How do you measure the success of medical-legal interventions in the lives of people with a complex interplay of health and legal issues?
Our Health-Justice Partnership (HJP) with Bendigo Community Health Services (BCHS) commenced in January 2014. Since then, this initiative has seen our HJP Lawyer Nickie King provide 86 legal advices and take on 74 cases at BCHS’s Kangaroo Flat centre. But numbers don’t tell the whole story. Sometimes you need to talk with people.
At the beginning of this year we engaged Dr Liz Curran (Australian National University) and Dr Robert Southgate (one of our solicitors) to lead the evaluation of this service. Their findings reinforced the value of the service and found it had become an integral and important part of BCHS’ practice.
The evaluation of the service was measured against key outcomes. The partnership needed to demonstrate that it improved the health and well-being of vulnerable and disadvantaged people through integrated legal and medical service delivery. And the partnership had to deliver direct legal services, legal education and policy work.
The research aimed to measure the Health-Justice Partnership’s impact on clients’ social determinants of health. We surveyed clients, BCHS staff and Loddon Campaspe CLC staff. The survey aimed to establish whether the partnership had led to an increase in capacity, collaboration, empowerment, advocacy and engagement, and whether it helped to prioritise the voice of the client. The preliminary data indicates a number of emerging trends.
The data indicates that an on-site and available lawyer is critical to the partnership’s success. The HJP lawyer and BCHS staff need to be available to support clients in a crisis. Secondary consultations between health staff and the HJP lawyer are critical to the partnership’s success and there is a need for continued legal training of professionals and the community, particularly in the areas of child protection, infringements and family law.
The research found that clients are getting better help and their lives are being positively impacted. Since the program commenced none of the clients has experienced a drug abuse relapse, and the clients reported lower stress levels.
The majority of clients referred to the service present with family law and child protection issues. The majority of clients are women. Many are sole parents and 50% of casework clients identified as having a disability. 8% of casework clients identified as Indigenous, compared to only 2% of Loddon Campaspe CLC’s generalist service. 94% of case work clients list their only income as a Centrelink pension.
But the HJP is not a one-dimensional enterprise. As well as providing direct legal service delivery, the partnership aimed to:
- Increase the capacity of local health service providers to address social determinants of health
- Develop and strengthen partnerships and networks within and between the legal and medical sectors
- Embed the concepts of social determinants of health and possible legal remedies within training and education structures, and
- Capture the reflections and empirical evidence for use in policy development and advocacy.
To these ends, the project has also worked across a number of different fronts:
- A range of legal educational sessions have been delivered to BCHS staff. Since January 2015 we have targeted legal education efforts towards mental health professionals and the carers of people with complex mental health needs. This training was supported by Medicare Local in Bendigo.
- In 2014 ARC Justice’s EO Peter Noble and BCHS’ Families and Children’s Services Manager Andie West presented at the Victorian Health Care Association’s Rural and Regional Conference on Health-Justice Partnerships as an innovative service delivery model.
- In March 2015 Nickie King and Andie West presented at a symposium promoting Health-Justice Partnerships hosted by the Royal Women’s Hospital.
- The partnership has contributed case studies and collaborated on a yet-to be published Health-Justice Partnerships Toolkit, which will be released at the National Association of Community Legal Centres’ Conference in August 2015.
- We made a submission and contributed case studies to the Office of the Public Advocate’s paper on disability and parenting within the child protection system.
- The partnership wrote to the Department of Health and Human Services (Child Protection) in relation to issues surrounding the use of confidential information from therapeutic service providers and their impact on the best interests of the child.
- In June 2015 Peter Noble will speak at the National Access to Justice Conference in Sydney about effective legal service delivery to people with disabilities and will reflect on the experience of the Health-Justice Partnership and related research.
- The partnership promoted the model as a good investment for philanthropic funders. (In 2014 the Legal Services Board and Commission funded ARC Justice and Primary Care Connect [a community health service in Shepparton] to pilot a Therapeutic Justice project that employs a lawyer at Goulburn Valley CLC and a case worker at Primary Care Connect to support people with complex and persistent health needs frequenting the Shepparton Magistrates’ Court).
The HJP model aims to improve service coordination and delivery by medical and legal agencies. Its primary intended beneficiaries are the vulnerable and disadvantaged clients of these services. So it is only fitting that we judge the success or otherwise of such projects by asking those for whom it is intended if it met their needs. One client’s quote tells the story:
I was heading to a very dark place…without that help I may have been dead by now. I thought I was going to gaol, but I ended up with a CCO [Community Corrections Order]. I’ve been in services for a long time and this one is remarkable…Stress has been reduced 100%. My life was out-of-control… now I feel more in control… I feel as if I have hope… I feel as though I have been empowered.