Advocacy

Using the target population identified earlier in your program design, in your initial post, respond to the following:

• How will you advocate for the needs of your population?
• For each potential or existing advocacy need, identify the related level or levels at which advocacy efforts are needed.
• Identify the various types of advocacy strategies you would use to address the needs and describe the anticipated outcome of each.
• Identify how you would structure program staff and activities around advocacy issues.

Chapter 14 pg 397-417 Program Development in the 21st Century: An Evidence-Based Approach to Design, Implementation, and Evaluation

ISBN: 9781452238142

By: Nancy G. Calley

Develop an Advocacy Plan

YES, I’M MAD, BUT WHAT ELSE CAN I POSSIBLY DO?

Tracey had been operating an outreach center for homeless and impoverished seniors for the past 2 years. She had recently added onsite Narcotics Anonymous and Alcoholics Anonymous meetings and a senior support group to further enhance her service array, which also included a warming center, two meals per day, medical exams, and basic care. Occasionally, Tracey would learn that one of her clients had been charged with indecent exposure for urinating in public. Because the city did not have any public restrooms, the homeless population did not always have access to restrooms. The situation was worsened by the fact that most of the shelters and warming centers had limited hours. Each time Tracey heard about one of her clients being charged in this way, she became enraged. Finally, on hearing the news that yet another client had been charged with indecent exposure, she immediately contacted Danielle, one of the prosecuting attorneys that typically handled these charges, to express her concern. Danielle stated that there was little she could do, as the law was the law.

Before Tracey could spend any more time on this issue, a crisis occurred at the outreach center that required her complete attention. As a result, she forgot about this issue until it was raised again. Several months later, one of her clients was arrested as a result of receiving his third indecent exposure charge. According to the recently passed sex offender registration and community notification laws in the state, three or more indecent exposure charges required registration as a sex offender, and therefore, her client not only received jail time but was also now required to regularly notify the public of his whereabouts.

On hearing this, Tracey was even more outraged, and this time, she went directly to Danielle’s office. Tracey argued that it was the responsibility of the region to provide public facilities to its residents and that by not doing so, the region and state stood to be punished, not her clients. She went on to share her utter disbelief that because the region could not effectively accommodate its residents, one of its most marginalized groups was being further marginalized through unnecessary legal action. Danielle replied that she understood Tracey’s frustration and that she shared it, particularly because of the unintended consequences that the sex offender registration legislation was causing. Danielle stated that the legislation was designed to promote safer communities through closer monitoring of individuals who had sexually offended—not to classify and punish homeless individuals who did not have access to bathroom facilities. But again, Danielle noted that she had to follow the law as written and that the situation could be changed only through legislative action. After further discussing this problem as a social justice issue, Danielle again agreed with Tracey but noted that she could not do anything about it.

Tracey left feeling that she had at least shared her concerns with Danielle, and she thought briefly about how she might raise awareness of this issue in an effort to change it so that her clients were no longer caught in the middle. Unfortunately, Tracey’s good intentions to rectify this issue did not last long. She realized that she was only one person and likely could not do much to change something so big—especially since statewide legislation was involved. Rather than devote any more time to thinking about the issue, Tracey turned her attention to her other duties when she got back to the outreach center—and she quickly realized that she already had enough to keep her busy.

CONSIDERING TRACEY

1. Do you believe that Tracey advocated for her clients? Why or why not?
2. What did Tracey mean when she referred to the issue of charging homeless individuals with a sex offense for publicly urinating as a social justice issue?
3. What do you believe Tracey’s responsibility is in this matter? Danielle’s responsibility?
4. As a busy mental health professional like Tracey, how are you supposed to get involved in advocacy while still attending to all your other duties?
5. If you were Tracey, what would you have done differently, if anything?

About This Chapter

This chapter focuses on a topic of specific significance to the mental health and human service industry—advocacy. Whereas advocacy has historically had a firm foundation in the mental health professions, as mental health professionals have continued to grow and develop a more sophisticated understanding of social justice, we have experienced a renewed sense of precisely what advocacy means. This is because advocacy and social justice are highly interrelated, and typically, efforts in advocacy on behalf of clients and communities are directly related to social justice. Therefore, advocacy—as well as social justice—plays a significant role in comprehensive program development and particularly in sustaining programs and organizations.

To frame this discussion of advocacy, we will first explore the history and significance of advocacy in mental health professions. We will follow this with an examination of the four levels of advocacy, which include the individual, community, public, and professional. Next, we will discuss various types of advocacy strategies, including individual empowerment, community-level, public arena, legislative-level, and professional. In order to further clarify the relationship that advocacy efforts have with one another, we will discuss this specifically. We will follow this with an examination of the concept of an advocacy orientation and its significance to work in the mental health professions. And in order to explore how to put an advocacy orientation into action, we will discuss the development and use of an Advocacy Plan. Finally, in order to clarify the major points of the chapter, a case illustration is provided, followed by an advocacy plan exercise.

STEP XII: DEVELOP AN ADVOCACY PLAN

Advocacy in Clinical Program Development

Advocacy is an innate part of clinical program development, since without some form of advocacy, clinical or human service programs would never come to fruition. In fact, think of a program with which you are familiar and then consider how it came to be. What you will likely find is that at the root of every clinical program is a voice—a voice demanding that a particular need be addressed, demanding attention to a specific population, demanding funding to support treatment or services, demanding to be heard, and demanding action. Without one such voice, the job that you currently hold or wish to hold in the future would likely not exist.

Unfortunately, Tracey was unable to effectively use her voice, and as a result, she was unable to prompt any change. This does not mean that all advocacy results in change, but it does mean that advocacy requires perseverance and focused efforts and not simply walking away after only a minimal investment toward change. Indeed, if the voices that helped create all that we enjoy in mental health and human services had not persevered, we would likely not have this incredibly rich field of practice. To better understand the role of advocacy in mental health and human services in the 21st century, it is necessary to both briefly review the history and examine the significance of advocacy today.

History and Significance

Advocacy is innately related to clinical professions and, as such, has been the driving force behind mental health and human services programming since the inception of the field. Regardless of the specific discipline—counseling, psychology, or social work—advocacy has been the impetus behind the evolution of that discipline as well as an essential role of the clinician. In their discussion of the history of advocacy in counseling, Toporek, Lewis, and Crethar (2009) provide a succinct summary:

Through the years that the profession has existed, there have always been career and employment counselors who fought against racism and sexism in the workplace, family counselors who brought hidden violence and abuse into the open, school counselors who sought to eliminate school-based barriers to learning, and community counselors who participated in social action on behalf of their clients. As long as there have been counselors, there have been counselor-advocates. (p. 260)

In the 21st century, social justice advocacy has taken center stage, particularly in the counseling profession, as counselors have renewed their vows and invested new energies into calling the profession to action in implementing advocacy strategies and interventions (Bemak & Chung, 2005; Stone & Dahir, 2006; Toporek, Gerstein, Fouad, Roysircar, & Israel, 2006). Much of this renewed focus on social justice advocacy has stemmed from increased recognition of existing inequities and the responsibility of clinicians to more adequately address the various forms of oppression that often present significant challenges to the individuals being served (Lee, 2007). As a result of systemic oppression and other inequities, clinicians must be not only committed to advocacy but able to effectively advocate on behalf of others in order to dismantle barriers and promote justice wherever injustice prevails.

In fact, according to Lewis and Bradley (2000),

Advocacy is an important aspect of every counselor’s role. Regardless of the particular setting in which he or she works, each counselor is confronted again and again with issues that cannot be resolved simply through change within the individual. All too often, negative aspects of the environment impinge on a client’s well-being, intensifying personal problems or creating obstacles to growth. When such situations arise, effective counselors speak up! (p. 3)

While advocacy is an innate part of our professional history, the role of advocacy has been much more specifically illuminated in the 21st century. This is particularly evident in the promulgation of the American Counseling Association (ACA) Advocacy Competencies (Lewis, Arnold, House, & Toporek, 2002). Whereas the model provides a graphical representation of the three levels of advocacy competencies of the client/student, the school/community, and the public arena, as well as the major domains of advocacy needed at each level, the 43 specific competencies that compose the model are articulated in the advocacy competencies. The ACA Advocacy Competencies are provided on the ACA website:www.counseling.org/publications.

The Advocacy Competencies serve a similar function to the Multicultural Competencies (Arredondo et al., 1996) endorsed by the Association for Multicultural Counseling and Development. This is because both sets of competencies highlight the significance that these two areas (i.e., cultural competence and advocacy) have in the counseling profession and both provide comprehensive guidance to counselors and other mental health professionals in these areas by articulating specific practice competencies.

The Advocacy Competencies were endorsed by the ACA Governing Council in 2003, and through this endorsement, the ACA “acknowledges that oppression and systemic barriers interfere with clients’ health and well-being and may even be the cause of their distress” (Toporek et al., 2009, p. 265). Moreover, the development of the Advocacy Competencies demonstrates the commitment of professional counselors to acknowledging and further understanding the role of advocacy in counseling.

Levels of Advocacy

As you will see in viewing the ACA Advocacy Competencies, they identify three levels toward which advocacy efforts can be directed: client/student, school/community, and the public arena. These competencies illustrate the need for mental health clinicians to engage in advocacy at multiple levels, because a different set of challenges is often present at different levels. For instance, at the client level, the clinician must engage in such advocacy as ensuring that the client receives the social security disability benefits to which s/he is entitled, while at the sociopolitical level, the clinician must advocate for such issues as state legislation for mental health parity. In addition to the three levels identified by Lewis et al. (2002), I would add a level of advocacy for the professional arena. This level of professional advocacy is often necessary to further the profession itself (i.e., counseling, psychology, social work) and, therefore, will also be discussed here.

Individual/Client

Advocacy at the individual level constitutes the most direct type of advocacy—connecting the client to the clinician and engaging in specific action to most expediently resolve an unmet need. Individual/client needs often are recognized by clinicians or other service providers during the course of treatment and may include such concrete needs as heat or other less concrete needs such as access to an entitlement, such as social security disability. In these situations, the clinician focuses on assessing the need for direct intervention, identifying allies, and implementing an action plan (Toporek et al., 2009).

Often, these needs may be shared among several clients with whom a clinician is working. This is particularly true when clinicians work with a specific subpopulation that may be treated unjustly or oppressed in a similar manner. For instance, the inequities faced by some students of color and students from low-income families indicate the need for clinicians to strategically address various environmental factors that are barriers to personal/social, academic, and career development (Ratts & Hutchins, 2009). As a result of continued exposure to this, clinicians may be much better prepared to specifically assess and address these issues. However, regardless of the number of individuals with an unmet need that a clinician recognizes, an unmet need for one individual typically implies an unmet need for other individuals. As a result, whereas clinicians must first address the needs of those whom they directly serve, the unmet needs of clients often reflect the unmet needs of the broader community. Therefore, while advocacy efforts must first be directed toward the individual, the advocacy needs of the individual often indicate the need for much broader advocacy at the community and public arena levels. As such, individual advocacy can often serve as an initial assessment and roadmap for advocacy efforts—providing essential information about widespread needs and guiding efforts to address such needs on a larger landscape.

Community

Community-level advocacy refers to advocacy that is directed at a broader population, such as a community, neighborhood, or school. Whereas individual-level advocacy focuses on the individual, community-level advocacy shifts to the needs of a group. As stated above, individual-level advocacy may move into community-level advocacy, particularly as one becomes aware that specific unmet needs go beyond one person and impact an entire group. The needs of groups may be the same as those noted in individuals (e.g., concrete needs, entitlements), and they often indicate the need for systemic or broad-based change in order to be effectively addressed. For instance, for some years, I worked with teenage girls who were living in community-based residential placements while they were involved in the child welfare system. These young ladies had been removed from their parents/caregivers due to abuse and/or neglect. As residents of new communities, these teens were often delayed admission to school and experienced delays in receiving Individualized Educational Plans to aid in academic placement and coordination of necessary supports. After having witnessed this occurrence more than once, it was clear that this type of discrimination was not simply happening to an individual but to a group of individuals. Moreover, it was clear that this type of discrimination was systemically generated by the school (i.e., the system). To address this, community-level advocacy was needed that would specifically target system change at the school level.

Public

Public-level advocacy goes beyond individual and group advocacy, impacting multiple and large groups across vast regions. Public-level advocacy is indicated when sociopolitical change is needed to address broad-based issues, and the objective of public-level advocacy is to impact public policy and influence legislation (Lewis et al., 2002). To accomplish this, increased public awareness is needed. Needs identified in individuals or in groups may indeed be needs that reach well beyond both individuals and groups and are much bigger than both, reflecting the need for public-level advocacy. For instance, as I learned, the discrimination that I witnessed against teens did not simply reflect the children in my region but, rather, reflected a widespread issue related to discriminatory practices leveled at child welfare–involved individuals. This meant that I had to engage in advocacy at both the individual and community levels in order to effectively care for my clients, but my efforts could not stop there; public-level advocacy was also needed to ensure that public policy was in place to protect these kids and families from further oppression.

Arguably, one of the most well-known public-level advocacy needs of the 21st century is mental health parity. Mental health parity, in the simplest terms, is pay and treatment access for mental health needs equal to those provided for physical health needs. And this has been an ongoing public-level advocacy issue for mental health professionals for several years. As a result, clinicians across the nation have worked tirelessly and collectively to raise public awareness and to influence legislation. Whereas these efforts have been successful at the national level with the passage of federal legislation, continued public-level advocacy is needed to address this issue at the state level.

Professional

Professional-level advocacy differs from individual, community, and public-level advocacy in that professional-level efforts are not geared toward directly impacting an individual but, rather, the professionals that belong to a clinical discipline. This does not mean that individuals/consumers do not benefit from some of these efforts, nor does it mean that these efforts are not related to other levels of advocacy; rather, it means that the intent centers on forwarding the profession. For instance, whereas mental health parity represents a public-level advocacy need, multiple mental health disciplines ranging from counseling to psychiatry have advocated for inclusion as mental health providers within this legislation.

Advocacy Strategies

Whereas advocacy is conducted at multiple levels—client, community, public, and professional—there are basically six types of advocacy strategies that can be used. As conceptualized in the ACA Advocacy Competencies (Lewis et al., 2002), these include individual advocacy and empowerment, community collaboration and systems-level advocacy, and public information and social-political advocacy that are targeted at the specific level (i.e., individual, community, public arena). Advocacy on behalf of the profession is most often related to other advocacy efforts; therefore, new strategies are not necessarily utilized, but rely on similar strategies. These strategies most often include collaboration, public information/awareness-raising activities, and social-political advocacy. As discussed above, there is often overlap among advocacy efforts—with advocacy beginning at one level and then moving to another. This is often the case since smaller-scale advocacy (e.g., individual, community-level) may serve as the catalyst for larger-scale advocacy efforts (eg, public-level).

Because advocacy needs go well beyond the purview of mental health professionals, advocacy lessons can be taught by many. In fact, the advocacy work of Alice Waters (Box 14.1) provides an effective illustration of how advocacy efforts may move from one level to the next.

BOX 14.1

ADVOCACY LESSONS FROM A CHEF

Alice Waters, the renowned chef and mastermind behind Chez Panisse restaurant in Berkeley, initially recognized the need for people to be intimately connected with their food—understanding its source, caring for it, and ultimately, bringing it to the table. As a result, the food she serves is a result of close relationships she has formed with farmers and gardeners who practice humane and organic farming and who are completely connected to their land.

Taking her philosophy outside the restaurant, Alice realized that a school serving kids in a poor neighborhood lacked any type of kitchen and nutritional food options but had a microwave oven available for cooking pizzas and burgers. As a result, the kids had absolutely no connection to the food they were eating (not to mention no access to healthy foods). To address this need, she met directly with the principal and then went to the school board to advocate that the school grow its own garden. Successful in her advocacy efforts, “she would create a garden at Martin Luther King, where the children—about a thousand of them in the sixth, seventh, and eighth grades—could learn to plant, cultivate, harvest, cook, and serve food that they grew themselves” (McNamee, 2007, p. 259). She called this The Edible Garden, and although it took some time to bring to fruition, through her staunch determination, perseverance, and undiluted energy, the garden did come to be. While the idea of school gardens did not originate with Alice Waters—school gardens were common in the 19th century—Alice Waters did reenergize this movement, which has long since received significant attention.

The Edible Garden was a monumental success, but Alice knew that large-scale change required large-scale intervention; therefore, Alice took her advocacy efforts to a broader platform with her Rethinking School Lunch campaign. One of the results of this was the successful change that she initiated from steam-table cafeteria food to freshly cooked, seasonal local foods at the American Academy in Rome.

Through her school and community advocacy efforts, Alice Waters—one woman—was able to accomplish a great deal in changing how we think about food and our relationships with food, as well as working to ensure that all people have equal access to healthy foods and, most importantly, that individuals and communities are empowered to be self-sufficient and hold the tools to create sustainable food sources.

Individual Empowerment and Individual Advocacy Strategies

When dealing with individual-level advocacy needs, individual/self-empowerment strategies are often used. Self-empowerment is consistent with the basic ideology of mental health professions today and initially evolved from behavioral theory in that mental health professionals strive to help individuals learn to help themselves. Because self-empowerment is taught, empowerment strategies must begin with an assessment to determine if the individual possesses the skills to successfully advocate on her/his behalf (Ratts & Hutchins, 2009). Empowerment strategies may include identifying individual strengths and resources, collaborating with others in advocacy efforts, and developing an advocacy plan (Lewis et al., 2002).

Individual/self-empowerment is necessary when individuals have been marginalized in some way and, as such, require advocacy. However, rather than speaking on behalf of the individual, empowerment strategies are used to teach individuals how to effectively speak on their own behalf. Self-empowerment is obviously very powerful, as it enables oppressed individuals to speak out and to take action, directly responding to the issue without a liaison or middleman. Moreover, once empowered, individuals may continue to recognize other forms of oppression and utilize their skills to effectively deal with new situations as they arise.

Whereas self-advocacy can be extremely powerful, it is often not enough to effect change either sufficiently or quickly enough when an unmet need exists, and as a result, advocacy on behalf of the individual is also needed. Advocacy on behalf of the individual means that the clinician must be the voice of the individual, call attention to the issue, and work to address the need. Individual advocacy skills include such activities as negotiating relevant services on behalf of individuals and helping individuals gain access to needed resources (Lewis et al., 2002).

For clinicians working with individuals who have been marginalized for any reason (e.g., socioeconomic status, criminal history, sexual orientation, race, age, mental health status, ethnicity), advocacy typically composes a core part of the work. As such, clinicians often find themselves working on behalf of their clients to remove barriers, navigate through complicated bureaucratic processes, and coordinate access to needed services. Just as self-empowerment strategies must be taught to individual clients, clinicians must learn advocacy skills so that they can most effectively speak on behalf of their clients. However, similar to self-empowerment, once learned, advocacy skills used on behalf of another have the potential to improve with use, thereby continuously enhancing the power of the clinician as advocate—a force to be reckoned with.

Community or System-Level Advocacy Strategies

Because community-level or group needs often reflect systemic problems, different types of advocacy strategies are necessary. System-level needs often are deeply embedded in a system and, as such, may require paradigmatic or ideological shifts in order to be effectively remedied. For instance, in the case of educational placement of kids in the child welfare system that I referenced earlier, practices were put in place by some schools to prohibit timely placements of these kids, thereby treating them differently from other residents in the community. Whereas these practices may have originated as a method for effective school management and not as a discriminatory practice, the fact is that they evolved into a discriminatory practice and, therefore, needed to be removed.

In order to advocate at this level, awareness-raising activities are often the first step. By gathering data pertaining to the issue (Lewis et al., 2002), clinicians are in a position to increase awareness and knowledge of the issue for community members and those in positions of power who can effectively resolve the issue. By engaging in various discussions with various factions, clinicians may be able to illuminate the problem and engage others in their efforts to resolve the issue. In fact, it is this type of dialogue with others that usually is the catalyst for the development of advocacy coalitions. This is especially true since clinicians and other professionals who work on behalf of others or who share similar values related to helping are often drawn to one another and are naturally situated as allies.

Advocacy coalitions are similar to other coalitions (as discussed in Chapter 13), as they are formed as a result of shared interests and seek progress through collective efforts and collective strength. Advocacy coalitions can be extremely powerful, particularly because advocacy work is driven by passion—passion for a specific issue—and as such, the collective energy built by passion can be not only contagious but tremendously powerful. Advocacy coalitions at the community level may focus on such issues as increasing home health services or developing nonpunitive measures to support children with behavioral challenges. The work of advocacy coalitions centers on a specific issue, set of issues, or population, organizing individuals and groups together in advocacy work.

Organizational actors in an advocacy coalition often serve as members of policy-making boards and monitor legislation or policy decisions. They can organize public education workshops or campaigns to gain support for specific issues, such as a workshop to educate the community on the proposed allocation of federal block grant funds. Their community education work can increase public attention to an issue by the use of various forms of the mass media. This public attention can put pressure on elected decision-makers to be more responsive to the needs of their constituents. Through coalescing around these advocacy efforts, a bond is created between the member organizations, as they seek to maximize their supply of scarce resources. (Roberts-DeGennaro, 2001, p. 137)

While we often think of community-level advocacy work involving a fight against a system, sometimes the system that must be fought is made of individual community members, and as mental health professionals, we sometimes find ourselves on different sides of the aisle. For instance, consider the dramatic changes in inpatient mental health care that were marked by the deinstitutionalization of psychiatric facilities that began in the 1970s and the subsequent dismantling and significant reductions in residential options and hospital stays that have continued to this day. Throughout this time, mental health professionals have often found themselves working to get their neighbors and local residents to support community living for individuals with severe mental illness and/or developmental disabilities while at the same time advocating for hospitalization stays when warranted as the most effective form of treatment.

Another example of this type of dual-directional advocacy has resulted from the more recent sex offender legislation—most specifically, the community notification and sex offender registration legislation. Whereas many mental health professionals and legal professionals have argued for this legislation and its objective of promoting safer communities, others have argued that the legislation is far too punitive and, in some cases, constitutes a civil rights violation. As a result, mental health professionals have again found themselves on competing sides, often trying to balance effective treatment with community safety and upholding individual civil rights.

Community-level advocacy is often complex for the very reason that systemic change is usually deeply rooted and, therefore, challenging to change. At the same time, it is because of the type of significant change that can ultimately be achieved t