Episode Transcript
[00:00:00] Speaker A: Imagine a justice system built on rigorous evidence, not gut instincts or educated guesses about what works and what doesn't.
More people could access the civil justice they deserve.
The criminal justice system could be smaller, more effective and more humane.
The Access to Justice Lab here at Harvard Law School is producing that needed evidence. And this podcast is about the challenge of transforming law into an evidence based field.
I'm your host, Jim Griner, and this is Proof Over Precedent.
[00:00:34] Speaker B: This is the Proof Over Precedent podcast from the Access to Justice Lab at Harvard Law School. And I am not your regular host, Jim Greiner. I am Renee Dancer, researcher, frequent podcast guest, and taking over the airwaves today to talk with my friend and colleague Emily Suske.
Emily's program was featured on podcast episode one, so Prime Billing. And so here we're going to talk to Emily a little bit more about the substance of her program. So Emily, thank you for joining me.
[00:01:06] Speaker A: Oh, thank you for having me.
[00:01:08] Speaker B: Very exciting.
Let's start by telling everyone who you are, your role, and what brought you there.
[00:01:16] Speaker A: Well, I am a faculty member. I'm a professor of law at the University of South Carolina, Joseph F. Rice School of Law, and I also am the faculty director and founder of our medical legal partnership, which is called champs, the Carolina Health Advocacy Medico Legal Partnership.
[00:01:34] Speaker B: Great. And how did you come to be at the University of South Carolina?
[00:01:39] Speaker A: Give us a little origin story, a little circuitously. I started my career as a lawyer in D.C. i spent a few years there, a couple of years in Charlottesville, Virginia, working at the Legal Aid justice center, and then about eight years in Atlanta. And in all of those places I worked interdisciplinarily, but not always in a medical legal partnership, but always working on behalf of children and doing children's advocacy. I did work at a medical legal partnership in Atlanta, which is called the Health Law Partnership, or help. And I was hired here to start a medical legal partnership clinic, which required me to start the medical legal partnership at the university.
[00:02:26] Speaker B: And for just a few follow ups for folks who may not know, what do you mean by working interdisciplinarily?
[00:02:34] Speaker A: So I've always worked. I have a JD and an msw. So I think I just sort of have an interdisciplinary bent. I couldn't quite decide whether to do one or the other. And then realized that way back in the day when I was in law school, that that was a thing one could do was do both. And so I did. And in doing child advocacy, both in D.C. and in Charlottesville, always was working with other disciplines, whether it was social work. Often it was medical professionals to effectively advocate. Then I was doing a lot of special education work, and that required a lot of work with other professionals in other disciplines to do the advocacy effectively.
[00:03:12] Speaker B: That's great. I think one thing we find in our work at the Access to Justice Lab is that it's hard for the legal profession to really kind of think of other professions as instructive. And so it's nice to hear about your interdisciplinary work. And so one more follow up from your prior origin story is for folks who may not know what is a clinic program at a law school?
[00:03:37] Speaker A: So a clinic program at a law school is a class that students take. It has a seminar component, but the bulk of their time is spent practicing law.
The original concept of the clinic and why it's called a clinic is based on the medical school model, where forever medical students have been practicing medicine in clinical rotations under the supervision of doctors.
And law schools 60 plus years ago started clinics to do that based on that model. That's why they're called clinics. And so students usually work in teams of two and a faculty member who's licensed supervises them as they learn to practice law. So it's very much an educational focus. So students aren't taking a high volume of cases, they're taking a very small number one to sometimes no more than that cases, so that they can really learn deeply how to practice law.
[00:04:33] Speaker B: Right. And I had actually never put two and two together that this clinic programs were modeled after the medical profession. So there you go.
[00:04:44] Speaker A: There was a little aha moment. It seemed back in the 60s.
[00:04:48] Speaker B: So though here I am living the.
Living the rebuke. I just.
[00:04:56] Speaker A: Yeah,
[00:04:58] Speaker B: so, okay, now I would like. So I want to talk.
As we go forward, we'll talk a little bit more about champs and how you're able to kind of incorporate that clinical model with an actual ability to serve more clients than a typical clinical model would. But before we get there, I still want to know more about you. And so tell us a fun fact about you. This is something we ask each of our guests to do. And the audience is tired of hearing my fun facts. So please tell us one about you.
[00:05:30] Speaker A: This is a hard one for me, but I think what I'll say is I put my. I don't know if I told you this, Renee. I put my children in a movie.
[00:05:38] Speaker B: Oh, you haven't told me that. Tell me, tell me a little bit more.
[00:05:44] Speaker A: So I was a stage mom for like two months. Well, then I have identical twins as you know, and you've met them. When they were babies, I stayed at home with them for a couple of years before I went back to work. And that was not a great fit. I wanted to stay at home, mother, and I was bored and know what to do with them. And I got an email ask, you know, across. Back then, this is. They're 17 now. There was a time when you had listservs for parents of multiples. Maybe they still exist. I don't know. I assume.
[00:06:16] Speaker B: I'm sure that I'm. I'm still on some list first. Not for parents of multiples, but
[00:06:22] Speaker A: there's probably better. A better group format. I don't know. Anyway, and I lived in Atlanta, which was becoming sort of a hot movie, you know, filming location at the time. And they were looking for twins for a movie with Cissy Spacek and Bill Murray and Robert Duvall.
And I love Bill Murray's movies. And I was like, well, I have twins.
They're identical.
And I thought I would just, like, get to see, like, maybe get to meet Bill Murray and just kind of see, like, how does one cast a baby in a movie? And that was the end. But they got cast. And so they were in this small sort of independent art house movie when they were babies.
[00:06:59] Speaker B: Oh, that's so interesting. And so, like, this is definitely not the subject of the podcast, but I have to know a little bit more. Was it. Were they looking for twins? Because it was like, the Full House issue, where they wanted to, like, be able to film longer periods of time, and so they were, like, substituting each of them in for different scenes. Or was it. They really wanted twins in the movie?
[00:07:20] Speaker A: No, they wanted to switch them out. They were switched out in the movie. They needed identical twins, and they wanted them to be a sort of a certain age and I guess, like, cute. And it turns out that, of course, mine were adorable.
And they wanted to. The casting really involved sort of just looking at them and making sure that they would go to strangers. Okay.
[00:07:41] Speaker B: Oh, that's interesting, too. Yeah.
[00:07:43] Speaker A: Yeah. And so they did. And. And I was like. And this was before. Like, this was 2009, so. Where iPhones either were just out or barely out.
And so we weren't, like, filming them. Right. We couldn't, like, we had to get a camcorder out of the drawer.
[00:07:59] Speaker B: Right on, like, the shoulder. Yeah.
[00:08:01] Speaker A: Yes.
[00:08:01] Speaker B: With the VHS tape. Yeah.
[00:08:04] Speaker A: So I was like. I was like, well, we could.
This is a really good home video.
[00:08:09] Speaker B: Have you.
This is my last question about this, because again, this is not the subject of the podcast. But have you like, added this to their college application?
[00:08:18] Speaker A: Probably should. Oh my gosh. Who do it?
I'm pushing, sticking up for CVs. No, we haven't. But yes, they were. Yeah, the movie's called Get Low, so if you ever see it, it's, you know, the baby in the movie is my children.
[00:08:34] Speaker B: Oh, my goodness. So for all of our listeners now, and I have two colleagues, both of whom are working on this child welfare study who have some sort of star studded background. Davida being in the Netflix documentary, and Davida is our colleague at Loyola of New Orleans doing us working on building a similar model to you and now you and with your sons.
I bet they love when you tell that story.
All right, so back to the matter at hand.
So today I think this is the first episode we're recording where we're discussing a different perspective on a study that we've already talked about on the podcast. We are looking at the effect of the CHAMPS Clinic, the medical legal partnership, on avoiding reports to the child welfare system for suspicions of neglect. And so that's a real high level. But today we're going to talk to Emily, who as you heard, runs the CHAMPS Clinic, about the research process from a different lens.
So we talked a little bit about how CHAMPS satisfies the law school clinical model and has, you know, incorporates educating students about real life practice, which is really a huge benefit of clinical models. And this one in particular, educating students about real life practice for folks who are experiencing issues of poverty.
But tell us more about the CHAMPS Clinic, kind of at a high level and like how you're able to.
I'm really interested in folks understanding how you're able to both incorporate the students in the work but still serve enough people in the community to be helpful.
[00:10:24] Speaker A: So we very early started just me and the students, but pretty quickly, which was very small number of cases we could handle. But pretty quickly our medical partners realized they understood our educational goals but realized they wanted more of the services than just a law school clinic could provide and initially did fundraising to help us hire our first attorney. And so by the end of the first nine months of CHAMP's existence, year of CHAMP's existence, we had an attorney in place. And so that is, that was how we began to be able to. That was how we came to be able to serve a higher volume of clients, which is what our medical partners wanted. They wanted, they wanted to be able to refer patients to us and for us to be able to serve them with legal Services and address the social determinants of health. And since then, we have grown. We currently have four attorneys now. We are soon to have five, hopefully by January, if not sooner. And so we are. We've become the largest medical legal partnership in the state, and we serve a large volume of patients and clients, but those attorneys.
[00:11:35] Speaker B: Right, and that helps you to kind of transcend the school semester schedule. And so you're able to serve folks on breaks and during summer recess.
[00:11:48] Speaker A: Yeah. So it serves the legal services needs of the partnership, and it also serves the pedagogical needs of the clinic because the lawyers are always handling the cases. So it's sort of like the clinic's a part of a legal services program, as opposed to the reverse.
And when it's time for me to start teaching clinics, I do teach just one semester a year.
They I can pull the cases from the lawyers desks, which they're perfectly fine with because they have plenty of cases that are pedagogically well suited for the students. And so it serves the pedagogical goals, but also the system works really well.
[00:12:25] Speaker B: Yeah, yeah, absolutely.
Okay, so keeping kind of on a high level, what are you hoping to learn from the study itself?
And feel free to describe the study in your own words. I think that's also helpful for folks to hear how what we say translates into, like, your real world.
[00:12:46] Speaker A: So for me, the study is, you know, it's a randomized control trial. Right. Which is great because it's the gold standard. We're not doing correlations here. We're hopefully getting cause aid, causal analysis. And what we're hoping the causal analysis will show, or our hypothesis is that champs our model, our particular model of a medical legal partnership reduces unnecessary DSS referrals from the health care provider, from our health care partners, and in addition, improves access to health care by way of, you know, providing insurance and Medicaid and things like that and making sure people have access to those things and saves the state and Medicaid expenditures.
And so anecdotal and preliminary data that shows all of that, but this is hopefully going to show it. Our hypothesis, we do this in a more than just anecdotal way.
[00:13:37] Speaker B: And I recall when we first began discussing this study, and that was many moons ago, that your medical partners were also interested in understanding whether or not something like this help to improve trust in the medical system with the like, a kind of theory being that when folks are able to access medical care without fear of being reported, that they might be more willing to do that. Is that still a focus or am I accurate in that description?
[00:14:12] Speaker A: I think that's a secondary focus.
[00:14:14] Speaker B: Yeah.
[00:14:15] Speaker A: Of the program and the project because we want to make sure that folks aren't getting referred to DSS because the healthcare providers have an alternative and to address needs that aren't. Abuse and neglect may present sometimes that way, if one does not like, sort of dig a little deeper or think a little more critically about what they're seeing, but in fact are not issues related to abuse or neglect. And so the more we can reduce that, the more.
Right. Being worried about going and accessing health care services.
[00:14:51] Speaker B: So if, if the study turns out the way you hope, what policies do you think?
What, what policy effects do you hope will. Will come about?
[00:15:00] Speaker A: I. I think a few things, hopefully. One is if we show that we are reducing unnecessary DSS referrals, that is important for the Department of Social Services because they're already a very burdened system. The child welfare system is incredibly overburdened by these unnecessary referrals. Right.
Large percentages, as you know, referrals to the Department of Social Services for abuse and neglect are just not necessary. They're unsubstantiated, but DSS still has to process them. So if we're able to show that we do reduce those, that's significant from a DSS perspective.
And then if we also. Should we save the state in Medicaid expenditures? That is important for the state. Right.
State's fiscal budget.
And so those two things, if we can show them, creates a pretty strong case, if not more than that, for the state to support medical legal partnerships that follow our model.
Because the more we can do this, the more we can reduce then those expenditures and those burdens on the system.
So that's sort of the big hope. And then that that translates to a model that other states can follow.
[00:16:23] Speaker B: Right.
[00:16:23] Speaker A: And do it in South Carolina. We could do it anywhere.
[00:16:27] Speaker B: Yeah. And I think that's kind of what we're working on. Right. Is at least I mentioned DaVita in New Orleans. Replicating, replicating your model a bit. And so I want to, I want to get back to your model. But before we get there, one final fun, fun element.
Tell me how the study came about.
What is our origin story, if you can remember? Because I think we might be on like our sixth anniversary or something.
[00:16:57] Speaker A: I feel like with this story, all roads lead back to Christopher Church.
[00:17:01] Speaker B: No. Right. At the six degrees of Christopher Church, shout out to Christopher. Yes.
[00:17:08] Speaker A: So I feel like everywhere we go, every day, people are like, his name Comes up and really gets him.
[00:17:12] Speaker B: It's so true. People are like, oh, well, do you know Christopher Church? We're working with Christopher Church.
I do.
I am so pleased to say I do.
Absolutely.
[00:17:24] Speaker A: He's a wonderful person. So, Chris. So for everyone, Christopher Church was the first staff attorney. That first person I mentioned hiring, but with the funding that the doctors supported us in and in obtaining, was Christopher Church. So Christopher Church was my first staff attorney. And he worked tirelessly, both as a staff attorney here and then later as a volunteer when we were stretched very thin.
[00:17:47] Speaker B: So.
[00:17:48] Speaker A: But he left us for his current position with Casey Family Programs, which is, I think, how you met him, Renee Conference or something like that. And he. Christopher has many, many wonderful big ideas. And one of them was, hey, wait a second, you should meet Renee. Emily, you should talk about this randomized control trial thing she does and that the Access Justice Lab does and see if we can study what CHAMPS does. So that's how we got introduced. I know Christopher used to be. On our very original phone calls.
[00:18:24] Speaker B: He did.
[00:18:26] Speaker A: And I have to say, I think I had a lot of questions at the beginning.
[00:18:29] Speaker B: Yeah, I mean, I'm good. You should. I don't think anyone should go into any sort of big project without lots of questions. And I'm hopeful. I mean, it seems like we worked through many of the issues, but if there are others, please let me know.
Maybe not in this setting, but.
Okay, so now. So let's go back to CHAMPS and learn a little bit more. I think your model is very important to talk through, but. And also I want to hear about what kind of services you provide.
So let's talk about your model and then talk about the services you provide kind of in the context of your model.
[00:19:10] Speaker A: So our model is deeply holistic and interdisciplinary.
And suddenly medical legal partnerships operate very much like a referral service, which is great. The services are happening. People are getting legal services. And by what I.
By that, I mean that they. The health care provider, who is the partner, is identifying issues related to the social determinants of health that maybe a legal service provider, their partner could help with and referring, and then the lawyer takes it from there. And that's kind of mostly the end of the work together. And ours is a little different. We are very much part of the healthcare team. And so we. And we train on that like, this is not just a referral service. We're gonna come back. We're gonna need you. We're gonna need you for evidence. We're gonna need you to explain stuff to Us, we, you know, those sorts of things. And so we work very closely with our healthcare partner. We've always also involved social work services for our clients. And so because we're trying to meet all the needs of the clients. So that means things like we open multiple cases for clients, they might come to us identifying one issue and we identify another and ask if they want help and they say yes or another one just comes up and they self identify it and bring it to us and we help them with it. And then we're also providing the social work services, whether that is accessing resource services.
It could also just be case management services. It depends what the client needs.
But we're always trying to treat the whole child and the whole family if we can, by providing all of those services.
So that's our model.
And it works even beyond that where my staff attorneys go to discharge planning. So they're helping folks identify when the hospital is trying to discharge kiddos and planning for that whether there could be a safe and legal discharge if we're needed.
So we're sort of always there working with the healthcare team and always trying to, as I said, holistically work with, treat and serve the families and their children.
[00:21:17] Speaker B: Yeah. So I mean this study is about, really about embedded legal services. And the medical legal partnership is really one of the kind of hallmarks of legal service delivery that truly embeds in a, in an, in another profession's area. And so in this case the medical space, you truly are like, have taken that and you are taking that to the fullest extent. Embedding, you have lawyers and lawyers who are based, who have office in the medical facility. And then you're also kind of embedding your services in the team, the medical care team. And so that's great to see.
[00:22:02] Speaker A: Yes. Yeah. Two of our staff attorneys have offices in the hospitals, one here and then one in Sumter, South Carolina. So they're very accessible for the healthcare team. They can help identify the issues, they can help make sure referrals are getting to us. They're just available for questions.
Has them so very much part of the team. Sure.
[00:22:25] Speaker B: And what kind of legal and social work service subject matter areas are you, are you focused on?
[00:22:32] Speaker A: So the. We do several. We're a little bit old school in our legal services model back in, back in the day, and that day was the 1990s or before probably legal services
[00:22:42] Speaker B: attorneys, right around the time Designing Women was peaking. That's right.
[00:22:46] Speaker A: It's going to be an 80s 90s themed podcast written that's my jam.
[00:22:51] Speaker B: Okay, I'm all for.
[00:22:54] Speaker A: I have a. I am on a new bring back the cosmopolitans crusade.
I was like, why everything back about the late 90s except for that.
[00:23:04] Speaker B: Listen, travesty, I just spot some flare jeans. So like things are all coming back. But anyway, I really digress.
[00:23:16] Speaker A: I could go OK situation but legal services lawyers used to be more generalist and then we moved for a lot of reasons into more being more specialist. That made a lot of sense. But this is a little bit of that older school model. So we all of my staff attorneys do lots of different things and so do my students. So we do SSI disability appeals and we do those to provide income support and stability of the clients, which is a social determinant of health and access to more comprehensive Medicaid services and plans. We do education cases, so special education discipline cases, section 504 cases.
We do housing conditions and evictions cases. That's a huge component of what we need to do at a huge social determinant of health. We do food security cases. So SNAP appeals used to be called food stamps. SNAP appeals. And we also do what we now call life transitions planning. So we work with kiddos who are aging into adulthood to help them get powers attorney and healthcare powers attorney so that they have assistance making decisions from. Often it's their parents they want assistance making decisions from. And so those are the big group of cases that we take and we take a smattering of others occasionally we do what we call family defense. If our clients we think have been inappropriately referred to will work work on those cases.
[00:24:43] Speaker B: And your, your social workers are kind of working or your social worker is kind of working like within those cases. So when we talk about for example, housing conditions issues, your social worker is both working to kind of figure out how to remediate those issues, but also maybe helping someone find a different housing or working on benefits applications.
But also things like, you know, I've you told me a story once where your social worker found a free mattress for a person or a, you know, a way to get a free mattress. Not like just a mattress on the street, but.
Right. It wasn't like a college move out situation. It was like an actual new mattress, but for free.
[00:25:27] Speaker A: Yes.
So the social worker works both alongside the lawyers to provide comprehensive services when the lawyers have legal cases that also those could benefit from social work needs. So. Right. If we have a housing case, for example, we can get a client out of terrible housing conditions. But it doesn't help if we've created a homelessness situation that's not actually done all that much for the client. Arguably negative net effect. And so we have our social worker get involved to make sure that the clients can access, can find new housing, have moving assistance, and sometimes it's secondary to the case.
[00:26:04] Speaker B: Right.
[00:26:04] Speaker A: Where.
Or sort of parallel to the case is probably a better way to put it. Right. So the mattress example you're talking about, that was an SSI case. Right. But we knew that the child's disabilities were causing the child to have a lot of incontinence issues and the grandma who was taking care of the child needed a new mattress. So we got on that, figuring out how to get a mattress that was not just another new mattress she would have to throw out, but a mattress that could manage that situation. Right.
But the social worker also does her own set of cases. Right. So one of the things that leads to us having to get involved as lawyers in SNAP cases or SSI cases is that clients have difficulty navigating just the application system for those benefits programs. And so Lacey, who's our fabulous social worker and she works with MSW students too, to maximize our capacity to provide these services as well as provide an educational training component to.
They all work together to help people fill out those forms. So they're getting filled out properly. So the follow up's happening so that as much as possible, we're preventing unnecessary denials of services that we have to then get involved with on the legal side.
[00:27:20] Speaker B: Right, right. And that's a good additional component that I think we didn't talk about until just this, this moment, is that you are training lawyers and, you know, future lawyers in a clinical program, but also future social workers in kind of a separate clinical program with your school of social work. So it's very.
[00:27:43] Speaker A: Doctors too. We have our fourth year with us right now doing a rotation.
[00:27:48] Speaker B: That's right. And the medical students, the future doctors. So. And also just to note that your model is really a generalist model, which as you said, and rightfully so, is unusual. So even within legal services providers where they're providing services to low income individuals for free, usually those there are kind of departmental specialties rather than generalists within the organization.
So I think one of the surprises for me, and this is total ignorance of some of the kind of legal issues and social work issues that you all work with, is the length of time some of these cases can take. So can you just talk about a little bit about, like, how long is it taking for folks to have to see some resolution to some of the issues that, that they're coming in for.
[00:28:46] Speaker A: It can take a very long time.
And we have clients who are with us for years and years, partly because anyone individual case can take a very long time, probably because we keep having new issues come up. Right. The effects of poverty are manifold and so there are many legal issues that can come up in our clients lives and we just keep working on them to the extent we have the capacity and can both the subject matter, you know, capacity, the literal human capacity to do the work.
So for example, SSI cases can go on 18 months, two years plus because there's such a lag time for getting those appeals processed and through the system because that system is also pretty overburdened and education cases couldn't go on for a year or more. So we spend a lot of time with our clients. We have clients who've been with us for years.
[00:29:43] Speaker B: So we've kind of danced around this a little bit. But tell me, who specifically are your clients and how are they finding you?
[00:29:53] Speaker A: So our clients are. Their geographic location has changed and expanded over the years. But who our clients are really has not. Our clients are overwhelmingly single black moms who are extremely poor. The two thirds of them are 100% of the poverty level or Medicare. So very, very poor. And we, so that's who we serve and primarily. And they come to us from our healthcare partners. So anyone who's touched the healthcare partner or is referred from the healthcare partner is eligible for our services. As long as you're low income as well.
[00:30:30] Speaker B: Yeah.
And this kind of tracks with the national statistics about who is occupying the child welfare system. Right. As well. So these are folks who are the medical care professionals think that if they didn't have another resource, they might feel like they need to report this case. But mostly because they don't have enough. They don't feel like they have another resource. And CHAMPS is kind of filling that other resource opportunity.
[00:31:06] Speaker A: Yes. And that was the surprise to me that our healthcare partner, that's what they said when that, that they were doing. They were referring to us instead of dss.
That was a big surprise to me when I heard that for the first time.
[00:31:22] Speaker B: Yeah, right. And that's actually like, that's how we formed our hypothesis is because you were hearing this anecdotally and we were like, oh, well, we should find out if that's true. Because that seems like an important thing to know.
[00:31:33] Speaker A: Yes, it was a huge surprise. I first asked them in front of students, oh, what did you do before you Referred to champs. And I thought they were going to say, oh, we sent to social work.
They said, oh, we referred to dss. And I thought,
[00:31:49] Speaker B: interesting.
[00:31:50] Speaker A: Glad you're not.
It's, you know, it's part of a larger issue which is their health care providers and other mandatory reporters of abuse and neglect. And every state's got a mandatory reporting statute that requires healthcare providers to report suspicions of neglect and abuse to their, you know, Department of social services or relevant agency. What looks like, can look like neglect is really just poverty very often granted.
And the reporting statutes don't require anyone to do any critical thinking about that. And so a child showing up at school without a coat can look like neglect if you don't question the cause.
[00:32:35] Speaker B: Right.
[00:32:36] Speaker A: Of failing to show up at a medical appointment can look like neglect. Right. Or failing to take your medication can look like neglect if you don't sort of do a little work to figure out what the cause of that is. And often it's simply poverty.
[00:32:50] Speaker B: Right, right.
Okay. So let's switch gears a little bit from talking about the CHAMPS model specifically to back to the study.
So we are randomizing or randomly assigning folks to either get your services, which you just described, or to get some self help materials which we developed kind of together.
How does that make you feel?
The big question that everyone wants to know,
[00:33:21] Speaker A: Ongoing struggle.
[00:33:23] Speaker B: Absolutely. Absolutely.
[00:33:25] Speaker A: Right. Like we're all legal services attorneys at heart, and so we want to serve. Right. We want to take on the cases and help the clients. And so saying no, essentially to someone. Right. No, you're not going to get the full panel services is hard. And I think that's all of my initial questions to you. When we very first met Lolis many years ago were around that, like what? We're. No, we're going to say no. That's not a thing we do. So it is hard. And I will tell you when it's particularly hard, Renee, is when a client who was a client five years ago or something like that and is no longer a client comes back and potentially gets randomized out. And heartbreakingly that happened recently.
And it is, it's hard, right, to say no because I know exactly who that person is. She was a wonderful client. She's a sweet grandma. And we had to, you know, she didn't get those services. And I think it's particularly hard for the client who've had our services in the past.
[00:34:19] Speaker B: Yes.
[00:34:20] Speaker A: Because they know what they're not getting.
So that has been hard. And we have discussions internally, some of which I've Told you about where, like, can we. Is there a workaround? Right. And the social workers at the hospital and the healthcare provider's like, can we work around this somehow? Can we just not?
And so we have to sort of buck each all of ourselves up together collectively to keep going. But what keeps us going is that we have our eye on the end game, which is that if our hypothesis proves to be true, we will be able to serve many more people, hopefully because of those policy changes we talked about.
[00:34:56] Speaker B: Right, exactly. And so let's talk about the self help materials a little bit.
So what are your thoughts on the materials?
[00:35:03] Speaker A: I mean, I think they're great and they are more than anyone's getting. We have as huge as many, many places have access to justice issue. In South Carolina we have counties without any lawyers or one lawyer. And so there are many, many, many people who are not getting legal services when they need them.
And so the self help materials are fantastic and robust and more than any client would get if they just could never made their way to us before or we simply hit a capacity level and couldn't serve.
So those are a wonderful resource and help sort of with the feelings, the hard feeling that we are giving people something and they're getting more than they would have otherwise.
And shout out to Lacey, our social worker, because I think we've heard from some of the folks who get randomized out that they feel like they got great service.
[00:36:04] Speaker B: Yeah, actually that anecdotally has come out right. In some of our regular discussions with Lacy and then also with the folks at Furman University who for everyone, just to bring everyone up to speed, they are doing a companion qualitative portion of the evaluation where they're doing interviews with a random selection of folks both in the self help group and the CHAMP services group, and then also have convened a community advisory board to kind of guide us through the research and making sure it's actionable for the community, which has produced results already as well, even though we're kind of midway through the study. But yes, anecdotally, both Lacey and our partners at Furman have said that the self help materials have been well received.
I'm sure that's not true for everyone, but we did, we did spend time making tailored materials, so materials that are subject matter specific for the issue that the individual presented with or issues at the time they agreed to participate. And they really do try to walk folks through the steps and set timing expectations. Because like I think we talked about, that's one of the surprises of, of this Reality of benefits acquisition especially is like how long you wait for a decision even though there's a promise of back benefits. That's hardly helpful to someone who absolutely needs those benefits today.
So we have I think made a lot of effort to do that and also use the opportunity to teach students about this work and have them help design and they're modeled kind of after some of the research we at the Access to Justice Lab have done about self help materials and folks ability to really consume them and use them.
That's another podcast for another day, but we can include I think in our notes the self help reimagined article that Jim Greiner co authored that might be helpful to see.
Back to the study after my self help material digression.
The outcomes under study are whether families avoid a report to the child welfare system.
We talked about secondary outcomes that include does that increase access to medical care, Is it improving their family and financial stability and their health and well being and the greater trust and also is it reducing the administrative burden on the agency and the fiscal burden on the state altogether as a result of that?
What are you most interested to learn? What of these A lot of different things we are trying to investigate. What are you most interested to learn about?
[00:39:00] Speaker A: I'm most interested in that primary question, are we reducing those DSS referrals? Because I think everything sort of flows from there. Even if we weren't as dramatically or at all reducing the Medicaid expenditures directly, I think we are even through those reduction in DSS referrals and certainly saving the state right in expenditures. And we want to do that. We're a public university. We want to make sure we're serving the state effectively and efficiently.
And so that's the one. And also just like for the families, right like that's the most important is that the families aren't making their way to DSS unnecessarily but are still getting assistance when they need it. So that's. That's the one I'm most interested in.
[00:39:44] Speaker B: Yeah, I tend to agree too. Right. Like this is has like the twin pillars of important policy making, right Fam the family, the families are getting the services that they need while the agency is able to kind of stop spreading themselves so thin and focus on families that really really need all of all that they have to offer.
And then of course all of that reduces the fiscal burden on the state.
So you kind of have this really nice kind of policy package. If this comes out the way we hope to, then it will.
[00:40:20] Speaker A: And I think the other policy piece, if I could just add, is that the longer term, if we do show that, Renee, then there's lots of room to reform what are now decades old mandatory abuse and neglect reporting statutes.
And in a way that this study could inform.
Right. That just off the top of my head, we could say report. Except if you think you could send an mlp. Right. Or something like that. Yeah. You know, where just those statutes are so old now and are from an era where we just thought we had to cast a wide net without regard for anything other than just make sure all the kids are caught by DSS no matter what, just in case. And we've learned in the decades since those statutes were enacted that that might not be the most effective way to provide children and safe, secure childhood.
And so there's lots of potential policy implications.
[00:41:23] Speaker B: Absolutely. Yeah. I think there's a couple different legislative reforms that we could consider or that we could suggest be it after we see the results, if they turn out the way we hope they will and that we think they will. Okay, so we've talked a little bit about this, but who are the stakeholders for this study? Obviously you. But other than champs, who are, who are your stakeholders? Who are you, who are you talking with here?
[00:41:49] Speaker A: Certainly the health care system. Right. DSS is a huge stakeholder and a supporter of this. They want to see the South Carolina Department of Social Services is very supportive study and wants to see if we're doing what we think we're doing. They're very innovative here and focused on preventative service. That is so huge stakeholder. Certainly the Department of Health and Human Services at the state level, which is our Medicaid, which administers the Medicaid program here for saving money is important. The General Assembly. Right. State legislators and up through the executive and the governor who support this work through funding are all very important stakeholders. And of course, our families. Right.
That we serve. And the kiddos in South Carolina, who are those low income kiddos who we hope are we're serving as effectively as possible.
[00:42:43] Speaker B: Yeah, that's great.
So we have a lot of different stakeholders. Pick one of those or two of those and tell me what do you think they hope the study shows?
[00:43:01] Speaker A: I think probably the most invested stakeholder at this point is the Department of Social Services.
[00:43:08] Speaker B: Yeah, they have been very supportive. I think we can't stress that enough that we could not do this evaluation without their help and support. And they have been there with us from the, I mean, not from like the first Christopher Church conversation, but shortly
[00:43:24] Speaker A: thereafter, I think Thereafter. Yes.
[00:43:26] Speaker B: And
[00:43:28] Speaker A: so, yes, I mean, we should shout out some probably specific people. Right. Mike Leach, the former director, hugely supportive. Tony Coutone, the current director, also hugely supportive. And Steven Farafino, who's the chief transformation officer for dss. I mean, just a huge cheerleader for us. Supporter, financial supporter of Champs, DSS's generally. So they, and they have facilitated the study when we needed help facilitating the study. They've been great.
And I think they're very interested and hopeful that this shows that we are reducing those referrals that bog them down and distract them, quite frankly, from the kiddos they need to be really focused on.
[00:44:12] Speaker B: Great.
We should not go on much further without talking about who's funding the study.
[00:44:23] Speaker A: The Duke Endowment said. The Duke Endowment is a private foundation that supports multiple different things but has been a supporter of champs. And they have given us a grant to. That's funding the study.
Four year grant. It's nearly a million and a half dollars. And they are very interested. They have a child and family wellbeing program that supports, funding or supports projects that are improving child and family wellbeing in north and South Carolina.
And they, we presented this study to them, Jim, Others a couple of years ago and as part of our grant, you know, application and pitch. And they really were interested in doing study randomized control trials. So it was a perfect match. And I'm excited to say they're happy and still very supportive and I'm very grateful to them because it is not the first time that Duke Endowment hasn't supported champs. This is a different project, but it's our second Duke Endowment grant. So they've just been a fantastic partner and supporter.
[00:45:28] Speaker B: Yeah. And they really saw the vision of the work, I think of not only your substantive work, but of the purpose of the evaluation. And we did struggle to, to get folks to see that vision. It is a difficult ask to get folks to think about interrogating the components of the child welfare system. And so we, which we were surprised by, but we learned through the process that that was a difficult ask. And the Duke Endowment, especially because of the support, I have to believe of the, of DSS in South Carolina where really saw that vision. And we're, we're super grateful for that.
[00:46:09] Speaker A: Yes. Yeah. They, it did not take as much work to get them there. Took very little, no work for them to understand that there might be, there might be some kids who don't need to be referred to.
[00:46:19] Speaker B: Right. Not every family that's referred actually should be there. I think the statistics say That I think we can say that plainly. Right. So we're just trying to find those families and avoid them getting there, right? Absolutely. Okay. So we also talked a little bit about the qualitative component. We kind of teed that up a bit with the interviews and the community advisory board.
So tell me why that component is important to you or why that component matters in this evaluation.
[00:46:51] Speaker A: It matters a lot to me because it gives voice to our client.
And as much as the numbers will speak to certain constituency, the numbers don't tell their stories as fully or meaningfully as the clients can tell their own stories. And so to me, it gives real meaning to whatever the findings are. Right. And what I don't think I fully realized, quite frankly, Renee, is how much it can inform our work even as we're doing it. Right. That we hear from clients that, you know, feedback that can. That we can incorporate right now to make sure that our services are even better. It's made me think, do we need to keep this up some?
[00:47:36] Speaker B: Yeah, I mean, that has been really true. We meet, right, you know, monthly with the full team, and we hear of the progress on the qualitative component. Because again, that's being done by Furman University. And we are not like. That is not our expertise at the Access to Justice Lab. That is their expertise. We're not micromanaging that, but we are hearing their report outs. And oftentimes it's. Well, we've heard a lot of this from clients or from interviewees. And is there a way to make a change that would affect that? And usually that's not a substantive study issue. It's really just a way to make the process work better for the clients, which we can usually accommodate.
[00:48:22] Speaker A: Yes, we're always wanting to do that. Right. Like, as much as we try very hard to provide wonderful services, holistic services, you know, sometimes we miss. Sometimes, you know, it's a process issue you may miss. Sometimes, you know, it's just an individual issue we miss. But we want to improve, you know, make sure as much as we can for our clients.
[00:48:46] Speaker B: That would be great if you could keep that up. We'll have to think about how to do that.
[00:48:50] Speaker A: You know what? Right away, continue.
[00:48:55] Speaker B: Okay. We have a couple more minutes. I don't want to take up more time than I asked for, but I have, like, these final three questions that are really fun to talk through. So we have alluded to this on this discussion, and we. I talked directly about it on our. On the first episode of this, about this study.
It took us A long time to start from idea to launch of this study. Like when I say a long time, like, I mean like years.
Not, not a reboot or something like that. A long time. People think of a long time. They think maybe like 30 days, 60 days. No, no, no, no years. So what made you keep going? I.
Maybe it's just me. I hope. No.
Oh, definitely.
[00:49:39] Speaker A: It was, you see, formal confidence about how do we like never end our relationship of working together.
You were definitely a part of it. But beyond that, I mean, I think there was a point, I know there was a point where I was like, renee, what if this, we don't get funding?
[00:49:53] Speaker B: You know, and I am never, I won't. And you know, I certainly had those thoughts secretively, but I'm always like, no, we will. We're just going to keep, keep trying.
[00:50:03] Speaker A: What kept me going with. Because I really do want to know, are we doing this? Right. I do see the like, you know, I do have my eye on the ball, on that longer term ball. And like if we're doing this, we need to know. Right. And so, and also I just am like a very persistent person, as are you.
[00:50:24] Speaker B: Yeah, that's how we did it.
[00:50:26] Speaker A: Constitutionally, I think we were primed to just keep going until we got. Till it started, till we could get it really going.
But really it was like, I can't imagine not trying to figure this out.
[00:50:39] Speaker B: Did you experience any challenges that you can recall along the way while we were spending our years trying to get the study funded?
[00:50:48] Speaker A: I think the beyond, you know, we didn't get some grants. Right. Because we could funders didn't understand what we were doing, as you mentioned. Right. They're like, why wouldn't you refer to dss? They just didn't get that and so didn't want to fund it. And a little bit here just having to explain to people what do you mean? It's sort of a similar reaction from some folks here about why but not refer to dss, what is the point of this study? But beyond that. No, I think it was really just sticking with it. But fortunately friends. And so it was always a fun time just to talk to you on film.
[00:51:22] Speaker B: I have said that and you are always the person I think of when I say this, that these studies really help you develop lifelong friends, not just colleagues. Right.
Okay. That is a great way to end. But I actually don't want to end there. I just want to, I want. Because it's such a nice way to end. But I want to know one final parting Dreams or wisdom?
What do you think we should know about this effort? Other than the fact that were sharing friendship bracelets after this
[00:51:58] Speaker A: Also now Cosmopolitans, because that's many.
[00:52:00] Speaker B: Well, yes, there's an episode where I discuss this as well. So it's just like part two, which you would have no way of knowing, but just my fun part.
[00:52:13] Speaker A: Emily and Renee, right.
[00:52:16] Speaker B: Just go on the road with this show.
[00:52:20] Speaker A: It's a new twist.
[00:52:22] Speaker B: We've already created a spin off of this, this wildly successful podcast from the Access to Justice Lab.
[00:52:30] Speaker A: Jim can come sometimes, special guest.
So I don't claim any wisdom. So I won't. I won't say this is wise words. I would say my dream is really just what we talked about, that. I mean, my dream is that it shows what we think it's going to show and that this study shows that we reduce the DSS referrals and we can sort of spread this word. Because if we can show that, I really think we can spread this and both in South Carolina and other states.
But I will say, and we've talked about this here with my staff, if it doesn't, and that's possible.
Right. Then I want to know why. Right. Why is it only anecdotal? Why is it only here and there? And what can we do differently?
That's my dream as well. Sort of. My plan B dream is if the study shows that we're not sort of significantly reducing DSS referrals. That doesn't mean I think that we should just stick with the system as is. But I think we need to figure out why and how we can pivot and change in big or small ways to make sure that we are more effectively doing that.
[00:53:43] Speaker B: And that truly is the best way to end this podcast. I mean, that's the reason to do research altogether, right? Is to understand the extent to which you're having an impact. And. And if that doesn't satisfy you, then what can you do to. To differently to get to the impact that you are? That does satisfy you. So. Absolutely.
[00:54:04] Speaker A: And I'm grateful for our partnership, Renee, as well as friendship.
[00:54:08] Speaker B: Likewise. Very much so. Okay. Well, Emily, thank you so much for your time today and I will sign us off from this episode of Proof Over Precedent from the Access to Justice Lab.
[00:54:20] Speaker A: Proof Over Precedent is a production of the Access to Justice Lab at Harvard Law School.
Views expressed in student podcasts are not necessarily those of the A J Lab.
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Here's a sneak preview of what we'll bring you next week.
[00:54:44] Speaker B: My name is Julia Saltzman, and I am A2L at Harvard Law School and a student with Professor Giner's access to justice Lab.
And I'm here today with Professor William Schneider, who is a professor at the University of Illinois School of Social Work.
And I'm talking to him because I found his study, which is called the Empowering Parents with Resources or Empower study, really interesting.
And the study hypothesizes that providing families with financial resources can prevent child mistreatment and mitigate the harms associated with the family regulation system.
