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The Northern Illinois University Health Advocacy Clinic is beyond excited to announce we officially opened our doors on August 18, 2014 and have begun accepting clients.
I will never forget how I felt when I saw the first client referral form in our mailbox at Aunt Martha’s. It was the most nerve-wracking but thrilling anticipation I had ever felt – Who is the client? What is his or her case about? When do I get to make my earth-shattering closing argument and win the case? As soon as Professor Boraca handed the referral form to my fellow student-attorney and me, I wanted to jump in my car, drive to the courthouse, and begin making arguments for our new client. However, before I could make it to the door, Professor Boraca asked, “What should your first step be?” My fellow student-attorney answered, “We should set up an interview with our client. That way we can meet him and get a better understanding of the facts of his case.”
Of course we should meet our client. Why didn’t I think of that? My mind was racing with legal arguments and “terms and connectors” I could use to create a good search for case law that I forgot about the logical progression of the case. Suddenly, I felt very overwhelmed. I was anxious to meet our client, but I had not even thought about what I was going to say when he or she came into the office.
As I considered my oversight, my mind drifted back to my decision to apply for the Health Advocacy Clinic. I remember talking to the previous student-attorneys about the Health Advocacy Clinic, and they told me how much they hoped to take their first client that semester. I felt fortunate to be following in the footsteps of a great team of student-attorneys who worked to build the clinic, ground-up. Thinking about my predecessors reminded me of the email Professor Boraca sent me at the beginning of the semester. Her email contained a number of intake forms, organized by topic, which list information and questions you might want to ask in a client interview. I breathed a sigh of relief. These intake forms gave me a good place to start, and once I read them, they prompted me think of other sources I could read to find out what information I needed to know for my first client interview.
Remembering the intake forms was more meaningful than simply giving me a place to start for my first interview preparation. When I initially read the client referral and didn’t know what next steps I should take, I felt alone, scared, and unsure of what would happen next. However, the intake forms reminded me I am part of a much bigger and very incredible movement.
As part of the Medical-Legal Partnership model, the Health Advocacy Clinic has partnered with Hesed House and Aunt Martha’s Health and Outreach Center. Since we began our experience at the Health Advocacy Clinic, the other student-attorneys and I have been fortunate to meet many staff members and guests at Hesed House, along with the staff at Aunt Martha’s Health and Outreach Center and at the Community Resource Center. Every single person we met has been welcoming and willing to help. From minor issues, like getting the copier unjammed, to some complicated issues, everyone we have asked to help us has been more than willing to do what they can for us. Their support is not only an integral component to our combined success, but also a beautiful reminder that we are part of a team working toward the same end: The eradication of poverty.
While I do not purport to understand the struggle that poverty and homelessness poses to those who endure it, I do think my moments of feeling intense helplessness gave me a very minute slice of how a person who is homeless might feel: scared, afraid, and unsure of what will happen next. However, my realization that I was not alone gave me great hope. Because of the support group I have, I felt like I had the tools needed to handle the case successfully, and I think this realization sums up one of the Health Advocacy Clinic’s goals. As one of my predecessor student-attorneys said, “[Poverty] is not a problem that can be solved without collaboration and exploiting countless skill sets, passions, and ideas—it will require a community and the use of all of its resources.” It is my hope that the NIU Health Advocacy Clinic’s partnership with Hesed House and Aunt Martha’s Health and Outreach Center will provide the same hope for those who are destitute or homeless that it provided for me: Support and confidence to realize they are not alone in their struggle, and knowledge that we are here to help.
Over the past week or so, I have been researching Medicare in preparation for the presentation Buri and I will make to Aunt Martha’s on Medicaid, Medicare, and the Affordable Care Act. I started with some of the sources Professor Boraca suggested and delved into the complicated, frightening world of Medicare. I slowly made my way through a small portion of material available on Medicare. I found several brightly colored charts that attempted to simplify the program and even documents explaining the many facets of Medicare in plain language.
As I pored over my research, I tried to make sense of it all and to imagine myself explaining the program, its many parts, and its processes to someone else. I tried to imagine helping a client enroll. Unfortunately, I quickly realized that Medicare is even more complicated than I had originally assumed. I could not imagine myself speaking intelligently about the Affordable Care Act or Medicare. They are topics that are relevant, interesting, and absolutely important to our partners at Aunt Martha’s and to our future clients. However, I found myself at a loss, wondering if I would ever ‘get it’ and have the necessary knowledge and skills to actually help either party. I started to think that both questions were to be answered with a resounding ‘no’ and that it was time for a break. Hoping that it was only exhaustion and residual negativity (from some difficulties with law review) talking, I left my computer in search of a cup of tea and some encouragement.
I didn’t anticipate the latter being as easily procured as the tea, so I made my way to our tea station and turned on the kettle. As I waited for the kettle to whistle, I reviewed my task lists for the week and the rest of the semester and wished that this presentation was over. For a moment, I viewed it as merely another task on a long list, an obstacle to overcome before graduation, another ball to juggle. Then I stopped and felt a bit ashamed. This is the very meat of the work I think is so noble. This is where I am truly learning and stretching my capacity to understand complicated concepts. This is where I am gaining the skills to actually meet needs. If I, who have the luxury of devoting uninterrupted time and thought to understanding public aid, am confused, overwhelmed, frustrated, how much more confused, overwhelmed, and frustrated must our potential clients be?
With my tail between my legs and my tea in my hand, I walked back upstairs and finished my research with new motivation.
A few weeks ago, we visited Mutual Ground, a shelter in Aurora for survivors of domestic violence and sexual assault, to talk to its staff about community partnership. We met with five members of the Mutual Ground staff, including the Executive Director, who gave us a tour of the facility.
This was my first visit to a domestic violence shelter. I wanted to know what services the organization provides and how it provides them, but I was unsure of what to expect. I found that in some ways, the organizational structure was very similar to that of Hesed House, and in others, quite different. As we were going through the meeting and the tour, my reactions were similar to how I had felt when touring Hesed House, but they were also more immediate. While taking the Hesed House tour, I had thought about what I would do if I was a single mother with two young children and suddenly became homeless, or if my husband and I became homeless with our children. But because it is hard for me to imagine myself in such a situation, I felt one step removed from the experience. By contrast, Mutual Ground had an immediate impact on me, because as a woman, this is a threat that always hovers in the background for me. It was not difficult for me to place myself in the situation of the women – or the men – walking into the shelter.
Many things surprised me and moved me beyond words at the meeting. To begin with, I had no idea that a shelter could provide so many resources. I do not know if Mutual Ground is a standard model in terms of what most shelters can provide, or if it is exceptionally well-equipped, but I was tremendously impressed to learn about its advocacy, volunteering, fund-raising, informational and support activities, and the services it provides for both sexes. For instance, I did not know that a shelter can send a legal advocate to support a domestic violence survivor when she/he appears in court. I did not know that a shelter can send speakers into schools and communities to educate children and the general population, and that such education is required in every grade in a school. I was astounded to learn that Mutual Ground staff members had conducted more than 1400 presentations at schools last year – an outstanding testament to the organization’s commitment to community advocacy and outreach. I did not know that the Executive Director of a shelter has to speak to the state’s General Assembly every year to fight to keep the shelter’s funding.
I found myself being surprised over and over again at how fearless, strong and realistic the women were, in terms of the services they provide, what they seek to achieve, and what they know they can achieve. There was an obvious bond of camaraderie, wisdom, strength and hopefulness about the group that undoubtedly exists in any organization such as Mutual Ground or Hesed House, and it provides an emotional and psychological support that such hard work surely requires, and that makes the work even more meaningful in my eyes. Over and over again, the matter-of-fact way in which the women talked about some issues and certain aspects of the tour were reminders to me of their daily battles. A woman who will return to her abuser repeatedly, the legal challenges to sole custody for a woman divorcing her violent partner, the two playrooms for children who have been sexually assaulted, the rooms filled with clothes and supplies so that the women feel at home and not devalued and dehumanized, the room on the first floor that was intended for women who cannot climb up to the second floor, sometimes because they have been beaten so badly, the police drop-offs at 2 a.m. – all these were stark realities.
At the same time, the fact that the women can only stay in the shelter for about 40 days but that most move out within two weeks was a clear indication that most of these women see themselves as survivors with lives that carry on despite the current trauma that they must overcome, particularly if their jobs and social networks remain in place and they can find a living space fairly quickly. Homeless persons, on the other hand, face a different set of challenges. If a homeless person does not have viable employment or someone willing to provide shelter, transitioning into a different mode of being is its own battle, and a homeless person may need more time to move out of a shelter than a survivor of domestic violence. Hence, Hesed House has a transitional living space for long-term residents, but Mutual Ground does not, which shed new light on these experiences for me. Both modes of being require tremendous resilience, courage and self-determination to conquer, but the challenges can be very different.
My own experiences with domestic violence and sexual assault make me deeply aware of the extreme shame that surrounds them, and the taboos that prevent an abused person from removing herself/himself from such a situation. There is a host of cultural, social, religious, financial, emotional, and psychological barriers to walking away from abuse. However, my visit to Mutual Ground demonstrated to me that if community members, and especially children, are educated about the nature of abuse, its immediate damage, its long-term impact, the irrelevance of many of the taboos, and the support system that exists for survivors – the information and support provided by an organization like Mutual Ground – it makes the process a little more bearable, and it can provide that last bit of strength one needs to walk away. I went through the tour thinking of how such information could be made ever more accessible to everyone, and how people could be made aware, truly aware, that it is okay and absolutely critical for them to talk about abuse and sexual assault and to find a safe space – because such spaces really do exist, created by places like Mutual Ground. For those who experience domestic violence and sexual assault, there really can be a “a shelter from the storm,” as Mutual Ground is described in its literature.
Sarmistha (Buri) Banerjee
In the clinic we have learned about and discussed several government-funded programs that aid those who are in need. The most recent program we have discussed is SNAP (Supplemental Assistance Nutrition Program). According to Snap to Health, a website that discusses SNAP, the first food assistance program was established in 1939. Snap to Health states that this program was implemented under the Franklin D. Roosevelt administration; specifically, it was enacted along with President Franklin’s New Deal program. In 1964, the Food Stamp Act was passed. Since this time, there have been various changes including an increase in monetary support in the 1970s , and a decrease in monetary support in the 1980s. In 2008, the program was renamed SNAP. What is interesting about this program is that there is a high likelihood that the next person you see walking down the street may be on SNAP because this program assists many people. For example, according to Building a Healthy America: A Profile of the Supplemental Nutrition Assistance Program, by the United States Department of Agriculture, 45 million people used SNAP benefits in the fiscal year 2011. This means that during that time period, one in seven Americans received SNAP funding.
There are basic requirements an individual has to meet in order to qualify for SNAP benefits. First, there are citizenship requirements. Both U.S. citizens and non-U.S. citizens can qualify for the SNAP program. If an individual is a non-U.S. citizen, there are several categories in which a non-U.S. citizen could qualify. Second, SNAP calculates benefits based on one’s household. According to the United States Department of Health Food and Nutrition Service, a household is all of the people who buy and prepare meals and live together. Last, there is a work requirement that mandates that an individual who is not exempted from working must actively seek a job and accept a job offer.
Emergency benefits are a significant advantage in the SNAP program. If an individual is in need of SNAP benefits immediately, emergency SNAP benefits can be expedited within five days of applying for benefits. However, emergency benefits are granted when an individual meets certain program requirements. According to the Department of Human Services’ website, in order to qualify for emergency benefits, one’s monthly income has to be less than $150 and the assets in an individual’s bank accounts cannot equal more than $100.
Once an individual is qualified to receive SNAP funding, the individual can then use the SNAP benefits for food items. Most food items in a grocery store can be bought with SNAP benefits, including nutritious foods such as breads, fruits, vegetables, dairy products, and non-nutritious foods. Non-food items and prepared food cannot be purchased under the SNAP program, such as cigarettes, alcohol, and animal food. In addition to these food restrictions, participants must report their income every month.
One of the more controversial issues is that there is no asset requirement in order to be eligible for SNAP. Notwithstanding two minor exceptions, asset limits have been eliminated in all households in the State of Illinois. This characteristic of SNAP increases the likelihood that one could abuse the SNAP program. For example, even if someone is not working and can qualify for SNAP, he or she may have assets of two million dollars. While this is not likely to happen, it is a risk that can be withstood. The right to food is a basic right. People cannot and should not starve, and, moreover, the government has an obligation to fulfill this right. It would be difficult to comprehend a program that could better serve the thousands of Americans who are in need of food. Moreover, would we not rather ensure that most people have access to food? The concerns surrounding SNAP are present and are owed deference, but at this point in time, what is the alternative? A person’s ability to access food outweighs the negative implications of the program because the risk of depriving those who are in actual need of the system is too great.
I have been working on several intake forms, which has been a learning experience in so many ways. With each new form, I learn more about what we need to know in order to help our clients. I have greatly benefited from not only making the forms but from also being able to see how we will be using the forms.
When I was starting each form, I did not know what the purpose of the form was going to be in the end. Each form had a topic but the purpose was something elusive. I began making each form without knowledge of whether I would be doing the task correctly or not. Instead, with each new form I hoped that I did what was asked of me to the best of my ability and understanding. During my review and creation of the forms I was always trying to keep in mind what we were going to use the form for and what was a necessary part of each form.
During each form I would always worry if I was making it correctly, and sometimes I would be nervous that I did not understand the reason I was making this specific form.
I think my feelings stemmed from my confusion at times about the purpose of each form. It was not that the form was not explained to me, it was because I lack the knowledge and background to know what is needed to start a clinic. Even though I have read a lot about the making of a Medical-Legal Partnership, the articles never list every form that is needed. The articles talk about how to handle clients and work with other professionals, not that you need an intake form, a medical release, a general release, a referral form and forms for each problem area. Not only was I not prepared to make them; I was not prepared to know how and when to use them.
The forms and basics of a clinic or any legal practice are not something that is exciting but I have come to realize that they are important. I want to learn how to use them. I hope to continue to grow by creating and using the forms. I think I learn a lot about what we are really doing in clinic with each new form. I hope to continue to learn how important each form is and the best way to use each form to benefit us, and the client.
About a week ago, our team toured the Hesed House facilities a second time and learned more about the transitional living portion of the shelter. Brightly painted doors leading to dormitory style rooms line both sides of a long hallway, and furniture sits in the hallway waiting for a thorough cleaning. Our guide explained that this was a very good sign, because it meant that someone had moved out and transitioned to independence. The communal kitchen is large and clean. As we passed through, a young mother was feeding her sons breakfast; they were dressed in superhero pajamas and seemed to be thoroughly enjoying their cereal. Our guide then showed us the communal living space, which included a space for watching television, two computers, and several dining tables. Residents must check out the remotes in order to watch television. There is also a children’s playroom that is used for structured children’s programs and can be reserved by parents for private family time.
I went into this experience expecting very little. I had experienced this tour only a few months ago. At that time, I had been incredibly impacted by the dedication of Hesed House and by its holistic approach to serving the homeless community. Although I looked forward to hearing about the organization again, I didn’t expect to gain a lot from it. However, as the tour began, I noticed things I had missed the first time. Having heard the impressive statistics and the theory behind each program before, I found myself focusing on the guests and the looks in their faces. I found myself wondering what it would be like to live at Hesed House.
The Hesed House facilities lie in stark contrast to the life of a sixth grade girl, Dasani, who lives in a New York housing project and was profiled in the New York Times’ series “Invisible Child.” Her family of nine is crammed into a room plagued with asbestos, lead paint, rotting walls, and mice. She and her seven siblings fear sexual predators and use the bathroom only in pairs. Mealtimes include an hour-long line to receive a meal and another line to microwave it each night.
Far different from Dasani’s life at Auburn, the families residing in the transitional living space in Hesed House enjoy clean, private rooms and share recreational space. The Hesed staff ensures that school buses pick up children each morning and that no child worries about safety. However, this second tour made the challenges inherent in not having a private home incredibly real to me. It would be difficult to ever feel relaxed and at home. There is something intangible about private space, about coming home and shutting the door to the world outside your family. Private arguments, meltdowns, and even illnesses are a luxury many do not enjoy.
Perhaps I was surprised and upset by this, because I place high value on time at home with family. With a busy family going in several directions, our time together without friends, employees, boyfriends, etc. is precious. Home is a place where I can let my hair down, cry about stupid things, and wear sweats all day without judgment. Even as a 25-year-old, I value the rare times where the stars align, and my entire family is together at home. Since I was very young, my mother and father regularly opened our home to anyone from foreign exchange students who had trouble with their host homes, to extended family who needed to leave dysfunctional situations and even dogs who faced the pound. The most recent additions to our family include an ex-convict, an elderly woman my mother picked up on the side of the street, a friend’s girlfriend, and a young hipster trying to find himself. My upbringing taught me to be comfortable with strangers around and to want to welcome people into my home and family, but it also caused me to cherish private time. I suppose I was so impacted by this experience, because I recognized a challenge that Hesed House guests and I share.
With this (small) piece of common ground, I will endeavor to understand where our clients are coming from. I can build upon this and find other areas in which we share challenges, interests, and goals. Practically, I hope to be able to give a little extra grace to clients, knowing more about the challenges they face.
One of the tasks that we undertook in our foundational work for the clinic was creating a survey that will be handed out to patients of Aunt Martha’s before we begin seeing clients. It is meant to provide us with a sense of which legal issues might be common or most urgent among the patients, so that we can determine which legal matters will likely require our attention. Given our resources, we will not be able to address every legal issue facing prospective clients and we will have to pick our battles. This is difficult because as clinic students we want to take on every challenge and represent every client. This survey will help us focus our skills in the areas that are affecting the most people.
Having completed nearly three years of law school, I have almost lost my ability to communicate with people in easily understandable language. When such communication involves connecting with persons who may have little formal education and who face language barriers, health concerns, financial crises and legal difficulties — private worries that they are being asked to expose to an unknown third party — every word in that communication becomes loaded. Even though the survey is anonymous, I can imagine how the person filling it out might feel. I feel the same way when I am filling out an intake form each time I see a new doctor or have to update my medical history. Every personal question seems like an intrusion into my privacy and I feel defensive at the very idea of anyone having this information. Why does the doctor need to know if I’ve ever done drugs, or tested positive for HIV, or got beaten up by a partner? Even though I laugh at my absurdity in my head, my heart resists. And I certainly have the education, the experience, and the social knowledge to understand why my doctor needs to know everything about me, and to also know that anything I tell him or her is protected by doctor-patient confidentiality. But what about the patient at Aunt Martha’s who comes in with a chronic breathing condition and is handed out a survey that does not appear to have anything to do with his medical situation? He is asked about his living conditions, his financial resources, his immigration status. Even though the survey says in bold letters across the top that it is confidential, he must circle his responses and return it to the medical practitioner who is treating him. That practitioner may glance down at his answers and inevitably, some may catch her eye. Will that make the patient feel a little more exposed, a little less worthy? Will that make the practitioner treat the patient differently, even if just by a little bit?
As law students, we train to be neutral and non-judgmental. We are taught to focus on the legal matter and to find the legal solution, to concentrate on the “facts” of the case. We are taught to be a zealous advocate, to be client-centered. But how can one separate the facts of the case from the reality of the client’s life? Especially when one’s client population is particularly vulnerable? For every word that I wrote for the survey, I had to put myself in the shoes of my prospective client. What would I think if I came to Aunt Martha’s and was handed this survey? How would these questions make me feel? Not only did I have to think of the language in a way that would be least shaming for the person filling it out, I also had to make it as comprehensible and non-technical as possible.
Creating this survey became a life lesson for me in how I could gain the most knowledge about the problems deeply affecting someone without undercutting her dignity. It was a humbling experience, and an invaluable learning experience in effective and respectful communication. At the same time, the exercise made me self-aware and mindful of the ever-present dangers of arrogance and patronizing superiority that seem to characterize our profession to the outside world.
Sarmistha (Buri) Banerjee