Arora Natasha, Terry Sarah, Stevens Holly R, Davis Vanessa W, Sorto Gerson, Hamilton Bethany, Conner Marisa, Cabrera Alejandra, Mueller Shane R, Casoni Maria, Elkhatib Hiba, Lawton Ellen, Tobin-Tyler Elizabeth
Center for Community Health and Evaluation, Seattle, Washington, USA.
Legal Services Corporation, Washington, District of Columbia, USA.
Health Serv Res. 2025 May;60 Suppl 3(Suppl 3):e14620. doi: 10.1111/1475-6773.14620. Epub 2025 Mar 26.
To assess reach and identify facilitators of and barriers to the implementation of housing-focused medical-legal partnerships (MLPs) within a large healthcare system.
In 2021, Kaiser Permanente (KP) launched the Health, Housing, and Justice (HHJ) Initiative to embed MLPs within five medical centers across four states. KP invested in the capacity of five publicly funded legal aid providers to collaborate with healthcare teams and focus on housing stability. This paper summarizes findings from a mixed-methods implementation evaluation conducted from 2021 to 2023 on staff and system capacity, operational facilitators and barriers, and lessons learned.
Data sources included key informant interviews with healthcare and legal staff, surveys of social workers and care navigators, and administrative data on 857 legal referrals made by medical staff in 2022-2023 for housing-related legal support.
Implementation characteristics and the rate of referrals varied across each of the six sites engaged in the multisite MLP. Attorneys reported that the MLP enabled access to legal resources for clients who typically would not have access. Most cases (82%) were addressed with fewer than 5 h of attorney time. Key implementation facilitators included clinical champions in the partnering medical team, staff training with a focus on knowledge of housing-related legal issues and MLP referral criteria, and existing social screening processes. Key implementation barriers were associated with information sharing, orienting legal partners to a complex medical system, and mismatches in service delivery areas between KP and the legal aid organizations.
Embedding MLPs upstream in healthcare systems can enable access to legal resources for underserved clients. Attention to key implementation factors can support the spread of MLPs within other large healthcare systems.
评估在一个大型医疗系统中实施以住房为重点的医疗-法律伙伴关系（MLP）的覆盖范围，并确定其实施的促进因素和障碍。
2021年，凯撒医疗集团（KP）发起了健康、住房与司法（HHJ）倡议，在四个州的五个医疗中心内嵌入MLP。KP投资于五个公共资助的法律援助机构，使其能够与医疗团队合作，并专注于住房稳定性。本文总结了2021年至2023年对员工和系统能力、运营促进因素和障碍以及经验教训进行的混合方法实施评估的结果。
数据来源包括对医疗和法律工作人员的关键信息访谈、对社会工作者和护理导航员的调查，以及2022 - 2023年医务人员为住房相关法律支持进行的857次法律转介的行政数据。
参与多地点MLP的六个地点中，每个地点的实施特征和转介率各不相同。律师报告称，MLP使通常无法获得法律资源的客户能够获得这些资源。大多数案件（82%）在律师花费不到5小时的时间内得到解决。关键的实施促进因素包括合作医疗团队中的临床倡导者、以住房相关法律问题知识和MLP转介标准为重点的员工培训，以及现有的社会筛查流程。关键的实施障碍与信息共享、使法律合作伙伴适应复杂的医疗系统以及KP与法律援助组织之间服务提供领域的不匹配有关。
在医疗系统上游嵌入MLP可以使服务不足的客户获得法律资源。关注关键的实施因素可以支持MLP在其他大型医疗系统中的推广。
