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Lessons Learned at the NIU Health Advocacy Clinic

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Lesson 1: Expect the Unexpected

At the end of August, I had my first client interview scheduled. Prior to the interview, we received a referral that explained a little about the client’s legal issue. I was pretty confident going into the meeting. I felt that I had done my research, had my questions, and was prepared for his answers. When our client arrived for our meeting, I asked him to tell me what brought him in. It turned out that his problem was entirely different than I anticipated. When he started to talk, I initially got a nervous feeling in the pit of my stomach. I then started to feel anxious and frustrated. When it turned out that the legal issue was different than I expected, I kind of felt like I was drowning. I did not think that any of my questions were relevant, and I did not know what to do or say next. I did not know how I was going to conduct this interview when I did not know anything about the area of law to which the client needed help with, and I was not prepared. I was kicking myself for not conducting more general research and preparing more general questions.

I have always been the person that is overly-prepared for everything. When going into a job interview, I practically memorize the website and mottos of the place where I’m interviewing and prepare many questions. I have always had a fear of failure and disappointing people. I have almost always had success when I am prepared and organized, which probably leads to my over confidence.

In the end, I was able to quickly regain my composure and go through some of the general interview questions that I had prepared. For not knowing the legal issue before hand, I was still able to gain valuable information about my client and begin helping him. This situation made me realize that I can’t prepare for everything. In fact, in situations similar to client interviews, no matter how much I prepare, things can and will surprise me. I need to learn to expect the unexpected and roll with the punches. In working with clients in the future, I will try not to be so upset when things don’t go the way I think they will. Instead, I will try to quickly bounce back and conduct the interview the best that I can.

Power of Attorney Event

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The first time I heard about a power of attorney for health care was during my summer internship after my second year of law school. As I watched my supervising attorney help a client create one, I never imagined that in a few short months, I would be doing the same work that a practicing attorney had been doing for many years.

Toward the beginning of the semester, Professor Boraca introduced us to an idea she called “Power of Attorney Day.” She explained we could plan this event for later in the semester where we would spend an afternoon preparing powers of attorney for health care for the guests at Hesed House. I immediately was excited because this sounded like a great opportunity to make contact with clients. Although I felt a little nervous about executing my first real legal documents, I was already anxious for Power of Attorney Day.

One of my fellow student attorneys coordinated the project and did a great job making sure we were ready to go on the day of the event. There was a lot of planning involved, but all the employees at Hesed House were gracious and willing to help make our event a success. After waiting for what felt like forever, Power of Attorney Day finally arrived. We went to the dining room before lunch where my fellow student-attorney gave a presentation on powers of attorney to over 50 guests, and he explained that we would be helping complete them that afternoon for those who wanted to sign up. As my fellow student-attorneys, Professor Boraca, and I helped served lunch, many of the guests expressed interest in creating a power of attorney, and I became more and more excited to help them.

As I sat at my desk waiting for my first client, I started to feel nervous, even though I thought I was prepared. I had spent several hours researching powers of attorney, I read the actual power of attorney document and statute many times, and I reviewed the example questionnaire. However, it wasn’t until I sat with my computer open that I realized what I was about to do had a major impact on my future client’s life. In fact, one day, a power of attorney could be the difference between life and death.

When my first client arrived, I began by explaining who I was and what a power of attorney was, just like I had practiced. Then, I started asking questions from the intake form. I felt uncomfortable at first because I wasn’t sure how to establish good rapport with a person I had never met but was about to ask personal questions, such as “When is your birthday?” and “What’s your address?” At that point, I realized no matter how genuine I sounded when I was practicing alone in my room, asking these questions upon meeting someone for the first time was going to be an uncomfortable experience until I had much more practice. This realization made me feel very fortunate to have the opportunity to begin my practice of law before I even graduated law school. Not only was I learning how to complete an important legal document, but I was learning how to establish rapport with people who had different personalities, how to interview clients, and how to issue spot the other legal problems the potential clients were telling me, all under the supervision of a licensed attorney.

After completing the intake form, I moved on to the retainer agreement. As I was transitioning between documents, I realized that soon I would be explaining the power of attorney to my new client. However, she would she would likely feel much more at ease when sharing information if I showed her I was confident in my abilities. Since I had explained retainer agreements before, I took the opportunity to show her my knowledge about the contract and the NIU Health Advocacy Clinic. I noticed a visible change in her demeanor. Instead of short and pointed answers, she began to relax as she told me a bit about her background. I realized that while I practiced asking the questions in the correct order, what I should have thought about is how to present myself in a way that helped the client feel comfortable to talk to me about these very intimate issues.

At that point, we moved on to filling out the actual document. I began by explaining what an agent is, what authority the agent would have, and what limitations she could place on the agent. The client seemed to understand what I was saying, and to start, things seemed to be going smoothly. I was feeling confident that she trusted me and was happy with the service I was providing. I then explained her options on when the agent’s power could vest. She seemed to have already thought about what she wanted, so she was able to make a quick decision. It wasn’t until I started explaining her life-sustaining treatment options that I started to feel nervous. I stumbled over my words because I was unsure how to approach the topic with her. As much as I had researched, read, and practiced, now that she was sitting in front of me, all I could think to say was “Is the length of your life or the quality of your life more important to you?” However, as I was thinking about that question in my head, I thought it sounded very abrasive. After a few seconds of fumbling, I was able to collect my thoughts, and started to read the first option on the form (even though that was not at all how I’d practiced). The first option indicates the quality of the client’s life is more important than the length of his or her life. On the other hand, the second option states the length of the client’s life is more important than the quality of his or her life. But, by that time, the client had already read both of her options, and she knew which one she wanted to pick. I simply moved forward with her selection, but this experience taught me something very important. As prepared as I thought I was, I had no idea what it would actually be like to ask someone I just met whether they wanted their body to be buried or cremated, or what their personal preferences were regarding life-sustaining treatment. I think these subjects were more difficult to ask about because they are intimate questions, and I was unsure how to “soften the blow” when I asked them. In other words, I felt like a doctor explaining to my patient that she was, in fact, going to die one day, as if this was a surprise to her. I am told this is a perfect analogy to what the practice of law is like: no matter how much preparation you do, something will arise that you did not plan for, and the best thing you can do is learn how to “roll with the punches.”

With each subsequent power of attorney, I improved my questions, my ability to communicate with the clients, and overall demeanor. Many of the opportunities I have had at the NIU Health Advocacy Clinic are helping to make me practice ready, but Power of Attorney Day sticks out as one of the most beneficial. I discovered that it is important to prepare, but it is also important to be flexible. I learned that although technicalities are important, the best way to ensure I follow the correct procedure is by emanating confidence so the client trusts that I am handling their legal issue well. Most notably, I realized that as an attorney, I am going to be dealing with sensitive and uncomfortable topics, and the more experience I have in dealing with them, the more I will be able to use my degree to benefit the public . . . which is what the NIU Health Advocacy Clinic is all about.

Rapport v. Mission

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I recently conducted my first client interview at the Health Advocacy Clinic. The client and I sat in a large open conference room along with another clinical student and my supervisor. Before the interview, I developed an outline and a strategy for conducting the interview. My goals were to establish rapport, get accurate information, and communicate to the client his next steps. I went in with a 4 page outline of relevant topics to cover and rehearsed my questions. I prepared very concise questions and I expected to get clear and concise answers. During the intake interview, I accomplished many of my goals. I established good rapport and learned about the client. But I did not get clear information regarding the client’s issue; or at least the amount of clarity that I was expecting. The interview brought some frustrations. I had specific and organized topics in my outline, but the answers I got were sporadic. In addition, the client brought in a large amount of unorganized paperwork. Trying to juggle listening to the client, looking at his paperwork, and writing things down was difficult. Another challenge was the client’s fatigue. I could have talked to the client for three hours. After about one hour he began to get tired and became more emotional about his situation. I tried to balance being sympathetic and also cutting through irrelevant stories. I was thinking about all of these different things during the interview. It caused me some confusion but overall, I think I accomplished the goals of the intake interview.

The biggest challenge in the interview was simply the amount of goals. I felt pressure to do a “good job.” But doing a good job in one area meant another area might be sacrificed. For example, this was the first time I met the client. He was hurting emotionally, and I wanted to establish trust. I wanted to really listen to the client and connect with him. I wanted to be patient and not dismiss the things he was saying even though some things were irrelevant. I wanted the client to leave feeling that we cared and could be trusted in both competency and zeal. Another goal of the intake interview was paperwork. I needed my client to fill out a large amount of intake paperwork, and I needed to sift through the large amount of paperwork that the client brought us. Most of all, I wanted to gather clear facts. These goals required concentration on my part.

I learned valuable lessons during the interview. Clients are coming to the clinic with diverse experiences. For example, some clients have had bad experiences with attorneys. I need to understand that and be prepared for emotional conversations, frustrations, and ambiguity in fact gathering. Part of interviewing with clients will also be setting good expectations for them and balancing my need to gather relevant facts against the client telling unrelated stories. I also need to practice. Building rapport and fact gathering will only come more naturally with additional experience. I’m excited to take advantage of more opportunities to interview and engage with clients.

Serving Lunch

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One day Kelli, Jason, Colleen, and I volunteered to help serve lunch at Hesed House after our class period. We went into the PADS dining room around 11 a.m. Walking in, there were a bunch of guests sitting at the tables. They were watching T.V., reading, doing crossword puzzles or word searches, and talking to each other. As lunch did not start until noon, we were each given a task to complete before we started to serve. I was put in charge of making sure that Hesed House guests checked in when they came in. I would let people through the door when they knocked, ask them if they had checked in already, and if not, confirm their ID. After that Colleen and I went to hand out mail. People would show us their identification card, and we would look to see if they received any mail. Before it was time for lunch, we introduced ourselves and told everyone about the Health Advocacy Clinic and the types of cases we handle. Some people came up to us to ask us specific questions about the types of cases we represent or tell us that they had a legal problem and would be coming to see us. It was then time for lunch. We each served food to the people after a Hesed House staff member said a prayer.

Before this experience, I was a little nervous about going. I thought I did not know how to relate to someone who lived at a homeless shelter. I feel really privileged compared to people experiencing homelessness so part of me thought that they would not want to accept help from someone who could not relate to their experiences. However, during the whole experience I kept thinking how all of the individuals sitting in the dining room reminded me of people waiting in a train station or airport. At a train station you see a bunch of different people just sitting or standing and waiting: waiting for their train to arrive and waiting for their next destination. During this experience, I saw similarities. There were a bunch of different people sitting around waiting: waiting for lunch, waiting for their circumstances to change, waiting to find out where they are going and what is happening next. I realized that even though I felt like an outsider, I am not really any different than people experiencing homelessness. Though I may be blessed with what I have, I, too, am sitting here waiting: waiting to figure out what I am going to do with my life, waiting to figure out what comes next.

I was really surprised by the overall experience. I went in feeling apprehensive. However, when I realized that we are all people and that we have things in common, I relaxed, and I really enjoyed talking to and helping the guests of Hesed House. I think that this experience will be very beneficial for my future. Through the clinic, I am going to be working with the guests of Hesed House so the fact that I now feel comfortable around them will be beneficial. This will make me a more effective advocate. I think that this will also help my future career. No matter what I do, I am going to work with people that I may not feel comfortable around or who are different than I am. Now that I have made the realization that I just need to find something in common in order to feel comfortable with someone, I will have a better chance of being able to feel comfortable around any type of person, no matter how much I think we are different.

NIU College of Law Health Advocacy Clinic is Open!

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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.

Medicare, Tea, and Renewed Motivation

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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. 

Those Who Fight for Those Who Cannot

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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