Transcript Canadian Cancer Society Relay for Life Evaluation

Clinic Transformation in
East Toronto Study
June 4, 2013
Context
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East of Yonge St. Study
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Created by Clinics
Funded through a grant request to LAO
Examined relationship between client needs and
existing structures
Explored refinements to client-centred model for
poverty law
Explored potential for expanded partnerships,
collaboration, other new relationships between Clinics
Poverty law exploration
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Community profiles
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Demographic analysis of each census tract in
catchments
Exploring concentrations of challenges relating to
income, housing, immigration and family obligations
Review of literature
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International English language literature
Service provision
Access to justice
Poverty law exploration
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Focus groups
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6 front-line Clinic staff focus groups
6 focus groups with Clinic clients
Key informant interviews
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6 Clinic Directors
2 Private Bar Lawyers
2 PBLO/Pro Bono Students
6 community organizations
Methodology
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Review of patterns of service use in all east end Clinics
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Review of caseloads in each Clinic by type
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Review geographic mix of clients in each Clinic
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Review of different staffing structures and models
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Comparisons of existing models of delivery in other
Clinics in Ontario
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Reviewed data, challenges, options with Clinic EDs
Data showed significant challenges
Growing demand for service by clients
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Pressure on scope and volume of service
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Volume of demand consistency exceeds capacity
Case selection reflected very dire need, not full scope of
demand
Services restricted to clients at very, very low income
levels
Demand for expanded areas of law
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Employment, more Immigration, Family law
Data showed significant challenges
Non-case related service
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Some Clinics face difficulties to maintain community
outreach and engagement
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Sustaining PLE and community development challenging
Unable to keep up with law reform demand
Front-line community outreach efforts often pushed to back
burner
Sustaining partnerships with other organizations serving low
income communities challenging
Data showed significant challenges
Access to justice
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Central consideration
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What impedes access?
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Who needs access?
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How do access questions affect the organization of Clinics?
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Concern about boundaries, structures affecting access
Total intake of six Clinics by FSA
Most clients
come from
areas closest
to Clinics
Toronto’s Three Cities
Needs don’t always match Clinic locations
Toronto Community Housing
Needs don’t always match
Clinic locations
Clusters of need
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Blue: Income
Red: Housing
Yellow: Immigration
Green: Family Pressure
Neighbourhood clusters of need
Clinic Boundaries
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Varied definitions of “local”
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Variations of geography – some Clinics in large areas, far
from clients
Larger potential for travel challenges and access issues
Clients in larger catchments less likely to access
service if office is far from home
Clinic staffing models
Staffing and structure
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Discrepancy in size results in discrepancy in staffing
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Variations in staff complements
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Larger Clinics form teams, smaller Clinics cope with
fluctuations
Different ratios of lawyers, community legal workers and
paralegals
Smaller Clinics express frustration about staffing
constraints/flexibility
Findings – access points and proximity
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Clients require familiar gateways to services
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Principle of local proximity strong determinant of good
service delivery
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Easy to reach
Presence of established, substantial, professional organization
Strategies needed for diverse communities and geographic
neighbourhoods
Review of target populations, patterns of services need,
barriers to service
Smaller Clinics found creating satellites or access points
more difficult
Findings - partnerships
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Range of informal partnerships supporting areas of law,
referral and service
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Broaden scope of service and enhanced capacity of Clinics
Potential for coordinated services, collaboration, co-location
Professional (pro bono), individuals, student partnerships
Intensity of partnerships must be based on strategy to meet
needs of community
Dedicated staff time needed for successful partnerships
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Smaller Clinics found dedicated partnership time harder to
accommodate
Findings – intake models
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Phone and walk-in intake support broader access
to service
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Informed intake staff familiar with legal and local social
services reinforce quality service
In-person intake preferred when possible
IT challenges to successful intake
Findings – Clinic structure
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No clear criteria underlying existing
boundaries
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Not aligned with adjudicating bodies, administrative
offices
Vary in size and population
Many too large for truly local access but too small to
create local hubs or satellites
Findings – staff structure
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Inconsistent staffing allocation criteria
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Smaller Clinics benefit from proximity to clients; challenges in
diversified team, flexibility and workloads
Larger Clinics share workloads, support specialized skills and
expertise; challenges in engaging and being responsive to
communities
Most Clinics operate primarily in three areas of law
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Landlord/tenant, income supports, immigration
Staff sizes range from 5-10 staff in each Clinic
Some Clinics working within an integrated team model
Findings – Clinic size
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Criteria varies too widely in size, volume of clients and
internal capacities
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New boundaries should be based on clear criteria
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Should reflect client populations and their needs, and ways in
which Clinics operate most effectively
Transportation barriers and proximity of service should be
integrated to increase access
Connection to community key element of success
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Sustaining awareness in context of ongoing demographic and
needs shift
Role of community boards, outreach staff share role in
leadership
Findings – catchment boundaries
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Relationships important in advocating on behalf of clients
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Local service networks and delivery systems shape
catchment
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Catchment boundaries based on adjudicating bodies,
governments sustain relationships
Elected officials as sources of referral, avenues for law reform
and client advocacy
Reinforce local, community input into service planning, referral
Physical proximity increases opportunities for local issue
identification
Well maintained relationships sustain effective service
delivery
Findings – information technology
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Multiple tools support staff communication and
enhanced client support
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Clients need access to in-person support,
complemented by other methods/tools
Online document management, including scanning
capacity
Mobile communication tools for staff (cell phones)
Management time necessary to support and coordinate
staff
Findings – locations, administration
Permanent locations
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Clients have more confidence in legal services delivered
by organizations with a clear physical presence in the
community
Administration
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Dedicated administrative support needed with enhanced
client-centred services
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Support for formal partnerships
Focused intake structure
IT infrastructure