1. Collaborative Innovation to Address Social Determinants of Health: The Medical-Legal Partnership Model Shannon Mace Heller, JD, MPH Public Health Specialist, Health, Education & Legal assistance Project: A Medical-Legal Partnership City MatCH Conference Savannah, Georgia 24 September 2013

2. What is Medical-Legal Partnership? MLP is a healthcare delivery model that integrates legal assistance as a vital component of patient care. MLPs 3 key activities transform the delivery of health and legal services and improve health and well- being for Americas most vulnerable 3. Where we work, live, and play determines our health status. 4. MLP Connection to Health Improved physical environment Increased access to health care Increased access to basic necessities Decreased stress Increased access to educational services 5. Unmet Legal Need Source: Legal Services Corporation, Documenting the Justice Gap in America: The Current Unmet Civil Legal Needs of Low-Income Americans (September 2009). 6. Health, Education and Legal Assistance Project: A Medical-Legal Partnership (HELP: MLP) Partners: Crozer-Keystone Healthy Start Crozer-Keystone Nurse Family Partnership Widener University School of Law One of three national Healthy Start project demonstration grantees (HRSAs MCH Bureau) 7. Referral Process } Education: Trainings provided about potential legal issues of participants } Screening: An integrated legal needs screening tool identifies unmet legal needs of participants } Referral: When a legal need is identified the participant is referred to HELP: MLP attorneys } Action: Attorney contacts the participant within 24 hours to begin addressing the problem } Follow-Up: Evaluation staff contact participant for follow up interview after obtaining informed consent Education Screening ReferralAction Follow-Up 8. I-HELP Legal Screening Tool Developed by the National Center for Medical-Legal Partnership Integrated into Healthy Start Participant Profile electronic case record Identifies common legal issues that impact health and well-being I Income Supports H Housing & Utilities E Education L Legal (immigration) Status P Personal & Family Stability 9. Evaluation Methods Program Participants: Collected data through telephone interviews 3-4 weeks after cases closed and review of case notes Measured: satisfaction, stress, health, and self- efficacy At time data was collected 21 participants had closed cases; 13 completed follow up interviews Healthy Start Staff: Conducted pre and post tests during trainings and follow up interviews at end of grant period Measured: satisfaction, knowledge and beliefs 10. Healthy Start Project Results (June 2012-May 2013) 29 Healthy Start Program participants received services benefiting over 100 individuals 70 Legal cases were addressed 59 Case consultations occurred with CKHS case managers & staff 12 Students from multiple disciplines educated 9 Trainings were conducted for CKHS staff & community partners More than 100 Individuals Helped 70 Legal issues addressed 59 Case Consults 9 Trainings conducted with CKHS 12 Students educated at WUSL 11. Legal Issues Resolved (May 2012- June 2013) 50% 14% 10% 6% 4% 6% 10% Public Benefits Disability benefits Housing Utilities Custody Consumer issues OtherN=70 12. 50% 33% 17% Change in Overall Health Following Services Improved Same Worsened n=12 13. Impact on Stress (May 2012-June 2013) 8.7 3.6 0 1 2 3 4 5 6 7 8 9 10 Prior to Services After services Client Average Overall Level of Stress Client Average Overall Level of Stress N=13 14. 8.3 1.375 0 1 2 3 4 5 6 7 8 9 Prior to services After services Average Level of Stress for Clients with Public Benefit Matters Average Level of Stress for Clients with Public Benefit Matters N=8 15. 50% 33% 17% Change in Overall Health Following Services Improved Same Worsened N=12 16. Prior to Services After Services Poor 5 2 Fair 5 2 Good 0 1 Very Good 3 2 Excellent 0 4 0 1 2 3 4 5 6Numberofresponses Quality of Sleep N=11 17. Always Most of the time Half of the time Rarely Never Prior to Services 3 5 4 0 0 After Services 0 1 1 8 2 0 1 2 3 4 5 6 7 8 9 #ofResponses How often do you feel you are facing a problem you cannot handle or ask for help with? n=12 18. Impact on CKHS Staff MLP integration has resulted in: Increased knowledge Increased capacity to serve clients Increased advocacy capacity Decreased stress Increased ability to identify and refer legal needs 19. Challenges Sustainability Evaluation IRB approval Lost to follow up Demonstrating ROI Longitudinal health outcomes Health system investment 20. Client Quotations I didn't know I could even get help like that. I didn't know where to turn. It made a big difference and I'm very grateful. She still keeps in contact with me. Having a lawyer really changes everything. Being able to say, "my lawyer will call you" gets results. I now know that if anything happens I can call my lawyer, Laura. Laura was a big help, she has been beyond a blessing. I didnt have a state ID or any other documents because of my personal problems and she was able to help me apply for benefits anyway. The issue she worked on I was working on for more than a year. No one knows how hard it was. She just stepped in and in a month everything was done. 21. sm.helpmlp@gmail.com helpmlp.org | @HELPmlp Thank you!