By Eric Krebs, J.D. candidate, Harvard Law School
In the latest episode of Proof Over Precedent, Access to Justice Lab researcher Renee Danser speaks with Professor Emily Suski, Professor at the University of South Carolina Joseph F. Rice School of Law, about CHAMPS, the Carolina Health Advocacy Medical–Legal Partnership housed at the USC School of Law. This episode is a follow-up to an earlier Proof Over Precedent episode and blog post, this time bringing the inside perspective on CHAMPS’ origins and results.
Danser and Suski’s discussion covers CHAMPS’s institutional design, service model, and an ongoing evaluation that tests whether medical–legal partnership services can reduce certain downstream system involvements—especially child welfare referrals that may be driven by poverty-related conditions rather than maltreatment.
Suski describes CHAMPS as evolving from a traditional law school clinic into a larger service-delivery organization. The initial clinic model—structured around semesters and student casework—did not match the scale and continuity that healthcare partners needed. In response, CHAMPS developed a staffing model that includes dedicated attorneys, supported in part by early financial contributions from medical partners. Suski characterizes CHAMPS as the largest medical–legal partnership in South Carolina, with multiple staff attorneys and plans to expand capacity.
This shift in structure serves two linked functions. First, it allows CHAMPS to provide year-round services rather than limiting representation to academic terms. Second, it maintains the pedagogical component: cases appropriate for student learning can be incorporated into clinic offerings when the semester is active, while staff attorneys ensure institutional continuity outside the academic calendar.
A central theme of Danser and Suski’s discussion is what it means for legal services to be “embedded” in a healthcare setting. Suski explains that CHAMPS attorneys operate as part of clinical teams rather than functioning solely as external referral recipients. This includes training and relationship-building with clinicians so that legal intervention is understood as iterative and collaborative, particularly when medical documentation and care-team coordination are essential to achieving legal outcomes.
Suski also notes that CHAMPS attorneys have offices physically located in hospital settings, facilitating accessibility and coordination. This design supports both informal consultation and more formal casework, including circumstances where legal barriers affect safe discharge planning or access to follow-up care.
In addition to attorneys, the CHAMPS model includes social work support, including social work placements for students. Suski frames this as part of an intentionally holistic approach: legal advocacy often depends on stabilizing non-legal needs (or preventing new destabilization) so that legal resolutions translate into improved living conditions.
CHAMPS provides a broad set of services that track common “health-harming legal needs.” Suski identifies core areas of representation and advocacy, including Social Security disability (SSI) appeals; education matters (including special education and related supports); housing conditions and eviction-related issues; and public benefits such as SNAP appeals. She also describes planning support for adolescents transitioning into adulthood, including instruments that help families manage medical and decision-making needs. Finally, CHAMPS sometimes engages in family defense work when the program believes a referral to child welfare authorities was not warranted.
Danser and Suski describe practical interventions that address material needs closely connected to health status and caregiving capacity, including targeted support for specific items that can make home care feasible.
The main empirical claim under examination is that CHAMPS may reduce unnecessary referrals to the South Carolina Department of Social Services (DSS). Suski describes the origin of this hypothesis in conversations with medical partners. When she asked what clinicians did before CHAMPS existed to address concerns that were affecting child wellbeing, she expected answers in terms of social work or community-based support; instead, medical partners reported that they referred cases to DSS.
Suski’s account emphasizes a legal and institutional gap: mandatory reporting regimes require reporting based on suspicion of abuse or neglect, but they do not necessarily require reporters to determine whether observed risks are better explained by poverty-related constraints rather than maltreatment. As a result, circumstances that present as “neglect-like” can lead to child welfare involvement even where the more appropriate response is assistance navigating benefits, housing, education services, or other resources.
Importantly, Suski does not frame the goal as discouraging reporting of maltreatment. Rather, the proposed benefit is to provide clinicians with an alternative pathway—legal and social support—when the underlying issue is resource scarcity, administrative barriers, or related conditions that can be addressed without initiating a child welfare investigation.
CHAMPS and the Access to Justice Lab are evaluating the model using a randomized control trial (RCT), which Suski characterizes as a “gold standard” approach for estimating causal effects. In the described design, families are randomly assigned either to receive CHAMPS representation/services or to receive tailored self-help materials. The RCT structure is intended to allow credible inference about whether access to the intervention changes outcomes of interest relative to a defined comparison condition.
The discussion frames this tension as a tradeoff between immediate service delivery and the longer-term goal of generating evidence that may support institutional adoption, public funding, and broader replication. Suski suggests that evidence of reduced unnecessary DSS referrals could have multiple implications. First, if medical–legal partnership services divert poverty-related cases away from child welfare investigations, this may reduce burdens on DSS screening and casework capacity and allow greater focus on higher-risk cases. Second, Suski also anticipates that program effects could be relevant to questions of Medicaid costs and state expenditures, to the extent legal and social interventions improve access to stabilizing benefits or reduce costly system involvement. And third, Suski describes a qualitative research component that collects family perspectives. She notes that qualitative data can both contextualize quantitative outcomes and provide feedback that improves service delivery during the study period, rather than only after publication.
The interview also addresses practical and ethical pressures that accompany randomized evaluation in a direct-services setting. Suski describes the difficulty of declining representation for families assigned to the comparison group, including situations where potential participants have previously been clients and return seeking assistance. “What keeps us going is that we have our eye on the end game, which is that if our hypothesis proves to be true, we will be able to serve many more people,” says Suski.
If you’re interested in more on this topic, listen to our Proof Over Precedent podcast episode.