247844 Medical-legal partnerships in community clinics: A model for patient-centered health homes

Tuesday, November 1, 2011

Rishi Manchanda, MD MPH , Program in Social Medicine and Health Equity, St.John's Well Child and Family Centers, Los Angeles, CA
Background: In 1993, medical-legal partnerships (MLPs) began to pair lawyers with pediatricians to address the social determinants of health. While the model has spread to 38 states and 180 sites, little is known about the extent to which MLPs help clinic and legal allies identify health policy problems or how community health centers can implement MLPs to become patient-centered health homes. Methods: St.John's Well Child and Family Centers, a large community health center network serving nearly 40,000 low-income residents in south Los Angeles, partnered with Neighborhood Legal Services of Los Angeles County, a private, nonprofit law firm to address social determinants of health. Extensive clinician training and key stakeholder engagement led to a clinic-based referral process and on-site legal services. Results: In 2010, 614 patients with multiple legal problems were referred for on-site medical-legal services. While 114 health insurance eligibility problems and 115 health care service problems were addressed, 709 problems related to other social determinants of health were identified. Housing problems reflected 35% of non-health insurance related issues, with issues relating to family law, immigration and food insecurity comprising 17%, 13% and 10% of cases. This data informed clinical innovations and policy and legal advocacy to improve patient-centered health care and population health and improved medical and legal workforce satisfaction. Conclusion: Medical-legal partnerships in community health centers can significantly improve health law advocacy, the development of patient-centered health homes, and contribute to both medical and legal workforce retention in underserved settings.

Learning Areas:
Administer health education strategies, interventions and programs
Advocacy for health and health education
Clinical medicine applied in public health
Other professions or practice related to public health
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy

Learning Objectives:
At the end of the session, participants will be able to 1) describe a community health center-based model for addressing social determinants of health through medical-legal interventions 2) discuss the implications of a community health center-based biosocial approach for health care service delivery system innovations such as patient-centered health homes.

Keywords: Health Law, Primary Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I direct the social medicine program at a large urban community health center network and am the medical champion of our medical-legal community partnership.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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