Northern Dental Access Center Medical-Legal Partnership
- Need: To help low-income patients in rural Minnesota overcome legal barriers to oral healthcare and self-sufficiency.
- Intervention: The medical-legal partnership of Northern Dental Access Center and Legal Services of Northwest Minnesota provides free consultations and support services.
- Results: The innovative and collaborative approach has been recognized regionally and nationally, and over 9,000 new patients have been screened for legal issues.
Opening in 2009, Northern Dental Access Center in rural Bemidji, Minnesota, serves low-income patients. Understanding the social determinants of health, the center partners with multiple agencies to address barriers to care, with services like insurance counseling, care coordination, and transportation assistance.
Increasingly, staff were seeing families with barriers that required legal remedies. Legal Services of Northwest Minnesota has been a partner agency since the clinic's opening, but in 2015 the partnership was formalized, expanded, and adapted to medical-legal partnership (MLP) best practices.
A full-time attorney is available to dental patients and the general community. This MLP is the first of its kind in a community dental clinic setting and helps low-income patients overcome legal barriers that prevent them from achieving optimal oral health.
Common legal barriers include:
- Child custody issues related to absent or unmarried parents
- Interruption in Social Security or other public benefits
- Unhealthy rental housing conditions
- Wage garnishments for consumer debt
- Domestic violence
The medical-legal partnership is funded by a 2015 Blue Cross and Blue Shield of Minnesota Foundation grant and a 2015-2018 Federal Office of Rural Health Policy (FORHP) Rural Health Care Services Outreach Grant.
Patients checking in for a dental appointment are given a self-screening document to identify any legal issues that may be interfering with health or self-sufficiency. Access to a community health worker (CHW) or an onsite attorney is offered.
Patients and community members can receive:
- Answers to basic legal questions
- Guidance in addressing legal barriers
- Full legal representation
- In-house referrals to other support services that can help low-income people overcome other barriers
Northern Dental Access Center also hosts "Know Your Rights" chat sessions, where Legal Services staff answer questions about topics such as landlord-tenant regulations or public benefits. These chat sessions take place four times during the year, and patients leave with wallet-sized "pocket guides" so they can share key points with friends and family members.
Over 9,000 new patients have been screened for legal issues, 30% of whom (69% female, 31% male) report having a legal issue:
- 93% took the MLP attorney's business card
- 7% report being ready to address a legal issue
- 8% report that they want to be contacted by an attorney
- 3% have been contacted and helped by an attorney
Patients' reported legal issues fit into three categories: financial support (66% of cases), housing and utilities (14%), and personal and family safety (20%). Even though 20% of people reported personal or family safety as an issue, 62% of the people actually assisted by the attorney were assisted with a family law or safety issue.
Northern Dental reports a patient satisfaction rate of 98%. The innovative and collaborative approach has been recognized regionally and nationally, including:
- Bush Foundation Community Innovation Award finalist
- Kate B. Reynolds Charitable Trust Innovations in Rural Health Award finalist
- Blue Cross Blue Shield of Minnesota Trailblazer Award winner
- Partner In Justice from Legal Services of Northwest Minnesota
You can read more about this medical-legal partnership in the 2016 Rural Monitor article Bringing Law and Medicine Together to Help Rural Patients.
These results came after overcoming a number of challenges, including:
- Adapting the MLP best practices to a dental setting
- Aligning both agencies' eligibility requirements for services and finding a way to meet both without restricting access
- Wording surveys and awareness materials in non-lawyer language
- Identifying meaningful data points and appropriate measurement tools to accurately report impact and outcome data
Many patients were skeptical about the presence of an attorney in the clinic, so clinic staff needed to articulate the differences between an attorney and law enforcement.
Clinical providers were trained to understand what barriers might benefit from legal advice and what cues from patients should prompt the suggestion of legal help. Attorneys were trained to understand the implications of poor oral health and to learn about the web of support services already available to clients so that attorneys could make informed referrals.
It can be difficult to build trust among a marginalized and sometimes voiceless population who tends to steer clear of social service organizations.
Utilize a focus group made of patients and pilot-test forms, events, and approaches. Then use this feedback to adapt and retest your approach.
Contact InformationJeanne Edevold Larson, Executive Director
Northern Dental Access Center
Social determinants of health
November 15, 2016
Date updated or reviewed
January 3, 2019
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.