South Carolina residents need more than good medical care to achieve and maintain good health. Research shows that an individual’s health also is influenced by genetics, personal choices and environmental factors and that social determinants play a major role in health disparities.
A $1.025 million, three-year grant from The Duke Endowment to the University of South Carolina will help address these issues for vulnerable patients in South Carolina. With funding from the grant, UofSC’s Carolina Health Advocacy Medicolegal PartnerShip (CHAMPS) and the Greenville Medical-Legal Partnership (GMLP) will join forces to create The South Carolina MLP Collaborative. The collaborative aims to improve patient and population health by eliminating legal barriers that families may face when seeking medical care.
“The support of The Duke Endowment will allow the two medical-legal partnerships in South Carolina—CHAMPS and the Greenville MLP—to collaborate on ways to leverage the resources of their different models and improve health outcomes for children and families throughout the state,” said Emily Suski, CHAMPS director and assistant professor of law at UofSC. “In addition, it will allow us together to develop a model for this kind of collaboration across MLPs for other programs to use and follow.”
Although many social aspects that influence health are guaranteed by law, patients often face financial, communication and other challenges when they require legal assistance to navigate the health care system. Medical-legal partnerships pair doctors with lawyers who provide free legal help for matters such as improving access to government-provided benefits, resolving guardianship issues and working with landlords to improve living conditions, with a goal of increasing positive health outcomes.
In addition, CHAMPS gives law, medical and graduate-level social work students at UofSC the opportunity to work as part of the medical team on legal and social issues affecting children’s health.
“These partnerships accomplish so much around education and medical care. They teach our medical students and residents the power of team care—working side-by-side with both law and social work students. It teaches them to see the patient holistically and to understand that even seemingly insurmountable issues in solving a problem and helping your patient can be addressed by coming together often with unexpected partners,” said Dr. Caughman Taylor, chairman, UofSC Department of Pediatrics, and senior medical director, Prisma Health Children’s Hospital-Midlands.
The MLP process starts at the doctor’s office, where medical screening traditionally has been done, but now there are new questions in the mix about income, housing and other issues that help identify legal barriers families may be facing.
“Access to an MLP helps physicians empower families and is a powerful addition to our tool kit to help patients,” says Dr. Kerry Sease of Prisma Health Children’s Hospital-Upstate, which helped pioneer MLPs in Greenville. Prisma Health-Upstate, formerly Greenville Health System, now offers MLP help at all its pediatric practices. “Physicians must rethink the concept of preventive health, especially now that we know the long-term impacts of toxic stress and adverse childhood experiences on the developing brain. These environmental factors have been proven to be the root of many adult-onset illnesses, including heart disease, depression, diabetes and stroke as well as an increase in alcoholism, smoking and substance use/abuse. That makes the availability of MLPs even more vital since routine screening for vulnerability is only useful if collaborative relationships exist to address these needs.”
One objective of the South Carolina MLP Collaborative is to show that when these issues are addressed, health care costs are lower and health disparities are reduced. Evaluation through data analysis will be facilitated by Furman University’s Institute for Advancement and Community Health in coordination with UofSC. A steering committee will determine specific areas for evaluation such as analysis of cost effectiveness, care coordination, patient satisfaction and legal outcomes.
“Furman is excited to expand our work in educating the next generation of medical and legal professionals while addressing health-harming legal needs. Partnering with the University of South Carolina presents a unique opportunity to better understand how MLPs can benefit people across the state and address the factors that contribute to poor health,” says Eli Hestermann, executive director of the Furman institute.
The idea of pairing doctors and lawyers to assist patients is not new. However, “medical-legal partnership” as a term and growth concept originated in the mid-1990s at Boston Medical Center. There are 333 MLPs in 46 states. The South Carolina MLP Collaborative will serve as a model for MLPs in neighboring states and across the nation by creating a blueprint for sharing resources, ideas and expertise to expand their reach while minimizing costs.
“So much of what impacts our health is driven by social factors,” said Lin Hollowell, director of health care for The Duke Endowment. “Medical-legal partnerships provide an additional approach to address those factors in a holistic way. This new joint effort will contribute to our growing understanding of how we can best serve disadvantaged individuals in ways that will positively impact their health and well-being.”
Last year, MLPs helped more than 75,000 patients nationally resolve legal issues that were impeding their health. Since its launch in 2017, CHAMPS has worked with 140 cases involving children and their families. GMLP has assisted with 209 cases since its launch in 2016.
CHAMPS has a strong educational focus, giving law, medical and graduate-level social work students at UofSC the opportunity to work as part of the medical team on legal and social issues affecting children’s health. The GMLP is more focused on providing legal services and serves geriatric patients in addition to children.
“In addition to providing legal and other services to patients and clients, CHAMPS exists to train the next generation of doctors, lawyers, and social workers to work together to improve health outcomes and leverage resources to benefit each other,” Suski says.