Legal Services of North Dakota
Report date
October 2018
What has been most instrumental to your progress?
Access to the MLP attorney in trusted spaces was instrumental to the success of Legal Advocates for Health Medical Legal Partnership (MLP).
The MLP attorney is on site at Family HealthCare on Tuesdays and Thursdays. At the start of the project she was also onsite at New American Consortium for Wellness and Empowerment on Wednesdays and one weekend per month. Due to the early success of the project, she now supports the New American Consortium by appointment or meets with the potential clients at Family HealthCare. The MLP attorney also does home visits as needed.
By having trusted spaces in the Fargo-Moorhead community, individuals are more likely to seek out legal civil services and see their case through to completion. Individuals are able to schedule their appointment with the attorney around the time of their medical appointments, making the service more accessible. Individuals may also drop-in to check in on the status of their case during office hours. Many clients have stopped by to check in while picking up their prescription or attending an appointment at Family HealthCare.
The MLP attorney is on site at Family HealthCare on Tuesdays and Thursdays. At the start of the project she was also onsite at New American Consortium for Wellness and Empowerment on Wednesdays and one weekend per month. Due to the early success of the project, she now supports the New American Consortium by appointment or meets with the potential clients at Family HealthCare. The MLP attorney also does home visits as needed.
By having trusted spaces in the Fargo-Moorhead community, individuals are more likely to seek out legal civil services and see their case through to completion. Individuals are able to schedule their appointment with the attorney around the time of their medical appointments, making the service more accessible. Individuals may also drop-in to check in on the status of their case during office hours. Many clients have stopped by to check in while picking up their prescription or attending an appointment at Family HealthCare.
Family HealthCare staff has been trained through a variety of methods, which has contributed to the MLP’s success. Providers and nurses were trained on the MLP referral process and how to identify health-harming legal needs at the beginning of the project. A follow-up training for providers has occurred and one for nurses is to occur in early November. The MLP attorney has had meetings with Refugee Health, Homeless Health, and the Director of Clinical Services at Family HealthCare to learn about unique patient needs and to provide education. On Valentine’s Day, the MLP attorney introduced herself to staff while distributing packages with candy and contact information. The MLP also had brown bag sessions on elder law, housing, and social security to assist staff in identifying health-harming legal needs that may be referred.
Engaging with Family HealthCare staff through a variety of methods has the ultimate effect of being more inclusive by offering more than one way to engage with the MLP attorney. Some were more comfortable asking questions one on one while distributing candy, while others enjoyed a discussion among the group during training sessions.
Engaging with Family HealthCare staff through a variety of methods has the ultimate effect of being more inclusive by offering more than one way to engage with the MLP attorney. Some were more comfortable asking questions one on one while distributing candy, while others enjoyed a discussion among the group during training sessions.
Meeting with community stakeholders and educating them about the MLP has been critical to the success of the MLP and the ability of stakeholders to identify a health-harming legal need that warrants a referral to the MLP. Following each training, there is an increase in the number of referrals coming from the trained stakeholder. The MLP has provided training to New American Consortium for Wellness and Empowerment, Job Services of North Dakota, Lutheran Social Services, and Fargo Moorhead Rape and Abuse Crisis Center to name a few.
Stakeholders have MLP post cards to provide their clients when a health-harming legal need is identified and also to have generally available to the public for self-screening. These materials are critical to ensuring individuals in the community have knowledge of and access to the MLP attorney by a simple and efficient means through a direct number and e-mail.
Stakeholders have MLP post cards to provide their clients when a health-harming legal need is identified and also to have generally available to the public for self-screening. These materials are critical to ensuring individuals in the community have knowledge of and access to the MLP attorney by a simple and efficient means through a direct number and e-mail.
Key lessons learned
The National MLP Center highlights the importance of screening patients for health-harming legal needs. Screening by providing patients a screening tool to complete and return to Family HealthCare staff during each visit was proposed. However, considering Family HealthCare has over 60,000 patient visits annually that method was deemed impractical. Further investigation and discussion with local Minnesota medical/healthcare legal partnerships caused the MLP to learn that many MLPs use an informal screening method by training staff on how to identify health-harming legal needs and ask the right questions as part of delivering care and also by incorporating stakeholders such as social workers to refer patients to the MLP. A more formalized screening tool may be developed in the future such as through electronic records. For now, educating Family HealthCare staff and employing an informal screening tool has been a successful method of screening patients. Additionally, MLP posters in provider rooms help patients identify if they have a have a health-harming legal need. The key lesson learned is that flexibility is critical and any goal may be accomplished through a number of ways.
A referral process was initially proposed that could be characterized as formal and informal. This combination has been used in other larger and more established medical legal partnerships. FHC staff was welcome to refer patients by a warm hand-off following the patient’s visit (informal) or to complete a form that would be provided to the MLP attorney for follow-up (formal). As part of the formal process there were multiple steps from when the provider or FHC staff identified a health-harming legal need to delivery of the form to the MLP attorney for patient follow-up. Only a few referral forms were received by the MLP attorney. Family HealthCare staff in working with referring patients preferred to use an informal process such as providing a patient with a rack card containing the MLP attorney’s contact information to follow-up and request an appointment by e-mail or telephone or by directing the patient to the MLP’s office during office hours.
The key lesson learned is that flexibility is critical to the success of the MLP and the easier and simpler the referral process for Family HealthCare providers and staff the more likely it is that the referral will be made.
The key lesson learned is that flexibility is critical to the success of the MLP and the easier and simpler the referral process for Family HealthCare providers and staff the more likely it is that the referral will be made.
Reflections on inclusive, collaborative or resourceful problem-solving
LAH is collaborative. In addition to the 3 main partners, LAH also partners with local organizations such as New American Consortium for Wellness and Empowerment (NAC), Rape and Abuse Crisis Center of Fargo Moorhead, and Lutheran Social Services of North Dakota. LAH leadership meets quarterly to brainstorm new ideas and troubleshoot issues that arise. To effectively deliver civil legal services to FHC patients, it has been critical to work with FHC leadership to understand and determine how best to incorporate the legal organizations into the fabric of the federally qualified health center. For example, leadership has discussed the referral and screening process for patients and has ultimately determined that a more informal approach is the best fit at this time. Stakeholders have been critical in identifying health-harming legal needs among their clients. For example, NAC has worked with LAH in referring individuals for legal services. Not only that, the NAC partners with LAH in providing a trusted space to meet with the client as well as transportation assistance, which has been critical to building trust with vulnerable populations.
Other key elements of Community Innovation
Working with stakeholders to be included in their existing frameworks and tapping into community resources have been key elements in our community process. LAH has been incorporated into existing frameworks, which has had the result of being less time-demanding upon stakeholders and created greater access and efficiency in delivering services to those in need. LAH has been providing education to stakeholders during standing staff meetings. LAH has used the same approach for community education. For example, Job Services of North Dakota has rotating educational seminars for job-seekers. LAH will be one of the standing presenters in the rotation. LAH has also tapped into community resources to deliver legal services in guardianship cases. LAH has sought out and teamed up local attorneys and social workers to provide their expert opinions in those matters. The willingness of these community professionals to volunteer in these cases is critical to the success and ability of LAH to provide this legal service.
Understanding the problem
In our grant application, we indicated that 1 in 6 people need legal care to be healthy according to the National Center for Medical-Legal Partnership. The work and outcomes data has clarified that patients need a wide variety of legal services, particularly in family law, housing, and income supports. Understanding the needs in housing, family law, and income supports LAH will focus community outreach efforts on those topics. LAH will also ensure that FHC staff and stakeholders will receive additional training on how to identify health-harming legal needs in the areas of education and employment and legal status to increase referrals. While it is possible that there is less of a need in these areas, it is also possible that the lower numbers are a result of FHC staff and stakeholders not having the training to identify health harming legal needs in those areas.
If you could do it all over again...
It would have been beneficial to provide additional training for stakeholders to inform them of the resource limits of the legal aid organizations in delivering civil legal services and to set collaborative boundaries. We have a mutual goal of delivering services to those in need. Legal service providers have ethical obligations to their client and develop legal strategies based upon the law. Our stakeholders do not have the same training and approach. A legal service provider is working on behalf of one client with the expected outcome of benefiting the client and most often the client’s family. Stakeholders are often family-focused, which has led to some confusion or difference in opinion regarding legal strategy. As these challenges have arisen, they have been addressed through open and direct communication and establishing boundaries. Had these limits and boundaries been established at the outset perhaps the time spent discussing them could have been allocated towards improving the delivery of our services to those in need.