The Medical-Legal Partnership: Cross-Sector Collaboration Improves Youth and Family Outcomes
By Sara Carrion, Policy Associate
Many families, in New York City and elsewhere, face challenges obtaining educational support for children struggling with learning and developmental disabilities and/or mental health needs. This is particularly true for families that live at or near the poverty threshold. An innovative effort by a hospital and a legal services provider in Manhattan is working to change that.
Mt. Sinai Morningside’s Child and Family Institute (CFI) is a hospital-based outpatient psychiatric clinic that works with children and adolescents ages 5-17 and their families. Through the Medical-Legal Partnership (MLP) with the Legal Aid Society (LAS), LAS staff are able to work within the CFI clinic two days a week, easily accessible to CFI patients and staff. CFI staff are trained to recognize which of their patients could benefit from LAS’ services, and provide referrals.
Through this partnership, youth with developmental and learning disabilities, emotional disturbances, or mental health conditions are able to receive trauma-informed clinical services in the same location where their parents and families also have access to civil and educational legal advocacy and support. Having all of these services in one place significantly reduces barriers to families and youth getting the supports they need to thrive, especially in school.
Many parents that are served by the MLP have limited access to the school-based services that their children need or are unaware of what services are available. The majority (77%) of families served by the Medical-Legal Partnership are in or near poverty, with a household income below $40,000. LAS matches each family with an attorney who advocates for their needs and helps them navigate this service landscape. The MLP works to protect youth against risk factors—such as low success in school, cognitive delays/impairment, and learning disabilities—or justice system involvement, while also collaborating across sectors and organizations to best serve participants’ needs.
The MLP was formalized and funded as a part of the New York County District Attorney’s Office Criminal Justice Investment Initiative (CJII) and has been serving families since the start of 2018. Findings from an ongoing evaluation of this program indicate that the program is beneficial to participants and staff and delivers benefits to families that far outweigh program costs.
Clinical Services and Educational Advocacy Improve Student and Family Outcomes
The Legal Aid Society helps families get the resources that their children need to thrive in school, including the creation of an individualized education program (IEP), placement in a more appropriate classroom setting or school, and supports such as therapeutic services or speech or occupational therapy. An LAS attorney walks families through school-system processes that often involve many steps over a long period of time. Many parents come to the Child and Family Institute because their children’s psychiatric conditions and/or disabilities have been identified due to behavioral issues. The Medical-Legal Partnership helps families address the root causes of these issues so that students can have a supportive learning environment that meets their needs.
In the realm of educational advocacy, what we see a lot is either families where the child’s diagnosis—that could be mental health or that could be some kind of learning issue or an intersection of the two—is getting in the way of their progress and their functioning, especially in school. [We try] to get a sense of, “Okay, what accommodations might they need? What aren’t they getting?” Oftentimes, they have part of it, they might have an individualized education program but not really have a sense of what that entails and not really be informed about what they’re entitled to. So some or most or all of those things are not actually being carried out even if they’re technically in the position where they should be receiving them.
—Clinician
LAS, like many other CJII organizations, has also adapted to assist families during the COVID-19 pandemic. While this time has been difficult for all students and families, students with disabilities have faced unique challenges. For many, it has been even more difficult to get access to the services that they need virtually. LAS has been able to advocate for families and ensure that they have plans in place and the devices that they need. LAS has also worked to connect families with supports including supplies (masks, hand sanitizer, etc.) and city food delivery services. They have provided assistance with truancy cases due to difficulty participating in remote instruction and helped families navigate the eviction moratorium process. They have also been able to continue representing families in virtual hearings and attending IEP meetings—both staff and parents have been able to attend more meetings due to them being held online.
An evaluation of the MLP is underway by American Institute for Research (AIR), and thus far the evaluation has found that program staff have helped parents identify their children’s educational needs and assisted families in obtaining the appropriate interventions that they may not otherwise have successfully accessed. Not only does the program advocate for students to get the supports that they need, it also educates parents and empowers them to advocate for their children themselves. Another aspect of the program that parents found valuable was the opportunity to speak to and learn from other parents with children facing similar challenges:
It’s hard to get [services] through DOE and we as parents may not fully understand our rights. LAS definitely assists with fighting for our kids to get the services they need
—Family focus group participant
Cross-Sector Collaboration and Co-Located Services Help Staff and Families Succeed
The co-location of staff from the Child and Family Institute and the Legal Aid Society has been central to the success of the Medical-Legal Partnership, facilitating collaboration and increasing accessibility for families. Cross-sector collaboration—a cornerstone goal of CJII—creates the opportunity to combine expertise and knowledge, pool resources, and innovatively serve participants:
I just think having them right here; that they’re down the hall ... that’s a really helpful part of it. Also, I think it aids in kind of the integration and coordination of care between their mental health needs, their medical needs and, and their legal needs. ... It just makes it easier to be able to coordinate care and help families get what they need when they’re right here. There’s no chasing anybody down that goes on. ... They’re really accessible to us and to the families. Not just for clinicians, but also for our families they’re really accessible and I think that’s helpful.
—Clinician
Co-location of CFI and LAS creates an opportunity for structured and unstructured regular communication. Staff from the two organizations meet twice per month to discuss cases and refine strategies to best serve families. On the days where LAS staff are not on-site, they are available via email and phone to answer any questions that CFI staff or families have. LAS staff also regularly hold trainings to help CFI clinicians better identify which of their clients could benefit from LAS’ services, as well as information about clients’ rights and education law.
The MLP’s Benefits Outweigh the Costs
The return-on-investment analysis of the MLP found that the program is a prudent investment in families and students:
Costs: The average per-family cost of the program was $2,155 over an average duration of 6 months working with a family. Costs included LAS and CFI staff time, nonpersonnel resources (i.e., office supplies and office space), and the time and resources of families.
Benefits: The value of benefits of achieving a milestone pursued through the program ranged from $1,149 to $64,536—in most cases this value was many times larger than the program cost. Benefits included attorney time, as well as the monetary value of services rendered in achieving the educational milestones, which ranged from obtaining advice on educational issues to a child being placed in a school that could meet their needs.
Conclusion: An Effective Investment for Policymakers
The mid-evaluation findings of the MLP show that the program supports children and families, consolidates expertise and resources among organizations, and is a wise investment in terms of the benefits achieved. The MLP serves as a successful model for creating cross-sector collaborations that provide needed supports that improve the lives of youth and families. As policymakers look for the best and cost-effective ways to support young people and families, give them opportunities for success, and disrupt the school to prison pipeline and other system involvement, this example of cross-sector collaboration contains many valuable lessons.
About the Criminal Justice Investment Initiative
The Manhattan District Attorney’s Criminal Justice Investment Initiative (CJII) focuses on three investment areas—crime prevention, reentry and diversion, and supports for survivors of crime. The MLP is funded through the Family and Youth Development initiative, whose goal is to provide supports to families that address risk factors associated with increased chances of youth becoming involved in the justice system. Some of these risk factors include low educational attainment, cognitive delays/impairment, and learning disabilities. This initiative is part of the CJII’s crime prevention-focused investments in Youth, Families, and Communities.
The CUNY Institute for State and Local Governance manages and provides technical assistance to CJII contractors, and conducts oversight and performance measurement throughout the lifetime of the initiative.