CDC - July 2013 Edition - Public Health Law News - Public Health Law

July 2013 - CDC Public Health Law News

Thursday, July 18, 2013
From the Public Health Law Program,
Office for State, Tribal, Local and Territorial Support,
Centers for Disease Control and Prevention

In this Edition

Announcements

Legal Tools

This Month’s Feature Profiles in Public Health Law

Interview with Ellen Lawton, Co-Principal Investigator, National Center for Medical-Legal Partnerships at the George Washington University School of Public Health and Health Services

Quotation of the Month

State Representative Terry Backer on Connecticut’s new shoreline construction laws

Announcements

The Health Insurance Marketplace opens October 1, 2013. The Marketplace is a new way to find health coverage that fits individual budgets and needs. Those using the Marketplace will be provided with tailored information about health insurance premiums and coverage options. Find more information about the Health Insurance Marketplace .
Webinar: Efforts, Challenges, and Successes of Policies to Reduce Sodium Intake in the U.S. Public Health Law Research and the American Society of Law, Medicine & Ethics will present this webinar on Thursday, July 18, 2013 from 1 to 2 p.m. (EDT). The webinar will address the importance of sodium reduction as a public health goal in the United States; highlight the regulatory and voluntary efforts of government and industry; describe implementation issues from the regulatory and voluntary aspects; discuss the unintended consequences of these efforts and the challenge in finding the best solutions; and discuss successes and best practices that have resulted in notable sodium reduction measures. Find more information and register for the webinar .
Public Health Law Research opens 5th call for proposals. Public Health Law Research has released its fifth call for proposals. Approximately $1 million for short-term studies will be awarded, with eighteen-month awards of up to $150,000 for each study. The program seeks to build the evidence for and strengthen the use of regulatory, legal, and policy solutions to improve public health and help people lead healthier lives. The deadline for submitting full proposals is July 24, 2013, at 3 p.m. (EDT). Find more information about Public Health Law Research and proposal requirements .
'PHLR: Theory and Methods' now available. Public Health Law Research has published a new book, "Public Health Law Research: Theory and Methods." It explores the mechanisms, theories, and models central to public health law research. The book covers framing public health law research, understanding how law influences the environment and behavior, identifying and measuring legal variables, and designing public health law evaluations. Find more information about Public Health Law Research and PHLR: Theory and Methods .

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Legal Tools

Domestic and sexual violence screening toolkit. In February of 2013, the U.S. Preventive Services Task Force issued new recommendations to support screening and response to intimate partner violence, also known as domestic violence, and recommended that health plans provide the service. The National Health Resource Center on Domestic Violence created this toolkit which offers health care providers and advocates for victims tools to prepare a clinical practice to address domestic and sexual violence. The toolkit includes screening instruments; sample scripts for providers; patient and provider education resources; and strategies for forging partnerships between health care and domestic and sexual violence programs. Find more information and access the toolkit .
Community benefit state law profiles. The Hilltop Institute has released Community Benefit State Law Profiles (Profiles) which present a comprehensive analysis of each state's community benefit landscape as defined by its laws, regulations, tax exemptions, and, in some cases, policies and activities of state executive agencies. The Profiles organize these state-level legal frameworks by the major categories of federal community benefit requirements found in § 9007 of the Affordable Care Act (ACA), § 501(r) of the Internal Revenue Code. Find more information and access the Profiles .

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This Month's Feature Profiles in Public Health Law: Interview with Ellen Lawton, Co-Principal Investigator, National Center for Medical-Legal Partnerships at the George Washington University School of Public Health and Health Services

Ellen Lawton

Title: Co-Principal Investigator, National Center for Medical-Legal Partnership at the George Washington University School of Public Health and Health Services
Education: J.D. (Northeastern University School of Law), B.A. (Union College)

CDC Public Health Law News (PHLN): What sparked your interest in public health law?
Lawton: I've always worked in the public interest sector, even before I went to law school. For me, public health law represents one of the best ways to positively impact people in communities around the country.
PHLN: Please describe your career path to the National Center for Medical-Legal Partnership (NCMLP).
Lawton: After law school, I clerked for a Massachusetts Appellate Court judge, which helped me realize that I really needed to work directly with people and not in a library researching case law! From there I became a litigator at the Massachusetts Department of Social Services, representing the state in child protection cases. I saw first-hand the horrendous effects of poverty and disparities on families and communities. I left that position in 1997 to work as one of the first attorneys at Boston Medical Center's medical-legal partnership (MLP). For me, it represented an incredible opportunity to use my legal skills to prevent some of the dire outcomes I witnessed in the child protection world. I became the MLP's director in 2001, and co-founded the National Center for Medical-Legal Partnership (NCMLP) in 2006.
PHLN: What is a medical-legal partnership and what forms can such a partnership take?
Lawton: One in six Americans live in poverty, and every single one of those individuals has some sort of civil legal problem that negatively impacts their health. But despite this health/law connection and the fact that civil legal aid offices and health care institutions have long treated the same patients or clients, there's never been a coordinated effort to address these problems, or to understand that many legal problems are health problems. That's where a MLP comes in.
An MLP is a healthcare delivery model that integrates legal care directly into patient health care, and uses three levels of legal interventions—at the patient, clinic, and policy levels—to address andpreventhealth-harming legal needs. Within every category of the social determinants of health, there are specific problems that cannot be addressed without the expertise of an attorney. There are families wrongfully denied food supports and educational benefits, necessary resources to meet their daily needs. There are children living in housing with mold or rodents, in clear violation of housing laws, whose physical environment makes them sick. And there are seniors being denied long-term care coverage they're entitled to, whose lack of access to insurance prevents them from getting the medical care they need.
While the core of every MLP is the same—an existing health care institution and an existing legal institution coming together to integrate their services and address these issues—one of the best parts of the model is its flexibility to respond to the local needs and resources of a particular community. More than 300 hospitals and health centers in the United States have developed MLPs in a range of healthcare settings, including rural and urban community health centers; disproportionate share and children's hospitals; veterans medical centers; and specialty care. They address the needs of children, families, veterans, chronically ill individuals, and the elderly.
PHLN: What are the origins of MLPs?
Lawton: The first MLP emerged from Boston Medical Center's pediatrics department in 1993 when the first lawyer was hired to help address housing conditions—such as mold and rodent infestations—that were negatively impacting child health, especially for kids with asthma. But there are many critical antecedents to MLP—examples where legal and health partners have come together over the years to address local issues related to the social determinants of health—like the provision of legal services in the care of HIV/AIDS patients in the 1980s. Dr. Jack Geiger, founder of the community health center model and a member of the NCMLP Advisory Council, speaks eloquently of an even earlier example, hiring a lawyer at the first community health center in Mississippi in the 1960s to handle discrimination and other legal issues that plagued the community.
PHLN: Can you give an example of how MLPs cooperate for patient/client care?
Lawton: MLPs provide patients three levels of legal care. First, at the individual level, when health care teams are trained to detect and manage legal problems related to health—such as the family who has been threatened with eviction for complaining about rodent infestation. Working together, the health and legal teams can ensure that landlords understand their responsibilities in addressing sanitary conditions, and hold them accountable for maintaining safe, healthy housing. The second level is legal care at the clinic level—building healthcare team capacity to address health-related legal problems through regular training, integration of screening and intervention tools into the electronic health record, and tracking patterns of legal issues that might benefit from policy intervention. And finally, at the policy level, where NCMLP medical director Dr. Megan Sandel talks about MLPs' ability to target failed policies with the twin expertise of lawyers and healthcare providers, for more effective policy advocacy at the local, state, and federal levels.
PHLN: Who benefits from MLPs and how?
Lawton: First and foremost, patient-clients benefit from the addition of legal expertise to the patient care team and from the elevation of healthcare provider voice in policy decisions and regulations. But the professions themselves benefit in big ways too. On the health care side, MLP builds capacity to handle patient legal needs, allowing healthcare team members to work at the top of their profession, rather than struggling to navigate complex government bureaucracies. Healthcare institutions benefit from a return on investment (documented through excellent research at Southern Illinois Healthcare

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) and by helping control costs for especially high users of healthcare resources. The civil legal aid community benefits from the ability to prevent legal problems, rather than simply react to legal problems that plague vulnerable communities, expanding their capacity to provide care.
PHLN: What is the NCMLP and how does it create and support MLPs?

Lawton: NCMLP is a project inside the George Washington University School of Public Health and Public Health Services' Department of Health Policy that leads research and policy activities to sustain and scale the MLP model of care and to align health, legal, corporate, and government partners to alleviate legal barriers to health and healthcare. NCMLP is funded by the Kresge and Robert Wood Johnson Foundations.
Between 1993 and 2005, the number of healthcare institutions with an MLP grew from one to almost 75. It was a grassroots movement with individuals hearing about the model and building partnerships in their communities. But the growing interest in MLPs and the need to promote the model consistently was a catalyst for developing the NCMLP in 2006.
Today, we develop and disseminate technical assistance materials and toolkits to emerging partnerships and promote learning across the nearly 300 program sites at our annual national summit

and across social media platforms. We convene government and professional stakeholders on specific projects to integrate MLPs into existing healthcare strategies and innovations, such as emerging quality measures for chronic disease. And we work to develop consistent metrics for MLPs that can be used by the health and legal communities to measure the impact of their work.
PHLN: What role does public health data play in MLPs and why is it important?
Lawton: Interestingly, a number of the public health priorities in communities across the United States are responsive to, or ameliorated by, civil legal aid interventions alongside public health strategies, whether infant mortality, asthma rates, or the impact of chronic diseases on low-income populations. But the traditional civil legal aid community doesn't have the statistical and analytical capacity of the public health community, and struggles to track the prevalence of legal needs and the effectiveness of its interventions. At NCMLP, we believe that civil legal aid expertise and infrastructure could be more strategically deployed to greater impact if the civil legal aid community truly partnered and synchronized with the health and public health communities.
PHLN: How can this data improve public health more broadly?
Lawton: As the broader health community better understands and tracks the skills and impact of civil legal services, they'll begin to see that the chronic, pervasive underfunding of civil legal services at the federal and state levels compromises public health and can be a linchpin for improving community health. The field of social determinants of health has focused understandably on measuring and describing the baseline in communities. Increasingly, we see MLPs as one of the few solutions that leverages existing skilled resources to produce a multiplicity of positive impacts in the clinical and public health struggle to address the social determinants of health.
PHLN: As you look to the transformation of our health system, what do you think the future holds for MLPs?
Lawton: There's no question that the shifting of the health care landscape to expand both direct access to health care services, and support for prevention activities, provides an opportune time to integrate an innovation like MLPs. As the healthcare team broadens to include new members like patient navigators and community health workers, it's crucial to include skilled legal aid attorneys who can boost the impact and productivity of those new team members and address a unique subset of social determinants of health that no other profession can, all while having a correspondingly positive impact on the millions of vulnerable people who come into the legal aid system every year.

PHLN: What role do you see medical-legal partnerships playing in the emerging accountable care delivery model?
Lawton: There is no question that the accountable care delivery model creates substantial opportunities to draw in strong, impactful community resources like legal aid closer to the healthcare setting, and in the process creating accountability as well as more seamless access for vulnerable patients. In the current landscape, patients who experience health-harming legal needs that are identified in a clinical setting that doesn't have an MLP must forge their own way, seeking out limited community legal resources that are not necessarily situated in close proximity to the health institution, nor are they experienced at interfacing with health care teams to achieve more effective cross-collaboration. MLPs can change that dynamic, and ACOs create the perfect environment for MLP to flourish.
PHLN: Are you working on any exciting projects you would like to share?
Lawton: This is a really exciting time for NCMLP as our own growth is aligning with opportunities in health reform. The Division of Health Resources and Services Administration (HRSA) at the Department of Health and Human Services made an early investment in a small demonstration project to integrate MLPs with Healthy Start home visiting programs in three sites. The pilot was extremely successful, and we are poised to disseminate those findings and work with HRSA to expand their role in MLP.
At the same time, the Department of Veterans Affairs (VA) has taken a real leadership role in HCMLP, and has already brought in some level of legal care into 38 of its medical centers, and has 4 active and several emerging MLPs. We’re in the early stages of working with them to develop evaluation metrics for VA-based MLPs. One of our lead funders, The Kresge Foundation, just invested in a multi-year project supporting MLP in nurse-managed health centers.
The private sector is also driving innovation in MLP. Some of our earliest and strongest leaders are in children's hospitals, and we're about to announce a learning network with a core group of children's hospitals that have strong MLP programs that's being backed by multiple corporate pro bono partners.
PHLN: If you weren't working in public health law, what would you likely be doing?
Lawton: I can't imagine not working in this field! If I weren't focused on MLPs, I think that I would work on changing the conversation in the United States about advanced care and end-of-life.
PHLN: Please describe any personal information, hobbies, or interests you care to share.
Lawton: I have two active boys so I need to keep in shape to keep up with them! We like tennis, swimming, biking, and camping. And my husband and I are avid comedy aficionados—Aziz Ansari and Jim Gaffigan are two favorites.
PHLN: Have you read any good books lately?
Lawton: I'm still recovering from the heart-stopping Gone Girl. Better still is the new TED book by my friend and colleague Dr. Rishi Manchanda, The Upstream Doctors—it's the ultimate public health manifesto!
PHLN: Is there anything else you'd like to add?
Lawton: I'm often referred to as a goodwill ambassador for the legal profession, a title I wear proudly! I believe that the legal community in general, and the civil legal aid community specifically, has a terrific expertise to bring to the cause of clinical and public health. I look forward to the days when we have a more accessible common language and better understanding of our combined strengths.
[Editor's note: Find more information about medical-legal partnerships across the nation

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Quotation of the Month: State Representative Terry Backer on Connecticut's new shoreline construction laws

"What we fail to understand is that we live on a moveable shoreline and have to design our plans for future changes. New Construction has to be vigilant as to how close to the water it can be," said Connecticut State Representative Terry Backer of Connecticut's new laws regarding coastline construction before and after storms.