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The Department of Veterans Affairs (VA) serves millions of veterans and operates the largest integrated health care system in the United States. But historically, it hasn’t focused on civil legal problems, like housing instability and eviction, which are social determinants of health.
However, annual surveys of veterans experiencing housing instability and homelessness report that civil legal assistance is among their top unmet needs. The VA is increasingly exploring medical-legal partnerships, a service model in which lawyers are integrated into health care settings to help patients resolve civil legal issues. In this first study of medical-legal partnerships for veterans, the researchers describe the outcomes of veterans who accessed legal services at four partnership sites in Connecticut and New York from 2014 to 2016.
The researchers used an online data capture system developed by Connecticut Veterans Legal Center and LegalHealth to collect administrative data on legal problems, legal services received, and legal outcomes for 950 veterans who received medical-legal partnership services. Intake and outcome assessments were conducted with a subsample of 148 veterans every three months, using measures of housing, mental health, and well-being.
- Almost half of the issues for which veterans sought medical-legal partnership services were VA benefits or housing issues. Each legal issue took an average of 5.4 hours of partnership time to resolve. This is minimal compared with the amount of time it takes for someone to find another housing arrangement or income source.
- Veterans who received medical-legal partnership services showed significant improvements in mental health within the first 3 months and continued improvement at 12 months. At 12 months, veterans whose legal issues were resolved showed increases in income and days housed.
- Veterans who received services relating to housing issues were more likely to achieve their legal goals than veterans facing criminal and military legal issues.
- Regardless of legal outcome, veterans who received more partnership services showed greater improvements in housing and symptoms of psychosis and posttraumatic stress disorder. In other words, the researchers note that veterans who received a larger “dose” of partnership services showed greater benefits.
- Medical-legal intervention at an early stage largely prevented litigation, and less than 10 percent of the issues required a court appearance or hearing attendance.