James E. Cabral, Abhijeet Chavan, Thomas M. Clarke, John Greacen, Bonnie Rose Hough, Linda Rexer, Jane Ribadeneyra & Richard Zorza
VI. TECH-SUPPORTED TRIAGE: THE KEY TO MAXIMIZING
EFFECTIVENESS AND ACCESS (BONNIE ROSE HOUGH &RICHARD ZORZA)
A. Why Triage?
It is a truism that courts, legal aid, and those in the bar
serving low- and middle-income clients are overwhelmed with unmet legal need.
It is also sadly true that these or to provide adequate services using the
current delivery methods. The current delivery model — with its lack of coordination304
and misallocation of resources — is unacceptable.
We simply have to find a better way to triage legal services
— to allocate the available services so they have the greatest impact on the greatest
number of people. As we will show, technology provides the ability to gather
data quickly and analyze patterns in outcomes to recommend cost-efficient
choices.
We suggest a multi-component triage system that would be
integrated with the present legal services delivery system. Full integration of
the five kinds of triage we describe will require a technology driven system,
which we discuss below. Adoption of a fully integrated triage system entails both managerial difficulties and risks
to litigants and clients; these challenges and risks must be more fully
explored. Our ideas should be considered a starting point for discussion, not a
fully realized plan or recommendation.
B. How People Enter the Access to Justice Triage
System
Access to this triage system must be via data-gathering
gateways, including the web, mobile apps, and voice systems. Ideally, every person
would have an “access to justice” account, which would contain their basic
information and a history of their prior interactions with the justice system.
These accounts would also be able to import information from other systems,
including information such as reported income, public benefits, employment
history, and social service agency records. The data in this part of the system
would be confidential and could only be released to other systems with the
person’s permission.
After logging in through a secure portal, the person seeking
access would answer some basic questions about her legal situation and the
algorithms of the system would make recommendations and appropriate referrals.
A service provider’s triage system must effectively identify
issues and available solutions, which will sometimes differ significantly from
the stated problem that brought a client or applicant to the provider’s door.
For example, a young parent may seek help with a child custody dispute. But it
could be clear in a comprehensive triage system that the parent first needs help
with a pending foreclosure to avoid housing instability that would create a
strategic disadvantage in the custody case. Users would always be given the
choice to explore only the specific issue that caused them to seek help in the
first place.
The comprehensive intake procedure exists to ensure users
are aware of additional possible legal solutions or complications. A triage
system could deal with such situations through real-time links to the local
court system. For instance, when a parent provided her name and address in a child custody dispute, the system
could pull data from the court computer network to flag the pending case. The system
could also use mathematical analysis of aggregated data to flag clients who
meet demographic or geographic profiles that fit patterns of other known cases.
The system could cross-check non-confidential data from other pending or closed cases to identify
recurring opposing parties or other factors which might warrant an enhanced response
to the new case.
The system should combine information from data sources with
knowledge about which issues or fact patterns are more likely to correlate with
certain common or predicted types of information likely to be provided by a
user. These presumptions could be based on accumulated expertise or on
data-mined patterns. For example, if experience or data shows that disabled applicants
in a certain county are likely to have been given improper Medicaid denials,
the system should ask questions designed to elicit the needed information even
if the user is not yet aware of the problem. These presumptions should be regularly evaluated against actual case outcomes and
altered as necessary.
E. What Is Needed to Build the System
The above is an algorithm-driven system. It must have the
capacity to take data and find the underlying patterns in real-world behavior, derive
protocols for how the institutions that make up the system should behave, and
then apply these protocols. The process of developing the protocols can be
human-driven, technology-driven, or a combination of both. To build the
triage system, the partners involved need to agree on the types of data and on
methods of interpreting that data that are likely to lead to actionable and
measurable results. This will require technical compatibility between data
formats if multiple database systems are involved.
Demographic data should be organized in formats that do not produce
ambiguous or conflicting results. For example, if one system identifies senior
citizens as fifty-five or older, but another only applies that designation to
applicants sixty or older, those differences must be resolved. Other
specialized data, such as legal problem codes, court case numbers, and the like
should be collected according to agreed upon protocols. Outcomes should be
vigorously evaluated for non-causal correlations or other factors that could
lead to false interpretations. Legal services providers should also look to
other disciplines outside of the legal system to evaluate whether correlations
with medical issues, educational attainment, mental health factors, or other
factors can enhance the predictability of whether a particular legal problem is
likely to arise, or whether a particular type of assistance is likely to produce
positive results. For example, if case data shows that a high number of children living in substandard housing in a
particular zip code suffer from mold-induced asthma, then the triage system
might automatically ask all applicants from that zip code whether their household
includes any children who have asthma. A positive response would warrant
follow-up questions about the family’s housing, even if the reason for which
the applicant contacted the service provider was entirely unrelated.
The mix of issues will differ depending on variations in the
service area. Questions for rural applicants may differ from those asked of
urban applicants. Questions in high unemployment areas may vary from those
asked of applicants from communities where unemployment is relatively low. The
goal is to reduce reliance on one-size-fits all triage methods and to use the
power of adaptable data processes to better guide resource allocation and
advocacy decisions.
G. Conclusion
Many of us believe that the development of appropriate
triage is critical to moving towards full access to legal services.328 Deploying
triage will be controversial and difficult. Confidentiality, the potential burden
on litigants, and the different cultures of participating organizations raise
critical challenges. But, in the end, there is no other way to take the data about
outcomes, and about litigants’ capacities and needs, and make sure that people
get what they need to obtain access to justice. We propose that the court and legal aid
communities, together with their partners, develop and engage in a multi-step
triage development strategy.
*Please see the full article for all referenced material. This post has been condensed from it's original for an easier read.
