NYT “Fixes” Column Highlights “Downshift Jobs” as Problem Solver — Consider Legal System Implications

Those who are worried about the emerging trend to use more non-lawyers in the legal system, including perhaps in the courtroom, might be somewhat reassured by the evidence that this approach is being used in other professions.  Indeed, a recent NYT Fixes Column highlights what it calls the “Downshift Jobs” approach to solving problems:

Reading Partners in Charleston, Project ECHO in New Mexico, and Strong Minds in Kampala all rely on task shifting: taking jobs normally restricted to specialized professionals and turning them over to people with far less training in order to reach underserved groups.

At face value, task shifting sounds dangerous. After all, we have professional qualifications for a reason. It takes training and experience to be a good teacher, hepatologist or psychologist. People in those professions have learned things they need to know.

.  .  .

Task-shifting doesn’t necessarily mean second-class care, and sometimes it produces better results than the specialists do. The patients with hepatitis C in rural New Mexico seen by local nonspecialists do better than those seen at the specialist clinic in Albuquerque, possibly because health workers from the same community do better at getting patients to stick to their care plans, and can interact regularly and catch problems early.

.  .  .

Especially when care involves behavioral change, less training can be an asset, not a liability. Who’s better at getting people to improve their eating and exercise habits? A doctor — an authority figure who can spend only 15 minutes and generally learns little about a patient’s life — or a health worker from the patient’s own community, with the same problems, who can visit the patient at home and has the luxury of spending time? Experience indicates it’s the latter.

Task-shifting can be an alternative any time resources are short and people can learn to do a specific activity without the full training specialists receive. Reading Partners succeeds, for example, because it isolated the key components of helping children learn to read, and found a way to teach them clearly and quickly to community volunteers.

Like other forms of task-shifting, this is a money-saver, as volunteers or low-paid workers are stretching the efforts of higher-paid professionals. Such programs also allow people to get access to preventive services, which almost always result in huge savings later. The advantages of task shifting can be summed up in the aphorism: “Don’t let the perfect be the enemy of the good.”

Anxiety about expansion of what some of us are calling “beyond laywer roles” is often expressed in terms of concern to the client.  What this article demonstrates so powerfully that sometimes a less trained person may be better (or rather often that a person who has less formal training but more experience in the specifics of a matter is better), and then even if they are actually not better, clients usually benefit from having something rather than nothing, someone rather than no-one.

With so many innovations in delivery moving forward, those who would restrict innovations bear a real burden in justifying prohibition of such innovations — which is not to say that all regulations are wrong or unjustified, only that the justification needs to be examined and tested.


About richardzorza

I am deeply involved in access to justice and the patient voice movement.
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