MLP: Innovative Collaboration in a New Healthcare Environment (APHA 2013)

• 1. MEDICAL-LEGAL PARTNERSHIP: INNOVATIVE COLLABORATION IN A NEW HEALTHCARE ENVIRONMENT Shannon Mace Heller, JD, MPH 141st Annual APHA Meeting 6 November 2013 Boston, MA

2. Presenter Disclosures The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Shannon Mace Heller No relationships to disclose 3. What is Medical-Legal Partnership? MLP is a healthcare delivery model that integrates legal assistance as a vital component of patient care. MLPs 3 key activities transform the delivery of health and legal services and improve health and well-being for Americas most vulnerable 4. The Affordable Care Act: Transforming health care system Patient Centered Medical Homes (PCMH) Health Homes Accountable Care Organizations Establishment of National Quality Measures Established the Patient Centered Outcomes Research Institute (PCORI) Health Information Technology Innovation grant funding 5. Health Home Team with Medical-Legal Partnership Mental Health Provider Attorney Primary Care Provider Substance Abuse Treatment Program Inpatient/ Hospital ED Urgent Care Community & Social supports Medical Specialists 6. Health, Education and Legal Assistance Project:A Medical-Legal Partnership (HELP: MLP) Partners: Crozer-Keystone Healthy Start Crozer-Keystone Nurse Family Partnership Widener University School of Law One of three national Healthy Start project demonstration grantees (HRSAs MCH Bureau) 7. Referral Process Education: Trainings provided about potential legal issues of participants Screening: An integrated legal needs screening tool identifies unmet legal needs of participants Referral: When a legal need is identified the participant is referred to HELP: MLP attorneys Action: Attorney contacts the participant within 24 hours to begin addressing the problem Follow-Up: Evaluation staff contact participant for follow up interview after obtaining informed consent Education Screening ReferralAction Follow-Up 8. I-HELP Legal Screening Tool Developed by the National Center for Medical-Legal Partnership Integrated into Healthy Start Participant Profile electronic case record Identifies common legal issues that impact health and well- being I Income Supports H Housing & Utilities E Education L Legal (immigration) Status P Personal & Family Stability 9. Evaluation Methods Public health faculty from Thomas Jefferson University led evaluation methods. Program Participants: Collected data through telephone interviews 3-4 weeks after cases closed and review of case notes Measured: satisfaction, stress, health, and self-efficacy At time data was collected 21 participants had closed cases; 13 completed follow up interviews Staff: Conducted pre and post tests during trainings and follow up interviews at end of grant period Measured: satisfaction, knowledge and beliefs 10. Project Results (Sept. 2010-May 2013) Over 300 Healthy Start Program Participants & their family members received services 187 Legal cases were addressed 151 Case consultations occurred with CKHS case managers & staff 38 Students from multiple disciplines educated 34 Trainings were conducted for CKHS staff & community partners More than 300 Individuals Helped 187 Legal issues addressed 151 Case Consults 34 Trainings conducted with CKHS 38 Students educated at WUSL 11. Legal Issues Resolved (May 2012- June 2013) 50% 14% 10% 6% 4% 6% 10% Public Benefits Disability benefits Housing Utilities Custody Consumer issues Other N=70 12. Impact on Client Stress (June 2012-May 2013) Client Average Overall Level of Stress Average Level of Stress for Clients with Public Benefit Matters 8.7 3.6 0 1 2 3 4 5 6 7 8 9 10 Prior to Services After services Client Average Overall Level of Stress 8.3 1.375 0 1 2 3 4 5 6 7 8 9 Prior to Services After services Client Average Overall Level of Stress N=13 N=8 13. Impact on CKHS Staff MLP integration has resulted in: Increased knowledge Increased capacity to serve clients Increased advocacy capacity Decreased stress Increased ability to identify and refer legal needs 14. Challenges Sustainability Evaluation Lost to follow up Demonstrating ROI Longitudinal health outcomes Health system investment 15. Client Quotations I didn't know I could even get help like that. I didn't know where to turn. It made a big difference and I'm very grateful. She still keeps in contact with me. Having a lawyer really changes everything. Being able to say, "my lawyer will call you" gets results. I now know that if anything happens I can call my lawyer, Laura. Laura was a big help, she has been beyond a blessing. I didnt have a state ID or any other documents because of my personal problems and she was able to help me apply for benefits anyway. The issue she worked on I was working on for more than a year. No one knows how hard it was. She just stepped in and in a month everything was done. 16. [email protected] HELPMLP.ORG | @HELPMLP Thank you!