Through the legal and health-care systems, these Penn State programs serve the most vulnerable Pennsylvanians
By Melissa W. Kaye
In a perfect world, there would always be someone to act as the voice of a person who is suffering or exploited.
The child who has been locked in closets; the teen with the parent in jail; the elderly woman abused by her son. Scholars in Penn State programs—one using the legal system and one health care—are serving as reliable advocates, tapping into resources University-wide and beyond to find effective solutions for those facing harm.
The Legal Clinics
For a neglected infant in Carlisle, Pa., a voice of support has come from the Children’s Advocacy Clinic (CAC) at The Penn State Dickinson School of Law.
The clinic speaks on behalf of children from birth to age 21 going through a crisis. “We handle cases where the child is in the dependency system and placed in foster care due to abuse or neglect,” explained Lucy Johnston-Walsh, clinical professor and director of CAC.
By law, in most cases, the court must first attempt family reunification. However, under certain aggravated circumstances—such as when a parent’s whereabouts are unknown or when the child has been the victim of serious bodily injury by the parent—the child’s guardian can argue for adoption. The clinic also seeks support for older teens transitioning out of foster care to independence.
CAC, and an Elder Law and Consumer Protection Clinic, are two of the clinics developed at The Dickinson School of Law following the Law School’s merger with Penn State in 2000. The clinics share office space with the Family Law Clinic, co-directed by law professors Thomas Place and Robert E. Rains; and the Disability Law Clinic, directed by Rains.
The clinics offer students, under the supervision of faculty and staff attorneys, the opportunity to represent citizens in need on pressing legal issues. While legal clinics at law schools are common, the Dickinson-Penn State merger allows law students and faculty to collaborate on cases with faculty in other Penn State departments and colleges, such as psychology, education and medicine, making the clinics a unique interdisciplinary effort.
Beyond a Client’s Concerns
The clinics have earned a high level of respect in the Carlisle area, where the Law School was established. Judge J. Wesley Oler Jr. of the Court of Common Pleas of Cumberland County noted the program “provides a significant resource in terms of legal services … to persons who might not otherwise be able to afford counsel. The program also provides an excellent opportunity for students to participate in the legal system.”
Tara Yutzy, a 2007 Dickinson graduate, handled cases in CAC. “[It showed] me how important it is for children who are at difficult points in their lives to have an unbiased voice to speak for them,” she said.
In addition, the clinics provide an opportunity for faculty and students to engage in larger public policy debates and craft solutions that go beyond the needs of an individual client.
Law professor and Elder Law Clinic director Katherine Pearson and her elder law class, for example, teamed up with state lawmaker Frank Pistella to draft a bill clarifying the role of third-party signers for nursing home care. The effort came on the heels of a clinic case in which a 94-year-old woman was being sued by her deceased husband’s nursing home, seeking payments on top of Medicaid and more than $300,000 in private payments. The woman urged the clinic to help others who may feel pressured to sign admission papers without a clear understanding of financial liability. Her concerns echoed similar complaints received by state legislators. While the legislative session ended before the bill was brought up for a vote, Pearson said that she and her students continue to work on different avenues. “It takes dedicated advocates to address systemic problems at state or federal levels,” she said.
From the elderly man who purchased a hearing aid that did not work to the widower whose neighbor cleaned out his bank account, the Elder Law Clinic’s primary outreach effort is to seek solutions for older adults in challenging situations. The clinic has attracted international attention, with a recent visit from an Australian scholar studying the potential for elder law clinics in his home country, and Pearson going to Canada this fall to present a program on creating university-based law clinics.
Meanwhile, Johnston-Walsh is seeking to expand CAC to State College in order to make face-to-face collaboration with University Park faculty more frequent. In a recent case, for example, the clinic received a psychological evaluation on a parent. “We needed assistance in interpreting the report and the diagnosis of a parent’s mental illness,” explained Johnston-Walsh. “More importantly, we were trying to learn about the impact of that parent’s illness on his or her ability to parent the child we were representing.”
Penn State professor of psychology Dr. Sandy Azar served as a consultant on this case as well as others. Said Johnston-Walsh: “When we open a clinic in State College, we could work together as a team more often.”
At the Doctor’s
The Family Support Program reviews medical charts to find the children who are missing their appointments. Supervisor Becky Dunlop (left) and Penn State family medicine resident Dr. Amita Dhatrika examine a patient.
The Health-Care Arena
Another program, administered by the Penn State Hershey Medical Center/Good Samaritan Hospital Family and Community Medicine Residency Program in Lebanon, serves as a voice for at-risk children and families in the health-care arena.
While there are laws requiring children to use bicycle helmets and car seats, other than immunizations, there is no requirement that says a child has to receive medical care before starting school. Most parents want their child to be seen by a doctor; it’s the children who aren’t showing up for medical appointments who are a concern and who are often at risk, says Janette Kurie, the residency’s director of Behavioral Medicine, who developed the Family Support Program in 1993 with Penn State residency faculty Dr. Carol Baase (who is now in a Penn State family practice).
At the heart of the program is an ongoing, daily review of medical charts of the so-called no-show children. “If we could reach them, we could identify their needs and work with those families early on,” said Kurie. “Some of the parents who are not bringing their kids in do not have insurance, or have problems with transportation or language; others have more psychosocial issues going on, like drugs and alcohol, severe depression, domestic violence in the home, or a parent in jail. There’s that small percentage of kids who do not show for appointments who are clearly at risk for all kinds of poor outcomes.”
Once the no-shows are identified, the office intervenes by calling, sending parents letters, contacting the relevant agency or making home visits, explained Becky Dunlop, program supervisor.
Take the example of David (not his real name), who Kurie and Baase found in a stack of no-show charts. Kurie detailed his story in the journal “Health Affairs”: David at 18 months had not seen the doctor since his last well-child visit at six months. When the office called his mother, she got defensive. While she agreed to an appointment, she failed to show up. Repeated phone calls were made, and it eventually took Protective Services to physically bring David in. David, who weighed as much as an average 6-month-old baby, was immediately hospitalized for failure to thrive.
“Where Were All of You?”
A meeting with the family revealed indifferent, angry parents who had been abused themselves as children, with the father incarcerated as an adult. “Where were any of you when I was a child?” cried David’s mother. “Where were all of you when my mother locked me in closets?”
David was placed in a foster family for nearly a year. The parents eventually complied with a treatment plan, and David returned home. Now 14 years old, David is living with his sisters and mother, who has since divorced and remarried. David has severe attention deficit/hyperactivity disorder, post traumatic stress disorder, impaired hearing and seizures, and he is in a class for children with learning disabilities. His mother now consistently brings David and his sisters into the doctor’s office.
As of January 2007, the program has identified, tracked and offered interventions to more than 1,800 children from birth through age 6. The program also exists to train family medicine residents how to care for these psychosocially complex families.
Currently Kurie and several Penn State faculty, including Residency Program Director Dr. Paul Aitken, Family Support Medical Director (and Penn State Family Physician) Dr. Aaron Lane, and Dr. Peter Lewis of Penn State’s Department of Family and Community Medicine, are consulting with Penn State’s Department of Health Evaluation Sciences to evaluate the program’s overall outcomes. So far it has found that children under 6 with frequent ER visits (i.e., two within six months) often have histories of abuse, domestic violence and no-shows for well-child exams.
In 2005 in Pennsylvania there were more than 4,000 confirmed cases of child abuse. Kurie contends that a simple review of pediatric no-shows and involvement by physicians and social workers with these more at-risk children and their parents might possibly help prevent some abuse.
Dr. Kevin Hepler, past medical director for the Department of Public Welfare in the Office of Children, Youth and Families and a former Penn State Milton S. Hershey Medical Center faculty member, agrees. “Child welfare is notoriously short shrifted. Ultimately what the program proposes is dirt-cheap,” he said. “If you see kids aren’t coming in for medical care, someone needs to find out why. There should not be simply a penalty fee imposed for missing a child’s appointment for health care.”
Family Support will be sharing the program evaluation at regional and national conferences, as well as in journal submissions. “I’m hoping it will demonstrate the need to pick up and identify children at risk early on within a health-care setting and show that there are ways we can improve their overall health,” said Kurie.