2010 MLP Summit Agenda and Session Descriptions

Plenary Sessions

Revolutions and Reforms in the Health Community
Thursday, March 25th
9:30am – 10:45am

• Moderator: Megan Sandel, MD, MPH, Medical Director, National Center for MLP
• Cindy Mann, JD, Director of the Center for Medicaid and State Operations, Centers for Medicare & Medicaid Services
• Ed Paul, MD, Director of Graduate Medical Education, Yuma Regional Medical Center
• Sara Rosenbaum, JD, Chair, Department of Health Policy, George Washington University
• Salvatore Russo, JD, General Counsel, New York City Health and Hospital Corporation

Panelists will share perspectives on health care reform strategies and challenges for meeting the needs of vulnerable populations with an emphasis on funding mechanisms, the role of the medical home, and where medical-legal partnership fits in the new rubric of health care in the U.S.

Patients to Policy: What Does it Take to Change Policies That Impact Vulnerable Communities?
Thursday, March 25th
1:15pm – 2:30pm

• Moderator: David Shipler, Author and Journalist
• Tom Koutsoumpas, Senior Vice-President of ML Strategies/U.S., Mintz Levin LLP
• Lauren Smith, MD, MPH, Medical Director, Massachusetts Department of Public Health
• Marc Wetherhorn, MBA, National Advocacy Director, National Association of Community Health Centers

Join policy experts in law and medicine for a discussion of how policy decisions are made at the institutional, state and federal level. Using case examples, panelists will examine the role of grass roots movements in public policy and how they gain traction back to the state legislature and Washington DC.

Revolutions and Reforms in the Legal Community
Friday, March 26th
9:00am – 10:15am

• Moderator: Hannah Lieberman, JD, Principal, Hannah Lieberman Consulting, LLC
• Victor Fortuno, JD, President, Legal Services Corporation
• Robert Grey JD, Partner, Hunton & Williams, Legal Services Corporation Board
• Alan Houseman, JD, Executive Director, Center for Law and Social Policy
• Gerry Singsen, JD, Principal, Singsen/Terrell Associates

Panelists will offer insights on the role of legal aid and pro bono service in the U.S., from the civil rights era through the reauthorization of LSC. The session will examine innovations, opportunities and leadership in the broad legal community, and the connection between access to justice and access to health.

The Medical-Legal Partnership Network: A Strategic Roadmap for the Future
Friday, March 26th
12:45pm – 2:00pm

• Abby Fung, MBA, Consultant, Root Cause
• Ellen Lawton, JD, Executive Director, National Center for MLP
• Megan Sandel, MD, MPH, Medical Director, National Center for MLP
• Everett Shorey, MBA, Senior Consultant, Root Cause

Over the past year, the National Center for Medical-Legal Partnership partnered with Root Cause to develop business plan strategies for MLP. Consultants from Root Cause and National Center staff will share preliminary conclusions.

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Break-out Sessions

Thursday, March 25th
11am - 12:20pm

Medical-Legal Partnership 101

• LeeAnna Botkin, MD
• Kathleen Conroy, MD
• Ellen Lawton, JD
• Kate Marple
• Maureen Van Stone, JD

Are you thinking about starting a medical-legal partnership or are you in the early stages of development? Staff from the National Center and MLP Network will walk through start-up basics – from building relationships with partner institutions, referral procedures and feedback loops, training basics, strategies for service delivery and more!

Resolving the Social Security Enigma: How Healthcare Providers and Legal Advocates Can Collaborate on Disability Applications and Appeals

• Kevin Kenneally, JD
• Ed Paul, MD
• Anne Ryan, JD

Two thirds of disability applications are initially denied by the Social Security Administration and over 90% of these remain denied at the first level of appeal. Appropriate actions by healthcare providers are critical to increase benefit approval rates for disabled patients. Panelists will describe successful Social Security disability programs in place at two medical-legal partnerships, the Tucson Family Advocacy Program and LegalHealth, a Division of the New York Legal Assistance Group. Learn who may be eligible for Social Security disability benefits; how disability is defined and evaluated for Social Security purposes; and effective steps you can take to help your disabled patients.

MLP Ethics and Confidentiality: At the Cutting Edge

• Steve Blatt, MD
• Samantha Morton, JD
• Chad Priest, RN, MSN, JD
• Jerry Tichner, JD

Your site has grappled with the fundamentals of MLP ethics and confidentiality principles, having crafted appropriate release forms with the blessing of General Counsel, and so forth. Now you want to know what lies ahead in the world of clinician-lawyer-patient communications in this cross-disciplinary model. Panelists will share their adventures in (1) designing an MLP electronic database for use by both medical and legal partners; (2) revisiting the attorney-client privilege in the MLP context; (3) clarifying the role of medical residents when they shadow MLP legal intake interviews; and (4) much, much more!

Quality Care and Improvement and MLP

• Karen Goldstein, MD, MPH
• Rob Kahn, MD, MPH
• Amy Zimmerman, JD

Quality care and improvement is a dominant theme in health care today.  Medical settings that service vulnerable populations, including FQHCs, often have access to a range of legal, social and support services, but may lack effective means of coordinating, collaborating and monitoring referrals.  This session will provide an overview of QI, and spotlight initiatives in an urban children's hospital and an urban FQHC that address screening, referral and barriers to service provision.

I-HHELPED: Training Healthcare Providers to Recognize Legal Needs Across the Lifespan

• Stewart Fleishman, MD
• Eric Hardt, MD
• Kerry Rodabaugh, MD
• Megan Sandel, MD, MPH
• Valerie Zolezzi-Wyndham, JD

The I-HHELP mnemonic describes the legal issue areas that medical-legal partnerships address on behalf of patients – Income supports, Housing and utilities, Health insurance, Education, Legal status and Personal and family stability. Developed to train doctors to take a new kind of social history and make appropriate referrals to medical-legal partnerships, this session will explore how to train healthcare providers to recognize legal needs – in pediatrics, geriatrics, oncology and more.

Meeting Them Where They Are:  Incorporating the Medical Voice for Systemic Change at the Local Level

• Marie Clark, MD
• Carolyn Pointer, JD
• Diane Pappas, MD, JD
• Shale Wong, MD, MSPH

Medical-legal partnerships sit at the intersection of patient care and public policy and are well situated to elevate the experienced medical voice for systemic reforms on behalf of vulnerable populations. This session will explore strategies for incorporating doctors, residents, nurses and social workers in systemic initiatives aimed at changing institutional, regulatory and legislative policy.

Thursday, March 25th
2:30pm - 3:50pm

A Case Study in MLP Systemic Advocacy: Utility Shut-off Protection

• JoHanna Flacks, JD
• John Hardiman, NP
• Megan Sandel, MD, MPH

Join MLP | Boston for a chronicle of the site’s most sweeping systemic advocacy campaign to date -- utility shutoff protection – which in late 2008 resulted in progressive regulatory changes by the MA Department of Public Utilities. Panelists will share the genesis of the project, its early focus on training health care providers on the health impacts of fuel insecurity, the eventual creation of a designated legal clinic, major behavior changes among health care providers, and ultimately, successful regulatory advocacy that both expanded protections for low-income utility consumers and acknowledged the operational constraints under which health care institutions currently labor.

Obtaining the Patient-Client History: How Doctors and Lawyers Can Learn Interviewing Skills From Each Other

• Steve Blatt, MD
• Kelly Gonzalez, JD
• Suzette Melendez, JD

Of the many hurdles facing a medical-legal partnership, none is more important or at times more difficult to overcome, as cultural differences between the legal and medical professions. This is no more evident than the interviewing techniques employed by the two disciplines. Additionally, the different focus of each profession leads each interviewer to pursue significantly different avenues of questioning. This interactive workshop will explore commonalities and differences in interviewing approaches used by both professions and techniques to teach them to trainees and practicing professionals.

Connecting the Dots: Stress, Health Disparities and Legal Intervention

• Ann Ryan, JD
• Lauren Smith, MD, MPH
• Kerry Rodabuagh, MD

This session will briefly present relevant evidence on stress, toxic stress, and their connection to health and health disparities. Panelists will examine what MLP can do to interrupt stress and reduce disparities.

Rural or Urban: How to Make Pro Bono Work at Your Medical-Legal Partnership

• Melissa Nott Davis, JD
• Diane Goffinet, JD
• Chad Priest, RN, MSN, JD
• Bonnie Roswig, JD
• Kelly Scott-Flood, JD, LLM

Medical-Legal Partnerships provide unique experiences for pro bono attorneys. This session will discuss how medical-legal partnerships have transformed pro bono. Lawyers from both urban and rural setting will discuss how different pro bono models have been implemented at their medical-legal partnerships. The session will also included descriptions of pro bono models created recently as well as how to revamp traditional referral methods.

Medical Championing Forum

• Ellen Cohen, MD
• Bob Pettignano, MD
• Greg Nelsen, MSSW
• Dana Weintraub, MD
• Clare Wohlgemuth, RN, GCNS

The success and sustainability of a medical-legal partnership is directly tied to the strength of its medical champions. The most successful MLPs have engaged medical champions both on the front-line and in the administration. This session is designed as an open-forum with experienced medical champions to answer your questions. It’s great for new medical champions looking to define their role in MLP and attorneys looking for help strengthening the medical component of their partnership.

Community Health Centers and MLP: A Match Made in Heaven

• Bery Engebretsen, MD
• Kaitlin McColgan
• Michelle Swanstrom, JD

What is an FQHC? How does it operate? What is their core mission? How do their priorities align with medical-legal partnership? Get answers to these questions and more as representatives from the National Association of Community Health Centers and members of the MLP Network discuss the varying types of community health centers, how they operate and how medical-legal partnerships integrate into the work they are doing.

Thursday, March 25th
4:10pm - 5:30pm

Legal Services Corporation in 2010: New Vision, New Opportunities

• Mallory Curran, JD
• Alex Gulotta, JD
• Alan Houseman, JD

The Legal Services Corporation oversees federal funding for civil legal aid in the United States, and forty LSC-funded legal aid agencies have developed medical-legal partnerships. With the change in administration, the framework of legal aid service delivery is changing as well. This session will combine a briefing on the LSC reauthorization together with analysis on how LSC tracks its impact and how it relates to MLP.

Medical-Legal Partnerships and Core Competencies in Medicine

• Ellen Cohen, MD
• Kathleen Conroy, MD
• Ed Paul, MD
• Pamela Tames, JD
• Valerie Zolezzi-Wyndham, JD

The Accreditation Council for Graduate Medical Education (ACGME) outlines six core areas that residents must demonstrate competency in. Incorporating MLP into a residency training program can meet some of these components. The benefit is two-fold – training new doctors to screen for legal needs while simultaneously meeting the hospital’s need to fill these core requirements. This workshop will provide an overview of models and curricula that MLPs have developed to teach residents about social determinants of health, relate the curricula to the ACGME requirements, and help participants develop new educational interventions or use in their own residency program.

How Do We Take Care of Our self? MLPs and Vicarious Trauma

• Julie Branfield, JD
• Sylvia Caley, JD, MBA, RN
• Susan Cohen, MD
• Maile O'Hara, PhD
• Bob Pettignano, MD
• Johnnathan Ward, M. Div

This interactive panel will discuss stress and vicarious trauma within the MLP and provide tips for their effective management. Client needs and their situations, the reality of death and dying issues within the MLP, the increasing demand for legal services combine to create continual stress and possible vicarious trauma. Panelists including lawyers, a psychologist, a palliative care doctor, an intensivist, and a chaplain will discuss how stress and vicarious trauma manifest and approaches for relieving and managing their side effects. Speakers will use a case example and discuss tools and safeguards that can be utilized to help staff cope.

Too Many Cooks Make a Great Broth

• Greg Nelsen, MSSW
• Diane Pappas, MD, JD
• Carolyn Pointer, JD

When starting a MLP, people ask if this will replace the work of social workers or nurses. Learn how doctors, lawyers, nurses and social workers see their role in creating good patient outcomes, and how we all work together without getting in each other’s way.

Public Hospitals and MLPs: Why We Are Natural Allies in Serving the Neediest Populations

• Lee Anna Botkin, MD
• Randye Retkin, JD
• Salvatore Russo, JD
• Amy Whittle, MD

A panel of doctors and lawyers from MLPs within public hospitals and health centers will share their experiences about establishing and operating a program within a public health system. The panel will cover how these partnerships differ from partnerships with private hospitals and what is needed to establish a MLP (for example how to deal with the extra layers of administration and government approval involved). Partnerships in public health care settings offer unique challenges and opportunities. This session will hopefully be an inaugural event to build relationships and a network among MLPs that include local government as a third partner.

Collaborative Strategies for Improving the Educational and Health Outcomes of Children with Mental Health and Behavioral Disorders

• Aaron Cromly
• Joan Griffith, MD, MHA, MPH
• Kate Mitchell, JD

This session will include a facilitated discussion between medical providers, mental health providers, and attorneys regarding strategies to improve educational and health outcomes for children with mental health and behavioral health issues. The session will begin with a brief overview of legal standards, mental health factors, and pediatric perspectives. The session will then include a discussion of one case study with contributions of successful strategies utilized by participants. Finally, the session will address methods of individual advocacy, litigation strategies, and policy advocacy strategies and will consider the role of the lawyer, the mental health provider and the pediatrician for each.

Friday, March 26th
10:15am - 11:45am

The Next Generation:  How Leadership in Academic and Professional Settings Changes Systems

• David Keller, MD, MPH
• Megan Sandel, MD, MPH
• Liz Tobin Tyler, JD
• Imoni Washington, JD

Join panelists from national medical and legal organizations that support fellowships, together with MLP members, for a lively session on what it takes to be a leader in your profession, and what kinds of strategies will get you the results you want in your profession, your institution and your community.

Strategies for Interdisciplinary Training

• Lisa Bliss, JD
• Suzette Melendez, JD
• Diane Pappas, MD, JD
• Pamela Tames, JD

This workshop will explore best practices for training healthcare and legal professionals to recognize the connection between unmet legal needs and health, and to work effectively with other professional disciplines and with patients-clients.  Participants will watch and discuss role plays that raise important aspects of effective training.  Presenters will provide concrete suggestions for both formal and informal training.

Effective Data Management for Your MLP

• Steve Blatt, MD
• Kelly Gonzalez, JD
• Joe Keogh, MD, JD

Medical-legal partnerships, whether established or just starting, face numerous challenges including the diverse cultures between the medical and legal partners, funders who want data and statistics that are difficult to obtain, confidentiality issues that make sharing data between the medical and legal partners cumbersome, and lack of access to professionals in data management. This interactive workshop is designed for all participants in a MLP, regardless of computer skills or expertise in data management and statistics. Workshop participants will learn how to approach their own data management and reporting needs and how these functions can be facilitated by computer-based systems. This session will present one such system, Advosyst™, designed for the particular needs of the advocacy services of a Medical –Legal Partnership. Please note, this session will not address issues of MLP case counting in the LSC context.

Demystifying the Medical Record

• Sylvia Caley, JD, MBA, RN
• Bob Pettignano, MD
• Edith Robertson, RN, CPN

Navigating the medical record and understanding its contents can be a daunting task even for the most seasoned individual. Legal and other non-medical providers will participate in a three-part journey via role play and case presentation that will (1) dissect the medical record to understand its general structure and (2) assist in identifying areas of importance to find information. Finally, a medical interpreter will translate “med speak” incorporated throughout the record and identify the relevance and meaning of specific data related to medical problems in adult and pediatric diseases.

No Silver Bullet: Basic Fundraising for MLP

• Meredith Benedict, JD, MPH
• Ellen Lawton, JD

Securing start-up and sustained funding for your MLP requires a commitment from both partners. The vast majority of partnerships derive funding from a blend of local health and community foundations, bar foundations, legal aid offices and healthcare institutions. This session will cover the basics of funding streams and key strategies for collaborative fundraising between healthcare and legal development offices and sustaining your MLP.

Preventive Law Priority Setting in Action: Immigration and Education

• Cristina Dacchille, JD
• Kate Lufkin, LICSW
• Jim Manzi, JD
• Samuel Senft, JD

Following up on last year’s Summit plenary on MLP preventive law priority-setting, MLP | Boston staff attorney, pro bono, and social work stakeholders will share their successes in “bending the priorities” in the practice areas of immigration law and education advocacy. Panelists will share unique advocacy curricula/tools for health care professionals and pro bono volunteers regarding Special Education, Naturalization, and HIV Waivers, and also share tips on how pro bono colleagues can make preventive law a reality at your MLP.

Friday, March 26th
2pm - 3:30pm

Adopting a Health Clinic 2.0

• Michelle Garvin, PhD, JD
• John Hardiman, NP
• Samantha Morton, JD

The MLP “adopt-a-health-clinic” model has been thriving since early 2006 and is now at a turning point. Law firms and health clinics are now taking their MLP collaborations to the next level, exploring community service contributions, best practice dissemination, community-specific policy advocacy, law firm engagement with MLP outreach/training activity, and more. This “next generation” model is exemplified by the MLP | Boston / Ropes & Gray / Dorchester House Multi-Service Center partnership serving low-income patients at a health center in Dorchester, MA. Representatives of each organization will share breakthroughs and lessons learned.

Clinical Training Priorities: End of Life and Advanced Care Planning

• Eric Hardt, MD
• Pamela Tames, JD

Geriatricians and internists cite patient decisional capacity and safe housing as priorities for stabilizing seniors, yet health care teams struggle to identify, triage and address these needs in low-income populations. Increasingly MLPs are seen as having the tools and strategies to train health care staff and provide the relevant intervention to ensure that health care staff can support seniors to promote stability and longevity. This session will lay out training and service priorities for the geriatric MLP.

Lessons Learned in MLP Evaluation: IRB, Recruitment and Measuring Outcomes

• Edward De Vos, EdD
• Mark Hansen, MPH

Medical-legal partnerships across the U.S. have conducted multiple small scale quantitative and qualitative evaluations examining the impact of MLP on provider knowledge, attitude and behavior; stress; and patient self-advocacy. MLPs have also measured the outcomes of legal interventions and the money recovered for healthcare institutions. This session will cover lessons learned from some of these studies, including working with academic institutions’ Internal Review Boards, patient-client recruitment and best practices in constructing studies to measure outcomes.

Understanding Ethical Issues from the Medical, Bioethical and Legal Perspectives Deepen Collaboration in MLPs

• Amy Campbell, JD, MBE
• Paula Galowitz, JD, MSW
• Randye Retkin, JD
• Jay Sicklick, JD

In this multidisciplinary session, the principle tenets of medical/bioethical and legal ethics are examined and the ethical nature of the key domains of medical-legal partnerships are compared. The theories are grounded in case examples, wherein ethical strictures and guidance are applied to actual MLP experiences to illuminate opportunities for deepened collaboration. The role of ethics committees and its relationship to the partnerships will be discussed. In-depth guidance will be provided to help navigate the rich ethical opportunities that are presented to medical-legal partnerships.

Legal Systems 101 for the Healthcare Provider

• Katie Lamb, JD
• Donita Parrish, JD

Essential information for any medical partner, this session will examine the dynamics and infrastructure of the local, regional and national legal community with a focus on agencies and lawyers who serve vulnerable populations. Participants will learn (1) the roots of legal aid, (2) the role of pro bono service and law schools, and (3) the landscape of legal aid activities, funding and restrictions.

The Role of Students in MLPs: More Than Just Free Labor

• Margaret Bacigal, JD
• Siddhartha Dante
• Sean McKenna, MD
• Liz Stokes, RN
• Kate Zedler

This panel discussion will explore the role students play in the Richmond CHAP MLP. Presenters will discuss the educational objectives for a student chapter including designing elective coursework, service based initiatives, expanding the students role in the community, recruitment and challenges encountered toward making an impact in the Richmond community. Students and educators will be engaged to participate in describing best practices, brainstorming new ideas and providing feedback on how to develop a robust student chapter.

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Affinity Groups

Going Global

• Open Society Institute

This session will focus on practical models from around the world that integrate legal services into palliative care, harm reduction, and HIV/AIDS clinical programs. Integrating legal services into these programs enables comprehensive care and increases access to justice to underserved and marginalized communities, thereby also improving their health. Palliative care patients face complicated legal questions related to the disposition of property, accessing social benefits, and combating discrimination. No matter how good a harm reduction program, it cannot be effective if police harassment prevents people who inject drugs from using services. Discrimination, child marriage, sexual and domestic violence, disinheritance, and economic disempowerment are all drivers of HIV vulnerability.
 
Come meet the experts involved in these cutting edge programs in Kenya, South Africa, Georgia, and Ukraine and bring your questions. During our affinity group lunch, you can find out how these programs are set up, what legal issues they encounter, what their most effective practices are, and how they provide legal support when trained lawyers are in short supply.

Interdisciplinary Education

• Sylvia Caley, JD
• Patricia Flanagan, MD

Medical-legal partnership is increasingly becoming a part of medical and law school curricula and medical residency programs. Educational offerings include electives, rotations, clinics, and courses dedicated to MLP. Integrated, interdisciplinary education is a crucial component of training the next generation of lawyers and health care professionals about MLP. Join faculty from law and medical schools and residency programs for a discussion of interdisciplinary education successes and strategies.

MLP Evaluation Working Group

• MLP Evaluation Working Group

For the last three years, the MLP Evaluation Working Group has met on monthly conference calls to share MLP research and evaluation strategies and best practices. In 2009, the Working Group developed a pilot questionnaire in an effort to describe the collective efforts of MLP sites and the patient population being served by MLPs. This questionnaire was piloted as part of the 2010 MLP Network Site Survey. During lunch, the Working Group will review the results of the pilot data.

MLP Legal Fellows

• Trinia Arellano, JD, BSN
• Jessa Barnard, JD
• Shana Platz, JD

The Medical-Legal Partnership (MLP) Legal Fellows Affinity Group lunch will feature a panel of three current MLP fellows who will discuss their educational and career backgrounds, the specifics of their MLP sites, and their journey to become MLP fellows.  The panelists will also discuss tips for the application process, what a typical day in the life of an MLP fellow is like, funding sources, and the value that a postgraduate MLP fellow can bring to medical and legal organizations.

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