Increasing Access to Justice for Adolescents through Medical-Legal Partnerships

Background and purpose: In healthcare settings, adolescents occupy an ambiguous position: they are rarely afforded the full rights and autonomy of adults, yet they may be excluded from the presumptive protections extended to young children. Adolescents seek medical care for a range of reasons but stress-related health needs are a leading cause. Adolescent stress-related health needs intersect with and are compounded by many social determinants such as unstable and substandard housing, exposures to violence, inequities in access to education, racism, anti-LGBTQ stigma, and more. Medical-Legal Partnerships (MLPs) are formalized interdisciplinary collaborations that embed civil legal aid services into healthcare settings to address health needs of patients that may have remedy in the law. There is evidence of the efficacy of MLP models generally, but limited research has focused on services for adolescents. This study explores how these models address the needs of adolescents and the legal, developmental, and ethical considerations for professionals working in collaboration with this unique patient group.

Methods: We conducted qualitative semi-structured interviews with 15 medical and legal professionals experienced working with adolescents through MLPs in late 2025 and 2026. Participants worked in hospitals, universities, and other clinical settings across diverse geographic and political settings in the United States. We transcribed the interviews and conducted a reflexive thematic analysis using a combined inductive and deductive approach. In the interviews we focused on how participants identify, characterize, and address the legal needs of adolescents. We also sought to explore facilitators and barriers in the provision of high-quality collaborative care including priority issue areas, knowledge and skill development, institutional factors, and ethical considerations.

Results: MLPs provide an array of legal aid services for adolescents presenting in healthcare settings, which are both overlapping and distinct from other pediatric and adult populations, including access to public benefits, educational rights, housing rights, emancipation, access to reproductive and other gender-related healthcare, immigration, and more. MLP service providers encounter unique ethical and legal considerations when working with adolescents, such as capacity for medical and legal-decision making, the role of parents and guardians, transitional age changes to benefit eligibility, and a politicized terrain for reproductive healthcare and LGBTQ youth rights. This study identifies MLPs as an advocacy-based model increasing access to justice, especially where legal and health systems intersect in unique ways for youth who are LGBTQ+, unaccompanied, undocumented, disabled, or impacted by the child welfare and juvenile justice systems.

Conclusion: Approaches to adolescent care often over-emphasize individual physical, cognitive, emotional, and behavioral change in ways that can obscure structural and external sources of stress and limit autonomous decision-making and self-determination. Advocacy-based services addressing civil legal needs can help shift the focus of service provision towards access to justice for adolescents, while building the capacities of healthcare professionals to identify, contextualize, and participate in interventions that address social and legal determinants of health. These existing interventions, developed primarily for adults, must be adapted and evaluated with adolescents to better meet their specific needs and experiences.