Tag Archive for: health care

When Legal Assistance Can Improve Health

By Lonnie Powers

In April, The National Center for Medical-Legal Partnership (NCMLP), an organization dedicated to “leading health, public health, and legal sectors in an integrated, upstream approach to combating health-harming social conditions,” played host to more than 400 legal and health care professionals at its 11th annual Medical-Legal Partnership Summit in Indianapolis. The annual confab seeks to help organizations leverage the various ways in which civil legal aid—free legal assistance and representation for low-income people facing non-criminal legal issues—can protect individual and public health.

The idea that legal assistance could impact public health was proved in 1975, when California Rural Legal Assistance won a groundbreaking victory in Carmona v. Division of Industrial Safety, which banned the use of short-handled hoes by farm workers because they forced workers to stay bent over for long periods of time, causing them crippling back injuries. Field managers had required the use of short-handled hoes because if they saw workers standing up, they knew they were not doing their work. After the hoes were banned, back injuries among the farm workers dropped more than 30 percent.

More recently in Massachusetts, Greater Boston Legal Services (GBLS) won two victories that enhance the health, safety, and independence of disabled people. First, GBLS settled a federal class action lawsuit against the Massachusetts Department of Transitional Assistance (DTA) for disability discrimination, based on claims that DTA didn’t have adequate systems to provide disabled clients with reasonable accommodations and that it routinely screened out disabled people from food stamp and cash assistance programs in violation of federal law. In a second class action lawsuit, GBLS took on the MBTA, Boston’s regional public transportation system, reaching a settlement requiring the MBTA to improve accessibility to bus and subway services. As a result, the MBTA has made nearly all of its stations fully accessible and has trained staff to respond to the needs of differently abled people using public transportation.

The formal medical-legal partnership model was created at Boston Medical Center (BMC) in the 1990s, when Dr. Barry Zuckerman, then the chief of pediatrics, became frustrated by the lack of clinical progress of his young patients as a result of substandard housing, poor nutrition, and other life circumstances―what are known as “social determinants of health.” Zuckerman hired a part-time attorney from Greater Boston Legal Services for the Pediatrics Department to assist his patients in addressing these unmet needs. The success of the program ultimately led to the creation of NCMLP.

Today, there are nearly 300 medical-legal partnerships in health care facilities in 36 states, including a partnership launched last September between Community Legal Aid and UMass Memorial Health Care in Worcester. Medical-legal partnerships involve embedding lawyers and paralegals in the medical setting to ensure that patients can meet basic needs for food, housing and utilities, education, employment, health care, and personal and family stability and safety―all of which are essential ingredients to maintaining good health. The concept is best encapsulated by the description of a September 2015 segment of PBS NewsHourthat examined a medical-legal partnership in Nebraska: “What happens when a little boy gets a lifesaving bone marrow transplant for his leukemia, but can’t return home because the house he lives in has cockroaches that threaten his recovery? His doctor calls a lawyer.”

The partnerships go far beyond direct advocacy to encompass training for health care workers to identify health-harming social conditions, reforming clinical practice and institutional policies to better respond to patients experiencing health-harming conditions, and preventing such conditions by detecting the broader societal patterns that create them and advocating for policy and regulatory remedies.

Medical-legal partnerships are taking off as health care providers increasingly acknowledge their positive effects on patient health, the ability of health care workers to better understand and screen patients for social determinants of health, and in reining in health care costs. A study of a medical-legal partnership in California, for example, found that two-thirds of the families who participated in the program reported improved child health and well-being. Another study, which focused on a collaboration in Georgia, found increased physician satisfaction, a bump in Medicaid reimbursements to the partnering hospitals for their services, and a savings of $10,000 in annual continuing education costs.

From migrant farmworkers in California in the 1970s to disabled people in Massachusetts three decades later, civil legal aid organizations have long demonstrated expertise in identifying and rectifying the environmental factors that adversely impact the health and safety of vulnerable and underserved communities. Institutionalizing that expertise on the health care continuum through medical-legal partnerships is a logical step that enables our health care system to treat our most complex and vulnerable patients more effectively, efficiently, and cheaply. And that benefits all of us.

Lonnie Powers is executive director of the Massachusetts Legal Assistance Corporation.

Communication Matters: Getting Your Message Out

By Lonnie Powers

When it comes to creating social change, strategic communications brings great value. The Communications Network, a nonprofit that supports foundations and nonprofits in finding ways to communicate more effectively, puts it this way: “Communication matters. Organizations that do it well are stronger, smarter and vastly more effective.”

The civil legal aid community here in Massachusetts is taking that message to heart, using three approaches to communications in order to broaden its impact. These approaches apply to foundations and nonprofits alike.

The first is to communicate proactively with the media to educate the public. We have partnered with Voices for Civil Justice, a new national, non-partisan, Washington D.C.-based communications hub funded by the Public Welfare Foundation and the Kresge Foundation to raise public awareness of the vital role of civil legal aid in helping people protect their livelihoods, their health and their families. We strive to show how important civil legal aid is on a wide range of critical issues that affect lower and middle class Americans, such as increasing educational opportunities, ensuring access to safe, affordable housing, and preventing domestic violence to name just a few.

Those of us who work in civil legal aid already know its value in helping people with basic necessities such as housing, employment, classroom accommodations for our children with disabilities and family conflicts related to child support and custody, divorce and domestic violence. Yet opinion research shows that the public is largely unaware of what civil legal aid is, and many of the daily victories that come about thanks to civil legal aid are not reported as such. Instead, media stories about poor people who have successfully fought illegal home foreclosures, obtained court protection from a domestic abuser, or appealed for federal benefits that were improperly denied, are told as stand-alone battles without revealing the critical role of legal advocates and unconnected to the broader civil legal aid movement.

With Voices for Civil Justice, we are teaching civil legal aid organizations how to change this by engaging proactively in media outreach in order to tell their stories to a wider audience. We encourage organizations to employ tactics as simple as asking reporters to define their organization as a “civil legal aid organization.” We also encourage them to submit letters to the editor and opinion pieces about the impact of civil legal aid on a wide range of issues in the news every day.

Another communications tool that can be employed to influence policymakers and elected officials who direct public spending on social justice issues, is the issuance of a nonpartisan, data-filled report. This past October, the Boston Bar Association Statewide Task Force to Expand Civil Legal Aid in Massachusetts released a groundbreaking report that quantified the unmet need for civil legal aid, and estimated the savings to taxpayers if those needs were met. The report found that 64 percent of eligible clients in Massachusetts are turned away by civil legal aid organizations due to lack of resources. The three independent economic consulting firms that did analyses for the Task Force also found that every dollar spent on civil legal aid in eviction and foreclosure cases saved the state $2.69 on state services associated with housing needs, and every dollar spent on assisting qualified people to receive federal benefits brought in $5 to the state.

While these reports generate media coverage, they can also influence elected officials to direct more resources to important social issues. Look no further than the Bill and Melinda Gates Foundation to see the importance of communicating effectively with the public sector to achieve policy goals. The Gates Foundation is endowed with approximately $30 billion, which sounds like a lot of money until you compare it with the budget of the National Institutes of Health (NIH), which is approximately $30 billion annually. That’s why when the Gates Foundation launched its Grand Challenges for Globe Health (GCGH) initiative, it engaged in a strategic campaign to influence decision-makers at NIH to direct more resources to global health challenges. The campaign, which included the issuance of policy and research papers directed at NIH decision-makers, was successful. A 2008 article in the scholarly journal EMBO Reports reported that “NIH supplemented the GCGH with increased funding of approximately US$1 billion for global health issues at a time when the overall NIH budget experienced little growth.”

The final communication strategy that every funder should embrace, and which we employ in the civil legal aid community, is to make it clear to grantees that it’s okay to spend resources on communications. By sharing stories of success, grantees are doing much more than assuring funders that the work is getting done. They are educating the public about existing need, and inspiring others to create change as well.

Lonnie A. Powers is the Executive Director of the Massachusetts Legal Assistance Corporation. He has more than 40 years of policy and legal experience at the state and national levels, having devoted the majority of his career to establishing, building, sustaining and revitalizing legal aid organizations. Lonnie began his legal career in his native Arkansas, first with the Attorney General’s Office and later with Legal Services of Arkansas, where he served as Executive Director.