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Today’s first panel highlights one of the most effective examples that we’ve seen And I’d like to dive right in and have Debbie, Darren, and David tell you about that, how they do it Debbie, let’s start with you Could you tell us, please, could you describe VA Connecticut, Connecticut’s Errera Community Care Center, what it is, who you serve, and how your partnership with the Legal Aid Program, that is, Connecticut Veterans Legal Center, how it developed and evolved over time? Thank you for the opportunity to participate in this field hearing today We really do feel that some veterans have some challenges when they come back from the service And this work is incredibly important And we actually have found at the Errera Community Care Center– I’ll tell you what we are We are a 14 different outpatient programs that focus on psychosocial rehabilitation and recovery services What that means is we partner with the veterans that come to our programs and to help them obtain the things that they are looking for in their lives Same things that you and I are, same things that everybody is, the things for meaningful relationships, jobs, works, school, a place to live where they choose And so that’s what we partner with our veterans for We– the population we serve are veterans who has serious mental illnesses They may have substance use disorders They may be homeless, or they have socioeconomic barriers The umbrella of the program actually covers the State of Connecticut, and we have three main sites that we operate out of The programs, in general, are group-based treatments We have employment programs, clinical case manager, and peer support We actually focus on wellness, because we know a lot of the veterans that are coming back, physical activity is very important to them So we have wellness We have justice involved veterans programming, and a whole array of homeless services, which certainly utilize the legal services of Connecticut Veterans Legal Center And Dr. Dave Rosenthal will talk a little bit more about the patient line– aligned care team And just for an idea, we kind of average anywhere from 90,000 to 100,000 contacts a year with our veterans and our programs We are mostly community focused, so some come to our center, but many are out in their own homes And we’re out placed We’re not a main hospital So it’s a very community feel And so with that community feel, veterans kind of feel like they own this space, which we like We like that they feel– they have an ownership to the care that they are involved in And that kind of dovetails into how we got started with Connecticut Veterans Legal Center We had a volunteer attorney who came back in 2007 And as the veterans found out that he was an attorney– a retired attorney, they all started asking him, oh, can you help me with this? Oh, I have this issue Can I ask you this– your opinion? And there was such a demand It was such an organic process, and there was such a demand to have conversations with this attorney who was volunteering a couple days a week that he started making appointments OK Come meet me at this time And the issues that they were coming to him were with– they had evictions, they had past bills that needed to get paid They had issues with families, or they had substance use issues that got them into legal trouble And so they were all really appropriate things that on some level, sure, they’re absolutely clinical issues But we really have to work closely with the legal component in order to really take care of somebody’s needs We had wonderful– we still do– have wonderful legal aid services in New Haven, Connecticut But as probably many people would agree, legal aid is in popular demand, and the resources are stretched thin And so when they would go, some of us would take the veterans to go see our legal aid partners in the neighboring town, they would– the veterans would have to follow up on a lot of stuff Well, that’s very hard to do when

what you’re concerned about is, do I have a roof over my head today? Where am I going to get my next meal? Am I going to be safe? And so by coming to where they also receive their care, their outpatient care, and helping them live in the communities of their choice, and being able to also access this attorney, we found that veterans felt much more comfortable in doing that So this went on for about a year, at which point, about 2008, we had this young very vibrant brand new graduate attorney come in She talked with this retired volunteering attorney, and she was like, I absolutely would love to do this work with veterans And so that’s where the flame was lit Margaret Middleton was the founder– the co-founder of Connecticut Veterans at the time legal clinic, because there was one attorney And she was just filled with enthusiasm about doing this work We had to figure things out So we said, OK, this makes sense It makes sense to have it co-located We can see the differences in how veterans feel And so we had to get our executive leadership, our hospital leadership, on board with us We had to consult with our general counsel at the VA We had to do MOUs We had all that groundwork to do, because we were co-locating And because we weren’t just making a referral and handing off the case, we actually were partnering So we had to make sure we had consent So we had to make sure that we appreciated each other’s perspectives and each other’s roles, because they’re very distinct roles But what we found over time was it was clear when we had a partner to work on the legal issues, while we were able to– the clinicians were able to work on the clinical issues, it made a huge difference in the satisfaction, and the services, and the life outcomes for our veterans We have continued to do that Darren will talk about their expansion But we went from one attorney in a room the size of a closet to seven attorneys in the room the size of a closet until we actually had expanded a little bit with our own programs And we have Connecticut Veterans Legal Center through– with our medical legal partnership with them They are on site at three different sites at our VA We span the State of Connecticut But they have space on three different sites to make sure that it is available to all services– all veterans in our state Thanks, Debbie That’s terrific I appreciate that Just before we turn to Dr. Rosenthal, a housekeeping matter If people have questions of any of our panelists, we should have time for those Probably the most efficient way to ask questions is to drop them into the chat And certainly at the end, if not before, I’ll call on you and ask you to state your questions so that all of us here on Zoom and the 100 or more people who are listening in on and following us on Facebook can hear it, as well So David, let’s turn to the health care part of our collaboration here Could you tell us what is the Homeless Patient Aligned Care Team? And what is unique about how you and other multidisciplinary mental health professionals at the Errera Community Care Center serve veterans? Sure Thank you so much for having me and for having us to describe what we do here at Errera Community Care Center So just a point of clarification So I am a primary care doctor, not a mental health provider Although, for what we do– most of what we do is both physical and mental health combined So I’m a primary care doc here at the Errera Community Care Center, and the Medical Director of our HPACT Program, which as you say, is the Homeless Patient Aligned Care Team, or sometimes we call it the Housing Patient Aligned Care Team, as well And as Debbie had mentioned, I’m here representing one program, but there is an array of 14 different programs that work here in West Haven, Connecticut, co-located with our medical legal partner, the Connecticut Veterans Legal Center, which is down the hall from me here in clinic And I’ve been here for eight years And one of the joys of working here is working collaboratively with the legal clinic, and working with all of the 14 partners So the HPACT program, just for people

who may not know all of the VA sort of lingo, we– PACT model is a patient-centered medical home care model of primary care So team-based collaborative care at the VA And the Homeless PACT, we are one of now 61, over 60, Homeless PACTs across the VA or across the country that help focus on the medical care, as well as the social care, of those experience– those veterans experiencing homelessness, trying to focus on providing a different level of access, and a different level of services to those who need it What we’ve discovered is that we have a no wrong door approach, meaning that of the 14 programs here at the Errera Community Care Center, we work very closely with lots of different homeless program providers, case managers, psychologists, social workers, psychiatrists Wherever the veteran presents, we try to meet them where they’re at to figure out what their needs are, whether they’re medical needs, whether they’re psychiatric needs, whether they’re social needs, or whether they’re legal needs And oftentimes, they’re all at the same time And so what we enjoy about doing– working in that environment is that it doesn’t matter where the veteran presents, which program they work with, or which programs, we all refer into the legal clinic, if needed If that’s something that we think might provide some assistance to that veteran So that– I’ll stop there, but just– we can talk more about the referral process as we go David, thanks You mentioned 14 programs What kind of programs are you talking about? There are a number of homeless programs within the VA So some of them you may have– some of the members on this call may have heard of things like the HUD-VASH Program, which is a program that is– combines through HUD Housing Urban Development and VA And the VASH stands for VA Supported Housing So that is a– HUD provides a Section 8 voucher through the local housing authorities, and the VA provides case management for those veterans experiencing homelessness, either chronic homelessness, or long periods of homelessness that requires more support And so that program, to give an example, we have, I think, around 900 veterans in the State of Connecticut vouchers in the HUD-VASH program We have many case managers in that program So that’s a large program for those experiencing homelessness who are veterans Programs such as the Grant Per Diem, which is transitional housing for veterans The Supportive Services for Veteran Families, which is a program that the VA funds working with community partners Our housing programs are HCHV programs And some of that case management programs– I’ll stop with the acronyms There’s a number of them But we– as Debbie mentioned, things that help people with case management, maintaining sort of independent living out in the community, make sure people can live at home, get jobs if that’s what they want So helping them work therapy Pretty much anything that you can imagine, we’re there to help them And that’s a nice segway into the legal services, which is that as someone mentioned earlier on the call, we realize that legal services and legal needs were not being addressed And so that was a real wonderful way to sort of introduce the legal clinic And they’ve been a wonderful partner for the last eight years that I’ve known– I’ve been here That provides a great segway into my next question for you It’s a great idea to have legal aid lawyers available as part of your team You’ve gotten medical training and medical school, obviously, as [INAUDIBLE],, and your colleagues have health care training How is it that your health care team determines if a patient has a legal issue? You probably didn’t necessarily study that in medical school So how do you accomplish that? You are correct We did not I will tell you that as a– so I teach at Yale Medical School And we are moving– the curriculum is moving in most medical schools to address some of the social determinants of health And sort of– certainly, the need, people are recognizing this that oftentimes the social determinants of health make up 80% of the actual sort of health care dollar Some places look at 40%, if you look at the National Academy of Medicine Report on cost of care, but we know that some of those initial sort of social determinants are very important And things that as a physician– or as a physical– as a nurse practitioner, or as a physician associate, we’re oftentimes ill-equipped to try to help our patients with So we rely on our– on working in teams

So like I said, it could be anywhere that those people present, whether that’s an issue that comes to me, we screen everybody in our clinic that comes through for legal needs That’s just part of what we’ve learned to do Our social workers, we work very closely with social workers I think we have on order about 67 licensed clinical social workers here through the Errera programs They are very well addressed at what issues, social needs that– it really would help to have a lawyer supporting you Or these are issues that I might not be able to help you with as a social worker I think these are legal issues So those clinics will also do their screening So I think to answer your question more directly, we all know that we need legal services help We all know that we need social determinants of health work And I think it’s becoming very apparent to the medical community at large that we need to make large investments in helping people with these social determinants of health, whether that’s social work, whether that’s lawyers’ legal services, access to legal services, whether that’s psychologists, whether that’s transportation All– and all of the above, to be honest with you You referred to social determinants of health, which is, obviously, a key driver of this medical legal partnership model What is the social determinants of health? What does that mean? That’s a great question I think it means a lot of different things to a lot of different people And we define it differently in this country than they do in the United Kingdom, for example, where they often talk about– so they’re– instead of medical, legal partnerships, they’re talking about health justice partnerships, right? And they talk about social needs and their social needs program I think social determinants of health, at least the way we define them, is the things where medical care, whether they be procedures, surgeries, medications, any of the things that we do to treat people are not your traditional pharmacy or surgery The social determinants are those things that are made up in where you live and relate to your zip code, and your geography, not your genome And not necessarily the behaviors, the health behaviors, that you may come with It’s very much relies on things– the social factors, who you live with, if you live alone, where you live Is it clean housing? Is it safe housing? Is it affordable housing? Is there pollution? Is there environmental harms to your health? Those things we’re starting to recognize are the social factors that are much more important And certainly in the world that Debbie and Darren and I work in of homelessness and those who are experiencing extreme poverty I mean, it’s so obvious, the social determinants of health It’s less obvious when you move up in– and it’s sort of hidden, and it’s not really necessarily seen But we know we have a number of veterans who are suffering, who are not seen on the street corners, who are suffering in their apartments, or suffering in places And that’s sort of where we think of we need to address a much larger aspect of the population Thanks, David Darren, I’m a lawyer, so I’m anxious to hear the legal part of this collaboration, and you’re our representative there Can you describe the various ways that veterans come to you at the Connecticut Veterans Legal Center? And then the second question is, what kind of issues do you regularly help with? Thanks, Ron Let’s take that in one piece at a time So we do have a referral process where clinicians at the Errera Center, or any of our community partners within the VA, can make referrals to the CVLC for legal issues And what we usually say is, it’s better to refer when you’re not sure But sometimes referral will come with a conversation with the clinician saying, should I refer this before they make the referral? Sometimes it’s actually veterans just dropping by say, I’m having a problem with this My clinician sent me down And sometimes it’s going to monthly meetings and groups to talk about what’s been changing, what’s been going on, especially over the past six months with COVID There’s been a lot of changes in the law that impact the work that we’re doing in Connecticut So getting updates on moratoriums and other things that are going on We’re doing that, as well And the way the programs are so connected in Connecticut is that the referral might come from David and HPACT,

but they’re also in two or three other programs So we try to track where they’re coming in from But honestly, it’s a collaborative team from all different pieces So oftentimes, they may be a HUD-VASH referral, but the issue might actually be more about their mental health So we’re pulling in someone from the big hospital, right, to help figure out what’s going on with benefits, right? So to kind of transition where they’re coming from to what they actually need help with So the Connecticut Veterans Legal Center is a civil legal aid for veterans and the NLP model, right? So for the non lawyers in the room, we’re not doing any criminal law, right? The lawyers in the room, we’re filling the needs that cannot already be filled in the State of Connecticut So we’re not doing SSD, for example, right? There is a large Bar in Connecticut that takes that work And there’s a way for them to get paid for that work And we will push that work to them We get referrals, there is a lot of ways to get that But where SSD will take overpayment cases and reinstatement of benefits, removes the Bar actually don’t get paid to do that work Although, that is one example, it’s a small part of our work A large amount of our work is really involving around housing, whether it is eviction prevention, or it would be in securing new means of income, whether it is assisting them to get VA benefits, dealing with debt issues, whether it’s a case in small claims and their security deposit returned A lot of what those of us who work in legal services know words like the bread and butter of legal services work We do a little bit of different work, as well, we think about the MLP model And so we also expand the MLP model, because we help veterans who are not allowed to get access to VA health care, or on their face that they cannot help them either through the discharge upgrade process, through the DOD, or the recharacterization process through the VA And that’s VA benefits getting increases, because when we’re looking at a veteran, we send a visual team to call income check Bring them in, sit down, talk about where are you getting benefits from, where else could you be going? And the beauty for us is that we can do the legal work, but let’s say when we assess the housing case and it doesn’t look like we have a chance of saving the housing, we can pull in the VASH social worker, the Homeless Prevention Team, and talk about what options do we have to get this veteran rehoused, hopefully, without getting an eviction on their record And having those conversations, being pulled in and looking at the full array of resources make my job as a lawyer so much easier I’ve done some family work without social workers And I think most of my family clients in the past could have used a social worker, a mental health clinician But knowing that they’re there and that they’re connected and they’re invested in that veteran’s success makes my job so much easier so I can focus on what do we need under the law to make them successful? How do we lower this child support, if they’re permanently disabled so they’re not building a six figure debt? And what can we do to help them be successful as they move forward? What are the typical kinds of cases that you’re seeing? I’m technically doing the general area practice So bulk of my caseload is VA benefit cases, housing cases, debt cases, child support cases When we have a little– part of the [INAUDIBLE],, we kind of show a breakdown of what’s come in and out over the past year and a half But with that being said, it’s really a mix, and probably– I don’t have that slide in front of me, but it’s about a quarter of our work is housing, about a quarter to a third is VA benefits, then a mix of other stuff in between Now, that’s the issues, right? Sometimes one client’s going to come in who’s being evicted, needs VA benefits, is being evicted because of nonpayment, and also has a child support contempt pending because they’re not able to pay all their bills So it’s not one issue per one veteran Sometimes it’s a lot of issues for one veteran, but it’s really the goal of working with that And we also have a lot of volunteer attorneys, or pro bono attorneys, as we call them, who will help pick up some of these cases, as well So it’s not just us doing direct services, which is the majority of our work We’re actually doing full rep for these veterans, not just advising counsel, or one time advice And we’re getting them attorneys from the community to also help expand our capacity For those of us in the legal aid world, this notion that people don’t have one issue is something that we live with every day It’s the rare client of any sort, but certainly, legal aid clients who only has one problem, or one issue They’re typically many If you look at our Justice Gap Study from 2017, wow, 71%,

I believe, was the number of low income folks in America face civil legal issues every year A very high percentage of those face multiple issues, and veterans fall in that same category David, let’s talk– let’s turn back to you for a moment This is all about outcomes It’s great to collaborate It’s great to have no wrong door and all of that But at the end of the day, how does this affect health outcomes for your patients for Darren’s clients, if you will, they’re the same people So how does this collaboration affect health outcomes for vets? Yeah, that’s the $64,000 question, or maybe I guess in today’s world, it’s the billion dollar question, right? And I think the answer to that– I always talk about these things as both anecdotes and evidence, right? There is like two And I can tell you the anecdotes are really easy to come by I mean, I see patients here three days a week I mean, just this morning, I saw a patient who’s been helped by the legal center and a legal clinic And what I can tell you is that maybe– someone who– and last week I saw a couple of patients who did– the ability to not lose your housing, right? When someone tells you that they’re at risk of losing their housing of eviction and they have the wherewithal, or the ability, to talk to a lawyer who then advises them and is able to help them prevent an eviction does amazing things to someone’s mental health and their mood I mean, you can just imagine yourself, right, with that sort of impending stress And then having that resolved So the anecdotes, I have thousands of anecdotes, right, of places where veterans have been helped and that their mental health and their physical health then improves because of the work of working with this multi-modal clinic that we have And that’s sort of the anecdote So that’s much easier The harder one is the evidence, right? What is the evidence base? What are the outcomes that we can prove to those to show a return on in our investment of the energy and the resources that go into that? And that’s harder We really have, I would argue, a gap in our knowledge base We have– I always come back to our one paper that we published here in Health Affairs about our group I hope it’s included in here I always come back to it This is the Health Affairs article that was published in 2017 by Jack Tsai and Bob Rosenheck and the CVLC partners, as well And I’ll tell you, what they looked at in the data, right– so from 2014 to 2016– looking at both our medical legal partnership with Darren’s group, as well as some medical legal partners in the New York VA, as well, that they actually were able to quantify benefit, both [INAUDIBLE] at three month and at 12 month in mental health scores, right, in sort of our standardized metrics for improvement in mental health, both anxiety, hostility, paranoia, all of these sort of PHQ-9, they had statistically significant improvements in mental health And just to give a sense, right, for those who received here a major finding in the study was that veterans who received medical, legal partnership services showed significant improvements in mental health within the first three months, and continued to show these improvements at 12 months, at which time they also showed increases in income and days housed as their legal issues were resolved So just to give a scale, so what, right? I mean, so what? Why do we care about people? And I would tell you that our society, if we had a pill that saw– that improved people’s mental health for three months or a year, right, our Wall Street would pay billions of dollars for that It’s very easy to pay for products that improve mental health, but to pay for services, we sometimes discount that And so I would argue we have good data that this works We think– we do need to do more research to try to prove the return on investment But I do think this is incredibly valuable for the patients that we see, certainly, in the patients that Darren sees And now we just need to go about methodically proving that to convince everybody else David, thank you That’s absolutely the case There’s, I believe, enormous benefits, not only obviously to the individuals who are receiving these bundled services, but to our country, both

in terms of fully realizing human resources And if you just look at it in stark economic terms, enormous savings But it’s easy for me to say that And we really, as you say, have a huge need to get data to bear that out And that is something that we’re turning to, and a number of the medical, legal partnership programs are focused on that And we look forward to seeing the results of their work Darren, let’s go back to you How does the presence of your program, the Connecticut Veterans Legal Center, how does your physical presence in the Errera cluster there that Debbie described, how does that affect your ability to reach veterans? I mean, the traditional vision we all have of legal aid going back maybe 30, or 40, or 50 years, is a bunch of lawyers sitting in an office waiting for people that show up That’s not– that’s not your model And how does it affect your ability to reach veterans? We’re in the middle of everything, so that really allows us to pick things up where they’re happening, Ron So our office is in part of what’s called a CRRC, Community Resource and Referral Center as part of the community cluster as one of our bases Dave is– the next door is David On the other side of us is the homeless team where veterans are dropping in who are in need of housing and needs So literally, we are the next door over And they’ll make referrals for us there But many of the veterans in Connecticut, especially in the [INAUDIBLE] area, know the Errera Center as a place for them to go when they need help, right? So we had the benefit of being where they are looking for resources So we’re already there And we have space in the building to meet with them If we need their clinician, we don’t have to drive five miles to find them They’re actually up on the second floor, right? So we’re all in that same building We all have the ability to work together, and it allows for just to be a lot more efficient And plus, it allows for those one-off conversations with clinicians, which you wouldn’t get, where– so we can say, oh, I’ve been hearing about this Is this really an issue for a hypothetical client? And we’re going to have that discussion about, yes, it is You should definitely refer them Or following up with saying, what is the housing plan for this veteran if we can’t get them to stay there? And it’s very fluid We have a whole part of our office that their job is just dealing with referrals Touching base with the veterans either in the foyer of the building, or in the waiting area when you come in We’re reaching out We’re calling them Bringing them in And it’s like this is a one big circle of us passing the law to clinicians, and back and forth based on what the needs are And we actually have some of the data that you’re talking about, about the results, right? We know that every dollar that we get we’re returning $20 back to the veterans, whether it’s through access to benefits, housing, or other resources, right? We’re meeting the majority Usually 3/4 of our goals of keeping veterans housed, including their income, and helping them work on long-term stability So we see the results We know who we’re working with And they also come back, right? As you were talking earlier about it’s not just one issue, but they know when there are other issues down the road, they can refer and they can get help Plus, the veteran community talks to each other, right? So it’s very often we’ll get, oh, my so– Bob told me that I need to go talk to you guys for this or that, right? We have stories of veterans who while they’ve been possibly in prison, right, getting ready to exit, a talk with one of their veterans in [INAUDIBLE] while they were in jail, convince them to start going into treatment and then working on those pieces, and us being there to help them when they get out, as well So it’s really a holistic approach to dealing with the needs and the social determinants so people can be working on what they want, which is housing stability, economic stability, be able to take care of themselves I’d like to underscore the point by asking you a slight variation on the question If you were instead of being at Errera were just at a– and you’re not only physically located but you’re operationally embedded in the work that is being done there If you were physically distant and not embedded in the holistic way you’ve described, how does that affect the trust and credibility that you have with a new potential client?

You get a referral from somebody, a doctor, or a social worker, or somebody has told somebody, a veteran or any other person living in poverty, you really ought to talk to a legal aid program, go see Darren over in Connecticut– this Connecticut Legal Services program What’s the difference between your relationship the way you get your referrals at Errera and that sort of more traditional model where people are– it’s a much colder handoff Right Well, I mean, I think logistically speaking, for those who have not had the pleasure of being to Connecticut, mass transit is not as plentiful as we would like, right? So one, the thought of just thinking you’re going to go the next town over, which where they would have to go for us, the nearest legal provider, would require a couple of bus transfers from West Haven, unless they knew how to navigate it elsewhere So beyond just logistics, right, of being able to get to that person, it’s those follow up phone calls, the phone being shut off, 300 minutes a month When I know during Non-COVID times, that VASH social worker’s out there once a week at their house And I can say, listen, Stephanie, I’ve not seen so and so in a week and a half I’ve called them When you go out there, can you call him for me? And we’ll do a call together to see what’s going on For me as an attorney, I also know the lingo So when David starts rattling off his acronyms, nine times out of 10, I usually get it right And at least I know which program [INAUDIBLE] But I can also speak to the understanding of what a DD 214 is, what it means that when you’re trying to access the VA benefits, and why it’s not surprising that you lost your whole check this month because the VA just took it, right? Because you forgot that you owed a debt that they didn’t tell you about, right? So having that internal knowledge of the system– and I’ll do training to my colleagues at the legal services so when they have a veteran sometimes, they understand the lingo and knowing how SSVF works And so they can pay a security deposit, or get some back rent But it’s that institutional knowledge and the co-training that goes on between being able to ask Debbie a question when I don’t understand some archaic VA procedure, for a lack of better terms, right? And understanding why that is coming our way And in our work of trying to get veterans into the system, being there, knowing where the roadblocks are, and helping them navigate that, is invaluable I mean, the VA is a bureaucracy, like many other government organizations It has a good goal It’s a great purpose And it’s doing great work in Connecticut But people still get lost And sometimes it has nothing to do with ourselves, or the VA, but it’s a symptom of their mental health, or their lack of access to resources So having everything together with the resources to bring them together really, really, really makes a big difference And, Ron, if I can just add, the co-location what Darren’s talking about, is the secret sauce of this place We have all these programs together We all know each other If it was just a referral out to some organization that I don’t know that’s out of sight, out of mind, I really don’t have that trust I know Darren I know Cindy I know Liam I know all the people who work here And because we have lunch together, because we know each other, I can make that warm handoff for a veteran Trust does not come easy to many of these veterans And so whoever has that trust relationship, whichever program it is, we work to share that trust among the group So that’s the secret sauce If it can’t be referred out because the minute they miss a bus and they have a problem, it’s gone They’ve given up on that relationship So the secret sauce is the co-location Debbie, first of all, thank you I mean, we’ve just heard for the last half hour or more a remarkable program, a program that’s clearly impacting people, veterans, in a very positive way But if we go back 40 minutes and you describe the origins of the program, it wasn’t always like that You really were in at the ground floor and have built this collaborative model to where it is today So thank you for that And we shouldn’t take it for granted because as I want to explore with you the wonderful model that you have going at Errera is not necessarily the case elsewhere So can you describe the VA’s efforts to study what you’re doing and replicate the model? And what are the barriers to if I were ruler of the universe,

I’d just press a button and I would replicate Errera all across the country But unfortunately, I’m not So talk about the barriers that we collectively face and the VA faces to do this Sure Thanks, Ron I’ll tell you, so I’ve worked in the VA for over 30 years and have watched a lot of this really develop from the ground up And one of the things that I think the VA does that I’ve always seen is they always want to do the right thing by the veteran, always And we started this, but there were some other partnerships that have developed with other legal services in the VA, although they may not be co-located And I think because it is just a clear need that veterans have And so about, I don’t know, maybe six or seven years ago, Lara Eilhardt, who is the moderator– and Lara, I’m sorry if I mispronounced your last name– of the next panel But she was chairing the– is chairing, I believe still, the task force to start up MLPs throughout the country And one of the things the VA does really well is they’re good at disseminating information And so the task force for the MLPs really is a wealth of information about what you should be thinking about, how you should implement things, what policies and procedures have worked People who go to the VA, they’ll say, well, services might be equitable across all VAs You can get the same kinds of mental health services They’re not all located the same way And we have always located ours under one umbrella And I think that that has been tremendously helpful for exactly what Darren and Dave described when you’re co-located, when everybody’s reporting up a similar ladder, then the information really gets disseminated in an appropriate way And so while not all VAs have the same– I mean, the Errera Center has been in development for 33 years And what we’d like to say is, what you see today is not going to be what you’re going to see next year because we’re constantly looking at how we can make services better So I think it does take time I think that communication is incredibly important I think having a champion so– I’ve taken opportunities to say, gee, CVLC, you’re doing such really wonderful work Would you like to talk to the social work department, to the mental health care line, to the psychology service? Maybe it would be helpful, I’ll talk with the hospital director Are there things that would be helpful to be sharing with the hospital director? And so constantly talking about what are the benefits of these kinds of partnerships I also know that the VA’s task force really has their networks everywhere, also in the community The VA can’t live alone in its own walls We are part of the greater community And so I think tapping into the resources that are out there is incredibly important, because I think that’s the only way we’re going to be able to be as rounded as we possibly can and meet all the needs that our veterans have from a legal and medical perspective And I think that I’ve been in a very nice position to make sure we’ve had some renovations and expanded to make sure that we make sure we have an office for CVLC to practice out of, to see veterans out of, in all locations Because we want to make sure all the veterans in Connecticut have these services And they also, in our hospital, whether it’s a small community-based outpatient clinic that’s 75 miles away or not, they know that these services are available I’ll get emails saying, how do I reach the lawyers that you guys have? And I remind them, they’re not our lawyers They’re not VA lawyers They are outside lawyers And you’ll need to get your consents and all But this is how you reach them So I constantly serve in the function of making sure people are aware Because it’s not only the Errera Community Care Centers programs

that utilize CVLC, but it’s also the general mental health clinic and things like that Just to kind of tack on a little bit to what Debbie was saying, and one of the things that being co-located and having space given to us is a fantastic resource Unfortunately, that’s only one small part of our funding So a lot of our hope and a lot of our work from the advocacy standpoint is asking Congress to consider– and there are some legislation out there– to ask the VA to help support the legal work that we’re doing SSVF, for those who don’t know, Support Services for Veterans Families, they have some ability to give some money towards legal services And theoretically, the GPD program, as well, which is Grant Per Diem But at the end of the day, our financial resources come from fund-raising and grants, not from the VA So asking– this is the MLP question, right? How do you get the M and the L and the P to be sharing resources this way Because we all agree it works, but unfortunately, it’s not a question of asking David or Debbie We have– it’s going higher up the chain of command, so to speak, using the military term, right? And having those conversations and getting people to realize the great work that we’re doing isn’t free Although, we tap into pro bono attorneys to expand our capacity But this is my full time gig We are full time attorneys who’ve committed to doing this work And finding that funding is an important part of this work So as it replicates, which we’re willing to help other places do, but knowing that a local legal service if they want to do this, they need some money to be able to put someone there every day to be at the VA like we are Because we’re there Every day the VA is open, we have someone there who is willing to help Thank you, Darren I really put this out to the task force as that– as you get to the questions at the end of the day about potential recommendations to think about this issue, because really hard for Debbie to tell her seniors at the VA, much less members of Congress, and say likewise for Darren, or for David So it’s really for decision-makers and thought leaders and influencers around the country to become aware of the success of this MLP model and the value of it in human terms and in financial terms And it’s really up, really to us as a task force, to educate the public about that And I think that’s a big part of what we’re doing here I’d like to– we have a number of questions But before we get to those questions, I’d like to ask each of our panelists for just sort of one closing thought, which is, what advice would you give to legal aid and health care providers who are interested in improving the coordination of services to veterans in their community, who are starting maybe from scratch, or maybe not quite from scratch, they do referrals now but not in the way that you all have done it Debbie, I’m going to ask you to start because you’ve done this before You started from scratch So what’s your advice to people around the country who want to try to replicate what you’ve been doing? The biggest thing in my head is to have a champion on both sides So somebody from the legal side who wants to do something like this And somebody at the health care side You need a champion to move this along, to develop a strategic plan so that this really does become a reality as opposed to, gee, wouldn’t this be a nice idea? To really have it planned out who you need to be to inform, to educate, and to utilize what resources are out there But I think having a champion who is part of their being to move it along is really essential in establishing these kinds of relationships and partnerships David? Yes, I agree with that, having a champion on both sides For me, the big thing is access, access, access, and focus on access And for that, meaning that the legal services need to meet people where they’re at And that’s true of medical services, too, right? You need to find people It’s not like there are many legal aid clinics all over the place The question is, are you reaching the folks who need it the most? And how do they reach you? Especially, if they’re– don’t have a phone or just don’t know about you And so I would– if you’re going to think about doing this, reach in to the medicals, into FQHCs, into Friendly Qualified Health Centers,

reach into where social workers, medical social workers are I feel like the social workers will be your best friend and your biggest ally for finding what the needs are of the population Darren, what’s your advice to legal aid programs around the country who are thinking about how to replicate this model? Yeah I think, especially in this time of COVID, people tend to get isolated and forget that there are other people out there trying to do the same work that you’re trying to do And you’re not alone, right? We, as an organization, are always willing to talk to people who are trying to get this started Debbie and David do the same thing We’re willing to have these conversations We believe in this model, right? We’ve championed it here in Connecticut to great success But on a more micro level, I think communication is so important In this day and age, sending in– it’s more than just sometimes sending an email It’s actually picking up the phone, going to the local VA and figure out who and the best programs to start talking to, right? There are some natural programs, like HUD-VASH, for example, where there would be some great confluence of agreement of working on pieces But– and the people in your community will know what works best and what the greatest need is And the VA knows this, too The VA does a challenge study every year where it talks about what the needs are of homeless veterans around the country And no surprise, it’s a lot of the work that legal services are doing and need to be addressed But it’s asking that questions, not as– being willing to listen and have communication by not just asking, but listening when they say, this is what we see the needs are, and these are the people that are organization that are willing to kind of have this discussion And then it comes That’s the first step, I think Thanks We have time for some questions and we’ve gotten a few Some of them have been answered But others maybe not And also, because we have folks on– many dozens of people following this on Facebook, they haven’t heard the questions or the answers So let me start out with Evan Seamone Can– you had a question Could you give us the question? Sure I really appreciate what you’re doing It’s a pleasure to be here I’m an attorney who cares deeply about veterans benefits and also a veteran myself And when you talked about the number of legal issues facing veterans and their families, it caused me to think about the way that veterans treatment courts have been an amazing way to coordinate services for veterans, and in the words of Dr. Rosenthal, those who need it the most at the most pressing times The question I have is whether you’ve seen the same kind of, I’d call it surveillance, attempts to identify veterans by other courts besides criminal courts– bankruptcy, family, small claims, eviction, and using that as the funnel through which to refer those veterans to additional resources I know Benjamin from New York, he knows a lot about Suffolk County’s veterans traffic court where they have an idea of finding veterans who are having driving issues and trying to address their issues before they progress into criminal issues or other types And I was thinking maybe one good thing to do would be to create legislation, or guidelines, requiring courts to identify veterans at the filing of a petition, and to make referrals to organizations much like we’ve heard of today So that’s the question Is that happening enough in areas besides criminal courts? Thank you Open at first to any of our panelists who have a thought on that? Yeah, I have, I guess, two thoughts on that One thought is kind of where you’re catching people in the stream Our model is really focusing on trying to catch problems upstream before they get into the courts So in housing cases when you got that first notice for an informal hearing, not waiting for someone’s complaint One of the challenges that we see on another point is not every veteran is willing to disclose their veteran status And a lot of the veterans we work with, because of either bad paper, or other stigma due to MST, are not willing to bring those up I have clients who don’t want to come to the VA, so their referrals from our Vet Centers If you don’t know about that program, the VA is aware of this, as well, on some levels,

and has other community-based resources for those that want to come in But I agree, [INAUDIBLE] doesn’t cover every veteran here in Connecticut, because it’s also means tested, right? So there are different pieces to keep in mind But it’s– Connecticut’s not doing that The VJO program, which we’ve not talked about, The Veterans Justice Outreach, they’re all social workers in most courts around the country who are kind of helping catch most people But that’s also through the criminal justice system But I think the more ways to catch people before they get down that road, prevention is much easier than solving it afterwards I’ll just add briefly that we do have the Veterans Justice Outreach workers at our site We do not have veteran courts in Connecticut, but we have our VJO staff, which is the Veteran Justice Outreach, are phenomenal And they cover the entire State of Connecticut We have relationships And so when there are veterans who show up because of traffic issues, because they were not doing really well and they were speeding, or they had a firearm in their car, or whatever that might be, that our Justice Outreach staff, they are usually referred to them They have done trainings with all court personnel They have done trainings with all Connecticut state judges So the judges are aware of their existence And so– and they will often work with, as Darren said, with CVLC, as well So we do cover that I tend to agree with Darren, if we can do prevention, that’s better However, for people who do get in some trouble, legal trouble, there are avenues to get their needs addressed, as well This is Butch Tate, Chief Counsel with Justice for Vets and the National Association of Drug Court Professionals Evan, good to hear from you I’m not surprised that you’ve offered us a wonderful question to think about I would suggest that in our training and technical assistance to the courts, we’ve seen no systematic effort to connect veterans and civil court with the referral process that typically happens just by routine course of action in the criminal courts So I think what you suggest is a very, very good idea Doesn’t mean the referrals aren’t happening What it means is that it’s typically ad hoc But that said, it’s very, very good The VJOs, in my view, along with the course of mentors remain the secret sauce to these treatment courts But we’ve not seen a concerted effort to make that connection in civil court Nonetheless, it’s an exceptionally good idea Thanks– thanks for the idea, Evan It’s a great idea I was just going to say prevention is incredibly important and certainly in COVID times, I think thinking about creative ways to prevent eviction as we– we have a pending housing crisis coming in a couple of months And the more that social workers and legal services can be in the housing courts to help people understand their rights, and the CDC suggestion, I mean, I think it’s a great idea, and we need a lot more resources there Benjamin Pomerance, you’ve been sharing a couple of thoughts on this If you’re around, we’d be happy to hear from you Sure I want to– I was responding to the question initially that Evan had raised to– or the point he had raised about the veterans dockets, the traffic court docket in Suffolk County Just a couple of facts that into the chat box has been around for about three years It was the first of its kind in the nation Suffolk County was sort of a natural testing ground for this, given that it’s reported to be the county with the largest veterans population in the country And it’s worth pointing out that when you look at the VA’s project challenge survey, consistently, you see driver’s license suspension as being one of the top 10 most common unmet veteran needs reported by the veterans who are confronting homelessness So it’s one of those, I think, below the radar civil, legal challenges that comes up I know in Suffolk County, also the [INAUDIBLE] Law Center has a veterans rights law click And one of their areas of focus is restoration of driver’s licenses It’s not so much focusing on [INAUDIBLE] benefits They’re looking at things are not being met in their county in their estimation by other legal professionals in driver’s license suspensions

of that The other thing I mentioned in the chat is kind of a broader comment that we often see in veterans treatment courts, those veterans who are justice [INAUDIBLE] coming to the courthouse with one or more unaddressed civil legal needs are often needs that have gone unaddressed for a significant time periods And when you start to unpack the situation that that veteran is facing, you often see these correlations of how those long addressed civil [INAUDIBLE] leads have led to or at least been a strong contributory cost to the reason why the veteran did what they did, that brought them to the criminal law courthouse So there’s a lot of unfortunate correlations between civil law side of the house and the criminal law side of the house as far as unaddressed needs in one area leading to justice involved [INAUDIBLE] in the other Thank you, Benjamin We had several questions about some of the details of the operations of the collaboration of the MLP in Connecticut Nicole Perez, I think you have some questions One, could you share those with us? Sure Well, thank you, Ron Hi, everyone My name is Nicole Perez I’m the Managing Attorney of the Veterans Justice Center at Legal Aid Foundation of Los Angeles, an LSC organization My question is, really, as I’m thinking about how to replicate this type of model across different organizations that may not have full resources for a full, similar model, I’d like to know just a lot more details about the co-location itself So for example, some of the things that came to mind are, how many days or hours per week are the attorneys actually co-located there at the center? When you’re thinking about what makes the secret sauce kind of work and gel, do you have in mind a minimum number of days or hours that you would think an attorney would really need to be co-located in order to build that trust and rapport and make this work well? And also, just in terms of access to resources Debbie, you had mentioned it was a closet, and then it got a little bit bigger Within that closet, do you have access to things like copy machines, printers, computers, internet access? I’ve heard various things over the years about how sometimes resources like internet can be challenging to access at VA medical centers So if you wouldn’t mind just sharing more details about the co-location, that’d be really helpful for organizations like mine So I think the biggest thing that we are actually able to provide, really, is the space Space is a hot commodity Like we were just overflowing So our particular situation, we were overflowing And we ended up having two things that came in the same time to allow us to expand and renovate one space, and then move into a brand new space for another So we built in the space, or CVLC, when we did that However, in terms of how often somebody should be there, I mean, the biggest complaint I get from staff is that they need more, more of CVLC, more attorneys, more time But with that said, we started with two days a week And those two days a week were full, and that was the volunteer I think the space we– the things that we are able to provide is when a veteran comes to meet with CVLC, it’s our front desk that greets them, has them wait, notifies CVLC But you are absolutely correct with the Wi-Fi, that has been an issue So they provide– CVLC provides their own and, actually, their computer So they’re not connected to VA computers They’re not connected to VA Wi-Fi and the such Now, they’re– and the problem is in the VA has been giving more and more Wi-Fi, things like that, free Wi-Fi for guests, veterans who come in But again, that’s not secured So it’s hard for the real center to really tap into that because it’s not a secured Wi-Fi system So that really is through them And Derek could talk a little bit more about that But really, we give the space, we give the free PR, so to speak, in terms of we’re constantly letting people know like what’s available, and how to connect and make referrals We make sure that we are educating in regards to CVLC We will invite them to staff meetings, make sure that they’re visible

But the nuts and bolts of operating, Darren, do you want to take it from there? Yeah, I think– yeah So to give you an example, we are full time five days a week at the Errera Community Care Center of the CRRC We have an office there It’s usually, under pre-COVID times, staff for the paralegal who is doing a lot of screening, working at least one or two attorneys We– but for example, we cover the whole state, like VA Connecticut does So about three or four years ago, we put a attorney two days a week up in the Newington VA And by doing that alone, we saw a 50% increase in referrals out of the Newington campus Plus, we also do outreach to the CBOCs, Community-Based Centers, as well as the Vet Centers So– but having a core base like the Errera Community Care and it being a community-based system has allowed us to make sense of how to kind of spread out to the state Computers and Wi-Fi just for a legal practice, we want to have control over our files And under a traditional MLP model, right, there’s usually some sharing of the medical database So there’s some referrals going back in there But we have online access to the benefit side of the house We do have to do record requests for the health care side of the house But– and we do ROIs across the board, both coming and going from both sides That’s just part of that paperwork But– and like we can use photocopy machines, right? But our printing, our infrastructure, our databases, our computers, we control that so we can protect our client data, which is sometimes excluded from the VA data So we take that pretty seriously But I do think starting small, a couple of days, as Darren just said, and getting your footing into a– into an institution can make a big deal, make a big difference Because then you can see the results You can see what the need is Do some tracking of the referrals, what are the needs And the VA is supportive of these relationships Right I think what we learned from starting, we had one person there full time who was Margaret And she was kind of doing a little bit of everything as it came in I would also, in addition to like having small staff, I would as an attorney, try to focus on if you can on what you think the biggest need is in the area of law, rather than trying to do it all yourself, depending on how experienced your attorney is, right? Right now imagine doing housing cases how busy you were going to be, then to be going to family court You need to have some focus with what you’re doing But that’s part of those early communications with the VA about what they’re seeing and what they’re hearing from veterans, and making those determinations, right? We went from one to two to four to seven Not all at once, but once we got enough momentum, it was much easier, and as Debbie said, we could fill more need if we have the resources Thank you Ellen Rheaume from Chicago Legal Aid, I believe you also had how does this work questions I’m Ellen Rheaume I’m an attorney at the Legal Aid Chicago Veterans’ Rights Project And I have a question about the legal services provided by the MLP And I was just wondering, as Darren had mentioned that the common legal issues that you see are housing, VA benefit, and child support It’s curious if the attorneys work in general and work on whatever cases that come in, or if you offer legal assistance with specific types of cases only? On a couple of ways So we encourage clinicians to refer any case, civil legal, and even– so our model is, we do have some areas but we do more focus on We have pretty much three general practice groups I’m in the generalist group where we’re doing general civil legal aid We have one or two attorneys just focused on VA benefits specifically And then an attorney have focused just on discharge upgrades So we pulled those two out In the generalist group which I am in kind of supervising, we are doing a wide range So we pick out the areas that are already covered by the Bar privately that we don’t need to do, like SSD appeals But we’ll still give advice early on One of our goals is if you have some statistics that we’re kind of sure we do some review and advise, but those cases are more where we actually can’t give them legal help And a referral is not going help, either it’s explaining maybe your judgment proof, or maybe you shouldn’t be asking for a child support modification based on your income, or whatever that area is So– and we also use our pro bono partners when we have a higher flux in cases, like they do some of our housing cases, as well So we’re sort of picking those resources And as we look at our data and see

what cases are we seeing that we’re not doing, two of the three federal courts of Connecticut to have a pro bono panel for bankruptcy So we make sure that they have those applications to get those in One of them does not, so then we just want to make sure that they can reach out to other bankruptcy attorneys if that’s what they need to resolve their debt issues Lara Eilhardt, I don’t know if you’re going to be moderating our next panel, but if you’re ready for a question now, I have one for you And the question is this, this is obviously a terrific model And for those of you who don’t know Lara, Lara has been a tremendous resource and supporter for legal assistance of various types– the veterans within the VA, and in particular, with regard to MLPs has been a tremendous resource for providing information and education within the VA Lara, could you tell us, assuming you’re still with us, where this stands now? What– how many VA facilities have partnerships with lawyers, and how many of them are– roughly, are co-located? Just sort of where do we stand nationally Yeah No, thanks for that question, because it seems relevant certainly to all the discussion going on And I’ll address it later in our second panel, as well But basically, we have about 165 VA legal clinics and medical legal partnerships that traditionally over time, the number has grown steadily each year And traditionally, they are located on site, as you know, as we’ve been discussing Now, most of them are not I’d say the vast majority of them are not operating on site However, they’re still active and operating most at their full capacity, albeit virtually So there is still– there are hotline numbers There’s phone– there’s lots of phone calls and emails In some cases, video calls And so those resources are still available And I would also add that VA has been working hard to keep that connection strong And it’s probably a testament to the types of MLPs, like this– like CVLC that those relationships were already there, that they’ve been able to sustain into this new era And VA has been holding regular check-in We call them VA MLP check-in wellness calls with the MLPs And now, we’ve added the legal clinics So we’ve been basically having those every six weeks to keep up that relationship and to field questions that have arisen during this time Thanks very much But we’re at the end of our session here It’s been a terrific session I want to thank Debbie and Darren and David, not just for being here today and making this terrific presentation, but for the work you’ve been doing every day for many years It’s terrific And I started out by saying that one of the major aims of the task force was to shine a spotlight on effective service delivery models Folks, this is it This is one of those models And I think that the components of it have been well articulated, finding clients where they are I can’t just sit back in your legal services office and hope that people in need will come in, even before COVID-19 But this program, obviously, finds veterans where they are at the VA, and in particular, at various VA service programs Some of them in collaboration with other government offices Second, collaboration, legal aid can’t go it alone Dr. Rosenthal can’t do it himself And his health care colleagues can’t do it themselves There’s got to be collaboration We’ve also talked about how important an effective co-location is to promote that collaboration I think David referred to it as the secret sauce And Lara just mentioned that in normal times,

the legal services that are offered at the various VA health care facilities are located on site So that’s a key component Another key is no wrong door I think David described 14 different programs at the Errera Center providing various different services, some solely VA, some in conjunction with other government programs And from any of those places, you can get referred to Darren and his colleagues And that’s critical So– and then the last thing I’d say is having the resources to fund the kind of operation that has been described over the course of the last hour We’ve been having high quality services, whether it’s health care services or social So social work services or legal services, if you don’t have those building blocks, if you don’t have high quality programs, if you don’t have the funding to bring them together the way this program does, you’re really in a bad place So some things to think about as the task force moves forward Thank you for tuning in Thanks to all of you Stay well

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