Dissertation Title: Exploring how Medical Legal Partnerships (MLPs) utilize a social ecological approach to addressing social determinants of health

Student Concentration: Health Services Policy & Research

Dissertation Chair: Dr. Ashli Owen Smith

Dissertation Abstract: 

Medical-Legal Partnerships (MLPs) have emerged as an innovative model for addressing adverse social determinants of health (SDOH) through interdisciplinary collaboration between healthcare and legal professionals. This dissertation employs a three-pronged approach to assess the impact of MLPs on SDOH through the Social Ecological Model (SEM), interprofessional education, and healthcare utilization outcomes. 

First, a systematic review examines how current MLP research aligns with SEM, identifying gaps and opportunities for program development and evaluation. The findings reveal that while MLPs conceptually address SDOH at multiple levels, there is a scarcity of empirical research quantifying their outcomes within the SEM framework.

Second, the dissertation evaluates the effectiveness of interdisciplinary education and training (IDET) within MLPs in fostering interprofessional collaboration (IPC) among healthcare professionals and legal practitioners. Using survey data from fourth-year medical students, the study assesses shifts in knowledge, attitudes, and referral practices following participation in MLP-directed IDET. The results suggest that while students enter with a strong understanding of SDOH, experiential learning enhances their inclination to refer patients to legal services.

Third, a retrospective observational study assesses the impact of MLP services on healthcare utilization and costs. By analyzing administrative claims data, the study explores the relationship between legal services and emergency department (ED) visits, inpatient stays, and overall healthcare expenditures. While findings indicate a trend toward improved healthcare access and utilization, statistical significance remains limited, highlighting the complexity of measuring MLP effectiveness.

This research underscores the potential of MLPs to mitigate adverse SDOH through direct services, education, and systemic advocacy. It also highlights the need for more rigorous, empirically driven studies to measure MLP impact across the SEM. Future research should incorporate matched comparison groups, longitudinal analyses, and enhanced data integration to better quantify the role of MLPs in improving health outcomes and reducing healthcare disparities.