Prevalence of Civil Legal Needs and Associated Characteristics Among US Department of Veterans Affairs Patients: A National Survey.

BACKGROUND

The Department of Veterans Affairs (VA) refers patients to affiliated legal clinics to assist with health-related social needs like housing and benefits. However, little is known about the prevalence of various types of civil legal needs (CLNs) among VA patients and sociodemographic/clinical correlates. This limits the VA's ability to tailor medical-legal collaborations to patients' needs and identify subpopulations most likely to experience these needs.

OBJECTIVE

To estimate the prevalence of eight types of CLNs (housing, family, wills/inheritance, VA benefits, non-VA benefits, finance, military discharge upgrade, and employment) among VA patients and test CLN associations with sociodemographic and clinical characteristics.

DESIGN

We administered an online survey to a stratified random sample of VA patients and linked responses with VA administrative data. We calculated CLN prevalence, the proportion of participants who received help with CLNs, and correlations among CLNs. We used logistic regression to examine bivariate associations with sociodemographic and clinical characteristics.

PARTICIPANTS

A random race/ethnicity- and rurality-stratified sample of VA healthcare patients was invited to participate (n = 19,714). Those who answered CLN questions were included (n = 1,858; participation rate = 9.42%).

MAIN MEASURES: Modeled measures included CLNs reported by ≥ 10% of the sample and a combined measure of any (versus no) CLNs.

KEY

RESULTS

The most prevalent CLNs were for wills/inheritance (30.52%), VA benefits (24.92%), finance (13.08%), family (10.82%), and housing (10.23%). In bivariate models examining sociodemographic and clinical correlates, financial strain was significantly associated with all individually modeled needs and any CLNs (ORs 1.23-3.32, p < 0.01-0.03). Education beyond high school was significant for all CLNs except housing (ORs = 1.46-2.38, p < 0.01-0.04).

CONCLUSIONS

CLNs are prevalent, and financially strained VA patients and those with higher education are more likely to report these needs. The VA should explore and evaluate tailored modes of screening and outreach to identify Veterans who could benefit from free or low-cost civil legal services.