A health justice partnership for young people: strategies for program promotion to young people and youth workers
Alison Ollerenshaw
A * and Margaret Camilleri A B
A Centre for eResearch and Digital Innovation, Federation University Australia, PO Box 663, Ballarat, Vic. 3353, Australia.
B Institue of Education, Arts and Community, Federation University Australia, PO Box 663, Ballarat, Vic. 3353, Australia.
Australian Journal of Primary Health 29(5) 422-427 https://doi.org/10.1071/PY22266
Submitted: 16 June 2021 Accepted: 28 April 2023 Published: 26 May 2023
Abstract
Health justice partnerships (HJP) are innovative models for delivering integrated health and legal services to people experiencing complex issues. An HJP was established in regional Victoria, Australia, for young people. Promoting the program to young people and workers was essential for program uptake. There is a dearth of published information about strategies that support program promotion for young people and workers. In this practice and innovation paper, three promotional strategies were employed: a dedicated program website, secondary consultations, and legal education and information sessions. Each strategy is examined, with information presented about why and how these strategies were implemented alongside this HJP. The strengths and limitations of each strategy are explored, with some strategies appearing to engage audiences with the program more than others. The insights about each of the strategies established for this program may inform other HJPs with their planning and implementation for increased program awareness.
Keywords: health justice partnerships, legal advice and referrals, promotion, promotional strategies, rural and regional, young people, youth workers.
Introduction
Health Justice Partnerships (HJP) are transformative models that bring together legal and health professionals to support the social, health and legal needs of different population cohorts (Ball et al. 2016; Hills 2016; Health Justice Australia 2018). HJPs in Australia have flourished (Health Justice Australia 2021), accompanied by an emerging body of research about their implementation with specific population cohorts, including young people (e.g. Ollerenshaw and Camilleri 2017; Curran and Taylor-Barnett 2018; Forell and Nagy 2019; Lewis et al. 2019; Taylor 2020).
Young people experience legal problems at approximately the same rate as the whole population (Macourt 2014), yet they are unlikely to seek advice or take action to address legal issues (Courmarelos et al. 2012). Unattended legal issues in young people can lead to poorer legal outcomes (Courmarelos et al. 2012), including, in some instances, their arrest and incarceration. Research shows a strong correlation between disadvantage/low socioeconomic status and legal problems (Courmarelos et al. 2012; McDonald and Wei 2013), with each additional level of disadvantage having a compounding effect on the number of legal problems (McDonald and Wei 2013).
Notable barriers exist for the delivery of services for young people. Many factors (structural and age-related) may prevent them from accessing services (Burns et al. 2008; Robards et al. 2018) and contribute to their reluctance to seek support (Rickwood 2014). It is recognised that the regional and rural service delivery of HJPs for young people is challenging; young people present with complex health and legal issues (Ollerenshaw and Camilleri 2017), requiring services to meet their varied needs (Curran and Taylor-Barnett 2018).
Strategies for program promotion targeting young people and staff working with youth may assist in increasing the uptake of HJPs. However, little information is available about strategies for program promotion to engage young people, and partner and agency staff. This is despite claims that engaging young people with services is critical (Fargas-Malet and McSherry 2018).
An HJP for youth in regional Victoria was established in 2015. Promotional strategies were implemented across the life of the project to increase the awareness and use of the HJP among young people and workers. This paper reports on these strategies, which includes a dedicated program website, secondary consultations for workers, and legal education and information sessions. We outline each strategy, why they were chosen, and their associated strengths and limitations.
Setting and service
An HJP for young people (aged 15–25 years) was introduced in a central-west region of Victoria that incorporates six municipalities with an estimated population of 207 300 (Regional Development Victoria 2022). The percentage of young people (aged 15–24 years) in each municipality ranged between 7.8% and 12.4% (Australian Bureau of Statistics 2016). The region is characterised by ‘places of high disadvantage’ (Infrastructure Victoria 2019, p. 2), and poorer than the state outcomes on a range of disadvantage indicators (Vinson et al. 2015). This includes elevated numbers of people with a disability, and areas where there is an increase in young people (aged 15–24 years) that (a) have not completed school, and/or (b) are not in work/education/training (Infrastructure Victoria 2019, p. 1–2). The region has high, albeit fluctuating, numbers of criminal incidents (Crime Statistics Agency 2021).
The HJP was established to support a range of disadvantaged young people in the region who were at risk of complex issues, including those that were homeless, attending drug and alcohol programs, visiting sexual health clinics, and/or had mental health issues. However, the program was available to any young person, and young people could self-refer to the program. Typically, staff at partner agencies referred clients to the HJP; however, the program was inclusive and supported the broader regional community with referrals accepted from external agencies1.
The HJP partners included a community legal organisation (which midway through the project was replaced by a community youth-focused legal organisation), a community health agency and a tertiary education provider (which was the lead agency providing financial administration and to conduct research to evaluate the program). Funding was secured for the HJP from the Victorian Legal Services Board + Commissioner. The program lawyer was embedded with the youth team at the community health agency. This included being physically located within the offices of the youth team, collaborating with staff to assist clients by attending client meetings and outreach visits.
The data presented in this paper offers insights about the contribution and uptake of each promotional strategy. Ethics approval was granted for this research through the Human Research Ethics Committee, Federation University Australia (approval number: A15-016).
Program promotion
Three strategies were implemented to promote the HJP: a dedicated program website, secondary consultations, and legal education and information sessions. The intended audiences for each promotional strategy included either young people or the workers supporting the young people. Each strategy provided information about the program and common legal issues that may impact young people. Each strategy was developed in consultation with staff from the partner agencies, including the program lawyer. Some strategies were informed by previous insights in the literature about their contribution for service engagement (Curran 2016). The strengths and limitations of each strategy is examined below.
Program website
A key strategy for promoting this HJP was a publicly accessible website, implemented at the program’s outset with the aim of reaching a wide audience (young people, agency/external staff, the general public). The website was hosted by the tertiary education provider and lead organisation for the project. However, the partner agencies included links to the website from their organisation’s website. The development of a website was informed by the published literature which suggests that the Internet offers an important avenue for young people to connect and seek out mental health/health-related information (e.g. Rickwood et al. 2007; Burns et al. 2010). Planning and developing the website involved consultation with two young people who provided input on its look, accessibility and functionality.
The HJP website contained program-specific information about accessing legal advice, how to contact the program lawyer and making an online referral. It was a clearinghouse for information about legal issues commonly experienced by young people, with an extensive repository of information about family violence, unpaid fines, unpaid bills, issues with rent/bond, bullying at school/work, sexting, sexual assault, graffiti, cyber bullying, traffic offences and internet downloads. The website was promoted widely and the website address was disseminated at legal education and information sessions. The website address was also included on postcards and posters that were developed about the program and distributed to agencies and organisations in the region.
A Legal Health Check (LHC), developed by the program lawyer in consultation with agency staff, was available via the website as a tool for workers to use during initial discussions with young people. It comprises a series of statements about common legal issues (i.e. Does the young person have debt? Has the young person been charged with a criminal offence? Does the young person have outstanding fines?), and could be used to assist in the identification of legal issues and referring clients to the HJP.
Based on website analytics, the website was accessed frequently in the months following the program’s launch, however, visits to the site waned over time, increasing periodically following the delivery of legal education and information sessions. The online referral function and the LHC were accessed infrequently.
The value in establishing a program-dedicated website for this HJP is mixed. If implemented as the sole source of program promotion, referral, and legal information its contribution appears limited, as demonstrated by its diminished use over time. Yet the costs and time to establish this resource was high. A website is a method for sharing service information, accessible to multiple audiences across a wide geographic area. However, the website for this HJP and its intermittent usage did not meet the original expectations linked to wide and continued program promotion.
Secondary consultations
Secondary consultations are informal discussions about legal issues that occur between the program lawyer and staff at partner and external agencies. Australian researchers have previously identified that secondary consultations between partner agencies are effective for HJP uptake and success (Curran and Taylor-Barnett 2018). Secondary consultations were provided to connect partner and external agency staff with the program, as a mechanism for building program awareness for services, for promoting the LHC and enabling program referrals.
Project partners identified this approach as important for enabling the delivery of legal information to workers in which a trusted and known person (the lawyer) provided advice about a range of legal matters. The opportunity for informal, one-on-one discussions was crucial to establishing this trusted relationship, and for building an understanding of the program. The program lawyer delivered 86 secondary consultations on a range of legal topics about contemporary law, including intervention orders, assistance animals, police, family law and child protection, and being a witness in court. Responses from an evaluation survey of workers indicates that secondary consultations helped guide their responses and actions when clients have a legal issue. This is highlighted in the following comments:
Secondary consult for clients, assisting to make appropriate referrals and understanding limitations of different legal roles.
I have been able to liaise with the lawyer about issues that face my clients and, therefore, provide options and achieve better outcomes.
Secondary consultations may have also facilitated timely program referrals. The advantage of secondary consultations for all agencies and organisations – not just those from the partner agencies – is that direct connections and program promotion can occur across the region, with the lawyer. Previous research has identified that HJPs can facilitate early identification and intervention (Noble 2012). A limitation of this approach, however, was that secondary consultations were time intensive for the lawyer. When program partners became aware of this issue, more time was allocated to the program lawyer to prioritise the delivery of secondary consultations, advice, and/or information to workers and young people.
Legal education and information sessions
Legal education and information sessions were implemented to aid in the sharing of program information. The sessions were developed in consultation with staff (external and agency staff), and are strategies commonly used by Community Legal Centres to inform large groups of people about a specific issue. The strength of this approach was that the sessions could be developed in response to, and with input from, workers about information directly relevant to their needs and that of the young people they assist.
Seventy legal education and information sessions were delivered by the program lawyer. Sessions were delivered to organisations as a free service, and at their place of work, as requested. Session content included:
Making referrals and using the LHC;
Disclosing health information to third parties;
Youth rights and sharing information with police;
Mandatory reporting for teachers;
Your rights with police;
Arrest and protective service officers;
The law and you/know you rights;
Legal issues impacting young people during the COVID-19 crisis;
Legal Aid and Youthlaw.
When a new partner organisation joined the program in 2018, the delivery of legal education and information sessions escalated, and the youth lawyer adopted a proactive approach to legal education. Efforts by the lawyer to consult with workers, not only about their education needs, but also about the delivery andformat of these sessions assisted inbuilding the rapport with, and trust in, the lawyer.
The strengths of this approach were associated with program promotion and wide audience reach. Feedback from session participants confirmed this. First, sessions raised awareness about the program and how the HJP supports staff and their clients, as highlighted in the following participant feedback: ‘Good general information that can be passed on to clients. Knowledge about website and referral process.’ Second, the sessions provided access to, and clarification about, legal information/awareness for workers, as captured in the following participant quote: ‘Becoming more aware of services. Civil matters covered. Criminal history checks and how they work.’ Third, the material and information shared during the sessions, including the LHC and the website, connected workers with program resources: ‘Website and ongoing capacity to have suitable resources. Great brief overview. ‘Health Check’ advice.’
Legal education and information sessions were also delivered to young people (n = 420). The sessions were facilitated by the program lawyer, who promoted the program while simultaneously informing young people about important legal issues. These sessions were delivered at school, providing information about legal issue frequently experienced by young people, including sexting, cyberbullying, young people and the law. The support provided by the schools enabled the events to be scheduled onsite, and at times that would maximise student and teacher attendance.
Formal assessment of these sessions was not conducted; however, anecdotally, the student audiences were fully engaged at each session. A challenge with negotiating legal information sessions for young people in school settings is: a) the varied audience size and b) tailoring the approach consistent with school requests to deliver sessions on specific content that were sometimes made at short notice. Planning these sessions was time intensive for the lawyer; however, allocating time in their role for these activities helped address this issue. The content of the information sessions was also developed, with some sessions being reused, with amendments, for other groups and audiences.
Key learnings
Until now, promotional strategies for HJPs have been under-reported in the published literature. The complexity of delivering dual sector programs requires a considered approach to planning, developing and integrating promotional strategies for stakeholders. This paper reported on three strategies for promoting the HJP to young people, and external and host agency staff. Although it is not possible to determine how each strategy contributed to the uptake of the program, it is likely that the collective approaches were successful in promoting the program, based on the consistent number of program referrals, including self-referrals.
A dedicated website was considered an essential promotional strategy, established upon commencement of the program. Visits to the website waned over time, as evidenced by the web analytics, suggesting that this strategy alone was not sufficient for program promotion. However, it was observed that website visits increased following the delivery of legal education and information sessions. Records also showed that the delivery of legal education and information sessions led to an increase in secondary consultations. This finding implies that (a) a dedicated program website does have a role to play in program promotion when other promotional strategies are also implemented, and (b) that multiple approaches, when delivered concurrently, were effective for program promotion.
Secondary consultations, legal education and information sessions enabled the sharing of program-related information about various legal issues commonly experienced by young people. It also introduced and connected workers with the program lawyer, building trust and providing an avenue for future ‘warm’ referrals. This is consistent with previously published research that attests to the importance of establishing trust and building trusted relationships throughout these programs (see Curran and Taylor-Barnett 2018).
Delivering information and education sessions at schools was also helpful in promoting the program directly to an audience of young people; the ‘target’ recipients of this program. These sessions gave young people an opportunity to see and hear from the lawyer, establishing a face-to-face connection with the program and potentially leading to positive perceptions about the service, and of the lawyer, as trustworthy and approachable. Although it is difficult to determine whether the sessions for young people were useful (permission to collect feedback from young people was not available at the time), it is noted that 21% of referrals came from the young people themselves. This is an important finding, and suggests that individual, all or a combination of promotional strategies used with young people were successful in raising awareness about the program, resulting in an increase in self-referrals to the program.
In summary, this HJP was widely used, with young people accessing the service following their referral to the program. The promotional strategies adopted have been successful in achieving this outcome. However, it has not been possible to establish which of the three key strategies, alone or in combination (and the magnitude of each strategy’s contribution), was effective in generating program referrals. Further investigation is required to identify which of these promotional strategies was most helpful in facilitating program referrals.
Records documenting the provision of secondary consultations offer support for the proposal that the promotional strategies that involve face-to-face interactions, such as secondary consultations and the delivery of legal education and information sessions, are highly valued and regarded. The contribution of these two promotional strategies appears to be further strengthened when they are delivered simultaneously.
Conclusion
Various strategies were implemented to promote the HJP program to young people and agency staff. Secondary consultations, legal education and information sessions provide the opportunity for face-to-face interactions and a point of access to a ‘real person’ – the program lawyer – that can provide young people and workers with legal advice and support. The information sessions and secondary consultations enable the lawyer to become a familiar person that young people and agency staff recognise and trust. Support for this is evidenced by young people self-referring to the program. Website visits waned over time, signifying that this approach – in isolation – is insufficient for sustained program promotion. Time and resources are required to develop promotional strategies at the onset and for the duration of the program. This assists in raising awareness of the program, and requires that sufficient consideration is allocated for this task for ongoing promotion of the program to recipients and workers.
Data availability
The data referred to in this paper cannot be publicly shared due to ethical or privacy reasons and may be shared upon reasonable request to the corresponding author if appropriate.
Declaration of funding
The HJP and the embedded evaluation received funding in 2014 from the Victorian Legal Services Board + Commissioner – Major Grants Program (Registration number: 2014-MG009). However, the funding organisation was not involved in data collection or in the writing of this manuscript.
Acknowledgements
Jennifer Corbett provided support with the survey data distribution and compilation.
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