This concluding chapter outlines some promising practices that are effective at meeting the many challenges that face professionals working together collaboratively to delivery multidisciplinary family services. Like others, we use the term “promising practice” to express the idea that certain practices seem effective at meeting the challenges for professionals of multidisciplinary paths to family justice, although the effectiveness of the practice may not have been confirmed by an evaluation. Promising practice also expresses the idea that it may not be effective for all multidisciplinary family services. The promising practices identified in this chapter provide we think a mapping of how to realize the vision of multidisciplinary paths to family justice and ultimately how to address the legal needs of families in Ontario in a fashion that is different from the prevailing approach today.
It was clear that co-location is a key ingredient to the effective delivery of multidisciplinary family services. The actual site should be comfortable, inviting, and child friendly. A single central site can be supplemented by satellite sites providing services and programs that are located within communities with the particular needs being serviced. For families needing services, one-stop-shopping for families allows them to easily access a multitude of services – some of them they may not have realized they needed before entering the door – and be able to follow-up referrals without leaving the site. For professionals, it allows them to receive and make referrals in a seamless fashion. Just as significant it gives that professional some measure of quality assurance about the referral. It also allows for informal interactions between professionals in a way that simply cannot happen when professionals are siloed away at their own places of work.
These co-located sites should function as a gateway where the services provided can be adapted to the needs of the family. The gateway could literally be a door or it could be something like a phone number. The gateway in whatever form it takes should express the idea that it is never the wrong door to enter – families in need should just enter. Once inside, there should be timely opportunity to tell their story and have a counsellor assigned to them who can accompany them to the services they need. And, if necessary, remind them about what they need, for example, in an interview with an on-site family lawyer or dispute resolution specialist.
Co-located sites should have a managing coordinator who is able to have a vision of how the services and partners fit together and how the funding from diverse sources can be effectively utilized. The coordinator is essential in order to manage tensions between professionals when they arise. In sites that utilize information technology for collaboration along the lines described in the next section, the coordinator is the person who will make this happen.
There is no set template for the family service professionals who must be on-site. A slogan that captures this well is, “Not everyone can be co-located but everyone can collaborate.” It is clear however that there is a real value in having a family lawyer on site. Having a mediation service that would be a clear off-site alternative to mediation services provided by FLICs would also seem useful. Likewise, in sites where services for victims of domestic violence are provided, it is important to have a High Risk committee or team that can identify and respond to high risk situations quickly. A Crown Attorney on-site like in Waterloo is also beneficial. Ultimately, the actual set of professionals that are on-site should reflect the particular cluster of family problems and challenges that are faced by the community it services.
Collaboration Through Information Technology
An important challenge for multidisciplinary family service providers is how to bring together all of the professionals they need when those professionals are not co-located in the same physical space. This is an especially pronounced problem in more remote areas such as northern Ontario. We saw in Chapter Three how geography presents itself as a barrier to access services in northern Ontario. Can emerging inexpensive information technology be utilized to lower this barrier to access multidisciplinary family services?
Some software solutions, such as Cisco’s Webex, seek to imitate a collaborative meeting environment—without the need for members to come together at a real location. With the advent of web technology, connecting professionals from across the globe has moved far beyond phone conferencing. While using Webex, users connect to an online server, which has all the features of an everyday phone conference, but also allows everyone that has connected to view presentations, see documents, and run applications set up by one of their peers. In addition to viewing these elements, users can also make contributions of their own, annotating brainstorming sessions or highlighting documents. And all of this can happen on any computer with an internet connection and a webcam, anywhere in the world.
GoToMeeting, a similar service offered by Citrix Online, shares much of the functionality of Webex, with its only real difference being an invitation system by email or SMS messaging, as opposed to the login features of Webex. Adobe also offers its own Adobe Connect, which places more emphasis on video calling and relies on its ubiquitous Flash technology. Web conferencing is a rapidly growing industry, and many companies, including Microsoft and IBM have released software of their own in the past few years.
A nice illustration of a family service provider in Ontario using information technology to facilitate collaboration is Brant County’s regional domestic violence coordinating committee. This committee, which is called the Brant Response to Violence Everywhere Committee (BRAVE), has created a virtual hub of family service providers by utilizing Cisco’s Webex technology. Webex provides BRAVE with a secure online way to link professionals from all over Brant County with clients needing their services. It allows for up to 25 individuals in different places to share documents and collaborate in the provision of services. The estimated cost for Webex is $200-$250 per month.
BRAVE has a coordinator who arranges for virtual meetings between service providers and clients. BRAVE has received a commitment from all of its main partners to be available from 9 am – 3 pm every Wednesday for these sessions. Based on what the client needs, the coordinator will contact the relevant professionals and set up a time for the online meeting. The counsellor who made initial contact with the client will ordinarily be with the client when she or he participates in the meetings. It is possible that on a given day, the client could have six of these meetings – without the technology, this number of meetings could take weeks. Webex enables BRAVE to share the same information and documents with all of the service providers, which makes it unnecessary for the client to repeat his or her story again and again. The Webex technology also allows for some cultural sensitivity in the delivery of services – clients who do not want to be videoed can, for example, stand off to the side and just be heard. The virtual hub is also convenient for professionals because they too don’t need to spend time travelling to meetings. Ultimately, for professionals using this virtual hub, what is required is a paradigm shift in their thinking in terms of how they can provide their services.
BRAVE does not at present include legal professionals among those participating in its hub. Legal professionals have expressed reservations about professional standards and the provision of legal advice through information technology. However, in the case of low-level legal services – legal information, legal consultation, and informal community mediation – these professional reservations seem misplaced, for the reality is that people in Ontario turn to the internet regularly for legal information and governments encourage them to do so. In the case of BRAVE, it is easy to imagine a community legal clinic or FLIC joining the virtual hub and being available to provide low level legal services for clients with legal needs. We noted in Chapter Three that for some individuals there is some intimidation and uneasiness when physically accessing FLICs or legal clinics. From our perspective, by providing services through a virtual hub, these concerns about accessing the services offered by FLICs or legal clinics may be dissipated.
Cross-Training of Professionals
An extremely important element of successful team building is to have ongoing cross-training of professionals. These sessions are most often lead by professionals within the team. In this cross-training, the professionals share their expertise with others who may not be familiar with well established norms within those other professions. The emphasis in this cross-training is evidence-based findings and developments. A good illustration of this is the Strangulation Awareness Initiative in the Waterloo Region Domestic Violence Project. Attempted strangulation is widely accepted in risk assessment teams as a sign of increased risk of domestic violence. For many other professionals in fields such as medicine or education, this is not well known. Having a cross-training session on this theme heightens awareness across all professionals on the team.
Cross-training also facilitates dialogue and conversations, which enhances the bond and relationships between members. Moreover, by having individuals from different fields exposed to well received findings in one profession, it encourages scrutiny of received practices in that profession and reduces the likelihood of tunnel vision that is a problem for all professional practices that operate in a silo.
Defined Professional Roles and Boundaries
Successful multidisciplinary family service delivery models rely on clearly defined professional roles and boundaries. Often, this can be established by having partners reflect these professional boundaries. There has to be a high level of respect for collaborating professionals and deference when something falls within someone else’s professional boundaries. A fundamental principle that needs to guide all interactions is a principle of equality among providers. Different professionals must be mindful of where others are coming from and the limitations this sometimes puts on collaboration.
Clear Procedures for Dealing with Confidentiality
Confidentiality concerns generate some of the most tensions in the provision of family services. Professionals wonder who they can share information with and whether others are sharing with them. A common perception is that some professionals not sharing information with others on the delivery team is obstructionist. Some of these tensions can be eased with a greater understanding and respect for differences in professional responsibilities regarding confidentiality.
What is especially important is that multidisciplinary family service centres have clear procedures for dealing with confidentiality and privacy issues and that those procedures set standards that exceed the minimum ones set by professional bodies. The actual form of the procedures is flexible. One approach uses very explicit client consent forms where the client fills out a consent-to-share form that allows him or her to indicate for each agency whether or not information can be shared. A different approach, which is prevalent in health care settings, is a blanket consent to treatment form and judgements about what can be shared is based on a “circle of care” principle.
Effective multidisciplinary family service centres have communications strategy. Their messages are ideally in jargon-free language that does not reflect only one community of professionals. For reaching its client base, the media plays a fundamental role. Accessing the print media – larger newspapers and community newspapers – is one way to get the message out. Free public service announcements should also be a platform. A website is fundamental at this point in time. One multidisciplinary family service centre in Calgary, CONNECT, has developed a simple but extraordinarily effective slogan, “All it takes is one call”, which underpins all of its communications.
Another piece of the communication strategy is sharing information among family service centres. Rather than view other centres as rivals, what works is a spirit of generosity and support where other centres are viewed as resources or mentors and everyone is recognized as working together to help families who need their support.
A common theme is that there is no manual or formula for a successful multidisciplinary partnership among professionals. It is rather all about building relationships. Aside from relationships with clients and their families, there are many sorts of relationships that need to be built. Relationships among colleagues from different professions are especially important. These relationships need to reflect flexibility where individuals with different professional perspectives may agree to disagree and still problem solve together. They need to be sustainable and provide for repeated interactions. The relationship with communities should revolve around opportunities for volunteers and creating for others such as local businesses in the community a vested interest in the centre. Ultimately, the success of multidisciplinary paths to family justice relies on having people who are like-minded and genuinely believe in a multidisciplinary approach to family problems and challenges free from professional hierarchies and stratification based on status, income or job function.
Although there are some tensions between professions over the idea of empowering families, when done well this can improve the quality of the services provided in very significant ways. There are at least two strands of empowerment. The first is to make the processes and steps in the access to family services transparent, including professional responsibilities around the duty to report child abuse. The second strand is to inform people about their rights and provide them with the means to decide when to act on those rights. A nice illustration of this is the proposal to provide victims of domestic violence with personal iPhones that would enable them to call 911 directly, without using the home phone.
When legal services are integrated into a multidisciplinary family service centre, the most contentious program or service to add-on is a police presence. Views differ about the need to layer on a police presence. And some service providers such as those that provide a lot of services to marginal youth or illegal workers and their families worry that a police presence will make it much more difficult to do their job.
Assuming that there is a will to integrate police, there are some best practices worth noting. One is that police should keep their visual presence to a minimum by using plain clothes officers, no police cruisers, and no police paraphernalia.  Not carrying guns onsite seems also to be a good idea. Accommodating the special needs of the police is also important. For example, to preserve the confidentiality and integrity of their evidence gathering and records, host sites need to provide for separate internet servers for the police. Using explicit client consent forms where the client fills out a consent-to-share form that allows him or her to indicate that information should not be shared with police is also a good practice.
Curriculum Development in Professional Programs
Although multidisciplinary collaboration among professionals in the delivery of family services is becoming the norm in Ontario and elsewhere, this is not reflected in the curriculum in many professional programs. A common message from providers is that change has to begin with curriculum development. Some programs have introduced required courses on multidisciplinary service provision. Seneca College’s new Bachelor Degree in Child Development has a required third year course for all students titled “Interdisciplinary Practice: A Team-Based Approach to Child and Family Services.” Although some law schools in Ontario now offer joint degrees with Social Work, American law schools have shown much more curriculum innovation in developing courses and programs with a multidisciplinary focus around law and family services. These examples provide models for other professional programs.
This paper has been organized around the vision of multidisciplinary paths to family justice where the provision of low-level family legal services oriented towards legal information, legal consultation, and informal community mediation and other forms of dispute resolution are integrated into a multidisciplinary family services model involving a diverse profile of professionals. The argument of the paper has been that this broad vision fits with the most important developments in the provision of family services in Ontario as evidenced by innovations in primary health delivery and early childhood education. But it has also been emphasized that there are many pressing challenges for professionals in this vision. This final chapter identifies some promising practices in Ontario that can help us overcome these challenges. These promising practices provide we think a mapping of how to realize the vision of multidisciplinary paths to family justice and ultimately how to address the legal needs of families in Ontario in a fashion that is different from the prevailing approach today.
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