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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
Sometimes there are just things that we cannot understand. I have found myself feeling that way more often than not. This may not be the most understandable position to take when dealing with the effects of poverty on individuals but it is hard for me to wrap my logic around why so many people are struggling with poverty. I know that there are so many reasons why poverty happens, from society to personal. I try to think of ways to solve the problem, that is when I realize that there is not just one problem. How can you solve a problem that has so many aspects? It is disheartening; maybe there is no solution.
But I can at least be part of a solution; anyone can be if they choose. Awareness is the first step, but what I have come to realize is that awareness takes time. We are all aware that poverty exists, but what we need is a deeper awareness. A deeper awareness to me is a type of understanding that brings every aspect of the problem together to show you the big picture. After three months I am beginning to see the bigger picture, but that is after countless years of prior awareness. Now, I am learning, experiencing and gathering. I am learning about the factors that can cause poverty, how each one is unique and influential. I am experiencing my conceptions and grasp of the world around me shift. I am gathering the information needed to have awareness and be able to help combat the problem. I have had the tools to be aware all along. However, I am only now starting to use those tools.
Setting up the clinic has been vital to my learning experience. You can only go so far on your own. Everything I have read for class has expanded my ability to understand what I will be working toward in the clinic. I will be making a change. Although each change will be a small step and maybe only one step in the right direction, to the person I am helping, it could mean survival. Survival, this is something I have never had to fight for. But individuals living in poverty have to fight for survival everyday. One wrong decision could lead to a downward spiral of negative consequences and struggle. It is hard to imagine one decision that could create such a response. It is especially hard to imagine when that one decision can be something simple like paying rent or eating dinner. Those decisions are things that an average American would not have to make, but individuals in poverty deal with those decisions everyday.
Decisions that should be made easier through change to the way our society handles these problems. Make things simpler. Make things easier. I don’t feel strongly either way about governmental aid; I see positives and negatives to both sides. What I do feel is that our society already has programs in place that give aid and if they are in place they should be utilized to better the lives of others. Often, the only need, which creates the ability to survive, is one thing. What I have learned is that one act, one thing, one decision can make a difference or can be the undoing of everything. I do not know why that is what has stuck with me, but it has made a huge impact on my perception of poverty.
I think of the family who does not know about a resource, so they do not receive that one thing is the difference. That is what makes this clinic stand out to me. We could provide assistance to those who need that one thing that is the difference. We could be the difference in someone’s life. I want to be that difference. I am excited for the clinic to start making a difference and an impact on the community surrounding it. What this class has taught me is that we can help. We can make the difference that is needed and affect the lives of those who need help the most. Isn’t that what being a lawyer is about? Advocating for those who need it? Who needs it more than someone in poverty, where only one act can be the difference between survival and losing it all?
I will take what I have learned with me into my practice of law. I will hopefully be a better listener, more understanding and most importantly a trusted advocate. I understand why we need to learn about all aspects that create poverty. We need to not only be able to pick them out so we can help solve the problems they cause but we also need to understand them so we understand our client. I now have a better understanding of my potential clients through this experience. It has been a great learning experience, and will hopefully make me a better advocate.
It turns out that when they call clinics “experiential learning,” they really mean it.
Emily, Buri, and I are enjoying the unique opportunity to participate in setting up a medical-legal clinic. We are seeing things from the very beginning stages and learning about all of the thought and planning that goes into a clinic before you ever meet your first client.
We drafted agreements, started a blog, communicated with healthcare professionals, researched social determinants of health, and delved into the world of poverty through research and in-depth discussion. Our experiences thus far have been both challenging and engaging; they have opened my eyes to a new world and new ways of thinking. I expected that, but I did not expect to learn so much about myself.
This was supposed to be the safe semester. We are not even taking clients. I believe that I subconsciously hoped my work this semester would be just a half a step away from the classroom context I have become so comfortable with. This was not the case. In place of the intellectually stimulating but rarely upsetting work I wanted, this clinical experience has been just that—quite an experience.
I have been forced to confront my own biases and the position from which I act and make decisions. A few short months ago, I was far less aware of these very real issues.
Through readings providing a vivid picture of poverty and homelessness, I was forced to acknowledge and adjust my view of the indigent population.
I was struck by the fact that there is no clear definition or profile for the “poor,” and there is no single party to blame. In the introduction to his book, The Working Poor, David Shipler suggests, but I will say that I believe, that society is largely to blame for poverty. Why don’t we care for our mothers, brothers, cousins, aunts who are in poverty? Yes, the individual is often responsible, but if there are poor, there is probably something wrong with our greater system. It cannot be just an isolated addiction or case of bad luck.
Mr. Shipler also addresses the morality of poverty. This is a concept I had not consciously addressed. He states that, for many, “hard work is not merely practical but also moral; its absence suggests an ethical lapse. A harsh logic dictates a harsh judgment: If a person’s diligent work leads to prosperity, if work is a moral virtue, and if anyone in the society can attain prosperity through work, then the failure to do so is a fall from righteousness.”
Do I subconsciously think this? I’ve never been very motivated by money or given it much thought in my personal life, but I’ve also never lacked it. I think that I may subconsciously give someone more value, or more credibility at least, when I learn that they make a substantial amount of money or drive an expensive car. Being the product of the twenty-first century that I am, I was quite uncomfortable admitting that this necessarily means that I place some moral judgment on those who lack social and economic success. This was directly challenged as I read countless stories of those who found themselves caught in the vicious cycle of poverty. Some lacked the hope to pull themselves out of it, and some were victims of misfortune that upset the delicate balance so many must maintain to stay out of poverty.
As we studied and discussed cultural differences and how to strive for cultural competence, I was forced to wrestle with my ability (or perhaps inability) to recognize that those who come from other cultures or family situations may communicate and think differently than me. Further, I was challenged to learn to look for similarities when they may not be obvious. I anticipate that the greatest challenge may be learning to appropriately balance the two.
As the ‘type A’ outnumbered in a very ‘type B’ family that often thinks it is the exception to every rule, I thought I was accustomed to being challenged and questioned. However, I am thrilled to say that this experience is stretching me in a new way. What a privilege to leave the confines of the classroom for “experiential learning” that is anything but safe.
For one of our classes, our professor had us read an article about Dana Suskind. Dr. Suskind is the co-founder of the pediatric cochlear implant program at the University of Chicago Children’s Hospital, bringing sound into the lives of children born deaf.
I am particularly vulnerable to stories about children, in any form. While the rest of the world runs around making grand gestures, children get hurt and very few of us do anything about it. Those who are in the trenches are driven by love, not for any glamor or glory that may come with it. I cannot think of anything that could be more rewarding than bringing a child’s potential into bloom. And Dana Suskind does that with her implants.
But Dr. Suskind does a whole lot more – she works in the world of holistic health care, where the connection between health and social determinants, the world that we explore in our clinic, is very real. Dr. Suskind’s research led her to the “30 million-word gap” – something that I was unaware of until I read the article. The 30 million-word gap shows that “by the age of 3, children of lower socioeconomic status will have heard about 30 million words less than their more affluent peers” – a gap that impacts everything in those children’s lives, from academic achievement to school preparedness to later success. And as we uncover more information about the social determinants of health, it becomes ever more apparent that life success is intricately connected to our health.
In response, Dr. Suskind has started the 30 Million Words Project, a program that addresses the gap through “parent-directed intervention.” The program “sends research assistants to the homes of at-risk children for 13 weeks and educates their parents about the importance of engaging their children in an ongoing dialogue – and, equally important, offers them the tools to do so.”
I find it remarkable that the connections to long-term health outcomes can be traced to such an absolutely basic idea – to how much a parent talks to his or her baby! And I find it equally remarkable that Dana Suskind has not confined her ethic of serving the most vulnerable among us to just her operating room, but has stepped into a world very different from one that she is used to, and is making a difference in real people’s lives in a way that a scalpel could not.
Sarmistha (Buri) Banerjee
What do Miley Cyrus and holistic medical care have in common? Foam fingers, bears, and twerking aside, both are at the center of a movement. Miley’s movement is more about shock and confusion than substance, but the same cannot be said for the movement to provide more effective healthcare that is sweeping the nation.
Medical-Legal partnerships are not alone in this quest. Across the country, legislators, lawyers, healthcare practitioners, social workers, and advocates for America’s poorest are realizing that there is no single, easily identifiable cause of poor health or poverty and that simple, one-dimensional solutions are ineffective.
“The Hot Spotters,” an article that appeared in The New Yorker on January 24, 2011, highlights several champions of effective healthcare.
Jeff Brenner studied the patterns of patients entering hospitals in Camden, New Jersey and found that, of the 100,000 people using medical facilities in Camden, about 1,000 people accounted for 30% of the city’s medical costs. He developed an innovative approach to healthcare by spending time with some of these high-cost patients to determine the individual causes of their health problems and then solving them by any means necessary. He worked with social workers, visited the patients at home, and even encouraged them to cook for themselves or attend Alcoholics Anonymous and church meetings. His theory is that by focusing on these patients, he can help them and the entire healthcare system.
Rushika Fernandopulle, who runs a clinic for hospital and casino employees with high medical expenses, uses “health coaches” to guide and support patients as they improve and manage their health. These coaches provide the intangible help that is often lacking in conventional medical settings. They connect with patients, gain an understanding of their lives and challenges, and encourage them on a regular basis.
It’s truly an exciting time to be part of the quest for health for our nation’s indigent population.
Check out “The Hot Spotters” at http://www.camdenhealth.org/wp-content/uploads/2011/03/Gawande-Camden-Annals_17.pdf