Case Study

Doernbecher Children's NICU Medical-Legal Partnership Provides Unique Opportunities to Help Families

Legal problems are health problems for Dr. Ladawna Gievers and Dr. Lauren Mutrie, the co-directors of Doernbecher Children’s NICU medical-legal partnership (MLP). The pilot program, which launched in October 2020, is the first NICU-specific MLP in the United States. It is designed to identify legal issues that impact the health of the family – such as housing concerns or domestic conflict – and address them through legal processes. The ultimate goal for the program is to provide long-term stability for infants and families.

After a year of the program, Dr. Mutrie said, “I cannot image practicing without an MLP. I cannot provide the level of care these families need without it.”

What is a Medical-Legal Partnership?

A medical legal partnership (MLP) is a patient care model that improves the health and wellbeing of patients and populations most impacted by injustice and inequity by: integrating legal professionals into the health care setting in order to identify and address health-harming legal problems. The approach involves individual patient legal interventions and policy interventions aimed at improving population health.

How the NICU MLP Works

Working with the partner attorneys, the entire care team receives training on how to identify issues that could be addressed through the MLP. While screening for social determinants for health can raise some issues that families are dealing with, most cases identified by the team have come from building relationships with the families in the NICU.

The team meets weekly to discuss potential cases. When an issue for a family is identified – usually by a nurse or social worker – they discuss MLP services with the family. If everyone agrees to move forward with the case, the family member(s) meet with the attorneys in a private room just outside of the NICU. They discuss the reasons why the family was referred and often identify additional issues during this discussion, as social determinants of health are interrelated. The attorneys then revisit with the health care team to come up with creative solutions.

The attorneys and NICU team are involved until the case is closed, even if the infant is discharged from the NICU. The NICU team continues to receive updates to ensure long-lasting stability is being achieved.

"The positive energy and gratitude from staff to have this new medicine perpetuates the work. It’s been beautiful to recognize how excited all staff is to be able to offer this service to families." - Dr. Gievers.

Challenges and Opportunities

The impacts of the Covid pandemic have exaggerated the challenge of building rapport with families, which is essential when dealing with sensitive topics. Still, the team has worked on more than 25 cases in the first year of the program. While funding is often a challenge for MLPs, Dr. Mutrie says they are lucky to receive institutional support for the pilot program instead of relying on grant funding alone.

The gratitude from both families and staff has been overwhelming. Families do not expect to have a “one-stop shop” to address all the issues affecting the health and wellbeing of their their infant, not to mention having access to this actionable service while in the hospital. It is convenient, efficient, and effective to directly address these issues through NICU services instead of relying on outside referrals that may or may not be acted on.

Opportunities to impact families through an MLP in the NICU are amplified because of the length of time patients have with staff. During a NICU stay, there is ample time to build rapport, identify issues, and see results.

Additional VON Resources

Medical-legal partnerships are one of the VON Potentially Better Practices for Follow Through. VON Quality Circle members implement potentially better practices through structured quality improvement in the iNICQ Improving Critical Transitions collaborative. Learn more about iNICQ.

Outcomes

The team is still in the qualitative phase of studying and measuring pilot impact – identifying the issues in the community and learning about the patient population are ongoing.  The needs of families with an infant in the NICU can be varied and unique. Of the cases identified so far, many have centered on custody issues, intimate partner violence, workplace discrimination, and housing instability.

A significant impact of the program has been on staff satisfaction. As staff learn about long-term improvement to the lives of families after the infant leaves the NICU, burnout and stress among staff decrease and professional fulfillment increases.

Dr. Mutrie and Dr. Gievers look forward to educating the next generation of NICU providers on the value and effectiveness of medical-legal partnerships.  The pilot program has already expanded to include services upstream with Fetal Therapy colleagues to be able to identify issues even earlier in the perinatal period. The impact for families of this first NICU-specific MLP will be felt for years to come and we have much to learn.