Medical-Legal Partnership/Boston
Adverse social circumstances continue to have a dramatic, negative impact on the health of vulnerable populations. Medicine alone cannot solve the health problems of those who struggle daily with material hardships that lead to eviction and other legal outcomes. Medical-legal partnership is a healthcare delivery model that integrates legal assistance as a vital component of patient care. Just as a healthcare provider refers a patient to a cardiologist for a heart murmur, a healthcare provider can refer a patient to an on-site attorney when an underlying social circumstance impairing a patient’s health is detected. MLP presents a compelling opportunity to leverage existing health and legal resources in order to create a new standard of care for vulnerable people.
About You
About You
First Name
Samantha
Last Name
Morton
Facebook Profile
About Your Organization
Organization Name
Medical-Legal Partnership | Boston at Boston Medical Center
Organization Website
Organization Phone
617-414-5574
Organization Address
801 Massachusetts Avenue, 1st Floor, Boston, MA 02118
Organization Country
United States, MA, Suffolk County
Country where this project is creating social impact
United States, MA, Suffolk County
Is your organization a
Non‐profit/NGO/citizen sector organization
How long has your organization been operating?
More than 5 years
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Innovation
Entry Form title
Medical-Legal Partnership/Boston
What change do you want to bring to the world?
Adverse social circumstances continue to have a dramatic, negative impact on the health of vulnerable populations. Medicine alone cannot solve the health problems of those who struggle daily with material hardships that lead to eviction and other legal outcomes. Medical-legal partnership is a healthcare delivery model that integrates legal assistance as a vital component of patient care. Just as a healthcare provider refers a patient to a cardiologist for a heart murmur, a healthcare provider can refer a patient to an on-site attorney when an underlying social circumstance impairing a patient’s health is detected. MLP presents a compelling opportunity to leverage existing health and legal resources in order to create a new standard of care for vulnerable people.
What are the primary activities of your project?
Because legal determinants of health are among the most serious, ubiquitous, and solvable social barriers to patient health and well-being, and because it is unrealistic in our current system to supply an affordable lawyer for every low-income patient, Medical-Legal Partnership | Boston – the Founding Site of the MLP Network – focuses on core activities that, in complementary ways, promote legal problem solving for vulnerable patients. These activities can positively impact not only access to justice, but also a range of health-related domains including health disparities, patient health and well-being, clinical workforce capacity, and cost-benefit/cost reduction: (1) legal assistance for patients on-site in the health care setting on a range of basic needs legal issues, (2) capacity-building within healthcare teams (including collaborative planning, reciprocal training, automation of screening and referral processes, and deployment of advocacy toolkits for providers), and (3) policy change, MLP | Boston represents the deepest integration of legal staff on a healthcare team, and as such is especially nimble in responding to trends and goals as a laboratory for best practices.
What is innovative about your initiative? How is it a new contribution to the field?
Traditional healthcare and legal services treat vulnerable populations in isolation from each other. On both sides, people living in low-income communities often fall through the cracks. Many patients suffer from preventable illnesses, frequently exacerbated by unaddressed legal problems. To address this, MLP bridges the divide to offer individuals and families the comprehensive care they need. In two key domains, the MLP model transforms the prevailing model. The prevailing model of legal assistance reflects that (a) Service is crisis-driven; (b) Individuals are responsible for seeking legal assistance; (c) the Primary pursuit is justice; the MLP model of legal assistance demands that (a) Service is preventive, focuses on early identification of and response to legal needs; (b) Healthcare teams work with patients to identify legal needs and makes referrals for assistance; and (c) Aims include improved health and well-being. The prevailing model of healthcare suggests that (a) Adverse social conditions affect patient health but are difficult to address; (b) Healthcare teams should refer patients to social workers/case managers for limited assistance; and (c) Advocacy skills are valued, taught and deployed inconsistently. In contrast, an MLP healthcare delivery system insists that (a) Adverse social conditions with legal remedies are identified and addressed as part of care; (b) Healthcare, social work and legal teams work together to address legal needs, improve health and change systems; and (c) Advocacy skills are prioritized as part of the standard of care.
What stage is your project in?
Operating for more than 5 years
Tell us about the community that you engage? eg. economic conditions, political structures, norms and values, demographic trends, history, and experience with engagement efforts.
MLP | Boston’s clients reflect the demographics of the patients treated at our healthcare partner sites, which collectively serve a high volume of low-income residents of Boston. The overwhelming majority of patient-families receiving medical care at these sites live with incomes falling under (and often well under) 200% of the Federal Poverty Level (FPL). Over half of our clients are immigrants (Haitian, Latino, Vietnamese, Cape Verdean, African, and Caribbean, in particular) and are low-literacy and/or non-English speaking, or speak English as a second language. The majority of children in families served by MLP | Boston have some disability or chronic illness; close to 50% of that group has asthma or a mental health issue. MLP | Boston prioritizes serving families whose household income is less than or equal to 200% of the FPL. While MLP | Boston does not have strict geographic guidelines, our clients typically live in the Greater Boston area (predominantly Suffolk County).
Share the story of the founder and what inspired the founder to start this project
With origins in the early vision of Harvard Law School and Harvard Medical School leaders Gary Bellow and JudyAnn Bigby, MLP | Boston was founded at New England’s largest safety net hospital, Boston City Hospital (later renamed Boston Medical Center, or BMC). Dr. Barry Zuckerman, Chief of Pediatrics at BMC, grew frustrated by watching his young patients fail to make clinical progress as a result of substandard housing, food insecurity, and other social determinants of health. Dr. Zuckerman hired a part-time attorney (supplied by Greater Boston Legal Services) directly into the Pediatrics Department to address his patients’ unmet needs for housing, food, and safety. Over the next 12 years, this program (initially called the Family Advocacy Program) evolved into a team of multiple lawyers, paralegals, and pediatricians; by 2005, the team was serving hundreds of patient-families annually both at BMC and at 3 BMC-affiliated community health centers. Following a 2001 New York Times article about the program, then-Executive Director Ellen Lawton and then-Medical Director Lauren Smith found themselves informally providing technical assistance to scores of health care institutions and legal services programs around the country who were hungry to establish medical-legal partnerships (MLPs) in their communities. Today, the model that was born at Boston Medical Center in the form of the program that is now know as Medical-Legal Partnership | Boston has spawned replication of MLP in over 230 healthcare institutions across the country.
Social Impact
This Entry is about (Issues)
Please describe how your project has been successful and how that success is measured
We measure MLP | Boston’s success through a number of metrics, including: Improved Patient Health and Well-Being. Our case records indicate that asthmatic children whose families receive our housing advocacy services are hospitalized less frequently after being connected to our services. Moreover, our utility service advocacy campaign culminated in amendments to state utility shut-off protection regulations that made the process more consumer-friendly. Enhanced Clinical Workforce. After introducing a multi-tiered utility service advocacy campaign within BMC Pediatrics, we documented a 300% increase in provider execution of shut-off protection letters – protecting financially and medically eligible patients from having their heat and lights shut off – over the course of just one year. Enhanced Institutional Revenue. Our health insurance advocacy for low-income patients (especially immigrants and domestic violence survivors) not only promotes healthcare access for those vulnerable patients, but also increases insurance reimbursements accruing to the institution. Replication. In 2003, MLP | Boston served patients treated at 1 hospital and three health centers. Today, just eight years later, we serve 3 hospitals and six health centers, and are fielding proposal requests from 5+ other potential institutional partners.
How many people have been impacted by your project?
More than 10,000
How many people could be impacted by your project in the next three years?
More than 10,000
Winning entries present a strong plan for how they will achieve growth. Identify your six-month milestone for growing your impact
Task 1
Secure one new healthcare institution partner.
Task 2
Disseminate a new EMR-based advocacy toolkit to providers treating patients at our 10 healthcare partner sites.
Task 3
Intensify health insurance advocacy to respond to changing healthcare and coverage landscape
Identify your 12-month impact milestone
Task 1
Collect and analyze data regarding improved patient health and well-being, enhanced revenue, and enhanced multi-disciplinary workforce.
Task 2
Launch web-based interactive tool to guide providers in supporting SSI disability applications submitted by eligible patients. As a federal law, this innovation can be replicated nationally.
Task 3
Serve vulnerable patients treated at a total of 12 healthcare institutions in Greater Boston
How will your project evolve over the next three years?
Over the next three years, our program will make a dramatic shift toward population-level impact. While we always will ground our work in direct legal assistance to individuals and patient-families, our task is to wield a bulldozer instead of a teaspoon. Three years from now, two-thirds of our program’s time will be dedicated to Capacity-Building (transforming cultural and professional norms in healthcare to integrate screening of and responses to unmet legal needs affecting health) and Policy Change (raising the healthcare voice to efforts to support health-promoting legislation and policy impacting vulnerable populations. We also will increasingly focus on serving chronic disease populations, for whom the connections between unmet legal needs and health outcome are most direct.
Sustainability
What barriers might hinder the success of your project and how do you plan to overcome them?
Expanding and deepening the MLP | Boston “footprint” will involve surmounting a number of key challenges. First, we must convince healthcare partners to engage in cost-sharing to support the programs. We are optimistic that as our research data accumulates (especially regarding improved patient health and well-being and enhanced revenue), institutions will be open to this type of arrangement. Indeed, we already have secured direct investment from a number of our current healthcare partners. Second, we must continue to support healthcare teams (especially physicians) in re-understanding their roles with respect to patients’ unmet legal needs. We again are optimistic since our MLP curriculum now is formally integrated not only into the Boston University of Medicine Pediatrics residency program, but also into the medical school program. We are helping to redefine how physicians view themselves during their earliest moments of professional development. Third, we must be vigilant in our quest to shift resources to population-level impact work, as opposed to individual-level impact work. Given the dismal (and in fact worsening) ratio of available legal services resources to individuals and families in need of legal support, it is natural that a team would feel drawn to responding to the needs of individuals and families as much as possible. We expect that as population-level successes begin to amass, this challenge will become easier to navigate.
Tell us about your partnerships
MLP | Boston services are integrated at the following nine healthcare institutions:(1) Boston Medical Center; (2) Children’s Hospital Boston; (3) Codman Square Health Center; (4) Dana-Farber Cancer Institute; (5) Dorchester House Multi-Service Center (via a partnership with Ropes & Gray); (6) East Boston Neighborhood Health Center (via a partnership with Day Pitney); (7) South Boston Community Health Center (via a partnership with Foley Hoag); (8) South End Community Health Center (via a partnership with Holland & Knight); and (9) Upham’s Corner Health Center. We currently have 18 law firm and in-house pro bono partners who supply millions of dollars worth of legal services to our clients annually. Especially as the economy continues to suffer and low-income people bear the brunt of the impact, MLP | Boston relies heavily on the network of services and support that our colleagues at Massachusetts’ legal services organizations provide; these partners serve the needs of low-income clients facing a constellation of poverty-related crises that even the most vigorous preventive advocacy cannot eliminate. Key partners include the Fair Housing Center of Greater Boston; Health Law Advocates; Massachusetts Justice Project and Legal Assistance Corporation of Central Massachusetts (now together known as Community Legal Aid); Massachusetts Law Reform Institute; the National Consumer Law Center.
Current annual budget of project, in US dollars
More than $1 million
Explain your selections
Historically, MLP | Boston has been funded through philanthropy (individuals and foundations), federal and state grants, and in-kind support from Boston Medical Center and our panel of legal sector pro bono partners. In 2010, we concluded a rigorous business planning process and now are focused on two key sustainability strategies: (1) expansion of service coverage to vulnerable adult patient populations and related medical disciplines; and (2) increasing our contractual revenue streams, such as investment from healthcare institutional partners, health care recovery dollars strategies, and more. We are experiencing momentum with respect to both strategies; currently service proposals are pending before over five healthcare institutions and departments which specifically invited them.
How do you plan to strengthen your project in the next three years?
We are focused on strengthening MLP | Boston over the next three years in the following ways: (1) increasing cost-sharing among our healthcare institution partners; (2) increasing the level of engagement by our pro bono law firm and in-house partners in order to build more capacity for case handling and policy change in particular; (3) systematizing dissemination of (and tracking of utilization of) our advocacy training and toolkit curricula through existing and new technologies and media; (4) integrating research and evaluation activity into every aspect of our service delivery; and (5) expanding our service delivery to public health programs (in addition to but distinguished from clinical programs) in furtherance of our efforts to ensure MLP is a public health intervention
Challenges
Which barriers to health and well-being does your innovation address?
Please select up to three in order of relevancy to your project.
PRIMARY
Limited access to preventative tools or resources
SECONDARY
Restrictive cultural norms
TERTIARY
Lack of access to targeted health information and education
Please describe how your innovation specifically tackles the barriers listed above.
MLP | Boston eliminates these barriers by (a) strengthening the patient-centered medical home by responding to an important (and historically unaddressed) health and well-being domain – unmet legal needs; (b) expanding the definition a healthcare team to include legal staff with expertise in issues affecting low-income patients; (c) supporting healthcare teams in screening for, identifying, and referring their patients’ unmet legal needs, before those legal needs convert into legal crises and medical emergencies; and (d) teaching physicians and their clinical partners that legal needs must be a part of the taking of a social history, and that they have a role to play in advancing successful legal advocacy for vulnerable patients (especially where compelling medical evidence is required).
How are you growing the impact of your organization or initiative?
Please select up to three potential pathways in order of relevancy to you.
PRIMARY
Grown geographic reach: Global
SECONDARY
Influenced other organizations and institutions through the spread of best practices
TERTIARY
Leveraged technology
Please describe which of your growth activities are current or planned for the immediate future.
MLP,conceived and innovated at BMC through MLP|Boston,is on the cusp of becoming an international healthcare phenomenon. Programs have emerged in Russia, Australia, South Africa and other countries in response to specific health realities in those regions. We look forward to supporting–through engagement with the MLP Network and the National Center for MLP Partnership–expansion of the model across the globe. We will systemically make advocacy training curricula and toolkits available to sister sites through our website and other venues.To this end, we will engage in a technology review to determine the best mechanisms through which to export learning.For example, currently we are exploring mobile phone applications that will make MLP tip sheets available to medical residents in real time.
Do you collaborate with any of the following: (Check all that apply)
NGOs/Nonprofits, For profit companies, Academia/universities.
If yes, how have these collaborations helped your innovation to succeed?
Government collaborations (several federal, state, and local government partnerships) are helping us to better analyze and understand our role in health disparities reduction and health equity. Non-profit partners expand case handling capacity for our patient-clients, as well as enhance our policy change capacity where another agency is coordinating a coalition-wide effort. Pro bono partnerships with private sector firms and in-house departments have exponentially transformed our direct legal assistance and policy change bandwidth. Academic collaborations, such as our formal integration into the Boston University School of Medicine medical student and residency curricula, are supporting the “revisioning” of what it means to be a physician and a lawyer in our society.
 | 35 weeks agoSamantha Morton updated this Competition Entry. |
| 36 weeks agoSamantha Morton updated this Competition Entry. |
| 36 weeks agoSamantha Morton updated this Competition Entry. |
| 36 weeks agoSamantha Morton submitted this idea. |
