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

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.