Background: Medical-legal partnerships (MLPs) represent an innovative intervention that integrates legal providers into healthcare teams to address complex problems and support the rehabilitation of vulnerable patient populations. In the MLP intervention, community legal providers partner with VA facilities to provide legal assistance to homeless and at-risk veterans. MLP staff can help veterans by negotiating with landlords, setting up alternative payment plans, and representing them in eviction court which may ultimately improve Veterans’ social integration and quality of life. Our group completed a 2-year uncontrolled study of VA MLPs and found that veterans showed significant improvements in housing, income, and mental health after receiving MLP services. A more rigorous research design is proposed as a next step in evaluating VA MLPs and their effect on the rehabilitation of veterans. Objectives: This project has two major aims: 1) evaluate the impact of MLP on housing outcomes (primary) and mental health outcomes (secondary); and 2) examine the veteran experience with seeking and receiving assistance from MLP and outside legal providers. Methods: For Aim 1, a randomized controlled trial of the MLP intervention for Veterans with housing-related issues (i.e., rent-based evictions, rule violations, landlord-tenant disputes) will be conducted. The study site will be the VA Connecticut Healthcare System, where the MLP intervention will be provided in partnership with the Connecticut Veterans Legal Center. A total of 300 homeless and at-risk veterans will be randomly assigned to either the MLP intervention or referral to an outside legal provider. Veterans in both groups will be assessed at baseline, 3, 6, and 12 months on housing, mental health, and various psychosocial measures. The primary outcome will be housing status and a secondary outcome will be mental health. Exploratory analyses will be conducted on outcomes such as financial status, legal status, social integration and citizenship, and quality of life. For Aim 2, a total of 30 veterans participating in the randomized controlled trial (15 participants each from the treatment and control groups) will be interviewed to collect qualitative data on their experiences receiving the MLP intervention or outside legal services. Significance: The VA is committed to preventing and ending veteran homelessness. While considerable efforts have been made to house veterans, services are needed to help them sustain housing and community integration. Numerous reports and surveys indicate that legal assistance for civil legal problems is a major unmet need among homeless and at-risk veterans. VA MLPs offer an opportunity to help veterans address housing-related issues, which could prevent homelessness and assist their rehabilitation. The MLP intervention is consistent with the VA’s comprehensive continuum of rehabilitative services for veterans and the movement towards multidisciplinary, integrated care to address social determinants of health. This project will provide needed data on VA MLPs and help inform decisions about the expansion of MLPs across the country for homeless and at-risk veterans.

This project will conduct the first randomized controlled trial of medical-legal partnerships in the VA, a healthcare delivery approach that partners VA healthcare and community legal providers to serve homeless and at-risk veterans. Veteran homelessness remains a persistent problem and many low-income veterans face landlord disputes, rent arrears, and evictions that legal providers can assist with to prevent homelessness and improve Veterans’ chances for rehabilitation and recovery. Medical-legal partnerships can address social determinants of health by providing legal assistance for housing-related issues. The results of this project will provide needed data on the impact of VA medical-legal partnerships for homeless and at-risk veterans on their housing and mental health. The results will inform VA about the potential of VA partnerships with community legal providers and identify important rehabilitation targets for MLPs. Ultimately, this project will help VA make data-informed decisions about this emerging, innovative intervention.