For Tim Flack, senior attorney of Memphis Children’s Health Law Directive (Memphis CHiLD), joining Le Bonheur Children’s Hospital’s medical-legal partnership felt like coming back home. His oldest daughter, Madeline, had been a patient at Le Bonheur since she was 10 months old when she was diagnosed with four congenital heart defects.
The Flack family had also served as volunteers on the hospital’s Family Partners Council. “Working at Memphis CHiLD allows me to really do patient and family-centered care more directly than I ever have and use what I was professionally trained to do,” says Flack. “The collaboration we have with community partners allows me to address the legal barriers to health care for the children in our community.”
Flack is part of a team that forms Memphis CHiLD, which consists of individuals from Le Bonheur Children’s Hospital, the University of Memphis Cecil C. Humphreys School of Law, Memphis Area Legal Services (MALS) and the University of Tennessee Health Science Center (UTHSC).
A creative legal partnership
Memphis CHiLD was different from other partnerships at its inception. Four organizations came together before the program launched, all sharing the same goal. Each wanted to partner and collaborate for the well-being of children. Formal talks began, and Memphis CHiLD launched in 2015.
Located inside Le Bonheur Children’s Hospital, the Memphis CHiLD attorneys are dedicated to the program, including Flack—who is one of only two attorneys in the country directly employed by a hospital for a medical-legal partnership.
The team accepts a variety of cases from patients and families, unusual among medical-legal partnerships, which usually focus on cases for specific issues such as disability, housing or special education needs.
“Originally, we focused on cases coming through our community asthma program,” says Flack. “But it soon became obvious that kids and families needed us to widen our net. While most medical-legal partnerships focus on one or two case types, we will take almost any civil legal matter that is presented to us.”
Each organization within the group plays a role to provide comprehensive legal care. In addition to four attorneys, the program includes a social worker and social work intern from the hospital, law students and professors, a physician champion and medical students and residents. “Partnership with all of these organizations is crucial in the effort to address social determinants of health and overcoming the legal obstacles to child health and healing,” Flack says.
Most of the funding for Memphis CHiLD comes from grants and donors, including Memphis’ Urban Child Institute. The partnership of multiple groups to form one organization drew funders to support the program and keep it sustainable.
The referral process
Collaboration on a case begins as soon as a patient or family is referred. Any Le Bonheur employee, physician, nurse, social worker or others can refer a family with a legal issue to Memphis CHiLD. The team determines if the family fits within the requirements, and they almost always do.
The team meets weekly to review cases. Reviewing referrals, they determine what each patient needs and who in the partnership can handle it best. Assistance runs the gamut from simple legal advice to a case that goes to trial. MALS, the primary provider of civil legal representation to low-income families in Tennessee, dedicates an attorney who works full time on cases from Memphis CHiLD.
“We ask ourselves, ‘How can we stabilize the lives of a family as much as possible?’” says Cindy Ettingoff, CEO of MALS. “Working in collaboration is the key for us to obtain all of the underlying information to truly help. Medical professionals can’t really obtain everything needed for a child from a legal perspective, and we certainly can’t provide medical care.”
Le Bonheur employs Flack as senior attorney as well as Lydia Walker, LMSW, social worker for Memphis CHiLD. Walker works in conjunction with the attorneys handling the legal aspects of the case. “Our case review process is all about how we can maximize our efforts and collaboratively get the best outcomes for the family,” Walker says.
An important aspect of the legal process is connecting with the child’s physician and care team. Participating families give lawyers permission to discuss health conditions with their child’s physicians.
Medical issues are interpreted by Le Bonheur Hospitalist and UTHSC Assistant Professor Emilee Dobish, M.D., lead for the UTHSC's part in the Memphis CHiLD collaboration. She serves as medical champion, promoting the program with Le Bonheur’s medical staff and serving as a resource for cases to interpret medical data.
“It’s important for us to have a conversation about how the diagnosis affects the child,” Dobish says. “Engagement from all medical disciplines is vital to break down legal barriers for families. Prior to this medical-legal partnership, the legal issues would never have been on a physician’s radar.”
Armed with the appropriate medical information, lawyers are better able to represent patients to get the legal help they need. Patients and families receive legal advice and discuss their case at a Medical-Legal Partnership Clinic.
Law students, taking an interdisciplinary course through the University of Memphis Cecil C. Humphreys School of Law, staff the clinic, which is led by Katy Ramsey Mason, assistant professor of law and director of the Medical-Legal Partnership Clinic. Students simultaneously provide free legal services while receiving an education on the intersection of law and health.
And for families whose needs extend beyond legal matters to social issues, social workers can step in to find housing and employment, work on individualized education plans or refer to other agencies that meet their needs.
Moving beyond legal issues
Memphis CHiLD’s role in helping families doesn’t stop with solving a single legal issue. Ultimately, the team works to address the social determinants of health that affect the patient and family. The team at Memphis CHiLD handles a variety of issues, but almost all of them are affected by social determinants of health in some way.
According to Walker, housing is a major issue in the Memphis area where the housing stock is outdated, and families struggle to pay utility bills. Walker and her social work interns from local universities work with families on the practical aspects of their situation, including finding housing, securing funds and avoiding eviction. Lawyers and social workers intervene to get improvements to housing conditions or find new housing for families.
Legal intervention and social services have a direct connection to child health. For example, finding stable housing for a child can reduce hospitalizations by reducing asthma triggers, mental stress and anxiety and minimize stress levels. “Stable housing is like preventive medicine,” Walker says. “Hearing families breathe a sigh of relief because they no longer have to worry about this issue makes it all worth it.”
A large portion of the program’s legal cases also center around supplemental security income (SSI) for children, particularly those who have been denied previously. Memphis
CHiLD’s experts know how to build the best case and present the right information to get approval for the child. Beyond these issues, the team helps patients obtain special education plans, conservatorships and Medicaid coverage.
“Families come in with one issue but have underlying barriers that prevent us from addressing that main issue,” Walker says. “There is always a social determinant of health involved, and a social service need that can affect it.”
As a social worker, Walker is on the frontlines of addressing these needs—her goal is to get families to a place of stability. But not all medical-legal partnerships have social workers attached to their programs.
“Being a social worker in this program involves being a case manager, liaison, advocate and broker all at the same time,” she says. “The diversity in our role shows just how effective a social work component of a medical-legal partnership can be.”
And while Walker focuses on individual families, the team realizes it is vital to influence children’s health on a larger scale. “For a long-term impact, we must have community change, not just individual family success,” Flack says. “Using the knowledge we’ve gained about the barriers from social determinants of health that affect children’s health, we can translate this legal intervention to larger scale community change.”
To accomplish this at a large scale, the partners at Memphis CHiLD focus on child health advocacy in the community in several ways. Through thought leadership, the partners work to inform the community and shape thinking around the intersection of policy and children’s health.
The power of patient success stories is one way the team leverages advocacy and donor engagement. The team hopes these tactics will affect policy change to break down barriers for families.
The future of Memphis CHiLD
As Memphis CHiLD has grown, goals for the future have as well. Plans are underway to formalize advocacy on behalf of children and families by collaborating with hospital and university leadership. An objective of Memphis CHiLD is continuing to educate physicians about the function of the program so they can better assist with its vital role.
UTHSC educates the next generation of physicians with an elective for residents taught by Dobish, covering the intricacies of the intersection of health and law. Training will continue for physicians on working to prevent special education-related issues from escalating to a legal matter.
Plans are in place to add new social workers, one for individualized education programs and one for housing, to intervene for families and avoid going to court.
The stories of collaboration and success of families are the best witnesses to how legal intervention can affect children’s health and the stability of a family.
“How do you quantify getting a landlord to clean up mold or establishing an individualized education program for a child?” says Flack. “Child advocacy among the partners of Memphis CHiLD is key to future sustainability of the program and the greater impact on the community we serve.”