Miller, Belinda; Lauman, Angela; Taplin, Kath --- "Integrated case management: Helping women to access justice" [2018] PrecedentAULA 11; (2018) 144 Precedent 42

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INTEGRATED CASE MANAGEMENT: HELPING WOMEN TO ACCESS JUSTICE

By Belinda Miller, Angela Lauman and Kath Taplin

Heidi^[1] is a young Aboriginal woman who approaches the Women’s Legal Centre (the Centre) for help. It is not her first visit to the Centre. After experiencing childhood sexual and physical abuse, Heidi dropped out of high school and entered into a relationship involving physical and psychological abuse. She has had several children to her abusive partner. One has a significant disability requiring ongoing specialist care. All of the children have been removed from Heidi’s care for an extended period by child protection authorities, who have cited the children’s exposure to the violence perpetrated against her as a primary reason for their removal. She hopes to have her children returned to her care within the next year. To achieve this, child protection authorities have said she needs to show that she has left her violent partner, that she can maintain a steady and sufficient income, has a car and a secure rental property. Over the past five years, she has engaged with a series of lawyers, some private, paid for by loans Heidi got from family, and some from Legal Aid and a community legal centre (CLC). She has had a tendency to disengage from many of the lawyers she has worked with, finding the process overwhelming and stressful, and has struggled to provide lawyers with the information that they need on time. Some have refused to continue working with her as a result. Heidi has ongoing mental health challenges; some she says were caused by the complex trauma she suffered both as a child and since. She has been on and off her prescribed medication over the past few years.

INTRODUCTION

Integrated case management (ICM), or the practice of offering integrated legal and non-legal services to a client, is typically regarded as a specialist CLC service offering for vulnerable clients with complex needs. Strongly associated with community legal approaches, ICM has not been the subject of significant academic or other research in Australia, and its application in alternative settings has been underexplored. However, a recent focus on ICM, in part caused by government support for the practice and associated funding for the community sector,^[2] has triggered an increase in CLCs adopting this integrated and collaborative approach. This article discusses ICM, including what it involves in practice through Heidi’s case study, and how it enables women to access justice. Ultimately, it argues that legal practices beyond the community legal sector should consider how to apply some of these principles in practice.

WHAT IS ‘INTEGRATED CASE MANAGEMENT’?

Heidi contacts the Women’s Legal Centre for assistance. She speaks to the Legal Support Officer and mentions several issues, including the fact that she is being harassed at work, that she has crashed her car, has taken out a payday loan she cannot repay, and that she wants to get her children back in her care in future. Some of these are legal issues that the Centre provides services in, some are not. The Legal Support Officer books Heidi in for a joint appointment with the Centre’s social worker and a solicitor specialising in employment and discrimination. The Legal Support Officer also immediately links Heidi to the Centre’s Aboriginal caseworker for culturally appropriate peer support during her engagement with non-indigenous lawyers at the centre.

ICM is a broad term encompassing a variety of practices.^[3] In the legal context, it refers to the collaborative provision of legal and non-legal services to meet a client’s needs.^[4] This may involve a social worker and solicitor working simultaneously to assist a client, or collaboration between lawyers and other skilled non-legal staff including caseworkers, cultural liaison officers, family violence advocates and health professionals. It may also refer to a broader range of practices, including close referral relationships between legal and non-legal service providers, inter-agency collaboration and information-sharing in relation to a client or the integrated offering of one service addressing both legal and non-legal needs through suitably qualified staff.^[5] It is sometimes referred to as ‘socio-legal practice’.

The absence of a precise definition of ICM has led to creativity in how services provide or facilitate combined legal and non-legal support. In the US and Canada, for example, multi-disciplinary practices assisting vulnerable and disadvantaged clients have emerged through law school clinical education programs.^[6] In comparison, UK approaches to integrated practice have centred around the co-location of legal and other services in health settings, with a focus on ‘public health and civil justice’.^[7] Co-locating legal services in health settings, often referred to as health-justice partnerships, is also gaining traction in Australia, with the newly established peak body Health Justice Australia recording 42 health-justice partnerships around the country.^[8]

Recognition of the potential benefits these integrated models offer vulnerable clients has increased in recent years; as has the acknowledgement that further research into the benefits and challenges of these approaches is needed. In 2015, the Australian government announced that $15 million would be provided to pilot specialised domestic violence units ‘...to provide access to coordinated legal, social work and cultural liaison services for women in a single location, and allow legal services to work with local hospitals, including for women from [culturally and linguistically diverse (CALD)] communities and women living in regional/remote areas’.^[9] This funding has since been extended to run until mid-2019,^[10] and to provide for further units to be established around the country.^[11] These pilots will be evaluated, building on the available evidence base in this area.^[12]

For the purposes of this article, we have chosen to define ICM as the joint provision of legal and non-legal support by professionals working collaboratively within one organisation. At the Centre, we have the benefit of both an Aboriginal Women’s Access to Justice Program (AJP) with a dedicated program manager, and an experienced social worker within the Centre’s Domestic Violence Program (DVP) offering integrated non-legal support alongside the legal assistance provided to clients.

WHY APPLY AN ICM MODEL IN LEGAL PRACTICES?

At the appointment, Heidi has difficulty communicating her needs clearly and presents as highly traumatised and experiencing great difficulty in focusing on the pointed questions from the solicitor. Recognising this, the social worker takes the lead, helping to draw out Heidi’s key concerns and needs. After some discussion, it becomes clear that Heidi’s primary concern is getting her children back in her care. She is acutely stressed about losing her job, feeling child protection authorities will see it as a sign she is unable to hold down employment and maintain a secure home for her children. She says she can no longer attend work due to the sexual harassment she is experiencing, triggering her trauma. She has developed a psychological condition as a result, and has sought medical assistance, although she struggles to afford the specialist help she needs.

A 2010 Australian survey concluded that 10 per cent of people accounted for two-thirds of legal matters,^[13] and that disadvantaged people – including those with a disability, single parents, and those experiencing domestic or family violence – were disproportionately represented in this 10 per cent.^[14] Disadvantaged groups are therefore more likely to experience a wide range of legal issues, leading to often complex and inter-related problems spanning a variety of legal and non-legal needs.^[15]

Women represent the majority of this disadvantaged group.^[16] Many of the Centre’s clients present at crisis stage, with complex multi-faceted legal and non-legal issues confronting them. Straightforward legal interventions will not, alone, assist such clients to exit crisis and address the challenges in their lives. ICM models are particularly beneficial when dealing with client groups presenting with complex issues at crisis stage, typically highly disadvantaged groups, including Aboriginal women clients, CALD women clients and those experiencing family violence.

The ICM model is particularly advantageous in assisting these groups to access justice, for several reasons. First, the different practical skills and focus brought by legal and other specialist practitioners, like social workers and Aboriginal caseworkers, can assist with communication difficulties the client may otherwise experience.^[17] Obtaining information from clients, particularly those who are disadvantaged or distressed such as Heidi, can be easier for solicitors in an ICM setting, as clients may be more forthcoming as a result of the skills of non-legal professionals. ICM models also help with client engagement and retention, because non-legal professionals can often bring an ability to look beyond the discrete legal issues to attempt to assist and empower clients to effectively address some of the broader issues behind their immediate legal crisis.^[18] By addressing more than their stressful legal crisis, a client’s engagement with the service is more likely to be retained. Finally, an ICM model also helps a service to deliver trauma-informed practice; a non-legal professional asking a client about their whole story and not just the legal issue helps the client to feel that they are being heard more fully than if they were faced only with a direct, problem-focused legal enquiry.^[19]

HOW DOES IT WORK?

After Heidi’s appointment, the social worker, the solicitor and Aboriginal caseworker have a case management meeting. Based on their appointment with Heidi, they categorise her needs into legal and non-legal, and triage them according to time frame. The solicitor has identified a short-term legal need in relation to her employment with both a Fair Work Commission claim and a workers compensation matter. Heidi would like to proceed with these actions but the social worker is concerned that it could further strain Heidi’s mental health. The social worker agrees to refer Heidi to a free counselling service to support her until a longer-term treatment can be sourced. The AJP Manager agrees to liaise with a community jobs provider to ascertain Heidi’s potential for alternative employment before the solicitor commences the legal action. It is agreed that the social worker will be the central point of contact for Heidi, in the hope that she will establish a relationship of trust with the worker and the Centre. Heidi has confirmed that her primary goal is to get her children back, which will involve working with a different solicitor who specialises in child protection work in the future.

Although ICM can take many forms, its practical operation has certain hallmarks. A key feature is the role and presence of a case manager able to encourage and oversee collaborative inter-disciplinary work towards achieving the client’s goals.^[20] This may be the solicitor or the social worker, depending on the needs of the client or even the stage of their engagement with the service. An important indicator of a successful ICM practice is clear understanding of the identity and role of the case manager, often established through case management meetings.^[21] Having an identified case manager helps the client to stay engaged and feel confident that their needs are understood, and that there is a commitment to attempting to meet them. A consistent point of contact helps the client to develop trust in the service’s ability to understand and meet their needs. In the experience of the Centre, trust can engender better communication, which can result in the disclosure of additional information and, in turn, greater clarity regarding the client’s challenges and needs.

ICM relies on a clear understanding of client goals and needs, both legal and non-legal. These are not always mutually exclusive and often the resolution of either a legal or social need will result in the mitigation of the other. ICM meetings are critical to establishing these needs, understanding them as they evolve (which is often the case in complex matters) and reviewing appropriate approaches to them as matters progress.

BENEFITS AND CHALLENGES OF AN ICM MODEL

The employment solicitor commences an employment law claim for Heidi. The social worker stays involved, including supporting Heidi through the conciliation. While Heidi wins a small settlement, she ultimately loses her job. The AJP Manager liaises with Indigenous community organisations to help identify new opportunities for Heidi. She also talks with Heidi from the perspective of an Aboriginal woman who understands intergenerational trauma and Heidi’s deep fear of child protection authorities and child removal. The social worker works with her to get her more ‘job ready’. The employment solicitor closes the legal file; however, Heidi remains involved with the social worker, who is helping Heidi to stay engaged with the Centre through weekly phone calls, and assisting her to achieve her goals of a stable home and income to prepare herself as best as possible to get her children returned to her care. Recently, the social worker has introduced Heidi to the Centre’s child protection solicitor, beginning their relationship ahead of Heidi’s likely need for legal assistance in this area. Together they are helping Heidi be in the best position possible in preparation for the matter possibly proceeding.

As outlined above, the model is very beneficial at improving client engagement and retention, in turn improving access to justice for disadvantaged groups. However, the ICM model is not without its challenges.

Resource-intensive

ICM approaches are resource- and time-intensive to set up and develop, and require leadership and staff engagement to achieve success over time. As Mary Anne Noone and Kate Digney have stated, integrated service practice requires ‘the investment of scarce resources and energy in developing and maintaining relationships with other organisations. Upper management involvement is critical in ensuring this occurs.’^[22]

While it is important to acknowledge the resource intensity required to develop effective ICM programs, integrated approaches can also bring efficiencies and effectiveness to working with clients with complex issues. This is achieved by managing a range of linked problems through more effective problem identification, the ability to leverage economies of scale and more enduring efficiencies achieved by addressing both underlying and presenting problems.^[23] Staff tend not to work on a case all at once, but rather the ‘load is spread’ across the organisation. In our experience at the Centre, the key is learning how to co-ordinate as a team and working in the same direction with minimal duplication. Willing and able teams get better at it as they go along.

Support from government funders is critical to the development of effective and sustainable ICM practices in the community sector, which is acutely under-resourced. While the Women’s Safety Agenda funding prescribes that legal support must be provided in conjunction with social work and cultural liaison services, this is not a common requirement of core CLC funding arrangements. If governments want to support innovative and effective ICMs across the legal assistance sector, they will have to ensure that the funding structures support and encourage this development.

Interdisciplinary tensions

As highlighted by Noone and Digney in their study of a Victorian Health Justice Partnership, the ability of different staff to work collaboratively is key to establishing and operating an effective ICM practice. In order to maximise the infrastructure underlying an ICM, such as co-location, staff have to recognise each others’ benefits and skills and think outside the traditional boundaries of their roles.^[24] While Noone and Digney’s observations are based on a project involving collaboration and co-location of two different services, in our view they apply similarly to the development of integrated multi-disciplinary case management within one organisation.

Working across disciplines can challenge staff to think outside their traditional roles and practices, and this can be difficult. For example, lawyers often take a problem-focused approach to assisting a client, whereas a social worker’s training and practice requires that a client’s situation is assessed holistically, and to work with them on both their immediate and underlying needs. Training, experience and skills of different professionals will impact on how they view their role and approach to working with clients to address their needs and problems.^[25] Noone and Digney also found that ‘risk and professional perspectives were seen as barriers to holistic and integrated service practice. This is particularly so when staff take a narrow view of the scope of their role based on their training and professional boundaries.’^[26] Perceived tensions or conflicts between professional roles can severely undermine the effectiveness of an integrated approach to service delivery.

Noone and Digney identified two different concerns about risk raised by participants in their study. First, some staff felt unqualified to raise issues outside their professional expertise, and would not do so even when they felt such issues were affecting a client. Others reported a sense of obligation to follow up when a risk was identified, as part of their duty of care.^[27] This tension is inherent in introducing integrated approaches which force all professionals involved to take a broader view of their role and of their responsibilities to clients. In our experience, these tensions do exist and can interrupt effective integrated practice. They can be addressed through training, mutual respect between disciplines, a shared commitment to client-centred decision-making, and effective structures being put in place to support case management and communication between professionals working together for one client.^[28]

Confidentiality and legal professional privilege

Tensions can also arise in relation to perceptions and realities around confidentiality, legal professional privilege and other professional obligations. This issue is deeply linked to the issues discussed above, and is highlighted in other research into integrated service delivery in the legal sector.^[29] The question of legal professional privilege in a multi-disciplinary practice is an untested question of law in Australia. While integrated legal and non-legal service models are relatively new in Australia, overseas experience strongly suggests that differing professional obligations and approaches to client confidentiality, and the issue of privilege, can be managed through training, consultation and awareness of these issues by all staff.^[30] Gyokri, in her study of health-justice partnerships in the UK and North America, found that ‘it is critical that the different approaches to confidentiality and what can and cannot be disclosed are considered at the outset...The differing obligations relating to mandatory reporting should also be made clear. All participants should be transparent about their obligations and consideration should be given to providing training on the differing obligations.’^[31] While Noone and Digney acknowledge that the professional code of conduct and specific duties of a lawyer are often presented as a barrier to multi-disciplinary legal practice, they found that this code of conduct did not routinely present a barrier to lawyers working holistically with hospital staff, and a professional respect for confidentiality, community and clients ensured trust and confidentiality were not breached.^[32] In our experience, this issue requires consideration, discussion, policy and training for all staff to feel satisfied that they are meeting their professional obligations and protecting client confidentiality.

CAN ICMS BE APPLIED OUTSIDE THE CLC CONTEXT?

While the need for ICM may be more pronounced in a community legal context, for the potential benefits of ICM are not limited to this setting. Similarly, while ICM offers concrete benefits for women, it does not exclusively support women’s access to justice. Many of the factors creating a need for ICM are present in non-community legal contexts. Any legal practice assisting individuals is likely to encounter scenarios or client groups that call for the assistance of a qualified social worker or case manager. For example, in a family law setting, the highly emotional subject matter and the disruption of a personal relationship underlying their legal issue is likely to create non-legal issues for clients, including permanent or temporary mental health issues and financial issues.

Particularly when a broad definition of ICM is adopted, it is apparent that any services firm aiming to support clients can benefit from considering applying elements of an ICM model to their practice. ICM models can be as rudimentary as having a facilitated referral path to related services and a strong practice of sharing client information (with relevant authority), through to co-habiting independent yet relevant service providers or having joint case management meetings. ^[33] Our Centre relies on a fully integrated social worker and Aboriginal case manager, as this targets the greatest need among our clients. However, other practices may benefit from close ties with a financial adviser or counsellor, supported by the infrastructure of timely communication and relevant authorities to share client information. This approach can allow clients to obtain the assistance of all relevant services, avoiding repeating information, and ensure that common goals are identified and collaboratively worked towards all at the same time.

An increasing number of Australian law firms are beginning to embrace some form of ICM. Some multinational law firms advertise services in consultancy and crisis management alongside their traditional legal offerings.^[34] Some family law practices are now engaging social workers on staff to assist clients or focusing on collaborative law approaches, involving non-legal workers in an approach similar to ICM.^[35] These expanded service offerings, tailored to meet the needs of a client group, demonstrate the same fundamental approach as that underpinning ICM and indicate that these concepts may be applicable and relevant outside the community legal context.

CONCLUSION

ICM models bring significant benefits in assisting clients to access justice. While the need among the most disadvantaged groups in society for assistance through ICM models is very clear, the underlying principles of taking a client-centred approach and addressing holistic client need can usefully be applied in most legal practices. The ICM approach is not without its challenges, however. Resource intensity, cross-disciplinary tensions and inherent contrasts in the infrastructure behind legal and non-legal services, including differing legal obligations, can create tensions when adopting an ICM model. However, with strong leadership, respect for the contributions that multiple disciplines working skilfully together can bring, and appropriate tools and processes to support case co-ordination, applying an ICM approach can bring unparalleled benefits to client outcomes and access to justice for vulnerable groups.

Belinda Miller is an Employment and Discrimination Solicitor at the Women’s Legal Centre (ACT & Region) Inc., Canberra, where Angela Lauman is a Solicitor in the Domestic Violence Program and Kath Taplin is a Solicitor in the Aboriginal and Torres Strait Islander Women’s Access to Justice Program. PHONE [phone] EMAIL [e-mail] WEB www.womenslegalact.org.

The authors would like to thank the staff and volunteers of the Women’s Legal Centre (ACT & Region) Inc. who assisted in researching, preparing and editing this article.

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^[1] ‘Heidi’ is not a particular client of the Women’s Legal Centre. Her situation is a composite based on those of real clients of the Centre. To protect the privacy of our clients, the Centre does not use clients’ real names or their real problems.

^[2] See, for example: Prime Minister’s Press Office, ‘Women’s safety package to stop the violence’ (Joint Media Release, 24 September 2015) <https://www.malcolmturnbull.com.au/media/release-womens-safety-package-to-stoptheviolence>.

^[3] C Coumarelos et al, ‘Legal Australia-Wide Survey: Legal Need in Australia’ (Law and Justice Foundation of NSW, 2012, Sydney) 206, 221.

^[4] M A Noone and K Digney, ‘”It’s hard to open up to strangers” Improving access to justice: the key feature of an integrated legal delivery model’ (La Trobe University Rights and Justice Program Research Report, La Trobe Law School, La Trobe University, September 2010) 29.

^[5] Queensland Council of Social Service, ‘A guide to integrated service delivery to clients for community service organisations’ (QCOSS, October 2013) 4.

^[6] See above note 4.

^[7] Ibid.

^[8] Health Justice Australia, Health Justice Partnerships Across Australia (2017) Health Justice Australia <https://www.healthjustice.org.au/hjp/health-justice-partnerships-in-australia/>.

^[9] See above note 2.

^[10] Attorney-General for Australia, ‘Third Action Plan to reduce family violence’ (Media Release, 28 October 2016) <https://www.attorneygeneral.gov.au/Mediareleases/Pages/2016/FourthQuarter/Third-action-plan-to-reduce-family-violence.aspx>.

^[11] Attorney-General for Australia, ‘Turnbull Government funds new domestic violence units’ (Media Release, 16 October 2017) <https://www.attorneygeneral.gov.au/Mediareleases/Pages/2017/FourthQuarter/Turnbull-Government-funds-new-domestic-violence-units-16-October-2017.aspx>.

^[12] Ibid.

^[13] See above note 3.

^[14] Ibid.

^[15] Ibid.

^[16] Ibid.

^[17] Tamara Walsh, ‘Lawyers and social workers working together: ethics of care and feminist legal practice in community law’ (2012) 21(3) Griffith Law Review 752, 754.

^[18] Ibid, 758.

^[19] C Kezelman and P Stavrapoulos, ‘Dealing with Trauma’ (2016) Law Institute of Victoria Journal <https://www.liv.asn.au/Staying-Informed/LIJ/LIJ/October-2016/Dealing-with-trauma>.

^[20] See above note 5, 7.

^[21] Ibid.

^[22] See above note 4, 218.

^[23] P Pleasence et al, ‘Reshaping legal assistance services: building on the evidence base’ (Discussion paper, Law and Justice Foundation of New South Wales, April 2014) 163 <http://www.lawfoundation.net.au/ljf/site/articleIDs/D76E53BB842CB7B1CA257D7B000D5173/$file/Reshaping_legal_assistance_services_web.pdf> .

^[24] See above note 4, 141.

^[25] Ibid, 142

^[26] Ibid.

^[27] Ibid.

^[28] Ibid, 143.

^[29] L Gyorki, ‘Breaking down the silos: overcoming the practical and ethical barriers of integrating legal assistance into a healthcare setting’ (Report, Winston Churchill Memorial Trust of Australia, 2013) 76 <https://www.churchilltrust.com.au/media/fellows/Breaking_down_the_silos_L_Gyorki_2013.pdf>; B Zuckerman et al, ‘Why Pediatricians Need Lawyers to Keep Children healthy’ Pediatrics 114(1), 2004.

^[30] Ibid.

^[31] Ibid, 77.

^[32] Ibid, 144.

^[33] See above note 5, 4.

^[34] See, for example, Linklaters: <https://www.linklaters.com/en/client-services/crisis-management>.

^[35] See, for example, Farrar Gesini Dunn: <https://www.fgd.com.au/what/what-is-collaborative-law/>.