Objectives

© 2009 MLP | Boston

Building Bridges, Building Trust, & Building the Case:

Top 10 “Universal Precautions”for Trauma-Informed &

Culturally Inclusive MLP Advocacy

JoHanna Flacks, JD Pro Bono Director

MLP | Boston


Objectives

• Validate pro bono volunteers’ intention to help vulnerable patient-clients

• Identify common obstacles to a successful MLP lawyer-client relationship

• Share tips learned from trial and error, which can be shared/adapted for your case/project


Take Home Messages• Cultural competence* is always a work in progress.

• You are already taking a step in the right direction by saying you want to help.

• One can imagine (sympathy) but no one can “know” (empathy) what another individual’s trauma feels like.

• Small gestures make a big difference.*Disclaimer: by giving this training I do not claim to have achieved cultural competence. Anyone

who does clearly has not! More than anything, I’m sharing the lessons learned from my trip-ups so far.


Many diversities are invisible . . .

Diversity is more than pink & blue and black & white

• Disability• Trauma history

• Ethnicity• Mother tongue• Gender identity

• Sexual/Affectional orientation

• Race

• Class• Religion

• Political Party• CORI• Age

• Literacy• Education level

What have I missed?


Remember: you’re representing an individual, not their identity group(s)

Beware of generalizations about cultural practices/preferences which may in fact clash with an individual’s comfort zone. (This might be the most challenging/paradoxical aspect of cultural inclusion efforts)

Don’t assume. Ask!


#1 Inclusive courtesies:

How would you like to be addressed?

(“You can call me XXXXX. How would you like me to address you?)

Is there anything I can do to make this interview more comfortable for you?

MLP tip: Ask the referring provider if s/he has any thoughts on how best to serve the patient-client based on prior experience.


#2 People have varying (sometimes positive, sometimes negative) experiences/views about

lawyers and governmentAsk patients if they’ve ever worked with lawyers before and what

it has been like.

Ask about their experiences with government agencies here and in their home country, if applicable.

Client empowerment tip: Explain that you work for them, and they control decisions about their case – you give information and advice – that’s your expertise. However the ultimate decision-making power is theirs.

Note: in some cultures, there is an expectation that competent professionals tell patient/clients what to do. Offering options can feel confusing at best, or seem incompetent at worst. Thus it’s important to explain why our professional ethics require us to inform and advise knowledgably, but leave the final choice to the patient/client.


Special concern: DSS/DCF“The best way to reduce maltreatment is to fundamentally reform our society so that those at the socioeconomic bottom have the kind of educational, economic, and other opportunities that would enable them to escape the conditions that breed child maltreatment. . . . What is more imaginable in the near future is to develop and expand programs that provide support for poor families and for fragile families at risk of falling into the kind of dysfunction that produces child maltreatment, so as to reduce the incidence of maltreatment. We need family support systems that give poor, single parents a better chance to make it. . . . ” -- Professor Elizabeth Bartholet, Morris Wasserstein Public Interest Professor of Law and Faculty Director of the Child Advocacy Program (CAP) at Harvard Law School

Doctors/clinicians: mandated reportersLawyers: confidentiality and privilege

There is tension between these obligations. In our MLP work we have to promote our common interest in improving family conditions for the benefit of the child by working with the clinician, and at the same time protecting the parents’ interest in avoiding DCF involvement.


#3 When in doubt, get an interpreter!

Again: when in doubt get an interpreter.

If it feels rude to recommend one when it hasn’t been requested, consider how rude it is to

represent someone without communicating.

Feel free to say that YOU need an interpreter because YOU don’t speak your client’s language. Legalese is hard to understand in any language

never mind a second language.


#4 Don’t expect your client to tell you all the details in your first few

meetings . . .• An under-considered emotion impacting the attorney-

client relationship is embarrassment*. And embarrassment across cultures is triggered by too many factors to list.

• Recalcitrance at first shouldn’t be interpreted as caginess; inconsistency shouldn’t be interpreted as dishonesty.

• It is not putting words in your client’s mouth to help them articulate complex, stressful feelings that they may not have vocabulary for.

*I learned this as a new lawyer representing sexual harassment plaintiffs.


. . . and talking about trauma is exhausting

Survivors relive the experience each time they retell it. Be prepared to meet with your clients for shorter periods of time because trauma symptoms affect stamina and memory.

MLP practice tip: We have the luxury of referring people back to referring providers and even offering to call together to the referring provider!


#5 Poverty is a full time job

If your client is running late, it’s not apathy.

It’s the stroller in the rain on the T on the way back from the food pantry and the clinic and the pharmacy and the line at the DTA (where the worker didn’t speak Kreyol and sent you to another office, which sent you back again to the first office), and the neighbor watching the other kids got home late . . . And the first two busses weren’t wheelchair accessible.


#6 Your client may not know your customs or share your communication style

Give clients the benefit of the doubt if they commit what you consider to be a faux pas

Practice Tip: Focus on substance of client’s comments, not tone, since tone/cadence varies from language to language. At the same time, be mindful that a lawyer’s attempt to sound accommodating can come across as condescending especially to people who may be older than you and equally educated/literate.


#7 “Externalize” problems to avoid being judgmental

For example:

“It seems like depression is making it hard for you to follow through on stuff. How can WE work through it?”

This makes a sensitive obstacle a “third party” that client and lawyer can work together to overcome.

Adapted from presentation by Chris Pierce, LICSW


#8 Just because the government accuses your client of fraud doesn’t mean it’s fraud

Recipients of public benefits are tangled in a system that presumes ineligibility and labels ineligible applicants/beneficiaries liars. Our job is to defend our clients as zealously as we would a tax client accused of evasion.


#9 Honoring diversity doesn’t mean accommodating discrimination

Clients who request help discriminating (e.g. I want my child assigned to a school without XXX kind of people) are not entitled to help discriminating even if the attitude may arise from a cultural more. You can offer help improving education but not promoting segregation and it does your client a service to be clear about that.


#10 The client isn’t working the system: the system is failing the client.

Some topics get hot with clinical colleagues because there is a concern about “enabling” patients – as though accessing public benefits is like drug dependency.

MLP tip: Help focus attention on objective eligibility rather than subjective “worthiness.”


#11 Shine the lighton unconscious bias

Always ask yourself: is there another strategy I’d be considering if my client were, e.g., English fluent, physically mobile, not bipolar, literate, younger, older, etc.

MLP tip: Learning from our doctor colleagues, we know that clinicians reflect on the life-threatening consequences of unconscious bias impacting medical practice. (e.g. African Americans are often offered less aggressive cardiac care even controlling for income and education level). We need to reflect in the same way to make sure we are offering truly equal opportunity to the best legal services available.


Let’s talk!

What should we include in the next evolution of this “Top 10 . . .”?

Documents

Objectives