Evaluating Heath Justice Partnerships: The ‘justice’ angle Seminar and workshop on the evaluation of Health Justice Partnerships 25 February 2015 Suzie Forell and Hugh McDonald Law and Justice Foundation of NSW

Outline The evidence for legal service participation in health justice partnerships Implications for evaluating legal assistance in HJPs Challenges to evaluation of legal assistance services – Identifying legal outcomes – Data available – Readiness of the sector

Why are legal services interested in Health Justice Partnerships? 10 years + of empirical research in Australia and overseas has provided a clear picture of the nature and distribution of legal need, and the capability of different people to manage their legal issues.

Evidence indicates that: 1.There is clear inequality in the experience of legal problems – The LAW Survey: 9% of respondents had 65% of legal problems 2. Inequity links to social disadvantage – legal problems are particularly prevalent among people with chronic ill-health/disability, single parents, unemployed and people in disadvantaged housing – link strengthens as severity of illness/disability increases, particularly for mental impairment (see Coumarelos et al, 2012; 2013)

3. Social disadvantage is linked to lower capability Those most vulnerable to legal problems: – less knowledge, self-help skills, motivation and resources to deal with legal problems without help – tend towards delayed, crisis-driven help seeking 4.Advice, if sought, is generally from non-legal advisers – Only 12% with legal problems go to legal advisers – 70 % who sought help only went to non-legal advisers (see Coumarelos et al, 2012)

5. Legal problems don’t exist in isolation – occur in defined ‘clusters’, often coexisting with ‘everyday life’ problems – can both result from broader social problems and reinforce disadvantage – Legal problems have adverse consequences (e.g. stress (20%), ill health (19%), financial strain (29%) (Coumarelos et al, 2012)

Implications: Services should be increasingly client focused targeted to reach those with the highest legal need and lowest capability joined-up with other services to address complex life problems timely to minimise the impact of problems and maximise the utility of services appropriate to the needs and capabilities of users. (Pleasence et al, 2014)

HJPs provide opportunities to: Target services to groups we know have high legal need and low capability – and may otherwise not get legal assistance Provide a pathway of trust to legal help by joining- up with services accessed by these clients Potentially reach clients in a more timely way – earlier or at a point they are ready for help Provide assistance which is appropriate to client needs and capabilities

In evaluation, seek to ascertain whether, compared to other service models: 1.the ‘right’ client groups are reached through HJP ‘Right’ = client groups with high need, low capability and otherwise do not access legal help 2.the assistance provided is relevant to client needs and appropriate to their capability (process) 3.Health justice partnerships are effective and worthwhile 4.the assistance makes a difference to clients’ legal problems (outcomes)...Herein lies the challenge!

1. Reaching the ‘right clients’? Assumption: legal assistance (advice or minor assistance) is a useful intervention Test: whether assistance provided though HJPs reaches more – Client (groups) known to have high legal needs – Clients with lower capability (skills, resources etc) – Clients who would otherwise not get legal help (or timely legal help) Comparison: in-office legal services, other outreach?

2. Providing relevant & appropriate services? Does the HJP conform to best practice? See Best practice principles for Legal Aid NSW outreach services ; Planning Legal Outreach (LJF, 2015) Why/ why not? How does the project confirm with the program logic (implementation fidelity – process)

3. Are HJ Partnerships worthwhile? HJP are one way of joining-up (working together) To determine whether HJPs are worth it, we need to consider the fidelity of partnering, as well as the costs and benefits of partnering – E.g. are the benefits of partnering outweighed by the challenge of partnering effectively (i.e. inefficient)? What makes HJPs work? – What features or components do you need to make them tick?

3. Are HJPs effective and worthwhile forms of joining-up? Typically evaluate partnerships by ascertaining whether or not key ‘building blocks’ are in place – E.g. UK Partnership Assessment Tool (Hardy et al. 2003) assesses partners’ recognition of: need for partnering (why partner with them?) clarity and realism of purpose (why are we partnering?) commitment and ownership (are we in this together?) development and maintenance of trust (do they walk the walk?) clarity and robustness of partnership arrangements (how manage it?) need for ongoing monitoring, measurement and learning (to improve )

4. Does the assistance makes a difference to the client’s legal issue? The challenge of legal ‘outcomes’ Contested notions of: – What is an outcome? – What is a ‘good’ outcome? – How we attribute the outcome to the partnership: what is making the difference? ‘Outcome’ of advice and minor assistance rarely known or recorded

Main data sources Administrative data collections (e.g., CASES, CLSIS) – Not collected for evaluation, not easily interrogated Program data – Limited research capacity in the sector, incl. skills to design data collection instruments, to collate and analyse these data. External data sources (ABS, other agency data, crime stats). – Access and expertise remain issues

Readiness and resourcing of the legal assistance sector 1.Legal assistance sector has a limited history of and very little resourcing for empirical evaluation 2.Rely on busy frontline lawyers for data collection: therefore data collection – and analysis - must be modest and achievable 3.A tendency to view evaluation as a tool to ‘prove’ rather than ‘test’ strategies

In summary There is a solid rationale for legal services to be involved in HJPs -to reach and assist priority clients who would otherwise not receive legal help -to provide legal support a shared client group with complex needs This purpose should be front of mind when evaluating legal service involvement in HJPs Keep the shared objectives modest, manageable and measurable

Main sources Coumarelos, C, Macourt, D, People, J, McDonald, HM, Wei, Z, Iriana, R & Ramsey, S 2012, Legal Australia-Wide Survey: legal need in Australia, Law and Justice Foundation of NSW, Sydney. Coumarelos, C, Pleasence, P & Wei, Z 2013, ‘Law and disorders: illness/disability and the experience of everyday problems involving the law ’, Justice Issues, no. 17, Law and Justice Foundation of NSW, Sydney. Law & Justice Foundation of NSW, 2015 ‘Planning Legal Outreach’ Updating Justice No. 45 Law and Justice Foundation of NSW, Sydney. pdf Hardy, B, Hudson, B & Waddington, E 2003, Assessing strategic partnership: the partnership assessment tool, Office of the Deputy Prime Minister, London Pleasence, P, Coumarelos, C, Forell, S & McDonald, HM 2014 Reshaping legal assistance services: building on the evidence base. A discussion paper, Law and Justice Foundation of NSW, Sydney. (full report) vices_FINAL.pdf (summary report)