Towards a multidisciplinary future: Giving vulnerable clients what they want.

MDP 2By Kat Ogilvie, Social Worker, CIJ

It’s well known that people rarely present with an isolated legal issue. Legal issues are often intertwined with associated social issues, such as mental health issues, economic disadvantage, family violence, tenancy instability, homelessness, physical health, relationship breakdown, just to name a few. Modern services need to become more responsive to the complex situations that people present with.  Just as people don’t have neatly carved out issues, professions can’t have nearly carved out roles.

The movement towards services that look holistically beyond a single issue (known by many names, such as multidisciplinary practice, integrated practice, or health justice partnership) have been highlighted recently in forums such as National Association of Community Legal Centres (NACLC) conference, where countless presentations outlined successful partnerships between lawyers and social workers leading to better outcomes for people with legal and social support needs.

Importantly, discussions in these forums also focussed on the need for awareness of trauma informed practice for all professions working with people who have complex issues, in order to work holistically, not just addressing the presenting symptoms. Trauma informed practice also addresses the need for self-care and debriefing and an awareness of vicarious trauma for all that work with vulnerable people.

A number of developments this year have confirmed the increase in awareness of the importance multidisciplinary approaches, such as RMIT’s new dual qualification Master of Social Work/Juris Doctor. There is a slow but steady change in focus to placing the vulnerable people needing support at the centre of what we do, rather than asking our clients to fit in with the needs of the professionals providing a service to them.

The Mental Health Legal Centre’s Inside Access program supports women in prison and ensures that women exiting prison receive holistic support, addressing both legal and social support needs. More and more community legal centres are incorporating a social support element in their practice, particularly those with family violence or housing/homelessness programs.

There are many benefits to a multidisciplinary/integrated/partnership approach to supporting people with legal and health/social support needs. A few of the many benefits include:

Being responsive to the needs of vulnerable people. Sometimes a positive legal outcome for someone is addressing little more than the tip of the iceberg. Any ongoing underlying issues will continue to have a pervasive influence on client’s life.  We also know that people may not identify their problem as ‘legal’ in nature, so having multiple workers with various skills involved can help to identify issues and identify them early! The approach also stops people trekking from agency to agency, which increases risk of people falling through the cracks. Furthermore, trust gets established with certain agencies, so people are more likely to stay engaged with the service.

Skill match. Social work and lawyers have complementary skills and perspectives which ultimately leads to better outcomes for people using their service – social workers are taught to look through a structural lens, to look at systemic oppression, not just individual deficits. Lawyers are trained to solve the individual’s legal issue. Lawyers can be said to advocate for a person’s stated interests which may not necessarily be their best interests; where social workers can try to establish what is in the person’s best interests, taking into account their holistic circumstances. When these professions work together, we can find a more balanced approach.

Smarter ways. Approaches that look to provide holistic support to people for legal and social support needs will lead to timely identification of issues, which reduces the number of times people have to present to different services. This is a smarter and more cost effective way of working, leading to more long-term preventative solutions.

Professional Growth. A multidisciplinary approach means more professional satisfaction for those working in partnership. Social workers learn important skills around navigating the legal system and use of legislation. Lawyers can learn about the importance of self care, debriefing, supervision, trauma informed practice and ways of working with people experiencing emotional distress.

Ultimately, the two professions have a common grounding in social justice. The Australian Association of Social Workers’ Code of Ethics outlines that social work is committed to three core values: Respect for persons; Social justice; Professional integrity. The fact that social justice is one of social work’s core values means that community lawyers and social workers are fundamentally aligned in this quest.

However it’s not all rainbows and lollipops and of course any new way of practicing and bucking tradition has its challenges. Some of these are outlined here:

There can be a risk of ethical conflicts, where lawyers may feel strongly about legal professional privilege and confidentiality, as well as their duty to the legal system. One context where these issues may arise is in the family violence space, where the safety of children may be a consideration. Lawyers and social workers have different reporting obligations and risk thresholds. In Victoria (in 2017), social workers are not mandatory reporters to Child Protection by virtue of their profession, however social workers may choose to report because of an ethical obligation, or because of organisational requirements of their employer. There are also important considerations around files and note taking – social work file notes can be subpoenaed (it’s not common, but it does happen), whereas legal notes cannot. For this reason, how files are organised will be a consideration.

The different approaches that are sometimes employed by each profession can be a challenge. For example, lawyers are often seen as problem solvers and social workers seen as ‘talkers’ and working the problem out over time, with an emphasis on building relationships. The legal profession can be at times siloed by nature and find it easier to co-exist with social workers, rather than to truly integrate. Further, how to prioritise the various aspects of the client’s issues can cause a tension – does the legal matter take precedence over other issues like the person’s acute mental health issue?

Another ongoing challenge is around professional Identity. Social workers are notorious for not being able to articulate what they do, or often lack confidence in asserting their expertise. There could be a lack of training, especially for lawyers, around engaging with other professions. There could be perceived hierarchies and power imbalances between the two professions. Some studies into the area of lawyers and social workers working together report a lack of mutual respect for the other profession, which can lead to an under-appreciation of workers from other professions, which can lead to under-utilisation of experience and expertise.

Earlier this year, at RMIT’s Juris Doctor 10th anniversary event, Bevan Warner, Victoria Legal Aid’s Managing Director, spoke about the partnership between lawyers and social workers. He noted the differing priorities of the professions; social work prioritises relationships, the law prioritises rights; social work demands engagement with the personal while the law requires depersonalisation. Bevan stressed that each profession has an ethical obligation to learn and understand more about the other, to ensure there is respect and an abiding curiosity for each with the other – to be a “social justice force to be reckoned with!”

There are some simple ways to overcome some of the challenges of a multidisciplinary approach to supporting people with legal and social support needs. Some small but important steps that services can take to smooth over tensions that inevitably arise where passionate professions partner together. Some of these include:

Establish a clear model for navigating the professional relationships with appropriate protocols. This takes planning, discussions, commitment and creativity. All players involved need to develop shared goals and expectations and constantly re-assess how the model is going, importantly incorporating feedback from people using the service. It’s important to make sure that staff at all levels in the organisation need to be on board as it’s ultimately a change management process. A non-hierarchical attitude is beneficial here, services could consider a no ‘lead’ discipline when working with vulnerable people, focussing on the person and what they need.

Developing a culture of open and regular communication. Clear and good communication is key – both with service users and between professionals. These are ongoing relationships that need nurturing.

Respecting each other’s specialised knowledge/professions. This can be achieved through training around the different professions, fostering mutual respect and a partnerships of equals. Including seeing beyond stereotypes and developing clear position descriptions. Set up an organisational culture of respect.

Multidisciplinary practices are here to stay, they are the way of the future for working with vulnerable people. As a sector, we need to find a way to best work together, embrace the challenges and bask in the benefits and most importantly provide the best service that we can for people that too often get stuck on a referral roundabout, or fall through the cracks of siloed services.

People receiving a service often don’t care what profession is helping them, as long as they are getting their needs met! Lawyers in a health setting, or social workers/youth workers/advocates/case workers in a legal setting, whatever it is called and wherever it happens, it’s time for smarter ways of supporting the people that need multidisciplinary approaches the most.