Overall health is a function of many determinants, including economic, social, environmental, genetic, and racial factors. These factors disproportionately impact low-income individuals, and the increased exposure to these factors exacerbate their medical conditions. These factors relate to material needs that are intended to be addressed by government laws and regulations for things like food, housing, and disability benefits. When access to these benefits is delayed or denied then a social need becomes a legal need because there are legal remedies. Poor families have an average of 3 unmet legal needs, 80% of which are not being met by free legal aid services. 1:6500.
Many people do not receive the legal benefits and protections that they are entitled to. This happens for several reasons. One primary reason is that safety net programs have become so complex that they are inaccessible to the average patient (and sometimes even the average lawyer!). Since 1996, federal and state legislators and regulators have focused more on preventing fraud than on enrolling eligible individuals and families. This has resulted in increasingly complex eligibility and reporting requirements. Another reason that many eligible people aren ’t receiving benefits is that they don’t know to enroll or are being wrongfully denied benefits. When people don ’t get the benefits they need, then medical care is undermined. An asthmatic patient living in a moldy, cockroach-infested house will not get better no matter how many prescriptions are given to him if the landlord refuses to remove the mold and pests. Similarly, a cancer patient who loses their job and income will be less able to rest, heal, and follow treatment regimens if she is being harassed by creditors and bill-collectors and is stressed out about ballooning debt.
Integrating legal services into the healthcare setting to help low-income patients meet their basic needs and address the legal issues that might be negatively impacting health and well-being.
The collaboration of lawyers and providers allows patients to leave the medical clinic or hospital with a more comprehensive prescription for improved health. While a physician or nurse practitioner may prescribe medication to treat an acute or chronic illness, a legal advocate may intervene with phone calls, letters, or court filings to address other underlying problems. The integration of legal services also helps lawyers advocate more effectively for their clients since advocating for legal needs often requires documentation from medical providers. The co-location of services streamlines administrative processes and helps patients more quickly obtain the benefits and protections to which they are entitled.
Patients generally trust their healthcare providers (including social workers) and regularly provide them with a wide range of personal and private information. This trust helps to facilitate the identification of health-related social problems. By extension, patients then generally trust and follow their provider ’s advice and recommendations. As most of you probably know, there is a shortage of primary care providers in the United States, and primary care visits have become shorter and less frequent. What this means in terms of our discussion today is that each clinic or hospital visit becomes more important, and that the MLP model becomes increasingly valuable to time strapped providers to identify and address the social factors that contribute to a patients morbidity.
Providing legal services and assistance to patients, with a focus on early detection and the prevention of legal crises. Healthcare providers perform triage. Focus on internal system improvement. The goal is weave early detection and treatment of legal needs efficiently into clinical care. (GO TO SLIDE) - Ex of a Tool: legal needs assessment, ideally integrated into the EMR, that is asked of every first time patient and at regular intervals over the course of a patient ’s care. Based on the answers to these questions, patients would be automatically referred to the MLP lawyer for intake. - Ex of better ways to treat: Drafting and scanning form letters into the EMR that can be accessed by providers without the need for a lawyer. Housing Code Violation. 3) Promoting change outside the healthcare system. Working with coalitions, developing policy intiatives, and participating in the legislative process. - Powerful clinical voice / lawyers help to elevate that voice - Cancer patients forced to recertify their condition repeat visits MLP lawyers helped clinicians submit testimony and worked with national advocacy groups - Dramatic regulatory improvements in shutoff protections fewer med cert letters needed, broader spectrum of providers are authorized to certify eligibility
FHC DV Webinar - Ben & Will
National OrganizationFor Victim Assistance Dr. Will Marling Executive Director
What is NOVA? Sin ce 19 75 Championing dignity & compassion for victims of crime and crisis
NOVA NOWNOVA is the secretariatDepartment of DefenseSexual Assault Advocate Certification Program(D-SAACP)Currently under development
NOVA NOW United States Constitution Crime Victims’ Rights Proposed 28th Amendment
Thank You!Dr. Will Marlingwillmarling@trynova.orgOffice: 703-535-6682Victim Assistance: 800-879-6682
Medical-Legal Partnerships: Apreventive approach to safety and care Friend Health Connection: Preventing Domestic Violence Among People with Disabilities Presented by Ben Beck-Coon, JD, MSW May 17, 2012 8
Session Roadmap Understand the basics of the Medical-Legal Partnership (MLP) model Explore the goals and rationale of MLP Illustrate the model through a case example Q&A 9
What is a Medical-Legal Partnership? A partnership between at least one attorney and a healthcare clinic or hospital, whose primary purpose is to serve low-income and other vulnerable individuals An innovation in healthcare and legal services delivery that integrates legal services into the healthcare setting to address the material hardships associated with poverty and illness, thereby reducing stress and increasing well-being 10
Basic Needs Safe, affordable housing Personal stability and safety Adequate, healthy food Appropriate Educational Setting Access to Quality Health Care Source: Lauren Smith, MD MPH – The Medical Legal Partnership for Children 11
Known Threats to Health Poverty Substandard and Unaffordable Housing Food Insecurity Inadequate Education Exposure to neighborhood and family violence Barriers to quality in health care Source: Lauren Smith, MD MPH – The Medical Legal Partnership for Children 12
Issues We Need to Raise… Awareness of the importance of social factors Recognition that access to health care and social services is paramount to good health Realism that resources to overcome social barriers are often beyond the reach of patients and providers 13 Source: Dr. Rupa Nimmagadda Department of Pediatrics- University of Chicago Comer Children’s Hospital
The Result….. Complex, unfamiliar social service systems make advocacy difficult, inefficient, and ineffective Social issues seem untreatable Medical treatments and care are undermined 14 Source: Dr. Rupa Nimmagadda Department of Pediatrics- University of Chicago Comer Children’s Hospital
15Source: Cartoon by Jack Maypole, MD, MLPBoston; Copyright MLP Boston 2009-2010
The (traditional) Clinical Team Doctor Nurse Practitioner Nurse Educator Social Worker Registered Dietician Physical Therapist Occupational Therapist Speech & Swallow Therapist Home NurseAnd introducing…. 16
The Lawyer and the Medical-Legal Partnership Lawyers as powerful sub-specialists Valuable means for effective advocacy Addresses significance of social factors Places solutions to social barriers within reach Increases the return on initial investment Improves overall health 17
Why integrate legal services in a healthcare setting? Cultivates a culture of advocacy in health care institution Promotes one-stop shopping experience in a clinical setting Builds on patients’ trust and familiarity Enables identification of legal issues through a preventive approach, decreasing the likelihood of legal (and health) emergencies. Source: National Center for Medical- Legal Partnership 18
The Unique Role of the Healthcare Provider Trust is implied Meetings take place in a safe environment The communications are confidential Patients already share many intimate details of their life with their provider – martial problems, eviction, job loss, school problems Unfortunately, often times providers are not trained as to what to do when they come upon these issues in their practice Source: Health and Disability Advocates, Chicago, IL; Diane 19 Pappas UVA Children’s Hospital/Medical-Legal Partnership Training Materials
Who are the legal and clinical partners in an MLP? Legal Partners Legal Aid Organizations (primary partners) Private Bar Law Firms (different models) Law School Clinicals Healthcare Partners Hospitals (nonprofit/for profit, public/private) Health Clinics Community Health Centers Federally Qualified Health Centers 20
A Growing Movement Lawyers and front-line healthcare providers (doctors, nurses, social workers) are partnered at 225 hospitals and and health clinics in the United States MLP has been officially recognized by the American Bar Association (ABA) and American Medical Association (AMA) Recognized as an innovation by the Agency for Healthcare Research and Quality (AHRQ) 23
Case Example – Jane Jones 45 year old woman with a h(x) of seizures, asthma, PTSD, major depression, and paranoid schizophrenia Referred by nurse for housing issues Client and son being abused by father/husband H(x) of hospitalizations A team-approach to Jane’s case Barriers to care 24
Using a Trauma Framework Shift in conceptualization of “symptoms” Recognizes the role of violence and abuse in the development of MH symptoms and disorders Renames symptoms as survival strategies Destigmatizes symptoms More balanced approach to treatment Focuses on empowerment, resilience, hope 25
MLP Resources/Contact Info National Center for Medical-Legal Partnership: www.medical-legapartnership.org My Contact Info: Benjamin Beck-Coon O: 267.597.3670 email@example.com www.lcdphila.org 26
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