Healthy Start for Medical-Legal Partnerships

The incorporation of Medical-Legal Partnerships into the US Federal Healthy Start initiative in 2010 represented a significant opportunity in the history of the MLP movement; providing the chance to profile the multi-disciplinary approach in the context of a well-established and regarded Federal health program.

The Healthy Start Program is administered by the Division of Healthy Start and Perinatal Services (DHSPS), within the Federal Health Resources and Services Administration (U.S. Department of Health and Human Services). DHSPS’ mission is to “…provide national leaderships in improving the health of women across the lifespan and decreasing infant and maternal morbidity and mortality during or associated with the perinatal period. DHSPS works in collaboration with Federal, regional, state, local governments and public/private organizations and consumers on programmatic and policy efforts to define and address the health needs of women before, during, and after pregnancy and of their infant and family through the baby’s second birthday.”1

In 2010, the suite of intensive services sponsored by Healthy Start incorporated three demonstration MLP pilots. Like all Healthy Start programs, these would target the needs of high risk pregnant women, infants and mothers in geographically, racially, ethnically, and linguistically diverse communities with exceptionally high rates of infant mortality.2

The expressed purpose of this funding opportunity represents a pretty good summary of MLP theory and practice:

“Because … differences in perinatal health indicators may occur by virtue of Social Determinants of Health, such as differential access to food, safe and healthy housing, stable utility access, and disability benefits, etc., this funding provides an opportunity for Healthy Start programs to go the next step, by integrating an attorney as part of the Healthy Start team, to build capacity for client advocacy, train Healthy Start staff on the connections between disparities and legal solutions, and leverage the Healthy Start intervention strategy to include access to legal expertise. Medical-Legal Partnerships combine early identification of legal problems and access to legal assistance that if left unchecked, may lead to serious health problems for children and families.”3 

While on the MLP tour I have been fortunate to visit the three sites funded under the program –

  • Children’s Law Center and Children’s National Medical Center, in Washington, DC
  • Crozer-Keystone Healthy Start and Widener University School of Law in Chester, Pennsylvania
  • SHIELDS Medical-Legal Advocacy Partnership in Los Angeles, California

While each have their own priorities and unique systems, reflective of the demonstration nature of the funding, each deliver integrated legal assistance, on-site at the health service.

The SHIELDS Medical-Legal Advocacy Partnership team and program participants

The Crozer-Keystone Healthy Start initiative best exemplifies this, with the  attorney permanently sited at the health service and embedded within the health team (albeit in a confidential office space). Another notable feature was the commitment and enthusiasm of the health/social service partner to delivering the programs. The energy of the SHIELDS team in Los Angeles was  extraordinary (though typical of all committed programs), and the clients who shared their stories of recovery and empowerment were deeply impressive.

As these projects progress through the demonstration phase, the evaluation results will not only prove critical to the expansion of the initiative within the program, they will prove vital to the entire MLP movement as it strives for effective ways to measure and demonstrate value (see MLP Metrics).


Peter Noble


1. US Department of Health and Human Services, Health Resources and Services Administration, Division of Healthy Start and Perinatal Services FACT SHEET, undated.
2. Op. cit.
3. Maternal and Child Health Bureau Division of Healthy Start and Perinatal Systems, Supplemental Funding Announcement “Promoting Family Advocacy through Medical-Legal Partnership”, 2010.

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