The YCSC Medical-Legal Partnership

Transcript

• 00:00Hello and thank you to those of
• 00:02you who took time to join us today.
• 00:04My name is Christiana Mills and
• 00:06I'm a Licensed Clinical Social
• 00:08Worker here at the Yale Child
• 00:09Study Center Outpatient Clinic.
• 00:11I am joined today by two colleagues and
• 00:13together we are excited to tell you more
• 00:15about the medical legal partnership,
• 00:17A collaboration between the Center
• 00:19for Children's Advocacy and the
• 00:21Yale Child Study Center.
• 00:22Here with me are Ana Maria Orosco,
• 00:24A licensed Clinical Social Worker on our
• 00:27clinical faculty and Katherine Meyer.
• 00:29An attorney at the Center for
• 00:31Children's Advocacy and the Director
• 00:33of the Medical Legal Partnership
• 00:34here at the Child Study Center.
• 00:36A couple years ago,
• 00:37we were lucky to receive funding
• 00:39and support to launch a medical
• 00:41legal partnership on site at
• 00:42the Yale Child Study Center.
• 00:44This collaboration is the only
• 00:46medical legal partnership in the
• 00:48nation dedicated exclusively to
• 00:50interdisciplinary advocacy in a
• 00:52children's behavioral health setting.
• 00:54This new partnership provides
• 00:56critical legal interventions for
• 00:57children suffering from family
• 00:59trauma and health harming,
• 01:00environmental stressors that have
• 01:02grave impact on their lives,
• 01:04especially for children of color.
• 01:06From things like a family struggling
• 01:09with a landlord over mold remediation
• 01:11leading to an exacerbation of a child's
• 01:14anxiety over their mother's health,
• 01:16to a teen that is unable to access education
• 01:19related to bullying in the school setting.
• 01:21To troubles accessing healthcare
• 01:24and entitlement programs.
• 01:26These are examples of stressors that
• 01:28frequently come up in a children's
• 01:30mental health setting as families
• 01:32report on the struggles they face.
• 01:35A medical legal partnership
• 01:36works in three ways.
• 01:38It helps clinicians learn more about
• 01:40the legal rights of their clients
• 01:42and roots of advocacy via trainees.
• 01:45It assists families and clinicians by
• 01:47providing quick legal consultation
• 01:49that serves to educate the clinician,
• 01:51but more importantly the family
• 01:53on their rights and options and
• 01:56in a smaller number of cases.
• 01:57In low income families where other
• 01:59routes of advocacy have failed
• 02:01or the situation is dire,
• 02:03legal representation becomes necessary.
• 02:07Over the course of the last year,
• 02:09we provided consultation to approximately
• 02:12150 families and over the course of today.
• 02:15Catherine,
• 02:15I'll tell you more about the
• 02:17medical legal partnership,
• 02:18and Anna Maria will give you some
• 02:20stories that helped bring it alive.
• 02:22Thank you for your time today.
• 02:24Thank you, Christy.
• 02:25I'm grateful for this opportunity to
• 02:27talk about the impactful work that
• 02:29we're doing here at the Yale Child
• 02:31Study Center Medical Legal Partnership.
• 02:33Before I delve into the specifics,
• 02:34I'm going to zoom out a little bit
• 02:36and share some background on the
• 02:37Center for Children's Advocacy,
• 02:38our history of medical legal partnerships
• 02:41and how this specific site came to be.
• 02:43The Center for Children's Advocacy,
• 02:44or CCA, began the first True
• 02:47Medical Legal Collaborative project
• 02:49in the country in April 2000.
• 02:51At the time,
• 02:52the newly founded Connecticut Children's
• 02:54Medical Center teamed up with us at
• 02:56CCA to start an interdisciplinary
• 02:59project whereby CCA would hire and
• 03:01embed an attorney at the hospital
• 03:03in order to work on improving the
• 03:05health outcomes of children that
• 03:06were being seen and treated there.
• 03:08This endeavor officially became the
• 03:10medical legal partnership a year
• 03:12later and shortly thereafter we
• 03:14expanded to other sites in Hartford.
• 03:16In 2013,
• 03:17CCA and Yale New Haven Health System
• 03:20formed the pediatric MLP at Yale New
• 03:22Haven Hospital and in November 2020,
• 03:24the Child Study Center MLP began.
• 03:27We founded that center as the
• 03:29first and only pediatric behavioral
• 03:32health based MLP in the country.
• 03:34Before coming to this site,
• 03:36I was an attorney for over 10
• 03:37years in our Bridgeport office,
• 03:38mainly providing educational advocacy
• 03:41for children ages 3 through 22.
• 03:44I was able to collaborate with
• 03:46many different mental health
• 03:48and community health centers,
• 03:49but not nearly to the same degree or
• 03:51efficiency as we're able to do here,
• 03:53which really has made an impact
• 03:55on what we can do for families.
• 03:57Now when I go to special education
• 03:59meetings or school discipline hearings
• 04:01or any other kind of advocacy table.
• 04:03The family has not just me as the attorney,
• 04:05but also their trusted clinician
• 04:07there with us.
• 04:09And together we're a really strong team.
• 04:10We have the parent there as
• 04:12the expert on the child.
• 04:13We have the clinician who has the the
• 04:15professional with the knowledge on
• 04:17the child's health and development.
• 04:19And then I'm there with the legal
• 04:21knowledge that's helping us work towards
• 04:22our goal for the child and the family.
• 04:24As Christy said,
• 04:26we see about 150 or we have
• 04:28about 150 referrals per year.
• 04:30And just to give you a sense of
• 04:32the breakdown of the topic areas,
• 04:34we see that there's about 70% of those,
• 04:37about 150 is around educational issues,
• 04:41which makes sense in the setting
• 04:43really because kids who have mental
• 04:45health issues unfortunately often
• 04:47struggle in the school setting.
• 04:49And the school can become a place
• 04:51where stressors are exacerbated.
• 04:52And so it's really imperative that we're
• 04:55able to support them in that setting.
• 04:57Also of the number of referrals
• 04:59we end up providing,
• 05:00about 70% of those referrals become
• 05:03consults to professionals here.
• 05:05So while I'm able to open cases and meet
• 05:07with families about 30% of the time,
• 05:0970% of the time I'm working
• 05:11directly with the providers,
• 05:12which also you know,
• 05:14works to increase the capacity and
• 05:15knowledge with the providers.
• 05:17So along those lines,
• 05:21you know when we're imparting information
• 05:22and advocacy tips to clinicians.
• 05:24We're also really aiming to impart
• 05:27this information to families.
• 05:29And so they were continuing to
• 05:30empower them and help them get
• 05:32the tools that they need to
• 05:33advocate for their children.
• 05:35And and you know,
• 05:35we see this time and time again,
• 05:36we have amazing parents who come
• 05:38through these doors who've done so much
• 05:40themselves and just need a little bit,
• 05:42you know, a few more tools,
• 05:44a little bit more information
• 05:45to know exactly how to best get
• 05:47what they need for their child.
• 05:50We've been able to
• 05:51work together here with our
• 05:53partners to provide a broad variety
• 05:55of legal topics and trainings of
• 05:57clinicians over the past few years.
• 05:59So I've been able to work with
• 06:01outpatient and in home clinicians.
• 06:03Also psychology fellows,
• 06:04psychiatry fellows and social work fellows,
• 06:07and some of the topics I've been able to
• 06:10present include educational advocacy,
• 06:12including special education,
• 06:13school discipline, and bullying.
• 06:15Also we've we've talked a lot
• 06:17about adolescent healthcare,
• 06:19consent and confidentiality particularly
• 06:21issues are on reproductive healthcare.
• 06:24And one more topic I wanted
• 06:25to highlight are the,
• 06:26the legal topic are the rights of L, GB,
• 06:29TQ plus youth in school and in the community,
• 06:32which again is, is an evolving landscape.
• 06:34And so it's really important for us to
• 06:36kind of keep on top of those issues.
• 06:39Now on the flip side of course
• 06:40is part of a partnership,
• 06:41it's it's a give and a take and
• 06:43so I'm really learning from my
• 06:44medical partners every day.
• 06:46I really love to sit in on rounds
• 06:48and case conferences a few times
• 06:50a month for a few reasons.
• 06:52First,
• 06:52it allows me to hear a larger swath
• 06:54of client stories so I can really
• 06:57understand the the larger patterns of of
• 06:59what folks are seeing here at at the center.
• 07:02It allows me to issue SPOT in real
• 07:04time so I can support clinicians
• 07:06right on that spot in the moment to
• 07:09answer legal questions as they go
• 07:11through the contours of the case.
• 07:13And 3rd,
• 07:13I just,
• 07:14I learned so much from my partners as
• 07:16to why and how they pick the treatment
• 07:18modality that that best serves the patient,
• 07:21how they handle obstacles in the treatment.
• 07:23And then really,
• 07:24of course,
• 07:24I love to hear the encouraging stories
• 07:27of success and the outcomes for families.
• 07:30So before I get into specific
• 07:32examples with Anna Maria,
• 07:33like to just share one more element
• 07:35of the work that I do with the
• 07:37MLP and as part of our larger
• 07:39Center for Children's Advocacy.
• 07:41So at CCA,
• 07:42all the attorneys engage and of
• 07:44course individual representation and
• 07:46the trainings that I just spoke of.
• 07:49And we also all have the opportunity
• 07:51to engage in systemic advocacy.
• 07:53And that means we're basically taking
• 07:55the patterns and issues that we see
• 07:57in our client population and we're
• 07:59trying to elevate them to a higher
• 08:00level so that we can change policy
• 08:02and legislation in order to impact as
• 08:05many children and families as possible.
• 08:07One quick example I'd like to share is
• 08:10that of I I started to see over the
• 08:12years that a lot of young children
• 08:15were being excluded from school.
• 08:17Now,
• 08:17legally this would be considered a
• 08:19suspension if you're excluded from
• 08:20school for more than 90 minutes.
• 08:22But what it looked like in in reality
• 08:24was that parents are being called
• 08:26frequently to pick up their child early.
• 08:29Parents were being forced to accept
• 08:31a shortened schedule.
• 08:33Sometimes the child was even
• 08:34being pushed out by saying
• 08:35they're not school ready yet.
• 08:36For example. And so in looking at these,
• 08:40you know, these matters,
• 08:41we are seeing that the children that
• 08:44most needed access to education and
• 08:46services were were really being,
• 08:48you know, excluded from those
• 08:50those services and education.
• 08:51And it was impacting families
• 08:53in so many negative ways.
• 08:55Parents were losing their jobs,
• 08:56parents are being threatened with
• 08:58DCF or police involvement and
• 09:00obviously it was very disruptive
• 09:02to the whole family structure.
• 09:04So in, you know,
• 09:05in considering this issue,
• 09:06we ended up working with a couple
• 09:08of partners in a coalition
• 09:10and developing legislation,
• 09:11which was the first legislation in
• 09:14the country that narrowed the ability
• 09:17of schools to exclude young children
• 09:19from school and that passed in 2015.
• 09:21And while a lot of progress has been made,
• 09:23we continue to really chip away this issue.
• 09:26We want to further narrow the
• 09:28ability hopefully to ban it one day.
• 09:31And and perhaps even more importantly
• 09:33we're we're really looking to increase
• 09:35access for young children in terms of
• 09:37the services and support they need in school,
• 09:39support educators and and helping
• 09:41deescalate children and really you know
• 09:44intervening at that point of crisis
• 09:45that the child is ultimately doesn't
• 09:47have to face that school exclusion okay.
• 09:53So to illustrate some specifics
• 09:55of our work together,
• 09:56we're going to have a conversation with
• 09:58Ana Maria about a few shared clients
• 10:01and referrals that we've had together.
• 10:03First,
• 10:03we can start with CC is a 14 year
• 10:06old 8th grader.
• 10:07He has some cognitive challenges.
• 10:09He has a diagnosis of a DHD and
• 10:11you brought him to my attention
• 10:13for a few reasons.
• 10:15So why don't you, why don't you share that?
• 10:16Sure. So just to give a little context as
• 10:20to why C originally started coming here.
• 10:23So originally he presented with some
• 10:26suicidal and unsafe behavior and his
• 10:29mom was the one who connected him here.
• 10:31She's a great advocate for him.
• 10:34When I first met, CI realized that
• 10:36there had been a lack of services that
• 10:38he needed and a lot of his symptoms.
• 10:42Although they were seen at home,
• 10:43they were also seen at school.
• 10:45And I think that a lot of the anxiety
• 10:47that he had was as a result of not
• 10:50having interventions that were
• 10:51helpful for him as far as socializing,
• 10:54peer connection and kind of the
• 10:56support he really needed at school.
• 10:58At the time, I realized he didn't
• 11:00have a 504 an IEP and he,
• 11:01he definitely seemed like like a
• 11:03kid who could benefit from it.
• 11:05And that was kind of what led me
• 11:06to consult with you, Catherine.
• 11:08Yeah.
• 11:10Obviously Anna Maria had a great
• 11:12relationship with the family and
• 11:13just knew them so well already.
• 11:14So then by the time I start to get
• 11:16involved with the family, you know,
• 11:17there's there's just a great basis
• 11:19of trust and that foundation,
• 11:21you know, between us and the family.
• 11:24So the interesting thing about Steve's
• 11:27situation is that his mom had been
• 11:29helping him during the pandemic to
• 11:31support him in education at home.
• 11:33And so she was doing the very
• 11:35best she could in a extremely
• 11:37challenging time for for all parents.
• 11:39And she was able to see through that
• 11:41support that he really was really
• 11:44struggling with his schoolwork,
• 11:45had difficulty just, you know,
• 11:47reading the directions to the to the to
• 11:49the work he was supposed to be doing.
• 11:51And I think she was able to kind
• 11:53of get a first hand look at where
• 11:55his peers were and where he was.
• 11:57And so of course the pandemic, you know,
• 12:00had so many negative outcomes,
• 12:02but this situation was actually positive.
• 12:04And that allowed mom that really close
• 12:06eyes on on what was going on with C.
• 12:09So with that information,
• 12:11MOM was really starting to advocate
• 12:13towards getting him more support
• 12:16educationally and because of the
• 12:18issues you mentioned before with
• 12:20kind of navigating social situations
• 12:22and pure conflict,
• 12:23C was also struggling with bullying
• 12:25which is kind of leading towards some
• 12:27school discipline issues as well.
• 12:29So once we were able to really get at
• 12:32you know the the heart of addressing
• 12:34the interventions academically.
• 12:36We were also able to start
• 12:39alleviating some of the other,
• 12:41you know,
• 12:42start alleviating some of the other
• 12:44challenges and how they are manifesting.
• 12:46So in working with C and his mom,
• 12:49we were able to look towards a more
• 12:52supportive,
• 12:52selfcontained environment for him
• 12:54that really wrapped around and
• 12:56embedded the services he need,
• 12:57provided a lot more structure and and
• 13:00supervision and kind of really people
• 13:03paying attention to what C needed
• 13:04and getting to know him a lot better.
• 13:06And so I think that made a huge difference
• 13:08in what he was able to do at school.
• 13:10Yeah.
• 13:11And I think it also helped him a lot
• 13:13with his self esteem and his confidence
• 13:14and kind of just being able to socialize
• 13:17and feeling good about his grades.
• 13:18I think that was the first time he ever
• 13:21really felt like really good about his
• 13:23academic achievement and mom also felt
• 13:25super supported and and everything.
• 13:27So it's been nice to watch. Watch that.
• 13:30Progress and now he's kind of you know
• 13:32looking into a more future thing.
• 13:34So it's it's always nice to see
• 13:35all of that come full circle.
• 13:38That's so great. I mean he just was
• 13:40able to get that feeling of success
• 13:42and like he said confidence to
• 13:44start looking at goals for himself.
• 13:45Okay. One more person, young person
• 13:47that you want to talk about is A,
• 13:50A is a 10 year old 5th grade
• 13:52student who has a 504 plan,
• 13:54which is an access plan for a
• 13:56student with a disability and
• 13:57A has a diagnosis of a DHD.
• 13:59She also is has struggled in school
• 14:01this year and maybe you could talk a
• 14:03little bit about your your work and
• 14:05your relationship with A and her family.
• 14:07Sure.
• 14:07So A is a kiddo that's been
• 14:10seen here for quite some time.
• 14:12She's a great kid to work with
• 14:14and and so is her caretaker.
• 14:15She's amazing and and advocating for A.
• 14:19So actually I at the beginning
• 14:21of this school year we were at
• 14:23a point where A's symptoms had.
• 14:25Lastly reduced and she was,
• 14:27we were already kind of we're
• 14:29getting ready to kind of discharge
• 14:31her from services just to give a
• 14:33little context of AIDS history.
• 14:34She does have a history of trauma and
• 14:36there are some disruptive attachments.
• 14:38So with that being said,
• 14:40my focus and treatment has been
• 14:42to really emphasize the important
• 14:43of secure attachments,
• 14:45right and really making her feel
• 14:47stable and safe and and that's
• 14:49also been helpful in reducing
• 14:50some of those symptoms that she
• 14:53originally presented with so.
• 14:55We were at a point where we were kind
• 14:57of getting ready to wrap up treatment
• 14:58and she started her school year.
• 15:00And I I think it's important to know too.
• 15:02Catherine,
• 15:03we've talked about this A has been
• 15:05always very connected in school.
• 15:07She's had really amazing,
• 15:08supportive teachers.
• 15:09She loves going to school.
• 15:11But this school year was a little
• 15:13different for her and I noticed
• 15:14it in the fall where she really
• 15:16didn't want to go to school.
• 15:17She was kind of avoiding it and we got
• 15:20to talk about it a little bit in treatment.
• 15:21She was also kind of seeking
• 15:22treatment a little bit more.
• 15:25She noticed a lot of changes
• 15:26in how she had been. Yeah,
• 15:29right when when the school year started.
• 15:31So in talking with her, she,
• 15:34she was able to share that she was
• 15:36struggling with her connection with
• 15:38her new teacher, which was really.
• 15:40You know different for her in regards
• 15:42to her relationships with teachers.
• 15:44So in talking with her and her
• 15:47guardian a little bit more,
• 15:49I was able to see that the teacher that
• 15:51she had this year was was struggling
• 15:54to provide her with that secure
• 15:56attachment that I think was has been so
• 15:58important for for her and her treatment.
• 16:02So I had a meeting,
• 16:03I requested a meeting with the school
• 16:05and just to kind of talk a little bit
• 16:08more about a history and treatment and
• 16:11and kind of my recommendations clinically.
• 16:13And at the time the teacher
• 16:16struggled to really understand
• 16:18her 504 and her diagnosis and.
• 16:20Kind of left their standstill
• 16:21because they didn't know how to
• 16:23push it forward with the school.
• 16:24And that was when we decided to
• 16:26consult with you, Catherine.
• 16:28Yeah. And that's again,
• 16:29illustrating our partnership is that
• 16:31you work with the family to do,
• 16:33you know, all these steps before,
• 16:35before I was able to get involved.
• 16:38And, you know, this was a really
• 16:41unusual situation because A's teacher.
• 16:46You know, I I usually are the
• 16:48teachers become the greatest advocate
• 16:50for children and A's teacher was
• 16:52really different in that way.
• 16:53And so even though we really
• 16:55tried to be collaborative with her
• 16:57teacher and the administrator,
• 16:58we really weren't getting the progress
• 17:00that we needed and A continued
• 17:02to feel targeted by the teacher.
• 17:05The teacher was sharing information
• 17:07with classmates that ended up
• 17:09leading to bullying of A and so
• 17:11we really needed to kind of step
• 17:13it up a little bit and so.
• 17:15After a few different meetings
• 17:16and and seeing that a continued to
• 17:19deteriorate in her mental health at
• 17:21home and at school and obviously
• 17:24increasing her need to to work with you,
• 17:27we did have to escalate the matter
• 17:28a little bit.
• 17:29We ended up filing a complaint with
• 17:31the Office of Civil Rights that who
• 17:33is now looking into the issue and
• 17:35it just illustrates that we do the
• 17:38best we can you know working with
• 17:40working with folks in different systems.
• 17:43But if we're not able to make progress,
• 17:44you know,
• 17:45A has really important rights
• 17:47that need to be respected.
• 17:49And the reason why we're reaching out with
• 17:51this complaint is not in a punitive way,
• 17:53but because we need to assert A's
• 17:56rights first and foremost and
• 17:57to help other kids who might be
• 17:59in a similar position.
• 18:01So I think,
• 18:01yeah,
• 18:02I think those 3 examples really
• 18:03illustrate well our work together.
• 18:05And I love collaborating with you.
• 18:06I love collaborating with you also.
• 18:09So I think that wraps up our webinar
• 18:12for today.
• 18:12We thank you so much for your
• 18:14time and attention to the medical
• 18:17legal partnership project here
• 18:18at the Yale Child Study Center.
• 18:20And we really appreciate your support.
• 18:22Thank you. Thank you.