Removing legal barriers to good health

Care management & redesign Legal & criminal justice

By Amy Yuen

New medical-legal partnership aims to improve complex care in Camden

Opportunities for better health begin where we live, work, play, and learn. But in many cases, unmet social needs can become a major barrier to improved health. Many patients who experience frequent hospitalizations encounter a broad range of legal problems that can block their ability to meet their basic needs and stay healthy — a threatened eviction, unsafe living conditions, a denial of disability benefits, to name a few. To better address the legal needs of community members involved in our complex care intervention, the Camden Coalition has partnered with Rutgers School of Law in Camden to pilot a medical-legal partnership program.

The medical-legal partnership is an innovation in healthcare delivery that integrates attorneys into healthcare settings to resolve social needs that can undermine patients’ health and wellbeing. Unlike the majority of these partnerships — which operate in healthcare institutions and are limited to specific concerns like housing rights or children’s health — this community-based pilot addresses a variety of civil and criminal issues faced by participants who receive our care coordination services.

“Our goal is to remove the legal barriers our participants face so they can live the life they hope to have,” said Laura Buckley, Senior Program Manager of Innovation Operations for the Camden Coalition. “We hope this will subsequently ease a lot of anxiety around legal issues that we constantly see, and improve their physical and mental health.”

Since November, our care team has been working closely with consulting attorney Jeremy Spiegel to assess the legal needs of community members who are encountering potential legal issues while participating in our care intervention. Spiegel provides legal guidance to help navigate around complex issues and, in cases suitable for legal intervention, accompanies the care team to meet with patients and directly provides them legal services. Alternatively, meetings with patients who lack access to a private space are conducted at a Rutgers legal clinic.

“A warm handoff”

“Lawyers typically provide legal services in their office and not in a patient’s home, but we have patients who have no transportation or can’t ambulate that well,” said Latonya Oliver, Clinical Manager of Social Work for Innovation Operations. “With Jeremy, he works alongside our care team. Patients have already formed a level of comfort with the team, so it feels like more of a warm handoff when he comes along and they meet him.”

One of the first participants receiving legal services through the program has been working hard to address a longtime substance use disorder. But because he missed a hearing on a drug-related charge and has a long criminal record related to his disorder, he now faces a possible sentence of several years. To bolster the patient’s case by showing his demonstrated commitment to improving his health, Jeremy met with the patient’s public defender, and the care team faxed letters of support to the judge’s chambers from the Coalition and his primary care provider, Project H.O.P.E. Their efforts made an impact. A day before the hearing, the judge suggested the patient apply for drug court as an alternative to being sentenced.

While the outcome of the case is still pending, Jeremy and Latonya are optimistic he will be released soon. “We feel that his being in jail for a couple of years would not be beneficial for his wellbeing,” said Jeremy. “He has been working diligently to address the underlying issue, which is his substance use disorder. We think it’s important to allow that work to continue.”

Although the pilot is still in its early stages of development, the Coalition has begun tracking the health and legal outcomes of participants who are using Jeremy’s legal services, with the goal of measuring the program’s short-term impact on improving health and wellbeing.

“I’m hopeful that this pilot will impact people’s lives,” said Laura. “In the last couple of years, we’ve had successful instances where we’ve contracted out with pro bono attorneys, so having a consultant who works closely with staff makes a lot of sense. It’s also really helpful for staff to understand the legal intricacies and concerns so we can better serve our patients.”

“It’s going to be an interesting initial year to really see what kinds of issues present themselves and what we can do to help the patients out,” Jeremy added. “I think it’s a natural fit with the work that the Coalition is doing. The care team is addressing a lot of different issues with thoughtful strategies. This partnership — and the ability to address patient legal issues — is another valuable tool to ensure better outcomes.”

The MLP is supported by the Holman Auto Group and the Rowan/Rutgers Board of Governors