Medical-Legal Partnerships: On the "Bleeding Edge" of Technological Innovation

Across the country, doctors’ offices and hospitals are adapting to new technology. Medical-legal partnerships are no different. Medical-legal partnerships are projects that target the nonmedical sources of health problems such as asthma, diabetes, and depression by training medical professionals to identify legal issues and providing lawyers ready to address patients’ legal needs.

In Louisville, Kentucky, the Legal Aid Society of Louisville and Doctors and Lawyers for Kids, Louisville’s medical-legal partnership, have developed a way to use tablet technology to identify pediatric patients who might need legal help. Called an automated legal needs screening tool, this advanced use of technology tries to help families stay healthy by preventing people from being evicted, making sure children are getting the services they need in school, and helping families pay their bills and apply for benefits.

Funded by a Technology Initiative Grant from the Legal Services Corporation, the automated legal needs screening tool is currently being tested at the University of Louisville’s Pediatrics Children & Youth Clinic. The tool has several components:

  • The “law and health survey,” which patients' parents or guardians complete on tablets;
  • An “alert” function that electronically notifies medical-legal partnership staff when a survey response flags a possible health-related legal need;
  • A “resource” function that lets parents or guardians ask for information about community resources, based upon their survey answers; and
  • A reporting function that allows the medical-legal partnership staff to gather data.

When a patient’s parent (or guardian) begins the survey, the survey tells the parent that if she or he responds in certain ways, the survey will ask for a name and phone number, or an email address. The survey then assures parents that their responses to the survey will be kept confidential.

Next, the survey-taker answers a set of yes or no questions designed to identify potential legal problems. The survey uses “question branching,” which means that the response to one question prompts the next question posed by the survey. One of the first questions the survey asks is: “Are you having any problems with your housing?” If the parent or guardian clicks “Yes,” the survey asks a series of follow-up questions about whether the survey-taker rents or owns his or her home, if the home is in good condition, if the utility bills have been paid, and whether the family is at risk of being evicted. Depending on the answers given, the survey-taker might be asked if he or she would like to speak to an attorney. For example, if a survey-taker responds that he or she is having problems with housing, the survey asks if he or she rents her home.  If the person clicks “Yes,” the survey asks:

Do you have any of the following problems?

  • owner not making repairs
  • heat or air conditioning not working
  • hard to keep mold, buts or rodents away
  • other unsafe conditions

If the survey-taker clicks that “it is hard to keep mold, bugs, or rodents away,” as well as that he or she is at risk of being evicted, the survey will ask if the person would like an attorney to call. The survey also emphasizes that “our services are free.” If the survey-taker responds “No” to the offer of legal services, the survey offers the medical-legal partnership’s phone number and states that the person can call in the future for help, and notes “you can also ask your doctor to refer you.” The survey also includes questions about educational services and family violence that operate in a similar way.

The survey can be taken in English or Spanish. To prevent confusion or distractions, the tablet cannot be used for any other purpose than taking the survey.

Like the Louisville medical-legal partnership, many of the medical-legal partnerships currently operating around the country focus on children. The model can be extremely successful in other contexts as well, however. The New York Times recently profiled the Medical-Legal Partnership for Seniors, a clinic operated jointly by the University of California Hastings College of the Law and the University of California, San Francisco. In the clinic, when a doctor working with an elderly patient realizes he or she has an unmet legal need, the doctor advises the patient to “Go down the hall and see my friends at U.C. Hastings for help.” The law students then help the patient apply for public benefits, obtain home health assistance, write an advance directive, or address whatever legal problem is having a negative impact on his or her health. The students even make house calls.

If you are interested in learning more about how medical-legal partnerships are using technology to help low-income patients, you can contact the National Center for Medical-Legal Partnership. You can also learn more about medical legal partnerships more generally by reading Medical-Legal Partnership: Evolution or Revolution?, co-authored by medical-legal partnership experts from across the country. For a closer look at how one medical-legal partnership helped alleviate the legal needs of low-income kindergartners, read Lucas Caldwell-McMillan’s advocacy story about his medical-legal partnership in St. Louis. And to see how the medical-legal partnership model can work in a mental health context, look at MFY Legal Services’ Mental Health-Legal Partnership.

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