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The Health Advocacy Clinic (HAC) is a medical-legal partnership with Aunt Martha’s Health and Outreach Center as well as Hesed House, the second largest homeless shelter in Illinois. Most of our clients are homeless. The ones who are not consist of low-income members of the community who struggle with poverty. Whether our clients stay in public housing or at Hesed House, they share one thing in common: their lives are stressful in a way that many of us cannot begin to comprehend.
HAC clients frequently experience stress trying to secure basic needs such as shelter, food, and safety. The effects of such stress can have long-term effects on their bodies and overall health. “The longer the stress lasts, the worse it is for both your mind and body.”1 Many of our clients are considered chronically homeless, which requires that they have been homeless for at least a year or have been homeless at least four times within the last three years and have a disability, and have therefore been subjected to the harmful effects of chronic stress.2 Although Hesed House provides its guests with a safe place to spend the night and three meals a day, guests are on their own during the day. Walking the streets of Aurora, they may become victims of crimes that threaten their safety simply because of their status as a homeless person. If they are disabled, physically or mentally, they may be perceived to be less likely to fight back during a physical attack, robbery, or sexual assault. Additionally, guests may be unable to find stable employment, which will prevent them from earning the funds necessary to escape homelessness.
The HAC works to secure Social Security Disability benefits for our disabled clients. Our work is necessary because of the strong link between homelessness and disabling conditions. According to the Department of Housing and Urban Development, “people living in shelters are more than twice as likely to have a disability, compared to the general population.”3 Even if a client’s disabling condition did not cause their homelessness, the condition certainly was not improved due to the chronic stress the homeless face. For example, a client of the HAC came to Hesed House with back pain problems. After having to spend every night sleeping on a mat on the floor, his back pain has become so severe that he walks with a cane and is being referred for spinal surgery. The disabling condition does not have to be physical; mental illness can be worsened by the stress of homelessness as well. A former client of the HAC struggled daily with managing several mental health diagnoses while staying at Hesed House. Now that she has been granted Social Security Disability benefits and was able to move into her own apartment, she is able to function in society much easier.
At the HAC, a student will learn the relationship between chronic stress and medical conditions. They will see how a controllable disease such as asthma or high blood pressure can be worsened to the point of disability by the chronic stress associated with homelessness. For HAC clients pursuing Social Security Disability, the condition must be disabling enough that the client will be unable to work for 12 months or more. A law student can attest to the fact that stress can have a negative impact on the human body, but it is the HAC clients who can show you how devastating chronic stress can be on every aspect of the human life: physical, psychological, and emotional.
“James” is client of the Health Advocacy Client who was recently awarded SSI benefits. This includes both a monthly payment and a larger award of back payments which will be paid out over several installments. As the Associate Director of Housing and Supportive Services at Hesed House, I act as his case manager.
James began staying at Hesed House in April 2012. He became a Lighthouse client in December 2014 which means that he lives in an apartment in the Aurora community as part of our long-term, permanent supportive living program.
When he was staying at Hesed, James was always getting sick because of his many health conditions. He is doing better now that he is staying in his own apartment. He even comes back and volunteers at Hesed when he physically can. Also, he’s very active in the Lighthouse community, especially by acting as a mentor for the younger residents which is beneficial for us as well.
One of James’s goals since I first met him when he started staying at Hesed was to pay off his many traffic tickets so that he could get his driver’s license back. Since he does not have a driver’s license, James has to rely on other people and public transportation. With his extreme health conditions, the reasons he was approved for disability, he has to see a lot of doctors and physical therapists. Relying on other people and public transportation to get to his appointments costs James a lot of money. Public transportation posed its own set of issues. Meals at Hesed are served at a set time and he would end up missing dinner because of how long the buses would take to get him back. At times, it seemed like James had to choose between his health or his sanity, and I don’t think anyone should ever have to make that choice. Once he gets his license back, it will be much easier to manage his health and his appointments.
The steady stream of income will be life-changing for James. He will be able to live a non-homeless life where he doesn’t have to worry about if the food pantry will have enough food for him. Now he will have money for groceries, especially fresh food, that will be more beneficial to his health. He’s also going to be able to afford cable, which is a big deal for him because he is a huge sports fan. He can be social and go out to eat now too. He can afford to buy laundry soap with the scents he wants, not just use the ones that are donated. These are things that people who are not homeless take for granted, but things that James has never had because of the uncertainty of his life.
I am so happy for James to finally be able to spend money, an ability he has never had before. However, he is worried about spending it in the right way since this is new for him, but I have assured him that I am willing to ease him into his new life. He finally feels like he is set on his path in life. James has a great support system here at Hesed between the case managers, staff, and other agencies, including the NIU Health Advocacy Clinic. It has been wonderful to see his life be completely changed for the better.
Hollie Nilles-Ohme, Associate Director of Housing and Supportive Services at Hesed House
Over the past several months, I have had the opportunity to briefly meet a number NIU HAC clients. One Friday morning, I noticed that there was an older lady, with a piece of luggage, just sitting in the woods. Later that day, I realized that this person was one of our clients and felt sad that she was sitting in the woods, all by herself on a cold Friday morning. During our meeting with that client, and other clients since, I have been impressed with the fact that our clients are intelligent, personable, and capable. In addition, I have come to the conclusion that we, as a society, could be doing so much more to help those who are homeless and in need. We should explore how we can empower our clients to take advantage of all of their talents. Specifically, there are ways to leverage technology and to teach practical skills that are in demand, such as bookkeeping and coding.
Almost everyone in America has attended school (at least through the second year of high school). In addition, our clients have an abundance of life experiences. I am worried that many of them are not taking advantage of opportunities that life offers, because they are living day-to-day and just trying to get by. When I see residents of Hesed House in the park, I wonder if even a few would be interested in furthering their education and developing marketable skills, especially in technology, as the internet has created many new possibilities for people to work remotely and as independent contractors. While this may not be realistic, I want to help.
I realize that there is much that I do not know. However, I remain optimistic because our clients are just like you and I in the sense that they want to be happy. I truly believe that if one is to be happy, one must feel as if they are being challenged, engaged, and adding to the greater good of society
Based on past experiences, military and civilian, I believe that when others are given access and opportunity that great things can happen. For example, when I was in Afghanistan, I was moved by the courage of so many young children to try to make a better life for themselves and their families – they gave me hope. Likewise, I know that organizations like Hesed House and our clinic, add value in so many ways to those in need. Therefore, my take away from my own experiences in life is that we can do even more.
I have learned more about myself over the past several months because of this experience at the NIU HAC and I hope to continue serving those in need, long after my time with the clinic is complete. Again perhaps we can use technology to assist helping the talented (regardless if they are poor or homeless) to find ways to continue to engage and make the world a better place for all.
During my time working at the Health Advocacy Clinic over the summer, our group of three students was able to serve lunch in the cafeteria to guests in the PADS program. The cafeteria was pretty full; there were a lot of guests. Looking at the tables, I saw some guests who looked exhausted with their heads down. Still there were others attentive who ready to eat and very talkative. Then there were a few who sat alone in silence. We were met by a woman who worked in the kitchen and seemed to be running the show. She immediately asked, “Which one of you has the strongest stomach?” We all sort of looked wearily at each other and finally someone asked why. She informed us it was because that day, they were serving “delicious” pigs’ feet. The woman explained to us that a very nice large donation had come in and there were also specific requests for pigs’ feet. Right away, one of the other students stood up and said he would serve them, at which time I let out a sigh of relief, ran to the chocolate pudding and guarded it like it was Fort Knox.
Once we were set up at our stations, there was another woman who asked the guests for silence for a few announcements. The first announcement was about how there would be a sign-up sheet for showers because they were being fixed; another about how Hesed House had organized a group choir and that they had five people show up to the first meeting. At the conclusion of the announcements, a guest led a prayer over the food. Hesed also had a drawing for the guests, where winners were allowed to go first in line. Following the winners from the drawing, staff released guests table-by-table to the food line in a very organized fashion. Overall, the guests were respectful and polite when coming through the line. While serving the food, I tried to make eye contact, say hello, and ask, every so often, how they were doing. I could tell there was a language barrier with some guests as they just smiled and nodded when I spoke to them. There were other guests who were more talkative and also asked me how I was doing. All the guests were humble, gracious, and never once did I see a guest turn their nose up at or complain about the food
Unexpectedly during lunch, most of the guests turned down what I thought was the best part of the meal: the dessert. What shocked me further was the fact that several of the guests actually commented how the sugar and sweets were bad for them and declined to take any pudding or cupcakes. It surprised me how concerned most of the guests were about maintaining good health. I think I was surprised at the guests rejecting the dessert for a couple of reasons. For one, I have a sweet tooth and to be completely honest it would have probably been the only thing I ate that was being served that day for lunch. Secondly, I again think that the media and the news have shaped my misconceptions about the homeless. I feel like they are portrayed as lazy, stupid, not concerned about maintaining good health, and just not really concerned about anything. I had a misconception that the guests wouldn’t really care about their figure. Third, I think it was surprising because I wouldn’t expect the focus to be on eating healthy with everything else going on in their lives. I think it showed me that the guests, although in a tough spot right now, are still striving to make health-conscious decisions.
I am so glad and grateful for this opportunity and the many others I have had to work with the guests throughout my time at the Health Advocacy Clinic. During my two semesters, my preconceived feelings and attitudes about homelessness, originally shaped by limited media sources, were put to the test. I can say now that my prejudices have morphed into an empathetic understanding of the underlying issues that face the guests at Hesed House. Obtaining this awareness through the Clinic, I feel powerful with these gainful insights about our society and culture and hope to use this knowledge as I continue my career in public service.
In July, I went to Oak Brook for a Social Security hearing. I was representing a client whose case I had been working on all summer. In preparation for the hearing, I wrote a pre-hearing memo, drafted questions to ask my client as well as the vocational expert, wrote an opening statement, and submitted medical records, support letters, and a pre-hearing memo to Social Security.
I had a lot of expectations going into the hearing. First, after talking to someone who had been in front of the same judge for a separate hearing, I assumed the judge was going to be friendly. I had also learned that the format of Social Security hearings varies between the different judges. I was, therefore, planning to give an opening statement. I anticipated that the judge and I would ask the client and the vocational expert questions. I also understood that Social Security judges do not make decisions immediately following the hearing. I did not think we would find out whether my client was approved for six to eight weeks afterwards, rather than in person.
My expectations did not exactly follow what actually took place during the hearing. First, the judge immediately began asking my client questions and then asked me to give my opening statement following his questions. This format through me off a little and made me nervous. Through my reading about Social Security cases, the normal practice seemed to involve the judge and representatives asking the client questions. At our hearing, the judge asked me the majority of the questions. Although I had a good grasp as to the answers, I was nervous that if I answered a question regarding my client incorrectly, it could ruin her entire case. In addition to asking me questions pertaining specifically to my client, he asked for specific exhibit numbers of evidence submitted to Social Security. This also made me nervous because an exhibit number is not something that is memorized but rather is something that can be quickly identified if the representative is well prepared.
Although the hearing was not exactly as I had anticipated, I was very relieved in the end with how it went. Because the judge asked me, and not the client, the majority of the questions, I was able to advocate for my client and get her story out to the judge. My client was also very nervous, and I was relieved she did not have to answer a multitude of questions. Although I was expecting to cross-examine a vocational expert and knew it would have been great experience, I was thankful the judge did not think it was needed. Instead, he granted my client benefits in person at the end of the hearing. Not only was I pleased at the end of the hearing, my client was very happy as well. Throughout the process, I learned how important it is for a client to have a representative. As a representative for my client, I knew what the best arguments were and how to get my client’s story to the judge. I also learned to be prepared for anything. It has been one of the most rewarding experiences thus far in law school.
On August 29, 2016, Assistant Professor Michelle Lilly from NIU’s Department of Psychology gave a presentation to our HAC class on “Working with Clients Suffering from PTSD and Mental Illness.” She offered a lot of valuable information concerning this topic and shared some of her experiences throughout her career. In addition to her presentation, our class also read two articles concerning PTSD [post-traumatic stress disorder] and mental illness. Both the presentation and the readings were enlightening and opened my eyes to my own misconceptions concerning the topic.
Going into the presentation, I was somewhat prepared because the readings had broken down the basics of what qualifies as PTSD. However before reading the articles, I was under the impression that PTSD was mainly used to refer to symptoms experienced by war veterans or people in similar situations. During Professor Lilly’s presentation, she gave a little more insight on the qualifications for PTSD. One of the things she spoke about that surprised me, but also made a lot of sense, was that the rate of PTSD is high among women.
She further explained that a lot of the high rates of PTSD in women are due to them being sexually abused at some point in their lives. Hearing this really made me sad because I began to think of a woman whom I personally know that has experienced sexual abuse. I began to realize that she fit all of the symptoms of PTSD. She was sexually abused as a child, and she always seemed to end up with guys that were either abusive or had a traumatic background as well. In addition, I realized that her PTSD had been triggered after she had her daughter. Recalling all of this information during the presentation made me sad because I realized that this entire time, I never realized she was suffering from PTSD. I always wondered why all of a sudden she was having all of these feelings of depression when in the past, she had always been good. I also knew that the birth of her daughter had triggered thoughts from her childhood, but I never really quite looked at it as PTSD.
I believe that my experience of being misinformed about PTSD is what caused me to feel sad. In addition, I come from a background where mental illness is not looked into. A lot of times mental illness is looked at as weakness unless you reach the point where you need to be assisted. For example, a person diagnosed as bipolar would be looked at as not having self-control or someone making excuses. In fact, that person would likely be labeled as moody and not able to handle adversity. As a result, we are taught to be strong and learn how to accept adversity because it is a part of life.
Although, I was always supportive of this woman, I never quite understood why she would react like she would. Professor Lilly’s presentation explained it all. It explained that some people with PTSD sometimes snap at small things because they don’t comprehend that they are small. This was my experience with this woman. I never understood why she would overreact to almost everything I considered to be small. However, I was surprised that I had already used some of the methods utilized to help communicate with people suffering from PTSD.
I can apply what I learned by taking into considerations some of the ways to recognize PTSD and use the methods taught during the presentation to deal with clients who may have PTSD. In addition, the presentation was useful in my personal life. For example, I called the woman who suffered from PTSD and spoke with her about the information I had learned and asked her if she knew anything about it. She informed me that she had in fact been diagnosed with PTSD but was not able to continue to attend counseling due to financial reasons. However, I spoke with her a month ago and she is now seeing her counselor again. I am happy that I learned this information because I was able to understand a friend on a much deeper level.
Today I visited my client with my supervisor and a Spanish interpreter so I could meet him and update him on the progress of his case. I introduced myself to my client and shook his hand. Via the interpreter, I explained that I was the new student attorney assigned to his case and how I was in the process of collecting his updated medical information to send to Social Security. I told him that part of how I planned to accomplish this was to schedule a meeting with his social worker. I explained that once I received all of the needed information, I would send a memorandum about his case to Social Security with the goal of having his case reviewed and approved without needing to wait for a hearing. Acknowledging his frustration with the rotation of student attorneys on his case each semester, I told him that I hoped that I would be the last student attorney he would have to see. I asked him if he had any questions. He did not but stated that he wanted to be present at the meeting with his social worker and that he wanted to be kept updated about the progress of his case. I assured him that both of these things would happen. He thanked us for meeting with him, and I thanked him for speaking with us. I shook his hand one more time and told him that it was nice to meet him.
I was not sure what to expect as I was aware that sometimes my client was very lucid and cooperative while at other times, he could be irritable and confused. Colleen told me that the last time she had seen him, he did not know who she was. Also, the way that the clinic is structured, student attorneys are assigned to a case for timeframes ranging anywhere from a summer to a whole school year. The amount of time that a student attorney is assigned to a case depends on how long they choose to stay enrolled in the clinic. Given that the clinic has been working on my client’s case for about a year, he has had three student attorneys before me, which I knew frustrated him. Because of these frustrations and his fluctuating memory and mood, I was concerned about how he would respond to me. I was relieved that he responded to me favorably for his peace of mind and for mine as well. I was proud that I still knew how to apply the people skills I had acquired from past work experience to put him at ease. It was rewarding to establish some trust with him and to give him a status report on his case that he appeared to be satisfied with.
Based on this meeting, I will strive to be diligent in keeping my client informed of the status of his case as it progresses. His frustration with having more than one student attorney gives me extra incentive to not only complete my memorandum in a timely manner but also to make sure that it provides enough strong details to encourage Social Security to review and approve his case before a hearing date.