Medical-Legal Partnership Clinic | Winter 2015

Medical-Legal Partnership Clinic at the University of Kansas School of Law

There are nearly 50 million people living in poverty in the United States. In Kansas, that amounts to nearly 14% of the population, and in Wyandotte County, nearly a quarter of all residents. Research shows that each individual living in poverty has at least 1 civil legal problem that negatively affects their health.

WHAT IS MLP?Medical-Legal Partnership (MLP) is a health care delivery model that integrates critical legal services into comprehensive patient care to address health problems that may have a legal solution. MLPs:u TRAIN health care and legal teams to work collaboratively and identify needs upstream.u TREAT individual patients’ health-harming social and legal needs with legal care ranging from triage and consultations to legal representation in the following “I-HELP” areas: q Income supports and insurance q Housing and utilities q Employment and education q Legal status (immigration) q Personal and family stabilityu TRANSFORM clinic practice and institutional policies to better respond to patients’ health‐harming social and legal needs.u PREVENT health-harming legal needs broadly by detecting patterns and improving policies and regulations that have an impact on population health.

KU LAW’S MLP CLINIC u The law school launched its MLP Clinic — the first MLP in Kansas — in January 2008. u The clinic is located on-site at the University of Kansas Medical Center and provides free legal services to its patients and patients of the JayDoc Free Clinic.

SPECIAL INTEREST AREASu KU Law students in the MLP Clinic engage in innovative INTERPROFESSIONAL EDUCATION AND PRACTICE experiences alongside medical, nursing, pharmacy, and health professions students to improve care for vulnerable patients.u The MLP Clinic is helping to identify HUMAN TRAFFICKING through the implementation of a screening guideline in the emergency department.u This year, the Elizabeth M. Gallup, M.D., J.D., Medical‐Legal Partnership Clinic Fellowship Fund for Mental Health created a new fellowship position to assist clients with MENTAL HEALTH needs, create greater awareness of mental health legal needs, and advance mental health law. The fellowship was created in memory of a local lawyer and primary care physician who leveraged her legal and medical training to help people suffering from physical and mental illnesses.

Member of the National

MLP Networkwww.medical-legalpartnership.org

Member of the National

MLP Networkwww.medical-legalpartnership.org

A NETWORK OF SUPPORT

135 hospitals

127 health centers

127 legal aid agencies

35 health schools

70 pro bono partners

46 law

schools

KU Law Medical-Legal Partnership Clinic | January 2015

KU Law Medical-Legal Partnership Clinic | January 2015

MLP & THE TRIPLE AIMThrough its work, the MLP Clinic pursues the Triple Aim:

In addition to improving patient experience and health outcomes, the legal care the MLP Clinic provides can save money for both patients and health care providers.

Successful appeals of denials of SSI and Medicaid can result in monthly payments and medical coverage for low-income patients and reimbursable expenses for health care providers.

Patients living in stable housing free from domestic violence can focus on their health and compliance with prescribed treatment plans.

Immigrants with successful VAWA petitions or U or T Visa applications may be eligible for public benefits or work authorization for employment that provides health insurance.

Appropriate advance care planning, or guardianships when necessary, can improve care coordination and transitions for patients at the end of life.

Improving the patient experience of care,including quality & satisfaction

Improving the health of populations

Reducing the per capita cost of health care

1 2 3

Born and raised in the Congo, “Marianne” witnessed the murder of her son and countless war atrocities, only to suffer further abuses in

a refugee camp. Things began to change when she was granted refugee status and moved to the United States. But this was just the first step on Marianne’s road to recovery. As a result of the trauma she faced in the Congo, Marianne had multiple physical disabilities and

was diagnosed with both depressive and post-traumatic stress disorders. For several years, she received Medicaid insurance to cover her medical and mental health treatments and Supplemental Security Income (SSI), a program that helps individuals with a severe illness or disability.

Marianne’s doctor knew her SSI benefits were quickly coming to an end and that as a refugee she would not be eligible for additional help unless she became a U.S. citizen. Normally, this is a problem that her doctor would not be able to treat. He was trained to help with Marianne’s physical recovery, not the citizenship process that would allow her to access the health care and public benefits crucial to her treatment. Fortunately, the doctor knew who to call. Marianne came to the MLP Clinic for help with her citizenship application. But there was a problem. Marianne spoke only French, and she needed to pass an English and civics test to apply for citizenship. Her physical disabilities made it impossible to attend English classes, and her mental health issues would make learning a second language nearly impossible. The MLP Clinic and the doctors treating Marianne worked together to obtain a disability waiver to request an exemption from the English and civics test. And the MLP Clinic also helped connect Marianne to a KU psychiatrist who could provide ongoing treatment for her mental health issues. Her

new psychiatrist completed an additional disability waiver to include with her citizenship application. In July 2013, Marianne became a citizen. With a safe and permanent home in the United States and secure SSI and Medicaid benefits, she will be able to keep food on her table and a roof over her head and continue to access high-quality medical and mental health treatment at KU to help on her road to recovery.

SUCCESS STORY: MLP Clinic creates safe haven for refugee

Law students Andrew Zarda, left, and Ben McFarlane helped “Marianne” navigate the complex naturalization process through KU’s Medical-Legal Partnership Clinic.

Marianne recently

participated in

her naturalization

ceremony, and

now her SSI

benefits are

secure.

CONNECT WITH KU’S MLPKatie Cronin, [email protected] | 913-588-3731Delp Pavilion 1059, Mailstop 40103901 Rainbow Blvd.Kansas City, KS 66160

law.ku.edu/mlpclinicOn our website, learn more about the services we provide to our clients and the educational benefits of this program.

KU Law Medical-Legal Partnership Clinic | January 2015

The patients we see in the Family Medicine clinic at the University of Kansas Medical Center have needs that go beyond the exam room and stem from their home environments and neighborhoods. So often, these needs

have to be met before they can focus on the medical interventions we pre-scribe. In fact, these needs — related to financial stability, safety, housing, immigration, disability — have to be addressed before our medical therapies even have a chance to work. Many of the patients I treat are elderly or have been diagnosed with terminal illnesses. Over the last three years, the lawyers and law students at the MLP Clinic have helped my patients with advance care planning — drafting wills and estab-lishing advance directives and powers of attorney. For terminally ill patients, this means knowing that their voices will be heard

when and if they cannot advocate for themselves. For their families, advance care planning allows them to focus on the immediate needs of their loved ones, all the while knowing they can express the wishes of their loved ones if needed. I cannot imagine practicing medicine anymore without legal services available on-site at the hospital to provide this kind of care to my patients. The MLP Clinic has also opened up a great learning opportunity for students. I am part of the Interprofessional Teaching Clinic that brings medicine, nursing, pharmacy, and health professions students

together to participate in shared learning at the point of care. Students see patients as a team, and when they identify I-HELP issues, they consult with law students. In addition, law students join “Studio Pop” a few times each semester. Studio Pop provides protected time for all of our students to reflect and debrief on their weekly interactions with patients and brainstorm how they can improve patient care through their collaborative efforts. The student teams also take their services to the community, doing in-home visits with patients who have complex medical and legal issues. During Studio Pop, students gain insight into each other’s training and profession and respect for one another’s expertise. We learn how to talk with one another without using the jargon associated with each professional culture. In doing this, we have a chance to reach one another as human beings and professionals, all for the sake of a common goal — our patients. — Jana K. Zaudke, MD, MA, is an Assistant Professor and Director of Interprofessional Education in the Department of Family Medicine at the University of Kansas Medical Center.

TESTIMONIAL: An indispensable model for medicine

KU Law Medical-Legal Partnership Clinic | January 2015

THANK YOU to our generous funding partners

A NATIONAL TOOLBOXIn 2014, KUMC was named a Nexus Innovations Incubator site for the National Center for Interprofessional Practice and Education (NCIPE). With support from the Josiah Macy Foundation, KUMC is designing a curriculum toolbox to support and enrich live interprofessional practice in primary care settings. The toolbox will be disseminated nationally and will include a simulation designed in collaboration with the MLP Clinic to train interprofessional teams how to speak with patients about the social determinants of health (SDH).

Madeleine McDonough & Cyd Slayton

I cannot imagine

practicing medicine

anymore without

legal services

available on-site

at the hospital.