Understanding Advocacy 300 words
The Concept of Advocacy
There are times when a rational argument presented in a highly civil manner does absolutely no good. As an illustration, recall the saying that there is no problem with adolescents that reasoning with them will not aggravate. From time to time in the natural course of events, determined and forceful action may be required of us, even if it runs against the grain. William James commented, “We are all ready to be savage in some cause.” He went on to qualify, “The difference between a good man and a bad man is the choice of the cause.” There are occasions in practice when advocacy on behalf of a client is an imperative, especially for vulnerable individuals with compelling needs. Professional integrity sometimes calls for taking sides, vigorously.
Advocacy figures prominently in almost all discussions of case management (Ashery, 1994; NASW, 1987; Raiff & Shore, 1993). Indeed, Lanoil (1980) identifies it as one of the two distinctive ingredients, along with social support. Fischer (1978, p. 21) observes that it is one of the important roles in professional helping generally, and states that the field of social work began “as an attempt to mediate between individuals and societal institutions. Gradually, however, this role became submissive to the clinical role of casework.”
This approach in the human services was given impetus for a time during the social upheavals of the 1960s. Advocacy planning came to the fore in the field of urban planning (Davidoff, 1965). The National Association of Social Workers established an Ad Hoc Committee on Advocacy (1969), which vigorously endorsed the advocacy role as a practice imperative deriving from the NASW Code of Ethics. The War on Poverty relied on advocacy as a prime weapon.
Advocacy and Case Management
There has been limited research on the use of the advocacy function within case management. However, empirical studies have been undertaken on advocacy in related areas that hold interest for comprehensive enhancement practice.
In the UCLA study, most of the practitioners said they engage in some form of advocacy—only seven of the forty-eight did not. The matter of internal agency advocacy was examined by Patti (1980). Most of the fifty-nine human service professionals he studied reported engaging in some form of internal advocacy during a recent two-year period—only six indicated no such involvement. The highest percentage of responses (29%) related to seeking improvement in client well-being through new or modified service and programs. Efforts of this nature were also directed at changing procedures for processing clients and obtaining new facilities and resources. Some of the efforts were more intraprofessional or career oriented, such as dealing with work flow, personal practices, and communication.
External advocacy was examined in another study. In a survey of 105 professionals in Michigan (Epstein, 1981), more than two thirds of the advocates (71%) reported encountering obstacles in their own agencies. This was in addition to the extensive external blocks, which were reported by 90%. The worker may pay a personal price for taking on this responsibility. Forty percent experienced burnout as a moderate or great problem as an aftermath. This suggests the need to provide greater support to those who engage in advocacy.
Purpose of Advocacy
Taking a psychosocial or ecosystems perspective, advocacy signifies the occurrence of a problematic person-in-environment fit. Ordinarily the environment, or a relevant part of it, will manifest one of three alternative responses to the entreaties of a person: positive, neutral, or negative. Sosin and Caulum (1983) visualize this interaction in terms of allies, neutrals, and adversaries. If the external stance is positive, the individual need only make a routine request in order to be accommodated. If neutral, calling attention to the matter forthrightly or providing convincing information may suffice to gain the desired ends. However, when the environment is negative, pressure of an adversarial nature may be required. Advocacy is an instrument for bringing about a more satisfactory person-in-environment fit for individuals seeking a given benefit from a recalcitrant system.
Advocacy typically comes into play when clients are denied service (Rose, 1992). Some clients may be perceived by agencies to be unattractive, to not match up with overly rigid service categories (Hasson, Grella, Rawson, and Anglin, 1994) or to behave in ways deemed inappropriate. Clients with dual diagnoses or persistent impairments often experience such rejection. For example, Lamb (1976) observed a pattern of resistance to meeting the needs of long-term mental patients, and this group has been characterized as a low-priority population (Los Angeles County Department of Mental Health, 1985).
Advocacy involves the use of strong influence or pressure to compel a target entity to engage in behavior sought by the advocate (Vourlekis & Greene, 1992). More specifically, in the human service field, the advocate serves as a professional spokesperson or agent who pursues the interests of a client treated unfairly by community institutions where the client, because of impairment or dependency is unable to achieve a remedy alone (Raiff & Shore, 1993). Thus, advocacy may involve resolution of conflict or confrontation aimed at inducing desired change in the institution (Vourlekis & Greene, 1992).
Human service professionals may naturally shrink from using advocacy tactics, preferring discussion, cooperation, and collaboration. When confrontation is necessary, there has to be deliberate and disciplined use of self on behalf of clients, similar in principle to the clinical context. One may need to go against one’s own proclivities and regroup internally (Dinerman, 1992).
Characteristics of Advocacy
There are certain core elements of advocacy, according to Sosin and Caulum (1983): change effort; focus on a specific decision to be influenced; involvement of three social actors (the advocate, the client, and a decision maker); an imbalance of power; andpotential for a positive outcome in affecting the decision. The authors put these pieces together defining advocacy as follows (p. 36):
An attempt, having a better than zero probability of success, by an individual or group to influence another individual or group to make a decision that would not have been made otherwise and concerns the welfare or interests of a third party who is in a less powerful status than the decision maker.
In the UCLA field interviews, practitioners characterized the role as “guardian for the client,” being a “client representative,” and “demanding services.” Sosin and Caulum mention champion, defender, supporter, and reformer.
Advocacy theory may be approached from a legal perspective. Social welfare services are assumed, in contemporary Western societies, to constitute a form of property that is obligated to particular classes of people as an entitlement (Reich, 1964). Social welfare institutions in their operations, however, often place their own corporate interests above the rights of their designated ben eficiaries. Clients under those circumstances need protection and representation.
McGowan (1974) found that outcomes were affected importantly by two variables: the resources mobilized by the advocate and the receptivity of the target. In addition, positive outcomes were associated with use of communication and mediation rather than power. One way to interpret this is that advocacy operated best when relatively moderate means were used in situations involving moderate conflict.
Advocacy cuts across different client populations and service settings. It has appeared prominently in such areas as public welfare, children’s services, the elderly, and mental health. In a special issue on this subject, the Practice Digest (Sancier, 1984) applied the concept broadly across family advocacy, adoptive parents, Vietnam veterans, the women’s movement, and an industrial union (seeGemmill, Kennedy, Larison, Mollerstrom & Brubeck, 1992, for case management advocacy in the military).
In addition to its application in various settings, advocacy can take place at most any point in the intervention process. It can comprise a vigorous form of monitoring to see that agreed-upon services are actually implemented, or may coincide with linking to assure that a client’s right to be offered a given program is not denied. Alternatively, it may occur during intake when it is learned that an older client has been locked out of his apartment and is undergoing elder abuse. In an important sense, the practitioner is acting as a vigorous supporter of the client in every step of the process, and intercedes with individuals and organizations on behalf of the client while performing functions other than advocacy. What makes advocacy distinctive is its forthright character among the many choices of action open to the worker. Advocacy is often the final action, the last arrow in the practitioner’s quiver.
Advocacy may be directed at the internal system or at outside agencies (such as Social Security or board-and-care homes). It may be directed to the original organization level at which a problem appeared or be elevated to a higher level (Ashery, 1994). For example, the practitioner may go to the supervisor of the offending party in the other agency or may pass the issue up to his or her own supervisor to pursue with the other body
Several studies have examined the issue of inculcating self-advocacy skills in clients (Rose, 1992). One of these surveyed the views of patient education managers concerning the skills they believed were necessary to develop in clients for them to act on their own behalf (Bartlett, 1986). Three sets of such advocacy competencies were delineated:
- general advocacy skills and strategies, e.g., developing effective personal relations, developing knowledge, self-confidence, and savvy, listening and negotiating;
- preparation skills and strategies, e.g., gaining access to administration, clarifying the role of the patient education manager, setting reasonable goals, and learning the rules of the game;
- implementation skills and strategies, e.g., being concrete in explaining patient education, establishing quality assurance policies, and persistence (thought to be extremely important by all participants).
The potential for clients to acquire and use such skills is addressed by Sievert, Cuvo, and Davis (1988). Focusing on mildly disabled clients, they produced a handbook instructing clients on how to redress violations of their legal rights in personal, human service, consumer, and community areas. Findings indicated that clients could learn and retain such information over a three-month period, which was the time frame of the study. Self-help advocacy guides were also employed by Seekins, Fawcett, and Mathews (1987) with clients having physical disabilities. They found that clients were able, with reasonable effectiveness, to apply three focal skills: presenting brief personal testimony, writing letters to the editor, and writing to public officials. Training clients for empowerment was supported by these studies as a feasible advocacy function.
A student comments on a previous experience with client involvement and empowerment:
An exciting example of group advocacy by clients occurred 2 years ago during one of the governor’s infamous budget-cutting bouts. Massive reductions in mental health and social services were being proposed, and at our small agency one full-time professional was in danger of being eliminated. We were able to get a few clients involved in self-advocacy by discussing the situation with them, helping them prepare a statement, and doing some necessary translating. We then helped arrange transportation to a hearing that was scheduled, and encouraged them to speak for themselves about why such drastic cuts should not be made. There were other clients from other agencies also, and their personal stories and pleas made the advocacy very meaningful and empowering. In this case, empowerment included both self-direction and social change, and as a result the staff position in our situation wasn’t cut out.
A study on forms of group advocacy identified two typical modes of organizational activity: forming issue-oriented alliances grounded on shared grievances, and using existing social networks based on friendship (Cable, Walsh, & Warland, 1988). Another investigation examined case advocacy in public welfare agencies where grievance machinery existed. It was found that clients were more likely to make use of these due process procedures when a legal representative was available to them (Hagen, 1983). A role for the practitioner is suggested, providing access to such representation as a facet of the advocacy function. Other studies have found that the propensity to use advocacy measures or to heighten their intensity is associated with reactions of targeted authorities in closing off communication or responding repressively (Oberschall, 1969). (This is related to McGowan’s finding that advocacy is affected by the degree of receptivity by the target.) With this awareness, the practitioner may be able to predict circumstances in which he or she is more likely to escalate to intensive advocacy, or when client groups are prone to be motivated to take collective action.
Modes and Tactics
Advocacy can take a micro or macro perspective, comprising case advocacy or social advocacy (Moxley, 1989; Willenbring, 1994). The terminology varies somewhat, broker advocacy versus group advocacy, or client advocacy versus system advocacy, but the concept is the same. Case advocacy indicates actions on behalf of a single individual, social advocacy entails concern for an aggregate population of clients.
As indicated above, the advocacy concept is sometimes expanded to include the notion of client empowerment through self-advocacy (Weil & Karls, 1985). Here clients are provided with the ability and the confidence to engage in advocacy by themselves on their own behalf (Rose, 1992). The practitioner advocate takes on a training role, transferring the capabilities of advocacy from the professional to the client. Such empowerment may relate either to individual clients or to groups of clients, who then engage in collective action. Two examples from the field of aging illustrate different forms of group empowerment. In New York City the Joint Public Affairs Committee for Older Adults has engaged elderly individuals in th e development of needed public policy and legislation related broadly to income, health, and social services (Duhl, 1983). At the Cambridge Nursing Home in Massachusetts, a political campaign model was employed among the local residents, wherein they take responsibility to act on their own behalf in upholding a residents’ bill of rights (McDermott, 1989). The immediate focus of professional attention and the skills employed differ in the indirect form of professional advocacy reflected in empowerment.
Empowerment viewed broadly has two dimensions: training clients to act on their own behalf as discussed, and changing the environment directly so that the rights and entitlements of the client are protected and experienced. In either of these ways, the life of the client is enriched and the capacity for fulfillment is enhanced. The power of the client to attain maximum self-fulfillment is increased.
The value of empowerment has been described by a practitioner as follows:
Very concrete advocacy skills, once developed and employed by clients, can be highly empowering. For instance, one of my clients was upset over how a bus driver had treated him. When the client arrived at the clinic in the morning, he told me that he thought that he should report the driver, having taken the step of marking down the driver’s name and badge number. I encouraged him to go ahead with that, and made my telephone available to him. I also sat near him, giving support but not direct assistance. After reporting the incident to a transport representative, the client felt much better and proud of himself, and shared this new-found skill with other clients. He was a superstar that day in the clinic.
A continuum of intensity in forms of advocacy is portrayed in the UCLA study. The mildest form involves discussion (65% of the responses): providing information, explaining, giving reminders, and joint problem-solving. The next level entails persuasion (42% of the responses): recommending, urging, repeating, and reasoned argumentation. Greater intensity involves prodding (21% of the responses): here one “pushes” the other party into compliance by mild threats (“I’ll go over your head,” “you wouldn’t want that decision to be known all over town”) and calling a meeting on the subject. Still another degree of assertiveness is indicated bycoercion (25% of the responses): taking legal action, releasing a story to the press, having an advocacy group mount a campaign, cutting off the flow of clients or funds, and contacting a legislator. Respondents did not confine themselves to only one level of intensity in their work. Intensity levels are made clearer through examples from the field interviews:
- Discussion. I advocate by speaking to supervisors at other agencies. I also send letters explaining the referral. If agencies withhold service, I explore with them why they did it and try to understand their criteria. I consult with them and I inform them of the special circumstances of my client. Just making people aware of the problems helps. They think they’re doing a great job and don’t realize what the situation is like from the client’s point of view.
- Persuasion. Of course I advocate. Maybe not the legislative kind, but if someone turns down a client of mine, I challenge them! And I am very persistent, and explain the situation completely. I usually get some results; I may say “just sign this person on temporarily until you have a personal interview.”
- Prodding. I do advocacy all the time. Outpatient facilities aren’t even following their own guidelines and if someone is thrown out for misbehavior, they don’t want to accept him back again. So you get on the phone with the outpatient facility, and the cops as a lever, and you try to negotiate. Also, putting the complaint in writing exerts a lot of pressure. People hate to look bad on paper. Organizations don’t want anything detrimental in writing, so if you get it down on paper, that really moves them into action.
- Coercion. If the patient is denied a service, often by Social Security, I must find a way for the patient to receive the service. This may involve getting legal help through specialized legal clinics. I show the client how to get an appeal. I will write letters or actually go with the patient to a particular agency to represent him, or I’ll attend a hearing. Advocacy is hard—it is always a bear. I have limited knowledge of the legal system, therefore, I must call in a consultant or do my own research. This is very time-consuming.
The single most popular form of advocacy was of low intensity, although a wide range of degrees of intensity was reported, and practitioners did not restrict themselves to one mode. There appeared to be a substantial amount of activity even at the highest level of intensity. Other ways of conceptualizing forms and levels of advocacy are presented in the practice section.
Sometimes different forms of advocacy are used in combination or sequence with a particular client, even over a short time period. A student intern described her work with a client who has chronic mental illness.
Since the day when the case was transferred to me, I have engaged in advocacy for this client, primarily focused on obtaining financial aid through AFDC. This particular client is easily confused and intimidated by fast-talking bureaucrats. As a result, one of the first tasks I helped her with was her initial application. After she went down to the AFDC office on her own, she came back to the clinic saying that they had turned her away. They said that she did not have sufficient evidence that she was a legal resident. When I called the AFDC office to inquire about her case, I was told that she should not have been turned away because she has 30 days to provide them with proof of residency.
The client had to go through the process of applying again, but this time I went with her so I could advocate on her behalf. I had to use various tactics with the many different workers that I dealt with in order to complete her application that day. With most of the workers, “persuasion” worked fairly well, and they helped me after I calmly repeated my requests. Although “discussion” would have been a more ideal place to begin, the workers I met that day were not open to discussion. In fact, with one particular worker who was giving us a hard time, “prodding” was necessary, and as soon as I asked to speak with her supervisor, she began to cooperate as much as she could.
Constraints on Use of Advocacy
There does not always exist a clear field for carrying out advocacy. The feasibility of the advocacy function has been questioned by some writers in the case management field who maintain that practitioners are faced with a conflict of interest: the needs of their clients versus the wishes of their employers (Wolowitz, 1983). Professionals are seen to occupy a middle position, with a “double-agent” task. It is suggested that practitioners in this bind seek to preserve their job, and tend to identify more with the interests of the agency For this reason, according to Wolowitz (1983, p. 82), practitioners may be compromised in exercising “zealous advocacy” on behalf of their clients. He suggests a number of solutions, including turning the advocacy function over to a third-party organization, building long-term funding into contracts so that withdrawal of funds cannot serve as an instrument of conformity over workers, and reaching firm prior understandings with the sponsoring agency about the place of advocacy. The ro le of ombudsman has been examined as an alternative formulation, and found to be more neutral and intraorganizational in the way it is implemented (Blazyk, Crawford, & Wimberly, 1987). While more stable in some ways, it is not a substitute for vigorous and partisan assertion on behalf of clients.
There are also constraints that derive from professional ideology. Some human service writers equate advocacy with “doing for” the client, an obnoxious form of paternalism. Others believe it drives a wedge between the client and the agency, thereby doing injury to the cooperative and holistic values of the human service field. While some professionals distance themselves from advocacy because it is too radical, others think case-by-case advocacy, in particular, individualizes problems that have broad social ramifications, and this can inhibit fundamental system reform (Ashery, 1994; Netting, 1992). These viewpoints notwithstanding, advocacy remains an established and highly regarded function, at some level, within the human services.
Influence Base for Advocacy
There remains the question of the means available to practitioners to engage viably in advocacy: what are their sources of influence and power when confronting recalcitrant organizations? The bulk of these resources lies in the practitioner’s knowledge and skill in organizing and manipulating the human service environment. Because of the complex and multi-layered aspects of advocacy its exercise requires diversified knowledge of the following:
- the client,
- the originating service organization,
- the community service network,
- the workings of other specific agencies, and
- broad community resources (Weissman, Epstein, & Savage, 1983, p. 164).
Moxley (1989, p. 105) groups the practitioner’s influence resources into five power categories:
- Authority. Use of formal authority to enforce access to services and standards of care. This authority may derive from legislative, legal, or administrative mandate.
- Human resources. Encouraging cooperation from other professionals, organized consumer groups, and watchdog organizations.
- Skill and knowledge. Using detailed knowledge of eligibility, licensing, and standards to induce services.
- Social psychological factors. Being charismatic, influential, or having an exemplary reputation in a way that enlists support for one’s clientele.
- Material Resources. Having funds to purchase services from providers, using these funds to assure service to a client by paying for the service or by withdrawing funds if the agency is not forthcoming.
Practice Guidelines for Advocacy
This discussion concentrates specifically on the performance of advocacy functions. Some points from the previous sections will be examined and new information will be introduced to illuminate implementation of the adversarial process.
Framework for Advocacy Planning
Because of complex and interactive variables that are at play, advocacy needs to be approached carefully. McGowan (1987) has proposed a mode of analysis that can be used to aid advocacy planning. Her delineation of the key factors follows.
Does the problem arise because of a special client need, a maladaptive relationship between the client and the service system, a structural or personnel deficiency in a service agency, an inter-organizational difficulty, or a dysfunctional social policy?
Is the objective to secure or enhance an existing service, resource, or entitlement; to develop a new one; or to prevent or limit client involvement with dysfunctional service system?
Is the target of intervention some component in the worker’s own organization (internal advocacy) or in another institution (external advocacy)? What is the service rendered by the organization? Is the relationship between advocate and decision maker one of allies, neutrals, or adversaries (Sosin & Caulum, 1983)?
What gives the worker the right or authority to intervene in a system that has not requested help? Does this derive from a client’s legal right, an administrative entitlement, a discretionary benefit, or a professional assessment of client need?
What assets does the advocate possess or have access to that could be used in the proposed intervention? Assets might include knowledge of a client’s situation, organizational and political dynamics, and community resources; influence with members of the target system or community power sources; communication and mediation skills; and assistance from a client’s natural support system, professional colleagues, or agency officials.
Potential receptivity of target system
What is the likelihood that the significant decision makers in the target system will be receptive to the advocate’s request? Will the advocate’s role and request be viewed as legitimate?
Level of intervention
At what level should the intervention be carried out? Can the objective be achieved by the action of an individual decision maker in the target system or does it require administrative or policy change (Davidson & Rapp, 1976)?
Object of intervention
With whom should the advocate intervene to secure the change needed? The object of intervention might be a line staff member, supervisor, or administrator in the target system; a policy-making or funding body; a public official; an independent service organization or community group; or an adjudicatory or legislative body.
Strategy of intervention
What approach and means should be used to achieve the desired objective? Should the advocate assume a collaborative, mediatory, or adversarial strategy? What actual modes of intervention should be employed: intercession, persuasion, negotiation, pressure, coercion, or indirect action—for example, preparing a client to take independent action, organizing a community or client group, asking an outside party to intervene?
Outcome of prior advocacy efforts
What can be learned from prior efforts to address the identified problem? Were there any unanticipated obstacles or consequences? Have new resources or problems emerged? Is there any need to reassess the problem, renegotiate the client contract, or revise the plan of intervention based on prior experience?
Determining When to Use Advocacy
Determining the circumstances and timing for use of advocacy is crucial. This includes the following considerations:
- Advocacy is an available tactic when community service organizations fail consistently to provide legitimate services to clients.
- Advocacy involves measures reflecting pressure and conflict. There are varying degrees of intensity of conflict that can be applied within an advocacy context.
- Generally speaking, it is a wise approach to use th e principle of “least contest” (Middleman & Goldberg, 1974, p. 73), meaning applying the minimum degree of conflict that will bring about the desired results.
- Controlled escalation of the intensity of advocacy allows optimal outcome for minimal expenditure of strategic resources.
The adversarial initiative contains within it potentially powerful forces of inducement. It also involves risk. The tactic often evokes counterattack, retaliation, resistant “digging in” of organizational heels, or negative and hostile attitudes that persist over time and go beyond particular matters at issue.
Given these factors, a disciplined strategy would combine the principle of least contest with the concept of controlled escalation in planning an advocacy action. A good rule of thumb is to start with the mildest appropriate form of advocacy and move up stepwise to more confrontational forms. There are several advantages to this. Stronger advocacy represents a heavier energy and emotional drain on the case manager than milder advocacy. Therefore, if a milder form will achieve the goal, that is preferred. This notion of least contest has been expressed with plain reason in the following way, “If you can persuade someone, then why mediate? If you can mediate, then why fight with them?” (Weissman, Epstein, & Savage, 1983, p. 105).
This can relate back to Epstein’s research in which he found many intraagency blocks to advocacy actions. Lower intensity advocacy is less likely to bring about disapproval from within one’s own organization. Also, McGowan’s study suggests that moderate intensity might be the most effective level of confrontation.
Advocacy is appropriate when there is an imbalance in power and resources. One common approach to advocacy is to create win-win situations, i.e., those that are mutually beneficial to all parties (Weissman, Epstein, & Savage, 1983). A helpful tactic may be to present a problematic situation as an exchange relationship to the target agency, i.e., you take our clients and we will give yours special consideration. The exchange may involve resources, time, assistance, or simply rewarding cooperative staff. The major underpinning at the bargaining table is that each party invests in the relationship and hopes for a payoff. If this type of advocacy is to be successful, the rewards must outweigh the costs. But keep in mind that the benefits and costs are affected by what the problem is, the procedure employed to present it, and methods used to obtain it.
Unlike some other approaches, advocacy may contain a mutually exclusive feature as a strategy. Many practice methods can be used concurrently in combinations that jointly maximize objectives. For example, in linking with agencies it is possible to emphasize interdependence by demonstrating potential instrumental gains for both. At the same time, the practitioner can draw upon an existing informal relationship of friendship with a key staff member. With advocacy, however, all additional options may become closed out by the antagonistic spirit that is generated. Put another way, “One cannot be in continual disagreement and conflict on one set of issues and expect others to cooperate on others” (Weissman, Epstein, & Savage, 1983, p. 148).
Advocacy in a given situation may be the valid and compelling way to proceed, and if so it should be carried out without flinching. But it needs to be considered with reference to effects on strategic mixtures that would be useful over time. When the continuance of an amiable working relationship is important, advocacy may not be the strategy of choice.
All of these areas could be discussed at length, however, one matter particularly deserves further consideration: the identification of the target of adversarial action. There is an amorphous quality to large formal organizations and urban communities. If appropriate power centers are not identified, much effort can be expended with little result (Ashery, 1994).
It is important to be attuned to organizational variables in defining the target. Who has the power or responsibility to make the decision? Is it an individual or a group? At what level of the organization is the target located: a clerical person who processes forms at the base; a program professional who delivers services; a supervisor who oversees a program area; an administrator who implements policy; a board that enacts or changes policy at the apex of the institution? Who is above the target in the organization? Is an individual or group decision necessary? To what kind of influence or pressure is each individual or group subject? For example, the clerk at the reception window might be “gotten to” through an immediate supervisor in the agency, but the administrator might only respond to external exposure through the media.
Tactics were examined earlier when results of the field study were presented. Responses fell into certain conceptual categories: discussion, persuasion, prodding, and coercion. The analysis of advocacy tactics is expanded here through a more detailed set of techniques. These will be grouped according to the degree of conflict intensity involved. Three levels of intensity are delineated (low, moderate, and high) because of the utility of that formulation for intervention planning. The principles of least contest and controlled escalation can be applied readily within this framework.
- Low Conflict Intensity: Discussion and Persuasion
- Contact provider
- Make the need known
- Use nonaccusatory firmness
- Coach client
- Accompany client
- Use special knowledge of the agency’s policies and procedures
- Moderate Conflict Intensity: Prodding
- Negotiate and bargain with organizational actors
- Invoke legal mandate of your agency
- Appeal to external ombudsman
- Use target’s grievance procedures
- Use your knowledge and authority robustly
- Make assertive requests
- Appeal to a higher authority in the target
- High Conflict Intensity: Coercion
- Appeal to target’s funding sources
- Seek community media exposure
- Mobilize organized consumer groups
- Use the courts
- Use outside authority (political leaders, state bureau)
- Invoke a licensing or regulatory agency
- Inform a government agency that had contracted for the service being sought
This listing is suggestive, not exhaustive. One way to use it is to apply a series of tactical questions to the set.
- Which of these options is most likely to induce the desired response from the target?
- Do I have the skills to carry it out (hard bargaining, public speaking, organizing demonstrations, etc.)?
- Do I have the sanction from my agency to use this tactic? (You may want to go ahead anyway in deference to the interests of your client. But it is better to know beforehand that you are not likely to get your supervisor’s support than to be taken aback and become disoriented at a crucial time.)
- Do I have access to resources necessary to implement the tactic (contacts with the media, legal knowledge or available consultation, an understanding with relevant advocacy groups, etc.)?
The UCLA field study identified a variety of techniques through which advocacy roles are exercised (Table 9-1). Six techniques (above the dotted line) are used by at least five respondents and perhaps merit attention: phoning, writing letters, preparing other written documents, listing the agency, getting legal aid, and referring the matter to a higher authority in the agency.
Table 9 -1 Advocacy Activities Reported by Case Managers
|Activity||No. of Times Reported|
|I phone the agency, provide information, problem solve, mediate, persuade, etc.||21|
|Write letters, give information||8|
|Visit the agency to give information, “raise a stink” if necessary||8|
|Get legal help through a legal clinic||6|
|Refer to my supervisor||5|
|Write reports: psychiatric verification, court documents, etc.||5|
|Show client how to self-advocate—get an appeal||4|
|Support or use clients’ rights organizations||3|
|Contact Congressman, City Council members, Board of Supervisors||3|
|Let agencies know of issues at community meetings||2|
|Negotiate (get on phone with the police and the facility)||2|
|Help the family to be competent to advocate for the client||2|
|Go above someone’s head||1|
|Call to account those who are rude to clients||1|
|Use constant follow-up procedures||1|
The field study indicated that influence can be exerted in some instances by accentuating, with exaggerated bureaucratic fanfare, the advocate’s agency and position. This means using all the trappings of formal status and authority. In one field report it was noted that a client came to the practitioner with a mysterious but official notice about an arrest warrant and fines that were due, but with no knowledge of what his crime was or how to interpret and deal with the frightening situation. Advocacy in this situation required the practitioner to determine the facts. Once it had been ascertained that the “crime” involved several unpaid jay-walking tickets the client had no memory of receiving, she successfully intervened. This was done by submitting a formal letter in response: using agency letterhead, the professional’s title, and as much officialese as possible in a respectful-though-strongly-worded request of the warrant holder that the action be dismissed as inappropriately demanding of this client with psychological disabilities. Luckily, this use of official pomposity was successful in altering the situation in favor of the client—the tickets, warrants, and all fines were dismissed and the client was freed from the legal limbo into which he had fallen.
When large and powerful bureaucracies inhibit client well-being, advocacy may also require pronounced exercise of technical proficiency. This was indicated in field notes on dealing with the Social Security Administration. One practitioner stated flatly that “the SSI report is where I always have to advocate for the client,” noting further that “these reports are classic examples of when advocacy can really matter … and of the way you present information can make a critical difference.” In the agency report it was necessary to document the need for services clearly and with designated categories and language so that when the report is later forwarded to the Disability Evaluation Facility they will not disallow benefits simply because of incomplete or ambiguously presented client information, including precise documentation of impairment. It seems that the length of presentation counts also as this case manager indicated “the longer the form is—the more you write out—the better they like it.” In this instance, it was meticulous and thoroughgoing attention to technical factors that served as a tool of advocacy.
This same target agency revealed additional observations about advocacy. The process of securing SSI monies for a client was sometimes exceedingly lengthy (spanning several years if there are application denials and appeals for reevaluation). This provides an example of combining the function of advocacy and the function of linkage to formal organizations within the practice model. Such mixtures are not uncommon. In working to effect a successful linkage of a client to an appropriate funding source (and thereby access to additional services the client could not otherwise afford to receive), practitioners were called on to advocate recurrently over time in various ways on the client’s behalf through an extended linking process.
Field reports showed that in carrying out advocacy activities practitioners with experience in a given location were at an advantage in being familiar with the workings and reactions of various organizations. This type of worker knew immediately how to deal with situations as they arose. Personal history will suggest which organizations are responsive and which are passive, which are flexible and which are rigid, which can be “reached” by friendly persuasion and which are closed off. The degree of assertiveness to be applied in various instances was relatively evident. Also, the quality of relationships that were formed with key members of the external organization had an effect on whether advocacy or normal linkage was required, and the level of intensity that might be necessary within the advocacy strategy. This suggests that some degree of longevity in the job is useful, and that newer workers should take advantage, collegially, of those with longer tenure.
Reisch (1990) studied advocacy in a cross section of human service agencies, examining factors that distinguished the more successful from the less successful organizations. The more effective of the 150 units he looked at structured their organizational efforts as follows:
- used a designated planning board,
- involved staff in key decision-making roles,
- used clear and formal means of internal communication,
- used established goal-setting procedures,
- involved women in key leadership roles,
- pursued consistent goals over time,
- sought to influence legislation and public opinion, and
- engaged in coalitional activities.
In general, groups that are well organized and that employ planned and controlled advocacy processes do better than groups that rely on informal means of action.
Applying Psychological Pressure
Social-structural elements have been covered through concepts such as targeting, escalation, and strategic mix. Emotional and cognitive processes in the target also can materially affect the results, to wit:
Go outside of the experience of your target
This involves shifting the play to your own turf, a domain that makes the target feel unsure, insecure, and vulnerable. If you are dealing with a routine-driven bureaucracy, bring salient professional elements strongly to bear. With a professional agency, couch the encounter around community politics; however, the se crossovers are not always the tactic of choice. Sometimes you can best outpoint the target on his own home grounds. Maybe embarrass the professional agency by dramatizing a section of the professional code of ethics that is being violated.
Lead your target to believe that you have power
Put your best foot forward in magnifying your potential threat. (Dropping a few names of individuals from the United Way might give the impression that you are better placed there than is the case. The target’s perception of your power is as good as the real thing. But don’t overextend yourself—beware of loss of credibility. Evident failure to deliver nullifies the weapon of threat.)
Use your target’s own norms against him
Exposure of violations of an organization’s own code of conduct is a potent tool. (This means gaining access in one way or another to the rule book, and either mastering it or having an insider provide intimate guidance in the area at issue.)
Keep the pressure on
Maintaining pressure results in the issue remaining open and the target remaining off balance. Large formal organizations may be able to respond to immediate pressures or disruptions, but they cannot easily tolerate extended instability. (By remaining resolute in pursuing the issue, the advocate can pass through the target organization’s allowable time period of self-defense and into a phase when it wishes relief from a sustained, routine-disturbing intrusion. This necessitates application of valuable time, energy, and emotional resources on the part of the case manager. As Epstein’s 1981 research showed, burnout is a common consequence of advocacy intervention. The cost/benefit element has to be weighed.)
This discussion has by no means exhausted examination of the use of confrontational methods on behalf of clients. The entire legal profession rests on this orientation as its foundation; however, what has been presented suffices for an overview of this available, and sometimes necessary, means of promoting client empowerment.
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