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The Health Law Partnership: A MedicalLegal Partnership Strategically Designed to Provide a Coordinated Approach to Public Health Legal Services, Education, Advocacy, Evaluation, Research, and Scholarship a

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Robert Pettignano MD FAAP FCCM MBA , Lisa Bliss JD & Sylvia Caley JD MBA RN a

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Emory University School of Medicine

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Georgia State University Published online: 26 Mar 2014.

To cite this article: Robert Pettignano MD FAAP FCCM MBA , Lisa Bliss JD & Sylvia Caley JD MBA RN (2014) The Health Law Partnership: A Medical-Legal Partnership Strategically Designed to Provide a Coordinated Approach to Public Health Legal Services, Education, Advocacy, Evaluation, Research, and Scholarship, Journal of Legal Medicine, 35:1, 57-79, DOI: 10.1080/01947648.2014.884892 To link to this article: http://dx.doi.org/10.1080/01947648.2014.884892

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The Journal of Legal Medicine, 35:57–79 C 2014 American College of Legal Medicine Copyright  0194-7648 print / 1521-057X online DOI: 10.1080/01947648.2014.884892

THE HEALTH LAW PARTNERSHIP: A MEDICAL-LEGAL PARTNERSHIP STRATEGICALLY DESIGNED TO PROVIDE A COORDINATED APPROACH TO PUBLIC HEALTH LEGAL SERVICES, EDUCATION, ADVOCACY, EVALUATION, RESEARCH, AND SCHOLARSHIP Robert Pettignano, MD, FAAP, FCCM, MBA, Lisa Bliss, JD, and Sylvia Caley, JD, MBA, RN*

He who sees a need and waits to be asked for help is as unkind as if he had refused it.1 Dante Alighieri

INTRODUCTION Low-income children, especially those with chronic disease and other health issues, are among the most vulnerable members of society.2 The Health Law *

Robert Pettignano is Professor of Pediatrics at Emory University School of Medicine. He is also the Medical Director of the Health Law Partnership and Medical Director of Quality for the Medicine Service Line at Children’s Healthcare of Atlanta in Atlanta, Georgia. Dr. Pettignano also serves on the Board of the National Center for Medical-Legal Partnership. Lisa Bliss is an Associate Clinical Professor at Georgia State University College of Law and Co-Director of the Health Law Partnership Legal Services Clinic. She is the Director of Experiential Education, and teaches interviewing and counseling. Professor Bliss holds an appointment as Adjunct Assistant Professor in the Department of Pediatrics at Morehouse School of Medicine. She supervises students from Morehouse who take an elective entitled “Law and Medicine,” and co-teaches with Morehouse faculty in the Fundamentals of Medicine course. Sylvia B. Caley is an Associate Clinical Professor at Georgia State University College of Law teaching in the HeLP Legal Services Clinic. She also teaches Health Legislation and Advocacy and is the director of the Health Law Partnership. She is a member of the Ethics Committees at Grady Health System and Children’s Healthcare of Atlanta. Please address all correspondence to Dr. Pettignano at [email protected] 1 ANTONIO SANTI, THE BOOK OF ITALIAN WISDOM 12 (2003). 2 Reducing Health Disparities Among Children: Strategies and Programs for Health Plans, NihcmFOUND. (Feb. 2007), http://nihcm.org/pdf/HealthDisparitiesFinal.pdf.

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Partnership, a medical-legal partnership (MLP), was developed to address the legal needs of low-income children and their families living in Georgia and who receive healthcare services from Children’s Healthcare of Atlanta.3 In keeping with Dante’s quote, HeLP’s creators understood the importance of proactively addressing the social determinants of children’s health, many of which have legal antecedents and result from illness and health-related complications caused by socioeconomic factors.4 Four attorneys5 saw the close link between poverty and poor health, and understood that the law could be used as a tool to help address the devastating effects that social, economic, and environmental problems have on the health of children and their families. To address these effects, they established HeLP. Their goal was to proactively address the legal needs of low-income children. These attorneys embraced the concept of MLP as a way of promoting the health of the community, by both addressing and preventing some of the barriers to good health, and they invited medical professionals to join them. They created an MLP to have maximum impact in four specific areas: (1) direct delivery of public health legal services; (2) education of professional students in multiple disciplines and education of professionals within the healthcare system; (3) advocacy on matters affecting public health; and (4) evaluation, research, and scholarship relating to the impact and efficacy of MLPs and other related topics. This article explains HeLP’s four-pronged approach to MLP designed by the three institutional community partners,6 explores the intentions and benefits of each area, and provides case studies illustrative of the four programmatic components of HeLP. I. A PARTNERSHIP WITH FOUR DISTINCT AIMS CREATED THROUGH PATIENCE AND PERSISTENCE In early 1991, the large, tertiary-care, indigent-care teaching facility in downtown Atlanta, Georgia, invited an attorney from the Family Law Unit of the Atlanta Legal Aid Society (ALAS) to serve as a community representative on the newly reconfigured Medical Ethics Committee. This facility and the legal aid office both served the same population of patients and clients. Through serving on the ethics committee, the attorney witnessed the challenges and 3

See Press Release: Children’s Healthcare Partners to Provide Low-Cost Legal Services, GA. ST. U. COLL. L. (Sept. 29, 2004), http://law.gsu.edu/clhs/pdf/AboutGwinnet.pdf. Id. 5 Id. The four Atlanta attorneys who shared the vision to create a medical-legal partnership (MLP) at Children’s Healthcare of Atlanta were Sylvia Caley, Dale Hetzler, Steven Gottlieb, and Charity Scott. 6 The three institutional community partners that entered into a Memorandum of Understanding in 2004 to create the Health Law Partnership (HeLP) are: Children’s Healthcare of Atlanta (Children’s); Atlanta Legal Aid Society (ALAS), Inc.; and Georgia State University (GSU) College of Law. Health Law Partnership, GA. ST. UNIV. COLL. OF LAW, http://law.gsu.edu/clhs/6480.html (last visited Oct. 7, 2013). 4

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frustrations encountered by patients-clients, health providers, and legal aid attorneys in dealing with matters involving patients’ health and well-being. This experience sparked the idea to establish a legal services office in the hospital.7 Mainly low-income, female heads of households needed legal assistance with family law matters, and all had minor children. These families simultaneously presented with a host of other problems, including health problems related to their socioeconomic status. The first formal proposal outlining the benefits to the hospital of creating an MLP was presented on October 7, 1991, to a mid-level hospital administrator. Chief among the benefits described was the fact that an on-site attorney could appeal denials of applications for disability benefits, which, if subsequently approved, would entitle recipients to Medicaid coverage.8 Previously uninsured patients would obtain a payment stream to assist with the cost of care. This first proposal was deemed interesting. Nevertheless, the timing was not right, and nothing happened. During the next 12 years, a total of four proposals were submitted to the institution. Early in the endeavor, a member of the faculty at Georgia State University (GSU) College of Law9 became the driving force in the effort to create a community collaboration to address the socioeconomic determinants of health. Faculty leaders from the two medical schools located in Atlanta—Emory University School of Medicine and Morehouse School of Medicine—joined the effort, calling for the creation of a medical-legal alliance10 at the institution. Hospital staff, particularly social workers, immediately saw the potential benefit of collaborating with 7

In August of 1991, the Atlanta Legal Aid attorney was invited to attend a meeting convened by Dr. Daniel Blumenthal, Professor of Medicine at Morehouse School of Medicine, to discuss a proposal entitled “Patients-Clients Proposal.” This proposal was designed to assist patients seeking health services to obtain necessary entitlements for which they might be eligible. The proposal was developed through a collaboration involving Harvard Medical School, Harvard Law School, and the Brigham & Women’s Hospital of Boston. The collaboration, headed by Dr. Howard Hiatt, was eager to have other communities adopt and implement the proposal. In October of 1991, Memorial Medical Center in Savannah, Georgia, invited Sarah Shuptrine & Associates, a consulting firm located in Columbia, South Carolina, along with William Riddle to put on a workshop designed to develop community advocacy and cooperation around the need to increase Medicaid enrollment by eligible residents in the Savannah area. Atlanta Legal Aid, Inc., sent the attorney interested in moving her law office into the hospital to attend. Information provided at the seminar motivated the executive director to support development of the first proposal to provide onsite legal services to patients at the large, indigent care facility in Atlanta. 8 Steven Gottlieb, Executive Director of ALAS, always has been supportive of staff attorneys’ innovative ideas for addressing unmet legal needs. Throughout the 13-year effort to create an MLP and during the decade-long experience with HeLP, he has remained steadfastly committed to holistic, interprofessional collaboration and problem-solving. 9 Charity Scott, JD, MSCM, is the Catherine C. Henson Professor of Law and Director for the Center for Law, Health & Society at GSU College of Law. Professor Scott represents GSU as a founding partner of HeLP. She spearheaded the development of three of the four initial proposals developed to create an MLP in Atlanta. Her tireless efforts single-handedly resulted in the creation of the project. She also was the driving force behind the creation of the HeLP Legal Services Clinic and served as its first director. 10 In June of 1992, Professor Charity Scott and the attorney from Atlanta Legal Aid made a site visit to the Medical/Legal Services Project, initiated by Harvard University’s Schools of Medicine and Law,

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attorneys to address legal problems affecting health and health outcomes. Despite ongoing support from healthcare providers to develop an MLP, 21 years later, one does not exist at the institution where the collaboration was first proposed. Explanations for declining the proposal to form a collaboration included bad timing, lack of funding, lack of available space to house the law office, inability to control the work of the attorneys directly, and the hospital’s concerns about increased liability exposure. Representatives of the institution frequently questioned why the law school and the legal aid program wanted to create a partnership with the hospital. Perhaps, the antipathy for attorneys, even well-meaning ones, ran too deep. The experiences with this institution tested the mettle, and the patience, of the leaders united in the desire to create an MLP. In 2003, when the team was at its lowest ebb, following a formal vote by the board of the hospital denying creation of the MLP, serendipity changed the course. During a sidebar conversation in a noisy hallway in the Georgia State Capitol with the Vice President for Government Affairs for Children’s Healthcare of Atlanta (Children’s), one attorney from the team recounted frustration about yet another “no” vote on the proposal to establish an MLP. Four hopeful words were uttered: “Children’s might be interested.” Quite literally, the rest is history. This leading healthcare administrator arranged for a meeting with the General Counsel for Children’s on May 15, 2003, to discuss the potential of forming an MLP. During the next year, all of the details associated with creating a formal collaboration among three highly respected community institutions were discussed, resolved, and memorialized in a memorandum of understanding (MOU) executed by representatives of the three partners. This MOU outlined the goals of the partnership, as well as the roles and responsibilities of each partner. All three partners committed to raise funds adequate to support and sustain the new partnership. From the outset, the partners agreed that a critical mass of three attorneys was necessary to meet the demand for services, provide educational services, and offer support to one another. Children’s provided dedicated space at two of its hospital campuses to house the project law offices.11 The College of Law provided funding to employ a part-time attorney. On June 3, 2004, the partners held a celebratory meeting and issued a formal to collect detailed information regarding the organization, funding, computerization, operation, patient selection process, and educational component employed by the Harvard project. This visit served as fieldwork for the development of an Atlanta project. During the fall of 1992 and the winter of 1993, leaders from GSU College of Law, ALAS, Morehouse School of Medicine, and Emory University School of Medicine met and developed a proposal for an MLP entitled the Atlanta Medical and Legal Alliance. The mission of the alliance was to improve the delivery of medical and legal services to the indigent population in Atlanta, to foster respect and cooperation between the medical and legal professions, and to enhance the interdisciplinary educational opportunities for medical and law students and faculty in Atlanta. 11 See generally Legal Services: HeLP Legal Services Clinics, CHILDREN’S HEALTHCARE OF ATLANTA, http://www.choa.org/patients-families/hospital-support-services/legal-services (last visited Oct. 12,

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announcement of the creation of HeLP. The first attorney began part-time employment with the project on August 9, 2004.12 HeLP is an MLP, defined as a healthcare delivery model that integrates legal assistance as a vital component of medical care. HeLP, based in Atlanta, Georgia, was the first MLP established in the South, and it is a community collaboration among GSU, Children’s, and ALAS.13 Children’s was the perfect medical partner for HeLP.14 As one of the leading pediatric healthcare systems in the country, it serves children and families who have legal needs in addition to their healthcare needs. Today, Children’s serves the Atlanta community from three hospital campuses and 20 neighborhood locations, including five urgent care centers. Children’s treats more than 350,000 unique patients every year, and in excess of 50% of these children live in low-income families. Many of these children experience barriers to care or exacerbations of their illnesses due to their socioeconomic status. To help address these challenges, each hospital location within the Children’s system has a dedicated HeLP office, staffed by a licensed attorney. In addition, there is a legal clinic at GSU where law students work collaboratively with medical students, social work students, and other professionals under the supervision of law faculty to serve HeLP clients and to learn professional, as well as interprofessional, skills. GSU’s College of Law was established in 1982 to provide publicly funded legal education through both part-time and full-time programs.15 The College of Law houses the Center for Law, Health & Society, which facilitates the law school’s involvement with the HeLP collaboration. The College of Law’s urban location in a capital city, near one of Children’s campuses, and its nationally recognized health law program, make it a perfect MLP partner. The third partner, ALAS, provides free legal services in civil matters to people with low incomes who cannot afford to hire counsel.16 Founded in 1924, ALAS now serves a five-county, metropolitan Atlanta area with five fully staffed offices and one satellite office. As part of its contribution

2013). Children’s now provides dedicated office space for HeLP attorneys at each of its three hospital campuses. Contact Us, HELP HEALTH LAW PARTNERSHIP, http://healthlawpartnership.org/index/contact us (last visited Oct. 12, 2013). 12 In keeping with the Atlanta experience of having the right people in the right places, HeLP would not have come to fruition without the approval and support of Steven Kaminshine, then acting dean and now dean of the College of Law at GSU. He approved the creation of HeLP and the College of Law’s participation as a partner. He encouraged faculty support and committed the financial resources necessary to initiate the project. Dean Kaminshine also supported the development of the HeLP Legal Services Clinic, and the hiring of faculty and staff necessary to bring the vision of an interdisciplinary MLP clinic to life. 13 See HeLP: MLP, http://www.helpmlp.org (last visited Oct. 6, 2013). 14 See http://www.choa.org (last visited Oct. 6, 2013). 15 See Georgia State University College of Law, http://law.gsu.edu (last visited Oct. 6, 2013). 16 See Atlanta Legal Aid Society, http://www.atlantalegalaid.org (last visited Oct. 6, 2013).

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FIGURE 1. HeLP Program Flow Chart (Color figure available online.)

to the partnership, ALAS employs three HeLP staff attorneys and an office manager. To meet their goal of effectively addressing the poverty-related cycle of health problems and hospitalizations of low-income children, the HeLP partners developed a coordinated, strategic plan designed to further the overall mission of the partnership. HeLP’s mission is four-fold: (1) to provide a comprehensive set of free, direct public health legal services that address the full spectrum of social, economic, and environmental factors that affect lowincome children’s health and well-being; (2) to promote the interdisciplinary education of healthcare, legal, and other professionals to work as a team to improve the health of children, especially those from underserved and vulnerable communities, and to contribute to the transformation of healthcare; (3) to recognize and address systemic policy issues affecting children’s health and well-being in a thoughtful and coordinated manner; and (4) to engage in self-evaluation, research, and scholarship designed specifically to improve service delivery, to introduce the uninitiated to the benefits of holistic, interprofessional problem-solving, and to establish HeLP as a model MLP. (See Figure 1.) All three partners take an active role in the oversight of the partnership. For example, representatives of each of the three partners have on-going meetings regarding all aspects of HeLP’s operations. An Advisory Council,

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established in 2003 and comprised of leaders in medicine, law, public health, social work, and higher education, meets quarterly with the partners and HeLP staff. The Advisory Council formed five subcommittees, made up of members of the Council, to assist HeLP in: providing effective educational programs to hospital personnel and other interested groups, raising funds to support the project and its aims, providing pro bono legal services to clients that HeLP is unable to assist, producing scholarship and other written materials relating to the work of the project, assisting with matters related to program evaluation, and enhancing public awareness of the partnership and its work on behalf of children and their families. The subcommittees provide important support for the activities of the partnership and extend the reach of HeLP beyond what the HeLP staff could achieve on its own. All partners and key personnel attend an annual retreat to assess and reflect on the prior year’s performance and accomplishments, consider new opportunities for development and improvement, and plan strategically for the upcoming year. The long-term sustainability of the partnership is important to all of the partners to continue the impactful work that began in 2004. Thus, the partners cooperate in sharing responsibilities, committing and developing resources, and applying for funding. HeLP is supported by grants, donations from private foundations and other donors, and the contributions of its partners. All partners contribute both financial and in-kind resources to support HeLP. Of particular significance and demonstrative of the physician engagement with HeLP’s mission are two grants to HeLP from the 1998 Society. The Children’s 1998 Society is a physicians’ philanthropic organization named for the year Egleston Children’s Hospital and Scottish Rite Children’s Medical Center merged to form Children’s Healthcare of Atlanta. Physicians at Children’s pledge their financial support to Children’s through the 1998 Society. Projects in need of financing are presented to the 1998 Society Board. The Society’s board discusses projects that otherwise may not exist or survive without special funding, and board members determine the distribution of funds based on need and alignment with the mission of the organization. The human resources element of HeLP is dynamic. Resources are arranged and contributed based on the shared commitment to the endeavor. All three partners contribute full-time-equivalent (FTE) professional services to HeLP’s operations. This means that HeLP has professionals employed by Emory University School of Medicine, Children’s, GSU College of Law, and ALAS. Children’s provides a medical champion, initially allocating 0.05 FTE to his work with HeLP. In 2013, the role of medical champion was formalized through the establishment of a Children’s Medical Director of HeLP. In establishing this position, Children’s increased its funding to support a 0.1 FTE. The Medical Director’s role is to coordinate the activities of the partnership from the medical side. GSU College of Law employs three clinical

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faculty members and an administrative coordinator to oversee the clinic at the law school, and financially supports the operations of the HeLP Clinic office. One of the faculty members is HeLP’s overall Director. ALAS employs and supports three staff attorneys and an administrative professional.

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II. MLP AS PUBLIC HEALTH LEGAL SERVICES A young man, a recent immigrant to the United States from North Africa, was left with his two-month-old daughter after the child’s mother, who suffered from mental health issues, abandoned the family and moved to California. While this father was unfamiliar with most community resources, he did know to take his newborn daughter for her well-baby check-ups scheduled with the primary care clinic at Children’s at Hughes Spalding. The attending physician caring for the child quickly identified several problems faced by this father and referred him to social work services and to HeLP. This father had no legal relationship with the child, as he and the child’s mother were not married, and he had not legitimated the baby. He was unable to pay for DNA testing, preferred by judges in legitimation cases, or to pay for service of process required to notify the mother in California of the intended legitimation and custody action. He also had challenges as a single father in finding childcare for court appearances and mandatory classes related to the case. HeLP, working with the Urban Health Initiative at Children’s at Hughes Spalding, was able to file the legitimation action on the father’s behalf, serve the mother in California, assist the client with obtaining childcare, and make a successful case on the father’s behalf without DNA testing. At the court hearing, the judge: legitimated the relationship between the father and his child; awarded permanent, sole legal and physical custody of the child to the father; and ordered the mother to pay child support. At the outset, HeLP was an attorney-driven program—envisioned, created, nurtured, and supported by attorneys. The General Counsel for Children’s, an inspired problem-solver, understood the value to patients, their families, the healthcare team, and the health system of addressing barriers to care and creating healthy outcomes in a holistic manner.17 To his way of thinking, adding an attorney to the healthcare team was good for patients and good for the hospital. He also understood the need for dedicated space so that attorneys could be imbedded at each of the hospitals within the Children’s system. Prior to accepting cases for representation, the HeLP partners crafted a mini needs assessment and administered it to the social workers at Children’s. 17

Dale Hetzler, JD, MSCM, in his role as general counsel, represented Children’s in the formation of HeLP in 2004. In 2008, he left Children’s to become general counsel at Erlanger Health System in Chattanooga, Tennessee, where he again instigated the development of an MLP. Members of the Chattanooga team paid a site visit to HeLP in spring of 2012.

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The assessment consisted of two questions: (1) if you had a attorney available to provide legal assistance to your patients, what kinds of problems would you refer; and (2) if you had a attorney available to provide educational programming on legal or socioeconomic issues that affect your ability to provide services to your patients, what types of programs would you be interested in attending. Overwhelmingly, the responses to both questions were family law-related issues. This clearly articulated need set the early agenda. The founders understood that the effort to create HeLP could be facilitated by broader-based community support. Again, very early in the life of HeLP, an Advisory Council was assembled. Initially, the members were attorneys, primarily health attorneys. As the principals developed relationships within Children’s and throughout the community, physicians, social workers, and nurses joined. Today, members of the HeLP Advisory Council provide financial support, policy guidance, pro bono legal services, advice and counsel, and meeting facilities. The Council meets quarterly, and, because the meetings are so motivating, everyone looks forward to them. Through referrals from hospital professionals, particularly social workers and self-referral by families, HeLP attorneys represent eligible clients on a broad array of civil legal problems. Families with children receiving care through Children’s facilities are eligible for free civil legal services when: the family lives at or below 200% of the federal poverty level; the child is younger than 21 years of age; and the legal problem is a type that can be handled by HeLP. Through experience and in response to demand for services by both families and providers, HeLP has developed a list of priority cases. Priority cases include issues involving housing conditions, family stability, access to education, disability benefits, public benefits, Medicaid and Georgia’s CHIP program, and permanency planning. One of the initial surprises at HeLP was that, upon opening its doors, it was immediately a state-wide program. (See Figure 2.) Children’s cares for children from all over Georgia and surrounding southeastern states. Upon discharge, they take their legal problems home with them. From inception, it was clear to the HeLP founders that a robust, dependable volunteer attorney pool that could serve clients living outside the metro area, as well as provide specialized services that HeLP could not offer, would be critical to the program’s success. The majority of the cases referred to HeLP are handled by HeLP attorneys. When circumstances, such as geographic location or the referral of legal problems beyond the scope of HeLP’s services arise, cases are referred to volunteer attorneys or other appropriate community legal resources. HeLP devotes much time and energy to developing a robust roster of volunteer attorneys, and provides training, assistance, and back-up, as necessary, to these volunteers. HeLP attorneys train and support volunteers to handle guardianship cases of adults and minors, education matters, housing conditions, and complex access-to-care issues. Many volunteer attorneys use

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FIGURE 2. Statewide Distribution of Cases (Color figure available online.)

the hospital-based HeLP offices to meet with clients. In 2012, 44 cases were handled by volunteers. To recognize the invaluable service provided by volunteers, each year HeLP staff notify the State Bar of Georgia of their service. Their pro bono work is registered, and they are rewarded with a certificate. If they have taken three cases or more in a calendar year, they receive a continuing legal education voucher valued at $150.00. Each also receives a hand-written thank you note. Many volunteers find their work in support of HeLP’s mission and on behalf of clients so rewarding that they accept cases regularly to fulfill their pro bono obligation. Clients presenting to an MLP frequently have more legal problems than the one that motivated their referral. At HeLP, most of the clients identify between two to five different legal issues affecting the family or a child’s

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well-being during the legal checkup portion of the case intake process.18 The client intake process19 includes a thorough legal problem assessment, including a review of issues, such as: the parent or guardian’s health status; the child’s health status; the effect of illness on the ability to work, attend school, and pay bills; and housing and safety concerns. During a weekly interdisciplinary case acceptance meeting, patient-clients’ health and legal problems are discussed in depth, and then the legal problem is triaged and assigned to a staff attorney for direct legal assistance, to a trained volunteer, to the HeLP Legal Services Clinic for supervised student representation, or provided with self-help support. Input from the medical providers in attendance about the medical problem and the impact of the legal problem in question on the child’s health contributes to HeLP’s ability to evaluate referrals quickly and triage appropriately. In addition to the continued focus on family stability issues, the types of legal problems referred to and consequently undertaken for assistance by HeLP run the gambit of a poverty law practice—income support, access to healthcare, other public benefits issues, disability claims, private health insurance issues, permanency planning, housing conditions, education issues, employment problems, and consumer issues. Every year, the leading categories of referrals to HeLP are for assistance with housing conditions, family stability matters, education issues, and denials of disability claims. In the ongoing effort to encourage referrals, HeLP staff continues to learn the critical role feedback plays in the healthcare delivery system. HeLP attorneys require direct consent from clients to share information with health provider colleagues. The attorneys make every effort to obtain this consent in each case and to communicate pertinent information to the providers. HeLP also incorporates language imprinted at the very top of the new client intake sheet that is read to each client. This paragraph explains that the project is interdisciplinary and that physicians and students in medicine, public health, social work, and other disciplines—in addition to law—attend and participate in case acceptance meetings. Each new client is asked to give permission to 18

For a discussion of HeLP’s success in providing public health legal services to children and families served by Children’s, see Robert Pettignano et al., Can Access to a Medical-Legal Partnership Benefit Patients with Asthma Who Live in an Urban Community?, 24 J. HEALTHCARE POOR & UNDERSERVED 706 (2013); Robert Pettignano et al., Medical-Legal Partnership: Impact on Patients with Sickle Cell Disease, 28 PEDIATRICS E1482 (2011); A.W. Houseman, The Future of Civil Legal Aid in the United States, CENTER FOR LAW AND POLICY (Nov. 2005), http://www.clasp.org/admin/site/ publications archive/files/0188.pdf. 19 Clients reach HeLP through multiple mechanisms. The goal always is to make access as easy and uncomplicated as possible while also preserving patient-client confidentiality and respecting institutional policies. Many are referred by providers who obtain parental consent to telephone HeLP directly or request that the parent or guardian call HeLP. At Children’s at Hughes Spalding, a formal referral process exists that facilitates referrals from all patient care areas to HeLP. Information on HeLP is included in patient information materials maintained in all patient rooms, is stocked in the family resource libraries located on each Children’s campus, and is stored on the Children’s Intranet. Directional signage indicating the location of the HeLP office is located throughout each Children’s campus.

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present his or her case to the interdisciplinary team during case acceptance and to inform the referring provider that the client contacted HeLP. If a client refuses, the case is not discussed at interdisciplinary case acceptance, and the referrer is not alerted. At Children’s at Hughes Spalding, almost every client referred to HeLP is asked to sign a bilateral release form that facilitates communication between the HeLP attorney and the health care provider. An accompanying, approved feedback instrument formalizes the feedback loop. This feedback instrument becomes part of the medical record. Of course, care is taken not to convey information that would violate client confidentiality or jeopardize the attorneyclient relationship. Despite these efforts to provide feedback, HeLP’s healthcare partners continue to request more feedback. In an effort to increase awareness of attorneys’ special duty to protect confidences, a segment of every educational presentation to hospital personnel covers confidentiality concerns. HeLP attorneys, in collaboration with health providers, continue to seek new, appropriate mechanisms for providing feedback. III. EDUCATION: PROFESSIONAL GRADUATE EDUCATION AND IN-SERVICE EDUCATION A. Law Student Collaboration with Physicians A HeLP client’s child was diagnosed with pervasive developmental disorder, sensory integration disorder, and poor weight gain, as well as auditory and language disorders, combined with other conditions. Because of the number of physical, psychological, and developmental conditions, the child lagged significantly behind her peers socially, physically, developmentally, and academically. Although she had multiple diagnoses, the child did not meet any listings for disability under the Social Security Administration guidelines. She applied for Supplemental Security Income (SSI) benefits and was denied. Law students collaborated with her physician, Director of the Autism Clinic at the Children’s Hughes Spalding campus to prepare an affidavit containing his expert assessment of the child’s conditions. This affidavit was filed together with a brief supporting the child’s claim. The law students presented the affidavit at a hearing on the child’s behalf. The administrative law judge issued a fully favorable decision. B. Medical Student Education A fourth-year medical school student with a special interest in law enrolled in the “Law and Medicine” elective rotation sponsored by the HeLP Clinic. She worked with law students in reviewing and analyzing medical records, participated in legislative advocacy projects with law students, and

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performed medical research on specific diseases to assist law students with clinic cases. She also attended and participated in law school lectures and classes, including Interviewing and Counseling, HeLP Clinic, and Health Legislation and Advocacy. Finally, she was invited to spend the day with an administrative law judge and observe the docket. Following her experience, she expressed that she had acquired important skills to enable her to serve her patients and an even greater interest in someday attending law school. C. Public Health Collaboration A client sought legal assistance from HeLP due to a rat infestation in her apartment, which she shared with her two sons. Despite the rats, the client did not want to move from the apartment, in part, because she had spent her own money installing carpet and other upgrades for the comfort of her autistic son. The law students inspected the apartment together with a master in public health (MPH) student. The law students researched the landlord’s legal duties, and the public health student researched the potential dangers caused by the presence of rodents in the home and methods for safe, healthy eradication. This research was used both to persuade and educate the landlord. The landlord took care of the rat problem, made multiple repairs to the client’s apartment, and shampooed her carpets at no charge. The public health student used her research to collaborate with the law students to create a brochure for future clients on how to keep rodents away, safe eradication, and steps to follow in the event that a rodent problem is discovered. Clinical legal and medical education are fundamental to achieving the goals of HeLP. Through its professional education strategy, HeLP is training the next generation of physicians, attorneys, and other health professionals to collaborate and holistically address the socioeconomic determinants of health. The three case studies above are representative of the different ways in which the education component of HeLP allows collaboration among different stakeholders from different disciplines. HeLP’s education component comprises professional graduate education, as well as in-service education and training of hospital-based medical and non-medical professionals, and community-based volunteers. The varied nature of this component ensures that HeLP is reaching the widest possible audience at each level of the partnership. It also ensures that the reach of the project will continue into the future. Every year, a new group of professional students graduate with skills in how to work collaboratively with other professionals. These students are then employed in law and health jobs across the country, and many are carrying the collaborative spirit they learned during their professional education with HeLP into their current professional roles.

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FIGURE 3. HeLP’s Inter-Professional Education Framework (Color figure available online.)

HeLP and the HeLP Clinic serve as a hub for interprofessional education in Atlanta. The HeLP Clinic offers an innovative curriculum designed to foster collaborative working relationships between law students, and among students of law, social work, medicine, and other professionals. The Clinic provides inter-professional experience for students from three universities: GSU, Emory University, and Morehouse School of Medicine (Figure 3).20 The HeLP Clinic enrolls law students, and serves as a year-long practicum placement for students obtaining their master’s in social work; these social work students work closely with law students to address social needs of clients and their families. Pediatric residents from Emory School of Medicine attend the HeLP Clinic case rounds to contribute to discussions and satisfy their systemsbased practice requirement. Case rounds is a group discussion, scheduled every other week during the semester, regarding the status of Clinic cases and specific legal, medical, ethical, and other issues that arise during the course of client representation. At case rounds, the class discusses various issues pertinent to student learning and client advocacy. Because no two

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For a comprehensive discussion of the HeLP Clinic Interdisciplinary Education Model, see Lisa Bliss et al., A Model for Interdisciplinary Clinical Legal Education: Medical and Legal Professionals Working Together to Promote Public Health, 18 INT’L J. CLINICAL LEGAL EDUC. 149 (2012).

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cases are alike, the case rounds process provides students with the opportunity to learn from the many different issues that arise from the entire Clinic caseload. Where appropriate, case rounds is used as an opportunity for the group to collaborate to resolve ethical issues, and to perform and critique mock hearings, mock counseling sessions, mock negotiations, or other simulations designed to prepare students to engage in real-world matters successfully. HeLP Clinic students are also exposed to a public health perspective through interprofessional enrollment. The HeLP Clinic has served as a practicum placement for MPH students from GSU. Most recently, an MPH Health Disparities Fellow spent two years with the Clinic, engaging in collaborative problem-solving with law students for the benefit of clients, as in the example case study involving the rodent infestation. The HeLP Clinic also served as a practicum placement for a physician seeking a master’s degree in bioethics from Emory University. Another aspect of collaborative interprofessional education involves students from Morehouse School of Medicine. The law students from the Clinic attend joint classes four times a year with third-year medical students at Morehouse School of Medicine, where law and medical students engage in small group work and exercises designed to expose them to collaborative problem solving. Additionally, fourth-year medical students from Morehouse School of Medicine may enroll in a four-week “Law and Medicine” elective rotation in the HeLP Clinic. Beginning in the fall of 2013, Emory School of Medicine also will offer this elective to its fourth-year medical students. The collaborative, interprofessional learning environment in the Clinic benefits the clients served by the Clinic, as well as the students. Clinical education, by its nature, involves real clients and patients. Students from different professions not only learn skills but also gain great satisfaction when they work as a team to help a client. Through their case work for lowincome families from Children’s, students learn core competencies that will enable them to succeed as professionals. Clinic students learn to appreciate, respect, and understand the culture of one another’s professions. They also learn that each profession has its own language and rules, including ethical rules. Students begin to see the similarities, differences, and areas where such rules may conflict among different professions. This understanding allows them to become better collaborators within and outside their own professions. The Clinic students learn to navigate problems collectively on behalf of a client-patient, and to see the unique perspective and contribution that each profession can bring to solving problems more holistically. They also gain a better appreciation for when the services of a professional outside their own discipline could further the health and economic status of a patient or client.

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The medical student in the case study above worked collaboratively with law students during her elective rotation in the Clinic. Her experiences engaging in the joint service and learning activities with law students further cemented her interest in law. HeLP’s education component goes beyond interprofessional graduate education. It also includes in-service education offered to hospital staff and the medical offerings to the legal staff. This aspect of the education component is vital to the ongoing success of the partnership and yields multiple benefits. HeLP’s hospital-based, interdisciplinary in-service educational component serves to strengthen the long-term effectiveness of the legal services component by training hospital professionals to understand, identify, and refer children and their families so that their social needs and legal rights can be addressed. The goals of the in-service educational component of HeLP are two-fold: (1) to increase knowledge about the legal, ethical, and policy issues that affect low-income children and their families at Children’s, thereby improving the ability of legal and healthcare professionals to provide appropriate services; and (2) to foster respect, understanding, and a cooperative spirit among the healthcare and legal professions. Key participants in these training sessions are healthcare professionals at Children’s, including attending physicians, residents, nurses, therapists, and social workers, as well as volunteer attorneys who work with HeLP. To increase awareness of HeLP’s presence and services at Children’s, HeLP provides educational presentations at all three Children’s hospital campuses and in different fora, including grand rounds, pediatric roundtables, physician practices, social work and nursing staff meetings, outpatient clinics, with school nurse liaisons and hospital school teachers, and administrative personnel. The substantive legal issues covered in these educational presentations are intended to target socioeconomic barriers that affect health and to educate the audience about the broad array of poverty-based legal issues referred to HeLP. Programming includes presentations on guardianship of minors, adoption by relatives, the Katie Beckett deeming waiver, asthma and the law, Georgia Medicaid issues, housing and landlord-tenant issues, disability, education law, legislative updates of issues affecting children, family violence, paternity and legitimations, family medical leave, and immigration law. In 2010 alone, HeLP provided 400 continuing education units to social workers within the Children’s system. Estimating a minimal cost of $25 for each credit, this resulted in $10,000 in education services at no cost to the system.21 In addition to formal educational programs, “HeLP’s educational component has an informal aspect as well. Physicians and social workers call HeLP 21

Robert Pettignano et al., The Health Law Partnership: Adding a Lawyer to the Healthcare Team Reduces System Costs and Improves Provider Satisfaction, 18 J. PUB. HEALTH MGMT. & PRAC. E1 (2012).

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regularly for immediate answers to questions on issues, such as the eviction process in Georgia, divorce matters, guardianship, and denials of Medicaid applications.”22 Each year, Emory University sponsors an “Acute Care” curriculum for the incoming pediatric residents where topics dealing with urgent or emergent care of patients are presented. The HeLP attorneys and law students are invited to attend and can pick the topics that are most pertinent to their practice. In addition, all of the educational opportunities offered to the medical staff can be attended by the attorneys and law students to enhance their knowledge of the more common medical problems that affect their clients. IV. SYSTEMIC ADVOCACY AND ITS PUBLIC HEALTH IMPACT Pediatric health providers were frustrated at seeing an increasing number of children with severe head injuries admitted to the emergency departments and intensive care units at Children’s. Staff members in the rehabilitation unit were aware that children between the ages of six and nine years were experiencing more severe seat belt-related injuries following motor vehicle crashes. Hospital Government Affairs staff were aware that state law regarding child restraints did not meet national safety advisories for children between the ages of six to nine. Simultaneously, HeLP staff had noticed an increase in referrals from Children’s providers involving children in this age range who had sustained injuries in auto accidents and needed help with SSI disability applications, housing accommodations, and education issues. Each group was worried independently of the others about this problem. Serendipitously, during an in-service education presentation to the rehabilitation staff, both the healthcare providers and the legal providers from HeLP recognized and discussed the fact that children between six to nine years of age appeared to be experiencing severe car-related injuries because they were permitted to be restrained by use of seat belts. Neither a booster seat nor other protective device was required for this age group. The rehabilitation staff asked HeLP attorneys whether anything could be done to improve child passenger safety.23 Through the systemic advocacy component, HeLP “strives to improve low-income children’s access to healthcare and the conditions that affect their health and well-being” by addressing global issues of concern or benefit.24 Because ALAS is one of the partners in HeLP and receives Legal Services 22

Directory of Pro Bono Children’s Law Programs, AM. BAR ASS’N 1, 54 (Jan. 2007), http://apps. americanbar.org/litigation/committees/childrights/docs/publications directory.pdf. See generally Child Passenger Safety Restraint Law in Georgia, CHILDREN’S HEALTHCARE OF ATLANTA, http://www.choa.org/child-wellness/child-wellness-prevention/booster-seat-law. 24 Directory of Pro Bono Children’s Law Programs, supra note 22, at 54. 23

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Corporation funding, a creative approach was needed to effectively address policy issues arising through the Atlanta MLP.25 The College of Law at GSU takes advantage of its location and understands the pedagogical importance of exposing students to the legislative and regulatory processes that contribute to the formulation and implementation of law and public policy.26 The College of Law offers a year-long course entitled “Health Legislation and Advocacy” (HLA). Students enrolled in the class work in pairs with non-profit community partners to address public policy issues arising from HeLP’s work with lowincome children and their families. In the case study above involving children’s injuries sustained in motor vehicle crashes, both the health partners and the legal partners independently observed an increase in numbers of children sustaining preventable injuries elevating this as an issue worthy of investigation by the HLA class. The Government Affairs staff at Children’s agreed to serve as the community partner, and two students were assigned to research and define the problem, suggest appropriate solutions, and provide appropriate support for the proposed solutions. The students assigned to the child passenger safety issue performed a 50-state survey of statutes regulating the use of safety restraints for children, particularly children in the target group of six to nine years of age. They discovered that the National Highway Traffic Safety Administration and the American Academy of Pediatrics recommend that children be placed in booster seats until they reach the age of eight.27 Students also discovered that even the Georgia Governor’s Office of Highway Safety recommended use of booster seats for children younger than nine years old.28 Tennessee required children to ride in such seats until reaching age nine.29 The students researched 25

“Federal regulations require that staff employed by ALAS be invited by a legislator before engaging in legislative advocacy or by government agency personnel before formally advocating for certain types of regulation and policy reform.” Health Law Partnership (HeLP), LEGAL SERVS. CORP. (Jan. 11, 2006), http: //lri.lsc.gov/legal-representation/projects-topic/health/medical-legal/health-law-partnership-help. Following receipt of an appropriate invitation . . . [a]dvocacy efforts focus on work at the legislative, policy-making and government agency levels on issues, such as Medicaid, Georgia’s [Children’s Health Insurance Program (CHIP)] (PeachCare for Kids), health insurance coverage issues, and other changes in law and regulations designed to improve the overall health and well-being of children. Id. Informal advocacy for policy change also is undertaken with relevant government agencies and community organizations that are involved in children’s welfare issues. 26 GSU College of Law is located within easy walking distance of both the state Capitol and the state agencies responsible for community health (i.e., Medicaid and CHIP), public health, behavioral health, and human services. Map and Directions, GA. ST. U. COLL. OF L., http://law.gsu.edu/about/directions. html (last visited Oct. 12, 2013). 27 See 4 Steps for Kids: Booster Seats, NAT’L HIGHWAY TRAFFIC SAFETY ADMIN., http://www.nhtsa.gov/ people/injury/childps/boosterseatprogress/pages/4Steps.htm (last visited Oct. 7, 2013); see also Ted R. Miller et al., Cost-Outcome Analysis of Booster Seats for Auto Occupants Aged 4–7 Years, 118 PEDIATRICS 1994, 1997 (2006), http://pediatrics.aappublications.org/content/118/5/1994.full.pdf. 28 GA. CODE ANN. § 40-8-76 (West 2011). 29 TENN. CODE ANN. § 55-9-602a(3)(2013).

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the science and engineering of seat belts and determined that young children are too small to be restrained properly by a seat belt.30 The students prepared a lengthy memo in support of increasing the age requirement for booster seats and presented their finding to Children’s, their community partner. Following a detailed discussion, including an assessment of political will, the students drafted proposed legislation to mandate that children be restrained in booster seats while travelling in a motor vehicle until they reach eight years of age. Children’s identified sponsors in both the State Senate and the State House of Representatives. Companion bills, as drafted by the students, were introduced in both chambers. The Senate version successfully passed both chambers and was signed into law within the legislative session in which the bills were introduced. The Governor was invited to Children’s for the official bill signing, and the students were invited to attend. Currently, HeLP is monitoring state data to determine whether increasing the age that young children must be restrained in more protective booster seats has reduced serious injuries in children within the targeted age range. While this is but one example, it is illustrative of HeLP’s approach to addressing systemic issues affecting the health and well-being of the children of Georgia. The two law students assigned to this project, as well as the entire class, experienced “sausage in the making.” They had the added benefit of working with professional lobbyists from Children’s on an issue of concern to the hospital system. Children’s received the benefit of substantial pro bono legal research, writing, and analysis efforts that resulted in a high-quality, written report and other materials that would have cost thousands of dollars had Children’s worked with a private consultant. Morehouse medical students rotating through HeLP on their one-month rotation participated in the HLA class and engaged in the activity at hand during their time with the program. Last, but not least, young children are now safer when they are placed in cars and taken out on the roadways of Georgia. Other systemic issues that have been addressed by HeLP through the HLA class and in collaboration with non-profit community partners include: • improving emergency preparedness in the state by granting corporations sovereign immunity for engaging in emergency operations; • restricting the use of cell phones while driving; • addressing the phenomenon, following passage of the Patient Protection and Affordable Care Act, where child-only health insurance policies no longer were available in Georgia; 30

F.K. Winston et al., The Danger of Premature Graduation to Seat Belts for Young Children, 105 PEDIATRICS 1179, 1182 (2000); Child and Youth Safety, NAT’L TRANSP. SAFETY BD., http://www.ntsb.gov/ safety/children.html (last visited Oct. 6, 2013).

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• reducing the blood alcohol content permissible for the operator of a boat on the waterways in Georgia; and • increasing the age that children must wear a personal floatation device when in a boat or watercraft on the waterways in Georgia.

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V. PROGRAM EVALUATION, RESEARCH, AND SCHOLARSHIP HeLP’s annual strategic planning meeting is structured around the current year’s program evaluation report prepared by an independent program evaluator.31 Details, including information on volume, outcomes, and satisfaction, are presented for each of the three service components of HeLP (i.e., legal services, education, and advocacy). Representatives of the three partners, all HeLP staff and faculty, and members of HeLP’s Advisory Council gather to review performance, analyze and address areas requiring attention and improvement, and set a course for the upcoming and future years. This day-long, annual event is scheduled months in advance and generates great excitement for it is the one time each year when we gather to reflect on the strides made and to chart our future. Through these meetings, we plan the expansion of our services, determine our research priorities, and outline our scholarship agenda. In 2004, following the negotiation and execution of the MOU that established HeLP and enumerated the roles, expectations, and responsibilities of each of the partners within the community collaboration, the team determined that effective program evaluation was a key element for assessing the present and charting a course for the future. In fact, development of the initial, comprehensive program evaluation template resulted in the creation of the blueprint for the components of HeLP that serves the program to this day. Before HeLP began providing services, Institutional Review Board (IRB) approval for the evaluation component of HeLP was obtained from both GSU and Children’s.32 Preparing the applications for IRB approval to engage in human subjects research, of course, provided the stimulus for the development of the comprehensive evaluation component of HeLP. The initial application, submitted to the GSU IRB in November of 2004, sought to evaluate HeLP’s participant population, including recipients of the public health legal services (i.e., parents or legal guardians) provided by HeLP, children who had attained age 18 but continued to receive care at Children’s, and participants in educational programs provided by HeLP. The initial IRB application outlined strategies for participant recruitment and provided 31

See Program Evaluation, HEALTH LAW PARTNERSHIP, http://healthlawpartnership.org/index/evaluation %26 research (last visited Oct. 6, 2013). 32 Institutional Review Board, HEALTH LAW PARTNERSHIP, http://healthlawpartnership.org/index/evaluation %26 research/IRB (last visited Oct. 6, 2013).

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detailed procedures to be used for research in all components of HeLP. In conjunction with preparation of the IRB applications, numerous policies and surveys were developed, including internal and external stakeholder interview scripts, and satisfaction surveys for clients, healthcare providers, social workers, pro bono attorneys, other professional volunteers, and students. The team analyzed the risks and benefits to all participants and developed informed consent instruments for multiple groups of participants. Today, 10 different informed consent documents protect the many different audiences with which HeLP engages. Established procedures define the process for maintaining confidentiality of data within all components of HeLP, and a case management data system (CMDS) assists in managing and facilitating reporting of data. The CMDS, a home-grown product developed by HeLP’s independent program evaluator and HeLP staff, continues to serve HeLP’s needs very effectively. To conduct business and fulfill all IRB responsibilities, staff also developed and received approval to use the following instruments: client intake sheet, legal problem checklist, retainer agreement, student authorization, authorization for disclosure of protected health information, case closing forms, and the data elements for HeLP’s CMDS. Throughout the years, the initial IRB approvals have been renewed and amended. The evaluation component exists to assess the quality and effectiveness of the service, education, and advocacy components of HeLP. Data that indicate the efficacy of each of these three components assist with internal quality assurance, management, and fundraising efforts necessary to support HeLP financially, stimulate participation in educational programs, promote volunteer efforts among professionals in the community to support HeLP, and encourage the referral of patients and families experiencing legal problems that may affect the health, well-being, and social welfare of children. Currently, HeLP’s evaluation protocol is very extensive, and now also covers the entire educational offerings of HeLP and the HeLP Legal Services Clinic, as well as the advocacy component. All amendments, modifications, and expansions have resulted from growing experience, new relationships, and analysis of the data for research related to specific legal issues and/or patient populations. HeLP’s independent program evaluator analyzes and compiles the data into a detailed annual report.33 Copies of the report are presented to the institutional partners, all staff, and members of HeLP’s Advisory Council. The evaluator also prepares an executive summary of each year’s report for placement on HeLP’s website.34 The data collected in the CMDS also are used for external publications of program quality, efficacy, and outcomes to encourage the development of programs similar to HeLP in other locations throughout the State of Georgia or 33 34

See Program Evaluation, supra note 31. Id.

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nationally. Research projects and topics for scholarly publication are identified through scrutiny of the environment in which HeLP exists, the priorities of the partners, and the overall impact on the body of literature that is necessary to substantiate the effectiveness of MLP. A meeting is held approximately every two weeks to update the status of active projects, brainstorm ideas for new research and scholarship opportunities, and identify appropriate venues to present the concept of MLP, and, more specifically, HeLP as a model from which other MLPs can be developed. An updated project list identifies priorities of the partnership. The list is a “rolling list,” on which completed projects are retained but moved to the “completed” section and new ideas are added.35 The project list also serves a stimulus for academic advancement for the participants in the project from the academic partners. CONCLUSION The idea for the development and day-to-day operation of the HeLP MLP has taught all involved many lessons and provided many rewards. Members of the team acknowledge being better professionals for the experience, and all hope the community is enriched by the collective effort. Experience indicates that key attributes and skills played major roles in the ultimate success. First and foremost, patience, tenacity, and a shared, collective vision for the future have been critical ingredients. Essential skills include, but are not limited to, effective collaboration skills, the ability to think outside the box, and keen organization and negotiation skills. These skills supported everyone in finding the right partners, the right staff, and the right mix of components, services, funders, and opportunities. HeLP created a paradigm shift in which attorneys, physicians, and other healthcare professionals work together for a common good. The team learned to manage the change in professional expectations, while embracing the fact that collaboration is hard work. The word “no” remains a common refrain in the effort to grow and expand, but an important lesson is not to take “no” for an answer. The four components, developed in HeLP’s infancy and out of the steadfast refusal to accept “no,” continue to serve the program well, allowing for growth, and the ability to recognize and seize opportunities. Creativity and flexibility have played important roles in the development of this MLP. Sustaining the love for the work and nurturing positive attributes and skills will allow for future development of new programs, funding sources, and ways to enhance that which already exists. An important discovery is that physicians and attorneys can work together well with the attorneys playing a positive role on the healthcare team. 35

Dave Johnson, Rolling Tasks Keep You Focused and Prioritized, MONEYWATCH (June 3, 2012), http:// www.cbsnews.com/8301-505143 162-57446232/rolling-tasks-keep-you-focused-and-prioritized/.

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Through the delivery of public health legal services, socioeconomic barriers to health are reduced, improving, in HeLP’s experience, the health and well-being of children. Interdisciplinary education on both legal and medical issues affecting health and well-being not only positively impacts professional attitudes toward collaborating across disciplines, but also creates better future attorneys, physicians, nurses, social workers, public health practitioners, health care executives, and other professionals. On a systemic level, policy advocacy addresses issues that are seen repeatedly and initially corrected individually. Finally, research and scholarship provide the evidence needed to allow acceptance of the tenets of MLP on a more global scale and to make the case for increasing support as we grow and develop both within and outside our system.

The health law partnership: a medical-legal partnership strategically designed to provide a coordinated approach to public health legal services, education, advocacy, evaluation, research, and scholarship.

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