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Chicago Family Advocacy Program: A Medical Legal Partnership for Children

Chicago Family Advocacy Program: A Medical Legal Partnership for Children. McDermott Will & Emery Tuesday, April 25, 2006. Julie Justicz Health & Disability Advocates jjusticz@hdadvocates.org 708/567-9471; 312/223-9600. Overview of Presentation. Background/Project Access

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Chicago Family Advocacy Program: A Medical Legal Partnership for Children

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  1. Chicago Family Advocacy Program: A Medical Legal Partnership for Children McDermott Will & Emery Tuesday, April 25, 2006 Julie Justicz Health & Disability Advocates jjusticz@hdadvocates.org 708/567-9471; 312/223-9600

  2. Overview of Presentation • Background/Project Access • Julie Justicz, JD, Health & Disability Advocates • Medical Perspective • Dr. Rupa Nimmagadda, MD, University of Chicago, Center for Healthy Families • CFAP Opportunities • Julie Justicz • Federico Guzman, JD, LAFMC

  3. BACKGROUND: Project Access 2000-2004 • Pilot Project – A Medical, Legal, Case Management Collaboration • Very low birth weight infants or medically high-risk infants from neonatal intensive care unit (NICU) at two hospital sites • Followed for one-year post-discharge in clinic setting • Families of infants met regularly (2-4 weeks) with lawyer/case manager • Rec’d range of legal help • Neonatal Infant Outcome Study (NIOS): Randomized-controlled study of project services

  4. BACKGROUND: Why Was Project Access Developed? • Convenience and access for families • Combined medical risk and socio-economic disadvantage of target families • Proactive model • Best practice model for providers • Help families access broad range of social support services and developmental therapies • Good results in several key areas: access to benefits, receipt of benefits, compliance with care

  5. NEW PROGRAM, May 2006: Chicago Family Advocacy Program • Medical and legal collaboration to assist families of infants and children with special health care needs; builds on successes of Project Access; expands patient base and range of services • Start Date: May 2006 at U of C • Partners: • Health & Disability Advocates • Legal Assistance Foundation of Metropolitan Chicago • University of Chicago Comer Children’s Hospital/Center for Health Families Clinic • McDermott Will & Emery

  6. CHICAGO FAMILY ADVOCACY PROGRAM • SITE: University of Chicago’s Center for Healthy Families • PATIENTS: Medically high-risk infants and children, birth to age 5, who seek follow-up care at clinic • MORE SERVICES: Broader range of legal help for families: LAFMC brings array of legal resources

  7. MEDICAL PERSPECTIVE: Dr. Nimmagadda • What we mean by “high risk” • Birth weight less than 3 pounds (Very Low Birth Weight or VLBW) • Living in low-income household (social disadvantage)

  8. Current Trends • Increasing numbers of VLBW infants • Decreasing mortality rates • Heavy resource allocation toward neonatal intensive care

  9. Current Survival Rates

  10. Current Outcomes • Primary long-term risk is developmental sequelae & poor learning • Optimal outcomes achieved through: • Medical home • Close monitoring of growth & development • Maximal social supports • Timely treatment modalities

  11. The Medical Home • Center for Healthy Families Provision of primary pediatric care, education, social support, and advocacy for high risk infants and children ages zero to five years. Comprehensive care from a multidisciplinary team

  12. The Clinic Team • Pediatrician • Nurse Practitioner • Nurse Educator • Social Worker • Registered Dietician • Physical Therapist • Occupational Therapist • Speech & Swallow Therapist • Home Nurse (collaborative relationship)

  13. What we know • Social factors exert a profound influence on the health of children • Early childhood is a “critical” period for brain development • Effectiveness of early childhood intervention programs persists into school years

  14. What we face • Awareness of the importance of social factors • Recognition that access to health care and social services is paramount to good health • Realism that resources to overcome social barriers are often beyond our reach

  15. The Result • Complex, unfamiliar social service systems make advocacy difficult, inefficient, and ineffective. • Social issues seem untreatable • Medical treatments become irrelevant

  16. The Medical-Legal Partnership • Valuable means for effective advocacy • Addresses significance of social factors • Places solutions to social barriers within reach • Increases the return on our initial investment • Improves overall health of highest risk infants

  17. Making a Difference…

  18. CFAP OPPORTUNITIES: Legal Help for Families • Lawyers meet families during medical clinic hours, assess cases, provide brief advice, referrals, counseling, or legal representation • Lawyers take referrals from hospital social workers, medical providers and provide assistance to families • Lawyers provide training, back-up and support to social workers and medical providers • Lawyers conduct individual representation and administrative advocacy on range of civil issues

  19. Types of Legal Services Provided • CFAP will provide full range of civil legal services including: Public Benefits – SSI, TANF and other benefits, Medicaid, Insurance, Housing/Landlord-Tenant, Consumer, Unemployment Insurance, Domestic Violence, Early Intervention, Special Education, and other issues.

  20. Case Example • Twenty-year old single mother comes to the clinic with her two-month old baby girl, Courtney. Courtney has congenital heart condition that will require two surgeries. • Courtney was denied SSI disability benefits on initial application. • Attorney helps mother file appeal, advocates with Social Security Administration, describes heart condition to claims adjudicator, and forwards medical report to adjudicator. • Baby receives benefits in two weeks.

  21. p<0.0001 SSA Outpost- Outcomes from SSA Outpost at U of C Average Number of Days before a Disability Determination was Made on the Low Birth Weight Applications in Illinois September 01, 2003 – August 20, 2004, Social Security Administration 36 infants Range 3-14 days 632 infants Range 1-259 days

  22. CFAP Pro Bono Opportunities • Provide on-site legal assistance at Center for Healthy Families – (approximately 2 hours at Wednesday clinic). Meet families, conduct interview, provide advice, referral, or possibly take legal case. • Accept CFAP “pre-packaged” case without going to clinic • Assist with trainings/material preparations in various areas of law • Conduct discrete research issue for CFAP attorneys

  23. CFAP Pro Bono Support • CFAP attorneys from HDA and LAFMC will be at Center for Health Families Clinic for support and assistance during all pro bono activities • CFAP attorneys will provide access to all of LAFMC’s and HDA’s resources, including forms, training manuals, experienced staff attorneys to discuss cases/strategies • Option to co-counsel cases with LAFMC or HDA attorney

  24. How to Get Involved Thank You! To get involved with CFAP, please . . .

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