Development of a Referral Pathway to Address Health-Harming Legal Needs at a Federally Qualified Health Center

ABSTRACT Background: Health-harming legal needs are legal burdens that negatively affect a person's overall health. Medical–legal partnerships (MLPs) are a cost-effective way for health care systems to improve overall health and access to health care and empower health care providers to become more active in addressing health-harming legal needs and social determinants of health. This article describes the implementation of a referral pathway to an MLP in a nurse-managed community health center. This pathway was used by the health center's clinical team to help connect patients who had burdensome legal needs with legal professionals who could further help evaluate those needs. Methods: An MLP team developed a referral pathway in which all adult patients were asked to complete a legal screening tool to assess whether they had legal needs that could be addressed by an MLP's intervention. If a legal need was identified, the patient would meet with the community health worker for further assessment. The community health worker would then present these cases for further review to the MLP team. The Plan–Do–Study–Act approach was used to make improvements to the pathway throughout the initiative. Results: The referral pathway was used in 70.8% of patient visits in the first seven weeks of implementation, with 209 legal screenings completed. Of those, 38 patients (18.2%) reported a legal need, 12 of whom (31.6%) were referred to the MLP. Conclusions: The referral pathway is a useful means of determining legal needs while also screening for social determinants of health. This process allows health care teams to address both health-harming legal needs and social determinants of health in a community health center.