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On this page: What is the MLPP?,
Mission Statement, Case Examples,
Learn More, Important
Resources, Documents, Presentations,
MLPP Contacts
What is the Medical Legal Partnership Project?
The Medical-Legal Partnership Project
(MLPP) is a medical-legal collaborative designed to improve the
health and welfare of low-income children and their families through
proactive legal assistance provided in a health care setting. The
MLPP is devoted to providing traditional legal representation for
children within a comprehensive approach to the child's health care
needs as well as advocating for children's health on a systemic
basis. In 2000, the Center for Children's Advocacy established the
Medical-Legal Partnership Project ("MLPP") on-site at Connecticut
Children's Medical Center ("CCMC") to provide improvements to children's
health through legal advocacy and policy reform. In 2003, the MLPP
expanded services to the capitol city's Charter Oak Health Center
and Community Health Services, Inc. - health clinics serving two
of Hartford's poorest neighborhoods. In addition, the MLPP accepts
referrals from pediatricians at Saint Francis Hospital & Medical
Center, the Burgdorf/Fleet Health Center, and the region's community-based
pediatricians. Together these primary care centers provide health
care to nearly 100% of the children who receive services in the
Hartford area.
MLPP is a joint medical-legal collaboration
between the Center for Children’s Advocacy, Connecticut Children’s
Medical Center, Charter Oak Health Center, Community Health Services,
Inc., and Saint Francis Hospital and Medical Center. The project
is funded through generous grants from the Hartford Foundation for
Public Giving, the Universal Health Care Foundation of Connecticut,
Connecticut Health Foundation, the Hartford Courant Foundation,
the Aetna Foundation, the Bob’s Discount Furniture Foundation, and
the Connecticut Bar Foundation.
Information
and History of Medical Legal Partnership Project
Mission Statement
It is the mission of the Center for Children's
Advocacy's Medical Legal Partnership Project (MLPP) to improve low
income children's health outcomes through interdisciplinary medical-legal
collaboration in the health care/clinical setting.
MLPP Goals:
1. The MLPP will utilize an interdisciplinary
approach to legal advocacy by forging partnerships with medical
providers to collaborate on addressing medical and legal issues
discovered and treated in the clinical setting.
2. The MLPP will address medical-legal issues
on behalf of children at risk by representing children and families
to address health issues that are identified by its clinical partners
that impact health and well-being. Representation will be based
on the family's need to address health and safety related legal
issues, such as housing, disability, access to quality healthcare,
education, and discrimination.
3. The MLPP and its clinical partners will collaborate
on education and training material to provide a greater ability
for the team to address children's health issues by improving advocacy
and changing the culture of pediatric health care delivery. Education
and training opportunities will occur in the clinical, academic
and legal environments.
4. The MLPP, working with its health care partners,
will work to change systems and policies that affect children's
health by engaging in collaborative advocacy.
5. The MLPP will work with regional and national
partners to replicate and proliferate medical-legal collaborations
by engaging in partnerships and producing materials and data to
enhance medical-legal collaborations throughout the country.
Direct Legal Representation
The MLPP represents clients in matters relating to
housing (habitability and conditions as well as disability
discrimination), disability benefits, including Supplemental
Security Income ("SSI") appeals, public benefits and entitlements
(public assistance and food stamp eligibility), Medicaid advocacy
(coverage denials for medically necessary care and treatment), educational
rights (special education and related services for children
with disabilities), immigration, civil rights (children's
confidentiality and emancipation rights) and access to appropriate
services for children with disabilities.
Multidisciplinary Education and Training
The MLPP provides multidisciplinary training to the
medical, social work, and legal providers at its health care partners
and in the community on issues affecting children's health outcomes.
In addition, the multidisciplinary nature of the training program
provides "cross training" by medical experts on issues concerning
child health to legal advocates. The MLPP conducts the following
training opportunities:
- large group, plenary
training sessions, such as "grand rounds", hospital-wide trainings
and legal advocacy seminars for legal practitioners;
- small group training
sessions, such as "in-service" trainings to pediatric departments;
individual consultations to medical and social work staff involving
medical-legal issues that directly affect children's care and
health outcomes;
- conference presentations
to medical, social work and legal providers involving medical-legal
issues; and
- residency training programs
in pediatric medicine and psychiatry through the University of
Connecticut School of Medicine.
Systemic Advocacy
The MLPP, in collaboration with its health care partners,
works to identify certain health related issues that require systemic
intervention to improve children's health and quality of life outcomes.
Case #1: The Team Approach and Emmett's Case
Emmett is a one-year-old boy who suffers from numerous
physical and cognitive impairments as a result of premature birth,
including developmental delays, failure-to-thrive, digestive disorder,
hearing loss and neuro-motor limitations. Upon evaluating Emmett,
the pediatric primary care provider ("PCP") immediately called the
MLPP for a consultation regarding public assistance and disability
benefits. After initial consultation, the MLPP worked with the child's
mother to ensure that all eligible benefits were accessed, and commenced
an investigation of an outstanding application for Supplemental
Security Income ("SSI") benefits.
The MLPP initiated an advocacy plan on Emmett's behalf
for disability benefits, but then worked with the PCP to engage
a multidisciplinary team to address his complex medical and social
needs. Taking the lead, Emmett's pediatric primary care provider,
and the CCMC Primary Care Center's ("PCC") clinical social worker
convened a multidisciplinary meeting that consisted of Emmett's
PCP, the department's clinical social worker, the PCC's nutritionist,
Emmett's managed care Medicaid insurer's case manager, a state Department
of Mental Retardation caseworker, the MLPP Director, and Emmett's
mother, father and grandmother. As a result of the meeting, the
team established a comprehensive plan to improve the family's access
to accessible state and federal benefits (including cash, disability
and nutritional benefits), health care services (including shift
nursing and home health aides), nutritional services, respite allocations,
and educational opportunities for Emmett's mother and father.
Case Outcome:
As a result of the meeting, the family was able to
achieve the following goals:
- Reestablish a legal claim for SSI with the
Social Security Administration
- Provide the household with nursing and home
health assistance on a regular basis
- Coordinate nutritional services with other
CCMC departments that provide Emmett with ongoing care
- Coordinate agency services between Medicaid
and DMR providers to ensure that the household is augmented to
meet Emmett's complex medical needs
- Bolster social support services to include
household education, and access adult educational services for
Emmett's parents
Case #2 – Disability Advocacy for a Child at Risk
KJ is a seven-year-old boy who was diagnosed with
sickle cell anemia since birth. In December 2003, a CCMC specialty
provider and social worker contacted the MLPP to assist the family
in appealing the denial of SSI benefits. At the time of the referral,
the Social Security Administration (SSA) had twice denied KJ's claim,
once during the initial application process, and the second time
during KJ's initial appeal. After assisting KJ's mother in filing
for a hearing with an SSA judge, the MLPP began the investigation
and document collection tasks necessary to evaluate his case. It
soon became apparent that KJ had suffered considerably over the
years due to his sickle cell disease, including requiring several
hospitalizations and ongoing treatment for anemia. After consulting
with his treating specialist, the MLPP agreed to represent KJ's
mother in an appeal with a Social Security Administration Administrative
Law Judge. After securing a retainer agreement with the family,
the MLPP initiated a three-point approach to KJ's SSI case.
First, the MLPP analyzed all of the evidence obtained
from KJ's primary care and specialty pediatric providers. Specifically,
the MLPP consulted with KJ's treating nurse practitioner who provides
KJ ongoing specialty care for his sickle cell anemia. After a strategy
meeting, the provider drafted a comprehensive report detailing KJ's
sickle cell symptoms, care and treatment, as well as the repercussions
suffered by KJ as a sickle cell patient. Of significant note was
the specialist's attention to detail as to how KJ's condition can
flare up at any time, and the chronic pain he suffers as a result
of his impairment.
Second, the MLPP staff assembled a package of documents,
including preschool records and home health reports, to support
the family's contention that KJ's condition causes him to miss preschool,
and causes significant chronic pain and discomfort.
Third, the MLPP attorney submitted a legal brief,
replete with multiple pages of supporting exhibits, documenting
how KJ's condition met the criteria for disability as defined under
the federal statute and the Social Security Administration's ("SSA")
regulations. The crux of the argument was that KJ's chronic anemia,
as referenced by hematocrit levels that hovered around and under
"25", rendered him categorically eligible for benefits under the
regulatory "listings" of medical impairments.
The legal argument, coupled with the strong presentation
of evidence, provided sufficient support to convince the SSA judge
that KJ's condition met the criteria for children's SSI benefits.
The judge's office contacted the MLPP to indicate that based solely
on the documentary evidence, SSA's denial of benefits would be reversed
and he granted the SSI benefits retroactive to March 2003, the date
of application. The case is illustrative of how the on-site presence
of the MLPP allowed for direct access to the medical provider, whose
expertise and evidentiary production resulted in a positive result
for a family at risk.
MLPP in The News
Important Resources
Documents
Presentations
MLPP Contacts
Project Director
Jay E. Sicklick. Esq.
Center for Children's Advocacy
University of Connecticut School of Law
65 Elizabeth Street
Hartford, Connecticut 06106
(860) 714-1412
Fax: (860) 570-5256
Staff Attorney
Bonnie
Roswig, JD
Staff Attorney, MLPP
Center for Children's Advocacy Connecticut
Children's Medical Center
282 Washington Street
Hartford, Connecticut 06106
(860) 714-1412
Fax: (860) 545-9234
MLPP Legal Intern
Alexis Williams
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