Spring 2016
The Docket
Quarterly Newsletter

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What's Inside...
  • A Message from the Executive Director
  • Client Profile: Isabel
  • Staff Profile: Isabel Raskin, J-MHAP's New Advocate
  • Disrupting the School-to-Prison Pipeline through J-MHAP
  • Board Profile: Dr. Lauren Smith
  • Upcoming Events in the Public Health World
  • Announcing: A New Initiative
  • Protecting Immigrants' Access to Health Care
  • HLA Staff News
Isabel Raskin,
HLA's new Juvenile Court Mental Health Advocate
As told to Emily Tabor

My passion has always been to work with kids. Growing up, I knew a lot of people in the juvenile court system, so I was aware of that process and its effect on those who go through it.

When I graduated from law school, I was fortunate enough to be offered a job at the Children's Law Center, where I litigated in juvenile, district, and probate courts for nine years. What was most rewarding was not cases won, but the relationships I formed with these young people and their families. I remember this one particular case: I represented a young man who lived with his grandmother. Though we lost the case, he told me, "Thank you. You made me feel more than just a cog in a wheel. You cared, I could tell that you really cared."

This was a profound moment for me for two reasons: I was reminded that I really love the work that I'm doing and I'm glad it means a lot to the people I'm working with, but it also meant that there is no single issue that lands a young person in the juvenile court system. Having an advocate, someone who fights for your best interest, can be a fundamental component to your success.

I was very much familiar with HLA's Juvenile Court Mental Health Advocacy Project (J-MHAP) because I knew (former J-MHAP Director) Meira Russ , (J-MHAP Mental Health Advocate) Lisa Morrow, and (J-MHAP Director) Marisol Garcia from my previous work in child advocacy. I thought, "if an organization has this many talented, passionate people on their team, I want to be a part of that work."

Right now, we're in the midst of an epidemic of young people with mental health issues that end up in the juvenile court system. We see it across the country. But J-MHAP hits this really sweet spot in a child's life. When there are so many points of view and so many agents working from different perspectives, a J-MHAP advocate comes in and puts all the perspectives together and searches for an objective truth. It is our job to be problem solvers.

There is no silver bullet to keep young people with mental health issues out of the juvenile justice system. These issues that land a young person in court don't arise overnight--so they're not going to be solved overnight. But through cooperation and advocacy, we can better provide the mental health services young people need to thrive and stay out of the court system for good.

Attorney Isabel (Izzy) Raskin joined the J-MHAP team in February 2016 and advocates for young people in the Lowell Juvenile Court. She received her Juris Doctor from Northeastern University School of Law and is currently a candidate for a Masters of Social Work from Salem State University. Izzy has extensive experience in child advocacy. Prior to joining HLA as a Mental Health Advocate, Izzy was a senior staff attorney at the Children's Law Center of Massachusetts, served as a hearings officer at the Department of Children and Families, and, most recently, was the Education Advocacy Clinic Director at Suffolk University Law School, where she developed the clinic, supervised law students, drafted legislation, and collaborated on educational policy with local advocacy organizations.

Upcoming Events
In the World of Health Care Advocacy  
April 22
: Health Equity & Leadership Conference, Harvard Medical School. Register here.

May 3: For The People, the annual fundraiser, Health Care For All. RSVP here.

May 14: Walk for Mental Health Awareness, NAMI Mass. Register here.

June 7: 10K/Day: Medicare's Future as 10,000 Americans Turn 65 Every Day, National Committee to Preserve Social Security and Medicare. RSVP here.

HLA's Transgender Health Access Project

HLA is working to ensure that those who are seeking gender-affirmation treatment are covered by their insurance, regardless if it is public or private.
HLA Staff Attorney and AmeriCorps Fellow Caroline Clair presents at Fenway Health to consumers and advocates.

This past February, HLA Staff Attorneys partnered
with the Mass. Transgender Political Coalition and Greater Boston PFLAG to
provide an informational training on consumer health care rights, how to appeal insurance denials, and more, with a particular focus on transgender health, at Fenway Health. In addition, HLA provides legal representation to individuals facing health care discrimination.

For more information, contact HLA Staff Attorney Andrew Cohen.

More to come in the Summer edition of The Docket!  

HLA Staff News
Please join us in welcoming the following addition to our fantastic staff:

Isabel Raskin, who joined J-MHAP in February 2016 as the new Mental Health Advocate in Lowell's Juvenile Court.  Izzy comes from an extensive background in youth advocacy.

We also bid a bittersweet farewell in December to:
Meira Russ, who managed our J-MHAP effort as part of our Children's Mental Health Campaign and contributed invaluable leadership. Pittsburgh is lucky to gain such a fierce advocate!
Thank you for the fabulous work you've done at HLA. We wish you all the best in your future endeavors!
A Message from the Executive Director
Dear Friends, 

We are very pleased to share this update on our work and organization. In the first quarter of 2016, we've already handled a 14% uptick in clients over the same period last year, conducted 15 community outreach and education programs, and spoken out on a host of policy issues ranging from protecting low-income consumers in MassHealth's transition to "accountable care" to promoting heath care access for transgender consumers and a lot more.

All of us at HLA are grateful for your partnership and support. They make our advocacy possible. Thank you and see you soon! 

With appreciation, 
Matt Selig
Executive Director 

Client Profile: Isabel
A little girl loses the nursing care needed to make sure she's breathing 
Arisleyda with her daughter, Isabel
Last August, 17-month-old Isabel was assigned a nurse to monitor her breathing throughout the night. Isabel has Down syndrome and was born with multiple holes in her heart, which cause chronic cardiac problems and severe obstructed sleep apnea. Prior to having a night nurse, Isabel's breathing would become dangerously irregular, leaving her with a decreased level of oxygen in her system. But, under supervision from the nurse, who is well-trained in monitoring Isabel's breathing through a CPAP machine, Isabel's condition remained stable throughout the night, even directly after having surgery to close one of the holes in her heart. Isabel's mom, Arisleyda, could finally rest at night knowing her daughter was safe.

In September, after a successful month of Isabel sleeping through the night with minor issues that were quickly addressed by the trained nurse, Isabel's health insurance plan reassessed her condition, and -- against her doctor's recommendation --decreased the night nurse's weekly hours from 56 to a mere 16. That's when Arisleyda called Health Law Advocates.

HLA Staff Attorney Andrew Cohen quickly recognized that her health insurance plan's conclusion that Isabel's condition had improved since having the night nurse was erroneous. Her condition did not improve, it was simply better monitored by a trained medical professional, and thus there were fewer instances of desaturations (sudden decreases of oxygen in her system).

Attorney Cohen represented Isabel and her mother in an appeal hearing to challenge the insurer's decision to cut their nurse's hours. By presenting testimony from Arisleyda and the night nurse, including compelling evidence that showed the nurse's log of observations and activity, Arisleyda's insurance agreed to reverse the planned reduction in nursing hours for Isabel.   
Another Chance at an Education
Advocating for the Mental Health of Young People in Juvenile Court  
The Juvenile Court in Salem, Massachusetts
Just over ten years ago, HLA began an initiative to address children's access to mental health services. Across Massachusetts, young people experience barriers accessing mental health care and substance abuse treatment. HLA is working to change that.
HLA's Juvenile Court Mental Health Advocacy Project (J-MHAP) works to disrupt the school-to-prison pipeline by advocating for young people involved in juvenile court who have become lost in our mental health or substance abuse treatment system and face even greater tragedy unless they receive the health care they need. All too often, young people end up in juvenile court because of poorly addressed, or simply unaddressed, mental health or substance abuse issues. Stories from our J-MHAP illustrate the high value of targeted advocacy for children in juvenile court struggling to receive mental health or substance abuse care. Here is one of those stories...

In March of 2015, HLA Mental Health Advocate Lisa Morrow was appointed by an Essex County Juvenile Court Judge to assist Gabby*, a 16-year-old girl whose mother filed the case in court because she was desperately trying to get help for her. Gabby had been recently hospitalized for severe depression and anxiety and was not attending school regularly. When she did attend, Gabby was splitting her time between mainstream classes and a smaller therapeutic support class - despite her desire to be fully enrolled in the smaller class and stating multiple times that the size of the school building and large number of students caused her extreme anxiety. However, the school district believed that her strong academic skills warranted her continued enrollment in mainstream classes, instead of enrollment full-time in a smaller special education school, despite her unending difficulty in her current placement.

In the Spring of 2015, Gabby continued to fall
far behind in school. She struggled with her mental stability, and consequently, her grades suffered. Near the end of last school year, Gabby fell short on credits due to continuous absences and was removed from the partial inclusion special education program and placed in the mainstream high school full-time. In an effort to keep her in school, the district enrolled her in a drop-out prevention program, where she attended for the last few weeks of school, but did not continue through the summer, due to her anxiety and related struggles with home-life.

Over last summer, Gabby's anxiety and depression manifested. She attempted suicide and was hospitalized. Attorney Morrow advocated for her to be found fully eligible for Department of Mental Health services and called for an emergency meeting with DMH, Gabby's community-based mental health providers, and the school to request a 45-day evaluation for Gabby at the smaller therapeutic school.

The district approved the request and over the course of the 45-day evaluation, Gabby flourished. She still had her tough moments during the 45-day assessment, but very much benefited from the individualized support the small therapeutic school was able to offer. She attended school consistently for the first time in two years, and staff at the school felt she was a great fit for their program.

In December 2015, Gabby's special education team met at the small therapeutic school to review the results of the assessment. Staff at the therapeutic school reported that Gabby made good use of the supports offered, was producing excellent work, and receiving good grades. The district agreed to keep Gabby at the smaller therapeutic school where she continues to do well. Attorney Morrow's advocacy gave her another shot at an education, when it was very likely she would drop out - or have much more tragic consequences.

Young people, like Gabby, can easily fall through the cracks of the health care and education systems when their mental health concerns are not addressed. HLA continues to advocate for young people in the Lowell and Salem Juvenile Courts, with the ultimate goal of making this service available for children in juvenile courts statewide. State Senator Eileen Donoghue of Lowell has said that this pilot program will be "a hallmark and a trailblazer for the entire country." A 2-year study evaluating the efficacy of the project conducted by Boston University's School of Public Health will provide further evidence that the program ensures children at risk have better mental health, do better in school and at home and have less court involvement.

HLA's J-MHAP receives generous support from The Peter and Elizabeth C. Tower Foundation, The Klarman Family Foundation, The C.F. Adams Charitable Trust, The Blue Cross Blue Shield of Massachusetts Foundation, Boston Children's Hospital, The John W. Alden Trust, The Gardiner Howland Shaw Foundation and generous corporate and individual contributors to our Annual Benefit Breakfast.

*Name has been changed.

Board Profile:
Dr. Lauren Smith

Dr. Lauren Smith joined HLA's Board of Directors in January of this year and comes from a breadth of experience in the medical and public health policy field. Her knowledge and background give HLA's Board a unique perspective to our mission and will be invaluable in the years to come.

We were able to sit down with Dr. Smith and ask a few questions...

What drew you to health policy?

For a long time, I believed that medicine was the ultimate path to make an impact on the well-being of a community. But after I became more exposed to political theory and sociology, I realized how a society is structured makes a huge impact on the overall health of a people. I was fortunate to have other opportunities to have an impact on a broader population, which was what ultimately drew me to policy.

What are the challenges you see in crafting public policy that represents the health needs of the public? For low-income public?

The cumulative effect of difficulties in different domains. Employment, housing, food access, affordable transportation, economic mobility, economic stability. The cumulative burden of the adverse impacts on those domains, literally and figuratively, weigh on people. Especially for low-income populations.

For example, I have a cold today and feel lousy. But I have the luxury with work flexibility, so I'm home right now. But for working poor folks, if they don't go to work, they don't get paid. Having that weigh over your head all the time can be a crushing burden. And I take that for granted, a lot of people do, because [sick time] is available to us.

How did you hear about HLA? Why did you decide to join the Board of Directors?

I knew HLA through the Benefit Breakfast. I attended many because of my work with lawyers in the health field. At that time, I knew about HLA's work through the medical-legal partnership in regards to child advocacy and policy work. [HLA Board member] Josh Greenberg reached out and asked if I was interested in joining the Board. I also knew [Board member] Ruth Ellen Fitch and her connection with HLA.

Part of what drew me to this Board was an interest in HLA's social and public policy. Individual representation, yes, but a holistic approach to enhancing the health and access to care for a neighborhood, for a region.

Where do you see HLA's role in improving public policy for Massachusetts' low-income residents?

Generally, I think the fact that HLA has been able to play such a strong advocacy role and is seen as an influential and savvy organization allows them to draw a lot of people to attention. The client work is rolled into an overall advocacy for low-income folk. Advocacy on an individual level creates windows in a peoples' experience, where one can identify patterns of system inequalities. There's an efficacy to representing a client, one at a time, but to engage the political system and change the environment for a broader and deeper impact--that's an important avenue of creating systemic change.

Protecting Immigrants' Access to Health Care
The Immigrant Health Access Coalition (IHAC) submits comments to the Executive Office of Health and Human Services 
The Immigrant Health Access Coalition (IHAC), comprised of roughly 30 health care organizations and advocacy groups, regularly convenes at HLA's office to discuss how to improve access to health care for low-income immigrants. Immigration status, language barriers, and lack of educational outreach can leave those who immigrated to Massachusetts without access to basic and necessary health care. The Coalition's ultimate goal is to secure short- and long-term care for non-U.S. citizens living in Massachusetts, a population that routinely faces obstacles to health care and has an uninsurance rate of more than 13%. 

IHAC recently advocated against regulatory changes that would limit full Health Safety Net (HSN) coverage for some very low-income immigrants. The HSN covers hospital and community health center services for low-income Massachusetts residents without health insurance. The new state regulations lower the income limit for the HSN to 1.5 times the Federal Poverty Level (FPL) (or $36,450 annually for  a family of four) from 2 times the FPL (or $48,600 for a family of four). HLA represents many low-income immigrants with unaffordable medical bills who face further financial crisis and lose access to health care as a result. There will be more if these regulations go into effect as scheduled on June 1.

IHAC came together shortly after the regulations were proposed and all agreed: lowering the income limit for the HSN would be extremely harmful for thousands of low-income consumers - immigrants comprising a disproportionate number of them, not to mention our hospitals and community health centers.

On February 26, IHAC submitted comments to the state's Executive Office of Health and Human Services and testified in person, arguing that significantly reducing coverage for this crucial program would result in a major gap in care and plague low-income consumers with mounting medical bills, hurting Massachusetts residents and health care providers alike.

In addition to lowering the income level, the proposed regulations significantly reduce retroactive HSN coverage from six months to 10 days from the date of application. For immigrants who are unfamiliar with the U.S. health care system, this reduction in retroactive coverage is especially detrimental. HLA has seen that uninsured members of this population often do not apply for HSN coverage until after they receive a big hospital bill weeks after their hospital visit because they could not apply while in the hospital. As a result, under the new regulations, many more immigrants will receive unaffordable medical bills, ruining their financial security merely because they needed health care.

We are also working with our partner organization, Health Care For All, and other members of the IHAC to support legislation that will prevent the new HSN regulations from taking effect. 

The Blue Cross Blue Shield of Massachusetts Foundation, the Cummings Foundation, The Clowes Fund, The Fish Family Foundation, and generous corporate and individual contributors to our Annual Benefit Breakfast support HLA's advocacy for immigrants.