Inter-Disciplinary Law & Health Student Clinic University of South Australia Dr Katia Ferrar

1. Inter-Disciplinary Law & Health Student Clinic University of South Australia Dr Katia Ferrar Mr Matthew Atkinson Ms Betty Kontoleon Ms Anja Kantic

2. Health Law

3. Plan The beginning – pro bono health clinic Law-health partnership Health justice Stakeholder consultation Educational module and workshop Trial clinic Evaluation Surprises and challenges

4. Pro bono Health Clinic • Open Door Health Clinic • opened May 2017 • AMP Tomorrow Maker Grant • Partnership with The Salvation • Army • unique in Australia • physiotherapy and podiatry services • for those experiencing homelessness • and in crisis

5. Law-Health Partnership • Email from Matthew Atkinson, Managing Solicitor of the UniSA Law Clinic • “…There is often connection between homelessness, health and legal problems. As such, I thought it might be useful to see whether in the future there is an opportunity for collaboration beyond referral. “ • Brainstorming meeting •  Internal UniSA grant application

6. Health justice • Social determinants of health • Access • Quality of care • Health  legal and legal  health • Inter-disciplinary approach = better outcomes • Trust: health worker vs lawyer •  responsiveness and effectiveness of • meeting needs of vulnerable people

7. Inter-Disciplinary Law & Health Student Clinic…

8. Stakeholder consultation Expert Students: law and health Staff: TSA and research team Virtual classroom and email rounds: Knowledge requirements, operational framework, referral process, clinic procedures, documents

9. Stakeholder consultation The process highlighted: High interest level High perceived need Low level knowledge about opposite discipline Different languages Complex nature of referral Different ethical and legal considerations Less considered ‘legal’ wording of health documents Student education required

10. Educational Module • Objectives: • Provide background homelessness and social determinants of health • Provide background on theory of health justice • What does a law student do? • What does a physio student do? • Ethical standards in physiotherapy and law • Policies and procedures and documents

11. Module Evaluation Students Flipped classroom issue – low perceived importance Good foundation “set me up for the first day” Peer delivered (videos) “I think it's always useful to hear from your peers and what they got out of a particular subject or what they do in their specific discipline”

12. Workshop • Objectives: • Interdisciplinary engagement in key educational concepts = • 1. Awareness and identification of law/health issues • 2. Exploration of different language/questioning used • 3. Health vs law ethical and legal requirements

13. Workshop Scenario-based working in interdisciplinary pairs/3s Awareness and identification of law/health issues Exploration of different language/questioning used SCENARIO 1: Geoff is a 60 year old male who is experiencing a long-term unstable housing situation. He was recently evicted from his property and is now living in unsuitable rental accommodation. He is very stressed around the whole move, especially as he recently experienced an attempted break-in at the property. Geoff has difficulty with accessing transport as he does not have a driver’s license. He continually telephone calls from various people asking for money. Geoff is struggling because the house is practically unfurnished which is impacting his sleep quality and pain levels. He is struggling to hold down a job and has recently lost his last position.

14. Workshop • Identify the issue(s) and consider how the health/legal issues might link with each other • What do you need to know more about to clarify a potential referral issue? What questions might you ask the client to find out this information? • Musculoskeletal pain and chronic pain • Some law students would have consider referral • No physio students would have considered referral • Language used different • Physio seek out psychosocial information ++

15. Workshop Health vs law ethical and legal requirements SCENARIO 2: Sally is a 15 year old female who attends the clinic and appears withdrawn. She complains of a sore right arm but is hesitant to provide detail about the cause of the injury and engage in conversation. She claims she fell down the stairs. She reports living with her 45 year old partner, Peter, but also says that he has anger issues so sometimes she has to stay at her friend’s house. She does report a history of other injuries but is reluctant to go into detail.

16. Workshop • What do you need to know more about to clarify a potential referral issue? What questions might you ask the client to find out this information? • What ethical implications from the legal and health perspective? How, as a team, would we work together to help Sally? • Confidentiality and privilege • Abuse and mandatory reporting • Under age clients

17. Workshop Evaluation Students “...the most beneficial part of the four weeks because we really delved in depth in what each profession was allowed to do what you're mandated to do how you could influence each other and stuff like that” “I just think it's not something we do get to do in any other setting and so I think that was really great and even when we go into practice it's good to know how things work on that side of things.” “I really liked the workshop …and the wind up at the end (debrief week 4) where we sort of shut the doors and all had a bit of a debrief everyone had a deep breath”

18. Trial Clinic • 8 weeks ( 2 x 4 week blocks), 1 afternoon/week • workshop day 1 each block • law students in pairs • physio students individual • referrals from TSA case workers and health/law • proximity allowed consultation between students and supervisors • debrief session week 4

19. Trial Clinic Evaluation • Students • Knowledge ↑ • “I think it probably opened my eyes to many more avenues of the relationship between health and the legal side of things” • understanding other profession and ethical and legal differences • Skill ↑ • issue identification and referral • perceived comfort working inter- D team • +ve but too short • forms and process needs refining • more inter-disciplinary interaction wanted

20. Trial Clinic Evaluation Clients Having both physio and law in one location also made it much easier to access. Especially if you don’t have access to transport More aware now of how something like a stressful legal situation can actually affect physical health 4 week duration difficult +++ clinic should continue

21. Challenges and surprises Steep learning curve for research team New languages Procedural ‘workarounds’ Workshops exceeded expectation Timeframe limitations Daily student interactions Proximity and confidentiality

22. Inter-Disciplinary Law & Health Student Clinic What now?

23. Inter-Disciplinary Law • & Health Student Clinic • feasible  • acceptable • share insights • scale-up • multi-site trial •  outcomes • evaluation

24. Inter-Disciplinary Law & Health Student Clinic Katia Ferrar Matthew Atkinson Acknowledgment: AMP Tomorrow Makers Fund UniSA Research Themes Investment Scheme grant The Salvation Army staff Clients Anja Kantic Betty Kontoleon