Bridging Health Disparity Gaps through the Use of Medical Legal Partnerships in Patient Care: A Systematic Review

Abstract

Over the past two decades, we have seen an increase in the use of medical-legal partnerships (MLPs) in health-care and/or legal settings to address health disparities affecting vulnerable populations. MLPs increase medical teams' capacity to address social and environmental threats to patients' health, such as unsafe housing conditions, through partnership with legal professionals. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, we systematically reviewed observational studies published from January 1993-January 2016 to investigate the capacity of MLPs to address legal and health disparities. We identified 13 articles for qualitative analysis from an initial pool of 355 records. The resulting pool of 13 articles revealed more information regarding the capacity of MLPs to address legal outcomes than their capacity to address health outcomes; only 4 studies directly addressed the impact of MLP intervention on patient wellbeing and/or patient utilization of healthcare services. We call for further evaluation/longitudinal studies that specifically address MLPs' short and long term effects upon patient health disparities. Finally, given the demonstrated capacity of MLPs to address unmet legal needs, and their evident potential in regards to improving health outcomes, we present the MLP model as a framework to address HIV-related legal and health disparities.

Get full access to this article

View all access options for this article.

References

RWJ Foundation, “What's Law Got to Do With It? How Medical-Legal Partnerships Reduce Barriers to Health,” July 8, 2015, available at <http://www.rwjf.org/en/culture-of-health/2015/07/what_s_law_got_todo.html> (last visited May 30, 2017).

National Center for Medical-Legal Partnership, The Medical-Legal Partnership Toolkit. Phase I: Laying the Groundwork (2014).

RWJ Foundation, “Health Care's Blind Side: The Overlooked Connection between Social Needs and Good Health,” 2011, available at <http://www.rwjf.org/en/library/research/2011/12/health-care-s-blind-side.html> (last visited May 30, 2017).

van Griensven and

R. D.

Stall , “Racial Disparity in HIV Incidence in MSM in the United States: How Can It Be Reduced?” AIDS 28, no. 1 (2014): 129-130; J. M. Ricks, R. A. Crosby, and I. Terrell, “Elevated Sexual Risk Behaviors among Postincarcerated Young African American Males in the South,” American Journal of Men's Health 9, no. (2015): 132-138; N. G. Milburn, M. Lightfoot, and V. C. Rueda, “Challenge of HIV Prevention in Diverse Communities,” in F. T. L. Leong, L. Comas-Díaz, and G. C. Nagayama Hall, and V. C. McLoyd, J. E. Trimble, and F. T. L. Leong et al., eds., APA Handbook of Multicultural Psychology, Vol. 2: Applications and Training (Washington, DC.: American Psychological Association, 2014): at 577-592; P. S. Sullivan, E. S. Rosenberg, T. H. Sanchez, C. F. Kelley, N. Luisi, and H. L. Cooper et al., “Explaining Racial Disparities in HIV Incidence in Black and White Men Who Have Sex with Men in Atlanta, GA: A Prospective Observational Cohort Study,” Annals of Epidemiology 25, no. 6 (2015): 445-454.

CDC, HIV Diagnosis Data Are Estimates from All 50 States, the District of Columbia, and 6 U.S. Dependent Areas. Rates Do Not Include U.S. Dependent Areas (2013).

Id.

Lambda Legal, HIV Stigma and Discrimination in the U.S.: An Evidence-Based Report (2010).

The Center for HIV Law & Policy, Housing Rights of People Living with HIV/AIDS: A Primer (2010).

Miyashita ,

Hasebhush ,

B. D. M.

Wilson ,

Meyer ,

Nezhad , and

Sears , “The Legal Needs of People Living with HIV: Evaluating Access to Justice in Los Angeles,” April 2015, The Williams Institute, available at <http://williamsinstitute.law.ucla.edu/research/health-and-hiv-aids/the-legal-needs-of-people-living-with-hiv-evaluating-access-to-justice-in-los-angeles/#sthash.vv4qN4Bv.dpuf> (last visited May 30, 2017).

10.

Cohen ,

D. F.

Fullerton ,

Retkin ,

Weintraub ,

Tames , and

Brandfield et al., “Medical-Legal Partnership: Collaborating with Lawyers to Identify and Address Health Disparities,” Journal of General Internal Medicine 25, Supp. 2 (May 2010): S136-S139.

11.

E. M.

Lawton and

Sandel , “Medical-Legal Partnerships: Collaborating to Transform Healthcare for Vulnerable Patients: A Symposium Introduction and Overview,” Journal of Legal Medicine 35, no. 1 (2014): 1-6.

12.

Moher ,

Liberati ,

Tetzlaff , and

D. G.

Altman , “Preferred Reporting Items for Systematic Reviews and Meta-analyses: The PRISMA Statement,” International Journal of Surgery 8, no. 5 (2010): 336-341.

13.

National Coalition of Anti-Violence, Anti-lesbian, Gay, Bisexual and Transgender Violence in 2008 (2008).

14.

Hallarman ,

Snow ,

Kapoor ,

Brown ,

Rodabaugh , and

Lawton , “Blueprint for Success: Translating Innovations from the Field of Palliative Medicine to the Medical-Legal Partnership,” Journal of Legal Medicine 35, no. (2014): 179-194; D. Atkins, S. M. Heller, E. DeBartolo, and M. Sandel, “Medical-Legal Partnership and Healthy Start: Integrating Civil Legal Aid Services into Public Health Advocacy,” Journal of Legal Medicine 35, no. 1 (2014): 195-209.

15.

A. F.

Beck ,

M. D.

Klein ,

J. K.

Schaffzin ,

Tallent ,

Gillam ,

R. S.

Kahn , “Identifying and Treating a Substandard Housing Cluster Using a Medical-Legal Partnership,” Pediatrics 130, no. 5 (2012): 831-838; M. D. Klein, A. E. Beck, A. W. Henize, D. S. Parrish, E. E. Fink, and R. S. Kahn, “Doctors and Lawyers Collaborating to Help Children — Outcomes from a Successful Partnership between Professions,” Journal of Health Care for the Poor and Underserved 24, no. 3 (2013):1063-1073; R. Pettignano, L. R. Bliss, S. B. Caley, and S. McLaren, “Can Access to a Medical-Legal Partnership Benefit Patients with Asthma Who Live in an Urban Community?” Journal of Health Care for the Poor & Underserved 24, no. 2 (2013): 706-717; R. Pettignano, S. B. Caley, and L. R. Bliss, “Medical-Legal partnership: Impact on Patients with Sickle Cell Disease,” Pediatrics 128, no. 6 (2011): e1482-e1488; K. J. Rodabaugh, M. Hammond, D. Myszka, and M. Sandel, “A Medical–Legal Partnership as a Component of a Palliative Care Model,” Journal of Palliative Medicine 13, no. 1 (2010): 15-18; D. R. Taylor, B. A. Bernstein, E. Carroll, E. Oquendo, L. Peyton, and L. M. Pachter, “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 26, no. 3 (2015): 676-685; J. A. Teufel, D. Werner, D. Goffinet, W. Thorne, S. L. Brown, and L. Gettinger, “Rural Medical-Legal Partnership and Advocacy: A Three-Year Follow-Up Study,” Journal of Health Care for the Poor and Underserved 23, no. 2 (2012): 705-714.

16.

Sandel ,

Suther ,

Brown ,

Wise , and

Hansen , “The MLP Vital Sign: Assessing and Managing Legal Needs in the Healthcare Setting,” Journal of Legal Medicine 35, no. 1 (2014): 41-56.

17.

S. B.

Fleishman ,

Retkin ,

Brandfield , and

Braun , “The Attorney as the Newest Member of the Cancer Treatment Team,” Journal of Clinical Oncology 24, no. 13 (2006): 2123-2126.

18.

M. M.

O'Sullivan

et al ., “Environmental Improvements Brought by the Legal Interventions in the Homes of Poorly Controlled Inner-city Adult Asthmatic Patients: A Proof-of-Concept Study,” Journal of Asthma 49, no. 9 (2012): 911-917; A. M. Ryan, R. M. Kutob, E. Suther, M. Hansen, and M. Sandel, “Pilot Study of Impact of Medical-Legal Partnership Services on Patients' Perceived Stress and Wellbeing,” Journal of Health Care for the Poor and Underserved 23, no. 4 (2012): 1536-1546; R. Sege, G. Preer, S. J. Morton, H. Cabral, O. Morakinyo, and V. Lee et al., “Medical-Legal Strategies to Improve Infant Health Care: A Randomized Trial,” Pediatrics 136, no. 1 (2015): 97-106; D. Weintraub, M. A. Rodgers, L. Botcheva, A. Loeb, R. Knight, K. Ortega 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 21, no. 2 (2010): 157-168.

19.

See Fleishman et al., supra note 17.

20.

See Weintraub et al., supra note 18.

21.

See Sandel et al., supra note 16.

22.

See Klein et al., supra note 15.

23.

See Pettignano (2013), supra note 15.

24.

See Rodabaugh et al., supra note 15.

25.

See Klein et al., supra note 15.

26.

See Beck et al., supra note 15.

27.

See Pettignano (2013), supra note 15.

28.

See Pettignano (2011), supra note 15.

29.

See Teufel et al., supra note 15.

30.

See Taylor et al., supra note 15.

31.

See Sege et al., supra note 18.

32.

See O'Sullivan et al., supra note 18.

33.

See Weintraub, supra note 18.

34.

See Ryan et al., supra note 18.

35.

See Beck, Klein, and Pettignano (2013), and Pettignano (2011), supra note 18; Taylor et al., supra 15; Sandel et al., supra note 16; Ryan et al. and Sege et al., supra note 18; Taylor et al., supra note 15.

36.

See O'Sullivan et al., supra note 18.

37.

See Rodabaugh et al., supra note 15; Teufel et al., supra note 15.

38.

Id. (Teufel).

39.

Sege ,

Kaplan-Sanoff ,

Morton ,

Velasco-Hodgson ,

Preer , and

Morakinvo et al., “Project DULCE: Strengthening Families through Enhanced Primary Care,” Zero to Three 35, no. 1 (2014): 10-18.

40.

See Sege et al., supra note 18.

41.

See Atkins et al., supra note 14.

42.

See National Coalition of Anti-Violence, supra note 13.

43.

B. R.

Flay ,

F. J.

Snyder , and

Petraitis , “The Theory of Triadic Influence,” in

R. J.

DiClemente ,

R. A.

Crosby , and

M. C.

Kegler , eds., Emerging Theories in Health Promotion, Practice and Research, 2nd ed. (San Francisco, CA: Jossey-Bass, 2009): 451-510.

44.

Ajzen and

B. L.

Driver , “Prediction of Leisure Participation from Behavioral, Normative, and Control Beliefs: An Application of the Theory of Planned Behavior,” Leisure Sciences 13, no. 3 (1991): 185-204.

45.

See Lawton et al., supra note 11; Moher et al., supra note 11; National Coalition, supra note 13; Hallarman, supra note 14; Atkins et al., supra note 14; Beck et al., supra note 15; Klein, supra note 15.

46.

C. A.

Brown and

J. L.

Richard , “The Stepped Wedge Trial Design: A Systematic Review,” BMC Medical Research Methodology 6 (2006): 54-59.

47.

A. T.

Campbell ,

Sicklick ,

Galowitz ,

Retkin , and

S. B.

Fleishman , “How Bioethics Can Enrich Medical-Legal Collaborations,” Journal of Law, Medicine & Ethics 38, no. 4 (2010): 847-862.

48.

See Model Rules of Professional Conduct, at R. 1.7 and 1.9 (2012).

49.

Boumil ,

D. R.

Freitas , and

C. R.

Freitas , “Multidisciplinary Representation of Patients: The Potential for Ethical Issues and Professional Duty Conflicts in the Medical-Legal Partnership Model,” Health Care Law and Policy 13, no. 1 (2010): 107-138.

50.

Mimiaga ,

Biello ,

Robertson ,

Oldenburg ,

Rosenberger , and

O'Cleirigh et al., “High Prevalence of Multiple Syndemic Conditions Associated with Sexual Risk Behavior and HIV Infection among a Large Sample of Spanish- and Portuguese-Speaking Men Who Have Sex with Men in Latin America,” Archives of Sexual Behavior 44, no. 7 (2015): 1869-1878; T. Starks, B. Millar, J. Eggleston, and J. Parsons, “Syndemic Factors Associated with HIV Risk for Gay and Bisexual Men: Comparing Latent Class and Latent Factor Modeling,” AIDS & Behavior 18, no. 11 (2014): 2075-2079, at 5p; C. E. Oldenburg, A. G. Perez-Brumer, and S. L. Reisner, “Poverty Matters: Contextualizing the Syndemic Condition of Psychological Factors and Newly Diagnosed HIV Infection in the United States,” AIDS 28, no. 18 (2014): 2763-2769.