The YCSC Medical-Legal Partnership

June 06, 2023

Information

June 2023

A first of its kind Medical-Legal Partnership (MLP) run in collaboration between the Yale Child Study Center (YCSC) and the Center for Children’s Advocacy (CCA) offers legal support for children suffering from family trauma and environmental stressors impacting their lives. Powerful impacts for YCSC families and providers alike have been documented, and this 20-minute webinar provides an overview of the work including some case examples.

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00:00Hello and thank you to those of
00:02you who took time to join us today.
00:04My name is Christiana Mills and
00:06I'm a Licensed Clinical Social
00:08Worker here at the Yale Child
00:09Study Center Outpatient Clinic.
00:11I am joined today by two colleagues and
00:13together we are excited to tell you more
00:15about the medical legal partnership,
00:17A collaboration between the Center
00:19for Children's Advocacy and the
00:21Yale Child Study Center.
00:22Here with me are Ana Maria Orosco,
00:24A licensed Clinical Social Worker on our
00:27clinical faculty and Katherine Meyer.
00:29An attorney at the Center for
00:31Children's Advocacy and the Director
00:33of the Medical Legal Partnership
00:34here at the Child Study Center.
00:36A couple years ago,
00:37we were lucky to receive funding
00:39and support to launch a medical
00:41legal partnership on site at
00:42the Yale Child Study Center.
00:44This collaboration is the only
00:46medical legal partnership in the
00:48nation dedicated exclusively to
00:50interdisciplinary advocacy in a
00:52children's behavioral health setting.
00:54This new partnership provides
00:56critical legal interventions for
00:57children suffering from family
00:59trauma and health harming,
01:00environmental stressors that have
01:02grave impact on their lives,
01:04especially for children of color.
01:06From things like a family struggling
01:09with a landlord over mold remediation
01:11leading to an exacerbation of a child's
01:14anxiety over their mother's health,
01:16to a teen that is unable to access education
01:19related to bullying in the school setting.
01:21To troubles accessing healthcare
01:24and entitlement programs.
01:26These are examples of stressors that
01:28frequently come up in a children's
01:30mental health setting as families
01:32report on the struggles they face.
01:35A medical legal partnership
01:36works in three ways.
01:38It helps clinicians learn more about
01:40the legal rights of their clients
01:42and roots of advocacy via trainees.
01:45It assists families and clinicians by
01:47providing quick legal consultation
01:49that serves to educate the clinician,
01:51but more importantly the family
01:53on their rights and options and
01:56in a smaller number of cases.
01:57In low income families where other
01:59routes of advocacy have failed
02:01or the situation is dire,
02:03legal representation becomes necessary.
02:07Over the course of the last year,
02:09we provided consultation to approximately
02:12150 families and over the course of today.
02:15Catherine,
02:15I'll tell you more about the
02:17medical legal partnership,
02:18and Anna Maria will give you some
02:20stories that helped bring it alive.
02:22Thank you for your time today.
02:24Thank you, Christy.
02:25I'm grateful for this opportunity to
02:27talk about the impactful work that
02:29we're doing here at the Yale Child
02:31Study Center Medical Legal Partnership.
02:33Before I delve into the specifics,
02:34I'm going to zoom out a little bit
02:36and share some background on the
02:37Center for Children's Advocacy,
02:38our history of medical legal partnerships
02:41and how this specific site came to be.
02:43The Center for Children's Advocacy,
02:44or CCA, began the first True
02:47Medical Legal Collaborative project
02:49in the country in April 2000.
02:51At the time,
02:52the newly founded Connecticut Children's
02:54Medical Center teamed up with us at
02:56CCA to start an interdisciplinary
02:59project whereby CCA would hire and
03:01embed an attorney at the hospital
03:03in order to work on improving the
03:05health outcomes of children that
03:06were being seen and treated there.
03:08This endeavor officially became the
03:10medical legal partnership a year
03:12later and shortly thereafter we
03:14expanded to other sites in Hartford.
03:16In 2013,
03:17CCA and Yale New Haven Health System
03:20formed the pediatric MLP at Yale New
03:22Haven Hospital and in November 2020,
03:24the Child Study Center MLP began.
03:27We founded that center as the
03:29first and only pediatric behavioral
03:32health based MLP in the country.
03:34Before coming to this site,
03:36I was an attorney for over 10
03:37years in our Bridgeport office,
03:38mainly providing educational advocacy
03:41for children ages 3 through 22.
03:44I was able to collaborate with
03:46many different mental health
03:48and community health centers,
03:49but not nearly to the same degree or
03:51efficiency as we're able to do here,
03:53which really has made an impact
03:55on what we can do for families.
03:57Now when I go to special education
03:59meetings or school discipline hearings
04:01or any other kind of advocacy table.
04:03The family has not just me as the attorney,
04:05but also their trusted clinician
04:07there with us.
04:09And together we're a really strong team.
04:10We have the parent there as
04:12the expert on the child.
04:13We have the clinician who has the the
04:15professional with the knowledge on
04:17the child's health and development.
04:19And then I'm there with the legal
04:21knowledge that's helping us work towards
04:22our goal for the child and the family.
04:24As Christy said,
04:26we see about 150 or we have
04:28about 150 referrals per year.
04:30And just to give you a sense of
04:32the breakdown of the topic areas,
04:34we see that there's about 70% of those,
04:37about 150 is around educational issues,
04:41which makes sense in the setting
04:43really because kids who have mental
04:45health issues unfortunately often
04:47struggle in the school setting.
04:49And the school can become a place
04:51where stressors are exacerbated.
04:52And so it's really imperative that we're
04:55able to support them in that setting.
04:57Also of the number of referrals
04:59we end up providing,
05:00about 70% of those referrals become
05:03consults to professionals here.
05:05So while I'm able to open cases and meet
05:07with families about 30% of the time,
05:0970% of the time I'm working
05:11directly with the providers,
05:12which also you know,
05:14works to increase the capacity and
05:15knowledge with the providers.
05:17So along those lines,
05:21you know when we're imparting information
05:22and advocacy tips to clinicians.
05:24We're also really aiming to impart
05:27this information to families.
05:29And so they were continuing to
05:30empower them and help them get
05:32the tools that they need to
05:33advocate for their children.
05:35And and you know,
05:35we see this time and time again,
05:36we have amazing parents who come
05:38through these doors who've done so much
05:40themselves and just need a little bit,
05:42you know, a few more tools,
05:44a little bit more information
05:45to know exactly how to best get
05:47what they need for their child.
05:50We've been able to
05:51work together here with our
05:53partners to provide a broad variety
05:55of legal topics and trainings of
05:57clinicians over the past few years.
05:59So I've been able to work with
06:01outpatient and in home clinicians.
06:03Also psychology fellows,
06:04psychiatry fellows and social work fellows,
06:07and some of the topics I've been able to
06:10present include educational advocacy,
06:12including special education,
06:13school discipline, and bullying.
06:15Also we've we've talked a lot
06:17about adolescent healthcare,
06:19consent and confidentiality particularly
06:21issues are on reproductive healthcare.
06:24And one more topic I wanted
06:25to highlight are the,
06:26the legal topic are the rights of L, GB,
06:29TQ plus youth in school and in the community,
06:32which again is, is an evolving landscape.
06:34And so it's really important for us to
06:36kind of keep on top of those issues.
06:39Now on the flip side of course
06:40is part of a partnership,
06:41it's it's a give and a take and
06:43so I'm really learning from my
06:44medical partners every day.
06:46I really love to sit in on rounds
06:48and case conferences a few times
06:50a month for a few reasons.
06:52First,
06:52it allows me to hear a larger swath
06:54of client stories so I can really
06:57understand the the larger patterns of of
06:59what folks are seeing here at at the center.
07:02It allows me to issue SPOT in real
07:04time so I can support clinicians
07:06right on that spot in the moment to
07:09answer legal questions as they go
07:11through the contours of the case.
07:13And 3rd,
07:13I just,
07:14I learned so much from my partners as
07:16to why and how they pick the treatment
07:18modality that that best serves the patient,
07:21how they handle obstacles in the treatment.
07:23And then really,
07:24of course,
07:24I love to hear the encouraging stories
07:27of success and the outcomes for families.
07:30So before I get into specific
07:32examples with Anna Maria,
07:33like to just share one more element
07:35of the work that I do with the
07:37MLP and as part of our larger
07:39Center for Children's Advocacy.
07:41So at CCA,
07:42all the attorneys engage and of
07:44course individual representation and
07:46the trainings that I just spoke of.
07:49And we also all have the opportunity
07:51to engage in systemic advocacy.
07:53And that means we're basically taking
07:55the patterns and issues that we see
07:57in our client population and we're
07:59trying to elevate them to a higher
08:00level so that we can change policy
08:02and legislation in order to impact as
08:05many children and families as possible.
08:07One quick example I'd like to share is
08:10that of I I started to see over the
08:12years that a lot of young children
08:15were being excluded from school.
08:17Now,
08:17legally this would be considered a
08:19suspension if you're excluded from
08:20school for more than 90 minutes.
08:22But what it looked like in in reality
08:24was that parents are being called
08:26frequently to pick up their child early.
08:29Parents were being forced to accept
08:31a shortened schedule.
08:33Sometimes the child was even
08:34being pushed out by saying
08:35they're not school ready yet.
08:36For example. And so in looking at these,
08:40you know, these matters,
08:41we are seeing that the children that
08:44most needed access to education and
08:46services were were really being,
08:48you know, excluded from those
08:50those services and education.
08:51And it was impacting families
08:53in so many negative ways.
08:55Parents were losing their jobs,
08:56parents are being threatened with
08:58DCF or police involvement and
09:00obviously it was very disruptive
09:02to the whole family structure.
09:04So in, you know,
09:05in considering this issue,
09:06we ended up working with a couple
09:08of partners in a coalition
09:10and developing legislation,
09:11which was the first legislation in
09:14the country that narrowed the ability
09:17of schools to exclude young children
09:19from school and that passed in 2015.
09:21And while a lot of progress has been made,
09:23we continue to really chip away this issue.
09:26We want to further narrow the
09:28ability hopefully to ban it one day.
09:31And and perhaps even more importantly
09:33we're we're really looking to increase
09:35access for young children in terms of
09:37the services and support they need in school,
09:39support educators and and helping
09:41deescalate children and really you know
09:44intervening at that point of crisis
09:45that the child is ultimately doesn't
09:47have to face that school exclusion okay.
09:53So to illustrate some specifics
09:55of our work together,
09:56we're going to have a conversation with
09:58Ana Maria about a few shared clients
10:01and referrals that we've had together.
10:03First,
10:03we can start with CC is a 14 year
10:06old 8th grader.
10:07He has some cognitive challenges.
10:09He has a diagnosis of a DHD and
10:11you brought him to my attention
10:13for a few reasons.
10:15So why don't you, why don't you share that?
10:16Sure. So just to give a little context as
10:20to why C originally started coming here.
10:23So originally he presented with some
10:26suicidal and unsafe behavior and his
10:29mom was the one who connected him here.
10:31She's a great advocate for him.
10:34When I first met, CI realized that
10:36there had been a lack of services that
10:38he needed and a lot of his symptoms.
10:42Although they were seen at home,
10:43they were also seen at school.
10:45And I think that a lot of the anxiety
10:47that he had was as a result of not
10:50having interventions that were
10:51helpful for him as far as socializing,
10:54peer connection and kind of the
10:56support he really needed at school.
10:58At the time, I realized he didn't
11:00have a 504 an IEP and he,
11:01he definitely seemed like like a
11:03kid who could benefit from it.
11:05And that was kind of what led me
11:06to consult with you, Catherine.
11:08Yeah.
11:10Obviously Anna Maria had a great
11:12relationship with the family and
11:13just knew them so well already.
11:14So then by the time I start to get
11:16involved with the family, you know,
11:17there's there's just a great basis
11:19of trust and that foundation,
11:21you know, between us and the family.
11:24So the interesting thing about Steve's
11:27situation is that his mom had been
11:29helping him during the pandemic to
11:31support him in education at home.
11:33And so she was doing the very
11:35best she could in a extremely
11:37challenging time for for all parents.
11:39And she was able to see through that
11:41support that he really was really
11:44struggling with his schoolwork,
11:45had difficulty just, you know,
11:47reading the directions to the to the to
11:49the work he was supposed to be doing.
11:51And I think she was able to kind
11:53of get a first hand look at where
11:55his peers were and where he was.
11:57And so of course the pandemic, you know,
12:00had so many negative outcomes,
12:02but this situation was actually positive.
12:04And that allowed mom that really close
12:06eyes on on what was going on with C.
12:09So with that information,
12:11MOM was really starting to advocate
12:13towards getting him more support
12:16educationally and because of the
12:18issues you mentioned before with
12:20kind of navigating social situations
12:22and pure conflict,
12:23C was also struggling with bullying
12:25which is kind of leading towards some
12:27school discipline issues as well.
12:29So once we were able to really get at
12:32you know the the heart of addressing
12:34the interventions academically.
12:36We were also able to start
12:39alleviating some of the other,
12:41you know,
12:42start alleviating some of the other
12:44challenges and how they are manifesting.
12:46So in working with C and his mom,
12:49we were able to look towards a more
12:52supportive,
12:52selfcontained environment for him
12:54that really wrapped around and
12:56embedded the services he need,
12:57provided a lot more structure and and
13:00supervision and kind of really people
13:03paying attention to what C needed
13:04and getting to know him a lot better.
13:06And so I think that made a huge difference
13:08in what he was able to do at school.
13:10Yeah.
13:11And I think it also helped him a lot
13:13with his self esteem and his confidence
13:14and kind of just being able to socialize
13:17and feeling good about his grades.
13:18I think that was the first time he ever
13:21really felt like really good about his
13:23academic achievement and mom also felt
13:25super supported and and everything.
13:27So it's been nice to watch. Watch that.
13:30Progress and now he's kind of you know
13:32looking into a more future thing.
13:34So it's it's always nice to see
13:35all of that come full circle.
13:38That's so great. I mean he just was
13:40able to get that feeling of success
13:42and like he said confidence to
13:44start looking at goals for himself.
13:45Okay. One more person, young person
13:47that you want to talk about is A,
13:50A is a 10 year old 5th grade
13:52student who has a 504 plan,
13:54which is an access plan for a
13:56student with a disability and
13:57A has a diagnosis of a DHD.
13:59She also is has struggled in school
14:01this year and maybe you could talk a
14:03little bit about your your work and
14:05your relationship with A and her family.
14:07Sure.
14:07So A is a kiddo that's been
14:10seen here for quite some time.
14:12She's a great kid to work with
14:14and and so is her caretaker.
14:15She's amazing and and advocating for A.
14:19So actually I at the beginning
14:21of this school year we were at
14:23a point where A's symptoms had.
14:25Lastly reduced and she was,
14:27we were already kind of we're
14:29getting ready to kind of discharge
14:31her from services just to give a
14:33little context of AIDS history.
14:34She does have a history of trauma and
14:36there are some disruptive attachments.
14:38So with that being said,
14:40my focus and treatment has been
14:42to really emphasize the important
14:43of secure attachments,
14:45right and really making her feel
14:47stable and safe and and that's
14:49also been helpful in reducing
14:50some of those symptoms that she
14:53originally presented with so.
14:55We were at a point where we were kind
14:57of getting ready to wrap up treatment
14:58and she started her school year.
15:00And I I think it's important to know too.
15:02Catherine,
15:03we've talked about this A has been
15:05always very connected in school.
15:07She's had really amazing,
15:08supportive teachers.
15:09She loves going to school.
15:11But this school year was a little
15:13different for her and I noticed
15:14it in the fall where she really
15:16didn't want to go to school.
15:17She was kind of avoiding it and we got
15:20to talk about it a little bit in treatment.
15:21She was also kind of seeking
15:22treatment a little bit more.
15:25She noticed a lot of changes
15:26in how she had been. Yeah,
15:29right when when the school year started.
15:31So in talking with her, she,
15:34she was able to share that she was
15:36struggling with her connection with
15:38her new teacher, which was really.
15:40You know different for her in regards
15:42to her relationships with teachers.
15:44So in talking with her and her
15:47guardian a little bit more,
15:49I was able to see that the teacher that
15:51she had this year was was struggling
15:54to provide her with that secure
15:56attachment that I think was has been so
15:58important for for her and her treatment.
16:02So I had a meeting,
16:03I requested a meeting with the school
16:05and just to kind of talk a little bit
16:08more about a history and treatment and
16:11and kind of my recommendations clinically.
16:13And at the time the teacher
16:16struggled to really understand
16:18her 504 and her diagnosis and.
16:20Kind of left their standstill
16:21because they didn't know how to
16:23push it forward with the school.
16:24And that was when we decided to
16:26consult with you, Catherine.
16:28Yeah. And that's again,
16:29illustrating our partnership is that
16:31you work with the family to do,
16:33you know, all these steps before,
16:35before I was able to get involved.
16:38And, you know, this was a really
16:41unusual situation because A's teacher.
16:46You know, I I usually are the
16:48teachers become the greatest advocate
16:50for children and A's teacher was
16:52really different in that way.
16:53And so even though we really
16:55tried to be collaborative with her
16:57teacher and the administrator,
16:58we really weren't getting the progress
17:00that we needed and A continued
17:02to feel targeted by the teacher.
17:05The teacher was sharing information
17:07with classmates that ended up
17:09leading to bullying of A and so
17:11we really needed to kind of step
17:13it up a little bit and so.
17:15After a few different meetings
17:16and and seeing that a continued to
17:19deteriorate in her mental health at
17:21home and at school and obviously
17:24increasing her need to to work with you,
17:27we did have to escalate the matter
17:28a little bit.
17:29We ended up filing a complaint with
17:31the Office of Civil Rights that who
17:33is now looking into the issue and
17:35it just illustrates that we do the
17:38best we can you know working with
17:40working with folks in different systems.
17:43But if we're not able to make progress,
17:44you know,
17:45A has really important rights
17:47that need to be respected.
17:49And the reason why we're reaching out with
17:51this complaint is not in a punitive way,
17:53but because we need to assert A's
17:56rights first and foremost and
17:57to help other kids who might be
17:59in a similar position.
18:01So I think,
18:01yeah,
18:02I think those 3 examples really
18:03illustrate well our work together.
18:05And I love collaborating with you.
18:06I love collaborating with you also.
18:09So I think that wraps up our webinar
18:12for today.
18:12We thank you so much for your
18:14time and attention to the medical
18:17legal partnership project here
18:18at the Yale Child Study Center.
18:20And we really appreciate your support.
18:22Thank you. Thank you.