What is it that health justice partnerships actually do?
In this post our Partnerships Director, Lottie Turner, explores the common activities undertaken by services working in health justice partnership. This blog is an edited excerpt from Health Justice Australia’s webinar with The International Foundation for Integrated Care Australia in March 2021.
At its heart, health justice partnership (HJP) is a flexible, place-based, person-centred approach to care and systems change. And while there will always be differences in the implementation of HJPs depending on their local context, infrastructure, resources and the like, we’ve been able to identify six common activities of services working in this innovative way.
The activities we commonly see in the work of HJP
1. Embedded legal help
This enables legal services to reach and assist those disproportionately burdened with legal need, but less likely to seek help directly from lawyers at all or in a timely way; and it provides health services with another tool to address the social problems that drive poor health. The notion of ‘timely’ here can mean early in the life of the problem (capturing issues before they descend into criminal justice – in health language, early intervention). But timely can also be the time and place that works for people, in terms of their readiness for help.
2. Referral pathways
Referral pathways – including those that support warm referral – are being established to enable streamlined, accessible and appropriate access to help from the health service to the embedded legal service, and from that legal service back into the partnering health service. Careful attention is being made by HJPs when building these referral pathways, so as to minimise the risk of people becoming trapped on a ‘referral roundabout’ and to ensure what is being referred is appropriate and within the scope of the services available.
3. Interdisciplinary training
Most commonly, training in HJP involves building partnering practitioner capability. When delivered by legal services to their health partners, the focus is often on how to identify health-harming legal needs and link patients/ clients with appropriate help. When delivered by health partners, interdisciplinary training most commonly involves building legal practitioner capability to provide assistance that is informed by the health needs and experiences of their clients (this can be anything from working in trauma-informed ways, to understanding the impacts of certain medications or diagnoses on a person’s behaviour).
4. Secondary consultation
Training isn’t the only way practitioners are working to build new capability. The activity of secondary consultation is also being enabled by health justice partnership.
In health justice partnership, secondary consultation refers to an information-sharing activity where a practitioner shares their legal or health expertise with a partnering practitioner, with the purpose of helping to directly support service users. This activity can be both formal (occuring within an agreed structure and process) and informal (more opportunistic discussions).
5. Coordinated care
There are lots of ways in which legal and health services are starting to coordinate their service responses. This might be the involvement of a lawyer in multidisciplinary team discussions, through to the team-based care provided by, say, a social worker and lawyer for a shared patient/client. We think the establishment of trust between partnering practitioners is key here; and the building of that trust requires a sustained and intentional approach by the partnering services over time.
6. Joint policy advocacy and systems change
This activity is really about advocating for and making changes to the policies and systems that are holding health inequity and injustice in place for the patients and clients of HJPs. The HJP model itself is a great example of local systems change.
Each of these activities provides the opportunity to work together to address health inequity and injustice, but what does it take to make them happen?
The partnering that enables HJP activites to thrive
As was put to me recently by a legal practitioner working in HJP, these activities don’t just happen when you insert a lawyer into a health service and stir. They require sustained investment in relationships and collaborative process to happen.
Now, this investment does vary across the health justice landscape, but at its deepest we see a real commitment from health and legal services to co-create a service model, and collaborative governance structure to oversee and implement that model towards shared goals and outcomes. This is a long-game investment by services and involves the building of trust and confidence in each other’s practice and contributions.
HJPs don’t always articulate this as being the case, but what we know from partnership evidence is that investing in partnership as a process will often involve the exploration on a number of principles, including notions of power and equity (as its held by and manifests in individuals, diciplines and service systems); how to draw on the diverse practices and perspectives of partnering services and practitioners; acting with transparency and openness, in relation to expectations, as well as what’s possible and what’s not; negotiating interests and finding an approach that aligns with the interests of all partnering services; and exploring the risk appetite of partners and what this means in the context of uncertainty around things like limited funding, or because the outcomes and return on investment are unknown.
All of that work takes courage and the ability of practitioners and service leaders to disarm themselves of the need to have all the answers. It means being able to sit with the discomfort of uncertainty, resisting the urge to fall back into individual ways of responding to problems when what’s required is a mix of perspectives, tools and resources.
