Sarah (a pseudonym) seemed caught in a vicious cycle: when she received services from the Rhode Island Department of Children, Youth and Families, she was able to parent her children to the satisfaction of all around her. But it was not easy. She was able to manage her mental health concerns temporarily, find work, and earn enough money to support her family. However, she did not have a permanent support system in place, nor did she have the skills necessary to sustain this success. To eliminate the department’s involvement permanently, she needed a different type of assistance.
The department first became involved with Sarah and her children in 2006 due to her lack of stable housing, steady employment, and suitable child care. Twice, with the help of a variety of social workers and clinicians, she was able to stabilize her family’s situation by finding work and affordable housing.
Sarah’s situation was more complicated by the time the department involved itself for a third time. Sarah had difficulty obtaining suitable employment due to a criminal record. She had been incapable of maintaining any employment she did get due to extreme, untreated anxiety, worsened by her chronic poverty. Without a steady, predictable income, she struggled to provide for her children and pay her monthly rent. She was evicted, and, although she entered a shelter with her children, she became homeless when she refused to comply with a shelter rule that required her to leave her children unattended while she completed various required chores.
The objective of the project was to create an interdisciplinary approach to the delivery of services in order to lift people out of poverty.
Here I tell the story of the implementation of Rhode Island Legal Services’ Holistic Legal Assistance Network and its impact on legal services clients in general and on Sarah in particular. Having had social and legal woes before the Holistic Legal Assistance Network intervened, Sarah faced new challenges over the course of this third involvement of the department. However, with targeted assistance, she was able to make lasting changes that enabled her to obtain stable housing and steady employment without the threat of ever-present departmental oversight.
Sarah’s situation is not that uncommon among legal aid clients across the country. Considering the myriad legal and social problems repeatedly affecting our clients, we saw that a more extensive approach was needed to stop the cycle of crisis.
Rhode Island Legal Services received a grant from the Kresge Foundation in 2013 to create a Holistic Legal Assistance Network. The objective of the project was to create an interdisciplinary approach to the delivery of services in order to lift people out of poverty. Traditionally clients receive legal assistance on an as-needed basis, and that assistance focuses on self-identified legal concerns. However, many organizations have started using a comprehensive legal intake for better identifying additional problems that can be resolved in-house. Rhode Island Legal Services’ Holistic Legal Assistance Network takes this concept one step further and incorporates interdisciplinary community partners that can help a client meet social needs as well.
The Holistic Legal Assistance Network Setup
Upon receiving funding, Rhode Island Legal Services set up an internal team of advocates and identified the interdisciplinary partners needed to complete the social portion of the program. Rhode Island Legal Services dedicates two full-time staff members—an attorney and a social worker—to the daily operations of the Holistic Legal Assistance Network, along with two director-level attorneys involved with debt reduction, tax liability, and financial stability. Rhode Island Legal Services has developed formal relationships with four interdisciplinary community partners to cover a range of services including adult education, English for speakers of other languages, financial literacy, microloans and car loans, and domestic violence services. As the needs of Rhode Island Legal Services’ clients evolved and word of the Holistic Legal Assistance Network spread through the community, we established informal relationships with more community organizations.
Internal Team Structure. At a minimum a holistic network internal team should include an attorney and a social worker. The attorney’s role is to analyze a prospective client’s legal situation in its entirety. The attorney must be a generalist—an individual comfortable with allowing a prospective client to speak broadly about a variety of topics. Further, the attorney must be able to cultivate relationships not only with clients but also with client advocates both inside and outside the organization.
The social worker’s role cannot be overstated and is the key to the success of any organization’s internal holistic team. The social worker must identify social obstacles that inhibit a client’s overall success and must offer the appropriate resources to empower the client to make decisions that lead to a maximum chance of long-term achievement. Most important, the social worker must help a client move from reactivity to proactivity.
Interdisciplinary Partners. Choosing appropriate interdisciplinary partners can be crucial to the development of a holistic program. Programs must evaluate the needs of their community to identify organizations that will assist clients in reaching their legal goals. Programs must also evaluate their own internal working groups to identify social service organizations that would most benefit from legal assistance. Ultimately a legal aid organization and a social services organization must develop a symbiotic relationship such that referrals can be made in both directions.
Once those partners have been identified, the responsibilities of both organizations must be established, and how they will interact must be outlined. Advocates from the Holistic Legal Assistance Network, for example, have conducted on-site outreach sessions to our partners’ staff and have offered on-site intake sessions to clients. Staff members from each organization routinely contact the Holistic Legal Assistance Network to refer new clients and to give or seek status updates on current clients.
Once the Holistic Legal Assistance Network was staffed and the interdisciplinary community partners were identified, advocates were tasked with implementing a holistic program. They examined these questions:
- How can advocates identify a client who might benefit from a holistic approach?
- How is that client, once identified, handled differently?
- How can we determine whether a holistic approach is, in fact, a better approach?
- Is the holistic approach sufficiently beneficial to justify the added time and expense inherent in the delivery of holistic service?
Screening for the Holistic Legal Assistance Network. Today most legal aid organizations use some sort of holistic approach even if that approach is limited to informal interdepartmental brainstorming about the fate of a mutual client. Rhode Island Legal Services’ Holistic Legal Assistance Network seeks to take that approach to a new level by screening all prospective clients for possible holistic services. To that end, the following questions are considered by all advocates in the initial legal services client interview:
- Does the client have more than one legal problem that can be handled by Rhode Island Legal Services?
- Does the client have a social problem (e.g., financial management concerns, safety planning needs, adult education requirements) that might be handled by a community partner?
- Is the client willing to take part in a comprehensive screening process?
Any client who fits in one of the first two categories and is willing to take part in a comprehensive screening process is referred to the Holistic Legal Assistance Network for further analysis. Social service organizations throughout Rhode Island refer clients to the Holistic Legal Assistance Network whenever a client would have more success were their legal problems addressed.
Holistic Case Management. Prospective Holistic Legal Assistance Network clients undergo comprehensive screening through a holistic intake tool designed to identify any legal and social problems contributing to a client’s current, self-identified concern, along with potential legal and social problems that might arise from this concern.
Sarah was referred to the Holistic Legal Assistance Network because her legal services attorney believed that she would benefit from a thorough review and analysis of her legal and social situation. The attorney also noted Sarah’s willingness to work with community organizations to stabilize her situation.
After seven years, Sarah learned the importance of finding housing, suitable employment, and appropriate health services, especially as it related to her children. But knowing what is important is very different from actually receiving specific tools to reach one’s important goals. The holistic intake revealed new information that proved helpful in getting Sarah the targeted assistance she needed to get back on track.
The holistic intake revealed new information that proved helpful in getting Sarah the targeted assistance she needed to get back on track.
Holistic Legal Assistance Network advocates were informed that Sarah most recently became homeless because her apartment had been infested with bedbugs, and she had not been able to afford ongoing rent while replacing her infested belongings. Holistic Legal Assistance Network advocates showed Sarah how to investigate an apartment’s conditions before entering a lease and advised her about exercising her legal rights to resolve future concerns without risking housing stability. They referred her to a financial coaching program to assist her in preparing a budget that would allow her to save money for her next apartment. Advocates gave her a rental resources guide so that she could obtain applications for subsidized housing, and they added her email address to an internal notification list so that she would be notified of any voucher openings throughout Rhode Island.
To assist in her job search and income stabilization, Holistic Legal Assistance Network advocates informed Sarah about job training programs, GED (general education development) programs, interview programs, and résumé-writing workshops. Further, they recommended a basic training program that would teach her the skills that she would need to retain her employment. The advocates also informed her about community health centers and free health care facilities for mental health treatment to curb the anxiety keeping her from reaching her full employment potential. She began attending therapy sessions to help control her anxiety, and she found work that she was able to keep long enough to save money to secure an apartment.
All prospective Rhode Island Legal Services clients who meet eligibility criteria and who have legal concerns within the program’s current priorities receive legal representation. Those individuals who choose to participate in the Holistic Legal Assistance Network also receive holistic follow-up with these components:
- How is the client progressing in terms of resolving the client’s initial legal concerns?
- Have any new legal concerns evolved?
- Has the client been able to participate in the community partner programs to which the client has been referred?
- Would the client benefit by working with different or additional community partners?
This follow-up continues throughout and beyond the resolution of a client’s initial legal problem. The Holistic Legal Assistance Network recognizes that a client’s situation is fluid; it changes over time to reflect the resolution of some problems and the evolution of new obstacles.
Soon after moving into her new apartment, Sarah learned that she was pregnant. In Rhode Island the Department of Children, Youth and Families does not facilitate services for mothers on behalf of their unborn children. Each time the department discontinued services, Sarah “relapsed”; she would lose her income and her housing and all semblance of stability. She could not afford to backtrack this time, especially with a new baby on the way.
The Holistic Legal Assistance Network recognizes that a client’s situation is fluid.
Thus the follow-up phone calls by and with the Holistic Legal Assistance Network made all the difference: the coaching enabled Sarah to break the cycle. The Holistic Legal Assistance Network social worker empowered Sarah to continue working through her anxiety problems, despite the strain of pregnancy. She encouraged Sarah to obtain appropriate prenatal care, enroll in parenting classes, and continue with her financial training. Sarah received glowing reports from her helpers.
The Holistic Legal Assistance Network attorney reviewed Sarah’s legal concerns monthly; ensured that she applied for food stamps, the Special Supplemental Nutrition Program for Women, Infants, and Children, and cash assistance when appropriate; and ascertained that her employer did not discriminate against her as a result of her pregnancy. The attorney also helped her apply for temporary disability payments so that she would not be without income during her first six weeks postpartum.
Eventually the Department of Children, Youth and Families closed its cases related to Sarah. Legal services’ involvement would end here normally. Instead the Holistic Legal Assistance Network’s monthly monitoring continued. Bolstered by her own success, Sarah returned to work and earned several promotions to the point where she became ineligible for public benefits—a major turn of events in that she started her journey with the Holistic Legal Assistance Network as unemployed and homeless. She continued to work with network advocates and partner organizations to establish an appropriate budget in light of her lack of public assistance. She was approved for a Section 8 voucher, which would assure her stable housing through any decreases in income.
The Benefit. The first 22 months of the Holistic Legal Assistance Network were evaluated by Dr. Ken Smith of the Resource for Great Programs. The evaluation consisted of interviews with the staff of both Rhode Island Legal Services and the interdisciplinary partners, along with focus groups conducted with clients. Dr. Smith analyzed data collected by the Holistic Legal Assistance Network on the number of clients served, the services given, client satisfaction with those services, and the outcomes achieved. He analyzed cases from 10 sample clients.
In his evaluation, Dr. Smith found that the Holistic Legal Assistance Network was having a “profound human impact” and that the “investment in holistic legal and social services can change the lives of clients and their families in ways that likely will last for many years into the future.” He hypothesized that the key to the positive results was the “integration of legal and non-legal support and the continuity that [the Holistic Legal Assistance Network] provides in that support.” The monthly coaching by network personnel allowed advocates “to address the underlying causes of a client’s situation rather than just treating the symptoms.”
The Holistic Legal Assistance Network attorney and social worker were available to Sarah any time she had questions or concerns. Their access to her allowed for the resolution of legal and social concerns before they became full-blown problems. The network’s intervention is what empowered Sarah to set up services for her unborn child, even without the assistance of the Department of Children, Youth and Families, and the intervention is what reminded her to apply for benefits for which she was newly eligible.
Cost-Benefit Analysis. Holistic Legal Assistance Network advocates spent 180 hours working with Sarah—time spent coordinating services for Sarah by the network’s lawyer and social worker, both within and outside Rhode Island Legal Services. It is time well spent—clients such as Sarah ultimately resolve more legal problems, overcome more social obstacles, and enjoy greater financial stability than clients who receive isolated services.
We are left with this question: Had Sarah received the same holistic intervention seven years earlier, would she have been able to stabilize her life sufficiently to preclude the Department of Children, Youth and Families’ involvement? We will never know. However, while time is the ultimate test of success, the skills and support that Sarah obtained through her work with the Holistic Legal Assistance Network appear to have created sufficient stability to avoid the department’s interference. Further, with the continuation of monthly coaching, our advocates will likely be able to detect those “wrong turns” of Sarah’s past before they become obstacles that could lead to the department’s involvement.
Sarah was one of the first Holistic Legal Assistance Network clients. Over the last few years, our advocates have developed systems and templates to make the use of holistic tools more efficient. For example, we have continued to modify the holistic intake tool to ensure that advocates obtain as much information as possible during the first intake. We have used the results of the evaluation to choose prospective clients for the network more easily. We add information about each local resource that we identify to a resource bank to minimize time spent on new research. And we have worked hard to establish relationships both inside and outside the organization, to cultivate reciprocal trust, and to make the external referral process faster and easier. Developing such practices will continue to sharpen the implementation of holistic services.
The mission statement of Rhode Island Legal Services has a specific reference to improving the economic well-being of the client. The same sentiment is in many legal aid charters throughout the country. Implementing holistic legal services, including the partnership with interdisciplinary community agencies, is a way toward economic improvement. The data so far verify that the effort and expense needed to set up holistic programs are worthwhile because the holistic approach works.