Dakota Conference 2019 Session 9: The Evolution of North ... · Legal Advocates for Health, Medical Legal Partnership 10 Family HealthCare} Mission: To provide affordable, quality

Legal Advocates for Health, Medical Legal Partnership

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Adele Page, Deputy DirectorLegal Services of North Dakota

2019 Dakota Conference on Rural and Public Health

June 12, 2019

The Medical-Legal Partnership (MLP) model combines health and legal services at a single site of care.

A multidisciplinary team works together to address medical and social/legal problems that have an impact on overall health.


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Conditions in the places where people live, learn, work, and play affect a wide range of health risks and outcomes.1

These conditions are known as Social Determinants Of Health (SDOH).

1 Center for Disease Control and Prevention

Minnesota Department of Health Advancing Health Equities Report, 2014

10%

10%

10%

30%

40%

Determinants of HealthGenes & Biology

Physcial Environment

Clinical Care

Health Behaviors

Social/EconomicFactors


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Slide Credit: National Center for Medical-Legal Partnership, Milken Institute School of Public Health, George Washington University https://medical-legalpartnership.org/need/

Marsha Regenstein, Jennifer Trott, and Alanna Williams. (August 2017). The State of the Medical-Legal Partnership Field: Findings from the 2016 National Center for Medical-Legal Partnership Surveys. National Center for Medical Legal Partnership. p 11. http://medical-legalpartnership.org/mlp-resources/2016-ncmlp-survey-report/

https://medical-legalpartnership.org/need/

http://medical-legalpartnership.org/mlp-resources/2016-ncmlp-survey-report/


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} 91% fewer adult asthma ED visits

} $2 million in Social Security benefits

} Better maternal-child outcomes

} Reduced child abuse

} Fewer missed appointments

} Improved cancer treatment adherence

} Better advocates for selves, able to discuss with MDs

Beeson, T., McAllister, B.D., & Regenstein, M. (2013).Zuckerman, B. (2014).

Slide Credit: Eileen Weber, Colleen McDonald Diouf, Karen Bonfil Ruiz. (November 4, 2016) Healthcare Legal Partnerships: Many Faces of Community Health (Presentation)

Income Supports and InsuranceFor Example: Food Stamps, Disability Benefits, Cash Assistance, Health Insurance, Unemployment, Medicaid, Consumer Law

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Housing and UtilitiesFor Example: Eviction, Housing Conditions, Housing Vouchers, Utility Shutoff, Landlord Disputes

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Education and EmploymentFor Example: Accommodation for disability at school or work

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Legal StatusFor Example: Criminal Background, Military Discharge, Immigration

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Personal and Family StabilityFor Example: Domestic Violence, Guardianship, Child Support, Advance Directives, Estate Planning

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Marsha Regenstein, Jennifer Trott, and Alanna Williams. (August 2017). THE STATE OF THE Medical-Legal Partnership Field: Findings from the 2016 National Center for Medical-Legal Partnership Surveys. National Center for Medical Legal Partnership. p 16. http://medical-legalpartnership.org/mlp-resources/2016-ncmlp-survey-report/

ThreeSectorsAddressSocialDeterminantsofHealthinSilos

HEALTHCAREtreats illnesses

caused or exacerbated by

SDOH.

LEGAL AIDensures access to

benefits & services, enforces

laws that keep people healthy.

PUBLIC HEALTHtracks diseases on population

level, addresses laws & education

aimed at prevention.

http://medical-legalpartnership.org/mlp-resources/2016-ncmlp-survey-report/


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Presenter NamePresenter Title

Date

Makingtheconnection:legalproblemsarehealthproblems.

Common Legal Problem Social Determinant of Health

Families wrongfully denied food supports or housing subsidies

Lack of basic resources

Children living in housing with mold or rodents, in violation of

housing laws

Physical environment

Seniors wrongfully denied long-term care coverage

Lack of access to insurance

Individual patient legal interventions arepathways to finding the policy interventions

for improving population health.

TheMedical-LegalPartnershipApproach


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◦ Most Common� Medical and Legal partners are separate

organizations

� Formal relationship memorialized by a Memorandum Of Understanding (MOU)

� 1 Information Sharing in Medical-Legal Partnerships: Foundational Concepts and Resources, Issue Brief One, Medical Legal Partnership Fundamentals, National Center for Medical Legal Partnership, at George Washington University

� Memorandum of Understanding:� Financial relationship� How referral are made� How information is shared



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◦Model 1: Referral Network � Medical partner refers to legal partner� Medical partner provides contact information� No direct communication� Any PHI from medical to legal is transferred by the

patient� Legal partner does not communicate directly with

medical partner


� Model 2: Coordinating Staff� Medical partner and legal partner agree to form MLP with

designated staff to coordinate referral and information

� Dedicated staff can be employed by either party but are typically on the site of the medical partner

� Dedicated staff obtain consent to share PHI with legal partner and facilitate communication between partners



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� Model 3: One Organization� Medical partner and legal partner are part of the

same organization

� Referrals are made by medical partner directly

� Information may be shared using a common

� Internal information management system (firewall may protect transfer of PHI and legal information)


} Legal Services of North Dakota (LSND)} Legal Services of Northwest Minnesota (LSNM)

◦ Non-profit civil legal aid organizations funded through federal, state, and private (grant) funds◦ Provide free legal services◦ Our mission is to provide a combination of services and

resources that help low income people and families of all backgrounds including those who face the toughest legal challenges: children, veterans, seniors, ill or disabled people, and victims of domestic violence – to effectively navigate the justice system.


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Family HealthCare

} Mission: To provide affordable, quality healthcare for every person.

} Primary care clinic that provides excellent medical and dental care to anyone and everyone who needs it, regardless of age, nationality, or ability to pay.

} Family HealthCare is a Federally Qualified Health Center (FQHC)◦ FQHCs are community-based health care providers

that receives funds from the Health Resources and Services Administration (HRSA) Health Center Program to provide primary care services in underserved areas. HRSA is an agency of the U.S. Department of Health and Human Services.

◦ FQHCs must meet a stringent set of requirements, including providing care on a sliding fee scale based on ability to pay and operating under a governing board that includes patients.


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} Fargo Veterans Administration Medical Center◦ Fargo VA Vision: The Fargo VA Health Care System

strives to be a patient-centered, integrated health care organization for Veterans providing excellent health care, research and education; an organization where people choose to work; a community partner and a back-up for national emergencies.

} A pilot study was conducted during the Summer of 2016 at Family HealthCare

} 2 summer law clerks and supervising attorneys} Family HealthCare staff was provided training

for referring patients to the MLP pilot program} Public postcards were developed with contact

information for each legal services organization} Invaluable lessons and data collected informed

the grant application and initial MLP design


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} LSND was awarded a Bush Foundation Community Innovation Grant to start North Dakota’s first cross-border medical legal partnership in collaboration with LSNM and Family HealthCare

Legal Advocates for Health has dedicated office space at Family HealthCare. Patient/clients may have a home visit or appointment at an alternative location.


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LAH has a variety of

methods to inform Family

HealthCare patients and the public about our services

} Rack Cards

} Posters in patient rooms

} Public Postcard

} Family HealthCare ◦ Providers◦ Registration staff◦ Nurses◦ Any staff may make referrals

} Community Stakeholders◦ Lutheran Social Services◦ New American Consortium for Wellness and

Empowerment◦ FM Rape and Abuse Crisis Center◦ Job Service North Dakota

} Self-Referral/Walk-In


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} Case Type: Guardianship

} 100 year old Somali Refugee needed dental surgery

} Lacked capacity to consent

} Secured an emergency guardianship and subsequently, a permanent guardianship for the ward’s grandson

} Case Type: Housing

} Eviction settlement case

} Security deposit and move out damages case

} Reasonable accommodation case


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} Case Type: Family Law

} Secured divorce with custody and child support for non-English speaking individual

} Routinely provide family law advice

CHART-IT OR, CAPTURING HEALTH -

AN ATTORNEY REPORTING TOOL FOR

IMPACT TRACKING

A Framework for Systematically Documenting

the Impact of Legal Assistance on the Health of Low-Income Individuals and

Families

(May 2016)


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Family HealthCare} www.famhealthcare.org/

Legal Services of North Dakota} www.legalassist.org/

Legal Services of Northwest Minnesota} lsnmlaw.org/

National Center for Medical Legal Partnership} medical-legalpartnership.org/

http://www.famhealthcare.org/

http://www.legalassist.org/

https://lsnmlaw.org/

https://medical-legalpartnership.org/

Documents

Dakota Conference 2019 Session 9: The Evolution of North ... · Legal Advocates for Health, Medical Legal Partnership 10 Family HealthCare} Mission: To provide affordable, quality