Civil Justice for All

Recommendation 5: Greater Collaboration

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Making Justice Accessible: Legal Services for the 21st Century

Recommendation 5. Foster greater collaboration among legal services providers and other trusted professionals—such as doctors, nurses, and social workers.

As the field of civil justice expands beyond lawyers to help provide more assistance to people in need, it should also build more systematic collaborations with trusted professionals from other fields. Such partnerships—for example, between lawyers and medical professionals—are among the most important innovations in civil justice in the last two decades. They help identify problems that clients are not aware of or do not realize have a legal dimension, such as illnesses related to substandard living conditions. They connect clients to legal professionals. And they accelerate the process of finding a legal remedy. They also provide a blueprint for a redesign of many legal services organizations’ programs.

The most successful and established of these collaborations is the medical-legal partnership, which grew out of a pilot project at Boston Medical Center in the early 1990s. That project was based on two related premises: 1) that complex nonmedical problems like housing, education, and economic stability are often (as much as 40 percent of the time) contributing factors to adverse health outcomes and disparities; and 2) that such problems have remedies in civil law.57 In these partnerships, hospital and clinic intake teams can be trained to recognize problems in a patient’s case history (such as an injury from domestic violence or asthma caused by mold in an apartment) and refer patients to lawyers or other civil justice problem solvers. As a result, legal solutions become part of healthcare solutions, and the efforts of legal partners are integral to those of medical partners.

As of May 2020, nearly 450 medical-legal partnerships had been established in the United States, in general hospitals, children’s hospitals, veterans’ medical centers, community clinics, tribal clinics, behavioral health clinics, and substance abuse treatment centers.58 In 2019, these partnerships helped more than 75,000 patients resolve legal issues impeding their health and trained more than 11,000 healthcare providers to better understand and screen patients for health-related social needs.59 The growth and success of these partnerships remain largely below the radar of the American public, but they are exciting advances that promise similar growth and success if applied on a much wider scale, and they should be publicized and promoted enthusiastically.

Medical-legal partnerships promote a broader understanding of health, one that encompasses not just illness and wellness but their social determinants—the external conditions that make health better or worse. Domestic violence is a paradigmatic social determinant affecting health. Violence causes physical and psychological harm, traumatizes children and keeps them from school, and can prevent victims from functioning well at work and at home. Uninhabitable housing is another paradigmatic determinant: moldy housing can trigger asthma, impair students’ ability to complete schoolwork, and undermine economic well-being.

Medical-legal partnerships represent a significant step toward a holistic approach to civil justice, a version of the “community legal practice” to which legal services lawyers have aspired since the 1960s. But they are only one model of a connecting partnership between trusted professionals and legal experts. Many other direct-service fields—workforce development, housing and family services, educational institutions, veterans organizations—offer similar opportunities, and each would be a valued partner in the effort to close the civil justice gap. In addition, collaborative work, between lawyers and social workers, for example, can help equip individuals with greater capacity to ask the right questions in pursuit of social services and benefits and then more effectively advocate for themselves.60