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.

Justice on Wheels in New York and California

In New York City and California, two very different organizations devoted to improving the lives of low-income people are using a common approach to reach underserved populations.

And that approach involves wheels.

New York Legal Assistance Group (NYLAG) provides free civil legal services to New Yorkers who cannot afford attorneys. With 51 intake sites located in courts, hospitals, and community-based organizations in all five boroughs of New York City as well as Westchester and Long Island, NYLAG helps thousands of people every year with legal problems relating to housing, public benefits, domestic violence, education access, and other issues.

OneJustice, by contrast, does not focus on direct client representation. OneJustice is a California nonprofit organization that helps low-income Californians indirectly—by supporting nonprofit legal services organizations and their pro bono partners. More specifically, OneJustice supports a network of 100+ nonprofit legal organizations and 800 staff attorneys with financial leadership, new fundraising strategies, executive coaching, board governance trainings, and more.

Despite these two organizations’ many differences, they both came to the same conclusion a few years ago: they could serve more low-income people if they brought lawyers into more direct contact with the low-income people they wanted to serve. So NYLAG and OneJustice both started thinking about wheels.

NYLAG spent years developing its Mobile Legal Help Center—a 41-foot-long Freightliner truck custom-designed as a fully functioning legal services office. The vehicular office is a partnership between NYLAG and the New York State Courts Access to Justice Program. Not only is the Mobile Legal Help Center a legal services office; a video link to the New York State courts allows judges to preside over emergency hearings in domestic violence and eviction cases. The Mobile Legal Help Center, which launched in January 2012, was an essential component of NYLAG’s Hurricane Sandy response. Storm victims in Red Hook and Coney Island in Brooklyn, the Rockaways in Queens, Staten Island, and Long Island were able to obtain help with FEMA claims, housing, and emergency public benefits quickly and safely, thanks to the Mobile Legal Help Center—even though NYLAG itself was displaced from its Hanover Square office.

OneJustice started its Justice Bus Project in 2007. The project emanated from the realization that low-income rural Californians were suffering from a double bind; they had lots of legal problems—some of them very specialized issues like water access—but very little access to low or no-cost legal assistance. So OneJustice began coordinating Justice Bus trips to bridge the gap between urban pro bono resources and rural and isolated communities that needed help. Often a Justice Bus trip is born when OneJustice contacts a rural legal services organization to discuss its community’s needs, and that conversation sparks an idea for a Justice Bus trip. Substantively, the Justice Bus has handled problems ranging from elder law to economic development. Recently, the Justice Bus traveled more than 600 miles round-trip to help Native American veterans.

Would a mobile component bring a new dimension to your organization’s work? How are these vehicles funded? What are the challenges of staffing them? The answers to these questions and much more can be found in the new issue of Clearinghouse Review, which features articles on the Mobile Legal Help Center and the Justice Bus.