of project implementation.

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Medical-Legal Partnership Outcomes

Impact of legal services on family stress

The Tucson Family Advocacy Program is currently measuring the impact of legal services on family stress using the PSS stress survey and Measure Yourself (MYCAW)

Impact of medical-legal partnership services on patient-families

In April 2008, NCMLP and MLP | Boston with Cornell University conducted a qualitative study to measure the impact of MLP on patient-families.  72 interviews were conducted with patient-families (36 had access to medical-legal partnership services, 36 did not).  The study found that MLP patient-families:

• Were more likely to acknowledge they had a problem when speaking with their doctors
• Were better, more skilled advocates
• Employed more effective strategies to solve legal problems then they would have otherwise
• Felt supported while receiving legal assistance
• Saw improvements in their families' well-being
• Were able to assist other families with the knowledge they gained

Drawing on the qualitative themes and outcomes, NCMLP and MLP | Boston are conducting a quantitative comparison site study with a target of 300 families, examining differences in perceived stress, access and other measures.  Cohort will be drawn equally from community health centers with MLP access and those without.  Read preliminary report

Impact of legal intervention on quality of life

In 2005-2006, Legal Health developed a pilot survey to measure the impact of legal intervention on quality of life.  The qualitative study interviewed 20 LegalHealth patient-clients who were cancer survivors.

• 75% of patients reported reduced stress
• 50% reported a positive effect on family or loved ones
• 45% reported positive effect on financial situation
• 30% reported legal services helped maintain their treatment regiment
• 25% reported being better able to keep their medical appointments

Read the report

Impact of training on physician attitudes and behavior

LegalHealth studied of impact of its training on physicians in 2005-2006 and found a definite change in attitude and behavior among physicians participating in LegalHealth’s training curriculum.  Physicians:

• Had a greater awareness of their patient’s legal needs
• Were more likely to make referrals for onsite legal assistance
• Were better equipped to assist their patient’s with needed forms and letters
• Recognized the importance of their role in resolving their patients’ non-medical needs

 

Effect of legal assistance on asthma

LegalHealth reviewed the cases of 21 patients whose asthma showed little improvement despite compliant use of inhaled steroid medication.  All of the patients lived in sub-standard housing, and 11 patients received assistance from legal team and repairs were made to their homes.  After one year – these 11 patients’ health improved dramatically:

• Patients who were taking emergency courses of oral steroids because of uncontrolled asthma were able to reduce those courses from 18 the year before their apartments were cleaned up to just two, the year after the clean-up.
• Reduced by 94 percent the need for visits to the hospital emergency department for asthma – 14 trips prior to legal intervention versus two visits after the homes were fixed.
• Significantly improved their asthma condition, with most patients improving by at least one level on the scale of seriousness of the lung disease.

Legal services effect on disparities

The Cincinnati Medical-Legal Partnership for Children is currently conducting a needs assessment to study whether addressing basic social needs through legal services helps lessen disparities.

MLP impact on family well-being and stability

The Bay Area Regional Collaboration in California is currently conducting a cross-site evaluation to measure the impact of medical-legal partnership intervention on family well-being and stability.  The survey is administered to clients through the legal aid partners.

Effect of Legal Assistance on Aspects of Health /
Feasibility of Cross-site Evaluation

In February 2008, the New England Regional Medical-Legal Network developed and piloted a client questionnaire for administration before legal intake at six New England partnerships.  The questionnaire examined aspects of “health” (stress, subjective well-being, ability to perform daily activities) and factors that may influence health (general self-efficacy, health locus of control, family/household stability, legal concerns) that might be influenced by legal assistance, regardless of the specific issue addressed.

The main goal of the pilot was to examine the feasibility of conducting data collection in various settings represented by (and with varying levels of resources of) each NERMLN program

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Medical-Legal Partnership Cost-Benefit

Multiple partnerships are engaged in healthcare recovery dollar work -- appealing wrongly denied insurance cases to simultaneously secure insurance for patient-clients and recover money for the hospitals they are partnered with.

LegalHealth conducted a two-year study that examined 381 cases handled by the medical-legal partnership.  The study found that 13% of cases generated revenue -- an average of $11,904 per patient.  Read the report

Medical-legal partnerships in Kansas City, MO, San Diego, CA and Carbondale, IL have also produced reports highlighting the revenue generated by their partnerships for their hospital partners.  In March 2008, NCMLP commissioned a white paper on healthcare recovery dollars that examines the practices of these four partnerships.  Read the 2008 MLP Healthcare Recovery Dollars White Paper

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