Health & Justice Initiative

Community Court

 

IMG_0179I was walking in downtown Spokane on my way to the library headed to Community Court. It is where all the cool kids hang out on Mondays mid-morning to early afternoon. Why do we hang out there, you may ask. Because we care about our community, because we want to help people, we want to make an impact.

Who are these cool kids and what do they do at the downtown library? We are a ragtag group of community organizations that collaborates with the courts to get disadvantaged (and usually impoverished) people the services they need.

Community Court is open to everyone but many start through the courts, as low level, non-violent offenders that would otherwise be jailed for minor offences that are often related their homelessness, drug or alcohol dependency or mental illness. Putting them in jail for minor offenses is expensive for the city and doesn’t help these folks. So the prosecutors, public defenders and the judge collaborate with community organizations to get them services instead.

There are a variety of organizations there to help people get signed up for mental health services, housing, public benefits and oh so much more. I go to represent the Center for Justice and to help people sign up for Medicaid or Washington Apple Health as it’s known in these parts.

Back to my story. I continued my stroll through downtown. IMG_0166The sun was shining, the air was crisp and not many people were out. I always enjoy the walk when the weather is nice. It’s only about a half a mile from my office and the stretch runs along beautiful Riverfront Park with its artwork, fountain and the river running right through the middle of it.

As I got close to crossing the street near the library, a bicyclist sped by and made eye contact. I gave a little nod and he nodded back. He was long and lean and a stocking cap covered much of his head but I could make out some short dreads underneath. He was holding a large piece of cardboard in one hand as he raced by.

I got to the library and settled in at my table with all the other service providers. Said my hellos to friends and set up my computer and my vast array of pamphlets. It got busy.

The tall cyclist came wandering in and sat at my table. He introduced himself. He had the name of a little town in California not too far from where I used to live in my youth. Hearing it brought a smile to my face.

He was soft spoken and polite. He looked like a guy who had just fallen on hard times and was trying to get himself back on track. I signed him up for healthcare without a hitch. He thanked me and left my table. I distractedly went on about my work and finished up for the day.

As I was walking out in a slew of others leaving, he came running up to me from behind. He was out of breath as he handed me the folded piece of cardboard. I opened it up and thanked him. He was gone in a flash. This is what he left behind. I think sharing his artwork was his way of extending a little gratitude for the help I had given him.

 

Comm Court pic

click the links below for more about community court

http://www.inlander.com/spokane/a-new-approach/Content?oid=2243257

http://www.spokesman.com/stories/2016/apr/19/spokanes-community-court-gets-200000-boost/

http://www.spokanelibrary.org/community-court/

Medical-Legal Partnerships: A Comprehensive Problem Requiring a Comprehensive Solution

MLP Image copy for blog

A huge thanks to our intern, Jerusha Dressel of Whitworth University, for researching and writing this blog post about one of our newest program areas, the Health & Justice Initiative.

 

Medical-Legal Partnerships: A Comprehensive Problem Requiring a Comprehensive Solution

Health care staff at Boston Medical Center, in the winter of 2010, found themselves faced with a problem that appeared to be propagating itself: patients living in sub-standard housing and suffering from chronic diseases would come in to receive treatment only to afterwards return to the same conditions, such as lack of heat, that initially provoked the issue.

It is evident how this could quickly become a self-perpetuating cycle:

  • A patient becomes ill due to asthma complications and consequently cannot go into work.
  • The individual loses income and cannot pay their utilities for the month.
  • The patient’s heat is turned off in their apartment, worsening the asthma issues.

Although regulations in Boston were set up to prevent those suffering from chronic conditions from having utilities turned off, they required paperwork to be filled out by the doctors themselves. Utilizing the resources provided by a medical-legal partnership (MLP), workers at Boston Medical Center were able to ensure that patients were receiving the legal protection they were entitled to under the law. Medical staff, though, found themselves overwhelmed with the paperwork from the massive amounts of individuals in need of a certification to keep their utilities from being turned off. Working as a team, medical and legal professionals were able to encourage regulation changes that lessened the paperwork required to guarantee legal protections for those dealing with certain medical issues. Because of the efforts of this MLP, 10,000 individuals with asthma and 400 with sickle cell are now less likely to need to visit a health care professional as a result of complications from their conditions and the burden on health care providers has been lessened.[1]

Problems similar to those faced by Boston Medical Center occur regularly. Health care and legal professionals employ different perspectives on patient-client issues. Health care professionals concern themselves with the medical side of the problem (e.g. helping the patient recover), whereas legal workers deal with the “justice” side of the issue (e.g. mold in an apartment building in violation of city code).[2] While both are working with aspects of the issue, they have not seen it as one broad issue, or even if they have, they have not been able to find a means to successfully, holistically combat the problem.

The problem facing health care and legal workers is like a puzzle. However, instead of being all together in the same box, the pieces are distributed to different individuals who have no interaction with one another. The lawyer has his or her group of pieces and can assemble a good portion of the puzzle to provide part of a solution, yet the lawyer has no clue as to what the doctor’s portion of the pieces look like and vice-versa. Thus, as much as these individuals may attempt to finish the puzzle and solve the problem, they cannot succeed because they are both lacking critical components. MLPs represent an effort to bring together all of the puzzle pieces.

According to the Journal of Health Care for the Poor and Undeserved: “Medical-legal partnerships (MLPs) seek to eliminate barriers to healthcare and improve the health of vulnerable and underserved populations by integrating legal assistance into the medical setting. These partnerships resolve various legal needs related to health (including medical insurance, Social Security benefits, housing, employment, and family problems) by affording medical patients the benefits and protections of legal services.”[3]

Basically, MLPs represent a partnership of legal and medical professionals. These organizations provide legal aid to patients suffering from chronic diseases. According to the National Center for Medical-Legal Partnership, MLPs have four different avenues through which they further their goal:

  1. They teach health care and legal professionals how to together recognize potential health threats in the patient’s social environment before they become major issues.
  2. MLPs use laws in place to combat these health threats.
  3. The organizations strive to alter the policies of health care providers so that they are more readily equipped to react to potential health threats to the patent.
  4. These institutions make an effort to preclude additional health hazards through the implementation of new rules regarding health issues.[4]

Today there are more than 275 MLPs stretched across thirty-eight states in the U.S., the majority existing in suburban areas. They are legal aid, changes to health and legal organizations and modification of regulations.[5] These groups place “lawyers and paralegals alongside health care teams to detect, address and prevent health-harming social conditions for people and communities.”[6] MLPs increase medical professionals’ awareness of the consequences of the legal structure on the individual’s health care while opening up the eyes of lawyers to the potential benefits of addressing problems before they become major issues

There have been several positive results of this partnership between medical and legal professionals. Among other benefits, the National Center for Medical-Legal Partnership noted that individuals suffering from chronic diseases are “admitted to the hospital less frequently,” patients more regularly ingest prescribed medication and health care costs have been reduced for the patient and the health care provider.[7] The results of a study examining the impacts of rural MLPs revealed an over three hundred percent return on investment of the Medical-Legal Partnership of Southern Illinois over the course of three years.[8]

MLPs present a viable solution to very real problems facing individuals today. Ellen Lawton, director of the National Center for Medical-Legal Partnership at George Washington University, summed up the importance of a partnership between legal and health care professionals such as the one that exists in MLPs saying that, “As we focus on how to build healthier communities over the next 50 years, we must remember that health does not exist in a vacuum separate from wealth, from the laws we write, from the systems we create to protect our citizens, or from the injustices that exist in each of these things. We must aim for health and justice in all practices and in all policies, knowing that more often than not, they are the same thing.”[9] In order to tackle this self-perpetuating problem, it must be approached not as two separate problems, one for lawyers and one for health professionals, but rather as one single issue. MLPs represent the partnering of individuals working in separate fields towards the same ends.

[1] “Changing the law to keep the heat and lights on,” National Center for Medical-Legal Partnership, November 1, 2010, http://medical-legalpartnership.org/utility-story/.
[2] “The Need for Medical-Legal Partnership,” National Center for Medical-Legal Partnership, accessed February 1, 2016, http://medical-legalpartnership.org/need/.
[3] James A. Teufel, Danilea Werner, Diane Goffinet, Woody Thorne, Stephen L. Brown, and Lori Gettinger, “Rural Medical-Legal Partnership and Advocacy: A Three-Year Follow-up Study,” Journal of Health Care for the Poor and Underserved 23, no. 2 (2012): 705-714, doi: 10.1353/hpu.2012.0038.
[4] “The MLP Response,” National Center for Medical-Legal Partnership, accessed February 1, 2016, http://medical-legalpartnership.org/mlp-response/.
[5] Tishra Beeson, Brittany Dawn McAllister and Marsha Regenstein, “Making the Case for Medical-Legal Partnerships: A Review of the Evidence,” National Center for Medical-Legal Partnership, February 2013,  accessed February 8, 2016, http://medical-legalpartnership.org/wp-content/uploads/2014/03/Medical-Legal-Partnership-Literature-Review-February-2013.pdf.
[6] “The MLP Response.”
[7] “Impact at a Glance,” National Center for Medical-Legal Partnership, accessed February 1, 2016, http://medical-legalpartnership.org/mlp-response/impact/; “FAQ,” National Center for Medical-Legal Partnership, accessed February 8, 2016, http://medical-legalpartnership.org/faq/.
[8] James A. Teufel, Danilea Werner, Diane Goffinet, Woody Thorne, Stephen L. Brown, and Lori Gettinger, 705-714.
[9] Ellen Lawton, “The Shared DNA of Health and Justice,” Huffington Post (blog), August 25, 2015 (4:05 p.m.), http://www.huffingtonpost.com/ellen-lawton/the-shared-dna-of-health-and-justice_b_8034788.html.