A.      Introduction

In the previous chapter, we referred to changes in accessing the family justice system that we believe might assist users who cannot afford a lawyer, who are not prepared for one reason or another to access the court system and who need help in using self-help materials. These changes focus on the role of community-based trusted intermediaries to assist those users of the family legal system who may need help for reasons of literacy, language, culture or lack of economic resources; easier access to information; improved access to self-help tools; properly regulated representation by lawyers trained to deliver less than full service; and service by legally trained persons other than lawyers. In this Chapter, we suggest that while these changes in and of themselves may improve access to the family justice system, delivering them in an integrated manner, linked to more advanced services, may help a person facing family difficulties move more effectively through to a resolution of their problems, to the benefit of both users and the system.

People in the midst of relationship breakdown face a number of challenges some of which are legal problems but many of which are not. Although a number of stakeholders in the family justice system appreciate that family breakdown gives rise to social and economic issues as well as legal issues, there have been limited efforts to date to provide integrated services. The result for many people is that they are required to devote a significant amount of time and energy, at a time of personal crisis, navigating a complex web of services. 

In some respects, this problem is analogous to the difficulties with the health care system. One commentator has written about the health care system, “without a clearly identified entry point, it’s much harder to co-ordinate efforts.”[406] He points out that “there is no place in the health care system where patients can routinely go to access the care they need promptly and efficiently and that tracks them throughout the health-care “journey.” The de facto entry point becomes the emergency room rather than a regular caregiver (family doctor). There is no real gatekeeper for expensive services and little continuity in care. He further points out that interdisciplinary teams, which includes nurses, pharmacists and other health professionals (but not necessarily doctors) could provide continuity. [407] We discuss the interdisciplinary approach developing in health care below. 

We believe that a similar interdisciplinary approach would be equally beneficial in dealing with family justice problems. Comprehensive or integrated entry points, “multidisciplinary, multifunction centres”, would offer information, counseling and services such as legal advice and assistance that would allow an individual to move smoothly through to a resolution of their matters whether through alternative dispute resolution (which could be provided on site) or, as appropriate, the courts. The primary purpose of the centres would be to improve access for those who cannot afford a lawyer; however, the implementation could be linked with private delivery to provide delivery on a cost basis, as private practitioners now might refer their clients to other services.

As we discuss below, these multidisciplinary, multifunction centres do not need to take a particular form in order to provide the services required to create effective entry points. Adherence to a particular form may not be practical for economic and other resource reasons and it also may not be optimal for all parts of the province. We discuss several models below. What needs to be common to them all, however, is that this single entry or access point provides a wide range of legal and non-legal services (or easy access to the latter), provides a seamless path for users through the system that is responsive to their needs and allows flexibility as users wind their way through the system. 

While collaboration is essential given that the responsibility for service delivery is diffuse among many stakeholders, it can take a variety of forms:

In the literature on human services organizations and inter-organisational relations, collaboration [means]…the formal joining of structures and processes between organizations. It is part of a spectrum ranging from the informal to the formal, beginning with cooperation (as an informal information exchange), through coordination (as in development of formal protocols) and ultimately, integration, which involves the formation of new organizational structures….[408]

Family breakdown is a multi-faceted problem, the most effective resolution of which is multi-pronged possible involving a number of organizations and service providers. All major stakeholders in the family justice system agree that early intervention and a timely resolution of disputes are better for families. Generally speaking, and where appropriate, negotiated resolution is more likely to be longer-lasting and satisfactory than one that is imposed, sometimes on a party who feel aggrieved by the result. A negotiated resolution may not be appropriate in some cases and this is accounted for by the system at the early stage, as we discuss in Part One. We believe, however, that integrated access to the system can contribute to more effective resolution at later stages. At present, there is no clear entry point into the family justice system which provides an integrated response. We believe that in the longer term, investments in an integrated access point can make the family justice system more responsive and efficient by reducing the pressures on persons in a family dispute and on the family justice system. We also believe that holistic approaches provide a more sustainable outcome which reduces the pressure on the system arising from families continuing to come to the courts as their needs and circumstances change. As Julie MacFarlane has noted, 

In the family area, family clients can benefit from the combined expertise of lawyers, therapists, child and family counselors, child welfare specialists and financial planners.  In each case the added value for clients who can afford a range of integrated services is that they are able to build comprehensive, long-term solutions to planning for uncertainties, crises, or conflicts instead of purchasing piecemeal advice, which may overlook opportunities for creative solutions or which may ultimately conflict or collide with advice from other professional consultants.[409] 

We appreciate that not everyone agrees with our recommendation for the integrated access point, partly because there is an assumption that it will be costly, but also, more substantively, it is believed that the goals of the integrated access point are already being met. For example, the Advocates’ Society suggested, in response to our Interim Report, that

Many of the objectives of the proposed “multi-disciplinary multi-functional” centre are already being implemented through the existing FLIC/IRC/MIP model. Expanded support and funding for the existing infrastructure is a more efficient and streamlined strategy than creating a new model of service delivery.

While we agree that the court based services referred to by the Advocates’ Society are beneficial, they do not address the issues we have identified throughout this Report, namely that there has been no systemic approach to addressing diversity; that the existing combination of Family Law Information Centres, with Information and Referral Coordinators and Advice Lawyers, and the Mandatory Information Program does not providesufficient affordable legal services; and while the IRCs are tasked with making referrals, they are in no position to provide a holistic response to all of the issues arising from family breakdown. Furthermore, although these services are not dependent on the individual’s having decided to make an application to the court, they are significantly linked to the courts. This is one of their advantages, but it also means that those at the earliest stage of thinking about their dispute or who for whatever reason are reluctant to enter the court system are less likely to receive help. 

The submission we received from the Ontario Collaborative Law Federation, supported the concept of providing interdisciplinary resources outside of the court system:

We agree that the resources for families (entry points) should not be tied to the court system and in particular parties should not have to start litigation to avail themselves of these resources. It is interesting to note that your interim report supports the need for families to be able to access mental health (family) professionals and neutral financial professionals as well as lawyers. This inter-disciplinary team approach is unique to the collaborative process.

A mental health or “family” professional (acting as a collaboratively-trained coach or a neutral facilitator or child expert is able to assist lawyers in screening for any power imbalances, personality issues or significant communication challenges. They often work with clients outside meetings to help address non-legal issues and to develop parenting plans. Collaborative professionals work together, not at cross purposes, and keep each other informed…Family law clients often need assistance with emotional and/or financial issues. Providing clients with the particular expertise they need helps expedite the time required to address their legal issues.

 

B.      Lessons from the Health Care Sector

Our health care system has been grappling with issues around lack of coordination in service delivery for a number of years and has identified “interprofessional care” as a model for effective patient-centred health care:

The envisioned system would involve and be representative of the individuals and communities served. It would integrate a continuum of services encompassing health promotion disease prevention, wellness and health maintenance into community based, facility based and specialized institutional forms of care.

It would foster collaboration between professionals and communities as well as between health and other sectors
.[410]

As with family law, where a large number of people do not have the assistance of a lawyer, in regard to health care, a growing number of people lacked access to a primary care physician. By 2005, 1.2 million Ontarians were without a family doctor.[411] A decade earlier, discussion about integrated medical delivery systems portrayed them as the way to respond to “fragmented decision making, with its attendant inefficiencies in meeting patient needs, managing and policy making” resulting from the organization of the health care system.[412] Integrated models may not cut across different specialties; however, the authors suggest that 

“vertically integrated” systems appear to offer greater potential for success. These systems provide a broad range of services; clients can move quickly through the continuum of care. The most successful systems are those integrated in a local community to provide services for a specific population.[413] 

Also similar to the legal profession, the medical profession as it existed did not initially widely support interprofessional collaborations. Jacobs and Jacobs note that the Ontario Medical Association originally opposed community health centres “on the grounds that they involved a practice of medicine that threatened the doctor-patient relationship both with regard to patient confidentiality and payment for service.”[414] On the other hand, the College of Physicians and Surgeons of Ontario stated a decade ago that “in order to better meet patient needs, health care has evolved such that delivery of care no longer takes place through exclusive domains of practice but through multidisciplinary teams”.[415] Other medical practitioners, such as the College of Midwives, are also committed to interprofessional care.[416]