JUSTICE(IN)HEALTH::HEALTH(IN)JUSTICE: A Participatory Assessment of the Value Proposition of Medical-Legal Partnership for Mothers with Opioid Use Disorder

Abstract

The Massachusetts Bureau of Substance Addiction Services funds integrated care clinics for mothers with opioid use disorder in Massachusetts through its Moms Do Care Program. Moms Do Care teams and participants experience many harmful impacts from laws and policies targeting opioid use disorder and its treatment. However, most care teams and participants lack the legal expertise and resources required to recognize and address these issues effectively. One of the Moms Do Care clinics has partnered with an organization called MLPB to receive legal education and supports to help them identify and problem-solve their law and policy issues. MLPB is interested in expanding its partnership to the other Moms Do Care Program clinics but lacks a clear understanding of its value proposition to these clinics. The objective of this thesis was to assess and improve MLPB’s value proposition to Moms Do Care Program clinics. This project applied Carlson’s NABCs of value proposition as a conceptual framework using qualitative research methods, including community-based participatory research approaches, to understand MLPB’s value proposition to customers. It produced findings across three different types of customer roles at Moms Do Care sites, and between one case and five control sites using an observational case-control study design. This thesis proposes five recommendations for MLPB to improve its value proposition to Moms Do Care Program clinics. The first recommendation is to help customers understand their legal needs through the novel lens of “disentitlement,” and its benefits as “legal harm reduction.” The second is for MLPB to clarify and reinforce the theory of change that is the basis for its Team-Facing Legal Partnering approach. The third recommendation is to improve measurement of the impact of enhancing legal problem-solving capacity. The fourth is for MLPB to promote both individual and collective agency as an output of its approach. The final recommendation is for MLPB to distinguish itself from its ‘competition’ and as a way to maximize the “legal partnering village.” This thesis also presents important lessons that can inform further exploration of law as a determinant of health and interventions aimed at reducing the harm of disentitling laws and policies.