A Systematic Review of Medical-Legal Partnerships Serving Immigrant Communities in the United States

Medical-Legal Partnerships are increasingly being embraced as a service delivery model for addressing the social, environmental, and political determinants of health experienced by low-income and vulnerable populations. The authors of this article carried out a systematic literature review to examine “existing forms of medical-legal partnerships that demonstrate how medical and legal professionals work together to meet the unique needs of immigrants.”  Five online databases were searched, and 222 English language articles (published between 2010-2019) were selected for initial screening.  After applying inclusion and exclusion criteria, the authors retained 18 articles for further analysis.  Forty-two questions were developed relating to 10 different themes. Cross-referrals of clients for legal and medical services (especially asylum evaluations) occurred between lawyers, physicians, and their clinics “Partnerships often engaged in advocacy work, provided translation services, and referred clients to non-medical providers and legal services.” Co-location of services was less often seen.  The articles generally lacked information about “follow up from the partnerships about the duration of collaborations,” “long-term legal and patient outcomes,” “duration of services through the partnership,” “success/failure rates of clinical care,” and “systems in place to support people’s legal and medical needs.” An essential component identified was demonstrating cultural and structural competence. This included understanding diversity within and across immigrant, refugee, and asylee populations as well as the impacts of trauma, persecution, and stigma. Addressing institutional barriers (e.g., “translation services, financial assistance, affordability, access to psychiatric care”) and integrating medical, mental health, and legal services was also of critical importance.  The authors conclude that “[m]edical-legal partnerships are crucial for investing in the mental and physical health of immigrant communities.”  They also note, however, that “… despite the increasing salience of such partnership, few have written up their lessons learned and best practices.”  Further ethnographic studies and dissemination of real-world findings are needed. General information about medical-legal partnerships may be found on the website of the National Center for Medical-Legal Partnership at George Washington University. (Robert Like, MD, MS)

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