Courtney Williams Coleman was already behind on her bills by the time she finally found answers that unlocked treatment options for her toddler, who was prone to pulling out her own hair and was not meeting typical developmental milestones.
In the midst of her daughter’s testing for autism, it seemed Coleman’s economic situation might be on the verge of improving. At a promising job interview, she informed the company about her daughter’s status. When she did not receive the job offer, Coleman says they told her she was not hired because of her child’s ongoing treatment.
“I was devastated,” Coleman said.
Economically-precarious families like hers who cannot afford the services of a traditional lawyer and who are already navigating a new diagnosis for their child might be at a loss for where to turn in such a situation. Luckily, her child’s Le Bonheur network doctor referred Coleman to a lawyer with Memphis CHiLD, a legal clinic located in a small section of the Children’s Research Center on Le Bonheur’s campus.
Attorney Pamela Kelly sits down with a Courtney Williams Coleman, a prospective client of Memphis CHiLD. (Brandon Dahlberg)
Memphis CHiLD fulfills legal referrals as one aspect of the larger iIMPACT network, or Institute for Interdisciplinary Memphis Partnerships to Advance Community Transformation for Children.
The partnership brings together the University of Memphis Law School, Le Bonheur Children’s Hospital, Memphis Area Legal Services, and University of Tennessee Health Science Center to create opportunities for low-income families like Coleman’s to get help for legal and environmental issues that affect their children’s health.
According to program coordinator Jamie Johnson, this is a first-of-its-kind medical-legal partnership in Tennessee, Arkansas, or Mississippi.
This partnership is part of a larger interdisciplinary initiative led by the University of Memphis to address the multifaceted adverse social experiences and their effects — such as impaired language development, asthma, autism, poverty, lack of quality childcare, nutrition, and stress — that affect Memphis families and children.
iIMPACT is a three-prong initiative that tackles the effects and causes of poverty through medical, legal and social services functions. They serve clients, lobby for policy change, conduct research and train the next generation of professionals to use evidence-based tools to approach their work in an interdisciplinary way.
While doctors and nurses can treat illnesses, the more complex diagnoses of poverty require complex solutions outside the realm of traditional institutions. Poverty not only impedes children being diagnosed and treated for conditions early, the environment of poverty causes and exacerbates many medical conditions and can cause trauma that affects children’s mental health and ability to learn.
For example, the Asthma and Allergy Foundation of America ranks Memphis No. 57 among all American cities for the prevalence of asthma, noting the high poverty rate and lack of anti-smoking laws as casual factors and the high crude asthma death rate as a concerning outcome. They also note that emergency room visits for asthma in Memphis are nonetheless lower than usual, which likely shows that Memphis families are less likely to have access to or use hospitals.
Research in the journal Paediatrics & Child Health posits that higher rates of asthma among children in lower income families and neighborhoods may be due to higher rates of low birth weight and lower rates of breastfeeding as well as unequal access to, and utilization of, healthcare services, which may result in lower treatment rates. Housing quality and exposure to environmental pollutants have also been suspected, primarily through their link with air quality, such as tobacco smoke and exposure to cockroaches.
Members of the medical-legal partnership Katy Ramsey, Jamie Johnson, Tim Flack, Lydia D. Walker, Pamela W. Kelly with Memphis CHiLD. (Brandon Dahlberg)
The same study shows that poverty also impacts children's mental health with the very poorest children having the highest rates of a number of poor mental health outcomes, including conduct disorder, hyper-activity and emotional disorders.
Hospital staff at Le Bonheur and occasionally the Shelby County Health Department and St. Jude Children’s Research Hospital refer families seeking treatment who have legal concerns or barriers to treatment to the clinic. The team of lawyers, social workers, medical staff, and evaluators perform advocacy and training work in addition to direct legal services relevant to the details of the case.
For a mother like Coleman, that may mean filing a suit against a discriminatory employer. For an asthmatic child with a rental home infested with cockroaches that trigger attacks, it might mean a legal suit against a landlord.
U of M Institute for Health Law and Policy professor Amy T. Campbell said their motivating question is how to have systemic change and not just individual service-driven responses.
“People don’t understand how important policy is. We can talk about these systemic issues, but it’s about policy at an organizational level — not just legislative. How do you influence the people in charge to do what is evidence-based?”
Part of the answer, it seems, is using the research of academic iIMPACT partners and their program evaluators to determine best practices while disseminating their findings through education and advocacy.
Related: "Facing the medical and legal consequences of poverty"
Evidence-based practices are likewise spread through the training of the next generation of professionals. iIMPACT is training nurses, scholars and — in the case of the Memphis CHiLD clinic and policy lab — lawyers to identify and address the social determinants of health.
Clinic coordinator Jamie Johnson says that the law students and other staff are processing about thirty cases at a time on issues that include income and insurance issues, housing and utility problems, employment and education, legal status, and personal family safety issues.
In one example, A child who needed a transplant didn’t have the guarantee of stable housing required for children to be released post-surgery. The case attorney was able to make contact with the family to ensure that the child had a guardian with a safe home to return to and made it possible for that child to get that life-saving transplant within 48 hours.
Some cases, like getting a family $90,000 in disability back payments, take longer.
However, the clinic does not stop at individual outcomes.
On a recent morning, the staff sat around their small conference table. A mother had contacted them because her child had not been able to make the progression from soft to solid foods. She said that when she attempted to buy puréed baby foods with her EBT card, the system rejected the purchase.
The team began talking out the issue: Could it be the ban on buying prepared foods with EBT? Should they contact Congressman Steve Cohen? Were they jumping the gun? They needed to verify that EBT was rejecting such purchases first. Had there been other cases like this?
Pamphlets in the Memphis CHiLD office explain the fusion of medical and legal services the staff is able to provide. (Brandon Dahlberg)
This was one of the first of such meetings for Katie Ramsey, the new director of the Medical-Legal Partnership, taking over the law school role from professor Janet Goode.
“My guess is it’s a perverse way to try to get [EBT recipients] to prepare their own food,” Ramsey said.
Social worker Lydia Walker said she had heard stories like this one before. “We have mothers chewing food for their child.”
They agreed they needed to know alternatives before they used political capital to try to get laws that ban the purchase of certain baby foods with EBT changed. It was likely a federal law, which would be much more difficult to change.
Memphis CHiLD hopes this interdisciplinary approach will be able to help Coleman as they continue the conversation with her about whether her child’s medical needs are being met and whether she is receiving appropriate accommodations at school. They are also deciding whether or not to take on an action against the employer for discrimination or to refer her elsewhere, such as to their partner, Memphis Area Legal Services for pro bono work.
Although Memphis CHiLD was launched in 2015, Johnson and law professor Daniel Schaffzin say that it took building trust between the medical staff at Le Bonheur and the clinic’s lawyers and getting the word out about their services before referral numbers started to rapidly grow.
“Doctors don’t think, ‘call the lawyer.’ They worry about being sued,” Schaffzin said.
“But, it works because there is trust. We had thirty referrals in a week in May. Thirty referrals in a week means there is something beyond a core understanding of the MLP [Medical-Legal Partnership) and a belief that it can help improve the health of patients and families. Just think about that. 30 referrals in one week,” he added.
The clinic says they have now had just under 1,000 referrals since the start in 2015, a distinction which they say is true of only the top 10 percent of all MLPs nationally.
“This is a partnership that services those most in need in Memphis, children — the most vulnerable of the vulnerable — in our communities,” Schaffzin said.
“It has layers that involve training and not just service for future nurses, doctors, lawyers, social workers who see the importance of treating community in this way and understands holistic, interdisciplinary care.”
Support for this story was provided in part by the Urban Child Institute; it is one article in a series highlighting the impact and importance of early childhood education. The Urban Child Institute focuses its grantmaking, advocacy and community support on kindergarten readiness and third grade literacy in an effort to improve the education, health and well-being of children and families in Shelby County.