Creating Innovative Community Creating Innovative Community Partnerships to Address the SocioPartnerships to Address the Socio--Economic Determinants of Health: Economic Determinants of Health:

Integrating Resources & Services to Integrating Resources & Services to Improve OutcomeImprove Outcome

Lisa Bliss, JD Lisa Bliss, JD

Sylvia Caley, JD, RN, MBASylvia Caley, JD, RN, MBA

Robert Pettignano, MD, FAAP, FCCM, MBARobert Pettignano, MD, FAAP, FCCM, MBA

June 8, 2010June 8, 2010

We want to knowWe want to know““Who is in the audienceWho is in the audience””??

�� CEOCEO

�� CFOCFO

�� COOCOO

�� SVPSVP

�� GCGC

�� DirectorDirector

�� ManagersManagers

�� CliniciansClinicians

�� StaffStaff

�� Anyone else?Anyone else?

Who is familiar with docs Who is familiar with docs and lawyers working and lawyers working together MLP?together MLP?

http://www.mlpforchildren.org/Nutshttp://www.mlpforchildren.org/Nuts----Bolts.aspxBolts.aspx Cartoon courtesy of Jack Maypole, MD (jackmaypole@yahoo.com)Cartoon courtesy of Jack Maypole, MD (jackmaypole@yahoo.com)

Why Professional Collaboration Why Professional Collaboration between Medicine and Law?between Medicine and Law?

IntroductionIntroduction

�� Workshop explanationWorkshop explanation

�� Discuss a specific collaboration modelDiscuss a specific collaboration model

��The Health Law Partnership The Health Law Partnership (HeLP) (HeLP) -- AtlantaAtlanta

�� Discuss creating a community collaborationDiscuss creating a community collaboration

��Germinating an ideaGerminating an idea

��Roles, responsibilitiesRoles, responsibilities

�� Financial supportFinancial support

��Program evaluation and researchProgram evaluation and research

��WrapWrap--upup

A Model MedicalA Model Medical--Legal Legal PartnershipPartnership

Workshop Workshop -- Part IPart I

HeLPHeLP

Lawyers in the Hospital!!Lawyers in the Hospital!!

Combining the expertise of health care Combining the expertise of health care

professionals with the legal expertise of professionals with the legal expertise of

attorneys provides a comprehensive set attorneys provides a comprehensive set

of services to address the multiple of services to address the multiple

determinants of childrendeterminants of children’’s health and s health and

wellwell--beingbeing

Change TheoryChange Theory

The ChildrenThe Children’’s Systems System

GoalsGoals

●● Become a model for interdisciplinaryBecome a model for interdisciplinary��community collaborationcommunity collaboration

��educationeducation

●● Create a culture of coordination and Create a culture of coordination and

cooperation among the partnerscooperation among the partners

●● Improve the physical, social and/or Improve the physical, social and/or

economic living environment for the economic living environment for the

patients/clientspatients/clients

Creating the HeLP Advisory Creating the HeLP Advisory CouncilCouncil

�� Need for specialized/interdisciplinary Need for specialized/interdisciplinary

expertiseexpertise

�� legal/medicallegal/medical

�� fundraising/public relationsfundraising/public relations

��evaluation/researchevaluation/research

�� Need for community credibilityNeed for community credibility

�� Funder expectationFunder expectation

�� Support and guidanceSupport and guidance

��Complicated structure Complicated structure -- 3 partners3 partners

The Four Components of HeLPThe Four Components of HeLP

��Public Health Legal ServicesPublic Health Legal Services

�� Education Education

��AdvocacyAdvocacy

��Research and evaluationResearch and evaluation

The Physical PlantThe Physical Plant

�� Law office in the hospitalLaw office in the hospital

��Issues:Issues:

��ResourcesResources

�� SpaceSpace

Public Heath Legal Services Public Heath Legal Services ScopeScope

�� Public benefitsPublic benefits

�� Private health insurancePrivate health insurance

�� Family stabilityFamily stability

�� Permanency planningPermanency planning

�� Environmental issuesEnvironmental issues

�� Housing conditionsHousing conditions

�� EducationEducation

�� EmploymentEmployment

�� ConsumerConsumer

Annual Client Intake:Annual Client Intake:State Fiscal Year State Fiscal Year

State Fiscal Year (SFY)State Fiscal Year (SFY) Client IntakesClient Intakes

2005 (a)2005 (a) 2323

20062006 195195

20072007 240240

20082008 276276

20092009 325325

TotalTotal 1,0591,059

(a) Represents intake beginning in January 2005 through June 30, 2005

Problems/IssuesProblems/IssuesPercent of Total Cases Percent of Total Cases

Dependent Health ProblemsDependent Health Problems

Legal Cases Legal Cases NotNot HandledHandled

●● Any case placing the patients or their Any case placing the patients or their

families in an adversarial position to the families in an adversarial position to the

hospitalhospital

●● Any case placing the parents in Any case placing the parents in

adversarial position to the childadversarial position to the child

●● Medical malpracticeMedical malpractice

Education ComponentEducation Component

�� InterdisciplinaryInterdisciplinary

��doctorsdoctors

�� lawyerslawyers

��head cook and bottle washers if they head cook and bottle washers if they

have interesthave interest

��other professionalsother professionals

�� Programs include issues of:Programs include issues of:

�� legalitylegality

��policypolicy

��ethics affecting patientsethics affecting patients’’ healthhealth

Education ComponentEducation Component

●● InIn--service training and didactics for service training and didactics for

healthcare professionalshealthcare professionals

●● Informal educational opportunitiesInformal educational opportunities

●● Legal clinic, externships, electives & Legal clinic, externships, electives &

practicumspracticums

HeLPHeLP’’s Ability to Educates Ability to Educate(Excellent or Good Ratings)(Excellent or Good Ratings)

Because we have no bad ratings!Because we have no bad ratings!

HeLP Legal Services ClinicHeLP Legal Services Clinic

�� Combines public health legal services Combines public health legal services

with education componentwith education component

�� Extends services provided by HeLPExtends services provided by HeLP

�� Opened doors in January 2007Opened doors in January 2007

�� Located at Georgia State College of LawLocated at Georgia State College of Law

��Students may also work at the 3 hospital Students may also work at the 3 hospital

campusescampuses

�� Functions as a model of interdisciplinary Functions as a model of interdisciplinary

law practicelaw practice

AKA AKA ““The ClinicThe Clinic””

Current/Future Interdisciplinary Current/Future Interdisciplinary Learners in the ClinicLearners in the Clinic

�� Law studentsLaw students

�� ResidentsResidents

�� Medical studentsMedical students

�� Masters in Public Masters in Public

HealthHealth

�� Masters in Hospital Masters in Hospital

AdministrationAdministration

�� Masters in Business Masters in Business

AdministrationAdministration

�� Masters in Social WorkMasters in Social Work

�� NursingNursing

�� Public HealthPublic Health

�� Science & ResearchScience & Research

Interdisciplinary Learning in a Interdisciplinary Learning in a Community CollaborationCommunity Collaboration

�� Expands concept of Expands concept of ““usus””

�� includes all partnersincludes all partners

�� silos disappearsilos disappear

●● AAllows joint problemllows joint problem--solving to benefit solving to benefit

patientpatient

●● Encourages broader thinking about Encourages broader thinking about

professional roleprofessional role

●● Provides mutual support from different Provides mutual support from different

disciplinesdisciplines

●● Multiple sources of referralsMultiple sources of referrals

Goals for Clinic Students Goals for Clinic Students -- II

�� ExperienceExperience

�� interdisciplinary educationinterdisciplinary education

�� the positive impact of interdisciplinary the positive impact of interdisciplinary

interventionsinterventions

�� Develop Develop

�� legal problemlegal problem--solving skillssolving skills

��professional and interpersonal skillsprofessional and interpersonal skills

Goals for Clinic Students Goals for Clinic Students -- IIII

�� Collaborate toCollaborate to

�� improve the health and wellimprove the health and well--being of being of

lowlow--income childrenincome children

��understand health issues and the sociounderstand health issues and the socio--

economic determinants of health in poor economic determinants of health in poor

communitiescommunities

��understand complex web of healthunderstand complex web of health--

related programs and servicesrelated programs and services

Lessons Learned Lessons Learned --Interdisciplinary EducationInterdisciplinary Education

�� HeLP model HeLP model –– great vehicle for a clinicgreat vehicle for a clinic

�� The model can be applied in any contextThe model can be applied in any context

�� students from many professional backgrounds can students from many professional backgrounds can

be assets in the hospital environmentbe assets in the hospital environment

�� MultiMulti--layered approach provides richness and layered approach provides richness and

complexitycomplexity

�� Meaningful experience for studentsMeaningful experience for students

�� Can influence their future approach to their Can influence their future approach to their

profession & commitment to communityprofession & commitment to community

Advocacy ComponentAdvocacy Component

●● Targeting systemic legal, policy Targeting systemic legal, policy

and social issues affecting health and social issues affecting health

and welland well--beingbeing

●● Collaborating with community Collaborating with community

partnerspartners

●● Legislative & PolicyLegislative & Policy--making making

PrioritiesPriorities

�� Health disparitiesHealth disparities

�� Access to health careAccess to health care

�� Improving overall health & social wellImproving overall health & social well--

beingbeing

Advocacy IssuesAdvocacy Issues

Policy IssuePolicy Issue

�� Sodas in school vending machinesSodas in school vending machines

�� Ban teen cell use while drivingBan teen cell use while driving

�� Emergency preparednessEmergency preparedness

�� Remove 5 year ban legal immigrantsRemove 5 year ban legal immigrants

�� Home Health Agency CareHome Health Agency Care

�� Health Insurance reformHealth Insurance reform

Community PartnerCommunity Partner

�� Nurse PractitionersNurse Practitioners

�� Barton Clinic Child PolicyBarton Clinic Child Policy

�� Div. Public Health & Div. Public Health & Atlanta Business GroupAtlanta Business Group

�� Hispanic Health CoalitionHispanic Health Coalition

�� ChildrenChildren’’s Healthcare of s Healthcare of AtlantaAtlanta

�� Georgians for a Healthy Georgians for a Healthy FutureFuture

Evaluation and Research Evaluation and Research ComponentComponent

● Monitor program effectivenessMonitor program effectiveness

●● Determine strengths, weaknesses & Determine strengths, weaknesses &

opportunities, threats (SWOT) opportunities, threats (SWOT)

●● Assess impact of research for funding, Assess impact of research for funding,

and replication purposesand replication purposes

●● Contribute to organizational change & Contribute to organizational change &

developmentdevelopment

31

Why do I have to conduct an evaluation? Why do I have to conduct an evaluation? I know when my clients are happy!I know when my clients are happy!

I need HeLP!I need HeLP! Thanks for Thanks for

the HeLP!the HeLP!

HeLPHeLP

Pro Pro

Bono Bono

ServicesServices

Social Social ServicesServices

Community Community ResourcesResources

Health care Health care

ServicesServices

Academic Academic CommunityCommunity

SelfSelf--reported health effects for reported health effects for clients and their dependents after clients and their dependents after

HeLP interventionHeLP intervention

Physical health Physical health Emotional health Emotional health

Case Outcomes SummaryCase Outcomes SummaryOutcome Category

SFY 2009Annualized

SFY2008Annualized

SFY 2007Annualized

Public Benefits $123,017 $ 101,647 $36,128

Consumer $ 258

Education Benefits $351,650 $ 147,700

Employment Benefits $ 25,740

Family Stability $ 1,380 $ 25,919 $ 22,968

Healthcare Coverage $220,630 $1,414,080* $ 70,033

Housing Issues $ 66, 029 $ 10,820 $ 5,400

Other $ 27,351 $ 11,399 $ 18,100

Total $816,055 $1,711,565* $152,629**

*Includes coverage of an experimental drug estimated value - $1.17 million**Many benefits obtained/received not captured in data collection

Challenges to Creating the Challenges to Creating the HeLP Evaluation and HeLP Evaluation and Research ComponentResearch Component

●● ““Getting to agreementGetting to agreement”” what to evaluate?what to evaluate?

●● Approval for human subject research Approval for human subject research

●● Developing:Developing:

��a research agendaa research agenda

��presently evaluation is our researchpresently evaluation is our research

��a data systema data system

��the expertise to use itthe expertise to use it

●● Motivating everyone to collect dataMotivating everyone to collect data

●● Constructive and effective data useConstructive and effective data use

●● Developing screening instrumentsDeveloping screening instruments

Lessons from the HeLP Lessons from the HeLP ExperienceExperience

�� FindFind

�� the right partnersthe right partners

�� the right staff the right staff

�� Be able to explain the model to funders & othersBe able to explain the model to funders & others

�� Learn to manageLearn to manage

�� changechange

�� numerous service lines and delivery pointsnumerous service lines and delivery points

�� mission creepmission creep

�� Embrace the fact that collaboration is hard workEmbrace the fact that collaboration is hard work

�� Maintain momentum when everything takes longer Maintain momentum when everything takes longer

than anticipatedthan anticipated

““Coming together is a beginning.Coming together is a beginning.Keeping together is progress. Keeping together is progress. Working together is success.Working together is success.””

Henry Ford (1863 Henry Ford (1863 –– 1947)1947)

Creating a Community Creating a Community Collaboration for Interdisciplinary Collaboration for Interdisciplinary

ProblemProblem--SolvingSolving

Part IIPart II

Germinating an Idea:Germinating an Idea:Finding the Right PartnerFinding the Right Partner

Think Outside the BoxThink Outside the Box

Push The EnvelopePush The Envelope

Challenge the NormChallenge the Norm

Norm

Developing a Community CollaborationDeveloping a Community Collaboration””The ToolThe Tool--KitKit””

�� An electronic copy is availableAn electronic copy is available

�� Designed as a stepDesigned as a step--byby--step guidestep guide

�� The tool kit will help you get startedThe tool kit will help you get started

��We will leave you withWe will leave you with

�� resourcesresources

��contact infocontact info

ToolTool--Kit ContentsKit Contents

�� Description of the Description of the ““Model ProjectModel Project””

�� Steps in developing a community Steps in developing a community

collaborationcollaboration

�� Germinating an ideaGerminating an idea

�� Finding partnersFinding partners

�� Defining roles & responsibilitiesDefining roles & responsibilities

��Sample Memorandum of Understanding Sample Memorandum of Understanding

(MOU)(MOU)

�� Cultivating financial supportCultivating financial support

�� Program evaluation informationProgram evaluation information

Step #1Step #1Identifying PartnersIdentifying Partners

�� Write 1Write 1--100 on a piece of paper100 on a piece of paper

�� Quickly make a list of 100 Quickly make a list of 100

entities/organizations that have a similar:entities/organizations that have a similar:

��missionmission

��populationpopulation

�� Think broadlyThink broadly

�� Do not judge or exclude any ideaDo not judge or exclude any idea

�� DonDon’’t worry about implementationt worry about implementation

�� Duplicates are OKDuplicates are OK

��May give you cluesMay give you clues

What Lists of 100 RevealWhat Lists of 100 Reveal

●●11-- 3030

��Ideas that are most familiarIdeas that are most familiar

●●30 30 –– 7070

��Emerging patterns of thoughtEmerging patterns of thought

●●70 70 –– 100100

��You strike gold You strike gold –– ideas that are gemsideas that are gems

��Here your perspective changesHere your perspective changes

Phases of MLP DesignPhases of MLP Design

Denial

Anger

Acceptance

Depression

CompletionMLP Process

Level of A

ccepta

nce

Bargaining

*Adapted from Elizabeth Kubler-RossPhases of Death and Dying

Lessons Learned: Lessons Learned: Collaboration Comes in All FormsCollaboration Comes in All Forms

�� There is no right way to begin a There is no right way to begin a

collaborative partnershipcollaborative partnership

�� Partnerships depend on the people Partnerships depend on the people

and their institutions and their institutions

Step #2Step #2Cultivating PartnershipsCultivating Partnerships

�� Look over your list from exercise #1 and Look over your list from exercise #1 and

for each namefor each name

�� identify a person you know within that identify a person you know within that

organizationorganization

�� If you donIf you don’’t know someonet know someone

�� list the name of someone who might know list the name of someone who might know

someone and will help facilitate an someone and will help facilitate an

introductionintroduction

�� If you still donIf you still don’’t have a namet have a name

��write write ““research contactsresearch contacts”” and do some and do some

investigatinginvestigating

Step #3Step #3Defining Roles and ResponsibilitiesDefining Roles and Responsibilities

�� Collaboration requires a shared Collaboration requires a shared

understanding among the participantsunderstanding among the participants

�� Imagine a potential collaboration with 2 Imagine a potential collaboration with 2

entities from exercise # 1entities from exercise # 1

�� Review the sample MOUReview the sample MOU

�� List the kinds of things that partners in List the kinds of things that partners in

a collaboration would want to have a collaboration would want to have

defineddefined

Video InterviewVideo Interview

Kathy Palumbo, MSW, PhDKathy Palumbo, MSW, PhD

Community Foundation of Greater AtlantaCommunity Foundation of Greater Atlanta

Financial SupportFinancial Support

Step #4Step #4Funding and Sustaining a Funding and Sustaining a

Collaboration Collaboration �� List potential funding sources including:List potential funding sources including:

��nationalnational

�� internationalinternational

�� locallocal

�� List partners who may provide:List partners who may provide:

�� inin--kind supportkind support

��private funding supportprivate funding support

�� Finally, list funders who have the same Finally, list funders who have the same

special interest in the issues your special interest in the issues your

collaboration seeks to addresscollaboration seeks to address

The Value PropositionThe Value Proposition

�� QUALITY X SERVICEQUALITY X SERVICE

PRICEPRICE

��COLLABORATIVE PROBLEM SOLVING X OUTCOMECOLLABORATIVE PROBLEM SOLVING X OUTCOME

COMMUNITY RESOURCESCOMMUNITY RESOURCES

Keys to Funding SuccessKeys to Funding SuccessSummarySummary

�� Demonstrated stability and sustainabilityDemonstrated stability and sustainability

�� Effective grant applicationEffective grant application

�� Demonstrate ability to provide ROIDemonstrate ability to provide ROI

�� Other potential funding sourcesOther potential funding sources

�� Determine funders preferences/prioritiesDetermine funders preferences/priorities

�� Beware of Beware of ““chasing the moneychasing the money””

�� Diluting the mission just for the moneyDiluting the mission just for the money

Program EvaluationProgram Evaluation

Step #5 Step #5 Program Evaluation and ResearchProgram Evaluation and Research

�� List the best ways to evaluate the List the best ways to evaluate the

success of the programsuccess of the program

�� List the best ways to initiate researchList the best ways to initiate research

Step #5 Step #5 Program Evaluation and ResearchProgram Evaluation and Research�� DefineDefine

�� a purpose or goal that the potential a purpose or goal that the potential

partners you identified may sharepartners you identified may share

�� how to allocate responsibilities among the how to allocate responsibilities among the

partnerspartners

��where will the collaboration be housedwhere will the collaboration be housed

��what potential conflicts are anticipatedwhat potential conflicts are anticipated

�� how you will address conflicthow you will address conflict

�� how will you communicate and how oftenhow will you communicate and how often

�� a plan can you make in terms of how to a plan can you make in terms of how to

““check incheck in””

Keys to Program Evaluation Keys to Program Evaluation SuccessSuccess

�� Program evaluation reveals how your Program evaluation reveals how your

program functions and performsprogram functions and performs

�� Decide early on: Decide early on:

��what needs assessmentwhat needs assessment

�� how will it be assessedhow will it be assessed

�� interviews stakeholders, clientsinterviews stakeholders, clients

�� who will use the datawho will use the data

�� will you need human subject research approvalwill you need human subject research approval

Keys to Program Evaluation Keys to Program Evaluation Success Success -- IIII

�� List the benefitsList the benefits

��motivationmotivation

��identifyidentify

�� unmet needsunmet needs

�� successessuccesses

�� opportunitiesopportunities

�� challengeschallenges

�� weaknessesweaknesses

Looking into the Future and Looking into the Future and Moving ForwardMoving Forward

Personal Lessons Learned:Personal Lessons Learned:

�� DonDon’’t take no for an answert take no for an answer

�� Be creative and flexibleBe creative and flexible

�� Approach many different partnersApproach many different partners

HeLP Specific InformationHeLP Specific Information

http://www.healthlawpartnership.orghttp://www.healthlawpartnership.org

For National InformationFor National Information

http://www.medicalhttp://www.medical--legalpartnership.orglegalpartnership.org

HomeworkHomework

�� Reflect on your ideasReflect on your ideas

�� Take them to the next levelTake them to the next level

�� Let us know what you are doingLet us know what you are doing

Lisa Bliss Lisa Bliss -- lbliss@gsu.edulbliss@gsu.edu

Sylvia Caley Sylvia Caley –– sbcaley@gsu.edusbcaley@gsu.edu

Bob Pettignano Bob Pettignano ––

Robert.Pettignano@choa.orgRobert.Pettignano@choa.org

Final PointsFinal Points●● Effective collaboration is hard workEffective collaboration is hard work

��the rewards are exponentialthe rewards are exponential

●● The model can be replicatedThe model can be replicated

●● The mix of people is The mix of people is extremelyextremely importantimportant

●● Critical to developCritical to develop

�� a shared, clear missiona shared, clear mission

�� a plan for sustainability & stabilitya plan for sustainability & stability

●● Strategic planning nurtures growth & Strategic planning nurtures growth &

developmentdevelopment

●● Program evaluation is essentialProgram evaluation is essential

●● Transparency builds trustTransparency builds trust

Questions ???Questions ???