Upstreamists are changemakers pioneering practices that improve health by blending medical and social care. In this series of profiles, HealthBegins highlights some of these bold leaders and their innovations, in settings large and small. Their stories show us that the journey upstream is not only necessary — it’s possible.
The People’s partnership began in 2012, when two puzzle pieces clicked together. The clinic’s Chief Medical Officer, Dr. Louis Appel, a pediatrician with an interest in addressing the social determinants of health, and clinic CEO Regina Rogoff, a lawyer and former executive director of Legal Aid of Central Texas, had been trying to start an MLP but struggling to find funding and convince their board that legal care wasn’t mission-creep. Keegan Warren-Clem was a new law school graduate with an Equal Justice Works Fellowship, via the nonprofit Texas Legal Services Center, to start an MLP in Austin. All she needed was a place to do it.
When the three met, the match seemed obvious.
Despite the administrators’ wholehearted support, logistics and traditions set the program up for a slow start. Warren-Clem began as a clinic outsider trying to make her way in. She worked out of an office in a separate building, paying visits to providers with a 10-item screening questionnaire and a laminated information card.
The program has since evolved in essential ways. Warren-Clem, as well as two additional full-time lawyers, has her office right in the clinic. A single, universal screening questionnaire (which the lawyers helped develop) checks for unmet health-related legal and social needs. Referrals to legal care are made through the exact same system as referrals to medical care. And medical and select legal information are embedded side by side in patients’ electronic health records.
Paid protected time for “clinical champions” — originally three and now 13 staff members ranging from physicians to social workers to receptionists, who identify and address challenges within the program — has also helped the collaboration take root.
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