Canadian Cancer Society Relay for Life Evaluation

Clinic Transformation in East Toronto StudyJune 4, 2013

1ContextEast of Yonge St. StudyCreated by ClinicsFunded through a grant request to LAOExamined relationship between client needs and existing structuresExplored refinements to client-centred model for poverty lawExplored potential for expanded partnerships, collaboration, other new relationships between Clinics Poverty law exploration Community profilesDemographic analysis of each census tract in catchments Exploring concentrations of challenges relating to income, housing, immigration and family obligationsReview of literatureInternational English language literatureService provisionAccess to justicePoverty law exploration Focus groups6 front-line Clinic staff focus groups6 focus groups with Clinic clientsKey informant interviews6 Clinic Directors2 Private Bar Lawyers2 PBLO/Pro Bono Students6 community organizationsMethodologyReview of patterns of service use in all east end Clinics Review of caseloads in each Clinic by typeReview geographic mix of clients in each ClinicReview of different staffing structures and modelsComparisons of existing models of delivery in other Clinics in OntarioReviewed data, challenges, options with Clinic EDsData showed significant challengesGrowing demand for service by clientsPressure on scope and volume of serviceVolume of demand consistency exceeds capacityCase selection reflected very dire need, not full scope of demandServices restricted to clients at very, very low income levelsDemand for expanded areas of law Employment, more Immigration, Family law6Data showed significant challengesNon-case related serviceSome Clinics face difficulties to maintain community outreach and engagementSustaining PLE and community development challengingUnable to keep up with law reform demandFront-line community outreach efforts often pushed to back burnerSustaining partnerships with other organizations serving low income communities challenging 7Data showed significant challengesAccess to justiceCentral considerationWhat impedes access? Who needs access? How do access questions affect the organization of Clinics?Concern about boundaries, structures affecting access8Total intake of six Clinics by FSA

Most clients come from areas closest to Clinics9Torontos Three Cities

Needs dont always match Clinic locationsNeeds dont always match Clinic locationsToronto Community Housing

Clusters of need

Blue: IncomeRed: HousingYellow: ImmigrationGreen: Family PressureNeighbourhood clusters of need

Clinic BoundariesVaried definitions of local Variations of geography some Clinics in large areas, far from clientsLarger potential for travel challenges and access issuesClients in larger catchments less likely to access service if office is far from home14Clinic staffing models Staffing and structureDiscrepancy in size results in discrepancy in staffingLarger Clinics form teams, smaller Clinics cope with fluctuationsVariations in staff complementsDifferent ratios of lawyers, community legal workers and paralegalsSmaller Clinics express frustration about staffing constraints/flexibilityFindings access points and proximityClients require familiar gateways to servicesEasy to reachPresence of established, substantial, professional organizationPrinciple of local proximity strong determinant of good service deliveryStrategies needed for diverse communities and geographic neighbourhoodsReview of target populations, patterns of services need, barriers to serviceSmaller Clinics found creating satellites or access points more difficult

Findings - partnershipsRange of informal partnerships supporting areas of law, referral and serviceBroaden scope of service and enhanced capacity of ClinicsPotential for coordinated services, collaboration, co-locationProfessional (pro bono), individuals, student partnershipsIntensity of partnerships must be based on strategy to meet needs of communityDedicated staff time needed for successful partnershipsSmaller Clinics found dedicated partnership time harder to accommodate

Findings intake modelsPhone and walk-in intake support broader access to serviceInformed intake staff familiar with legal and local social services reinforce quality serviceIn-person intake preferred when possibleIT challenges to successful intake Findings Clinic structureNo clear criteria underlying existing boundariesNot aligned with adjudicating bodies, administrative officesVary in size and populationMany too large for truly local access but too small to create local hubs or satellitesFindings staff structureInconsistent staffing allocation criteriaSmaller Clinics benefit from proximity to clients; challenges in diversified team, flexibility and workloadsLarger Clinics share workloads, support specialized skills and expertise; challenges in engaging and being responsive to communitiesMost Clinics operate primarily in three areas of lawLandlord/tenant, income supports, immigrationStaff sizes range from 5-10 staff in each ClinicSome Clinics working within an integrated team modelFindings Clinic sizeCriteria varies too widely in size, volume of clients and internal capacitiesNew boundaries should be based on clear criteria Should reflect client populations and their needs, and ways in which Clinics operate most effectivelyTransportation barriers and proximity of service should be integrated to increase accessConnection to community key element of successSustaining awareness in context of ongoing demographic and needs shiftRole of community boards, outreach staff share role in leadershipFindings catchment boundariesRelationships important in advocating on behalf of clientsCatchment boundaries based on adjudicating bodies, governments sustain relationshipsElected officials as sources of referral, avenues for law reform and client advocacyLocal service networks and delivery systems shape catchmentReinforce local, community input into service planning, referralPhysical proximity increases opportunities for local issue identificationWell maintained relationships sustain effective service deliveryFindings information technologyMultiple tools support staff communication and enhanced client supportClients need access to in-person support, complemented by other methods/toolsOnline document management, including scanning capacityMobile communication tools for staff (cell phones)Management time necessary to support and coordinate staffFindings locations, administrationPermanent locationsClients have more confidence in legal services delivered by organizations with a clear physical presence in the communityAdministrationDedicated administrative support needed with enhanced client-centred servicesSupport for formal partnershipsFocused intake structureIT infrastructure