Editor: Samantha, please give our readers some background on the history of the Medical-Legal Partnership for Children, which started at the Boston Medical Center in 1993.
Morton: The Medical-Legal Partnership for Children was a creation of the chair of Pediatrics at Boston Medical Center, Dr. Barry Zuckerman, who grew very frustrated in attempting to treat his young, vulnerable patients medically, when he found that many of their ailments could only be resolved through legal intervention for which he was not professionally trained. Fifteen years ago, with assistance from Greater Boston Legal Services, he hired a lawyer to start MLPC, then known as the Family Advocacy Program. MLPC's mission is twofold: to transform the way that health care is delivered by instilling a culture of advocacy in the health care setting, and also to promote access to legal services for vulnerable patients by creating a one-stop shopping experience in a clinical setting, allowing for the identification of legal issues before they become legal and health emergencies. After 15 years, its local office has grown from one attorney to a legal staff of ten. MLPC also has become a national model with 80 sites around the country engaging in some form of medical-legal partnership in over 120 healthcare settings.
Editor: Because of a grant from the Boston Bar Foundation of $75,000, your organization and the Volunteer Lawyers Project of the BBA have laid the groundwork for a project entitled "Healthy Homes for Healthy Families." Would each of you tell our readers what your respective roles are in this new organization?
Girton: The grant enabled us to hire a staff attorney who spends half of her time at VLP and half of her time at MLPC. Her presence has allowed the two programs to become interlinked in a way that simply would not have happened without the grant. The focus of her work and that of a number of our staff has been on how to use the housing laws to make healthier homes for children. We've done this by increasing the participation of professionals on our pro bono panel and also by relying on various firms that staff the health centers. Organizations don't always work together in a collaborative and complementary way, but in this case I'm so proud of the kind of relationship VLP, MLPC and the private bar with the help of the Boston Bar Association have developed. I think it's an unbelievable model in this city.
Morton: One explicit goal of the grant was to leverage the well-known expertise of VLP for pro bono service delivery, as well as MLPC's expertise in the delivery of legal services in clinical settings. The staff attorney made possible by the grant has truly brought about a wonderful marriage of those two groups of experts.
Macauley: My firm, Day Pitney, adopted a health center that is a part of the Healthy Kids Network. Also, I am a trustee of the Boston Bar Foundation.
Editor: Has the initial response to this project been everything you expected?
Girton: This has been more than we expected. The thing that I've been happiest about is the way that we've been able to identify systemic issues that affect VLP clients but also the patients that are seen by doctors and pediatricians in health care centers and at Boston Medical. For example, we've had several cases where people have lived next to smokers in their Boston Housing Association apartments. Our collective response has been to bring together a group of both legal advocates and doctors to help raise the consciousness of the legal community about the devastating effects of smoking on children, particularly children who have chronic lung problems. We've done similar work particularly around issues about the impact of violence on children and the access to utility services by low-income families. Lawyers in private practice on our panel are drafting affirmative conditions complaints that will make homes safer for people. Those are just some of the examples that we've been able to identify, just by coming together.
Editor: When was the Healthy Homes Project started?
Morton: It started in September of 2007, though private bar involvement in the medical-legal partnership predates that by several years. In the first nine months, over 150 cases on behalf of low-income families treated at partner health centers and hospitals have been placed with pro bono attorneys who are members of VLP's and MLPC's pro bono panels. We've also trained more than 150 attorneys and over 200 health care professionals on the connections between unmet legal needs and child and family health.
Editor : How do lawyers bring an added dimension to serving the needs of impoverished children? What can they offer in addition to the services performed by pediatricians?
Morton : Some physical ailments impacting children respond to medical interventions that are appropriate and effective, but other ailments require legal intervention to be cured. For example, Foley Hoag, which has adopted the South Boston Community Health Center, had tremendous success representing a vulnerable family where not only did both parents have profound mental health problems with which they were struggling alongside poverty, but one of their two sons had recently been diagnosed with autism and his symptoms were progressing quite severely. This family was living in public housing in South Boston in a two-bedroom apartment, but it became clear that the health of the younger non-autistic child who was sharing a bedroom with his older brother was being negatively impacted by sharing a bedroom with his brother. Seeking authorization from the Boston Housing Authority to transfer to a three-bedroom apartment was a legal challenge for this medically vulnerable family; only with the help of the Foley Hoag volunteers was this family able to get the relief that they not only needed but were legally entitled to.
Macauley: One hurdle to recruiting attorneys to work in a medical setting is that lawyers are often concerned that they lack expertise to provide these families with effective representation. Partnering with MLPC and VLP allows law firm attorneys to overcome this hurdle. Day Pitney handled a case involving a single mother whose daughter was legally blind. The mother was unable to work full time and had not been able to pay her utilities bills timely. The family's electricity was shut off. Winter was approaching. Day Pitney and MLPC worked with NSTAR to establish a payment plan, thereby ensuring electricity and heat through the winter.
Editor: How do you recruit lawyers into a clinical setting?
Morton : In fact, we are greeted by prospective partners with enthusiasm, in no small part owing to the extensive support provided by VLP. The feedback we get from participating volunteers is that it is very exciting to work with medical professionals in a non-adversarial context. It also is empowering for volunteers to know that when their pro bono clients present them with unmet social, medical, mental health or substance abuse needs, they actually have an existing pathway for referral to experts, and they don't feel isolated as a pro bono volunteer attempting to resolve things for which they don't have professional training. We also get feedback that it is very efficient from the pro bono volunteer's perspective to work on cases where the clinical evidence that is so crucial to the case's success is available from the very beginning of the case. For example, in many types of legal matters, such as substandard housing conditions cases, disability benefits appeals, and domestic-violence-based immigration cases, one needs testimony or affidavits from health care professionals both to assess the merits of the case and also to be successful in the proceedings.
Editor: How does the shift of legal and medical resources to that of a prevention model better serve the welfare of children?
Girton: To the extent that the Medical-Legal partnership focuses on prevention and not picking up the pieces after the fact, they do a great job of identifying the entire range of problems that a family may face. It's not that they can necessarily fix every problem, but they are well connected to a lot of other agencies who can be helpful. Our clients come with a multiplicity of problems, not just bad housing conditions alone. Viewing the family in a holistic framework is a whole different way of looking at the delivery of legal services to low-income people.
Macauley A Medical-Legal Partnership provides opportunities for transactional attorneys to participate in pro bono matters. The legal issues presented often simply require chain of command advocacy with a particular administrative agency for resolution - something that any well-trained lawyer can accomplish. There is a very high impact for vulnerable families when they work with lawyers from many different types of practices on the Healthy Homes for Healthy Families Model.
Morton: The prevention model not only serves the welfare of children, but also may serve the administration of justice. The legal systems in the Commonwealth and around the country are contending with many cases that present in an emergency posture. If there is a way to shift resources upstream before a cataclysm hits the family, it could be a win-win for many stakeholders.
Editor: How does the adoption by law firms of local health clinics supplement this program?
Morton: I would like to take the opportunity to acknowledge Leiha Macauley as absolutely critical to the successful launch of that model several years ago.
Macauley: In February 2006, I was a recent graduate of the Boston Bar Association's Public Interest Leadership Program, which educates new lawyers on Boston's pro bono legal landscape. Through PILP, I learned about MLPC. Day Pitney was hoping to increase the pro bono opportunities for its lawyers. With guidance from MLPC, we became the first Boston law firm to take on a weekly legal intake clinic. As a result of Day Pitney's adoption of the East Boston Neighborhood Health Clinic, more families have access to legal aid. We have served nearly 100 families, working closely with Jennifer Goldberg, staff attorney for the Healthy Homes for Healthy Families Program and MLPC.
Editor: How do you measure outcomes in both this program you've described at the health clinic as well as for Healthy Homes?
Morton: We record not only the placement of cases with pro bono volunteers but also the outcomes of those cases, which I can confidently tell you are successful in almost 100 percent of cases. We also record data regarding our training of health care professionals, accumulating information on how the training may impact their knowledge, attitude and behavior in terms of screening for unmet legal needs in the course of their medical practices. Finally, our ability to engage in systemic work is a barometer of the success of our individual case work, since the work of pro bono volunteers on behalf of patient-families exposes emerging structural issues that require redress at a broader level.
Editor: How do you see Healthy Homes for Healthy Families growing over the next five years?
Morton: We see it growing steadily but smartly because it relies on continued investments from the pro bono and legal aid community. We are in conversations with several law firms that are very interested in exploring the adoption of health clinics. We expect that interest to remain strong and to help interested legal partners be paired with interested health center partners.
Girton: The collaboration between VLP and MLPC and the private bar is well established. We talk to each other literally every day. I have to say that I have endless gratitude to both the Boston Bar Association and the Boston Bar Foundation for having nurtured us and believed in us.
Published August 1, 2008.
