DOI: 10.3886/icpsr38258.v1
title: Formative Evaluation of a Medical-Legal Partnership on the Westside of Chicago, Illinois, 2016-2021
title: Version 1

description: In February 2016, Under the Rainbow (UTR), a pediatric trauma-based therapy program within Sinai Chicago's Behavioral Health department, joined with the Legal Council for Health Justice (LC), the scope of which includes assistance in accessing public benefits and special education, to form a medical-legal partnership (MLP). Integrating legal services with health care, the partnership allows patients seeking services at UTR to receive referrals for legal services through LC. The partnership is built on access to judicial and legal services as a social determinant of health that can lead to improved health outcomes, and thus the goal is to provide training and support to providers on legal and social barriers to health and provide free legal assistance to patients.
In this study, the research team conducted a formative evaluation of the existing MLP between the two organizations (located in Chicago, Illinois, United States). The specific aims of this evaluation were to:

Determine how a medical-legal partnership (MLP) can improve knowledge and understanding of domestic and community violence
Understand how the MLP can serve different populations by looking at program process and implementation in-depth
Prepare the MLP for impact evaluation to determine how the MLP can fill gaps in victimization research and legal intervention programs

Existing data from patient health risk assessments collected by UTR and legal services data collected by LC were obtained and analyzed. Clients had been served by UTR and referred to LC between July 2016 and May 2021. Interviews with staff at both organizations were conducted in 2019 and 2020. The research team also completed documentation review and created other artifacts (e.g. protocols, implementation guides, process maps) as a result of the evaluation.
description: The objectives of this formative evaluation were to:

Determine how a medical-legal partnership (MLP) can improve knowledge and understanding of domestic and community violence
Understand how the MLP can serve different populations by looking at program process and implementation in-depth
Prepare the MLP for impact evaluation to determine how the MLP can fill gaps in victimization research and legal intervention programs
description: This evaluation utilized Sanou et al.'s (2011) model for conducting an evaluability assessment, then used the resulting findings to conduct a formative evaluation. The goals of the evaluability assessment were to understand the program theory driving the medical-legal partnership (MLP), identify appropriate methods of evaluation, and prepare the MLP for an impact evaluation. In the evaluation process, the team created a program description and structure, logic model, and appropriate evaluation metrics based on program output. To understand how the partnership could serve different populations, the team created a process map, program protocol, and implementation guide, and conducted preliminary data analyses.

The research team used a mixed-methods approach for data collection, which included semi-structured interviews with staff at the Legal Council for Health Justice (LC) and Under the Rainbow (UTR), program document review, and secondary analysis of existing clinical data and legal data.
Staff at LC and UTR were interviewed during 2019 and 2020, after the onset of the COVID-19 pandemic. For analysis, initial codes were developed based on the interview guide and applied to notes taken during the interviews. New codes were developed and applied as needed.
A thorough review of the MLP program documents was conducted to get a better understanding of the program. Documents included publicly available information from handouts and online sources, measurement tools, intake and discharge forms, resolution of issue documentation, and participant pre- and post-behavioral and emotional health data.
Individual-level clinical data were obtained from the Sinai Health System's electronic medical record system, NextGen. Individual- and case-level data were obtained from the LC database, Legal Server. Clients who had been served by UTR and referred to the MLP between July 2016 and May 2021 were included in the data.
description: Quantitative datasets can be linked together with the client ID <b>UNIQUEID</b>.
Demographic data (DS1) includes race, ethnicity, sex, insurance payer, and type of insurance (private vs. public).
Clinical data (DS2) consists of intake date and items from the Illinois Medicaid Comprehensive Assessment of Needs and Strengths (IM+CANS). Topic areas include potentially traumatic/adverse childhood experiences, behavioral/emotional needs, life functioning, risk behaviors, client strengths, cultural factors, and caregiver needs. For each item, staff rated on a scale of 0-3 the severity of the client's need (higher numbers = more immediate need) or, for strength items, the degree of development (higher numbers = more effort needed to strengthen).
Legal data (DS3) includes a brief description of the legal problem for which services were sought, whether the case was closed or open, and reason for case closure if applicable.
Staff interviews (DS4): In 2019, staff interviews focused primarily on the process by which referrals between the two organizations took place, intervention logistics, client outcomes, and potential changes to make processes easier and more efficient. Interviews occurring in 2020 focused primarily on procedural and client need changes based on piloted modifications and those due to COVID-19.
description: Presence of Common Scales: Illinois Medicaid Comprehensive Assessment of Needs and Strengths (IM+CANS)
description: Datasets: 
DS0: Study-Level Files
DS1: Under the Rainbow Client Demographics Data
DS2: Under the Rainbow Client Assessment Data
DS3: Legal Council for Health Justice Client Services Data
DS4: Staff Interview Data
description: Clients served by Under the Rainbow (UTR) and referred for legal services between 2016 and 2021.
description: coded on-site observation; face-to-face interview; on-site questionnaire