Integrating Social Workers into Medical–Legal Partnerships: Comprehensive Problem Solving for Patients

Bernstein (1977, 1980) first described the benefits of collaborations between social workers and attorneys within the health care setting in 1977. Since that time, social worker-attorney collaborations have grown within health care, most notably in the areas of geriatrics and HIV/AIDS (Golick & Lessem, 2004; Johnson & Cahn, 1995; Retkin, Stein, & Draimin, 1997). Since the dawn of the medical-legal partnership (MLP) movement in the early 1990s, the role of the attorney in the health care setting has greatly expanded. MLP's seek to partner attorneys with physicians and other members of health care teams to resolve legal issues affecting patient health (Cohen et al., 2010; Williams, Costa, Odunlami, & Mohammed, 2008; Zuckerman, Sandel, Lawton, & Morton, 2008; Zuckerman, Sandel, Smith, & Lawton, 2004). The attorneys in these partnerships provide representation to patients to achieve health benefits. They are distinct from a hospital's general counsel, which represents the interests of the hospital. Although social workers have been involved in the MLP movement, the full value that social workers can bring to any MLP has not been explored. In this article, we discuss the history of the MLP movement, the specific social work skills and perspectives that can enhance an MLP, and the differing legal and ethical obligations and professional perspectives of the social work and legal professions. Finally, we describe an MLP model that strongly relies on social work to demonstrate how social work can enhance the effectiveness of these partnerships. THE MLP MOVEMENT The first MLP was founded in Boston in 1993 in an attempt to address social factors affecting health that could be remedied through legal action (Sandel et al., 2010). For example, mold exposure within living quarters is a known trigger of asthma. The existence of dangerous or excessive mold (or conditions leading to mold, such as leaking roofs) is a housing code violation in many jurisdictions. When the medical treatment team collaborates with attorneys, the health of asthmatic patients can be improved through enforcement of housing codes (Das, 2007). In this way, the MLP legal staff differs from the hospital's general counsel; the MLP represents and serves a hospital's patients, whereas the hospital's general counsel represents and serves the hospital as an institution. MLPs do not pursue legal action on behalf of patients against the hospital, such as malpractice suits. In addition to housing law, many other legal areas can affect patient health: income supports and public benefits, health insurance, education rights, orders of protection and divorce for intimate partner violence, immigration, guardianship, and powers of attorney (Kenyon, Sandel, Silverstein, Shakir, & Zuckerman, 2007; Sandel et al., 2010). By reducing or eliminating legal concerns for families, MLPs also decrease patient stress and increase adherence with medical treatment, improving present and long-term patient health (Conroy, Sandel, & Zuckerman, 2010; Zevon, Schwabish, Donnelly, & Radabaugh, 2007). Similarly, Smith et al. (2008) have posited in the context of asthma that each family has an unconscious list of prioritized "worries" (such as housing instability, food insecurity, or home or neighborhood safety), collectively termed a "worry budget." Families with significant social stressors will often prioritize those worries over the health concerns of family members. As a result, health concerns must compete for attention with the other significant social stressors, possibly resulting in worsened health (Smith et al., 2008). By eliminating social stressors related to legal issues, MLPs can allow families to begin to prioritize their health. MLPs provide benefits to health centers beyond direct legal services for patients. Many MLPs provide advocacy training to medical residents and students (Cohen et al., 2010; Paul et al. …