Health, housing, and justice: Two-year implementation evaluation of a health system's multi-state medical-legal partnership to address housing instability

OBJECTIVE: To assess reach and identify facilitators of and barriers to the implementation of housing-focused medical-legal partnerships (MLPs) within a large healthcare system. 

STUDY SETTING AND DESIGN: 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 AND ANALYTIC SAMPLE: 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. 

PRINCIPAL FINDINGS: 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. 

CONCLUSIONS: 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.