ACLCO AGM May 2015
Medical-Legal Partnership Workshop
Examples of Health Justice Partnership Models
Presentation by:
Vinay Jain, Director of Legal Services, UNISON Health and Community Services
Johanna Macdonald, Staff Lawyer - ARCH Disability Law Centre and Onsite Lawyer at St. Michael’s Family Hospital Academic Family Health Team
Ann McRae, Director of Legal Services, Rexdale Community Legal Clinic
1)Street Youth Legal Services - Justice for Children and Youth
Funding & operational resources
Law Foundation & other supportive grants. In operation since 1999. Service carried out by the Street Youth Legal Services lawyer with operational leadership of Justice for Children and Youth. Incorporation of community legal workers, paralegals, and pro bono students at different times. Additional grants allow added partnerships in the area of public legal education.
Partnership
Justice for Children and Youth specialty community legal clinic and SHOUT Clinic (for street involved youth) at Central Toronto Community Health Centre. Partnership is not a formalized agreement but confirmed through support letters in funding applications. Clients are referred to legal services through Health Centre staff. Legal services operate on a drop-in basis.
Populations served
Homeless and unstably housed youth between ages of 16-24. (approximate #’s in Toronto = 2000 youth are unstably housed on any given day).
Program components
Street Youth Legal Services provides direct service, legal education, and law reform initiatives for an on behalf of street involved youth. The key element of the service is the outreach component so that the Street Youth lawyer travels to be onsite at different locations where street involved youth may frequent. Partnership with the Health Centre agrees that the Street Youth lawyer will be onsite at the Health Centre one afternoon per week to provide drop-in direct services and engage in educational opportunities and law reform with Health Centre staff.
Goals & intended outcomes
Partnership with the Health Centre is one of many partnerships the service is engaged with to provide accessible legal services to homeless youth. The focus of partnership with the Health Centre is to provide accessible direct services and engage in education with the health team staff.
2)ProBono Law Ontario Medical-Legal Partnerships for Children
Funding & operational resources
ProBono Law Ontario, Grants from Atkinson Foundation and Law Foundation for start up funding, London Children’s Hospital funded by Hospital Foundation, some SickKids Foundation funding. Sick Kids started in 2009, London and Ottawa and HBloorview more recently. One lawyer per hospital on site with the support pro bono partnerr law firms and pro bono students..
Partnership
Four children’s hospitals in Ontario & PBLO (Sick Kids (Toronto), Holland Bloorview (Toronto), CHEO (Ottawa), and London.
Populations served
Children and the families of children who are patients at the hospital both inpatient and ambulatory including emergency...Over 2,500 referrals to SickKids Program since 2009.
Program components
Lawyer at each hospital provide on site advice and brief services and triage patients and families to relevant legal resources available or pro bono legal assistance. Triage Lawyer leads legal education and law reform activities with hospital physicians and staff.
Goals & intended outcomes
To provide increased family and child-centered care as part of clinical care model addressing social determinants of health. Access to legal services for patients attending at the children’s hospital. Issue identification for legal education and law reform in partnership with the hospital staff and physicians.
3)Centre Francophone de Toronto’s Legal Aid Services
Funding & operational resources
Legal Aid Ontario and other grants. Funding for 1.5 lawyers, a receptionist, a community legal worker, and one day/week family lawyer. Additional funding may arrive for more immigration representation.
Partnership
Legal Aid Services is fully integrated as one of many services available at the Centre Francophone, a multi-service agency. Clients are referred to legal services on intake at the Centre (name and phone # only. Legal Aid informs referral source that contact has been made).
Populations served
Low-income Franco-Torontonians
Program components
Legal advice line to direct representation. 75-80% of work is immigration and refugee related. 15% tenant applications. Some employment and Social Benefit Tribunal work. Hosting education workshops.
Goals & intended outcomes
A one-stop shop for Franco-Torontonians. Robust service and access to legal representation for Franco-Torontonians.
4)Rexdale Community Hub, Rexdale Community Legal Clinic, Rexdale Community Health Centre and others
Funding and Operational resources
Nine independent community service agencies occupy a renovated high school, and self-manage it in a partnership model which includes community reps. A community board collects operational fees from tenant agencies for front desk staffing, security, wireless internet, and use of community (shared) spaces. The City of Toronto owns and maintains the building and collects rents. There is a chronic gap between community aspirations such as weekend hours and coordinated intake, and what the partner agencies are actually able to afford. In the absence of a lead agency, the City, United Way and the partners have incorporated their own non-profit agency, Rexdale Community Hub, to manage the community and agency interests.
Partnership:
The formal partnership (see above) is constrained by lack of funds, lack of planning forethought and confusion about the mission in the community of a United Way initiative such as RCH. Thus, there are limited hours, no central programming, intake or referrals at this time. User fees are high for weekends, or extended evenings, due to security costs.
Informally, agencies partner much better on projects and events that they did before they were co-located.
Population served:
North Etobicoke, regardless of income or issues. Each partner agency has its own focus, service restrictions and multiple programs.
Program components:
Partner agencies offer full Community Health Center programs, full settlement agency and employment agency programs, family and youth services, housing help centre, Boys and Girls Club, community legal clinic and Legal Aid advice/duty counsel services in family, immigration and criminal.
Goals and intended outcomes:
To provide in one location all services for all community needs, especially for low income residents, and to do so with efficiencies and cooperation and good referrals as a product of being co-located.
5)Health Justice Initiative – St. Michael’s Legal Services Program
Funding & operational resources
Three year grant from LAO capacity-building funding. 18 months of development pre-Dec. 2014 start of onsite lawyer. Funding to March 2017 for one on-site lawyer and one administrative support position.
Partnership
Signed Memorandum of Understanding between partners. Partnership between:
a)St. Michael’s Hospital
b)St. Michael’s Hospital Academic Family Health Team (SMHAFHT) – 45,000 registered patients. 140,000 visits last year.
c)ARCH Disability Law Centre, Aboriginal Legal Services Toronto, HIV Aids Legal Clinic of Ontario, and Neighbourhood Legal Services. I am employed by ARCH.
Populations served
Patients of St. Michael’s Hospital Academic Family Health Team (SMHAFHT) – 45,000 registered patients with 140,000 visits last year. The catchment service area runs from Bathurst to approximately Pape/Leslie, and the lake to Bloor Street.
ARCH Disability Law Centre serves persons with disabilities in Ontario. It is estimated that 1 in 7 persons in Ontario identify as having a disability, equaling 2 million people.
Aboriginal Legal Services Toronto serves persons identifying as aboriginal in the Toronto region. ALST provides programming and legal support for persons identifying as aboriginal. Approximately 30,000 individuals living in the Greater Toronto region identify as aboriginal.
The HIV Aids Legal Clinic of Ontario serves persons diagnosed with HIV Aids in Ontario, total number of persons = 30,000.
Neighbourhood Legal Services serves individuals who have low income and live in the boundaries of the DVP-Yonge Street, Bloor Street to Lake Ontario.
Thinking through the different population groups that the partners serve, we are looking to tailor service so that it coordinates well with existing legal services, and emphasizes the strengths that each partner brings to the program.
Program Components
1)Direct service from advice/referrals to case files & test case identification - referrals are currently processed through a health care professional or physician. Leading towards a self-referral process. Needs assessment surveyed social workers to judge legal needs of patients. I am in the process of creating a case selection criteria for representation beyond advice and referrals for each area of law.
2)Legal education of health team - health team is composed of 200 staff (clerical, managers, and nurses), and 60 physicians at six clinic sites. Current structure of education is attendance at team meetings and 1:1’s with the health team at one site. Curriculum is being developed.
3)Law reform and systemic advocacy – through education and direct service, we are working to identify points for law reform. Participation in the social determinants of health committee as part of the health team to collaborate and drive law reform.
4)Evaluation of program – project logic models are created for each program area to identify goals and outcomes. A pre-post survey evaluating a measure of access to justice and measure of improved health outcomes will accompany the direct service, education, and law reform.
Each program component will apply a tailored community development framework and knowledge translation goals.
Goals & intended outcomes
To provide holistic legal services to the most vulnerable patients of the Family Health Team. To measure the provision of legal services, education, and advocacy on the ability to increase access to justice and improve markers of societal determinations of health.
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