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Clinic Transformation in East Toronto Study

June 4, 2013

Context

East of Yonge St. Study


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

Community profiles

Demographic analysis of each census tract in catchments Exploring concentrations of challenges relating to income, housing, immigration and family obligations International English language literature Service provision Access to justice

Review of literature

Poverty law exploration

Focus groups

6 front-line Clinic staff focus groups 6 focus groups with Clinic clients

Key informant interviews


6 Clinic Directors 2 Private Bar Lawyers 2 PBLO/Pro Bono Students 6 community organizations

Methodology

Review of patterns of service use in all east end Clinics Review of caseloads in each Clinic by type Review geographic mix of clients in each Clinic

Review of different staffing structures and models


Comparisons of existing models of delivery in other Clinics in Ontario

Reviewed data, challenges, options with Clinic EDs

Data showed significant challenges


Growing demand for service by clients

Pressure on scope and volume of service


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

Employment, more Immigration, Family law

Data showed significant challenges


Non-case related service

Some Clinics face difficulties to maintain community outreach and engagement

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

Central consideration
What impedes access? Who needs access? How do access questions affect the organization of Clinics?

Concern about boundaries, structures affecting access

Total intake of six Clinics by FSA


Most clients come from areas closest to Clinics

Torontos Three Cities


Needs dont always match Clinic locations

Toronto Community Housing

Needs dont always match Clinic locations

Clusters of need

Blue: Income Red: Housing Yellow: Immigration Green: Family Pressure

Neighbourhood clusters of need

Clinic Boundaries

Varied definitions of local


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

Discrepancy in size results in discrepancy in staffing

Larger Clinics form teams, smaller Clinics cope with fluctuations Different ratios of lawyers, community legal workers and paralegals

Variations in staff complements

Smaller Clinics express frustration about staffing constraints/flexibility

Findings access points and proximity

Clients require familiar gateways to services

Easy to reach Presence of established, substantial, professional organization

Principle of local proximity strong determinant of good service delivery


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

Range of informal partnerships supporting areas of law, referral and service


Broaden scope of service and enhanced capacity of Clinics Potential for coordinated services, collaboration, colocation 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

Smaller Clinics found dedicated partnership time harder to accommodate

Findings intake models

Phone and walk-in intake support broader access to service


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

No clear criteria underlying existing boundaries

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

Inconsistent staffing allocation criteria


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 Landlord/tenant, income supports, immigration Staff sizes range from 5-10 staff in each Clinic Some Clinics working within an integrated team model

Most Clinics operate primarily in three areas of law

Findings Clinic size

Criteria varies too widely in size, volume of clients and internal capacities New boundaries should be based on clear criteria

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


Sustaining awareness in context of ongoing demographic and needs shift Role of community boards, outreach staff share role in leadership

Findings catchment boundaries

Relationships important in advocating on behalf of clients

Catchment boundaries based on adjudicating bodies, governments sustain relationships Elected officials as sources of referral, avenues for law reform and client advocacy

Local service networks and delivery systems shape catchment


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

Multiple tools support staff communication and enhanced client support


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

Clients have more confidence in legal services delivered by organizations with a clear physical presence in the community

Administration

Dedicated administrative support needed with enhanced client-centred services


Support for formal partnerships Focused intake structure IT infrastructure