Scene Report —
Building Community Care Networks: Training Legal Aid Attorneys at the 2017 American Bar Association Equal Justice Conference
by Dawn S. Opel
The American Bar Association holds its Equal Justice Conference each year to "join all components of the civil legal aid community to discuss and address issues related to the delivery of legal services to low-income individuals in need of legal assistance" (Equal Justice). Continuing legal education is a core component of the conference, with over 85 sessions offering relevant, accredited programming that fulfills legal aid attorneys' obligations to their state bar associations. Legal aid attorneys work across a broad spectrum of practice areas and often find that the legal assistance they provide will not be successful without support for their clients outside of the legal arena. If the goal of their work is equal access to justice, they find that legal assistance is inextricably connected to a variety of issues related to access to services across contexts, including housing, transportation, food, and other support offered through government and nonprofit entities. In short, justice means not only a particular legal outcome, but also the scaffolding of equal access to the services that enable that legal outcome to be sustained. This year, at the Equal Justice Conference held in Pittsburgh on May 4-6, 2017, a research collaborative of which I am a part was invited to lead a continuing education program in order to present, demonstrate, and educate ways to better create communication strategies to reach the partners in the community that they need to be successful. We call the relationships between professionals and other caregivers in the community "care coordination teams," and my research collaborative works to scaffold these teams' communication with technological support. Care coordination is particularly essential when the health and wellness of the client is a focus of the strategy; for instance, when applying for Medicaid benefits with the assistance of a legal aid attorney is essential to receive care from a primary care physician.
The Agency for Healthcare Research and Quality refers to care coordination as "deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient's care to achieve safer and more effective care" (AHRQ). For this reason, The Patient Protection and Affordable Care Act (ACA) focuses heavily on reform efforts geared toward care coordination inside and outside of clinics. For almost a year, I have been involved as a digital rhetoric and community literacy scholar-activist on a transdisciplinary research team that includes attorneys from Elder Law of Michigan, Inc. (a legal aid clinic that offers free legal services to older adults across the state of Michigan), a web developer, and a social worker. We have been brought together on a project to research, develop, and test software designed to facilitate community care coordination across legal, medical, and social services contexts to create more equity in access to all of these services.
The software, called Connectz, was developed with the help of several grants to visualize and activate the networks of support services offered to older adults in the state of Michigan who need the assistance of more than just one sector of support in our communities. Rather than hand a patient or client a brochure for a service, as is current practice in many healthcare settings and in agencies such as legal aid offices, this free, online system facilitates the care across settings by creating a space to make and track referrals across agencies and communicate across care provider roles. The goal of Connectz–and with other care coordination efforts incentivized under the ACA–is to create interprofessional networks that address the social determinants of health and wellness and combat health inequities.
Currently, these networks are nonexistent to informal. A social worker or agency representative may have a personal relationship within another agency that they rely upon for referrals, or they may consult a phonebook of services (although these are quickly outdated due to swift variations in funding and staff from year to year in the nonprofit and government sectors). Further, if a healthcare or social services professional wishes to make a referral, it often involves lengthy bouts of back-and-forth phone tag. When taken together, these difficulties discourage the practice of making community referrals, particularly in the healthcare sector as a healthcare provider lacks the means to efficiently learn if their referral was successful.
There is also no space to communicate to coordinate care over time. Connectz, then, is effectively creating networked writing spaces for health equity, in that it exists to make communities of support visible and able to act, across silos, in ways that improve the practice of the professionals and transform the lives of patients and clients. In this way, my role in this project has been directly influenced by Jeff Grabill's call to action for work as rhetoricians in community computing and informatics, in that failure to address these areas means "we will continue to see information technologies failing certain individuals and communities and persistent 'divides' related to technology and writing" (9). Our team is attempting to move community care coordination—with under resourced human services agencies and federally qualified healthcare clinics that serve the most under resourced communities—from the era of the phone book to the affordances of networked information technologies.
My work as a scholar-activist on this project is not only as a researcher, to design and test the software in clinics and offices, but to build a culture of awareness in care coordination as health equity activism among the professional communities that must participate in order for coordination to take place. This is where the Equal Justice Conference plays a role. Our workshop had three components: (1) addressing both cultural and procedural concerns about care coordination and the Connectz tool specifically; (2) equipping lawyers from across the country to begin their own work with care coordination; and (3) networking with workshop participants to leverage resources across initiatives from around the country, so researchers and professionals are not duplicating efforts and we might preserve critical resources for legal and social services in our communities.
Our workshop began with a PowerPoint presentation that provided the basic approach of Connectz and a demonstration of the software. Immediately, the audience began asking questions that fell into roughly two categories: cultural and procedural. These combine to create roadblocks to care coordination. Cultural concerns related to perceived roles and responsibilities of a certain profession, such as, "Is this work really a part of my job as a [lawyer/healthcare professional/nonprofit representative]?", or "Will my funding for my clinic or agency allow for this work?" To change these cultural conceptions of siloed work, it is important to communicate the research findings of the project to audiences such as the Equal Justice Conference. We relayed our experiences in legal and medical contexts to begin to build a culture of understanding that networking services is more efficient, cost effective, and transforms the lives of the clients they serve. Procedural questions related to the tool itself, and questions of, for example, whether communication facilitated by the tool may violate attorney-client privilege or HIPAA. Again, sharing our experiences with examples is important to dispelling the lore that prevents attempts to coordinate and make referrals. Some in the audience also shared their experiences, which helped to network lawyers from other states at varied levels of engagement with care coordination.
For example, one audience member is working with the Florida bar to develop a similar system that connects elder law practitioners to healthcare networks with an open source tool, and she shared that tool with the audience and offered her assistance in that geographic region. By the end of the session, many lawyers in the audience expressed their interest in building capacity to begin similar care coordination efforts in their communities. For me as a scholar-activist and for our research team, the Equal Justice Conference created an opportunity to expand the potential impact of our work to other areas of the country, and hopefully, into the lives of more people served by participating legal aid attorneys.
"Care Coordination." AHRQ: Agency for Healthcare Research and Quality, July 2016, ahrq.gov/professionals/prevention-chronic-care/improve/coordination/index.html.
"Equal Justice Conference–General Information." American Bar Association, 27 June 2017, americanbar.org/groups/probono_public_service/ejc/general.html.
Grabill, Jeffrey T. Writing Community Change: Designing Technologies for Citizen Action. Hampton Press, 2007.