Better Health through Partnership

Medical-legal partnerships are present within 333 health organizations in 42 states in the U.S. The realization of their importance in addressing the social determinants of health has led to questions of how to best develop an effective and sustainable partnership. We spoke with the National Center for Medical Legal Partnership Co-Director, Ellen Lawton, to discuss the future of education at the intersection of health and legal aid.

An osteologist, pathologist, historian, costume specialist, and genealogist walk into a bar… This is the motley crew that congregated when a particular archeological case needed analyzing. They met in the Smithsonian National Museum of Natural History, not a bar, and gathered around a rare, cast iron coffin excavated from an unknown, unmarked grave from a private, 19^th century cemetery. A single specialist might have been able to create a laundry list of observations about skeletal remains in an old coffin, but only a collaborative effort between several professionals were the observations puzzled together in a way that created a fully illustrated profile of the mystery man. Their shared contributions transformed disjointed evidence into the profile of Isaac Newton Mason, a wealthy man from Pulaski Tennessee, experienced equestrian and a private in the First Tennessee Confederate Cavalry Regiment who died in April or May of 1862 at the age of 35 due to injuries from an incident that occurred in Iuka, Mississippi.¹

Gaining insight from other fields of expertise is an integral part of archaeological work. Other professionals’ voices add perspective to the conversation, helping to highlight nuances in clues that allow for a more accurate, complete picture of the story behind the subject. The same can be said about a medical-legal partnership (MLP). When legal and medical professionals collaborate, they gain a new understanding of the patient, one that allows for a more holistic view of their health based on their life outside of the clinic walls. A doctor’s visit transforms into advocacy for improved housing conditions, changing of child custody to meet qualifications for a pediatric organ transplant, or assisting an individual to escape her abusive spouse. The growing recognition of their importance in addressing the social determinants of health, MLPs are becoming increasingly common. According to the National Center for Medical Legal Partnership (NCMLP), 333 health organizations have implemented MLPs in 46 states.² Lagging behind their emerging prevalence, however, is the shift in mindset that needs to occur in order to fully realize an MLP’s potential.

In late September, part of the NCEAS team spoke with Ellen Lawton, Co-Director of the NCMLP, to learn about the current gaps in MLP research. When commenting on when MLP education should be most ideally introduced, she highlighted undergraduate medical school while qualifying this idea as “revolutionary.” MLPs are still seen as auxiliary, optional components of healthcare delivery, and thus they are not deemed essential components in medical school curriculum. Many teaching hospitals with MLPs allow exposure to medical students in the clinic. Health Law Partnership (HeLP), for example, a collaboration between Children’s Healthcare of Atlanta, Georgia State University College of Law, and the Atlanta Legal Aid society encourages medical residents and students to participate in the MLP and witness the effects of legal aid on health firsthand.³ Moreover, many MLP programs such as Cincinnati Children’s Hospital incorporate Residency training into the program,⁴ but do not have a structured curriculum for medical students.

On the legal side of the coin, educational preparation for an MLP is similarly minimal. Many law schools such as Georgetown University, Yale University, and Loyola University Chicago take part in MLPs and offer experiential opportunities to students, but health law courses in the classroom typically focus less on the social determinant analyzing insurance coverage, disparities in access to care, and federal approach to reform. Lawton expressed that what is lacking from law classes is the presentation of a “preventative-strategy mindset.” She explained that on the civil side of the legal aid community there is such a strong emphasis on gaining courtroom experience, that little effort is dedicated to preventing the need to be on the court steps in the first place

Upstream work in the area of legal aid has been localized mostly to JD/MPH programs. Beyond these dual degree programs, law schools may eventually develop a Social Determinants of Health track for students particularly interested in preventative law and MLPs. As most important to the future of MLPs, Lawton emphasized the need for cross-sectional understanding. Legal and medical professionals must converse and learn about each other’s priorities, resources, and operations to promote smooth collaboration. Many health professionals cannot explain the difference between civil and criminal law, while similarly lawyers struggle to assign meaning to the terms chronic and acute. Combined classes with both law and medical students could be an opportunity to introduce interdisciplinary discussion early.

References

1. Owsley, Douglas W., et al. “The Man in the Iron Coffin: An Interdisciplinary Effort to Name the Past.” SpringerLink, Springer International Publishing, 19 Oct. 2016, link.springer.com/article/10.1007/BF03376735
2. https://medical-legalpartnership.org/
3. Dolin, Gregory, and Natalie Ram. “One Model of Collaborative Learning for Medical and Law Students at the University of Baltimore and Johns Hopkins University.” Journal of Ethics | American Medical Association, American Medical Association, 1 Mar. 2016, journalofethics.ama-assn.org/article/one-model-collaborative-learning-medical-and-law-students-university-baltimore-and-johns-hopkins/2016-03.
4. Klein, Melissa D., Robert S. Kahn, Raymond C. Baker, Elaine E. Fink, Donita S. Parrish, and Deanna C. White. “Training in social determinants of health in primary care: does it change resident behavior?.” Academic pediatrics 11, no. 5 (2011): 387-393.

-Mary Cormier, NCEAS Intern

*Mary is a junior at Northwestern University studying neuroscience and anthropology. She is passionate about health equity, humanitarian design, and the power of ongoing education to combat injustice.