Medical-Legal Partnership Intervention for Preventing Veteran Homelessness

Recruiting in Palo Alto (17 mi)

Overseen by Marc I. Rosen, MD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: VA Office of Research and Development

Disqualifiers: Conservator assigned, Moving away, Others

No Placebo Group

Approved in 1 Jurisdiction

Trial Summary

What is the purpose of this trial?

The legal team in medical-legal partnerships works with healthcare providers to improve their clients' lives. It is unknown whether this approach is better than providing usual legal services, with no special emphasis on non-legal matters and no particular collaboration with healthcare providers. The investigators propose to randomly assign 300 Veterans with housing-related legal problems to either legal help from a medical-legal partnership or help from lawyers in the community. The investigators will follow the randomized Veterans in this study for one year to determine if there is a difference between the two groups of Veterans in their housing situations and their mental health. The investigators will also interview Veterans in both groups about their experience of the legal services they have received.

Will I have to stop taking my current medications?

The trial protocol does not specify whether participants must stop taking their current medications. It seems unlikely that you would need to stop, as the study focuses on legal services rather than medical treatment.

What data supports the effectiveness of the treatment Medical-legal partnership for preventing veteran homelessness?

Research shows that Medical-legal partnerships (MLPs) can improve health outcomes by addressing legal issues that affect health, such as housing and income. In Colorado, MLPs led to improvements in health care experiences and reduced stress, while in North Carolina, they successfully resolved legal cases that contributed to better health and financial outcomes. ^{1 2 3 4 5}

How is the Medical-legal partnership treatment different from other treatments for preventing veteran homelessness?

Medical-legal partnerships (MLPs) are unique because they integrate lawyers into healthcare teams to address legal issues that affect health, such as housing and benefits, which are not typically addressed by traditional medical treatments. This approach focuses on the social factors that contribute to health problems, offering a comprehensive solution that combines legal and medical support. ^{3 4 5 6 7}

Eligibility Criteria

This trial is for Veterans engaged in VA mental health or homeless programs, with an income at or below 200% of the federal poverty level, and facing housing-related legal issues. It's not for those under conservatorship, already getting help from Connecticut Veterans Legal Program, or unable to complete follow-up assessments.

Inclusion Criteria

Able to provide informed consent

Engaged in a VA mental health or homeless program

Has a legal problem related to housing (e.g., eviction, rent arrears, housing violation)

Exclusion Criteria

Already receiving civil legal aid from Connecticut Veterans Legal Program

I can attend all required follow-up assessments.

I have a legal guardian assigned to make decisions for me.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either the MLP intervention or referral to pro-bono lawyers for housing-related legal issues

12 months

Initial in-person and subsequent in-person interviews, phone discussions, and formal hearings

Follow-up

Participants are monitored for housing status and mental health outcomes

12 months

Interviews at 3-month and 6-month follow-ups

Qualitative Interviews

Participants are interviewed about their experiences with the legal interventions

6 months

2 interviews per participant

Treatment Details

Interventions

• Medical-legal partnership (Behavioral Intervention)
• Referral to pro-bono lawyer (Behavioral Intervention)

Trial Overview The study compares two types of legal assistance: one through a medical-legal partnership that collaborates with healthcare providers and another through usual community lawyers. The goal is to see which better improves housing stability and mental health over a year.

Participant Groups

Group I: Medical-legal partnership Experimental Treatment 1 Intervention

Treatment group will receive the MLP intervention through the Connecticut Veterans Legal Center in partnership with the VA Connecticut Healthcare System. The MLP intervention can be categorized into seven activity components: initial in-person and subsequent in-person interviews; discussions with clients by phone; research and review of relevant documents; consultations with clinicians or other attorneys; interactions with opposing parties; time appearing at formal hearings; and travel time.

Group II: Referral to pro-bono lawyer Active Control 1 Intervention

Control group will receive outside legal aid, i.e., control participants will be referred to pro-bono lawyers in the state.

Medical-legal partnership is already approved in United States for the following indications:

🇺🇸 Approved in United States as Medical-legal partnerships for:

• Preventing evictions and homelessness among veterans
• Addressing housing-related legal issues
• Improving mental health outcomes

Find a Clinic Near You

Research Locations Nearby Select from list below to view details:

VA Connecticut Healthcare System West Haven Campus, West Haven, CT West Haven, CT

Who Is Running the Clinical Trial?

VA Office of Research and Development Lead Sponsor

Connecticut Veterans Legal Center Collaborator

References

1. United States pubmed.ncbi.nlm.nih.gov

Improving Health Outcomes in Vulnerable Populations: The Medical-Legal Partnership-Colorado's Experience. [2022] Medical-legal partnerships (MLPs) add legal professionals, trained specifically to tackle health-related social needs (HRSN), to the health care team. We evaluated the impact on health outcomes and health care utilization of a MLP housed in a large federally qualified health center in Colorado (MLP-CO). Clients screened for I-HELP (Income, Housing, Employment, Legal status, Personal stability) needs were surveyed at baseline and six months post-enrollment. Reasons for legal aid were legal immigration status (46.5%), income (30.8%), personal/family stability (14.8%), housing (4.8%), and education (1.2%). Overall, 61.4% attributed great/moderate improvements in their health care experience to the MLP-CO. Statistically significant improvements were noted for days with poor physical/mental health, and feelings of stress/worry. There was a reduction in emergency department visits, hospitalization days, and missed appointments, but only the latter was statistically significant. In conclusion, MLPs are a promising innovation to achieve the Institute for Healthcare Improvement's quadruple aim.

2. United States pubmed.ncbi.nlm.nih.gov

Better Together: A Descriptive Analysis of a Medical-Legal Partnership in Western North Carolina. [2023] BACKGROUND The medical-legal partnership (MLP) is an innovative and proven-effective approach to addressing health-harming social needs that have legal remedies (e.g., housing concerns, intimate partner violence). Yet, few MLPs exist within outpatient primary care practices and in rural settings.METHODS We describe the impact of an MLP between Pisgah Legal Services and the Mountain Area Health Education Center, which serves rural North Carolina counties, over a 24-month period.RESULTS Overall, 629 cases were referred to the MLP. Three hundred seventy cases were opened and investigated by a lawyer. Three hundred sixty-four cases were closed (i.e., a resolution was reached), yielding 808 outcomes, with an average of 2.2 outcomes per case. Domestic violence/family law and housing were the main socio-legal concerns addressed by the MLP. Eighty-six (24%) of cases included at least 1 representation outcome; the success rate in representation cases was 90%.LIMITATIONS We did not examine the impact of the MLP on patient health outcomes, nor did we have comparative outcomes data for similar individuals with unmet social needs but who did not receive MLP services.CONCLUSIONS The MLP was successful in helping to address multiple social needs faced by patients that contribute to worse health status and outcomes. Monetary benefits to patients were $309,902 plus an additional $174,733 from tax returns and the Earned Income Tax Credit. The MLP lawyer provided education and training to support clinicians, learners, and community organizations. These data highlight the benefits of collaboration between health professionals and lawyers in advancing equity by addressing unmet social needs.

3. England pubmed.ncbi.nlm.nih.gov

Medical-Legal Partnership: Lessons from Five Diverse MLPs in New Haven, Connecticut. [2020] This article examines five different Medical-Legal Partnerships (MLPs) associated with Yale Law School in New Haven, Connecticut to illustrate how MLP addresses the social determinants of poor health. These MLPs address varied and distinct health and legal needs of unique patient populations, including: 1) children; 2) immigrants; 3) formerly incarcerated individuals; 4) patients with cancer in palliative care; and 5) veterans. The article charts a research agenda to create the evidence base for quality and evaluation metrics, capacity building, sustainability, and best practices; it also focuses specifically on a research agenda that identifies the value of the lawyers in MLP. Such a focus on the "L" has been lacking and is overdue.

4. United States pubmed.ncbi.nlm.nih.gov

Partnerships Between Health Care and Legal Providers in the Veterans Health Administration. [2022] Medical-legal partnerships (MLPs) represent an innovative service model in which lawyers are integrated into health care teams to address diverse legal problems that affect vulnerable populations. The Veterans Health Administration (VHA) operates the largest safety-net health care system in the country and serves many low-income and disabled veterans who could benefit from MLP services. In this column, the authors describe the development and operations of MLPs at four VHA medical centers that serve veterans who are homeless or who have serious mental illness. The authors also briefly report on the characteristics of 700 veterans served by these MLPs from 2014 to 2016. MLPs can fit within the interdisciplinary, comprehensive system of care provided by VHA, and they offer opportunities to expand VHA-community partnerships to address social determinants of health.

5. United States pubmed.ncbi.nlm.nih.gov

Pilot study of impact of medical-legal partnership services on patients' perceived stress and wellbeing. [2013] Medical-legal partnerships (MLPs) bring legal services into health care settings to address patients' unmet legal needs. This pilot project examined whether MLP services impact patients' perceptions of stress and wellbeing.

6. United States pubmed.ncbi.nlm.nih.gov

Interprofessional Education in Medical-Legal Partnerships (MLPs) to Address Social Determinants of Health. [2021] Medical-legal partnerships (MLP) address legal needs that contribute to health inequities. Health providers express discomfort accessing legal services and a desire for greater training, however best practices remain unclear.

7. United States pubmed.ncbi.nlm.nih.gov

Evaluating the Efficacy of Medical-Legal Partnerships that Address Social Determinants of Health. [2022] Medical-legal partnerships (MLPs) are health system-community partnerships composed of multi-disciplinary teams designed to improve patient and community health. MLPs provide legal services to address health-harming legal needs that contribute to health inequities.