Inner Melbourne Community Legal Inc (Registration No A0014248J) helping you be heard HEALTH-JUSTICE PARTNERSHIPS: INTEGRATING LEGAL ASSISTANCE INTO A HEALTH-CARE

Inner Melbourne Community Legal Inc (Registration No A0014248J)helping you be heard

HEALTH-JUSTICE PARTNERSHIPS: INTEGRATING LEGAL ASSISTANCE INTO A HEALTH-CARE SETTING

Linda Gyorki, Senior Project Manager and Lawyer

Inner Melbourne Community Legal Inc (Registration No A0014248J)2

OVERVIEW

• About us: Inner Melbourne Community Legal

• Health-Justice Partnerships: integrating legal assistance into a healthcare setting

• Acting on the Warning Signs evaluation

• Other evaluations


INNER MELBOURNE COMMUNITY LEGAL

A not-for-profit community organisation that provides legal assistance to disadvantaged

and marginalised people in the City of Melbourne area.

Our mission

To promote social justice through advocacy, education and casework delivered by a unique, passionate and talented team.

Our vision

A just and empowered community.

Values

Respect, Excellence, Empowerment

Strategic Objective

To provide accessible legal assistance and preventative education to empower members of the inner Melbourne community experiencing disadvantage in collaboration with organisations who are also committed to improving community health and wellbeing.


EXTENSIVE OUTREACH

• The Royal Children’s Hospital – Wednesdays (weekly)

• The Royal Women’s Hospital - Tuesdays, Thursdays and Fridays (weekly)

• Inner West Area Mental Health Services – Wednesdays (fortnightly)

• Ozanam Community Centre – Wednesdays (weekly)

• Women’s Information and Referral Exchange (WIRE) - Thursdays (monthly)

• Centre Against Sexual Assault (CASA House) - Thursdays (monthly)


1. Legal needs ought to be considered as one of the social determinants of individuals’ health and wellbeing.

2. Individuals often seek legal advice from non-legal sources and frequently from health and welfare professionals.

Provision of a direct referral pathway to an on-site legal service has the capacity to improve health outcomes.

WHY INTEGRATE LEGAL SERVICES WITHIN A HEALTH-CARE SETTING?



LEGAL NEEDS & THEIR IMPACT ON WOMEN EXPERIENCING VIOLENCE

“Everything that’s written in our reports from day one has always been about trying to break the siloes down and trying to find out where the breaks in the chain are and trying to integrate law, mental health, hospitals, child welfare…”1

1 Meeting with Deborah Sinclair at the Barbra Schlifer Commemorative Clinic, Toronto, Canada, 2 May 2014.


Health-Justice Partnership with the Royal Women’s Hospital

Phase 1: August 2012 – August 2014; Phase 2: August 2014 – August 2016

Aims:

1. build the capacity and willingness of health professionals to identify signs of family

violence and provide appropriate information and referral pathways;

2. empower patients from low-socioeconomic backgrounds who are experiencing family

violence or at risk of family violence to obtain appropriate legal and non-legal

assistance;

3. develop and evaluate a model for a multidisciplinary approach to addressing family

violence in the hospital context.


Training:Since August 2012, 181 health professionals have been trained (Phase 1: 123 (exceeded 70 funded); Phase 2: 58 to date)

Full-day study days. 156 staff have participated. Multi-disciplinary model, including external presenters. 8 x full-day study days held 3 x study days scheduled for 2015

Doctors’ training. 2 x 90-minute sessions held in 2013 27 doctors attended RANZCOG accreditation Multi-disciplinary model 2 x 90 minute sessions scheduled for 2015.


• August 2012 – January 2014: on-site once per week

• January 2014 – August 2014: on-site twice per week

• August 2014 – present: on-site three times per week.

• Since August 2012, over 180 instances of legal advice provided.

• External evaluation of the Project shows:

• “the co-location of a regular and consistent legal practitioner within social work appears to be the mechanism that led to increased awareness and accessibility for social workers to refer women to this service”

• “seven of the eight women [who attended the IMCL outreach and were surveyed] believed that receiving legal advice had a positive impact upon their psychological and emotional health immediately during or after the consultation”.


Results of the Evaluation of Phase 1:

• Trained almost 10% of clinical staff

• 84/123 health professionals filled out survey 2

86% rated the training very good/excellent 98% felt it was a positive learning experience 91% would recommend it to colleagues

• Training significantly improved self-reported general knowledge of family violence and the common presenting symptoms of family violence.


Results (Cont’d):

• Significant improvement in self-reported confidence in having sufficient knowledge and skills to respond to women experiencing family violence and to refer.

• All of the 67 health professionals who responded to survey felt they were able to help or knew what to do if they had a patient with family violence.

• Significantly increased use of CPG with an extra 1 in 5 referring to it in the 3 months post-training.

• Post-training, 90% (cf 66% pre-training) understood the role of lawyers in a hospital setting.

• Notable increase in total referrals to IMCL outreach in 2013 (n=56) compared with 2012 (n= 39) and 2011 (n=26), including both family violence and non-family violence related clients.


DEVELOPING AN EVALUATION IN A HOSPITAL-SETTING

Hospital for SickKids, Toronto• The evaluation has shown that this model is addressing

research relating to advice seeking behaviour.

• “Clinicians were virtually unanimous in asserting that the on-site location was essential to the success of the model”.

• “Parents were asked if they or anyone else in the family had tried to get help for any of their legal concerns before they went to the lawyer’s office at SickKids. None of them had done so...”

• “the impact of legal problems was felt most strongly in two areas of parents’ lives: first, the level of stress and worry they were experiencing and, secondly, in their financial situation.”

• Approximately half of the respondents “estimated a moderate to significant improvement in regard to the child’s health or in their (the parents’) ability to help maintain the child’s treatment”.

• “the project works extremely well in a clinical setting at the hospital and enjoys the full confidence of hospital clinicians; [the project] has steadily enlarged its service capacity, [the project]….has created significant positive impacts for families…and that the project…was addressing significant unmet needs”.

1,2 Excerpt from an external evaluation conducted in 2012 at the Hospital for Sick Kids, Toronto in which 23 interviews were conducted with parents/patients who had received legal services. The evaluation considered the cases of 463 clients between September 2010 and September 2011.


THE NEWHAM GP ADVICE PROJECT

“The experience of the Newham GP advice project … found that people who may not normally seek advice are much more likely to do so when it is ‘prescribed’ by their doctor and they have the opportunity to see an adviser in their local surgery.”

The evaluation found that “over 1800 clients received free, independent, quality assured advice” and 65% of these clients were from an ethnic minority.

The cost benefit of this model of service delivery was highlighted in the evaluation which showed that “the outreach cost £267,247 [and] the service cost per client was £147. Extra benefits identified for clients were worth over £1.7 million per annum [and] an average of £978 per client, per annum in increased income”.


COMMUNITY HEALTH SETTINGS

Inner Melbourne Community Legal Inc (Registration No A0014248J)

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WHAT DO WE NEED?

Need for “longitudinal data showing the impact of MLP services over time on factors such as health, birth outcomes, mortality, emergency room utilisation, treatment compliance and absenteeism to provide even more compelling evidence on MLP efficacy.”

Daniel Atkins, Shannon Mace Heller, Elena DeBartolo and Megan Sandel “Medical-Legal Partnership and Healthy Start: Integrating Civil Legal Aid Services into Public Health Advocacy” (2014) 35(1) The Journal of Legal Medicine 195, 196


THE CAPACITY TO BRING ABOUT CHANGE

“… the true power of the MLP model lies in its potential to influence populations via broad-scale policy change”.1

1 Ellen Lawton, et al, ‘Medical-Legal Partnership: A New Standard of Care for Vulnerable Populations’ in Elizabeth Tobin Tyler et al (eds), Poverty, Health and Law: Readings and Cases for Medical-Legal Partnership (Carolina Academic Press, 2011), 76.


A FEW RECOMMENDATIONS

• Ensure a feedback loop

• Nurture the partnership

• Encourage the use of a legal screening tool

• Provide secondary consultations

• Provide a generalist service

• Engage students

• Evaluate the work


For questions, contact [email protected] or 9328 1885

For more information, see

www.imcl.org.au

For soft copies of the report from the Churchill Fellowship, visit:

http://www.churchilltrust.com.au/fellows/detail/3816/Linda+Gyorki

To see the blog, visit:

www.legalpulse.wordpress.com

mailto:[email protected]

http://www.imcl.org.au/

http://www.churchilltrust.com.au/fellows/detail/3816/Linda+Gyorki

http://www.legalpulse.wordpress.com/

Documents

Inner Melbourne Community Legal Inc (Registration No A0014248J) helping you be heard HEALTH-JUSTICE PARTNERSHIPS: INTEGRATING LEGAL ASSISTANCE INTO A HEALTH-CARE