Medical-Legal Partnerships: Developing and Expanding Outreach Services to Address Legal Needs of Underserved Populations

Outreach programs at Community Health Centers (CHCs) provide enabling services such as health education, case management, eligibility assistance, interpretation, and transportation to underserved populations to facilitate access to health care. Even so, the populations they serve face many barriers to their health and wellbeing that may go beyond a health center’s ability to address.  Issues such as job insecurity, immigration status, lack of safe housing, family custody or visitation rights, food insecurity, disability, and occupational hazards can impede patients’ ability to access health care and maintain a healthy life for themselves and their families.  While linking with other social and health services organizations in the community has been a useful strategy for outreach programs to address the complex needs of their populations, many of the aforementioned barriers can also be effectively resolved via legal channels. Developing medical-legal partnerships with legal service organizations can help outreach programs expand their enabling services to meet the legal needs in their communities and effectively provide comprehensive care to underserved populations.

Medical-Legal Partnership Defined

A medical-legal partnership (MLP) includes a legal organization, such as a legal-aid agency, pro-bono lawyers, or a law school, and a health organization, such as a health center, hospital, or other health services.  In a MLP, health staff screen for health-related legal issues and refer patients to the legal partner, who may provide services at the health organization itself.[1]  In some partnerships, health outreach staff and their legal partners conduct outreach activities together.  Medical-legal partnerships can be specifically focused on one type of legal need, such as workers compensation, or on a variety of legal issues such as visitation rights, domestic violence, eviction, immigration, disability, employment instability, food security, and receipt of public benefits. 

Why a Medical-Legal Partnership?

Many of the underserved populations served by CHCs face a variety of challenges in accessing health care services including low income, language barriers, low literacy, lack of transportation, and confusion about the U.S. system of health care.  Some underserved populations may be susceptible to even more barriers such as unemployment issues, disability, workplace issues, immigration, and housing issues.  Medical-legal partnerships can help outreach programs tackle these barriers in a manner that is consistent with the patient’s lawful rights and ensure access to care. In addition, MLPs can help outreach programs improve the delivery of quality health care by providing resolutions to issues that may impede patients’ ability to maintain their care coverage or healthy lifestyles.   Legal assistance can occur in the form of patient education on legal rights, building awareness of new and existing laws, working with families to resolve custody and visitation rights, and working on advocacy around policies that may affect their community.  Also, with the passage of the Patient Protection and Affordable Care Act, many previously uninsured populations will now be eligible for coverage.  Outreach staff will be key to connecting eligible individuals to public health insurance programs, from educating individuals and families about their coverage options, providing assistance during the application process, and helping families stay enrolled. However, for some underserved populations such as immigrant families, confusion or fear over residency status may hinder them from applying for public benefits. Legal staff can work with the outreach staff to help eligible but uninsured immigrant families determine the appropriate documentation needed to apply for coverage.  

The Importance of Outreach for Medical-Legal Partnerships

Outreach is essential to the establishment of medical legal partnerships.   Outreach workers:

• Have knowledge of community health and legal needs
• Are accessible and gain trust in communities
• Often possess language and cultural ties to the populations they serve
• Can build awareness and bridge community members with the services legal organizations provide 
• Can utilize existing relationships with the community to ascertain what their legal needs are, what organizations are currently addressing those needs, and where and how these needs are being met

When setting up an medical-legal partnership, it is important that outreach programs work with their legal partner to define the objectives of the partnership, the role and responsibility of each partner, the primary point of contacts, and what the limitations are. For outreach programs serving farmworkers, some of these limitations may involve determining how best to address legal issues on camps sites without threatening existing relationship with growers.

Examples of Integrating Legal Services into Outreach and Enabling Services

The first medical-legal partnership was first created in 1993 at Boston Medical Center, integrating legal assistance into their patient care with an interdisciplinary team of health care staff, attorneys, and paralegals.[2] Since then, MLPs have been developed by health centers and hospitals across the U.S., providing health and legal services to farmworkers, children, the elderly, immigrant populations, and other underserved populations.  While MLPs vary from heath center to health center, at the core, MLPs can assist outreach programs in facilitating access to health care by removing legal barriers.[3] Below are four examples of integrating legal services into outreach and health center programs.

The Medical-Legal Partnership for Children – Hawai’i (MLPC), a partnership between Kalihi Kokua Valley Comprehensive Family Services (KKV) and the University of Hawai’i William S. Richardson School of Law, works to address the legal and social needs of their patients, families, and community in the Kalihi Valley of Honolulu. MLPC operates a legal advocacy clinic at KKV’s main clinic site.  MLPC’s legal services are integrated into the activities of the health center, and the legal clinic hours are scheduled to align with the Well-Child checkups conducted by KKV’s pediatric team. MLPC works with the pediatricians and clinic staff to identify legal issues that their patients are facing and provide legal support on site. MLPC has been successful in helping KKV community members navigate the health and legal system, mitigating the legal concerns of their patient populations, and conducting systemic advocacy for immigrant communities.

Promotores at Quincy Community Health Center in Quincy, Washington, use monthly calendars developed by Northwest Justice Project, a legal service organization. The calendars highlight health issues, legal information, and other relevant information for farmworkers in the community. Quincy’s promotores utilize the calendar to schedule appointments and keep health information organized for their largely low-literacy, farmworker patient population.

Salud Para la Gente, a migrant and community health center in Watsonville, California, has a formal partnership with two legal organizations, Watsonville Law Center and California Rural Legal Assistance. The partnership addresses workplace issues for farmworkers including workers compensation and workplace injuries through a monthly workers’ compensation clinic. At the monthly clinic, legal staff conducts interviews with the injured workers while the health center staff treats their injuries.  As a result of the partnership, Salud Para la Gente incorporated workers’ compensation billing procedures into its billing system and can now generate additional revenue for the health center.

Maine Migrant Health Program of Augusta, Maine, developed informal relationships with legal agencies in their community to address the legal needs of farmworkers they serve. This informal partnership helps MMHP with basic counsel on legal and medical requirements for immigration residency process, education and awareness on new laws, and food access. A representative from their legal partner also serves on the MMHP board of directors and provides legal guidance to MMHP program planning. 

Mitigating barriers and facilitating access to care for underserved populations have been central to the mission of health outreach programs. Medical-legal partnerships are a key way for outreach programs at health centers to expand their services to respond to the legal needs of their patient populations. These partnerships in turn can improve health centers’ ability to provide comprehensive care and establish themselves as health care homes for the communities they serve.

For more on the medical-legal partnerships featured in this article, visit our Innovative Outreach Practices and Peer-to-Peer webinar:

• Fostering Medical-Legal Champions for Health in Hawaii. Medical-Legal Partnership for Children – Hawaii (MLPC). Kokua Kalihi Valley Comprehensive Family Services, Honolulu, HI <<insert IOP Link>>
• Integrating a Legal Resource Calendar with Health Outreach, Quincy Community Health Center <<insert IOP Link>>
•  Medical-Legal Partnerships For Farmworker Health and Legal Service Organizations. http://web.outreach-partners.org/resources/ptp

Coming Soon!! A Medical-Legal Partnerships resource for farmworker health and legal organizations by Farmworker Justice & Health Outreach Partners! This resource will be announced via HOP’s Outreach Connection.  To be on HOP’s mailing list, sign up at http://web.outreach-partners.org/resources/outreachconnection