5. NOVA NOW
NOVA is the secretariat
Department of Defense
Sexual Assault Advocate Certification Program
(D-SAACP)
Currently under development
6. NOVA NOW
United States Constitution
Crime Victims’ Rights
Proposed 28th Amendment
7. Thank You!
Dr. Will Marling
willmarling@trynova.org
Office: 703-535-6682
Victim Assistance: 800-879-6682
8. Medical-Legal Partnerships: A
preventive 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
9. 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
10. 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
11. 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
12. 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
13. 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
14. 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
16. The (traditional) Clinical Team
Doctor
Nurse Practitioner
Nurse Educator
Social Worker
Registered Dietician
Physical Therapist
Occupational Therapist
Speech & Swallow Therapist
Home Nurse
And introducing….
16
17. 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
18. 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
19. 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
20. 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
23. 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
24. 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
25. 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
26. MLP Resources/Contact Info
National Center for Medical-Legal
Partnership: www.medical-legapartnership.org
My Contact Info:
Benjamin Beck-Coon
O: 267.597.3670
bbeckcoon@lcdphila.org
www.lcdphila.org
26
Editor's Notes
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
