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Medical-Legal

Medical-Legal Partnership | Boston

To gain a better understanding of cross-sectoral approaches to addressing the social determinants of health, AAHC is interviewing individuals from organizations that utilize non-healthcare approaches to improve health. Here, we look at organizations involved in medical-legal partnerships.

An interview with Samantha Morton, JD
Executive Director, Medical-Legal Partnership | Boston


Describe what you do for work and the vision/mission of your organization.

The vision for Medical-Legal Partnership | Boston is a world where, regardless of socio-economic status, all people have what they need to achieve optimal health and well-being. Our mission is to equip healthcare, public health, and human services teams with legal problem-solving strategies that promote health equity for vulnerable people. We are the founding site of the national medical-legal partnership network.

We partner with 10 teams in Eastern Massachusetts and bring a legal problem-solving lens to their support of vulnerable people – ranging from cancer patients, to socially high-risk pregnant women, to families with young children, to newly-arrived immigrants, to mentally ill older adults, to survivors of violence and trauma. Our legal advocates are integrated into these healthcare and human services teams and focus on key prevention strategies:

  • training staff on the social determinants of health with legal remedies;
  • “legal triage” consultation to help diagnose barriers to people’s health and well-being and potential legal solutions;
  • coaching staff on role-appropriate problem-solving strategies, and
  • coordination of urgent legal care when legal advice or representation is necessary.

Tell us about the socio-demographic and socioeconomic factors and conditions in the community, population, or constituency you or your organization serves.

Our partners include, among others, two urban safety-net hospitals and health systems in Eastern Massachusetts (including the largest safety-net hospital in New England), as well as two community hospitals and home visitor programs serving economically distressed mid-sized cities.  We also serve two world renowned specialty hospitals focused on pediatrics and cancer care.  All services provided support vulnerable people living in Greater Boston and environs, which has one of the highest costs- of-living and housing cost profiles in the country. We focus our scarce resources generally on people with incomes at or under 200 percent of the Federal Poverty Level.

Socio-demographic diversity is broad in the patient/client populations served by our partners. The majority of people served are of-color and are immigrants or first-generation born in the United States.  Primary languages spoken by most Limited English Proficiency people served include Spanish, Cape Verdean Criolou, Haitian Kreyol, and Arabic. A history of trauma secondary to domestic abuse, community violence, or persecution in the patient's home country is very common in the populations we serve.  Almost all the households we support in collaboration with our partners contain at least one member with a disability.

Many patients and the family members we serve depend on public benefits due to their own disability, or have responsibility for the care of young children or dependents with disabilities.  Of those who work outside the home, most are employed in blue collar positions, including home health and custodial services, and have not pursued education beyond high school.  However, among the immigrants we serve, some pursued higher education in their home country and were employed as professionals there.

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What is the link between the social determinants of health and your work?

It is THE link. The medical-legal partnership model is grounded in a growing evidence-based linking of poverty, discrimination, and poor health, and a conviction that this link can be weakened if the healthcare workforce (including public health and human services workers) is equipped to help low-income people solve problems for which the law provides a remedy – but a remedy that requires deft navigation of complex systems.

Can you provide one or two examples of programs or activities that you are currently working on that is/are aimed at addressing an aspect of the social determinants of health?

We develop tools to facilitate better communication between providers and their patients regarding health-promoting benefits and services for which medical verification and other advocacy by a healthcare provider is often required by law.

We are active members of a state-wide consortium committed to ending racial and ethnic health disparities and advocating for the creation of a cross-secretariat Executive Office of Health Equity. 

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What are you goals for the program(s)? How do you measure and evaluate these goals?

We are committed to supporting population-level improvements in access to concrete supports (such as nutrition and housing resources), health, and well-being. To that end, we are participating in three randomized controlled trials led by researchers at Boston Medical Center that seek to measure the impacts of medical-legal partnerships. The results of the first study in which we participated – in the Pediatrics context – were recently published and quite promising.

How do you financially sustain these programs?

We partner with programs and institutions that share our commitment to health equity and that commit resources to sustain the MLP infrastructure on their teams.

Are there additional resources or partners needed to accomplish these goals? What are they?

We are increasingly invested in deep collaboration with the public health community, for whom a focus on prevention is long-standing. As the healthcare delivery system’s financing paradigm and quality metrics become more tied to social determinants, there is much we can learn from public health models in developing new team structures and interventions.

What opportunities do you see for connecting your work with the work of academic health centers?

Our work with the academic health center community is most synergistic in the inter-professional education domain and the medical research domain. As team-based care continues to be re-imagined, there are important opportunities for medical-legal partnership programs to support the next generation of community health workers, social workers, nurses, physicians, and many more critical members of the healthcare “family,” in helping patients and families navigate highly-complex systems that can often act as barriers to stable food, housing, and safety.

 

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