The Camden Coalition’s Medical-Legal Partnership (MLP), launched with Rutgers Law School in 2017, aims to address legal issues that are barriers to wellness among participants in our complex care management programs. In 2022, our MLP entered a partnership with Cooper University Health Care’s Cooper Center for Healing, an addiction medicine clinic located in the same building as the Camden Coalition’s offices.

This partnership is notable both because MLPs embedded in addiction medicine programs are rare, and also because our MLP is now one of the few medical-legal partnerships in the country that provides support and representation for criminal matters as well as civil ones.

In March, we and our partners at Cooper Center for Healing published an analysis of early findings from the first year of this program in the Journal for Law, Medicine, and Ethics’ issue on medical-legal partnerships.

We sat down with Jeremy Spiegel, the Supervising Attorney who leads our MLP program, to learn more about why this work has been such a success and what comes next.

 

Interview has been edited for length and clarity.

 

How did the partnership with Cooper Center for Healing come about?

Through the course of our Medical Legal Partnership program, we had worked with a lot of Center for Healing patients through our care management programs.

So we had that relationship, and there was a recognition on both sides that addiction medicine is a place where a medical-legal partnership can be very, very effective. It just took time because it’s an unusual arrangement, in terms of both the scope of what we’re willing to do and also to target this patient population. There are not a ton of MLPs that are specifically targeting addiction medicine programs.

 

Why is having legal services in addiction medicine so important?

Our philosophy is that integrating legal services into a complex care environment is really beneficial writ large. I think that is especially the case in an addiction medicine care setting.

A lot of folks that are coming into Center for Healing are making great progress coming out of periods of active addiction. But during those difficult times, a lot of folks have had engagement with the legal system, or have legal issues that haven’t been resolved and stand out as barriers to their recovery. This is the same thing we see with other complex care patients, but with addiction medicine patients you see more of it, and it’s more acute and more of a barrier.

There is a huge variety of areas where legal assistance can be beneficial and can help patients move forward with their treatment, with their care, with their recovery. I think this partnership is a great match between the services that we provide and a population that really benefits from it.

 

Were there any unforeseen challenges as you started this new partnership?

One challenge has been just the enormous volume of need for legal services. When we started, we knew that there would be a need, but we weren’t sure what it would look like. Initially we thought there would be a backlog of people who need legal services that we would have to tackle. But it has not slowed one bit. Actually, it’s increased over time.

This is in part because unfortunately, there’s a tremendous need for addiction medicine services and Center for Healing has continued to support lots and lots of patients. But the volume has also increased because our MLP attorneys Landon Hacker and Dawn Erickson have done such a terrific job serving their patients that the Center for Healing staff has tremendous confidence in our team.

And the patients themselves really appreciate it, and they communicate that to other people that they are in group with or just other folks at the clinic. So you get awareness through a word-of-mouth: one patient mentions that they have a dispute with their landlord, and another says, “You need to talk to Landon” or “you need to talk to Dawn” because they can help you with that and you don’t need to do it yourself. Which is a beautiful thing, but it has led to a really enormous volume of referrals.

And of course, there are other challenges that I think you always experience when serving complex care patients. These individuals have a lot going on in their lives. They’re dealing with really challenging medical situations, and poverty itself creates a tremendous burden on people having to deal with the day to day of just getting by. So their legal issues don’t always get the attention that they require. And sometimes it can be challenging to get clients to do the things that need to be done.

But by and large, it’s worked really well. Having us so integrated, being in the same building, is tremendously beneficial. And having a great relationship between our team and the Center for Healing care team means that if we’re having difficulty contacting someone, we can flag it for the folks at their front desk. Then when that person comes in for group or for an appointment, they let us know, and one of our attorneys can immediately connect with them. So that that close and positive working relationship helps to address some of those challenges.

 

What were some of the main factors that led to the success of this partnership?

When we’re serving patients, we’re taking a whole-person approach that’s true to the Camden Coalition. We’re meeting our clients where they are, and we’re helping them to not just address the one legal issue in front of us, but to put them in a better place overall so that they can address whatever their underlying medical needs are.

We have a team of attorneys that are just outstanding in their legal advocacy and in their willingness to think hard about the challenging legal issues that complex care patients face. And they have done this for a while and have a lot of experience.

But I think what’s even more important is the way that they relate to our participants, that they inspire trust and get people comfortable in very difficult and personally challenging situations. That’s really special and is not something that you necessarily learn in law school.

 

Why did we decide that it was important to provide criminal legal counsel as well as the civil legal support that MLPs traditionally provide?

I’m glad you asked that because providing criminal legal counsel is newer to us as an MLP but has become fundamental very quickly. I believe we are still one of the very few MLP programs that address open criminal justice issues. There is one other group up in Providence, RI, that’s created a partnership between an addiction medicine program and the public defenders up there, and they’re doing great work.

It’s wonderful to see that that others have recognized the importance of expanding the concept of medical-legal partnership to criminal issues, but you’re talking about only a couple places in the entire country. I’m hopeful that as people see this issue of the Journal of Medicine, Law, and Ethics and read a few examples of the way this is being done, that more and more people will recognize that.

The old concept of civil legal aid is still really important. And dealing with benefits and housing issues is essential. But there’s also a need for specialized attention to criminal issues.

In our situation, a lot of the referrals that come from the Center for Healing are for criminal cases. Some are current and some are open cases that date back years, often from periods of active addiction. The vast majority of these cases are relatively low-level criminal issues: petty theft, drug possession, and even some more benign things like jaywalking. A lot of times, when people think about what it would be like to start an MLP that addresses criminal issues, their minds immediately go to violent assaults and weapons. That’s not what we see.

One of the things that we try to point out whenever we talk about this is that even though these aren’t high-level crimes, the support we provide is still really important. These patients need good representation from people who can understand what they’re going through and can help them deal with these issues as part of their recovery.

 

What does criminal-legal counsel look like in a typical case?

It’s like any other representation in the sense that you get the referral and you engage with the person and identify what’s going on. In some cases, we try to get information from the police about what the charges are, like a discovery process. Getting that information helps us counsel a client about what they’re facing and whether the charges are legitimate or not.

I remember one crazy case we had: a client had been given a driving violation, but he insisted that he hadn’t driven a car in years. It turned out that someone had taken his identification and been pulled over, and the charges ended up falling on our client. Because of this program, we were able to jump in, immediately identify what was going on, collect the information that we needed, document everything for the prosecutor, and get the appropriate outcome.

In a lot of cases, we’re able to identify situations where someone was improperly charged. There are also a lot of cases where patients are in the middle of getting treatment and working hard towards recovery and also trying to deal with this backlog of charges that had accumulated over time. In those cases we try to get those old charges resolved as favorably as possible, putting those patients in a position to continue moving forward without the idea of jail time or warrants or enormous fines hanging over their head.

 

I imagine that this fills an important gap in the services available to people. Public defenders are probably more focused on the higher-level cases, and may not have the capacity to deal with these low-level charges in the high-touch way that you all can.

Yeah, I think that’s right. Our public defenders are wonderful and they work so incredibly hard. But their volume is enormous. They do their best to do right by everyone by working as hard as they can to try to get things resolved favorably.

We are able to put in more “high touch” direct engagement, and that’s particularly important when talking about the folks at the Center for Healing, who in many cases are in a challenging spot and really benefit from having maximum interaction with counsel who are already familiar with their medical providers.

 

What are the main takeaways from this paper for policymakers, and for people running existing medical-legal partnerships?

One takeaway is that there’s a tremendous need for legal services for patients recovering from addiction. I really feel strongly that that’s something that policymakers need to keep in mind. We’re still in the middle of this opioid crisis and I think too often we overlook the importance of legal services. It should really be seen as a pillar of addiction recovery. Hopefully we’ve demonstrated with this paper just what kind of impact you can have as an MLP by filling that role.

Here in New Jersey, we’ve advocated for the governor’s Opioid Council to support this work. We’re looking for more opportunities to bang that drum, because we really believe that you need to have legal services in place to treat patients with substance use disorders, because so many have legal issues hanging over their heads.

The second piece is to open people’s minds to having MLPs that address criminal justice issues. You can do it well while maintaining whatever else you’re doing in your program. It’s feasible. And yeah, that’s probably outside of the comfort zone of a lot of existing MLPs, but that doesn’t mean that they shouldn’t be thinking about it.

 

What are the main takeaways for addiction medicine programs that don’t yet offer legal services?

I would want to encourage them to have an open mind about incorporating legal services as well. If the initiative for this is just coming from the legal services side, it’s not going to be successful. The reason that we’ve been so successful with Cooper is because the Cooper team has been so engaged and so supportive.

Talk to your teams or institutions or whoever it is that is looking at the global picture and figuring out creative ways to improve care. It takes partnership. And that means both sides have to buy in.

 

What are some of the next steps of this work?

We’re really excited about starting up a new partnership with Maryville Addiction Treatment Center — we’ll be starting to take referrals from them in the coming weeks. We’re really looking forward to seeing how that develops. Each partnership in each institution works differently, so I’m sure we’re going to have some challenges and growing pains. But it’s going to really be exciting to expand and to see how we can support a different program with a slightly different model.

We have also engaged with the Walter Rand Institute at Rutgers University. Their researchers are doing a qualitative evaluation of our work with Cooper Center for Healing. They’ve been collecting data, interviewing patients, doing surveys, and also interviewing their team members. I’m really looking forward to the results of that evaluation.

Our dream is to have a phase two that’s more of a quantitative assessment of the work. As we’re trying to tout the value MLPs in addiction medicine settings, we want to have as much data as possible.