From Reactive to Proactive: The Importance of Screening for the Social Determinants of Health in a Medical-Legal Partnership

By: Katie Broyles, Spring 2019 HeLP Legal Services Clinic Intern

The majority of medical and legal practices today are inherently reactive, rather than proactive. In the medical field, most insurers will not pay for a great number of preventative healthcare services. In addition, many individuals lack access to basic health education emphasizing the benefits of early detection and seeking out regular preventative care. As a result, such individuals are not incentivized to plan ahead and cultivate a healthcare strategy moving forward in their lives (i.e. attend regular preventative check-ups, receive regular flu shots and stay current with vaccines, decide who their healthcare power of attorney will be or draft an advance directive, or check in with these decisions annually). Consequently, the majority of individuals in the United States healthcare system seek out health care only in the event of an emergency, leaving the medical system with no choice but to reactively address problems as they arise, thus attending to patients that use the emergency department nearly twice as often as patients in comparable countries. Interestingly, the legal field can present the same challenges to individuals faced with a legal system that is also largely reactive, in which individuals most often seek legal assistance because they have already been injured in some way and seek a reactive legal remedy as a result.

Medical-legal partnerships such as the Health Law Partnership (HeLP) can provide a partial solution to this reactivity problem by educating providers and attorneys about the benefits of informing one another about the legal implications in a medical case or medical implications in a legal case. The collaboration between both professions allows for both to be aware of the potential problems that may arise from each respective field and equip practitioners with better tools to prevent potential issues before they arise.

One such tool utilized by medical and legal practitioners alike to aid in a proactive approach to care or representation is screening for social determinants of health. Often, without implementing effective screening processes for social health determinants, appropriate interventions or remedies cannot be implemented in care or representation. For example, a medical provider that encounters a child with severe asthmatic symptoms may conduct a proactive screening for environmental factors that can exacerbate the patient’s condition, such as mold in the home, financial instability, or general stress. The results of such a screening can allow the medical provider to recognize such factors and recommend legal intervention to provide a long-term solution, rather than merely treating the health issue in the short-term and reactively addressing the patient’s same problems next time they arise. Educating providers to identify such legal issues allows them to begin building a case for a legal practitioner to act proactively to resolve some of the patient’s future medical problems, such as by contacting a landlord to resolve mold issues in the home, or filing for disability benefits for the child to prevent exacerbation of a child’s asthma in the future and ensure further financial stability and a reduction of general stress for the family.

Since 2014, the federal Health Resources & Services Administration (HRSA) has identified civil legal aid as an “enabling service” that healthcare providers can include in federal grant money. Individuals utilizing such services are then allocated free national training and technical assistance via the National Center for Medical-Legal Partnership’s National Training and Technical Assistance Cooperative Agreements. These resources give healthcare entities the financial incentive, free training tools, and technical assistance to easily implement screening tools that would assess patient social determinants of health and contribute to more comprehensive patient care, potentially leading to greater patient care satisfaction and quality.

Utilizing such screening tools helps cultivate a more productive health and legal educational environment for indigent patients who do not typically have access to such educational resources and may experience poorer health outcomes over their lifetime as a result. In turn, these screening tools help medical practitioners and attorneys alike shift from a reactive to proactive approach in improving both health and legal outcomes for patients and clients.