David Plough
Welcome to Collaborative Conversation season two. This is our first episode.
I'm your host, Dave, and I'm joined by our other host. Who are you?

Barbara Maxwell
Oh. Barbara Maxwell.

David Plough
Thank you for being here and helping us with this. So this first episode is you and Carrie Hagan. And Carrie Hagan is not a health professional. She is a lawyer. We've decided to do this because the first season was very academic a little bit outside of my personal wheelhouse. A little bit more in your wheelhouse.

Barbara Maxwell
Very much so.

David Plough
Yeah, in this season, we've decided to do something a little bit different and move more into the community. And I think I just want to give you a second to talk about why we did that.

Barbara Maxwell
Yeah. So, one of the things that you'll hear people say when you do the education piece, which was in the first series, is that. Oh, well, this is a nice like exercise today, but I, you know, it probably doesn't really happen in the real world. And so this series, we really wanted to show people that this actually really does happen in the real world. And that happens a lot. And it creates amazing outcomes for people. And the problem is that the people doing all that hard work to make it happen are busy making that happen. So we wanted to create a podcast series that could absorb, highlight the amazing work the people are doing with individuals and populations to collaborate, to really, like, change the lives of people and populations, particularly across Indiana where we are set and Carrie's work in that space.

I was so excited to talk with Carrie. I was really eager to have the conversation with her and, just really highlighting that amazing work that she does and that connectivity between social work and the law.

David Plough
She's also a professor here at the IU McKinney School of Law. So that's made for a nice little synergy for us. And it's also allowed us to bring her in on one of our regular collaborative topics, experiences, which is the cycles of addiction. She does a lot of work with that. And then we also are able to do other collaborative things with her.

So it was nice that we were able to get her in to actually have this interview and talk with her. And I like that you mentioned, and I'll go ahead and throw the episode here, but I like that you mentioned we want to show them actually doing the work for people, that it actually happens, because that is exactly where we're picking up in this conversation, is you mentioning, hey, we want to showcase that this work happens.

And with that, I think we're just going to go ahead and roll the episode and pick up right there.

Barbara Maxwell
This podcast series that we're doing at the moment is really focused on, kind of addressing two common things that I hear in my work space of interprofessional learning and, and collaborative practice. And that is that, there's often a misconception that, this type of work only involves people in health care. But when you think about the lives and the lived experience of people, there's so much more than their health care needs. And so there's there's commonly that sense that if you're going to make a difference in the lives of people, it's through the delivery of care services.

And so I know because I know something about your work that, that combination of partners outside health care can be incredibly impactful. And the other thing that we hear all the time is that, well, people don't really do this stuff, and people do do this stuff and they do it really regularly. And so I thought it would be great if we had, you know, had the opportunity to kind of document the ways that you work in collaboration and the impact,

So, how do you feel about kind of that notion that, you know, it's not happening out there because you.

Carrie Hagan
When I was thinking about what we're talking about today. I'm kind of the first time that this world of interdisciplinary collaboration, where I was able to interact with it. And I will say, I don't think it happened a lot in law school. We're pretty siloed in law school, and we are pretty much taught, you know, that we are to be lawyers. And it's black letter law, and this is our job and that is it.

So when you get in the real world and you start practicing saying, that's sort of your charge, right? And I remember when I was working at Legal Aid, I was assigned to two practice groups. And so one of them was family law, and the other one was I was able to help teach in a domestic violence clinic, which is basically what I do now. But in that role, I was a supervising attorney. And so I was really good at, you know, training my students how to meet with those clients and training my students how to go to court and making sure that we had everything we needed. But then the problem was our clients were at these terrible periods in their lives, and they had so many other needs, and I didn't have the skill set to be able to do anything about that.

And so I just remember, like feeling that could be really good at like 50% of what they needed. But then if they were homeless, what am I supposed to do about that? If they couldn't get on food stamps, what am I supposed to do about that? And I had a colleague who had just started in our benefits department. She wanted to sort of see what we were doing in the domestic violence clinic. So she sat in on a couple of our meetings, and I just remember we were having conversations about a couple of clients, and she goes, oh, well, I know what we can do about that. This client is eligible for A, B, and C, and that client can get free assistance through X and Y. And all of a sudden I was like, oh, right, I don't have to do this alone. And there are people I can reach out to. Of course, if something doesn't fit within my skill set, I should be able to connect with somebody else. So then the problem was, she was so good at her job and all of our clients had so many needs.

We eventually had to sort of select which ones to would help assign, but it was just this kind of light bulb moment where it was like, oh, well, I might not be trained in this, but there are others that are and I can absolutely ask them questions and rely on them for help. So that was sort of the start of my interdisciplinary-ish journey.

Barbara Maxwell
And that's a great description of what we talk about in the interprofessional world. Is the difference between individual competence and collective competence. So when you go to law school or you go to, you know, medical school, or you go to learn your profession, and the job of that whole training is to make individual competence. So to be able to do all those things that you mentioned at the beginning, you can really do the services that you're trained in, the skills that you're trained, and you can use the knowledge of your profession.

But you're right. We step into the real world of people's lives. And we talk a lot about whole being, holistic being, you know, really thinking about the whole person. Well, when we only carry our individual, competency and our expertise, you know, what you saw was, oh, hold on a second. There's so much more. And, and so finding those resources that, you know, not staying in your lane, not only your expertise, but knowing that there's other lessons that have that we all have to kind of come together.

So it's a really nice description of what collective competence says is that, connecting the dots between the services we can offer and the things that people need.


Barbara Maxwell
You've also been working with us as we roll out a phenomenal program,called Breaking the Cycle of Addiction, which is focused on really educating people about the lived experience of people who have substance use disorder and addiction. How that, kind of impacts a whole family. And so I'd really love to hear you kind of what your experiences are of that, program. And kind of working with others because it uses a really diverse group of people coming wearing very different professional hats.

Carrie Hagan
Yeah, I love that. If you can love an addiction scenario series, I love it for so many reasons. The groups we present to are just very different than what I'm used to. They are usually medical. So we have nursing and we have dental,
psychology. So that is fascinating because already I'm being in a room with a whole bunch of people who do disciplinary stuff that is very foreign to me. But then one of my favorite parts is usually I'm on a panel with anywhere from 3 to 6 others.

I think each of us has our own disciplinary specialties, so I am usually the only lawyer. But, I think I, I've been with a colleague who specializes in gambling and addiction. Fascinating. I can't tell you how many clients I have that have crimes related to gambling and addiction. Then we have folks that are actually,substance abuse counselors and supports.

A lot of my clients have convictions that deal with that sort of thing. We have medical doctors, and we have folks that have dealt with alcoholism and processing that. And so it really gives me an opportunity to not only share the sort of my perspective on what the laws impact is for each scenario, but also just to learn from my colleagues every single time I go, I learned something.

I hope that I'm able to give back a little to them. But, you know, I learned again, it's terminology, my understanding of language and terms and what is respectful and not respectful has changed for me personally, immensely because of those sessions. You know, I'm trying to think of specific terms, and of course I can't right now, but there are just some very obvious ones that we talk about with substance abuse and addiction and just some basic words that we use or have negative connotations with the person who's actually the, again, light bulb moment. For me, I hadn't really we just used those so often, I hadn't really thought about that. And just going through each of the different, I don't know, characters is the right word, but the different people that we are evaluating.

It's also really fascinating because it's not just one person, one person might have an issue, but there's a whole host of other people that not only to their issues of fact, but those folks have their own issues as well. So talk about like super holistic representation, right? We're trying to figure out how to assist one person, but in order to be able to help them, we really need to look around the table. So that their support around them may be struggling as well. And so there's different family issues. There's different social issues that are affecting everyone. And so, you know, taking the person in isolation and dealing just with what's going on here doesn't really move things forward as much as if we take the whole picture into consideration.

Barbara Maxwell
And I know we've talked before, but, you know, the impact of the social determinants of health, the other aspects of how people live, work, play, on like their health and well-being and their life course really as a whole.

Carrie Hagan
Yeah. And I think again it's just one of those things where not only do we have to be mindful of everything that you just said. Right. The fact that we have our trained skill set but others have the missing pieces. But it's also just not to be sort of afraid. I don't know if that's the right word of the questions that arise as you're going along in your work and then trying to figure out how to answer those questions and find the answers. In law school, we are trained to meet, sort of to meet with clients and how to get through our checklists of questions. But we aren't trained on how to sort of how to reintegrate the humanity back into practice and how to recognize human emotions when our clients express them, I don't know if I'm exactly answering your question, but I think there were a couple of scenarios where I realized that I needed to be able to be a better supervisor to my student, because I wasn't able to address all of the issues that our clients were bringing when they met with us.

So one example was when a client showed up really intoxicated. The students didn't know what to do with the with the client that showed up, and they actually went ahead and had them sign our retainer paperwork. When they got here and the client was so intoxicated, they sort of had to be helped into our office and then helped out. And so we had to have a really long discussion about all kinds of things. Right? How when somebody presents that way, you know, it's unethical for us to go ahead and go, we have to stop with our checklist. We have to make sure to look at the human being the way that they are on. The other problem that we found was because we weren't good with recognizing stressful situations and human emotions, was that social way I kept being asked to lecture in social work while social workers were being asked to go to court all the time, and they have to testify, and they have to talk about all of these things. But they didn't understand legal strategy and vocabulary and all of these things. And so to sort of get at that more holistic representation, I started an interdisciplinary law and social work clinic with a colleague of mine who teaches in social work so that law students could learn about all of the skills that social work students have. And social work students could get sort of an insight as to why the law operates the way that it does.

So I don't know if that necessarily relates to health, but it certainly helped us when we were able to serve a client, we both were able to serve them in a much more well-rounded way

Barbara Maxwell
Yeah. When you know what's around the edges of what is a profession. And you know who that contact. So it sounds like there were great benefits on both sides. Or the legal side. For the social work side, that collaboration allowed you to both be more effective because you had enough of a toe in another world to get together that extra knowledge. Because I think you said at the beginning something about, you know, it may be that we're afraid. And I think a lot of people are afraid of stepping a toe outside the world. My world, what I know here and website here can be, like, intimidating. Even the the notion of acknowledging that, I don't know. And that's a huge barrier to really effective work and to professional work.

Collaborative work.

Because that I'm, I'm not prepared to look beyond my blinkers. I always, give the example of, say, you're an audiologist, just pick up, picked a profession at the top of the alphabet at society or an audiologist, and you're a client walks into the clinic and they are visibly distraught. They're really visibly distraught. What do you do? Do you say, oh, we're we're doing this screening today, so let's get in the car, get in here and get this screen and done this as fast as possible so I can get you out. You're upset. Do you say, oh, this person's really having a difficult day. Let's react with we do the appointment or do you step in and say, I can see you're upset today what's going on?

Because it is that it's the process of like you mentioned that, you know, do we go through the motions of the process that we have to do, or can we stop and see that human being? So I really love to ask you about, when you're working in that setting with social workers, what would you say the best outcomes are? What what are the outcomes that you've seen from that collaboration specifically?

Carrie Hagan
Well, the first is that we started being much more comfortable with going with this third approach that you mentioned, which is you don't ignore. Right. It's kind of like when you make, a multicultural mistake, right? You can tell that you have said something that's upset somebody or that you have crossed a boundary that maybe you didn't know existed. And so rather than ignoring that, you have to acknowledge it in a respectful way so that you're able to have a relationship and move on. And so just by saying things like, you know, you seem really upset, do you just want to take a second? And are you are you comfortable going forward today? Would you like to reschedule all of that makes such a huge difference, because not only does it help you establish a relationship with the person that you're seeing, but I mean, I think again, you're just sort of recognizing where they are and you're giving them some space to just process as they need, and then they have the power to make the decision about how to move forward rather than us just, you know, because, again, I've had students that are like, oh my God, they're crying. Okay, well, why are you here today? You know, it's like, oh man, I'm so uncomfortable. Well you don't you don't have to do that. You can you can move on. And I think especially with the client who showed up really intoxicated, that was one thing that we talked about was, you know, you felt this pressure to really move through the interview.

Did it ever enter your mind that maybe this wasn't the best time to be conducting the interview, and maybe we should move it to a different time? You know, hadn't even occurred to them, quite honestly, that they had that power. So
the outcomes for us were were really more that everyone felt more comfortable in allowing our clients to be people recognizing where they were and then helping them make the decision about what to do next.

I think to one of my favorite stories is just how the different disciplines, what they took away from the client interviews that we did. So we had one example where we had a client come in and I don't remember the legal subject matter, but the way we also did this clinic was we had a social worker and law student paired up. So, we had somebody from each discipline in these interviews. So the client comes in and constantly is flipping their shoe on and off their foot, which was very distracting to the law student and really annoying, right? Flipping, flipping, flipping. And it just kept making this clacking noise. And so they conducted their interview, and then they got out of the interview.

And as we were debriefing as a class, a law student goes, it was so annoying. They just kept, you know, shuffling their shoe. And I could barely concentrate. And the social worker just so beautifully said, well, I honestly think that that's because their shoes didn't fit and they were too big. And lo and behold, the social worker was able to do an intake with the client.

That's exactly what it was. They were, you know, so simple thing, right? But they were able to find the client shoes that fit. But it was just oh, right. You know, they're not doing something to be annoying. There's something else going on in this situation. And we have the resources to help address that.

Barbara
You think; how many opportunities might that person have missed? Yeah, yeah. And that's the part of not knowing, you know. We don't know everything about the person that we're. And our with our professional hats. We're stepping into this moment. And, we don't really know much about them. And there's a great term, you know, within like really person centered approaches that's about, you know, really seeking the expertise of the individual, really understanding their lived experience.

I always talk about it when I talk about evidence based practice. Everybody loves evidence based practice. But it's been, when Sackett introduced, for example, in my work, the idea of evidence based medicine, it had three parts to it. It had the best available evidence, the clinical expertise and the unique perspective, knowledge and values of the individual themselves. And it has been taken and these two disappeared, and it became about randomized controlled trials and systematic reviews. And this is what the evidence looks like. But it was this judicious combination. This is the way Sackett describes of these three things, because nobody that we meet tends to fit what those systematic reviews, they exclude everybody for a start.

So we've kind of lost that focus on really understanding that unique perspective, values and knowledge set that people have. And, you know, when we understand that, when we take that moment to step in, then we bring more than our professional knowledge that when we put our professional skill hat in, that usually encompasses things like empathy and understanding. But we do. We get very driven by process. So, I think sometimes when we collaborate with other professions, when we step into those moments and opens a window for us that actually makes us better at what we do.

Carrie Hagan
Absolutely it does. And just simple things. Really?

You know, I remember my social work colleague, her name is Doctor Stephanie Boyes. We've actually done a workshop, for IPT together on client counseling, because that's what we did. We did the clinic together. One of the things I love about working with her are just these simple things that make me really have to think about my legal training. And one example is she taught us that in social work, they don't like to ask the question why? And it's because when you ask somebody why, it can imply judgment. And it was one of those things where as a legal professional, I never really thought about that. And you don't have to say it with attitude, like, why are you doing that?

Right? But it's like, no, but it's like, why are you filing for divorce? I mean, that divorce is not an easy thing. And so instead of saying, why are you filing for divorce? Why is it that you want child support? Those questions become a lot more loaded. We started rephrasing things to say things like, well, tell me a little bit about what brought you here today.

You know, very different story, very different ability for the person to open up. And then there's the one word right can impose so much weight. Kind of blew my mind, honestly, when I learned to call.

Barbara Maxwell
I often think about those words when I see medical charting and health care charting. And then even when you do an intake on people, it says, denies chest pain. You know, denies this, denies that. Affirms this, affirms that it's like it's language that is, you know, that is I'm guessing, originated from a legal status for documentation.

but it's not by the human being. There's lots of things in our process and language. So I think that's something that when people think about the impact of like interprofessional collaboration. So between, you know, between law and social work, that change that makes you better able to then understand and get get the information that you need because you change the way you frame a question using the skill set from social work.

And and I've learned that from like in pharmacy, I've learned that, pharmacists that are amazing because they get short amounts of time with people to discuss their medication and whether it's detrimental are going to impact them negatively or positively. These are the side effects. They get this teeny tiny window of time to do it. And so they give really concise and clear instructions in a very tiny time frame. And like other professions, don't have that. So if you if you need that to be conveyed in that way, finds a pharmacist, you know, to do it. Whereas, you know, we do we bring these unique kind of little pockets of the way we communicate, the way we engage with people, the language that we use, the way that we draw in or respect their perspective.

And when we're overrun by process, it can distract us from that. There's there's some lovely work looking at the difference between, like, productivity and effectiveness. And when we think about productivity on our work, it's about how much of this can we do in the time that we can? How many billable moments do we have? How many, you know, how many people can we get through pom pom pom? And this is all about process. But when you look at effectiveness, it's actually about humanistic factors. It's about the way we to the people we engage with, the way we engage with them. And yet in a lot of businesses and industries were so focused on productivity that we leave the side which has the human side behind. So I think there's drivers that that lead us to be in positions when we are focused on our individ competence, when we are in our silos, when we don't expose ourselves to the work and the ways and the habits of the head, the heart and the hand that come with a different profession, when we don't expose ourselves to that, we're limiting ourselves, in our own professional capacity. So I hear that from you when you're talking about, you know, the the opportunity you've had to work so closely with a partner in social work to shift your practice. I wonder what they would say about what your collaboration with them has done to their social work.

Carrie Hagan
We did do a survey. We got, IRB approval, and we did collect some data on that. And I think what the social workers really took away was a greater understanding of our motivations and why we ask what we do, how we structure what we do, why we might have some attitude. You know, they're usually having to testify. So we were really able to explain, you know, when we are doing a direct examination. So when we've called somebody as a witness and they're supporting our case, why those questions look different than when the other side in a case would be cross-examining them. And they would ask them things in a different way and just vocabulary. I mean, just, you know, there's so many words that we use which, you know, might sound very fancy, but there's a much simpler way to put those, those things.

And so that was a lot of what the social workers took away. And I think both disciplines also really noted just sort of the deficits that our siloed disciplines had in their curriculum. You know, so the law students really recognize that there were so many, I don't know, that soft skills as appropriate, but there were so many of those counseling skills that we were missing. And social work felt the same about the legal system because, again, they're constantly involved, but they didn't have the tools necessarily to be the most prepared.

Barbara
That and I don't like to use the word soft skills because. But I like that you brought it up.

So, it's been great to hear, you know, about those lived examples and about the outcomes. As I say, people imagine that this work isn't happening and it's happening every day in all kinds of settings. We just don't always write about it and put it in the literature. It doesn't mean it doesn't exist. And so I really appreciate you coming in and talking about your experience, in particularly in that legal and social work, collaboration and, you know, real tangible changes that are happening to your work, the work of your learners in the clinic.

And on the flip side, for social work, because you are taking the time and effort to view that person as a whole person and to see the things that you can help with and the things that they need someone else's house help with, and that you can actually do that collaboratively to me and the impact. So thank you so much for speaking with me today, Cass.

Carrie Hagan
No. Thank you. And I really, truly enjoy always being invited to be on honestly, with any sort of event that you all have. Because even just being able to sit there with other professionals, I still I learn something every single time from my colleagues that I'm supposed to be up there as an expert with. I never feel like an expert when I'm sitting with all of these other people, but I believe at the last session we were all downloading apps that the each other knew right about the different services that I mean.

So again, I just think you're right. We are doing this work. We are doing it all the time and the expertise is out there. And one should not be afraid to try and look for the worst thing that somebody can say is, I don't know. And then they usually will refer you to somebody else who might. So thank you for having me.

And it's so nice to chat.

Barbara Maxwell
Yeah. We came all the way back. Grown to fear you. I think that's a lovely way to end. To say don't be afraid to acknowledge what you don't know. To step in, to find out from a profession that's different from your own,
because you're only the better for it.

David Plough
And that is it for Barbara, your interview with Carrie Hagan.

First off, I want to say thank you, Carrie, for coming in and doing this.

Professor Hagan, Carrie Hagan, Esquire, wherever you want to be called.

I actually, I make it a point to add the Esquire because she once told me that she forgets to use it. So, thank you for doing that. Barbara. Is there anything you'd like to say?

Barbara Maxwell
Just said at the beginning of this, podcast I mentioned as we were doing the introductions, and I was really looking forward to talking to Carrie Hagan. And because I've witnessed the collaboration with her in the cycle of addiction experience, and all that she brings to it. And I was not disappointed. I could talk to carry all day.

Her work is amazing and is real life work, improving the lives of people and populations.

David Plough
Yeah. She does. She does some amazing work over there at McKinney. And everywhere that she ends up working, that she's really great to have around. So again, thank you, Carrie, for being a part of this. And if you want to know more about our IPE center, you can find us at IPE dot IU dot Edu. We're also on LinkedIn. You have to type in the full name, the Indiana University Interprofessional Practice and Education Center somewhere after Indiana University. In that last, I will start to pop up. So you don't have to type all of that. But, you know, that's how you find us.

And I think that's it. Do we have anything else to say?

Barbara Maxwell
No. Just make sure you come back for, For episode number two.

David Plough
Yeah. Episode number two, with Alex Buchanan and Samantha Mitchell will be up next. So thank you so much for listening. And we will, be right here next time.