Rochelle Wong, BS1,2, Rohini Chakravarthy, BA1,2, Allison Jones, JD3, Chay Sengkhounmany, JD4, Shannon Jordan, LMSW1, Robert F. Miller, MD1,2, 1) Shade Tree Clinic, Nashville, TN, 2) Vanderbilt University School of Medicine, Nashville, TN, 3) Legal Aid Society, Nashville, TN, 4) Sengkhounmany Law, Murfreesboro, TN
Unmet civil legal needs have a negative impact on overall health. 86% of civil legal needs remain unaddressed because legal services are limited. The medical-legal partnership (MLP) was created to better address the connection between poverty and poor health. Shade Tree Clinic (STC) is a student-run primary care clinic that serves as a free, comprehensive medical home for 380 uninsured patients and exposes future healthcare professionals to the MLP model early in their careers. Legal issues are common at STC due to limited access to resources and services. Our MLP program aimed to create a sustainable and effective means of identifying and addressing legal needs among STC patients.
The Shade Tree Social Work Department addresses the social determinants impacting the health of our patients. Ten medical student and nine law student volunteers work alongside a licensed social worker and two attorneys to connect patients with community resources and provide brief annual screenings for social and legal needs.
STC partnered with Legal Aid Society of Middle Tennessee and the Cumberlands to provide free legal services to low-income Tennessee residents. STC also works with Vanderbilt University Law School to bring law students to clinic when a licensed attorney is not available. Law students use a screening tool developed by the Tennessee Alliance for Legal Services to capture patients' civil legal needs and connect them to appropriate resources.
Legal didactic trainings were also provided as supplemental components of the medical and law school curriculum to improve legal literacy.
Between 2016-2017, of the 261 patients seen by STC social work volunteers, 65 patients (25%) had an unmet legal need identified. Of those, 54 cases were opened by Legal Aid Society. 20 cases were lost to follow-up or ineligible for services due to documentation status. 21 received advice, 5 received brief services, 2 were decided by an administrative agency, and 6 were ongoing. The majority of cases were social security or food stamp appeals, housing disputes, and immigration counseling.
From the didactic portion of the model, 100% of the 37 students and volunteers who received trainings said they had a better understanding of the legal issues patients face. 95% plan to use what they learned in their medical or legal practice.
There is a large need for legal services among low-income and uninsured patients seen at student-run free clinics. Our MLP model has been successful in providing a service that is financially inaccessible to most our patients, as well as improving legal literacy of future providers and attorneys.
Next steps include investigating the success rate of opened cases and obtaining qualitative data of patient satisfaction with legal aid services. Our data suggests the importance of utilizing funds to aid in establishing medical-legal partnerships.
Zuckerman, B., Sandel, M., Lawton, E., & Morton, S. (2008). Medical-legal partnerships: transforming health care. The Lancet, 372(9650), 1615-1617.
Legal Services Corporation. The Justice Gap: Measuring the Unmet Civil Legal Needs of Low-income Americans [Internet]. Washington (DC): The Corporation; 2017 Jun [cited 2017 Nov 10]. Available from: https://www.lsc.gov/sites/default/files/images/TheJusticeGap-FullReport.pdf
Fleishman, S. B., Retkin, R., Brandfield, J., & Braun, V. (2006). The attorney as the newest member of the cancer treatment team. Journal of Clinical Oncology, 24(13), 2123-2126.
Weintraub, D., Rodgers, M. A., Botcheva, L., Loeb, A., Knight, R., Ortega, K., ... & Huffman, L. (2010). Pilot study of medical-legal partnership to address social and legal needs of patients. Journal of Health Care for the Poor and Underserved, 21(2), 157-168.
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