Date of Award

January 2020

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Danya Keene

Abstract

Medical-Legal Partnership (MLP) is a model of integrating medical and legal care to address prevalent health-harming legal needs among socioeconomically marginalized populations. MLPs are able to address social determinants of health (education, employment, housing, access to public benefits) and as such have potential to improve population health and ameliorate health disparities. In this qualitative study, we examined one pediatric MLP at an academic medical center in New Haven, CT. We conducted semi- structured interviews with 20 parents and guardians who had engaged with the pediatric MLP as well as 20 pediatric health care providers (nurses, social workers, advance practice registered nurses, residents, fellows, and attending physicians). Our interviews aimed to better characterize and understand how parents/guardians and providers experience MLP services, how MLP services shape child health and family well-being, how MLPs shape the clinical encounter and affect the provider-patient relationship, and how MLPs advance systemic change to improve population health. We purposively constructed our parent/guardian sample to reflect the diversity of legal issues addressed (housing, education, income support) and legal interventions utilized (letter writing, representation in court, institutional advocacy). We purposively constructed our provider sample to reflect a diversity of clinical roles. We analyzed the data using inductive coding and memo writing. Our interviews suggest that MLPs reduce stress for parents/guardians and help parents/guardians feel empowered and efficacious in advocating for themselves to address health-harming legal needs. Our interviews also suggest that MLPs strengthened relationships between providers and their patients’ families. Additionally, our interviews suggest that the MLP improved provider awareness and efficacy in addressing social determinants of health, expanded provider perceptions of their role as advocates, and empowered providers to engage in systemic advocacy and change. Our findings have implications for MLP design and implementation, health care transformation, and addressing population health disparities.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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