becky carothers, md andrea hunt, jd july 12, 2013 · pdf filedoctors & lawyers for kids a...
TRANSCRIPT
Doctors & Lawyers for Kids A Medical- Legal Partnership
Becky Carothers, MD
Andrea Hunt, JD
July 12, 2013
• Describe the medical-legal partnership
movement nationwide and in Louisville.
• Relate how preventive legal care can
improve patients’ health and well-being.
• Identify social determinants of health with
a legal remedy.
• Introduce the referral process and how to
involve your patients.
Objectives
e
Timmy
• Toddler with a burn on hand from
touching an open oven
• Burn treated in ED
• His sister, Olivia,
returned with a
burn 6 weeks later
• CPS contacted
Barry Zuckerman, MD
Medical-Legal Partnership
Medical-Legal Partnership
• A preventive healthcare delivery model
• Improves health and well-being of
vulnerable populations
• Addresses unmet legal needs
• Removes legal barriers that impede
health
Michael
Traditional Approach
Mold/Pests
Asthma
Call landlord
Frustration, withholding rent
Eviction notice.
Legal Aid?
Substandard Housing Homelessness Overcrowding
MLP Approach
Mold/Pests
Asthma
Medical-Legal
Intervention
No mold/pests
Asthma well-managed
Why a Medical-Legal
Partnership? • Healthcare teams have early access to
vulnerable populations
• Build on trust in healthcare professionals
• Reduce barriers to legal services
• Channel limited legal resources
• Comprehensive services in ambulatory
practices
Retkin, Randye, et al. “Medical Legal Partnerships: A Key Strategy for Mitigating the Negative
Health Impacts of the Recession.” The Health Lawyer, Vol. 22 No. 1, (Oct. 2009).
Sandel, Megan et al. “Medical-Legal Partnerships: Transforming Primary Care By Addressing
The Legal Needs Of Vulnerable Populations.” Health Affairs, Vol. 29. No. 9 (Sept. 2010).
Asthma
• Retrospective review
• 12 adults with moderate to severe asthma
receiving a medical-legal intervention
• 22 ED visits and 11 admissions to 2 ED visits
and 1 admission (91% reduction)
• All patients had reductions in the dose
and/or number of medications
• During post-intervention, 11 (91%) patients
• dropped ≥2 classes in asthma severity.
– O’Sullivan, et al. (2012). Environmental Improvements Brought by the Legal Interventions in the
Homes of Poorly-Controlled Inner-city Adult Asthmatic Patients: A Proof-of-Concept Study.
Journal of Asthma, 49(9), 911-917.
Cancer
• Women with cervical cancer
– 75% patients showed a reduction in stress
– 30% increase in treatment adherence
– 25% patients had greater ease in keeping
appointments
– Captured ~ $923,188 of previously denied
benefit claims
Rodabaugh, K. J., Hammond, M., Myszka, D., & Sandel, M. (2010). A medical-legal partnership as
a component of a palliative care model Journal of Palliative Medicine, 13(1), 15-18.
•
– Fleishman SB, Retkin R, Brandfield J, Braun V. The attorney as the newest member of the
cancer treatment team. J Clin Oncol. 2006 May 1;24(13):2123-6
–
Resident Education
• Residents in clinics with social/legal
resources were more likely to:
– Ask patients about their social history and
situation with housing and public benefits.
– More confident regarding their personal
knowledge of social determinants of health
and screened for them more frequently.
– More confident about public benefits.
– O'Toole JK, Burkhardt MC, Solan LG, Vaughn L, Klein MD. Resident confidence addressing
social history: is it influenced by availability of social and legal resources? Clin Pediatr (Phila).
2012 Jul;51(7):625-31.
Return on Investment
• MLP of Southern Illinois
– 319% return on the original investment of
$116,250 between 2007 - 2009.
– Helped relieve $4 million in patients' health
care debt
– Claiming $2 million in additional Social
Security benefits for patients.
• Teufel, J. A. & Werner, D. & Goffinet, D. & Thorne, W. & Brown, S. L. & Gettinger, L. (2012). Rural
Medical-Legal Partnership and Advocacy: A Three-Year Follow-up Study. Journal of Health Care for
the Poor and Underserved 23(2), 705-714. The Johns Hopkins University Press.
Nationwide Successes
• 275 hospitals and health centers
• 54,000 clients receive legal assistance yearly
* 9,163 healthcare providers trained
* 2,696 residents trained
* $37.7 million recovered for patient-
clients by MLPs
* 2011 National Center MLP survey
Medical-Legal Partnership
1993 Boston Medical Center
2005 National Center for Medical-
Legal Partnership
2010 Doctors & Lawyers For Kids
Children & Youth Project
Legal Aid Society
• Up to 200% of
poverty level
• Divorces, DVOs, life
planning documents,
foreclosures,
evictions, &
other civil legal
needs
4,000
served
6,000
Turned
away
Source: Legal Services Corporation, Documenting the Justice Gap in America: The Current Unmet Civil Legal Needs of Low-Income Americans (September 2009).
Legal Aid:
Supply & Demand
Medical-Legal Interventions
Individual representation
Changing healthcare and legal institutions
Policy changes and
“impact litigation”
Advocating for Patients
Collaborative Approach
• Cincinnati
Children’s Hospital
• 4 patients referred
in a 6-week period
• Poor-quality
housing cluster
identified
Beck A.F., Klein M.D., Schaffzin J.K., Tallent V., gillam M., Kahn R.S. Identifying and
Treating a Substandard Housing Cluster Using a Medical-Legal Partnership. Pediatrics
130:5, 11/2012 pp. 831-836.
Evaluating Effectiveness
• Multi-pronged
advocacy
strategy
• Study confirmed
effectiveness of
medical-legal
partnership
Beck A.F., Klein M.D., Schaffzin J.K., Tallent V., Gillam M., Kahn R.S. Identifying and
Treating a Substandard Housing Cluster Using a Medical-Legal Partnership. Pediatrics
130:5, 11/2012 pp. 831-836.
I Income supports: Unfair denial of
benefits
H Housing/Utilities: Unsafe conditions
E Education/Employment: Special needs
L Legal status: Naturalization
P Personal safety and stability: custody for
grandparents
I-HELP
Identifying Legal Needs
• How are you making ends meet?
• Do you have enough food to eat?
• Are you worried about your (child’s) safety?
• Where are you living?
• How is the environment in your home?
• How is your child doing in school?
• Would you like to talk to a social worker or
legal today?
Coordinating Services
• ULP: All Scripts
• KCH: Social Work Dept.
• Attorney’s duty of confidentiality and
attorney-client privilege
• Transitional care to prevent future
admissions
Julia
Income as a Determinant of
Health
Source: P.A. Braveman, et al., “Broadening the Focus: The Need to Address the Social Determinants of Health,” American Journal of Preventive Medicine, 40, no. 1S1 (2011): S6.
Income as a Determinant of
Health
Low Income
Financial Trade-off
Health Impact
Social Risk Index and
Re-Utilization • Relationship between home address
and hospital re-utilization
• Geocoded home addresses
• Social risk index: poverty rates, home
values, graduation rates
• Patients admitted for asthma placed in
one of three geographic risk strata
Beck AF, et al. Geomedicine: area-based socioeconomic measures for assessing risk of
hospital reutilization among children admitted for asthma. Am J Public Health. 2012
Dec;102(12):2308-14.
Re-Utilization Rates
Low Risk Medium Risk High Risk
Beck AF, et al. Geomedicine: area-based socioeconomic measures for
assessing risk of hospital reutilization among children admitted for asthma.
Am J Public Health. 2012 Dec;102(12):2308-14.
• Ms. Sowell video clip with pictures
179 Families Helped
44
66
24
8
37
I H E L P
KCH
General
Pediatrics
Clinics
Sources of Patient-Clients
Sources of Funding Children's Hospital
Foundation
UofL Pediatrics
Glass Slipper Society
Greater Louisville
Medical Society
KY Bar Foundation
KBA Health Law Section
Louisville Bar
Foundation
Ramble by the River
Gheens Foundation
Timmy and Olivia
Summary
• Medical-legal partnership is a new
approach to comprehensive healthcare
• Legal needs can affect patients’ health
• Preventive legal care can improve
patients’ health and well-being
• You can refer your patients to Doctors &
Lawyers for Kids if they may face legal
barriers to their health.
References 1. Beck, A.F., et al. Geomedicine: area-based socioeconomic measures for
assessing risk of hospital reutilization among children admitted for asthma. Am
J Public Health. 2012 Dec;102(12):2308-14.
2. Beck A.F., et al. Identifying and Treating a Substandard Housing Cluster Using
a Medical-Legal Partnership. Pediatrics 130:5, 11/2012 pp. 831-836.
3. Fleishman SB, Retkin R, Brandfield J, Braun V. The attorney as the newest
member of the cancer treatment team. J Clin Oncol. 2006 May 1;24(13):2123-6
4. Knight, 2008. Health Care Recovery Dollars: A Sustainable Strategy for
Medical-Legal Partnerships?
5. Legal Services Corporation, Documenting the Justice Gap in America: The
Current Unmet Civil Legal Needs of Low-Income Americans (Sept. 2009).
6. O’Sullivan, et al. (2012). Environmental Improvements Brought by the Legal
Interventions in the Homes of Poorly-Controlled Inner-city Adult Asthmatic
Patients: A Proof-of-Concept Study. Journal of Asthma, 49(9), 911-917.
References 7. O'Toole JK, Burkhardt MC, Solan LG, Vaughn L, Klein MD. Resident confidence
addressing social history: is it influenced by availability of social and legal
resources? Clin Pediatr (Phila). 2012 Jul;51(7):625-31.
8. P.A. Braveman, et al., “Broadening the Focus: The Need to Address the Social
Determinants of Health,” American Journal of Preventive Medicine, 40, no. 1S1
(2011): S6.
9. Retkin, Randye, et al. “Medical Legal Partnerships: A Key Strategy for
Mitigating the Negative Health Impacts of the Recession.” The Health Lawyer,
Vol. 22 No. 1, (Oct. 2009).
10. Rodabaugh, K. J., Hammond, M., Myszka, D., & Sandel, M. (2010). A medical-
legal partnership as a component of a palliative care model Journal of Palliative
Medicine, 13(1), 15-18.
11. Ryan, A. M. & Kutob, R. M. & Suther, E. & Hansen, M. & Sandel, M.(2012). Pilot
Study of Impact of Medical-Legal Partnership Services on Patients’ Perceived
Stress and Wellbeing. Journal of Health Care for the Poor and Underserved
23(4), 1536-1546.
References
12. Sandel, et al. “Medical-Legal Partnerships: Transforming Primary Care By
Addressing The Legal Needs Of Vulnerable Populations.” Health Affairs, Vol.
29. No. 9 (Sept. 2010).
13.Teufel, J. A. & Werner, D. & Goffinet, D. & Thorne, W. & Brown, S. L. &
Gettinger, L. (2012). Rural Medical-Legal Partnership and Advocacy: A Three-
Year Follow-up Study. Journal of Health Care for the Poor and Underserved
23(2), 705-714. The Johns Hopkins University Press.
14. Zuckerman B, Sandel M, Lawton E, Morton S. Medical-legal partnerships:
transforming health care. Lancet. 2008;372(9650):1615–1617.