The social determinants of health — including education, unemployment, job security, social inclusion, non-discrimination, safe and affordable housing — are now well recognised as key drivers of the health of populations. These determinants are influenced by a range of actors and factors, including and beyond those in the health sector. As such, cross-sectoral collaboration is regarded by many as essential for addressing the social determinants of health, and improving the health of people and populations.
Health justice partnerships (HJP) are practitioner led collaborations between legal service providers and health clinicians, and have been established in response to a growing body of evidence that people who are vulnerable to intersecting legal and health problems are also unlikely to seek legal services as support for solutions.
Strong, meaningful and genuine collaborations are therefore critical to the success of health justice partnerships.
In our recent webinar exploring collaboration for systems change, we were in conversation with a health justice partnership (the HALO HJP) between Gateway Health and Hume Riverina Community Legal Service, as well as the national centre for excellence in health justice partnerships- Health Justice Australia.
The HALO HJP brings together the skills and resources of health practitioners and lawyers to create a collaborative approach to intersecting health and legal problems faced by vulnerable community members. The partnership has a client-centred, holistic, outcomes focus, which also seeks to build workforce capacity in both health and legal sectors, aiming for true transdisciplinary care. With support from HJA, the HALO HJP has been piloting a program of work over the past 3 years providing place-based support and coaching in the design and implementation of the HJP.
In our webinar, four key takeaways emerged:
1. At the heart of place-based programs are people experiencing complex, intersectional issues affecting their health. Meeting people where they are, in settings where they have trusting relationships and feel safe has been a central feature of the success of the HALO HJP where lawyers have been embedded within Gateway Health primary care teams.
2. High respect and engagement between partners are critical to achieving transformative health outcomes in health justice partnerships.
3. Adaptive leadership is essential for partners to change and grow within partnerships and ultimately support client outcomes.
4. Measuring the outcomes of a partnership is complex, with a range of beneficiaries to consider: clients, practitioners and the services seeking to partner, each with their own goals and what they seek to achieve together.
From its beginnings as a pilot program, through to its current state today as an integrated partnership between Hume Riverina Community Legal Service and Gateway Health, the HALO HJP has excelled at championing the needs of local people and practical outcomes for individuals and community, while carving space to work on the partnership and continue to invest in the success factors of the partnership.
A true exchange of skills, capacities and knowledge, the HALO HJP creates space for clinicians to view social, structural issues with new vantage points, and for legal services to support individuals to navigate issues in a holistic way. Jonelle Hill-Uebergang, General Manager of integrated primary care within Gateway Health explains,
“Key to our partnership being successful is that we ensure we have engagement across both agencies, and to do that we have to have genuine respect for what each brings to the table, and placing clients at the centre of all we do. In addition, staff capabilities and building understanding and skills has been an extraordinary journey for me. It has opened my eyes to what having lawyers working in true partnership with us to achieve incredible outcomes for individuals.”
Those that can benefit most from the work of integrated and holistic services are often the vulnerable individuals trying to navigate complex challenges. It is well understood that seismic, purposeful and systemic changes are required to redesign services that work for everyone. Acting Principal Solicitor, Deborah Fisher from Hume Riverina Community Legal Service shares how partnership working can actively change systems,
“If we are here to help the most vulnerable, we can’t keep working in siloes. We can’t just provide advice and refer people to self-help and to navigate their own way through complex systems. The most disadvantaged people in our communities cannot do that without support, and we as lawyers cannot do that without working with colleagues in health, education and community services.”
While HJPs such as HALO are helping to break down these siloes and work effectively across local health and legal service settings, they also operate in regional and national contexts — both of which can inhibit or enable partnership work. As HJA’s Partnership Director, Lottie Turner explains,
“Working at a national level enables us to translate the evidence of effective partnering to further refine and develop HJPs across the country. What’s hard at a local level isn’t always because of the individual psychology of the people who work in the organisations in the partnership, but rather the systems that work around them are setting them up to fail.”
There are therefore real and practical ways that HJA’s national perspective seeks to support health justice partnerships to thrive in communities. One of these is through gathering and sharing insights across HJPs about what works, for whom and why — providing context sensitive lessons on how to partner effectively across sectors, and how to evaluate their outcomes.
Suzie Forell, Research Director at HJA has been grappling with how to measure the outcomes of health justice partnerships, as well as how to assess the value of HJA as a supportive, intermediary organization:
“Beyond our activities, we look to our connections, our influence and our contributions. In the area of knowledge creation, we look to understand how the relationships we are building with health researchers, and services to promote the value of a legal service for client outcomes are leading the way to new skills, capacities and uptake of knowledge products.”
The role of HJA is therefore an important one: helping to advance our knowledge of the structures, processes and outcomes of health justice partnerships, as well as create and enable the systems that support strong partnering across sectors. These roles bring together local, regional and national perspectives, and are critical for supporting collaborations between services that result in better health and justice outcomes for vulnerable communities.