Tag: community health

Bioethics for Breakfast: Medical Legal Partnerships: A Tool to Help Address the Social Determinants of Health

Bioethics for Breakfast Seminars in Medicine, Law and Society

Megan Hoberg and Pamela Hoekwater of Legal Aid of Western Michigan presented at the December 1st Bioethics for Breakfast session, offering their insight and expertise on the topic “Medical Legal Partnerships: A Tool to Help Address the Social Determinants of Health.” Bioethics for Breakfast is generously sponsored by Hall, Render, Killian, Heath & Lyman.

The session provided an overview of medical legal partnerships (MLPs) and their impact, discussing the Legal Aid of Western Michigan (LAWM) partnership with Cherry Health—Michigan’s largest Federally Qualified Health Center that operates in six counties. Speakers Hoberg and Hoekwater defined a medical legal partnership as “an integration of lawyers into the health care setting to help clinicians, case managers, and social workers address structural problems at the root of so many health inequities.” MLPs are increasing in popularity across the U.S. and can result in patient success stories, provider satisfaction, and increased recognition and reputation from organizations in the community.

They explained that a big part of MLPs involves screening for issues that might not have an obvious legal component to them. They shared four legal aid practices that relate directly to different social determinants of health: family law, housing, public benefits, and individual rights. One component of an MLP is training the health organization’s work force to help identify potential legal needs in the patient setting.

A memorandum of understanding (MOU) between the relevant stakeholders is generally a starting point to form MLPs. Hoberg and Hoekwater shared that there are a variety of ways that MLPs are funded, including AmeriCorps/Equal Justice Works, private donors, law firms, bar associations, health organizations, and foundations. They shared the evolution of their partnership with Cherry Health, which started with a pilot program and now includes a full-time on-site attorney and community health worker. The MLP currently focuses on maternal infant health and the senior population. The MLP operates as a multi-step process that begins with a referral to the MLP team through the electronic health record which leads to a meeting between the patient and attorney.

Hoberg and Hoekwater also shared challenges associated with MLPs, such as stability of funding, balancing legal and medical ethics, systems integration, and internal communication. Challenges aside, they shared both quantitative and qualitative data that supports the positive impact of MLPs. One example of a specific impact is patients reporting improved mental health and lower levels of stress and anxiety.

It was clear during the question and answer potion that attendees were interested in learning more about how they can pursue forming MLPs at their organizations, and how they can help their patients receive the legal support they need.

Related items

About the speakers

Megan Hoberg is a Staff Attorney with Legal Aid of Western Michigan (LAWM). Previously, she worked as the Medical Legal Partnership Attorney, for the MLP LAWM maintains with Cherry Health. Megan’s perspective sheds light on how MLPs operate on a daily basis and the impact they produce for patient/client communities. Megan was drawn to MLPs during her time at Wayne State University Law School, when she served as a student attorney for The Legal Advocacy for People with Cancer Clinic and earned the 2020 Outstanding Clinical Student Team Award from the Clinical Legal Education Association (CLEA). Starting her career in healthcare and bioethics, working with MLPs and poverty law allows her to use her legal training to advance public health goals in an interdisciplinary setting. She is a member of the following organizations: State Bar of Michigan Professional Ethics Committee, Women Lawyers Association of Michigan, and American Society for Bioethics and Humanities.

Pamela Hoekwater serves as the Executive Director for Legal Aid of Western Michigan (LAWM). She has over 20 years’ experience in poverty law work since starting her legal career as a Staff Attorney in 2001 and has developed innovative partnerships with local agencies to integrate legal services in the community, including the YWCA, Goodwill Industries, and Hope Network. Having helped launch LAWM’s first medical legal partnership (MLP) in 2017, Pam holds a unique perspective and expertise as to the challenges of maintaining and advancing MLPs. Notably, she contributed to the formation of the Medical Legal Partnership with Cherry Health, which has been fully funded and staffed since 2019. Pam strives to advance social justice and equity through her participation/leadership in the following organizations: Resource Committee for Michigan Justice For All Commission, State Bar of Michigan Diversity and Inclusion Advisory Committee, Michigan State Planning Body, and Legal Services Association of Michigan.

By Liz McDaniel

Police violence as a reproductive justice issue

Bioethics in the News purple and teal icon

This post is a part of our Bioethics in the News series

By LeConté J. Dill, DrPH, MPH

In July 2017, Sacramento police officers raided Zityrua Abraham’s apartment during a no-knock warrant, and threw her to the ground, where she landed on her stomach. Ms. Abraham was eight months pregnant, and her one-year-old son was inside of the house. Furthermore, the police officers were at the wrong house. In May 2019, Phoenix police officers pointed guns at Dravon Ames, his pregnant fiancée, Iesha Harper, and their two young daughters, ages four and one, after their four-year-old accidentally took a doll from a Family Dollar store. Although Ms. Abraham, Ms. Harper, their unborn babies and their families “survived” their police encounters and were not murdered, we must also consider and more rigorously document the impacts of police violence on pregnant and parenting “survivors” and other witnesses.

How does police violence impact people’s reproductive decisions?

After the murder of Michael Brown in 2014 by police in Ferguson, Missouri, Imani Gandy, Rewire Senior Editor of Law and Policy, tweeted “I saw so many people on Twitter saying “I don’t want to have/raise Black children in this country.” That is a reproductive justice issue.” Since then, the intersections of police violence and reproductive justice have received more attention in the popular press. “Reproductive justice,” first coined in 1994 by a group of Black women, has spurned into a movement that supports “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.” The U.S. does not foster “safe and sustainable communities” particularly for Black, Indigenous, and other people of color, and that lack of safety is perpetuated through disproportionate and excessive surveillance, policing, and punishment by law enforcement. Black people have flocked to social media to vent about how even the fear of police violence threatens their reproductive and parenting decisions. Writer and journalist Hannah Giorgis has remarked that “Any force that systematically and unapologetically turns unconsenting Black wombs into graveyards is a reproductive justice issue.”

Photo of a black child with their head and hand resting on the exposed pregnant belly of their parent.
Image description: a young Black child is lovingly resting their hand and head on the exposed pregnant belly of their parent, who is standing with their arm around their child. Image source: Anna Carolina Vieira Santos/Flickr Creative Commons.

How do pregnant people experience police violence?

In 2020, the state-sanctioned murders of Breonna Taylor, George Floyd, Tony McDade and other Black people raised the public consciousness of an all too pernicious, long cycle of racist state-sanctioned violence in the United States. Ongoing advocacy and activism efforts were bolstered, calling for decreased use of force by officers, demilitarization of law enforcement, divestment of police department funding and redistribution to social services, and abolition. Nevertheless, since the summer of 2020, law enforcement has continued to disproportionately harm Black people, including assaulting and arresting pregnant Black women. In a recent study, Dr. Rachel Hardeman and colleagues found an 83% increase in the odds of preterm birth among those who reside in neighborhoods with high levels of police exposure, contact, and activity relative to those in low police exposure neighborhoods. After Zityrua Abraham’s assault mentioned earlier, she was in physical pain and her pregnancy became high risk. Although Ms. Abraham’s contact with police did not end in her murder, such exposure to law enforcement and their technologies of surveillance is still violent—physically, mentally, and emotionally. This is a type of “slow death”—a cumulative trauma borne out of the daily round of living, and in this case, living while Black.

Bearing witness

It is also critical to acknowledge and address the mental, emotional, and physical ramifications of witnessing police violence. Darnella Frazier was 17-years-old when she filmed George Floyd being murdered by Minneapolis police officer Derek Chauvin. This footage helped to galvanize worldwide protests against police violence and became primary evidence in the conviction of Chauvin. Frazier has talked openly on social media and in news stories about the chronic post-traumatic stress that she has experienced from bearing witness to Floyd’s murder by police. Additionally, her then-nine-year-old cousin also witnessed the murder. Similarly, the children and other young family members of Korryn Gaines, Atatiana Jefferson, Philando Castile, and Jacob Blake witnessed or were in close proximity to the murders of their loved ones by law enforcement. Dr. Rhea Boyd’s research and advocacy acknowledges this, and she notes the glaring absence in the research literature of the impacts of young people who have witnessed their family members murdered by law enforcement. Ultimately, we must ask what are the consequences of witness and of survival; what coping practices exist and persist amidst chronic trauma; and will we ever be able to reproduce justice?

Photo of LeConté Dill

LeConté Dill, DrPH, MPH, is an Associate Professor in the Department of African American and African Studies at Michigan State University. In her work as a community-accountable scholar, educator, and poet, she listens to and shows up for urban Black girls and works to rigorously document their experiences of safety, resilience, resistance, and wellness.

Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Wednesday, November 24, 2021. With your participation, we hope to create discussions rich with insights from diverse perspectives.

You must provide your name and email address to leave a comment. Your email address will not be made public.

Continue reading “Police violence as a reproductive justice issue” →

Upcoming webinar on the relationship between the criminal legal system, structural racism, and health

Monday, September 13, 2021; 1:00-2:30 PM ET
Zoom registration: bit.ly/bsj-hfhs-sept13

Trauma, Community Health and the Criminal Legal System

Why should we care about the effects of incarceration and policing on communities and their health? This virtual panel discussion and audience Q&A on the relationship between the criminal legal system, structural racism, and health will also explore terminology—including “mass incarceration”—and explore different ways of thinking about trauma.

This webinar is co-presented by the Michigan State University Center for Bioethics and Social Justice and the Henry Ford Health System Health Disparities Research Collaborative. Panelists include Jennifer Cobbina, PhD, and Christina DeJong, PhD, from the Michigan State University School of Criminal Justice, Carmen McIntyre Leon, MD, from Wayne State University School of Medicine, and Center for Bioethics and Social Justice Director Sean A. Valles, PhD. Henry Ford Health System Health Disparities Research Collaborative Director Christine Joseph, PhD, will moderate the session.

This webinar is free to attend and open to all individuals. A recording will be available following the event.

About the panelists

Jennifer Cobbina, PhD

Jennifer Cobbina is an Associate Professor in the School of Criminal Justice at Michigan State University. She received her PhD in criminal justice at the University of Missouri-St. Louis in 2009. Her primary research focuses on community responses to police violence and the strategies that communities employ to challenge police expansion and end state sanctioned violence. Her research also examines the intersection of race, gender, and how neighborhood contexts shapes crime and criminal justice practices. Finally, her work focuses on corrections, prisoner reentry and the understanding of recidivism and desistance from crime. She is the author of Hands Up, Don’t Shoot: Why the Protests in Ferguson and Baltimore Matter and How They Changed America.

Christina DeJong, PhD

Christina DeJong is an Associate Professor in the School of Criminal Justice at Michigan State University. Her research interests focus on gender, sexuality, crime, and justice. Dr. DeJong’s current work is focused on Queer Criminology, specifically the homicide of transgender people in the United States and how sexuality shapes juvenile offending. She is also currently studying bullying and misconduct in academe. Dr. DeJong received her PhD in Criminal Justice and Criminology from University of Maryland. She is an associated faculty member with the MSU Center for Gender in Global Context.

Carmen McIntyre Leon, MD

Carmen McIntyre Leon completed undergraduate studies at the University of Michigan, attended Wayne State University for medical school, and the Medical College of Pennsylvania (now Drexel) for psychiatry residency and NIMH research fellowship. She worked as medical director for partial programs, inpatient units, research units, and SUD/Methadone programs before returning to Michigan, eventually co-founding Community Network Services, an adult community mental health provider in Oakland County. After a brief stint in New Zealand she returned to Detroit to help lead the newly created Detroit Wayne Mental Health Authority as the Chief Medical Director. She is now the Associate Chair for Community Affairs and Director of Public Psychiatry Fellowship with the Wayne State University School of Medicine Department of Psychiatry and Behavioral Neuroscience; and Chief Medical Officer for the Michigan Department of Corrections.

Sean A. Valles, PhD

Sean A. Valles is director and associate professor in the Center for Bioethics and Social Justice in the Michigan State University College of Human Medicine. Dr. Valles is a philosopher of health specializing in the ethical and evidentiary complexities of how social contexts combine to create patterns of inequitable health disparities. His work includes studying the challenges of responsibly using race and ethnicity concepts in monitoring health disparities, scrutinizing the rhetoric of the COVID-19 pandemic as an ‘unprecedented’ problem that could not be prepared for, and examining how biomedicine meshes with public health and population health. Dr. Valles received his PhD in History and Philosophy of Science from Indiana University Bloomington.

Christine Joseph is a Senior Epidemiologist in the Department of Public Health Sciences at Henry Ford Health System. Her research interests include racial/ethnic health disparities, adolescent health, asthma and allergic disease, adherence, and school-based health management. She has experience in the design and implementation of community-based and pragmatic clinical trials. Dr. Joseph has worked on a variety of studies focusing on vulnerable populations and social determinants of health, and has publications in the areas of asthma, food allergy, sleep, LGBTQ health, and health literacy.