Aboriginal Legal Services of Toronto

Health Justice Initiative

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Aboriginal Legal Services of Toronto

ARCH Disability Law Centre

HIV & AIDS Legal Clinic Ontario

Neighbourhood Legal Services

St. Michael’s Hospital

Health Justice Initiative

St. Michael’s Hospital Academic Family Health Team, Department of Community and Family Medicine

JULY 2015

Johanna Macdonald, Onsite lawyer

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Health Justice Initiative

•Partnership between the community legal clinics and St. Michael’s Hospital Academic Family Health Team is well into our pilot phase.

•The partnership was developed over an 18 month time frame prior to my start onsite at 80 Bond since December 15th, 2015.

•My salary is funded by Legal Aid Ontario in a grant running to March 2017.

•The Initiative’s goals are to improve both access to justice and the social determinants of health for our patient-client population.

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Health Justice Initiative

Our Initiative is backed by a community development framework and includes four components:

(1) Direct legal services to patients of the Family Health Team

(2) Legal education with the patient population and Family Health Team health care providers

(3) Leadership on advocacy and law reform

(4) Engaging in evaluation of the Initiative

Each of the Initiative’s program components are being evaluated. I split my time between direct client service (60%), legal education (20%), and law reform (20%).

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Pilot Phase – December 2014-September 2015

•For our pilot phase, we have provided direct services only at 80 Bond.

•We are currently creating an operational structure for the Initiative with an activity plan, procedures and protocols.

•Alyssa Lane is our summer Health Law intern and is completing a paper on confidentiality that will inform our communications procedures.

•In September, I will be joined by Rosa Tavares, our legal administrative assistant, and two students from the ARCH student Disability Law Intensive program.

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Timeline and Procedure for Roll-out

•We want to expand our Initiative to all clinic sites in a manner that is transparent, equitable, and that builds capacity for the entire Family Health Team as we go.

•We will roll-out beyond 80 Bond site-by-site starting in September 2015.

•Today, we will choose the sequence of sites by way of random selection.

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Legal Education and Roll-out of Direct Services

•By September 1, 2015, all health care providers will have access to legal resources including and we will host legal education sessions.

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Roll-out of Direct Services

Three months after rolling out to an additional site, we will monitor the following factors to decide whether we have capacity to expand to a next site:

(1) Wait times for contact from legal services;

(2) Is there sufficient time to provide direct legal assistance to patients;

(3) Are we on target for educational goals to health team and patients;

(4) Are we sufficiently engaged in systemic advocacy activities; and

(5) General sense of capacity based on program goals and future plans with input from lawyer, administrative support, clinical champion, SMH and ARCH management.

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Proposed Time-Line

Jan 2015-Aug 2015: 80 Bond

Sept 2015-Dec 2015: 80 Bond + Site 1

Jan 2016-April 2016: 80 Bond + Site 1 + Site 2

May 2016-Aug 2016: 80 Bond + Site 1 + Site 2 + Site 3

Sept 2016-Dec 2016: 80 Bond + Site 1 + Site 2 + Site 3 + Site 4

Jan 2017-April 2017: 80 Bond + Site 1 + Site 2 + Site 3 + Site 4 + Site 5

May 2017-Dec 2017: all sites continue, end of LAO grant

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Direct Services Snapshot to date

Referred Source / Client #'s / %
Non-80 Bond / 12 / 13%
80 Bond Social Worker / 23 / 25%
80 Bond Physician / 44 / 48%
Income Security / 8 / 9%
FHT Consult / 5 / 5%
Total / 92 / 100%
Month / # of Intakes
December / 18
January / 7
February / 24
March / 30
April / 20
May / 23
June (11 to June 15) / 24
Total (133 to June 15) / 146
Total # of visits by client-patients / 134
Total # of telephone calls with client-patients / 120
Average Time Spent Per Intake / 2hrs
Average Time Spent Per Retained Client / 15hrs

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Intakes by Area of Law

SMHAFHT Intakes by Area of Law (15 Dec 2014-15 June 2015) / Total
Criminal / 12
Employment including ESA, Occ Health, WSIB / 11
Human Rights including ADP / 7
Family including child welfare / 16
Violence / 6
Health Care / 6
Housing / 13
Immigration / 12
ODSP / 8
Income Maintenance to include OW, CPP, CPP-D, LTD and Consumer Debt / 10
Advance Care Planning / 17
Personal Injury and Civil Litigation / 6
General Admin/ Misc. other / 9
Total / 133

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Type of Legal Service / #'s / %
Legal Information and Referral Only / 10 / 8%
Advice Only / 32 / 24%
Advice & Assisted Referral Private Bar / 19 / 14%
Advice & Assisted Referral Clinic or Other / 31 / 23%
Advice & Advocacy/Drafting Brief Service / 16 / 12%
Advice & Advocacy/Drafting Brief Service & Assisted Referral / 13 / 10%
Advice & Brief Service & Retained / 5 / 4%
Not contacted / 7 / 5%
Total Legal Services Intakes / 133 / 100%

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Direct Service Outcome Summaries

ADV = adviceAR = assisted referral

BR = brief service advocacy/negotiation

Housing

Issue / Service / Outcome / Systemic Issue?
Lack of repairs causing poor health / BR – negotiated for repair/ gave advice and template letter for repair / Knowledge of rights Empowerment re. advocacy with landlord
Medical transfer –social housing / BR – negotiate/advocate with landlord / Disability accommodation knowledge Hopefully speedier transfer

Violence

Issue / Service / Outcome / Systemic Issue?
1st ever report of sexual violence / BR - Investigation on perpetrator, provide support in service / Understanding of rights and process for victim’s rights. Feeling of security & potential for redress.
Personal injury / AR - Consult and assisted referral to private bar lawyer / Advice and understanding of rights. Potential $$.

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Direct Service Outcome Summaries

Criminal

Issue / Service / Outcome / Systemic Issue?
Charge outstanding –bail conditions no go home / BR - Negotiated with Crown / Bail variation able to go home (resolved homelessness) & rights advice about criminal process
Criminal record implicating job prospects/causing stress / BR – query re. record and request for destruction / Record destroyed. Decreased stress. Further employment opportunities

Employment

Issue / Service / Outcome / Systemic Issue?
Let go from contract job without notice / AR - Assisted referral to employment lawyer / Advice and rep. on wrongful dismissal/employment standards claim. Recovered income
Let go from job for being sick and/or pregnant / AR - Assisted referral employment lawyer. Identification of employer’s breach re. accommodation in employment / Advice and rep on human rights complaint and/or wrongful dismissal

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We look forward to working together with you!

Johanna Macdonald, Onsite Lawyer

(416) 864-3004

Rosa Tavares, Program Assistant