Medical-legal partnerships

Medical-legal partnerships (MLPs) integrate legal services into health care settings. Health care providers refer patients to onsite legal assistance, which can include legal aid attorneys, private practice lawyers operating on a pro bono basis, and law professors and students (). Patients are typically screened for legal needs in waiting rooms (Speldewinde 2015, , Cohen 2010); electronic health records (EHRs) may also prompt providers to screen for legal needs (). When needs are identified, legal providers work with health care providers and patients to address concerns related to housing, food and utilities assistance, and social services. Social workers, often located onsite, can also provide guidance (Speldewinde 2015, , Cohen 2010). MLPs can be funded by hospitals or health care systems, health foundations, federal legal aid, law schools or firms, or state governments ().

Expected Beneficial Outcomes (Rated)

  • Improved access to legal services

  • Improved health outcomes

  • Improved well-being

  • Reduced stress

Other Potential Beneficial Outcomes

  • Improved access to social services

  • Increased enrollment in social services

  • Improved economic security

  • Increased housing stability

Evidence of Effectiveness

There is some evidence that medical-legal partnerships (MLPs) improve access to legal services (, Speldewinde 2015, , Hernandez 2016), patient health outcomes (, Speldewinde 2015), and well-being (, , , , ), and reduce stress (Speldewinde 2015). Additional evidence is needed to confirm effects ().

Early intervention to address legal problems contributes to improved health outcomes (, Speldewinde 2015, , , , ), including mental health (Speldewinde 2015, ). MLPs can improve short-term and long-term health, in part by reducing stress and improving patient adherence to required medical treatment (Speldewinde 2015). MLPs can also improve patient well-being and increase appropriate use of health care services (). MLPs have been shown to improve health and well-being for children and families (, ), including families of children with asthma (). MLP participants report reduced stress (, ) and improved well-being (, ).

MLPs can remove barriers to health care for low income families by addressing cost and insurance concerns and increasing access to preventive care (, ) and vaccinations (). MLPs may also improve treatment compliance (NCMLP-Regenstein 2017, Pettignano 2012).

MLPs have been shown to increase access to stable, affordable housing (Hernandez 2016) for populations including veterans (), families of children with sickle cell disease (), and families of children with asthma (). By screening for energy insecurity (, Hernandez 2016) and issuing certificates of medical need, MLPs can prevent utilities shut-offs and increase energy security, particularly for families with vulnerable children (). A Buffalo, NY-based study of an MLP that serves cancer patients receiving palliative care suggests MLPs can also secure emergency funding from the Low Income Home Energy Assistance Program (LIHEAP) to alleviate heating costs ().

MLPs can increase access to social services and supports (, , NCMLP-Regenstein 2017, , ), including social security benefits, family law services, end of life guidance (, ), and Medicaid (, Pettignano 2012). MLPs can also increase access to education, employment (NCMLP-Regenstein 2017, , ), and Supplemental Nutrition Assistance Program (SNAP) benefits (, ). MLPs have been shown to increase access to legal services for disadvantaged populations (Speldewinde 2015), families with low incomes (), cancer patients (), families of children with chronic health conditions such as sickle cell disease () and asthma (), and patients experiencing homelessness ().

MLPs have been shown to increase patients’ comfort engaging with legal services (Hernandez 2016) and can reduce the need for litigation by addressing legal issues through administrative or informal processes ().

Experts suggest that MLPs include social workers onsite to connect patients to social services and supports and to better address disparities in the social determinants of health (). Programs may be more effective if providers use screening prompts in electronic health records (EHRs) to discuss legal issues and access form letters to connect to additional services (). Small budgets, reliance on volunteers with constrained time, and difficulty getting appropriate reimbursements for health care appointments can be challenges to sustainable MLP programs (). Including MLP training in medical residency programs may increase providers’ understanding and use of MLPs (Paul 2017, ).

Evaluations of MLPs have shown that health care providers and lawyers working together can advance health equity for vulnerable community residents (). Experts suggest that screening patients for legal issues become a standard practice in patient care ().

Studies of MLPs in New York City, Atlanta, and rural Illinois have shown positive returns on investment (, , , ). MLPs may improve reimbursement for hospital services and contribute to health care system improvements (Pettignano 2012).

Impact on Disparities

Likely to decrease disparities

Implementation Examples

As of Summer 2018, there are medical-legal partnerships (MLPs) in 373 health organizations across 47 states (NCMLP). The National Center for Medical-Legal Partnership (NCMLP) provides research and technical assistance to organizations interested in creating MLPs and offers a handbook with MLP evaluation guidelines (NCMLP, NCMLP Handbook). NCMLP and the American Bar Association each maintain lists of partners participating in MLPs across the nation (NCMLP-Partnerships, ABA-MLP).

The Washington Medical-Legal Partnership is an example of a long-standing MLP; it has provided direct legal assistance to 2,200 individuals and trained 2,000 health care providers and social workers in legal advocacy since its establishment in 2008 (WA MLP). Medical-Legal Partnership Boston is another MLP that provides training, coaching, and technical assistance to interested organizations (MLPB).

Implementation Resources

NCMLP Handbook - National Center for Medical-Legal Partnership (NCMLP). National Center for Medical-Legal Partnership performance measures handbook. Social Interventions Research & Evaluation Network (SIREN). University of California San Francisco (UCSF); 2016.

NCMLP-Regenstein 2015 - Regenstein M, Teitelbaum J, Sharac J, Phyu E. Medical-legal partnership and health centers: Addressing patients’ health-harming civil legal needs as part of primary care. Issue brief. Washington, DC: National Center for Medical-Legal Partnership (NCMLP). Milken Institute School of Public Health, George Washington University; 2015.

NCMLP-Utilities - National Center for Medical-Legal Partnership (NCMLP). MLP in action: a utilities case study: What happened when the heat went off? An MLP patients-to-policy story. Washington, DC: Milken Institute School of Public Health, George Washington University; 2018.

Citations - Evidence

* Journal subscription may be required for access.

Sandel 2010a - Sandel M, Baeder A, Bradman A, et al. Housing interventions and control of health-related chemical agents: A review of the evidence. Journal of Public Health Managenment and Practice (JPHMP). 2010;16(5):S24-33.

Atkins 2014* - Atkins D, Heller SM, DeBartolo E, Sandel M. Medical-legal partnership and healthy start: Integrating civil legal aid services into public health advocacy. Journal of Legal Medicine. 2014;35(1):195-209.

Martinez 2017* - Martinez O, Boles J, Muñoz-Laboy M, et al. Bridging health disparity gaps through the use of medical legal partnerships in patient care: A systematic review. The Journal of Law, Medicine & Ethics. 2017;45(2):260-273.

Speldewinde 2015 - Speldewinde CA, Parsons I. Medical-legal partnerships: The role of mental health providers and legal authorities in the development of a coordinated approach to supporting mental health clients’ legal needs in regional and rural settings. Rural and Remote Health. 2015;15(4):1-11.

Theiss 2017* - Theiss J, Regenstein M. Facing the need: Screening practices for the social determinants of health. The Journal of Law, Medicine & Ethics. 2017;45(3):431-441.

Regenstein 2018* - Regenstein M, Trott J, Williamson A, Theiss J. Addressing social determinants of health through medical-legal partnerships. Health Affairs. 2018;37(3):378-385.

NCMLP-Regenstein 2017 - Regenstein M, Trott J, Williamson A. The state of the medical-legal partnership field: Findings from the 2016 National Center for Medical-Legal Partnership surveys. Washington, DC: National Center for Medical-Legal Partnership. Milken Institute School of Public Health, George Washington University; 2017.

Rosen Valverde 2018* - Rosen Valverde JN, Backstrand J, Hills L, Tanuos H. Medical-legal partnership impact on parents’ perceived stress: A pilot study. Behavioral Medicine. June 2018.

Sege 2015* - Sege R, Preer G, Morton SJ, et al. Medical-legal strategies to improve infant health care: A randomized trial. Pediatrics. 2015;136(1):97-106.

Colvin 2012* - Colvin JD, Nelson B, Cronin K. Integrating social workers into medical-legal partnerships: Comprehensive problem solving for patients. Social Work. 2012;57(4):333-341.

Hernandez 2016 - Hernández D. “Extra oomph:” addressing housing disparities through Medical Legal Partnership interventions. Housing Studies. 2016;31(7):871-890.

Paul 2017 - Paul EG, Curran M, Tobin Tyler E. The medical-legal partnership approach to teaching social determinants of health and structural competency in residency programs. Academic Medicine. 2017;92(3):292-298.

Pettignano 2011* - Pettignano R, Caley SB, Bliss LR. Medical-legal partnership: Impact on patients with sickle cell disease. Pediatrics. 2011;128(6):e1482-e1488.

Pettignano 2013* - Pettignano R, Bliss LR, Caley SB, McLaren S. Can access to a medical-legal partnership benefit patients with asthma who live in an urban community? Journal of Health Care for the Poor and Underserved. 2013;24(2):706-717.

Pettignano 2012 - Pettignano R, Caley SB, McLaren S. The health law partnership: Adding a lawyer to the health care team reduces system costs and improves provider satisfaction. Journal of Public Health Management and Practice. 2012;18(4):E1-E3.

Rodabaugh 2010* - Rodabaugh KJ, Hammond M, Myszka D, Sandel M. A medical-legal partnership as a component of a palliative care model. Journal of Palliative Medicine. 2010;13(1):15-18.

Ryan 2012a* - Ryan AM, Kutob RM, Suther E, Hansen M, Sandel M. Pilot study of impact of medical-legal partnership services on patients’ perceived stress and wellbeing. Journal of Health Care for the Poor and Underserved. 2012;23(4):1536-1546.

Sandel 2010a* - Sandel M, Hansen M, Kahn R, et al. Medical-legal partnerships: Transforming primary care by addressing the legal needs of vulnerable populations. Health Affairs. 2010;29(9):1697-1705.

Taylor 2015* - Taylor DR, Bernstein BA, Carroll E, Oquendo E, Pachter LM. Keeping the heat on for children’s health: A successful medical-legal partnership initiative to prevent utility shutoffs in vulnerable children. Journal of Health Care for the Poor and Underserved. 2015;26(3):676-685.

Tobin-Tyler 2016* - Tobin-Tyler E, Teitelbaum J. Training the 21st-century health care team: Maximizing interprofessional education through medical-legal partnership. Academic Medicine. 2016;91(6):761-765.

Tsai 2017* - Tsai J, Middleton M, Villegas J, et al. Medical-legal partnerships at veterans affairs medical centers improved housing and psychosocial outcomes for vets. Health Affairs. 2017;36(12):2195-2203.

Tsai 2017a* - Tsai J, Jenkins D, Lawton E. Civil legal services and medical-legal partnerships needed by the homeless population: A national survey. American Journal of Public Health. 2017;107(3):398-401.

Weintraub 2010* - Weintraub D, Rodgers MA, Botcheva L, et al. Pilot study of medical-legal partnership to address social and legal needs of patients. Journal of Health Care for the Poor and Underserved. 2010;21(2 Suppl):157-168.

Teufel 2012* - Teufel JA, Werner D, Goffinet D, et al. Rural medical-legal partnership and advocacy: A three-year follow-up study. Journal of Health Care for the Poor and Underserved. 2012;23(2):705-714.

Citations - Implementation Examples

* Journal subscription may be required for access.

ABA-MLP - American Bar Association (ABA). Medical-legal partnerships pro-bono project.

NCMLP Handbook - National Center for Medical-Legal Partnership (NCMLP). National Center for Medical-Legal Partnership performance measures handbook. Social Interventions Research & Evaluation Network (SIREN). University of California San Francisco (UCSF); 2016.

NCMLP - National Center for Medical-Legal Partnership (NCMLP). Washington, DC: Milken Institute School of Public Health, George Washington University.

NCMLP-Partnerships - National Center for Medical-Legal Partnership (NCMLP). Partnerships across the US. Washington, DC: Milken Institute School of Public Health, George Washington University; 2018.

WA MLP - Washington Medical-Legal Partnership (WA MLP). Working towards better health through legal advocacy.

MLPB - Medical-Legal Partnership Boston (MLPB).

Date Last Updated

Aug 9, 2018