A. The Approach
The government of Ontario has taken up the challenge to create better partnerships among service providers. Given that many service providers delivering public services are from the non-profit sector, the government is looking at ways to strengthen its relationship with this sector. In 2010, the Ontario government launched the Partnership Project, led by the Ministry of Citizenship and Immigration and the Trillium Foundation. A report in 2011 described the “conversation between Ontario’s not-for-profit sector and the Government of Ontario.” The conversation focused on
- ways to improve collaboration between government and not-for profits;
- policy and legislative frameworks to enhance the effectiveness of the not-for-profit sector;
- funding mechanisms and new approaches to financing that would allow not-for-profits greater fiscal security and flexibility; and
- more effective methods of coordinating policy, research communication and practice.
The Partnership Project report contains the following recommendations:
- Promote a culture of respect and recognition within government and within the public by appointing a minister to be responsible for and accountable to the sector and by issuing an annual report on the state of the non-profit sector and the progress made in strengthening its relationship with government.
- Foster coordination and collaboration by providing the not-for-profit sector with an identifiable, central and authoritative point of contact within government.
- Build sector capacity through enhanced communication, avenues for greater collaboration in policy development and legislative and regulatory oversight, work with the sector to develop new approaches to funding, as well as appropriate performance measures and invest in projects which support intra-sector cooperation, communication and networks.
- Leverage technology to break down silos, increase transparency and share information.
- Invest in social innovation.
In March 2011, the government announced the creation of the Partnership Advisory Group to Project Partnership Office to implement the Report’s recommendations.
The Trillium Foundation has taken a great interest in the development of collaborative partnerships to help build greater capacity in the not-for-profit sector. Trillium’s granting program supports collaborative efforts through flexible, multi-year grants. In the past several years, 16 per cent of all grants have been to collaborative initiatives. For example, through its Future Fund, it funded the environmental sector to build capacity by having larger organizations to partner with smaller groups.
Some of the models described in the previous section are representative of the kind of partnership efforts envisioned by the Drummond Report, the Ontario Government and the Trillium Foundation. Many of the costs which would need to be incurred to create a multidisciplinary centre are already being incurred. For example, in the Consortium Model, there would be some additional costs to co-ordinate the delivery of the services which are already being provided, but would not add significantly to the cost of providing these services, yet would add the value of coordination. In the Family Justice Centre model, each service provider is delivering the services within their own budgets. The Centre provides a place for the services to be delivered and the visioning and strategic planning process allowed these services allowed for deeper integration of these services and the use of common tools and processes. The principle of progressive realization promotes identifying a long-term goal, taking steps to achieve that goal as feasible, identifying the continued gaps and stating how the gaps would be filled. This approach could be taken to creating the centres.
The consortium approach might work well in urban centres with large populations and many service providers. In other parts of the province, it may be necessary for the services to be provided directly by the government either through the creation of centres or through the use of technology to create “virtual centres” as there are few services providers locally. Increasingly sophisticated ways of using technology make this more feasible than in the past where appropriate. Over time, access to the internet will improve everywhere. However, the use of technology may not be optimum until all areas of the province have access to broadband internet or other means of access. In this regard, an interim measure might be mobile services that can provide in person assistance on a regular basis with access to virtual resources.
As stated above, the fact that the practice of family law remains largely a private enterprise is a challenge to the creation of multidisciplinary centres. The legal services provided in the Consortium model are provided by a community legal clinic and the legal services in the Family Justice Centres are provided by Legal Aid Ontario. A multidisciplinary centre operating as an entry point into the family justice system will need to find a way to deliver some legal advice and assistance historically provided by a lawyer for those that cannot afford legal services but do not qualify for legal aid. However, links can also be established between private practitioners and the centres. The ability to do this will improve if the stakeholders in the justice system move toward making the changes contemplated previously in Part Two intended to improve the accessibility of legal services. For example, a multi-disciplinary centre could have a lawyer on retainer providing summary advice and other limited scope services to clients, as well as students and possibly paralegals, under the lawyer’s supervision. If Legal Aid Ontario provided some services to a broader number of individuals, then it could have a greater role to play in the development and delivery of the legal services component of a multi-disciplinary centre.
B. Considerations in Implementing Multi-Disciplinary Multi-Function Centres
1. What are the Challenges?
Perhaps the biggest concern about the establishment of these centres that we heard about is what they may cost to implement. In the Interim Report we recognized that the establishment of these centres may be aspirational given the current economic climate and we received responses which echoed this point. For example, the Ministry of the Attorney General underscored the need for considerable resources, including facilities costs, and the Advocates’ Society stated that funds could be better spent on improving the existing supports. However, as we have discussed above, there are various models of integrated service delivery, some of which do not involve a significant investment of public money or infrastructure.
Apart from the concern about cost, there are several practical and logistical challenges that would arise from the integration of services provided by different professionals and different organizations.
A group of professionals working together in a team may have different professional obligations set out by their own regulator. Lawyers are able to offer services in conjunction with other professionals. However, rules that govern lawyers entering into a partnership with other professionals designed to protect users of legal services make this a limited option today. These rules are of particular significance for our long-term recommendations about multidisciplinary centres.
Rule 6.10 of the Law Society of Upper Canada’s Rules of Professional Conduct states, “A lawyer in a multi-discipline practice shall ensure that non-licensee partners and associates comply with these rules and all ethical principles that govern a lawyer in the discharge of his or her professional obligations.” Multi-discipline practices are governed by Law Society of Upper Canada By-law 7. It provides, among other things, that a “licensee” (under the Law Society Act) may provide the services to a client of someone “who practises a profession, trade or occupation that supports or supplements the licensed activity” and may enter into a partnership or association (that is not a corporation) in order to do so, as long as the entity satisfies certain conditions. The conditions include the following: the other professional abides by the Law Society’s rules and would be under the “effective control” of the licensee; the licensee is responsible for ensuring that the other professional practices his or her profession with the “appropriate level of skill, judgement and competence” and that the other professional abides by the Law Society’s rules; and that the licensee maintains insurance coverage for the other professional in the amount the licensee acquires for him or herself. Our recommendations are not designed for private firms; however, the ease of structuring multidisciplinary centres in a way that is truly collaborative may be affected by these rules.
Other professional have their own rules. For example, there are different professional obligations with respect to confidentiality and the duty to report. Lawyers in Ontario have a duty to maintain client confidentiality under Rule 2.03 of the Rules of Professional Conduct which is subject to the requirements of the law. Some professionals working in a multidisciplinary family centre may have a duty to report suspected physical or sexual abuse of children under section 72 of the Child and Family Services Act. Lawyers are exempted from this requirement, however, which does not abrogate solicitor-client privilege. This concern about confidentiality is acute for survivors of domestic violence. In its response to the Interim Report, Luke’s Place supported the creation of multidisciplinary centres but cautioned that many women survivors of violence are concerned that their information be kept confidential.
Jacobs and Jacobs discuss other factors which suggest a “culture clash” between the professions that may be involved in resolving the issues arising from family breakdown. MacFarlane notes challenges in determining issues of control and role parameters as well as differences in practice methodology and philosophy. She observed that: “[t]here is a tendency for each profession to value its particular expertise above others”. Those in the helping professions may regard lawyers as overly adversarial and skeptical of the judgments of others. There is concern that lawyers escalate conflict. Professionals may also have pre-conceived notions about the nature and value of work done by other professionals. Moreover, the perspective of what the appropriate outcome should be may be informed by the professional’s perspective. For example, inconsistent behavior and memories may be understood differently by a social worker who is counseling a client as compared with a lawyer whose advice may change depending on the facts provided by the client. This last, at least, should be an advantage of multidisciplinary service provision if professionals are open to learning from others.