Improving Child Health
The Medical-Legal Partnership Project (MLPP) is a medical-legal collaborative that improves the health and welfare of low-income children and their families.
Proactive legal assistance provided in a health care setting makes legal services easily accessible for the children and families we serve. Our offices are on-site at Connecticut Children’s Medical Center, Saint Francis Hospital & Medical Center, The Hospital of Central Connecticut, Charter Oak Health Center, and Yale-New Haven Hospital.
We provide traditional legal representation with a comprehensive approach to the healthcare and mental health care needs of each child.
Partnering with Health Care Providers
We are changing the culture of pediatric health care. Our attorneys partner with pediatric providers in low income communities to improve children’s access to appropriate care.
Our representation reduces social and environmental factors – such as substandard housing, inadequate income and benefits, disability rights, access to education and health care – that adversely affect children’s health.
Our partnerships with medical providers allow us to collaboratively address medical and legal issues discovered and treated in the clinical setting. We provide education, training and collaborative advocacy. We work with regional and national partners to replicate and proliferate medical-legal collaborations throughout the country.
Direct Legal Representation
The Partnership represents clients in matters relating to:
- Housing – habitability and conditions, 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
- Civil Rights – children’s confidentiality and emancipation rights
- Access to Appropriate Services for Children with Disabilities
Education and Training
The Partnership provides training and education on issues affecting children’s health outcomes to medical, social work, and legal providers throughout the community. The multidisciplinary nature of these training opportunities provides “cross training” by medical experts for legal advocates. Some of the training opportunities include:
- Large Group Sessions – grand rounds, hospital-wide trainings and seminars for legal practitioners
- Small Group Trainings – in-service sessions for pediatric departments, individual consultations to medical and social work staff
- Conference Presentations – to medical, social work and legal providers
- Residency Training Programs in Pediatric Medicine and Psychiatry – through UCONN School of Medicine
In collaboration with our healthcare partners, we identify health related issues that require systemic intervention to improve children’s health and quality of life outcomes. Administrative and legislative advocacy help change state systems to benefit children throughout Connecticut.
When Alina looks at you, you see a quiet teenager with soft brown eyes. When you look more closely, her eyes reveal a lack of focus that gives pause for great concern.Alina’s family moved from Puerto Rico to Massachusetts two years ago. Her stepfather had been offered work and the family found housing close to his job. After only a few weeks, the extreme domestic violence the family had suffered in Puerto Rico began again; Alina’s stepfather beat both the girls and their mother. Alina was raped repeatedly, and her mother finally took action, escaping with the girls to seek refuge with a cousin’s family in Hartford.
Alina’s history of abuse at the hands of her stepfather, and the domestic violence she continually witnessed as a young girl, contributed to problems that had begun to manifest years earlier. She suffered from ongoing seizures and began to experience auditory hallucinations. Alina’s doctor, a pediatrician at Connecticut Children’s Medical Center (CCMC), was very concerned about her physical and mental health status. She was looking for a way to help the family get assistance from the Department of Social Services (DSS). The mother’s application to DSS had been denied and Alina’s application for disability from the Social Security Administration (SSA) had been rejected. Alina’s pediatrician called the Center’s Medical Legal Partnership for help.
We immediately contacted DSS and explained the family’s need for assistance. Years of violence had left the mother with disabling trauma, making it very difficult for her to find full time work. Alina was so emotionally disabled that she could not attend school on a regular basis and needed her mother’s constant care.
Our successful legal advocacy helped Alina’s family receive emergency assistance from DSS. At Alina’s SSA disability hearing, we submitted a brief that included evidence of Alina’s psychiatric impairments, including records from medical and psychiatric facilities in Connecticut and Massachusetts. We also obtained Alina’s educational records, which documented significant learning disabilities exacerbated by her psychiatric condition. As the day of the SSA hearing approached, we were concerned about the stress Alina’s mother would suffer when she testified to the domestic violence, sexual abuse and psychotic episodes that led to the application for disability. Fortunately, the Court ruled in favor of the appeal based on submitted documentation and Alina’s mother did not have to testify.
Alina’s physical and emotional challenges continue, but she’s moving in a positive direction. We recently helped Alina secure an appropriate educational setting and we continue to carefully monitor the family’s progress.
With the bravado only an eleven year old can muster, Marco decided his wheelchair could navigate the pile of rocks at the bottom of the hill. Gaining speed as he approached, Marco hit the rocks and was dumped onto the roadway. The story could have a simpler resolution if Marco had been on a bicycle, but Marco suffers from Spinal Muscular Atrophy Type II – he has no lower body strength and only limited motion in the top half of his body. A broken wheelchair was only the latest problem for Marco and his mother, Millie.
Marco’s medical problems meant that Millie had to carry him when he had to use the bathroom or the shower. While not a perfect system, this worked when Marco was little, but he now weighs almost 100 pounds. This past summer, Millie fell when lifting Marco and they both wound up in the emergency room.
Marco receives ongoing care from the Connecticut Children’s Medical Center Orthopedic Department. Clinicians recommended installation of a lift system in the house – a track installed on the ceiling that allows the user to sit in a sling and navigate through relevant rooms – to prevent further danger to Marco and Millie.
To the dismay of the family and Connecticut Children’s Orthopedic Department, the request for the lift system (durable medical equipment) was denied by Millie’s Medicaid/HMO insurance carrier. Marco’s orthopedist called the Center’s Medical-Legal Partnership for guidance. We spoke extensively with the clinicians and the family to assess the insurance denial and secure this important equipment for the family. Connecticut’s legal standard for such equipment is medical necessity, defined as “health care provided to correct or diminish the adverse effects of a medical condition.”
After taking pictures, making diagrams and gaining a new appreciation for the practical as well as legal definition of medical necessity, we filed an Appeal of Denial with the State of Connecticut Department of Social Services. Within days, an attorney from the Medicaid HMO called and agreed to discuss a resolution for the family.
Marco has many hurdles to face, including a spinal fusion in the very near future. Some challenges will be eased with the installation of the newly-approved lift equipment that will make his life, and his mother’s, easier and much safer.
- How Bioethics Can Enrich Medical-Legal Collaborations, Mental Health & Illness, Journal of Law, Medicine & Ethics, Winter, 2010
- Utility Access and Health: MLP Patients-to-Policy Case Study, Medical Legal Partnership, Boston, June, 2010
- Poverty Grown Up: How Childhood Socioeconomic Status Impacts Adult Health, Abstract: Socioeconomic status and health status are directly related across the world, Kathleen Conroy, MD, Megan Sandel, MD, MPH, Barry Zuckerman, MD, Journal of Developmental & Behavioral Pediatrics, 2010, www.jdbp.org
- Medical-Legal Partnerships Practicing Preventative Law, ABA Health eSource, July 2009
- Medical Legal Partnership Insight and Passion Change Culture & Practice
- CCA’s Medical Legal Partership: Doctors & Lawyers Work Together to Solve Problems that Harm Health
- School of Law Graduates Instrumental in Creating National Center for Medical-Legal Collaboration, Northeastern Law Magazine, Summer, 2006
- Social Security Benefits – Is Your Child Eligible for Supplemental Security Income (SSI)?
- Social Security Benefits – A Guide to SSI for Healthcare Providers
- Physician’s Report for Child’s Claim of Disability
- Resource Card for Pediatric Practitioners (PDA format)
Important resources to help families access benefits and services
- Children’s Disability – SSI Code Card
Disability advocacy for pediatric practitioners.Adolescent Health Care
- Adolescent Health Care: The Legal Rights of Teens
- Is it Confidential? Guide to reproductive healthcare for teens (English or Spanish)
- Helping Families Understand Employment Law
- Immigration Law in the Medical SettingUtility Law
- How to Keep Your Lights and Gas Turned On – Preventing Utility Shutoff (for families)
- Navigating Utility Law to Help your Patients – Preventing Utility Shutoff (for providers)
- Starting College: Tips for Special Education and Disabled StudentsOther
- Judicial Intervention For Morbidly Obese Children (PPT)
- OCA Report & Executive Summary – Children with Special Healthcare Needs
- Facts about the Center’s Medical Legal Partnership Project
- Links to Medical-Legal organizations
- What’s so Interesting about Medical Necessity? Jay E. Sicklick, Esq., October, 2009
- Teenage Confidentiality, Adolescent Health & Mandatory Reporting: A Primer for Practitioners Jul 2004, Community Health Services
- Judicial Intervention for Morbidly Obese Children Jay E. Sicklick, Esq., Oct, 2007
- Adolescent Confidentiality and Teenage Legal Rights: A Primer on Reproductive Health Issues
- CCMC Grand Rounds – The Social Determinants of Health Lauren Smith, M.D., M.P.H., Jun, 2006
- High Profile Tragedy and Mental Health Concerns: CCA Testimony before the CT Legislature’s Bipartisan Task Force on Gun Violence Prevention and Children’s Safety/Mental Health Services Working Group, Jan 2013
- Mental Health Services Working Group Testimony 2013
Jay E. Sicklick
(860) 714-1412 Fax: (860) 570-5256
Senior Staff Attorney
(860) 714-1412 Fax: (860) 545-9234
Dr. Sarah Schlegel