Addressing Health Disparities through Medical-Legal Partnerships: The Role of Social Work

Background: Integrated healthcare teams including social workers have helped improve access to and outcomes of healthcare among the most complicated patients; however, many of the social factors that affect health outcomes require more than a biopsychosocial intervention. Health-harming legal needs (HHLNs) are social determinants of health that require legal redress (NCMLP, 2017). Although federal and state-funded civil legal aid is available in most states, they are persistently overwhelmed and fewer than one in five legal problems are addressed. Additionally, marginalized minority populations have 1 to 3 unmet civil legal needs and have less access to legal aid than the general population (Sandel et al., 2010).  Social workers who work in these contexts serve as trusted liaisons introducing vulnerable patients into these programs and guiding them as they work through their legal consults.

Methods: The University of Texas Health Science Center at Houston (UTH), in collaboration with Lone Star Legal Aid launched a medical-legal partnership in March 2018. Patients were recruited from four UTHealth community-based primary care clinics in the Greater Houston area. Using a legal screening form, patients were classified as positive or negative for indicators for HHLNs. Descriptive analysis was performed on preliminary data to gather from the pilot launch. The analysis also helped inform the creation of I-HELP, an assessment instrument to help standardize the screening process and aid program implementation in remaining community-based clinics.

Results: In the first year of the program 4,038 primary care patients were screened for HHLNs; 963 patients age 18 and above, screened positive and 562 patients received a referral to the UTH-Medical Legal Partnership (MLP) program. As of March 2019, of those who were referred, 208 received legal assistance and 116 of those cases have been resolved. I-HELP categories of assistance are: income and insurance (35.6% screened positive), housing and utilities (17.3% screened positive), education and employment (7.2% screened positive), (other) legal issues (5.8% screened positive), and personal and family stability (34.1% screened positive). Patients who screen positive for potential HHLNs but who are not eligible for legal assistance receive follow up from the social worker, indicating a significant categorical overlap on the screening tool.  

Implications: As of now there are no standardized screening tools for medical-legal partnerships which fails to differentiate between legal and social needs. There is still a significant gap between those who screen positive and those who agree to receive services. Social workers can help to identify and reduce patient’s barriers to receiving the legal services available to them through the MLP program. Additionally, legal needs do not occur apart from other psychosocial needs creating a space for the social worker and the health attorney to engage in client empowerment and advocacy in a synchronous process. Finally, as they continue to grow in the healthcare systems across the country, MLPs have significant implications on a new direction of dual MSW/JD degree programs.