Photo by Elizabeth Earl/Peninsula Clarion Bob Patterson and his daughter Rowen Patterson, both Kenai, wait in the lobby of the Kenaitze Indian Tribe's Dena'ina Wellness Center on Thursday, Oct. 6, 2016 in Kenai, Alaska. With an Americorps grant, the Kenaitze Indian Tribe will soon add a legal fellow to its center, with free services available to low-income and some qualifying customers.

Photo by Elizabeth Earl/Peninsula Clarion Bob Patterson and his daughter Rowen Patterson, both Kenai, wait in the lobby of the Kenaitze Indian Tribe's Dena'ina Wellness Center on Thursday, Oct. 6, 2016 in Kenai, Alaska. With an Americorps grant, the Kenaitze Indian Tribe will soon add a legal fellow to its center, with free services available to low-income and some qualifying customers.

Alaska Legal Services, Kenaitze partnership places lawyer in health clinic

A patient at Kenai’s Dena’ina Wellness Center may present with anxiety, but sometimes underlying that anxiety is a social problem like impending homelessness.

Doctors sometimes encounter their patients’ legal or social problems in the course of care. Often, other than telling a patient to seek legal help, there’s little they can do. Patients may not have the money or may forget to seek legal help, and the consequence can be worse health outcomes.

A new partnership with the Alaska Legal Services Corporation will allow the Kenaitze Indian Tribe to add a lawyer to its operations at the Dena’ina Wellness Center in Old Town Kenai. The lawyer would be available to help patients with legal issues affecting their health, such as lack of housing, denial of public benefits and domestic violence.

The partnership fits with the mission of the Dena’ina Wellness Center, which aims for better holistic health for its patients, said Jaylene Peterson-Nyren, executive director of the tribe.

“From our perspective, when our providers see a social determinant of health of a customer walking through the door, they can refer them to a legal member of our medical team,” she said. “…You don’t know how your health is going to be affected until you’re at the brink of losing your home or you get something repossessed or you’re not able to navigate a (public benefits) system.”

The AmeriCorps program provided a three-year, $273,000 grant to fund legal fellows in six communities across Alaska, supported by the Alaska Legal Services Corporation. The fellows will set up in or near health care facilities in Nome, Juneau, Sitka, Anchorage, Fairbanks and Kenai.

The idea is to provide another resource for patients who need legal help, said Alaska Legal Services Corporation Executive Director Nikole Nelson.

“Oftentimes, doctors and health care providers are on the forefront of seeing social issues such as domestic violence, homelessness or disability related legal problems,” Nelson said. “But they’re not lawyers, and they don’t have the legal toolkit to address those issues. It’s to make that referral process easier by putting the lawyer right there. “

Alaska Legal Services Corporation has 11 offices around the state and provides free services through staff attorneys and a network of pro-bono attorneys in those communities for low-income and elderly Alaskans in need of legal services. Nelson said she encountered the program about two years ago on the Navajo Nation in the Southwest, where she attended a conference on Native American health.

Providing legal services can provide legal interventions that help improve social determinants to health, such as stabilizing income, providing access to education or work and reducing exposure to domestic violence, according to the National Center for Medical Legal Partnership. The Navajo Nation began a medical-legal partnership in some of its health clinics that was able to help individuals resolve civil legal issues and stabilize incomes.

“While I was (at the conference), I realized this would be a great fit for Alaska,” Nelson said.

The Alaska program is the result of about a year and a half of work and is part of a multi-state effort, including New Mexico, Arizona, Nebraska, Oklahoma, Utah and Alaska. The six attorneys in Alaska will join a network of 14 total across the six states, who will support each other in their work, Nelson said.

About half of Alaska Native women and a quarter of Alaska Native men experience physical and/or sexual violence at some point in their lives, according to a 2013 publication from the Alaska Native Tribal Health Consortium. Nearly one out of 10 Alaska Native women who recently gave birth were physically abused in the year before giving birth, according to the publication.

Nelson said access to legal help could play a major role in alleviating some of the problems with domestic violence.

“We do know that there has been study after study that (shows) one of the best ways to solve domestic violence is to provide legal services to a victim of domestic violence,” she said.

The medical-legal partnership joins another legal effort from the tribe — a joint therapeutic court between the tribal court system and the Kenai District Court. Peterson-Nyren said Alaska Native people have been poorly served by the differences between traditional court systems and Western court systems, and the joint court has been a way to help remedy some of those differences. The legal help available through the new partnership will fit well with the therapeutic court effort, she said.

“I think that everyone regardless of race is susceptible to anything — stress, going down the wrong path,” she said. “I think that for Alaska Native communities, we happen to be in more of a struggle.”

The National Center for Medical-Legal Partnership, which is based at George Washington University in Washington, D.C., asserts that using medical-legal partnerships can help move toward population health by intervening before health conditions worsen. In a report released Oct. 4, the organization outlines how providing civil legal aid to patients earlier in the process can help prevent worse health consequences — and thus higher costs — further down the road.

AmeriCorps provided the grant to New Mexico Legal Aid, a nonprofit in Las Cruces, New Mexico that provides free civil legal services to low-income residents similarly to the Alaska Legal Services Corporation, which then disbursed the funds to coordinators in the five other states. The agencies in those states will be responsible for hiring the legal fellows, said Samantha Warford, a spokesperson for AmeriCorps.

The legal fellows will join a force of approximately 1 million other volunteers in programs across the country, she said.

“They’re joining a kind of incredible group of people,” Warford said. “They’re coming at a time where there’s a lot of focus on the work that they’re doing, and particularly in tribal communities.”

Peterson-Nyren said the medical-legal partnership follows the Kenaitze Indian Tribe’s recent efforts to reduce redundancy and improve outcomes for the community.

“We’re excited to be moving forward with this,” Peterson-Nyren said. “I believe it’s going to be a huge success on behalf of all of our customers.”


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