Integrating Medical-Legal Partnerships to address the social determinants of health in primary care clinical practice and training.

Medical-Legal Partnerships (MLP) present an opportunity for medical students, residents and practitioners to develop practical approaches and skills to addressing social determinants of health and to practicing in interdisciplinary teams. This study examines various training models to prepare providers to practice in these settings.

Project Summary

It is estimated that up to 60% of preventable mortality is attributable to socioeconomic conditions (1). Yet, despite the impact of these social determinants of health (SDH), many providers do not feel confident addressing these nonmedical factors (2,3). Health-related social problems are further complicated when they are entangled in federal, state or local policies and laws that require expertise in poverty or administrative law (4). Medical-legal partnerships (MLPs) can bridge the gap between clinical and legal needs by integrating attorneys more generally into the health care setting.

Utilizing MLPs

The first formalized MLP was introduced in 1992,(6) and have since been established in approximately 373 health organizations (7). MLPs vary in structure, but typically incorporate three fundamental components: 1) they provide legal assistance to clients, 2) they transform health and legal institutions, and 3) they achieve policy changes (8). Legal-aid attorneys are uniquely suited to aid patients due to their in-depth knowledge of how federal, state and local policies affect patients’ ability to access health and public benefits (9). MLPs function by integrating lawyers trained in poverty law into health care teams to address patients’ social and legal needs in a clinical setting (10). Various MLP programs across the U.S. have demonstrated that they are a promising mechanism to effectively address SDH and may improve patient health (8). However, as the integration of MLPs in clinical settings continues to grow, there is a need to develop empirical evidence to support the expansion of the model and to understand the components that contribute to programs’ successes.

At NCEAS, we are conducting a collaborative, scoping review of the current workforce needs to determine what key information providers and lawyers should know in order to effectively utilize MLPs.

Supporting Literature:

  1. Organization WH. A conceptual framework for action on the social determinants of health. 2010.
  2. Schroeder SA. We can do better—improving the health of the American people. New England Journal of Medicine. 2007;357(12):1221-1228.
  3. Goldstein DHJ. 2011 Physicians’ Daily Life Report: Robert Wood Johnson Foundation; 2011
  4. The Need. (n.d.). Retrieved April 27, 2018, from
    Sandel, M., Hansen, M., Kahn, R., Lawton, E., Paul, E., Parker, V., … & Zuckerman, B. (2010). Medical-legal partnerships: transforming primary care by addressing the legal needs of vulnerable populations. Health Affairs, 29(9), 1697-1705. Zuckerman B,
  5. Sandel M, Lawton E, Morton S. Medical-legal partnerships: transforming health care. Lancet. 2008;372:1615–7
  6. Partnerships Across the U.S. (n.d.). Retrieved April 27, 2018, from
  7. Beeson, T., McAllister, B. D., & Regenstein, M. (2013). Making the case for medical-legal partnerships: A review of the evidence. White Paper.
  8. Regenstein, M., Trott, J., & Williamson, A. (2017). The State of the Medical-Legal Partnership Field: Findings from the 2015 National Center for Medical-Legal Partnership Surveys.
  9. Paul, E. G., Curran, M., & Tyler, E. T. (2017). The medical–legal partnership approach to teaching social determinants of health and structural competency in residency programs. Academic Medicine, 92(3), 292-298.
  10. McCabe, H. A., & Kinney, E. D. (2010). Medical legal partnerships: a key strategy for addressing social determinants of health.

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