Community Driven MLPs: Exploring the New MLP with Christian Community Health Center & LCHJ
Author: Belle Duguid, Special Populations Community & Partner Liaison, AmeriCorps VISTA at the Legal Council for Health Justice.
In 2019, Legal Council for Health Justice partnered with Christian Community Health Center to initiate a new Medical Legal Partnership (MLP) serving Chicago’s far South Side and South Suburban neighborhoods. In May of 2022, the MLP had its official soft launch. This post will detail the origins of this MLP, the importance of community feedback and building relationships, Q&As with key players in the process, and recommendations for advocates in the early planning stages of a MLP.
A Brief History and Background
Legal Council for Health Justice, originally called AIDS Legal Council of Chicago (ALCC), was founded in 1987 as a response to the lack of legal services available to people with HIV. In 2014, ALCC became Legal Council for Health Justice (LCHJ) as their services were expanded to address health disparities more broadly. Currently, LCHJ has three programs: the AIDS Legal Council, the Children and Families Program, and the Homeless Outreach Program. These programs work together to support the mission of LCHJ, which is to use “the power of the law to secure dignity, opportunity, and well-being for people facing barriers due to illness or disability.”
Christian Community Health Center (CCHC), founded in 1991, is a 501 (C)3 non-profit organization and federally qualified health center dedicated to providing “high-quality primary healthcare and related services to the community regardless of the ability to pay.” CCHC strives to meet the holistic needs of both individual patients and their communities by providing services related to: health and prevention, housing and shelter, intervention and support, and education and life skills. CCHC has three locations throughout Chicago’s South Side and the South Suburbs, as well as a mobile health van that travels around the greater Roseland area and adjoining South Suburbs to provide health care and social services.
In expanding access to free legal services, the CCHC-LCHJ Medical Legal Partnership will complement CCHC’s holistic vision of health care. The two organizations will work in tandem to address patient’s health-harming legal needs, including: HIV/AIDS discrimination and confidentiality; public benefits assistance (e.g., SNAP, Medicaid/Medicare, Social Security, Ride Free Permits, ADAP, etc.); unemployment benefits; landlord-tenant issues; expungement and sealing of criminal records; name and gender marker changes; health insurance; and estate planning (e.g., Power of Attorney and simple wills).
Medical Legal Partnership in Action: Q&A with Kenya Garrett-Burnett, Ben Handy, and Nooreen Reza
Kenya Garrett-Burnett, born and raised in Chicago, joined LCHJ in 2017 and is the Legal Director of the AIDS Legal Council. Kenya has played an integral role in the creation of the CCHC-LCHJ MLP with her background in community health combined with over a decade of experience working in Chicago. You can read more about Kenya’s background here.
Ben Handy is the Community Organizer for the AIDS Legal Council and joined LCHJ in May of 2021. Ben has extensive experience in community outreach and non-profit/public sector management, and is currently focusing on community engagement and feedback through the creation of the Community Council (further details regarding the Community Council can be found in the “Community Feedback, Outlooks Regarding the Future, and Recommendations for Advocates” section). You can read more about Ben’s background here.
Nooreen Reza, is an attorney and Powell Fellow for the AIDS Legal Council and joined LCHJ in September 2021. Nooreen is passionate about integrating community and movement lawyering practices into direct services provision, and is currently on-site once a week at CCHC. You can read more about Nooreen’s background here.
The MLP between CCHC and LCHJ had its official soft launch in May of 2022. Right now, the focus is on providing free legal services to CCHC Housing patients, Ryan White patients, and PrEP eligible patients as LCHJ works towards eventually increasing capacity to all CCHC patients. Below is a Q&A with Kenya, Ben, and Nooreen about how and why this new partnership was established, their vision of community-driven medical legal partnerships, and their experiences thus far.
Question: What does a typical day in the life look like for you all?
Kenya: Meetings, meetings, and more meetings! *laughs* A typical day consists of meeting with team members to discuss their cases, troubleshooting issues, and assisting with professional development. Another focus of my role is policy advocacy. For example, recently I have been doing a lot of work with the Getting to Zero initiative, which is the statewide initiative to have no new HIV transmissions by 2030. Specifically, I’ve been focusing on HIV confidentiality training for care coordinators. I also spend time providing trainings to other organizations and advocating on behalf of our clients.
Ben: It’s still early days so my typical work schedule continues to evolve. When I joined LCHJ a year ago, the majority of my time was spent pouring through reports and statistics about health and legal issues affecting residents in our MLP service area. This work was critical in bringing me ‘up to speed’ with the why’s of our MLP. Later, I became the point person for our second phase of information gathering…surveys and focus groups gathered from the community. Most recently, I have been doing more traditional Community Organizing work. Pandemic restrictions are lifting so I’ve been pressing the flesh at CCHC Clinics, talking with Staff about our MLP to generate referrals, and recruiting new members for our Community Council.
Nooreen: Since I started at LCHJ in September 2021, the nature of a typical day has changed a lot. We went from being fully remote to having a hybrid in-office/at home model with me also being on site at our partner, Christian Community Health Center (CCHC), once a week. One thing that has remained a constant throughout is client relationships, though. A good portion of my days are spent calling clients about their cases to give them updates or discuss how things are going and gather information. When I’m not speaking with clients, I may be in meetings for our MLP project, doing research for cases, and occasionally doing presentations to different audiences, like CCHC staff and patients, about our MLP or other topics of relevance to them.
Q: Kenya, how did the new Medical Legal Partnership with Christian Community Health Center come about? Why now?
Kenya: We were looking at how we can make more of an impact in the African American community. This is not to take anything away from other communities, but we knew before the pandemic and before the protests in 2020, that health and social disparities existed in the South and West sides of Chicago in African American communities. There have been studies showing how, even when you control for education, socioeconomic status, and income, Black people receive poorer health services in their communities across the board; and the root cause of this problem is structural and societal racism. Therefore, we wanted our partner to be rooted in the Black community and to have a different population from the MLPs we were already serving. Approximately 90 percent of CCHC’s patients identify as Black; thus, partnering with CCHC happened naturally because their patient population would allow us to better serve clients in the far South Side and South Suburban communities, and we (LCHJ) already had an existing relationship with them.
Also, when you look at who is being impacted by HIV, the face of HIV has changed. It has changed from exclusively white gay males to that of people of color. While we have done a great job of reaching those traditionally impacted with HIV, we had to figure out a way to reach a more diverse population. So that was my push. It's great that we’re serving our current clients, but what about everybody else? We wanted to extend our reach to everyone impacted by HIV.
I have to give a lot of credit to Adoley Jordan, LCHJ’s former Development Director, because this project was really important to her. We also had support from our senior management team, and I want to say thank you to the McCormick Foundation who gave us funds to help really get this project off the ground.
Q: Ben, how has your role as a Community Organizer translated into creating this new MLP?
Ben: I’ve never been involved in an MLP before. As I understand it, although it’s typical to embed attorneys with healthcare professionals in most MLPs, it’s not so common to have a Community Organizer as part of the team. I see my role as important in communicating the power of law to address the social, physical, and economic conditions that affect individual and community health. We listened to the community and learned about historic mistrust of medical professionals and attorneys. I’m neither. I’m just a regular guy...albeit a charming one…and in many circumstances community members feel more comfortable and open to engaging with peers rather than with legal or medical professionals. I facilitate relationships based on trust. These relationships form the foundation of our Medical-Legal Partnership.
Q: Nooreen, what has your role been in the creation of this new MLP?
Nooreen: As the staff attorney on the project, my main role is to provide direct legal services to the clients referred to us by CCHC. That covers areas like public benefits, social security, Medicaid/Medicare, criminal record expungements, and some other issues as they arise on a case-by-case basis. So, that is more or less what I have been up to. I would like to think I’ve played some helpful role in the building/organizing side of things as well but my other team members are probably a better judge of that one, ha! (The other team members agree!)
Community Feedback, Outlooks Regarding the Future, and Recommendations for Advocates: Continued Q&A with Kenya Garrett-Burnett, Ben Handy, and Nooreen Reza
Another essential component of the creation of the CCHC-LCHJ Medical Legal Partnership was the collaboration between Legal Council for Health Justice and Candeo Consulting, a woman-owned consulting company, to gather information from South Side and South Suburban residents about the medical and legal needs in their communities. Feedback was obtained via focus groups and surveys, with a central focus on the following three questions: 1) What are the legal, health, and community needs and assets within the communities that CCHC serves?; 2) What are barriers to meeting legal, health, and community needs?; and 3) What assets and strategies can be leveraged to meet these needs?
The importance of community feedback and how it will be used to guide the MLP is discussed below, followed by the team member’s outlooks on the future of the MLP, and any suggestions or recommendations they may have for advocates looking to start a new MLP.
Q: A key element of the Legal Council for Health Justice and Christian Community Health Center Medical Legal Partnership is the feedback received from the community via Zoom and in-person focus groups, and also via the Community Needs Assessment Survey. Could you talk about your experience with, and the importance of community feedback when starting a Medical Legal Partnership?
Kenya: We want the community to guide this work. If we are off base, if we’re over there and the community says, “no we want you over here”, then we have to be able to make changes to get where the community needs us to be. Getting that voice and valuing people’s time is really important. It is also important to acknowledge that community members are not under any obligation to give us anything. Just because I have some degrees behind my name, doesn’t mean that I’m any more valuable than the person whose community I'm looking to impact. We have to continue to push this narrative and get the community to see that their opinions and what they have to say matters and is important.
Also, I have to credit Carrie Chapman. All along she has been pushing this idea of getting community input and valuing the community as a partner and not just as a group to which we’re providing services. We’re all equal, and she has never let us forget that. As a society we’re so used to jumping in and saying, “we’re lawyers, this is what we do, let us solve your problems and then we’re going to leave.” Carrie has always pushed our agency towards the model of everyone being equal partners, a model where legal aid lawyers value the community voice.
Ben: Certainly. Community input is critical to the success of our MLP with Christian Community Health Center. We put a lot of collective thought into crafting the questions used in both the survey and focus groups to coax out insights into both overlooked assets that make the community great as well as unmet needs that chronically challenge neighborhood wellness.
I’ll give you an example. One of the major findings that came out of our focus group discussions identified lack of social cohesion coupled with unreachable power brokers, like politicians, as caustic to individual capacity for self-advocacy or community-advocacy. Using this information, one of our new Community Council members, a young man from Calumet City, suggested we approach local government with an idea for an intergenerational arts project that would engage seniors with young people in shared story-telling and creative expression. Similar activities have been shown in studies to be effective in reengaging disconnected individuals in social activity and community building. I arranged a meeting with Calumet City officials, presented our idea and not only did they commit to support our proposal, they even offered a dedicated staff person to participate on our growing Community Council in future activities. That’s a win in my book which owes everything to community input.
Q: Nooreen, you began going in-person once a week to Christian Community Health Center starting in May, how has that been going so far?
Nooreen: So far it’s a little slow going! But I think that’s normal with the beginnings of any MLP—everyone is still getting used to the fact that this new resource exists and learning how to integrate into their daily rhythm of interactions with patients. We are working on building our profile through doing presentations for staff and just getting to know people at CCHC better. Hopefully that will result in more client referrals very soon.
Q: What are you most excited about with this new Medical Legal Partnership? Is there anything you’re nervous about?
Kenya: I’m most excited about getting the Community Council started, hearing what the community finds is important, and coming together to make an impact. What I'm most nervous about is people falling out of that process. So, what do I mean by that? It takes time to get a group of people together and to keep them engaged. I'm nervous that people may not stay along for the ride and may drop out before we are able to get the results that we want, and to make the change in the community that we hope to make. These things take a long time; but, I have faith in the community that we serve and I am very hopeful that we will be successful.
Ben: I’m very excited about the synergies that will come from directly engaging people in working to solve some of the community’s most intransigent problems. We’re working to address those, “someone ought to do something about….” problems that we all face. My job is to help folks embrace the idea that they are the ‘someone’ they’ve been waiting for all along. That’s what most excites me and what keeps me up at night. Many of us have been spooked and traumatized by two plus years of pandemic related lock-downs, job losses, and closures. Recruitment for our Community Council is going well but I still worry sometimes, what if I can’t motivate people to work together on big picture projects that tackle the Social Determinants of Health in their community?
Nooreen: I am really excited to see how the community-empowerment aspects of our MLP project come together. Since law school, I have been interested in community and movement lawyering concepts and how to put them into practice in the legal aid field. So, it was refreshing for me that this MLP project began with a strong emphasis on taking the lead from community members’ articulations of what their needs are. Not only their needs, but also their aspirations and goals for a healthier community. I’m looking forward to seeing where our community partners lead us. As far as nervousness goes, I’m always nervous about making sure I’m doing a good job for our clients!
Q: Based on your experience thus far, do you have any suggestions or recommendations that would be helpful for advocates looking to start their own Medical Legal Partnerships?
Kenya: First, I think that you should survey the community to really find out first-hand the needs of the people you are serving and the issues that are important to them. For us, it turned out that there was a large overlap between the issues the community identified and the services we provide; also, make sure that expectations related to these services you will provide in your MLP are clear between you, your medical partner, and the community.
Second, it is important to remain flexible. Keep in mind that things change as you go along, so you may have all these great ideas and have planned everything out, but then you get a year down the line and realize that maybe those ideas weren’t realistic given your allotted resources. For that reason, if you have never started an MLP before, I would say start small and build from there. It can definitely be a lot and you don’t want to get overwhelmed, but also don’t be discouraged. Just know that it starts slow and it takes time to build trust with staff and patients seeking legal services.
Also, as much as you can, have a plan for funding. You may get some type of grant initially, but that money will eventually run out. It’s important to have open and realistic conversations about funding with your medical partner because the worst case scenario would be having to wind down an MLP because you ran out of funding.
Finally, you have to build relationships with your partner(s); so, go to lunch with them, get invited to their meetings, go to company outings. You need to make yourself a part of their team. You have to go out and talk to people and build trust with them. For example, you can host “chat and chews” where you bring in coffee and donuts for staff and potential clients, providing a space to introduce yourself, and to spread awareness about the legal issues that the MLP plans to address. The MLP won’t work if you don’t build these relationships. Establishing trust between medical and legal partners, but also between the partners and the community, is one of the most important aspects of creating a new MLP.
Ben: I’m reminded of the old expression that to a hammer everything in the world looks like a nail. So, at the risk of my advice seeming to apply only to someone in my position, I would still counsel to always remember that building an MLP is really about building relationships. Your MLP is just a network of relationships shared among multiple constituencies. The stronger the relationship, the stronger the MLP. This takes time. Be patient with yourself and never miss an opportunity to listen and learn from others. Be someone others can trust and they’ll not only view you this way, they’ll see your MLP in the same way too.
Nooreen: Hopefully, folks starting a new MLP in the future will be fortunate enough not to be doing it at the height of a global pandemic! I think that’s really been the biggest obstacle for us, in many ways. Overall, though, I think there are some suggestions that apply to any new project, pandemic or not. As I mentioned above, I really do think seeing community members as equal partners in a journey, and not just recipients of a service, is crucial. The last few years of racial justice protests and movements I hope has made it clearer to institutions that, no matter how well intentioned they may be, they cannot swoop into communities and presume to know what is best for the people living there. The sooner that lesson gets internalized into service delivery models, the better, in my opinion.
That said, it is certainly a challenge even in more normal times to put those lessons into action because I think as a part of the legal profession we are all still learning how to pair organizing and building community power with entrenched, top-down, legal services models. Not to be too much of a nerd about it—I just want to say that it’s a challenge and no one should feel bad if they are starting a new MLP with these aspects in mind and find it’s a very trial and error driven process!
Q: Any final thoughts?
Kenya: The key word in an MLP is “partnership”. I value the partnership between Christian Community Health Center, their patients, and the community. I look forward to this exciting endeavor and our work with the Community Council.
Ben: I want to salute all the many selfless, compassionate people who daily put aside self-interest to work on behalf of others. The world needs you more now than ever!
Nooreen: Thank you for sharing our project on the website! If there’s anyone out there who is also interested in community lawyering within legal aid, I’d love to hear from you.
Summary
As Kenya, Ben, and Nooreen all emphasized, the most important aspect of establishing a new Medical Legal Partnership is building relationships and trust among the partners, and also with the community. We firmly believe in moving towards a more modernized model of viewing community members as equal partners in the MLP. Our clients are not just recipients of our services, they are key players in keeping the MLP going, and their opinions and suggestions are of the utmost importance. Creating a new MLP, especially during a pandemic, can seem like quite a daunting project. However, with a passionate and committed team, integrated feedback from the community, and open and honest communication, establishing a new MLP is achievable, and can be a great asset for all parties involved.