Medical-Legal Partnerships: Transforming Primary Care By Addressing The Legal Needs Of Vulnerable Populations

Sandel, Megan; Hansen, Mark; Kahn, Robert S.; Lawton, Ellen; Paul, Edward; Parker, Victoria A.; Morton, Samantha; Zuckerman, Barry

doi:10.1377/hlthaff.2010.0038

Cited by 106 publications

(101 citation statements)

References 9 publications

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“…Doctors must learn from lawyers to screen patients for unmet social and economic needs in areas such as income, housing and utilities, education, immigration, and personal and family stability; they must also refer patients with unmet needs to lawyers. Lawyers must learn from doctors how to resolve issues during phone consults, advise doctors about other legal and social services, and schedule patients for intakes and treatment at their legal clinic.Research shows that MLP reform allows patients to leave medical clinics with comprehensive prescriptions for improved health (Sandel et al 2010). For instance, asthmatic patients not only obtain prescriptions for inhalers, but also strategies to compel recalcitrant landlords to remove mold and exterminate pests (Zuckerman et al 2004).…”

mentioning

confidence: 99%

Brokerage Professions and Implementing Reform in an Age of Experts

Kellogg¹

2014

Am Sociol Rev

160

129

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In this comparative ethnographic case study of the implementation of a reform related to the Affordable Care Act in two community health centers, I find that professionals may not compete to claim new tasks (and thereby not implement reform) if these tasks require them to acquire information unrelated to their professional expertise, use work practices that conflict with their professional identity, or do impure or low-value tasks that threaten their professional interests. In such cases, reform may be implemented if lower-status workers fill in the gaps in the division of labor between the professions targeted by the reform, playing a brokerage role by protecting each profession's information, meanings, and tasks in everyday work. When the new tasks represent professionally ill-defined problems, brokers can be more effective if they use buffering practices rather than connecting practices-managing information rather than transferring it, matching meanings rather than translating them, and maintaining interests rather than transforming them-to accomplish reform. By playing a buffering role in the interstices between existing professional jurisdictions, lower-status workers can carve out their own jurisdiction, becoming a brokerage profession between existing professions that need to collaborate with one another for reform to occur. Public health activists argue that because low-income people's health problems often occur long before they get to their doctor, for the Affordable Care Act to be successful, patients need access to primary care physicians and to enabling programs that address the social determinants of health. Activists across the country have received funding for these programs (American Public Health Association [APHA] 2010). KeywordsMLP reform is an enabling program designed to improve the health outcomes of traditionally disadvantaged groups by changing the everyday practices of health center doctors and legal aid lawyers.Health center doctors typically treat low-income patients' medical problems; with the implementation of 3 MLP reform, they also address the social and legal problems that affect patients' health (e.g., if a patient's apartment lacks heat, it will be difficult for the patient to recover from an ear infection). Lawyers, in working with low-income clients, often use individual cases to bring legal reform for large numbers of the poor; with the implementation of MLP reform, they gain new access and treatment points for vulnerable clients by expanding legal screening, and they increase their ability to solve legal problems related to health for large numbers of the poor by getting doctors to assist with reform efforts.To implement MLP reform, both doctors and lawyers need to change how they screen clients, determine their eligibility for treatment, and treat them. Doctors must learn from lawyers to screen patients for unmet social and economic needs in areas such as income, housing and utilities, education, immigration, and personal and family stability; they must also refer ...

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mentioning

confidence: 99%

Brokerage Professions and Implementing Reform in an Age of Experts

Kellogg¹

2014

Am Sociol Rev

160

129

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“…[72][73][74] The MLP model was designed to meet these SDH, and MLPs currently exist in ∼300 hospitals and health centers nationally. 75 MLPs generally share 3 objectives: (1) to provide direct civil legal services to families who have a civil legal need that affects health; (2) to transform both health and legal organizations; and (3) to provide systemic advocacy to improve laws and policies affecting health outcomes.…”

Section: Mlpsmentioning

confidence: 99%

“…75 MLPs generally share 3 objectives: (1) to provide direct civil legal services to families who have a civil legal need that affects health; (2) to transform both health and legal organizations; and (3) to provide systemic advocacy to improve laws and policies affecting health outcomes. [72][73][74][75][76][77] The National Center for Medical-Legal Partnership provides support for new and existing programs, helps to build the evidence base for MLPs, encourages interdisciplinary education, and focuses the health dialogue on at-risk populations. 75 Studies indicate that MLPs can reduce subjective stress and improve self-reported well-being, legal problem-solving skills and sense of empowerment, and health care utilization and self-reported health and well-being.…”

Section: Mlpsmentioning

confidence: 99%

“…81 Other studies have addressed program sustainability, demonstrating the ability to provide financial benefit to the clinical setting by resolving improperly denied insurance claims. 73,[82][83][84] In lieu of an established MLP, practices could consider approaching local law firms or private attorneys to see if they may be willing to undertake pro bono work.…”

Section: Mlpsmentioning

confidence: 99%

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Determinants of Health and Pediatric Primary Care Practices

Beck

Tschudy²,

Coker

et al. 2016

Pediatrics

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More than 20% of children nationally live in poverty. Pediatric primary care practices are critical points-of-contact for these patients and their families. Practices must consider risks that are rooted in poverty as they determine how to best deliver family-centered care and move toward action on the social determinants of health. The Practice-Level Care Delivery Subgroup of the Academic Pediatric Association's Task Force on Poverty has developed a roadmap for pediatric providers and practices to use as they adopt clinical practice redesign strategies aimed at mitigating poverty's negative impact on child health and well-being. The present article describes how care structures and processes can be altered in ways that align with the needs of families living in poverty. Attention is paid to both facilitators of and barriers to successful redesign strategies. We also illustrate how such a roadmap can be adapted by practices depending on the degree of patient need and the availability of practice resources devoted to intervening on the social determinants of health. In addition, ways in which practices can advocate for families in their communities and nationally are identified. Finally, given the relative dearth of evidence for many poverty-focused interventions in primary care, areas that would benefit from more in-depth study are considered. Such a focus is especially relevant as practices consider how they can best help families mitigate the impact of povertyrelated risks in ways that promote long-term health and well-being for children.abstract

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“…88,92,93 Medical-legal partnerships link legal services with primary care to identify and intervene when families require legal services for poverty or social environment concerns, such as housing or food insecurity. [94][95][96] The Reach Out and Read program has become a basic staple of WCC; this modest intervention improves the home learning environment for children by promoting early literacy habits, particularly for children who might otherwise not have an optimal home learning environment. [97][98][99] Proven comprehensive models, however, remain elusive.…”

Section: Community Connections Approachmentioning

confidence: 99%

Does Well-Child Care Have a Future in Pediatrics?

2013

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The most common adult chronic diseases affect 1 in 3 adults and account for more than three-quarters of US health care spending. The major childhood drivers of adult disease are distinctly nonmedical: poverty, poor educational outcomes, unhealthy social and physical environments, and unhealthy lifestyle choices. Ideally, well-child care (WCC) would address these drivers and help create healthier adults with more productive lives and lower health care costs. For children without serious acute and chronic medical problems, however, traditional pediatric preventive services may be largely ineffective in addressing the outcomes that really matter; that is, improving lifelong health and reducing the burden of adult chronic disease. In this article, we examine what role WCC has in addressing the major childhood drivers of adult disease and consider various models for the future of WCC within pediatrics.

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Medical-Legal Partnerships: Transforming Primary Care By Addressing The Legal Needs Of Vulnerable Populations

Cited by 106 publications

References 9 publications

Brokerage Professions and Implementing Reform in an Age of Experts

Brokerage Professions and Implementing Reform in an Age of Experts

Determinants of Health and Pediatric Primary Care Practices

Does Well-Child Care Have a Future in Pediatrics?

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