Transcript Veterans and healthcare

MEDICAL-LEGAL PARTNERSHIP AS ANOTHER TOOL TO
PREVENT BURNOUT AND COMPASSION FATIGUE
PRESENTED BY: KRISTA SELNAU, ESQ.
PINE TREE LEGAL ASSISTANCE
ROADMAP
 1. Acronyms and Terms
 2. Overview
 3. Case Examples
 4. Preventing Burnout through MLP
 5. Eligibility
 6. “Magic Words”
 7. Referral
 8. Review
 9. Contact
ACRONYMS AND TERMS
 MLP: medical-legal partnership
 SDH: social determinants of health
 Health partner: healthcare system partner of a medical-legal partnership
 Legal partner: legal aid agency partner of a medical-legal partnership
 Health-harming civil legal need: unmet civil legal need harmful to patient health and well-being
 Legal care: medical-legal partnership legal assistance provided to patient after referral from healthcare
partner
 Consult: medical-legal partnership consult for healthcare partner from legal partner
OVERVIEW OF THE HEALTHCARE SYSTEM (VETERANS)
 Healthcare systems exist to provide healthcare for all individuals
 Healthcare systems operate differently based on funding
 VA operates the largest healthcare system in the United States and provides care to about 8
million veterans
 The VA has about 1,400 care facilities, including 152 VA medical centers, 135 offering nursing
home care, 909 ambulatory care facilities and outpatient clinics, 47 residential rehabilitation
treatment programs, 108 comprehensive home-care programs, and 232 readjustment
counseling centers
 Every veteran is not automatically entitled to VA health care
 In general, to be eligible for VA health care the veteran must have served the required length
of time
OVERVIEW OF CIVIL LEGAL AID
 Civil legal aid provides necessary legal assistance to low-income individuals free of charge
 Civil legal assistance includes: family law, housing and foreclosure, consumer, employment
and income maintenance
 Nearly 60 million Americans – 1 in 5 – qualify for free civil legal assistance (125% or less
FPL); more than 50% are turned away because of lack of resources
 Civil legal aid cannot meet the need for services alone
 Civil legal aid agencies play a critical role in addressing social determinants of health
SOCIAL DETERMINANTS OF HEALTH
 Social determinants of health: where we live, learn, work and play
 Example: Living in a “food desert” leads to a lack of access to
healthy food which can lead to or exacerbate health conditions
 Often lead to racial, ethnic, and economic health disparities
 Can result in a “revolving door” in which patients are repeatedly
hospitalized
WHERE THE TWO CONNECT: MEDICAL-LEGAL PARTNERSHIP
 Healthcare systems and civil legal aid agencies can work together to address the social
determinants of health
 A “medical-legal partnership” is generally defined as a partnership that integrates the
expertise of healthcare, public health and legal professionals and staff to address and prevent
health-harming social and legal needs for patients, clients and populations
 There are over 292 health institutions that partner with legal aid agencies throughout the
United States to address social determinants of health – that is, the economic and social
conditions that influence the health of people and communities
 Interdisciplinary collaboration and education to address social determinants of health
“upstream”
 Every 1 in 6 persons needs legal care
HOW CIVIL LEGAL AID HELPS HEALTHCARE ADDRESS THE
SOCIAL DETERMINANTS OF HEALTH

EXAMPLE 1:

Tiffany is a single mother with a part-time job. She recently applied for food stamps but was denied. Her daughter
has been experiencing an increase in asthma flare-ups recently and Tiffany has had to miss a lot of work to take
her daughter to the doctor. She is concerned about missing too many days from work because she needs her job
to pay the bills. She moved into a new apartment two months ago. Around the time she moved in was when her
daughter began to experience the asthma flare-ups.

Impact on health: 1) being able to afford enough healthy food helps people manage chronic diseases and helps
children grow and develop[; 2) consistent employment helps provide money for food and safe housing; 3) a
stable, decent, affordable home helps individuals stay healthy and avoid costly emergency room visits

Related social determinant of health: 1) increase the availability of resources to meet basic daily needs; 2) create
equal access to the opportunity to work; 3) ensure healthy physical environments

Legal aid intervention: 1) appeal denial of food stamps; 2) enforce workplace rights; 3) improve substandard
conditions
HOW CIVIL LEGAL AID HELPS HEALTHCARE ADDRESS THE
SOCIAL DETERMINANTS OF HEALTH

EXAMPLE 2:

Ryan received a denial letter for SSI in the mail two days ago. He doesn’t understand why because his doctors
have told him he is disabled and can’t work and he receives VA disability. He hasn’t been able to pay his rent for
the past several months and his landlord told him he is taking him to court to evict him. Ryan has fallen behind on
his federal student loan payments. He has been unemployed since he was diagnosed with cancer four months
ago.
 Impact on health: 1) increasing someone’s income means s/he makes fewer trade-offs between affording food
and health care, including medications; 2) a stable, decent, affordable home helps individuals avoid costly
emergency room visits related to homelessness; 3) consistent housing helps people follow their medical
treatment plans
 Related social determinant of health: 1) increase the availability of resources to meet daily basic needs; 2)
ensure healthy physical environments
 Legal aid intervention: 1) appeal denial of benefits; 2) prevent eviction; 3) enforce discharge of federal student
loan debt
HOW CIVIL LEGAL AID HELPS HEALTHCARE ADDRESS THE
SOCIAL DETERMINANTS OF HEALTH
 EXAMPLE 3:
 John lost his job last year and hasn’t been able to make his court-ordered child support
payments. He never modified the child support order. Yesterday he received a letter in the
mail telling him he owes $6,000 in arrears and his license is suspended. He also goes to
Togus once a week for therapy.
 Impact on health?
 Related social determinants of health?
 Legal aid intervention?
HOW CIVIL LEGAL AID HELPS HEALTHCARE ADDRESS THE
SOCIAL DETERMINANTS OF HEALTH
 EXAMPLE 3:
 Impact on health: 1) ensuring access to a drivers license helps make consistent
employment and medical care compliance possible; 2) increasing someone’s income
means fewer trade-offs between affording food, health care, and a home
HOW CIVIL LEGAL AID HELPS HEALTHCARE ADDRESS THE
SOCIAL DETERMINANTS OF HEALTH
 EXAMPLE 3:
 Related social determinant of health: 1) increase the availability of resources to meet
daily basic needs; 2) create equal access to the opportunity to work
HOW CIVIL LEGAL AID HELPS HEALTHCARE ADDRESS THE
SOCIAL DETERMINANTS OF HEALTH
 EXAMPLE 3:
 Legal aid intervention: 1) Resolve license suspension and modify underlying child
support order based on old income information
MEDICAL-LEGAL PARTNERSHIP AS ANOTHER TOOL IN THE
TOOLBOX
 Medical-legal partnerships allow us to practice at the top of our fields with the largest impact
 Frees up clinician time from writing “legal” advocacy letters to landlord to attempt to stave off eviction
 Assists lawyers with complex disability claims requiring medical letters of support and records
 Both examples above would be less successful without collaboration from their health/legal partner
 Clinicians focus on medicine/social work and lawyers focus on legal work
 Utilize medical-legal partnership as a tool in the toolbox to prevent clinician burnout
 Interdisciplinary training to issue spot for legal issues
 Referral system to pass legal issues to legal partner
 Communication and collaboration to learn from health/legal partner
BASIC ELIGIBILITY
 Patient must be a veteran receiving healthcare at VA Togus Primary Care or
Mental Health
 Civil legal needs only; no criminal cases
 Must have a health nexus (health-harming civil legal need)
 Income guidelines apply only to extended representation cases (200% or
below FPL)
HEALTH-HARMING CIVIL LEGAL NEEDS
 Medical-legal partnership provides legal assistance for civil legal needs only:
 Housing
 Income and benefits
 Employment
 Education
 Consumer
 Family law
 VA benefits
 *Discharge upgrades
“MAGIC WORDS”
 Magic words to look listen for that trigger a medical-legal partnership referral:
 Eviction
 Mold
 Problems with my license
 Denied for… (government benefits, food stamps, VA benefits)
 Losing my home
 Can’t pay all my bills
 Concerned about my safety
 Behind on payments (rent, credit cards)
REFERRAL TO MEDICAL-LEGAL PARTNERSHIP
 Call Krista at Pine Tree Legal Assistance (207) 400-3251 or email at
[email protected] to schedule an appointment (veteran or clinician may call)
 Walk-In hours as available: Mondays and Thursdays 8:30-1pm, Room 202
Building 206
 May 2016: referral screener form available
 Summer 2016: legal training series
REVIEW: MEDICAL-LEGAL PARTNERSHIP
 Healthcare systems and civil legal aid agencies can work together to address the social
determinants of health
 A “medical-legal partnership” is generally defined as a partnership that integrates the
expertise of healthcare, public health and legal professionals and staff to address and prevent
health-harming social and legal needs for patients, clients and populations
 Interdisciplinary collaboration and education to address social determinants of health
“upstream”
 Every 1 in 6 persons needs legal care
CONTACT INFORMATION
Krista Selnau, Staff Attorney
Veterans Medical-Legal Partnership
Pine Tree Legal Assistance
[email protected]
(207) 400-3251