1. Health Justice Initiative St. Michael’s Hospital Academic Family Health Team, Department of Community and Family Medicine JULY 2015 Johanna Macdonald, Onsite lawyer macdonaj@lao.on.ca

2. Health Justice Initiative Partnership between the community legal clinics and St. Michael’s Hospital Academic Family Health Team is well into our pilot phase. The partnership was developed over an 18 month time frame prior to my start onsite at 80 Bond since December 15 th, 2015. My salary is funded by Legal Aid Ontario in a grant running to March 2017. The Initiative’s goals are to improve both access to justice and the social determinants of health for our patient-client population. 2

3. Health Justice Initiative Our Initiative is backed by a community development framework and includes four components: (1) Direct legal services to patients of the Family Health Team (2) Legal education with the patient population and Family Health Team health care providers (3) Leadership on advocacy and law reform (4) Engaging in evaluation of the Initiative Each of the Initiative’s program components are being evaluated. I split my time between direct client service (60%), legal education (20%), and law reform (20%). 3

4. Pilot Phase – December 2014-September 2015 For our pilot phase, we have provided direct services only at 80 Bond. We are currently creating an operational structure for the Initiative with an activity plan, procedures and protocols. Alyssa Lane is our summer Health Law intern and is completing a paper on confidentiality that will inform our communications procedures. In September, I will be joined by Rosa Tavares, our legal administrative assistant, and two students from the ARCH student Disability Law Intensive program. 4

5. Timeline and Procedure for Roll-out We want to expand our Initiative to all clinic sites in a manner that is transparent, equitable, and that builds capacity for the entire Family Health Team as we go. We will roll-out beyond 80 Bond site-by-site starting in September 2015. Today, we will choose the sequence of sites by way of random selection. 5

6. Legal Education and Roll-out of Direct Services By September 1, 2015, all health care providers will have access to legal resources including and we will host legal education sessions. 6

7. Roll-out of Direct Services Three months after rolling out to an additional site, we will monitor the following factors to decide whether we have capacity to expand to a next site: (1) Wait times for contact from legal services; (2) Is there sufficient time to provide direct legal assistance to patients; (3) Are we on target for educational goals to health team and patients; (4) Are we sufficiently engaged in systemic advocacy activities; and (5) General sense of capacity based on program goals and future plans with input from lawyer, administrative support, clinical champion, SMH and ARCH management. 7

8. Proposed Time-Line Jan 2015-Aug 2015: 80 Bond Sept 2015-Dec 2015: 80 Bond + Site 1 Jan 2016-April 2016: 80 Bond + Site 1 + Site 2 May 2016-Aug 2016: 80 Bond + Site 1 + Site 2 + Site 3 Sept 2016-Dec 2016: 80 Bond + Site 1 + Site 2 + Site 3 + Site 4 Jan 2017-April 2017: 80 Bond + Site 1 + Site 2 + Site 3 + Site 4 + Site 5 May 2017-Dec 2017: all sites continue, end of LAO grant 8

9. Direct Services Snapshot to date Referred SourceClient #'s% Non-80 Bond1213% 80 Bond Social Worker2325% 80 Bond Physician4448% Income Security89% FHT Consult55% Total92100% Month# of Intakes December18 January7 February24 March30 April20 May23 June (11 to June 15)24 Total (133 to June 15)146 Total # of visits by client- patients134 Total # of telephone calls with client-patients120 Average Time Spent Per Intake2hrs Average Time Spent Per Retained Client15hrs 9

10. Intakes by Area of Law SMHAFHT Intakes by Area of Law (15 Dec 2014-15 June 2015)Total Criminal 12 Employment including ESA, Occ Health, WSIB 11 Human Rights including ADP 7 Family including child welfare 16 Violence6 Health Care 6 Housing 13 Immigration 12 ODSP 8 Income Maintenance to include OW, CPP, CPP-D, LTD and Consumer Debt 10 Advance Care Planning 17 Personal Injury and Civil Litigation 6 General Admin/ Misc. other 9 Total133 10

11. Type of Legal Service#'s% Legal Information and Referral Only108% Advice Only3224% Advice & Assisted Referral Private Bar1914% Advice & Assisted Referral Clinic or Other3123% Advice & Advocacy/Drafting Brief Service1612% Advice & Advocacy/Drafting Brief Service & Assisted Referral1310% Advice & Brief Service & Retained54% Not contacted75% Total Legal Services Intakes133100% 11

12. Direct Service Outcome Summaries ADV = adviceAR = assisted referral BR = brief service advocacy/negotiation Housing Violence IssueServiceOutcomeSystemic Issue? 1 st ever report of sexual violence BR - Investigation on perpetrator, provide support in service Understanding of rights and process for victim’s rights. Feeling of security & potential for redress. Personal injuryAR - Consult and assisted referral to private bar lawyer Advice and understanding of rights. Potential $$. IssueServiceOutcomeSystemic Issue? Lack of repairs causing poor health BR – negotiated for repair/ gave advice and template letter for repair Knowledge of rights Empowerment re. advocacy with landlord Medical transfer –social housing BR – negotiate/advocate with landlord Disability accommodation knowledge Hopefully speedier transfer 12

13. Direct Service Outcome Summaries Criminal Employment IssueServiceOutcomeSystemic Issue? Charge outstanding –bail conditions no go home BR - Negotiated with CrownBail variation able to go home (resolved homelessness) & rights advice about criminal process Criminal record implicating job prospects/causing stress BR – query re. record and request for destruction Record destroyed. Decreased stress. Further employment opportunities IssueServiceOutcomeSystemic Issue? Let go from contract job without notice AR - Assisted referral to employment lawyer Advice and rep. on wrongful dismissal/employment standards claim. Recovered income Let go from job for being sick and/or pregnant AR - Assisted referral employment lawyer. Identification of employer’s breach re. accommodation in employment Advice and rep on human rights complaint and/or wrongful dismissal 13

14. Direct Services Referrals Form on EMR and Self Referrals 14

15. We look forward to working together with you! Johanna Macdonald, Onsite Lawyer macdonaj@lao.on.ca (416) 864-3004 Rosa Tavares, Program Assistant tavaresr@lao.on.ca 15