Effective Legal Representation
The organization's legal representation should be geared to achieving the client's objectives and obtaining lasting outcomes. In order to address the community's most pressing legal needs, the organization should focus its advocacy strategically. This can be accomplished by:
- Establishing priorities, goals and strategies, and projected outcomes
- Allocating resources correspondingly
Projects by Topic
Medical-legal partnerships (MLPs) combine health and legal services at a single site of care to address and prevent civil legal problems that affect health. The strength of these partnerships lies in the collaboration between health care, public health, and civil legal aid professionals who don’t normally work together, but collectively engage in trainings, patient care, and policy work. To be more specific, in an MLP, lawyers work with patients to alleviate—through legal intervention—social or other stressors that are impacting their health; doctors, nurses, and social workers receive training on how to screen for possible legal issues that affect their patients’ health and well-being.
As a result of their joint efforts, according to the National Center for Medical-Legal Partnership, “problems are detected sooner than they would be in a crisis-driven civil legal aid setting, health care providers have a critical resource for treating patients who are made sick by their environment, and both professions are in a better position to detect systemic problems and inform healthier public policies.”
Hundreds of health care and legal institutions across the country have developed MLPs to help children, the elderly, veterans, and people with chronic illnesses get and stay healthy. These partnerships are taking off as health care providers increasingly acknowledge their positive effects for patients and health care workers alike.
A 2010 study of a medical-legal partnership in California, for example, found that two-thirds of the people who participated in the program reported improved child health and well-being. Another study, which focused on an MLP in Georgia, found increased physician satisfaction, a rise in Medicaid payments for the partnering hospitals’ services, and a savings of $10,000 in annual continuing education costs.
Currently, nearly half of all LSC grantees operate MLPs, including Legal Aid of Nebraska—whose Nebraska Medical-Legal Partnership was featured on PBS NewsHour in September 2015—and Legal Aid of Arkansas.
Legal Aid of Arkansas’ Medical-Legal Partnership
In 2009, the Walmart Foundation and the Walmart Legal Department donated $100,000 to Legal Aid of Arkansas and the Arkansas Access to Justice Commission to better assist low-income Arkansans in getting the help they need.
An MLP was then formed in 2011 between Walmart, Arkansas Children’s Hospital, and Legal Aid of Arkansas, through which Walmart attorneys provide free legal services to patients and their families. Since then, more than 700 patients have been referred through the hospital, and over 120 Walmart attorneys and professional staff associates have volunteered approximately 1,400 hours on various pro bono projects, including patient cases worth more than $200,000 in free legal services.
Due to the success of the partnership—the first of its kind between a large corporate legal department and a major hospital, as well as Walmart’s first foray into free legal services—more are on the way. After Arkansas, Walmart funded an MLP between Texas Children’s Hospital and Houston Bar Association’s Houston Volunteer Lawyers in 2012, and it wants to create a national network of MLPs at children’s hospitals. Children’s hospitals are also increasingly embracing the partnerships.
For more information on Legal Aid of Arkansas’ medical-legal partnership, view the PowerPoint slides from the organization’s presentation on “Innovations in Civil Legal Aid” at the 2015 NLADA annual conference here.
How the Alaska Legal Services Corporation Was Able to Receive a Multi-Year Grant to Expand Its Medical-Legal Partnership Efforts and Improve Capacity-Building
The Alaska Legal Services Corporation (ALSC) has 12 offices across the state and fewer than 30 attorneys, who serve approximately 6,400 low-income Alaskans per year. Forty-five percent of these clients are Alaska Natives, whose access to justice can be hindered and exacerbated by the isolated areas where they live.
In October 2016, ALSC partnered with New Mexico Legal Aid and DNA-People’s Legal Services on the Navajo Nation to apply for a grant from the federal AmeriCorps program to start a network of medical legal partnerships (MLPs) in tribally operated health care facilities in six states. The joint project was awarded $273,000 over a three-year period as part of the Obama administration’s investment in tribally sponsored AmeriCorps programming. It will fund legal fellows to work with health care providers at six tribally operated health care organizations in Alaska—specifically in Anchorage, Fairbanks, Juneau, Sitka, Kenai, and Nome—to “identify and treat domestic violence, housing, income maintenance, and disability/aging-related problems.”
Not only does this initiative provide a lawyer in or near a health care facility in a collaborative effort to facilitate the referral process and combat health-harming social conditions, but it is also a significant addition of six attorneys—a 20 percent increase—to ALSC’s team of approximately 30 attorneys.
This project likely wouldn’t have existed, though, if it were not for a conference on Native American health held about two years ago on the Navajo Nation in the southwestern United States. That is when ALSC Director Nikole Nelson learned about the Navajo Nation’s MLP with DNA-People’s Legal Services in Arizona. Such a collaborative effort, she realized, would be a great fit for Alaska and its widespread population.
After a year and a half of hard work, the project got funding and became part of a six-state public and private investment that includes 14 new sites and 14 legal fellows who will support each other as they work in MLPs in tribal communities in New Mexico, Arizona, Nebraska, Oklahoma, Utah, and Alaska.
Looking to the future, it is possible that additional partnerships in Alaska may be formed over the course of the three-year project, modeled after the MLP between the Navajo Nation and DNA-People’s Legal Services and the other 300 MLP’s across the country.
Breast Cancer Projects
Legal Aid of Nebraska’s Breast Cancer Legal Hotline
Struggling through an illness such as breast cancer is never easy, especially when money is tight.
One of the few legal aid organizations to have such a program—Atlanta Legal Aid Society is another—Legal Aid of Nebraska’s (LAN’s) Breast Cancer Legal Hotline provides access to free civil legal advice, service, and representation to breast cancer patients and survivors, regardless of income.
The hotline, started in 2013 with a grant from Susan G. Komen Nebraska, is an important part of LAN’s medical-legal partnership (MLP). The partnership initially began in 2009 with funding from Nebraska Medicine. The hotline is available five days a week from 9 a.m. to 12 p.m., and is staffed by a paralegal who is solely responsible for intake and litigation support.
The hotline is all-encompassing too, in the sense that any breast cancer patient or survivor can call in to receive legal assistance—as well as representation—on a number of issues. These issues may include but are not limited to consumer law, family law, public benefits, employment discrimination, and end-of-life issues. This enables patients and survivors to focus on their health and healing instead of being worn down by the stresses of their legal situation. To put LAN’s work in context, one particular case involved helping a client who was in an abusive relationship get a divorce while she was going through chemotherapy.
The organization’s work has also shifted in terms of location. LAN has been able to identify the areas that need help the most based on which places have higher incidences of breast cancer. For example, they frequently serve clients in Omaha, part of Douglas County, which has nearly double the number of breast cancer cases annually than the second-closest county, Lancaster County. (Omaha, the largest city in the state with a population of approximately 446,618, also has a poverty rate of 16.8 percent.)
These data paint a complicated picture, specifically of the prevalent need and LAN’s efforts to meet it. On the one hand, need is often tied to socioeconomic status. According to the Centers for Disease Control and Prevention:
A person’s [socioeconomic status] (SES) affects his or her ability to get health care. A person with more education is more likely to get a job that pays well and provides health insurance and paid sick leave. People who have higher incomes and health insurance are more likely to get tests that can find cancer early, and get the right treatment if cancer is found. So people with a higher SES often have higher cancer survival rates.
People with a low SES are less likely to get cancer screening tests. So their cancer is often found at a later stage when it causes symptoms. Even if their cancer is treated, patients are less likely to survive cancer that’s found after it has advanced.
On the other hand, LAN has been actively working to meet the need, and it has been making progress. In fact, LAN’s MLP has grown from one department in one hospital to all five of Omaha’s major hospital systems, including two neighborhood clinics. And, according to a PBS NewsHour segment on the MLP in September 2015, Nebraska Medicine’s payments to LAN have increased from $25,000 to more than $200,000 a year.
Atlanta Legal Aid Society’s Breast Cancer Legal Project
For the past 12 years, Atlanta Legal Aid Society’s (ALAS) Breast Cancer Legal Project (BCLP) has provided legal assistance to low-income people living with or affected by breast cancer who are dealing with issues related to employment; Social Security disability; short- and long-term disability insurance; access to health care; housing and landlord-tenant, consumer, and debt issues; public benefits; end of life and estate planning; and more. (In Georgia, breast cancer is the leading cause of cancer incidence among females in the state and accounts for 31 percent of all new cancers in women.)
Shortly after the project started, in 2005, the Greater Atlanta Affiliate of Susan G. Komen for the Cure gave it funding. Since April 2010, ALAS has received seven grants from Komen Atlanta, totaling $337,403.
Notably, the BCLP was the first project in the country to do what it does: provide direct legal services specifically to low-income breast cancer patients and survivors. It now serves around 150 clients per year through a variety of means and operations, including:
- Phone intake from 9 a.m. to 12 p.m., Monday through Thursday
- On-site intake and consultations
- Specialized outreach, similar to that done in medical-legal partnerships, on the second and fourth Thursdays of each month from 1 p.m. to 3 p.m.
- Targeted outreach to specific areas of the community to reach more breast cancer clients, and working with health care providers in those areas
- Continuing legal education (CLE) estate planning training to pro bono attorneys
- Estate planning case referrals to pro bono attorneys through the private bar, which allows for a better use of the staff’s—five attorneys and two paralegals—time on the project
- Collaboration with local and national cancer advocacy and resource organizations, as well as several local medical centers
- Community-based training and education
For more information on ALAS’ Breast Cancer Legal Project, click here.
Coalition Building and City Government Partnerships: Philadelphia Hoarding Task Force
From the seemingly harmless act of collecting, to the accumulation of stuff, to the inability to let go of anything, hoarding is a real problem that can have an adverse effect on individuals, families, and communities.
Hoarders currently account for between 2 percent and 5 percent of the population—an estimated 23,600 to 59,000 adults in Philadelphia. Unfortunately, they also lack access to legal services, and legal representation for tenants and homeowners with hoarding behaviors facing eviction can be challenging, time-consuming, and frustrating.
In response, Community Legal Services (CLS) of Philadelphia partnered with the Philadelphia Mayor’s Office and several other organizations in 2013 to form the Philadelphia Hoarding Task Force (PHTF), which “seeks to improve outcomes for people who hoard and reduce the catastrophic consequences related to hoarding for residents of the City of Philadelphia.”
CLS staff initially reached out to a number of organizations to discuss the idea of starting a task force. Around the same time, Mayor Michael Nutter convened a task force of city agencies to implement hoarding-prevention strategies. Then, after PHTF was formed, CLS found speakers from across the United States and Canada to educate members of the task force about hoarding disorders and best practices for hoarding intervention.
PHTF doesn’t provide direct services, but rather ensures access to resources, training for provider organizations, and education about hoarding in the Philadelphia area. This is important because developing a shared understanding of what leads to hoarding behaviors among the organizations that work with these issues and, in a general sense, improving outcomes for those who hoard, is critical.
For more information on the Philadelphia Hoarding Task Force, view the PowerPoint slides from Community Legal Services’ presentation on “Innovations in Civil Legal Aid” at the 2015 NLADA annual conference here.
LawNY's Re-entry Project
In New York, criminal history is the basis of a “protected class” regarding employment discrimination. However, many residents are unfairly denied licenses necessary for some businesses or employment contrary to the New York Corrections Law.
LawNY—an LSC grantee that serves a 14-county area through 7 offices—developed a re-entry project that provides civil legal services to re-entering former offenders. It resulted from the organization’s involvement with community groups that help ex-offenders. The project kicked off in LawNY’s Rochester office in 2006, and has since been replicated in two other offices.
Funded by a grant from New York State, the project allows an attorney in LawNY’s Rochester office to work on the project in addition to three Equal Justice Works Employment Opportunity Legal Corps fellows. The fellows are housed on the points of a triangle covering LawNY’s service area in Jamestown, Ithaca, and Rochester.
The project is largely focused on community partnerships. Some of its initiatives include:
- Emphasizing coordination and involvement with community groups through mutual referral systems.
- Training volunteer attorneys about certificates of rehabilitation.
- Educating the legal community—including judges—on available options and barriers that exist.
- Participating in Federal Reentry Court and New York Criminal Court’s Drug Treatment Court.
For more information on the re-entry project, view LawNY’s presentation on “Innovations in Civil Legal Aid” at the 2015 NLADA annual conference here.
The average consumer is susceptible to a number of threats at any given time, spanning the areas of money and credit, online privacy and security, and more.
The Federal Trade Commission (FTC)—the nation’s consumer protection agency—works to protect consumers from fraud and deception in the marketplace, and in partnership with LSC, it released several webinars geared towards legal aid organizations.
‘Unauthorized Billing and Charges on Consumers Accounts: What Can You and Your Clients Do to Fight Back?’
This webinar has practical information to help clients who have experienced unauthorized charges—whether a credit card, debit card, bank account, prepaid card, gift card, telephone bill, or app store account. It also discusses the importance of complaining about unauthorized charges.
To view the PowerPoint slides from the video, click here.
‘New Resources to Prevent and Recover from Identity Theft’
In this webinar, staff from the FTC’s Bureau of Consumer Protection talk about and walk through the agency’s identitytheft.gov website, which provides personal recovery plans for victims of identity theft. In addition, they discuss tips for preventing and addressing identity theft, as well as the growing problem of tax identity theft.
‘Consumer Issues in Auto Buying’
This webinar discusses a variety of scams and deceptive practices that may affect the clients of legal aid organizations when they purchase cars. Among the topics covered are: misleading automobile advertising; deceptive and unfair acts and practices in the sale of add-on products or services; deceptive and unfair financing tactics, often known as yo-yo financing; law enforcement actions filed by the FTC combating these practices; and other FTC initiatives and consumer resources on these topics.
To view the PowerPoint slides from the video, click here.