Recommended Standards and Self-Evaluation Guidelines for Medical-Legal Partnerships in Texas
Disclaimer: These standards are recommendations, not requirements, developed by the Board of Directors of the Texas Medical-Legal Partnership Coalition to support individual medical‑legal partnership (MLP) programs in Texas. They are designed to be used as a self‑evaluation tool by each MLP program, using an annual assessment to characterize partnership configuration, identify strengths and opportunities, and guide quality improvement over time regardless of programmatic design. The assessment does not presume that greater organizational integration is the appropriate goal for every program, and partnership categories are not ratings of program quality. Adoption of these standards is voluntary and does not in itself confer accreditation. If you have feedback about these guidelines, contact us anytime.
To complete the evaluation, click here. To download the questions, click here.
About the Coalition and the MLP Model
The Texas Medical-Legal Partnership Coalition (the Coalition) is a network of medical-legal partnership (MLP) practitioners and allied professionals across Texas working at the intersection of healthcare, law, and public health. The MLP model addresses health-harming legal needs of patients in hospitals, clinics, and other facilities—such as unsafe housing, food insecurity, and lack of access to transportation—by embedding legal professionals into health care settings. These problems are known in Texas as non‑medical drivers of health, reflecting the ways in which income, housing, education, employment, legal status, and personal and family stability shape health outcomes. MLPs create a culture of health justice and advocacy, transforming clinical practice, and ensuring that expertise in the structures that predominantly shape health are integrated within the delivery of healthcare.
The Coalition’s mission is to improve the health of all Texans by supporting and promoting integration between legal and health professionals. The Texas Medical-Legal Partnership Coalition serves as a network and coordinating body to leverage these partnerships and their work, as well as to build stronger relationships and promote best practices in the development and operation of MLPs.
The Coalition’s goals are to create a community of MLPs and other resource partners who can share their work, expertise, and best practices among its members; advise and provide technical assistance to organizations wishing to establish an MLP; advocate for health-affirming laws and policies; and promote the development and operation of MLPs, including access to resource materials for establishing an MLP. Doing so requires model fidelity.
Framework for the Standards
Because MLPs vary in scope, size, setting, and services, these standards use the eight core components of an MLP, as defined by Regenstein et al in Health Affairs, to identify common functions and elements that can be monitored across MLPs regardless of program variation. For MLPs with academic partners, the standards also incorporate the 11 components of academic MLPs described by Girard et al. The standards align with the indicators used by the National Center for Medical‑Legal Partnership to delineate a continuum of integration. Limited other studies are incorporated as appropriate.
Using the Self-Assessment
Each standard is intended to be scored by individual MLP programs, most as a yes/no item and others through a 5-point Likert scale. The Coalition uses these responses to characterize the organizational arrangements and patterns of collaboration among Texas MLPs, including referral-based, collaborative, and fully integrated partnerships. These categories describe how partners work together; they are not rankings of program quality or required stages of development. A referral-based partnership may be an intentional and appropriate model for the population served, the participating organizations, and the local context. Programs can use their assessment results to identify improvements within their chosen arrangement or to consider changes to that arrangement when appropriate.
Definition of an MLP program
For purposes of this self‑evaluation, an MLP program is defined as a one-to-one relationship between a single health care organization and a single legal organization, which may also include additional collaborating partners. Each health care or legal organization may participate in more than one MLP program, but existing Coalition scans of the Texas MLP environment suggest that other arrangements are currently somewhat rare. We use this program-level definition to ensure that assessments are aligned to a consistent unit of analysis and that results can guide integration, quality improvement, and future accreditation for each distinct MLP program.
Recommended Standards
Formal partnership agreement
This section asks whether the MLP has a clear written foundation for the partnership. A strong agreement helps define roles, expectations, confidentiality, and shared responsibilities between the health care and legal partners. It also supports continuity when personnel change. i, iii
1.
The MLP operates under a written agreement (e.g., MOU, contract) between at least one healthcare organization and one legal services provider, including one law school clinic that defines joint goals, partner responsibilities, and protections for privacy and confidentiality.
2.
The agreement specifies expectations for each of data-sharing, resource commitments, and quality improvement activities.
Defined population and non‑medical drivers of health
This section asks whether the MLP is focused on a clearly identified patient population and the non-medical drivers of health most relevant to that group. Programs should be able to describe who they serve and why those needs were selected. Over time, the MLP should revisit those priorities as community needs and program capacity change. i, ii, iii, v
3.
The MLP identifies a defined patient population (e.g., by clinic, condition, or demographic group), and bases its target population on evidence of poor health outcomes caused by non-medical drivers of health (NMDOH).
4.
The MLP uses available data (e.g., health system reports, community assessments) to select its priority NMDOH and priority legal interventions, and to revisit and assess NMDOH and legal priorities.
Legal need screening strategy
This section asks how the MLP identifies legal needs that affect health. Screening may occur through health system workflows, the electronic health record, or other structured processes. The goal is to understand whether the program has a reliable and repeatable way to find and respond to legal needs. i
5.
The MLP uses structured screening processes, integrated into both health system workflows and the electronic health record (EHR), to identify health-harming legal needs.
6.
Screening tools draw on frameworks such as I-HELP and broader social risk instruments (e.g., PRAPARE or similar) to capture legal problem categories like housing, income supports, education, employment, legal status, and family stability.
Legal staffing and services
This section asks whether the MLP has the legal capacity needed to serve its population. Programs should consider both the kinds of legal services offered and whether staffing is sufficient for the volume and complexity of need. This section also looks at whether staffing is tested against actual demand over time. i, iii, iv
7.
The MLP has dedicated legal staff (e.g., legal aid, law school clinic faculty and students, pro bono partners) that provide a continuum of services that may include brief advice, full representation, consultation to health providers, participation on health institutional workgroups, and systems-level advocacy to address recurring NMDOH.
8.
Legal staffing capacity is aligned to the identified population and priority legal-need domains (e.g., housing, insurance, domestic violence), and the MLP periodically uses empirical methods (e.g., referral and case-volume analysis, wait times, unmet need estimates, or benchmark ratios) to test whether existing human resources are sufficient to meet demand and/or to inform future staffing decisions.
Lawyer-in-residence
This section asks whether legal professionals are meaningfully present in or connected to health care delivery. Integration may occur in person or virtually, but the key issue is whether legal services are accessible within the care setting. This section also asks whether legal staff are treated as part of the care team. i, iii
9.
10.
The MLP provides regular, predictable access to legal professionals, in-person or through virtual protocols.
Legal professionals participate in care team meetings (e.g., huddles, case conferences), showing the health organization recognizes them as integrated members of the team addressing NMDOH.
Health care staffing and services
This section asks whether health care staff are actively engaged in the MLP’s work. Strong programs often include clinicians and other health team members in setting priorities, reviewing cases, and identifying system-level opportunities. The section also considers whether the health care partner makes protected time available for this work. iii
11.
Health care team members (e.g., clinicians, social workers, care managers, community health workers) are involved in identifying priority case types, clinical focus areas, and systems level targets for the MLP.
12.
The MLP’s health care partner allocates protected time for key staff (e.g., champion clinicians, social workers, administrators) to participate in MLP activities, such as program meetings, providing medical evidence for legal interventions, case conferences, trainings, data review, and systems change work.
Training and interprofessional education
This section asks whether the partnership builds shared knowledge across disciplines. Training should help health care staff recognize legal needs and understand how legal services can help. Regular meetings between health and legal leaders also help keep the program aligned and responsive. i, iii
13.
Legal professionals provide at least annual training for medical, nursing, behavioral health, and/or population health staff on spotting health-harming legal needs and understanding legal remedies.
14.
The MLP holds regular joint meetings between health care and legal leadership (e.g., program administrators, clinical leaders, legal supervisors) to review program operations, address challenges, and set priorities.
Information-sharing, data, and evaluation
This section asks whether the MLP has the communication, data, and workflow structures that make the partnership truly integrated. Strong MLPs often do more than refer cases; they create a feedback loop so that legal and health teams communicate about referral status, outcomes, and next steps. This section also asks whether data are used jointly to improve care, staffing, and system-level response. i, ii, iii, iv
15.
The MLP uses compliant mechanisms (e.g., consent processes, data-sharing agreements, secure documentation) to share information bidirectionally between health and legal partners in ways that support coordinated care and closed-loop referrals.
16.
The MLP collects and uses deidentified data on activities and outcomes (e.g., referrals, case types, health related impacts) to monitor performance and/or report impact to each partner; to engage in quality improvement activities, such as refining workflows; and to contribute to broader evidence in NMDOH and MLP effectiveness, such as by sharing with the Coalition.
Information-sharing, data, and evaluation
This section asks whether the MLP has the communication, data, and workflow structures that make the partnership truly integrated. Strong MLPs often do more than refer cases; they create a feedback loop so that legal and health teams communicate about referral status, outcomes, and next steps. This section also asks whether data are used jointly to improve care, staffing, and system-level response. i, ii, iii, iv
15.
The MLP uses compliant mechanisms (e.g., consent processes, data-sharing agreements, secure documentation) to share information bidirectionally between health and legal partners in ways that support coordinated care and closed-loop referrals.
16.
The MLP collects and uses deidentified data on activities and outcomes (e.g., referrals, case types, health related impacts) to monitor performance and/or report impact to each partner; to engage in quality improvement activities, such as refining workflows; and to contribute to broader evidence in NMDOH and MLP effectiveness, such as by sharing with the Coalition.
Resources, sustainability, and systems change
This section asks whether the MLP has the resources needed to operate and grow. Sustainable programs usually have a mix of support from both health and legal partners, along with planning for future stability. This section also asks whether the MLP works to change systems, not just handle individual cases. i, iv
17.
The MLP secures resources from both the health and legal sectors (e.g., in kind and financial support, grant funding, institutional investments) to maintain operations and plan for sustainability.
18.
The MLP invests in systems-level work—such as clinic workflow changes, institutional policy reforms, and advocacy on laws and regulations—to prevent or reduce recurring health harming legal needs.
Field Engagement
This section asks whether the MLP is connected to the Coalition and participates in shared learning and coordination. Designated representatives help ensure that each program has a voice in Coalition activities. This section also considers whether Coalition information and lessons are brought back to local stakeholders. iii
19.
The MLP has appointed at least one healthcare and one legal team member to participate in Coalition activities on behalf of that MLP.
20.
The MLP communicates Coalition updates and opportunities (e.g., learning sessions, advocacy, data initiatives) back to local stakeholders and incorporates relevant lessons from the Coalition into program planning.
Academic MLP (University Settings Only)
This section applies only to MLPs with academic partners. It asks whether the program includes learners from multiple disciplines and has clear educational, assessment, and scholarly goals. Academic MLPs should also have structures that support teaching, evaluation, and dissemination. ii
21.
22.
23.
The MLP integrates students from multiple disciplines into direct service, team‑based care, and reflection about NMDOH.
The MLP has explicit educational objectives, curricula, and assessment strategies for learners from law and healthcare professions.
The MLP Program supports scholarship, program evaluation, and dissemination (e.g., co-authored publications, presentations, and contributions to national and statewide MLP data efforts).
Citations
i.
Regenstein, M., Trott, J., Williamson, A., & Theiss, J. (2018). Addressing social determinants of health through medical-legal partnerships. Health Affairs, 37(3), 378–385. https://doi.org/10.1377/hlthaff.2017.1264
ii.
Girard, V. W., Perry, D. F., Kessler, L. P., Cannon, Y., Bhatnagar, P., & Roth, J. (2022, September). The academic medical-legal partnership: Training the next generation of health & legal professionals to work together to advance health justice. Georgetown University Health Justice Alliance & National Center for Medical-Legal Partnership. https://www.medical-legalpartnership.org/mlp-resources/academic-mlp-report/
iii.
National Center for Medical-Legal Partnership. (2014, February). The medical-legal partnership toolkit phase I: Laying the groundwork. https://kresge.org/sites/default/files/Uploaded%20Docs/Medical-Legal-Partnership-toolkit-phase-1.pdf
iv.
Park, J. K., Beck, A. F., Warren, K., & Sage, W. M. (2026). Medical-legal partnership as value-based primary care: Interprofessional teamwork for health-related social needs. Journal of General Internal Medicine, 41(10), 2901–2909. https://doi.org/10.1007/s11606-026-10402-w
v.
Beck, A. F., Henize, A. W., Klein, M. D., Corley, A. M. S., Fink, E. E., & Kahn, R. S. (2023). A data-driven approach to optimizing medical-legal partnership performance and joint advocacy. The Journal of Law, Medicine & Ethics, 51(4), 880–888. https://doi.org/10.1017/jme.2023.158