A child in public housing may be able to get treatment for her asthma, but her doctor can’t force her landlord to remove the black mold that’s causing it. Likewise, a lawyer can’t provide treatment for a senior living with cystic fibrosis, but she can fight to ensure his utilities stay on so he can keep his medications refrigerated. For people in poverty, legal issues can exacerbate health problems, and health issues can trigger legal problems.
To improve health outcomes and legal outcomes, both sides need to connect health care with patients’ broader social needs. To that end, health care providers and social service providers are teaming up to address the social determinants of health and poverty – such as income, housing, education, and employment, with Medical-legal partnerships. MLPs — the topic of LAF’s latest Brownbag Roundtable—are a prime example. In addition to helping patients and communities become healthier, MLPs reduce healthcare spending for high-need, high-use patients and improve reimbursement rates for clinical services, meaning that medical providers have more resources to help more people.
“As lawyers, we’re often frustrated that despite the best legal outcomes we can accomplish, our clients are still trapped in poverty because of chronic illness. Physicians and other medical providers we’ve talked to share that same frustration—that despite their best efforts, their patients are trapped in poor health because of factors beyond their control,” Trey Daly, Director of LAF’s Public Benefits Practice Group, explained at the Brownbag Roundtable last week. “MLPs bring together those two important roles in the lives of low-income Chicagoans, to find creative solutions that deal with both their legal and medical problems.”
The Health Justice Project, LAF’s flagship MLP, is a partnership between LAF, Erie Family Health Center, and Loyola University School of Law. “The providers at Erie understand social determinants of health, which makes them good at spotting legal issues, especially when a patient maybe didn’t even know their problem was a legal issue,” says Amelia Piazza, LAF’s MLP Project Coordinator. About half of the referrals come from doctors; while the rest come from a variety of other providers, including nurses, case managers, and behavioral health specialists. “We work to identify health-harming legal issues early, before they become critical. That way we can engage in preventative lawyering to help people stabilize their situation before they seek help through traditional means, after they’ve already lost their utilities or are facing eviction,” explains Alice Setrini, LAF’s MLP Supervisory Attorney.
Another perk of these partnerships is they enable LAF to reach populations that are harder to reach through traditional avenues. Of the clients that went through LAF’s regular intake process so far this year, only 7% speak Spanish as their preferred language—far less than the actual proportion of Spanish-speaking residents of Cook County. But since a large portion of Erie patients are Spanish speakers, more than 40% of patients they’ve referred this year speak Spanish as their preferred language.
LAF also hosts MLPs with Rush’s Road Home Program, a partnership with Rush’s Center for Veterans and their Families that aims to increase patient access to Veteran-specific public benefit, and partners with Howard Brown Health Clinic and Provident Hospital in efforts to bring legal aid to the traditionally underserved HIV/AIDS community on Chicago’s south side. LAF’s newest MLP, Health Forward/Salud Adelante, launched just this year. It’s an innovative partnership is with Cook County Health and Hospitals System and the Chicago Department of Public Health, and it started taking referrals in March.
Thanks to all who joined us for this informative presentation on MLPs at LAF, and how they are closing the health justice gap, one patient of a time.
Last month at our Annual Luncheon, LAF presented the Jerold S. Solovy Equal Justice Award to Dennericka Brooks, a dedicated Supervisory Attorney in our Housing Practice Group. This award is given annually to one attorney on LAF’s staff whose work embodies the work of Jerold Solovy, an attorney whose life’s work was given meaning by helping to change the legal system and improve the lives of people living in poverty. Dennericka lives up to that mission as well as anyone at LAF, and her speech at the Luncheon reminded all of us about the lifelong impact our work can have. We’ve highlighted a selection of it here.
“Every once in a while, I wonder what you see when you look at me. Do you see someone that DCFS threatened to remove from her family after an accident because we were poor? Do you see the little girl that in second grade was told by an adult that she couldn’t be a doctor and she should try something else? What about the middle school girl who went downtown with her teacher to a science fair and had someone ask her white male teacher if he was okay? Do you see someone who because of the poverty sometimes didn’t have heat or hot water? Who, because of gang infestation, looked down the barrel of a gun and was caught in gang crossfire more than once? Do you see someone that was exposed to domestic violence?
If you don’t look at me and see those things, I want you to start. I want you to see them because despite those things, I am here now. I want you to see the child of former LAF clients that was provided a safety net and given a little more stability because of legal aid. Our clients face obstacles like mine every day. It is also the humanity and kindness of others, including the attorneys at LAF, that children see when they step in and help. It’s important to know and believe that through our work, we also lift families out of poverty. Our children are watching. I was watching. It is the humanity of others that made me always want to help others. So I’d ask that everyone in this room be a Jerold Solovy: considerate, generous, humble. Accept the privilege that we have, acknowledge the responsibility given us because of our positions, and hold each other accountable as stewards of justice with the ability to remove barriers and break the cycle of poverty for impoverished families.
We affect the lives of not only the adults that we help, but also of the children. Our children see us, they see our intervention and our work propels our children to seek better, to do better, to help others. When you look out at our clients, see me. See what is possible if we keep working together to provide equal access to justice.”
In the latest edition of LAF’s Brownbag Roundtable series, LAF attorneys spoke yesterday about the Comprehensive Legal Assistance for Survivors Project (CLASP), a collaboration between LAF, Pillars, and YWCA Evanston/North Shore that offers comprehensive legal assistance to survivors of sexual assault and domestic violence.
“50% of sexual violence victims quit or are forced to leave their jobs in the year following their assault,” said Cynthia Sadkin, LAF’s Director of Client and Community Services. “A victim who knows her rights—and gets help to enforce them—has a better chance of keeping her job, her health insurance, and being able to pay the rent and keep utilities on.”
Sexual assault is traditionally addressed within a criminal context, or in the limited civil context of suing for damages—which is only viable if the perpetrator has money and the defendant has access to legal representation. But sexual assault is vastly underreported, undercharged, and rarely results in conviction—and when survivors do come forward, they’re too often left in limbo during a long investigatory process. In Cook County for example, it takes 4-6 months to get initial biological evidence results and a full year for the actual DNA analysis to be completed. In the meantime, survivors may be left with unaddressed safety concerns and trauma that impacts their stability—especially in cases of intimate partner sexual assault. “Given that upwards of 90% of victims know their abuser either intimately or casually, they have a whole other set of barriers when they’re looking for help,” explained Supervisory Attorney Neha Lall. “They’re less likely to report, more likely to blamed and more likely to be scrutinized.”
But through programs like CLASP, LAF is taking a more innovative approach: using civil legal remedies to keep survivors safe and address their needs. “This is a new conversation for civil legal service providers,” Neha said. “This has challenged us as a legal services agency to look beyond our traditional models that focused primarily on family law needs, and step up to address the many other civil legal needs of sexual assault victims.” Such needs range from access to Orders of Protection and safe housing, to time off work to address trauma through counseling.
“Our jobs as advocates is to help them understand that there are other forms of justice available on the civil legal side as well,” said Senior Attorney Nubia Willman. As part of LAF’s Immigrants and Workers’ Rights Practice Group, she works with sexual assault survivors who may be eligible for certain types of immigration relief like a U visa, available to victims of crimes that have cooperated with law enforcement. “These clients come to us in the midst of a crisis, concerned more about their immediate safety than their immigration status,” she noted. “My job is to present the big picture—to let them know they may be eligible for this remedy if they work with law enforcement. Because in the long term, getting stable immigration status will empower them to change the trajectory of their life in a substantial way.” With attorneys working together to help sexual assault survivors with such a wide range of legal matters, it’s clear where CLASP gets its name.
Staff Attorney Myka Held shared the story of former client Sarah, a high-school student who was sexually assaulted on her way home from school by a group of 13 boys, most of whom were classmates. After reporting the assault, she felt unsafe both at school and at home since some of her attackers lived nearby. Since Sarah lived in public housing, attorneys from LAF’s Housing Practice Group advocated for her family to be transferred to another neighborhood, while Myka and the Children & Families Practice Group focused on getting her back to school. They requested a safety transfer through the public school system and helped her get some accommodations in place, such as an escort between classes to make sure she feels safe. Unfortunately, Sarah’s new school failed to take her trauma or safety concerns seriously, so LAF advocated for her to be placed in a therapeutic day school that would better suit her needs. She was able to move into a new apartment and started at her new school earlier this year.
“But that wasn’t the end of our legal advocacy,” said Myka. “We felt the public school system had not handled her complaint with any sensitivity or care,” so LAF filed a Title IX complaint with the US Department of Education’s Office of Civil Rights, which is now investigating Sarah’s former school district based on her case.
“One of the great things about CLASP is that we’re able to work closely not just with the attorneys we typically work, but also with attorneys from other practice groups,” said Staff Attorney Karen Doran. “It’s great to be able to collaborate that way.”