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

Review of literature International English language literature Service provision Access to justice

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

Toronto’s Three Cities

Needs don’t always match Clinic locations

Needs don’t always match Clinic locations

Toronto Community Housing

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

Variations in staff complements Different ratios of lawyers, community legal

workers and paralegals

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, 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 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

Most Clinics operate primarily in three areas of law 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

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