Category: Advocacy

Advocacy has been defined as the process of helping the cause of, speaking, or writing in favour of a person or group as well as interceding on behalf of the person. (Segens Medical Dictionary 2012). According to Segens Medical Dictionary 2012, advocacy provides information and acts as a tool to provide self-empowerment for patient’s health and social care as well as helping patients obtain needed services.

Evolution of advocacy

The active support of a cause is advocacy and therefore advocacy can be understood as standing up as well as speaking out for a moral good, voicing out your concerns in relation to disadvantaged or vulnerable people and collaborating individuals or groups who need support utilizing their preferences and rights (Influence through advocacy: Raising awareness, advancing change, 2020).

There has been lack of certainty and also debate about what is the clear meaning of advocacy, which is as a result of lack of universal agreement which evolves from recent and debatable history of advocacy in the social health care sector and the role of people who works in the fields as an advocate (Advocacy Skills for Health and Social Care Professionals, 2020 Neil Bateman).

Negarandeh et al., 2020 also stated that advocacy over the recent two decades has been a topic of much debate in the nursing profession, and this crucial role has been embraced by nurses even though it is often limited in practice. Patient or nursing advocacy is one of the enhanced procedures that has been highlighted by nursing organizations around the world. This procedure is a relatively new idea, but its first movement began in the Florence Nightingale’s era (Shirmohammad Davoodvand, 2020).

Florence Nightingale advocated for patients in the Crimean war to have better hospital condition and for the nurses to also have better education. She advocated for improvement in health conditions and better care for the sick and vulnerable by influencing government, policymakers, physicians, and philanthropists (influence through advocacy: Raising awareness, advancing change, 2020). Nurses are the leading advocates for patients and therefore act as a link between the patient and the health care system and therefore patient advocacy is seen as an exceptionally important roles of nurses (Shirmohammad Davoodvand, 2020).

The skill needed in nursing to be a successful advocate who supports a cause or interest on one’s own behalf or that of another, requires skills such as problem solving, communication, influence and collaboration (Advocating for Nurses and Nursing, 2020).

Advocacy is important in safeguarding individuals who are vulnerable and has been discriminated against , speaking up for individuals who are unable to speak for themselves, empowering individuals by helping them express their own needs and make informed decisions, enable individuals to also access information, understand their option and also to express their views, wishes and feelings , and lastly actively help supports individuals to make informed choices.(2020)

Shirmohammad Davoodvand, 2020) indicated that there are patient or clients who are vulnerable and have faced various degrees of damage and therefore there are various opportunities for nursing in enforcing patient advocacy and this turns the nursing profession into the most reliable profession regarding patient advocacy.

According to Voiceability, advocacy plays an important part in preventing abuse by helping people to know about their rights and be confident in promoting them. Advocacy is therefore key in detecting and reporting abuse and those who advocate for people provides a trusted point of contact to divulge allegation of abuse and therefore their presence in hospitals and care homes , as well as their understanding of norms and training helps to deal with allegations or observations of abuse.

Communication in advocacy

Nurses advocates for the community and they are also communicators and coordinators within team and therefore communications skills for nurses are important. (Sibiya 2018)

Communication has been defined by Sibiya 2018 as exchanging information between people through sending and receiving which can be achieved through speaking, writing, or using any other medium. Sibiya 2018 state that clear communication enables information to be transmitted effectively between people and for nurses to be successful communication skills are important. Also, nurses interact with people of various educational, cultural, and social background and therefore interaction must be done in an effective, caring, and professional manner, particularly when interaction with patients and their families.

According to kourkouta and Papathanasiou 2020, there are three foundational skills that are needed in communication and these are; Communication without words or non-verbal communication , which is an ongoing process which is embodied by facial expressions, gestures , postures and physical barriers which includes distance from the speaker. Also listening is also a skill needed in communication which involves concentration of attention and utilizing all the senses for perception of verbal and non-verbal messages which is produced by the patient and the lastly personal relations is another foundational skill in communication which is obvious by kindness, compassion and care ,nurses therefore can develop good personal relations which gives nurses the ability to ask questions with kindness and provide information that does not scare and that also shows interest and create a feeling of acceptance trust and pleasant-sounding relationship, particularly in a modern multicultural society.

The process of communication has several barriers such as language, psychological, emotional, physical, and cultural and so on, and this can lead to misunderstanding and failure of communication (Barriers of Communication: Types of Barriers to Effective Communication 2020).

Nurses and nursing staff are the fore front of communication and therefore assess, record and report on treatment and care, they handle information sensitively and confidentially, deal with complaints effectively and are duty bound to report things that they are concerned about (Principles of nursing practice Royal College of Nursing, 2020)

According to the Nursing and Midwifery Council (NMC 2018), nurses should be able to recognise when a person is at risk or need extra support and protection and take reasonable steps to safeguard them from abuse. Also, the need to use different range of communications skills and methods which include verbal , non- verbal and written to acquire and interpret and record their knowledge and understanding of peoples need, and also use technologies to support person-focussed care and enhance quality and safety.

The nursing and midwifery council(2018) states that nurses must take into account different ways people communicate and the ability to recognise and respond effectively when a person find it hard to communicate and when language interpretation or other forms of communication support is needed and how to obtain the support.

Identification

Practitioners such as Nurses can identify and interrupt domestic abuse and this can be done by recognising the indicators of abuse and finding ways of supporting and referral for protection as needed. (Responding to Domestic Abuse: A Resource for Health Professionals, 2017

In the scenario in video 2 they Nurse was able to recognise some indications of signs of abuse such as marks on the arms of the patient, how nervous , afraid and hesitant she was and also the partner not allowing the patient to speak for herself, which is an indication of abuse.

According to the Department on health on Responding to Domestic Abuse: A Resource for Health Professionals, 2017 There are indicators to guide health professionals that a patient may be facing domestic abuse. Some of them are understated and therefore professionals must remain alert to these signs and respond appropriately. Some victims may drop hints in their interactions with health staff and their behaviours may also be telling. There is therefore the need for the health professional to listen, persist and enquire about the signs and cues.

Barrier for advocacy

The Video Scenario 2 – A close observation of the scene in scenario two highlights some of the key issues and challenges nurses are confronted with in their line of duty. The nurse was faced with 2 barriers of advocacy which was language and the presence of a spouse acting as a communication barrier for effective advocacy being utilized by the nurse to safeguard the patient who may be abused by her partner.

In my opinion the nurse could have ask the spouse to wait outside to enable her to examine the lady further with regards the bruises on her arm and potentially on other parts of her body. Also, that would have given her the chance to alert another member of staff to investigate the matter and get an interpreter to enable effective and clear communication between the patient and the nurse.

Beynon et al, 2012 did a study on barriers that healthcare professionals such as nurses faces in relation to asking about intimate partner violence and some barriers predominately described by nurses were language barriers and in the second scenario the nurse was not able to communicate with the lady because she did not speak English and the partner was speaking on behalf of the lady, also partner presence was also seen as a barrier because abusive partners tendency to stay by the woman side and nurses in the study also wrote that the partner presence made it challenging to interview the woman alone as depicted in the second scenario

Partner or spouse always attends appointments unnecessarily • the patient is submissive or afraid to speak in front of the partner or spouse. The partner or spouse is aggressive, dominant or over attentive, talking for the patient or refusing to leave the room (, Responding to Domestic Abuse: A Resource for Health Professionals, 2017)

People who insist on escorting their partners to appointment or speaking for their partner may seem to be caring and protective and this may be plausible , however, controlling their partners access to the nurse is part of the abuse as depicted in the second scenario and this support the need for advocacy. . Responding to Domestic Abuse: A Resource for Health Professionals, 2017

Intimate partner abuse is widespread and therefore victims often cannot or do not advocate for themselves and therefore the onus falls on nurses to be aware of these problems, be familiar with any risk factors, patterns of injury associated with intimate partner violence and understand how and to whom intimate partner violence should be reported.(2020)

Solution

Healthcare providers such as nurses can help by screening for domestic violence through documenting abuse in the patient medical record, through safeguarding evidence, providing medical advice, referrals and safety planning , showing sympathy and also compassion(Domestic Violence , Sexual violence , intimate partner Violence 20)

Only ever raise the issue of domestic abuse with a patient when you are alone with them in private and, if not, ask the escort to wait elsewhere

Privacy- Only ever raise the issue of domestic abuse with a patient when you are alone with them in private and, if not, ask the escort to wait elsewhere.

Using an interpreter Never use a relative or friend of the victim as an interpreter. Always use a professional interpreter, who has had domestic abuse training or an advocate from the local specialist domestic abuse agency. The interpreter needs to be the same gender as the victim and should sign a confidentiality agreement. Look at your patient and speak directly to them – not to the interpreter.

They need staff to follow up conversations in private, record details of behaviours, feelings and injuries seen and reported, and support them to act suitable for their organisation’s systems and local pathways(, Responding to Domestic Abuse: A Resource for Health Professionals, 2017)

Advocacy is an act of soliciting for a cause, idea, policy or support with the desire to provide help and support to encourage individuals in the state of need (Almog-Bar & Schmid, 2014). Social media have been identified by many researchers has a strong medium for advocacy, it has expanded advocacy efforts by connecting new networks of community actors to take necessary actions (Guo & Saxton, 2014). Social media advocacy is a form of media advocacy, it is defined as a process of influencing decision-makers through the media channels that are of importance to them such as newspapers, radio, television, newsletters, journals, magazines, and social media (Fresina & Pickles, 2013). Social media serves as an innovative tool for enlightening and mobilizing the community by aligning with the community psychology principles to enable individuals contribute to social issues and change efforts (Scott & Maryman, 2016).

The use of media advocacy is strategic, it requires the fundamental principle of knowing the goals to be achieved, the individuals to be targeted, framing issues and message construction, construct media advocacy plan to deliver messages, create pressure for change and evaluate these are five strategies for considering media advocacy by (Wallack, 1994). (Bowen, Gordon, & Chojnacki, 2017), organized a group of student to conduct a social media research to test the engagement rate of social media usage for advocacy, in the research there was a fixed goal to create awareness on different personal issues like domestic violence, the given target individuals were youths and their messages were constructed to promote change. The evaluation of the research lead to the conclusion that social media could be used for advocacy because it facilitates engagement through different platforms for different individuals.

Social media has a wide range of platform such Facebook, Twitter, Blogs, and Instagram, twitter for instance have been used to generate hashtags to lay emphasis on different issues, it helps spread advocacy for different cause to like-minded individuals and other social media platform users. Also, these hashtags are to be engaging, educative, communicate effectively and create dialogue between individuals (Saxton, Niyirora, Guo, & Waters, 2015). The use of hashtags effectively can increase interactions on different social media platforms since these platforms are interconnected.

This essay will evaluate and highlight the similarities between the values and principles that underpin mediation, counselling and advocacy. It discusses the role of mediation within young people and how it may impact in the case study of Sam. A particular type of advocacy and its impacts will be explored and recommended for Sam.

The principle of voluntary participation in mediation demonstrates the willingness of the party to communicate with each other in order to resolve conflict. The party benefits from remaining in control all the way, participation is freely agreed and is a matter of choice ( ). However, mediation is based on more than one perspective, requiring both parties to agree for mediation in order for negotiation to take place. It is important for each party to recognise that they are in the mediation process out of their own free will to work through the dispute ( ). Mediation becomes difficult if either party is unwilling to co-operate or compromise to come to a solution. Voluntary participation is equally important in mediation and counselling services.

A significant difference in mediation is that mediators need to remain impartial, not taking anyone’s side or giving advice( ). This ensures the parties involved that they are not being judged or blamed. It can become particularly difficult to agree on a solution when both parties believe in the strengths of their own case and not being able to verify the weight of an argument.

One of the core principles relevant to counselling is beneficence. Beneficence is the act of charity, mercy and kindness. A counsellor promotes what is good for the client and strives to provide the best care with the expectation that the client will benefit from counselling ( ). However, counselling is not always the best answer to a problem. The client is weak and vulnerable and need someone to help them decide. The counsellor holds the position of trust, power and authority which comes with high levels of responsibility to ensure these standards are upheld.

Respecting the client’s autonomy empowers the client to make their own decisions, enabling the client to deal with the difficulties in a more productive and independent manner. Autonomy helps with independence, to identify personal goals and bring out desired changes for self-realisation in order to find ways to progress ( ). However, one of the common ethical difficulties in counselling may arise when the client’s decision conflicts with the counselor’s duty of beneficent of looking out for their best interest. For example, if a young person wants to continue to binge drink even when the drinking is causing problems in their relationships, the counsellor will have to respect the young person’s decision even while trying to convince the young person otherwise. Autonomy is promoted in counselling, mediation and advocacy services.

Advocacy aims to provide clarity of purpose, their role and responsibilities for acting for the client is made clear which is key for the client to know what to expect. Advocates seeks to ensure the clients voice is heard; they do not make the choices for them even if their ideas differ( ). Having good knowledge on the laws and rights for the individual can help to protect clients and voice their concerns. Communication is important, the advocate needs to fully understand the issue in order to interpret for complexity of the case and produce an effective response (Moss, 2015). A similarity between counselling and advocacy is that they are bias towards their client’s needs whereas mediation is an impartial service.

Family relationships often break down in stressful situations to the extent that families feel that living apart is the best option. The involvement of a neutral third party can help support the family to continue to live together through mediation. For a young person life chances are usually better the longer they are living at home. Mediation can provide practical help in dealing with conflicts in family relationships. Learning how to resolve their difficulties and helping the young person to remain in the family home until it is appropriate for them to leave. The National Homelessness Advice Service (NHAS) suggest that mediation can help to avoid family breakdowns through resolving disagreements and conflicts, preventing problems escalating to the point of crisis, improving communication and relationship skills, learning how to compromise through improving and strengthening parent-teenager relationships. Mediation may not be appropriate in all situations such as the young person is suffering from violence or abuse in the family home or if they feel coerced into mediation then it is set up to fail.

Baginsky, 2004 suggests that young people confide in other children rather than adults (Lawrence, 2000). Peer mediation is a process in which students act as mediators to resolve disputes amongst themselves. This is a form of constructive conflict resolution in a non-violent manner based on negotiation and mediation by their peers. With the help of peer mediators’ disagreements are openly faced, working towards shared understanding and agreements through careful exploration of the conflict. Mediators work with their peers to help resolve conflicts, disagreements and low-level disciplinary problems such as addressing instances of bullying, spreading rumours and preventing fights. A good mediator would display a range of personal qualities such as communication skills, respect for their peers, self-confidence, empathy, leadership, willingness to receive feedback, ability to speak in front of groups. (Scottish mediation)

Peer mediation for young people can be set up in schools, youth organisations or any other relevant settings. Peer mediation promotes leadership skills, communication, cooperation skills, confidence and tolerance, enhancing strengths and building resilience amongst those involved. Paterson identified how peer mediation consistently helps with friendships, they are honest and willing to help, training is key to successfully lead.

According to Stopbullying.gov (2019) peer mediation is not the appropriate intervention for Sam as bullying is not a conflict but a form of victimization. Mediation can send the out wrong message to students as the process assumes no one is right or wrong. The message for bullies should be that this type of behavior will not be tolerated. The message to Sam should be received as she does not deserve this, she is being fully supported to stand up against bullying. Mediation may upset Sam as facing the bully may make her feel worse.

There are more opportunities for bullies to act in a large secondary high school as hallway supervision, individual monitoring is limited. It is challenging when the youth voice is too timid, too quiet, too distanced, too inexperienced, and too ignorant to have any impact (forward).

Peer advocacy provides the opportunity for students to take a more formal action. Four actions have been identified to have the most potential to improve outcomes for victims of bullies through spending time with students who are bullied, trying to get students who are bullied away from the situation, listening to students who are bullied, telling the student that no one deserves to be bullied (Youth Voice Project, 2010).

The peer advocacy process establishes a support system from peers as well as organising the movements for adult supervision and support. Purposeful engagement of peers to intervene in systematic ways is a powerful step to reduce bullying.

Peer advocates are educated, trained, supported and encouraged to safely speak out and take action when they see instances of bullying (peer advocacy guide)

Advocacy requires a person to have the confidence and the capabilities to stand up and stand by another individual. Helping them to have a voice, working to protect them from harm and arranging for resources to meet the individual needs. In times of trouble peer advocates can offer friendship, sympathy and support and bring strength and encouragement to recognise and defend own rights. Advocates risk being antagonised by other peers as they are seen as taking sides. Advocacy involves commitment, time and energy and may damage reputation. (Williams, evans)

Peer advocacy is probably the most suitable type of intervention as it can empower Sam to stand up against the bullies and to enable her to return to school. Sam could do with the support from someone of a similar age who will listen to her and understand her situation through own similar experiences. Shared experiences can lessen the imbalance of power between Sam and the advocate. Peer advocacy can help build/rebuild her self-esteem, confidence and well-being, allowing her to take back control of their own life ( ). A peer advocate appreciates having the opportunity of making a difference in another student’s life and can provide practical support and encouragement ( ). Showing Sam that she is not alone in this anti-bullying fight, and that they will always be someone there for her by her side. The advocacy process is centered around the individual which can help Sam to reflect on her personal situation and explore her options. Peer advocates can talk to staff members, email or phone support services which Sam may not feel confident to approach by herself.

Most values and principles interlink between mediation, counselling and advocacy, however there some distinct to one another which supports their different roles. Mediation being an impartial service can help with normal disagreements but as pointed out by Stopbullying.gov (2019) bullying is victimisation which needs to be addressed in a formal disciplinary manner. For Sam, confiding with her peers and receiving their support in voicing her concerns is more likely to help her back into school knowing that support is in place for her.

In the modern world of research, numerous individual has come out to increase the depth of studies conducted previously regarding the diverse areas of study in the world currently. Among the many areas of study, socioeconomics has become a core area of research mainly due to its application in the everyday lives of people around the globe. Additionally, society and economics are heavily linked primarily because the efficient functioning of society relies on a healthy economy (Wilks, 2012). Based on this, numerous studies and theories have been forwarded in the field practising advocacy for social change and social actions pertinent to social change. These areas of study, which have been a subject of research for decades now allow for continuous social, economic, and political development. In this light, this paper will analyze four theories on advocacy and social change, subsequently developing a comparative analysis of the respective theories. Before this, it is, however, crucial to describe the selected advocacy models and theories of social change.

Brief Description of Selected Advocacy Models

According to Stewart & MacIntyre (2019), advocacy has existed in different countries around the world for decades now, at least since countries and their citizens developed the need of improving themselves, economies, and societies among other core facets of human life. Consequently, advocacy takes different forms and also has different characteristics but the base line is that there are five models of advocacy used in research. For this essay, self-advocacy and peer advocacy will be selected in undertaking a comparative analysis of the same.

In simple terms, self-advocacy can be defined as an approach used by an individual in addressing various social, economic or political issues affecting their living. An example of self-advocacy in work is when a student issues a request to have more books available to them in a library for better studies. Self-advocacy is therefore based on personal interests or grievances with the purpose of improving personal wellbeing among other personal rights. This approach is developed over time and involves self-discovery whereby an individual comes in terms with his or her social needs. After this, the individual masters the courage to address the issues that he or she faces. Through this, therefore, self-advocacy comes in handy. This attitude mostly involves individuals’ personal initiatives and not influence from any forces,

On the other hand, peer advocate as a model of social advocacy refers to individuals, usually of the same background or who share a common grievance join forces to seek improvement of specific social, economic or political issues affecting them. It, therefore, means that peer advocacy is done collectively by a group of people sharing a common problem. Circumstances dictate the approach individuals take and what decisions they make. Peer advocacy apart from being a collective approach, is dictated by the circumstances the individuals undergo so as to give them the motivation to fight for their interests. These circumstances are what calls for change.

Comparative Analysis of Self-Advocacy and Peer Advocacy Models

According to Stewart & MacIntyre (2019), self and peer advocacy are widely different mainly because they address personal and group issues respectively. It, therefore, follows that self-advocacy is designed for individuals to address personal issues affecting their social, economic or any other spheres of life (Wilks, 2012). This means that the model is not adequate for improving specific issues facing people in a given society. Peer advocacy, on the other hand, is designed to create a platform for individuals, sharing a common background or problem in their society join forces to remedy the same.

Focusing on a trending Brexit debate, British citizens in different parts of the country have joined forces lobbying the government and politicians supporting Brexit not to leave the EU, given the expected social and economic issues associated with the leave. It, therefore, follows that unlike self-advocacy, the model of peer advocacy allows for balanced power among individuals in solving specific issues affecting their living. Consequently, due to the collaborative power in this model, it is more effective in addressing a common problem affecting people.

Theories of Social Change

Traditionally, societies have been dynamic primarily because peoples’ needs have an evolutionary nature. In this way, it is key that people living in different societies across the world change their environments based on prevailing needs and or problems affecting their living. With respect to this, sociologists developed five models of social action (Arbor, 2015). For this comparative analysis, the Economic and Conflict theories of social change will be used.

According to Arbor (2015), the economic theory of social change is heavily embedded in Marxist views of global societies and economies. The theory is based on the fundamental premise that an economic change in a society or country is the most critical source of desired societal changes. The model advocates for continued changes in political, ideological, legal and religious infrastructural systems in a said society with the goal of establishing a platform for continued economic improvements in the face of a specific social problem. According to Marx, religion and its manifestations, morality and the different social structures all depend on economics. The manner people choose to worship is based on their views, Calvinists, for instance, are capitalists. There is a direct relationship between economics and social aspects which implies that in order to achieve social change then economics need to be considered as well. Further, Marx argues that the efficient change in what measure is that which encompasses both the social and economic aspects.

On the other hand, the Conflict theory of social change revolves around the idea that all societies must function as a unit. In this way, social integration leads to conflict between individuals, and or groups of people in a given society when faced by a common issue (Wilks, 2012). Consequently, this theory was developed on the premise that societies function as a unit and as such their members must from time to time disagree on changes required to improve their social, political and economic environments. Change according to this theory, is based on interactions. Human beings being social by nature cannot avoid change as their interactions in one way or another cause this. Life is a competition characterized by daily efforts to distribute resources and power. Additionally, persons deserve equality, and this is sought by them. Through this, there is a motivation for social change.

Critical Analysis of the Economic and Conflict Theories of Social Change

Analyzing the two approaches to sparking change in a given society, it is clear that both theories focus on the same issues, namely the social, political and economic issues affecting groups of people. Unlike the conflict theory, however, the Economic theory takes a broad approach in describing that all changes required in a given society are related to the state of its economy. As such, it can be inferred that the economic theory focuses on creating social actions to improve the state of an economy with the broad goal of supporting changes in other social spheres (Wilks, 2012). Notably, this theory is more effective in creating impetuses for social changes primarily because all social changes in the modern world are dependent on economic welfare. For example, using the Brexit issue affecting a significant number of British national presently, it is evident that the conflict theory of social change cannot suffice in bringing about the desired social changes is the political move is to pass.

The economic theory can, however, be adequate in establishing effective social, political and economic infrastructures if the British people are to remain sustainable in their societal and economic spheres.in this way. it can be argued that the economic model of social change is more effective and practical in developing social actions need to bring about the diverse changes people in different countries across the globe continue to seek in the face of different problems. This is primarily because any broad social action is heavily dependent on the economic welfare of a society, as opposed to the level of integration described as the precursor to bringing about social changes in the Conflict theory of social change.

The economic sanction model is characterized by elites gaining control over social, economic and political weapons to gain access and derive benefits from the society (Armitage, 1996). The elites gain control over the country’s resources and at the same time using it as a direct threat to obtain unmerited benefits from clientele.

Nonetheless other models of social action as legislative model depicted a process where elites conducted studies of the extend, gravity and urgency of problems while creating public opinion and various lobby groups aimed at modifying the social policy (Barker, 1994). The general population and various target groups are directly not involved in this process. They invest in lobbying and other key activities aimed at achieving significant benefits from a given segment while preventing maladies from affecting their world or clientele as well as removing issues hindering this growth. The elites in turn set up their commission with a vested interest and conduct research or studies on the extent, and urgency of the issue. They chalk out our feasible and, scientific interventions, pursue lobbying and create public interventions. (Berman-Rossi, 1988) Upon finalizing this process, the elites discuss the matter with Ministers and concerned officials while persuading them to implement appropriate interventions.

The Dialectical mobilization based on conflict model helps in promoting conflicts and misunderstandings in order to exploit various contradictions in a given system as well as the belief that various intervention will finally emerge. Dialectic model is an art of key logical disputation. This process involves a thesis or initial propositions which generates counter propositions as well as rational context. When two people or groups take up such extreme positions with a heated argument, the position of one side can be described as a thesis while the other as antithesis (Berg, 1995). The posing contradictory positions aimed at reaching consensus is usually termed as dialectics and actionist who usually follow this process take the logical path to the ontological. It’s based on the assumption that forces in human institutions and nature clash and develop. In turn, every social force and institution in itself is actually an element of its disintegration (Day, 1970). They are able to expose key contradictions with a given system while promoting conflicts and expecting higher result in economic, social and even political structures.

Analysis and Examples of advocacy Theories in Practice

There is a huge range of models of advocacy whereby each has a distinctive characteristic which depicts a type of work, the length of its involvement and the kind of person who needs to take up this role. Although there is inadequate evidence about the efficacy of the advocacy due to lack of understanding and differing definitions about its role. Some evidence suggests that the process of advocacy ensures the voices of citizens who need the services are heard while promoting increased confidence (McNutt, 2011). Advocates need a significant skill set to actually undertake a given role effectively towards maximizing its effectiveness.

Advocacy has existed in many countries notably the UK for the last 30 years, and it’s through this period that a range of schemes and models have emerged especially for those who access the support (Collins, 2006). The features of this advocacy include empowerment, independence from services, supporting citizens to access support, promote social justice and challenging inequality. Essentially advocacy helps people get the right information, understand their needs, rights as well as making the right choices. Advocacy is however not about counselling, mediation, befriending, giving advice, taking complaints and giving advice although these elements can be found to some degrees across various models.

Due to a lack of understanding and conflicting definitions about the role of advocacy, it’s quite difficult to also measure the overall impact of advocacy has on the impact and outcomes for people who have access support. Action for advocacy has, in turn, developed the outcome measures which has in turn been used in various research (SIAA, 2008). SIAA has continuously developed some evaluation framework aimed for advocacy by providing tools for analyzing and measuring the effectiveness of advocacy against their standards and principles.

Using this framework, the organizations can, in turn, establish the key differences which have been established, the methods of advocacy which works and develop a comparative picture of the overall achievements. People who have better access to support and have experienced advocacy depict a high level of personal satisfaction. This satisfaction, in turn, relates to the powers that advocacy has towards empowering citizens to access the support services by enabling their voices to be heard (Ward, 2009). Nonetheless, with regard to these participation, people or citizens who still access support reported to having great understanding and knowledge of key processes involved. This makes them understand the language used and their rights hence leading to such an increased sense of empowerment. This sense of empowerment, in turn, led to increased self-reporting and self-efficacy creating confidence.

Citizens who have such access support report high levels of self-satisfaction especially when they receive support or help. The provisions of this moral support have reviews as significant during formal; proceedings but sometimes it’s described as intimidating. The relational aspect of this advocacy is confusing science; it appears as a key indicator of various satisfaction levels across different advocacy provision. Peer advocacy, self-advocacy and citizen advocacy are said to offer great chance and potential towards support and promotion of social networks while building a relationship through a stable and safe environment (Carlisle, 2000). Higher levels of trust lead to higher levels of participation.

The creation and development of legislative access to advocacy have such big potential to create a two-tier form of support system. The individuals under mental health legislation or compulsory measures are likely to access advocacy. Rather unintended effect of this would probably be the promotion of social networks and social inclusion. However, in peer advocacy and citizen advocacy similar concerns actually, exist. The difficulties which have been documented relating to peer advocates include lack of confidence to actually undertake this role as well as disassociation with those who possess similar label due to fear of discrimination and stigma (Lawton A., 2009).

Advocates should possess a required skill, expertise and skill level in order to outperform their role and be taken seriously. For those under volunteer advocacy or self-advocacy, they should develop appropriate training and support. This can be a challenge on organizations which are mainly dependent on any short term funding. There is usually tensions between representing individual views and empowering them towards reducing the power imbalances (Stewart, & Gillian, 2019). This imbalance is usually due to a lack of fundamental understanding of purpose and role of advocacy.

Nonetheless, there has been great issues when it comes to working with those who have complex needs of support. Various assumptions are made around the capability and capacity of those who access these support and make decisions. Self-advocacy hence has huge potential to challenge these assumptions by stressing on control and choice of those who access these support (Arbor, 2015). However, these leads to complete isolation of the self-advocates basically from organizations which seek to challenge them.

The most effective advocacy needs independent and long term funding. Its always hard to deliver on advocacy principles of loyalty, independence, commitment to empowerment and justice and at the same time balancing on key obligations of a funding organization. A trusting relationship developed over time influences key participation. Familiarity, continuity and consistency is key to its success. Support and training are also paramount towards enabling advocates to develop a knowledge base, understand roles and create skill set and confidence (Dalrymple, 2011). Cultural sensitivity is important also towards providing understanding and ability to address key issues faced y significant groups.

Analysis and Examples of Social Action Theories in Practice

Social action shows a number of interventions which have been developed and directed towards a social change. These are efforts which represent key strategies which may be a target for services, change, institutions and structures which make up a given society (Harvey, 2012). It represents strategies and interventions which help towards realizing the goals and objectives of social reforms. These interventions are changes which leave the existing structures in place as well as those aimed at social transformation which alter the current social structures.

Social action can, however, be termed as contentious by challenging the status quo. Weber (1919) expressed his concern with the increasing number of social relationship and social actions based on consideration of calculations and efficiency. Durkheim’s concern was based on institutional arrangements which maintain social structure cohesion. However max vision of a given society is was also informed by the preoccupation of conflicts between productive relations and social classes within social structures (Beethham, 1985). Weber’s main focus was based on subjective meanings which various human actors always attach to their individual actions and mutual orientations.

According to Weber, the social action defined in sociology is those which men engage in goal-oriented or purposeful rational action. This rational action can be value-oriented whereby they act from affective or emotional motivations. Purposeful rationality defines both means and goal as rationally chosen and exemplified by those related means to ends. Value-oriented rationality is thus characterized by working for a substantive goal which leads to ascetic self-denial or attainment of salvation (Gidden, 1960). Affective action is also anchored in a state of actor’s emotion rather than weighing the rationality of means and ends.

Weber was concerned with a western society where the behaviour was mainly dominated by goal-oriented rationality as opposed to earlier periods where it was motivated by value-oriented rationality. Whereas the sphere of economics and politics in the realm of interpersonal relationship and law, the application of these means to end has actually become quite predominant and in turn replaced another form of social action.

During the period of great depression of 1930 which was characterized by the collapse of economy, ideological and militant ideas were greatly influence the labour struggles inspired by the communist party. The social action was based on class struggles and organized in terms of social revolution and the industrial revolution. Advocacy was also carried by key members of the working class (Advocacy, 2006).In effect, the labour or working class spoke for itself as compared with relying on the other middle-class reformers. Local interest and needs were mainly connected to broader and international concerns. However with the effects of world war and its aftermaths such as forces generated by the new deal, economic expansion and cold war hostility undermined and dampened any kind of social action.

However, after this period of civil rights movements and the war on poverty, a period of disruption and unrest was ushered which included a different form of demands which aimed at equitable distribution of state benefits. Advocacy becomes class-based, less ideological and single focused. Professionals mainly undertook this advocacy with movement groups. These movements were in the form of organized confrontations by clients and staff. Other community organizers as Saul Alinsky, developed and promoted key strategies of conflict over building coalitions and consensus (Dalrymple, 2011).

While the 1970 movement was necessitated by the oil crisis, further decay in US cities and increasing debt, there was a decision to cut entitlement and service programs. The conservative agenda was focused on changing individual’s rather economic and social institutions. It is evident that social work was influenced mainly by humanism and supported by values based on beliefs of human potential as well as models aimed at advancing knowledge through measurement and observation. In order to link these theories, paradigms, power, perspective, the manner of social action interventions and practice frameworks is based on Lincoln and Guba typology (Lawton, 2006). The paradigms of post positivity and positivity are mainly compatible with visions of the world which depict a structural functionalist and contains pluralism power relation explains the societal functioning. On the other hand, the paradigms of constructivism and critical theory represent such alternate visions characterized by elite power relations which led to critical societal structure analysis that support a structural approach to practice by utilizing social action as key strategy to social transformation (Martineau, 2010).

Conclusion

While considering the history of advocacy and social action in any social work, the definitions of these principles are key. Social action is based on a coordinated effort aimed at achieving institutional change, solve a problem, change a need and correct a given form of injustice. This, in turn, identifies initiators of advocacy and social action as those in social welfare, politics, economics, military and religion which can be directly influenced by a problem.

The global complexity in health and life of the modern population often enforces the healthcare practitioners in being health advocates for the general population. As per the definition of WHO, it is proved that advocacy can be considered as one of the critical three health promotion strategies, which can be performed by using different types of promotional channels and attributes. Based on the previous campaigning strategies, it can be stated that health advocacy is a combined approach, for gaining policy support, system support, social acceptance, and political commitment. Therefore, in order to cater to the unexpected event of a miscarriage, it is necessary to design a social media-based advocacy campaign, for supporting, the women experienced the adversities of miscarriage. The current assignment sheds light on a social media campaign; named #IHadMiscarriage, along with it’s all over the structure, ethics, policies, and reflective actions.

From the evidence collected from the previous health advocacy campaigns, it can be assumed that it is necessary for supporting the people suffering from different adverse health status, for assessing their concerns, service information, choices, and rights. On the other hand, Johnson & Langford (2015) mentioned that advocacy in health practices is fundamentally taken for enacting notable changes and modifications over a larger scale. During the preparation of my first assignment, I have understood that the concerns of modern healthcare practitioners about miscarriage are extremely lower and therefore, the areas of nursing interventions regarding miscarriage are required to be implemented through an effective way.

The health advocacy campaigning supports in providing attention to each of the issues associated with miscarriage, understanding the negative points faced by the women, and designing various health promotion or intervention strategies for them. The benefit of using social media campaigning is it does not require high-cost structure and the concerned message about miscarriage would reach to the entire target audiences within a specific time (Ipas | Health. Access. Rights, 2019). Therefore, from the designed concern I have explained in my first assignment about miscarriage, I think that a social media advocacy plan would be beneficial for improving awareness about the event.

As mentioned earlier, the name of the campaign would be #IHadMiscarriage, and the campaigning would be performed through different popular social media channels. The structure of the advocacy campaign are as below: Campaign goals and tracking: The primary purpose of the campaign is to explore the health supports required after the event of a miscarriage, for regaining the strength of living a healthy life. Apart from this, the campaigners would also focus on encouraging the unfortunate women for voluntarily accepting this state of living. Supporting the women in overcoming the stage of grief and bereavement is also a potential aim of this advocacy campaigning program. Apart from this, the mothers would also be encouraged for living with a definite sense and preparing for their future motherhood. As influenced by the viewpoint of Karen Gill (2018), the campaigners would measure the perspectives of the affected mothers, towards living healthy lives, through which the success or failure percentage would be identified.

Campaign targeting and insight: The campaigners would try to reach to the unfortunate mothers, who have suffered from the phase of miscarriage and still living under the depressed and anxious mental condition. Apart from this, the campaigners also would try to influence the mothers along with the other family members in regaining their spontaneous nature of lives. However, this media campaign would not be only for the unfortunate women; this would also target the men, or especially the fathers, who have lost their children. Ockhuijsen, van den Hoogen, Boivin, Macklon, & de Boer (2015) mentioned that it is necessary to incorporate fathers in the health advocacy campaigning, as they need to perform more critical role after the incident, as supporting their wives, other family members, and dealing with self-mindset.

Key campaign message: The campaigners would focus on explaining different advocacy strategies regarding miscarriage, for supporting the women in overcoming the physical and mental stages. (All the advocacy strategies are discussed in the following section after completing the campaign structure.) Additional to that, the campaigners would also promote that they will conduct some periodic face-to-face interview sessions, for understanding the distinctive experiences of the women and try to support them both physically and mentally (Miscarriage, 2019).

Campaign media budget and plan: Since it would be a social media campaigning, therefore, the campaigners would target the most popular social media channels for promoting the health advocacy strategies of miscarriage. The primary campaigning channels would be FaceBook, YouTube, Twitter, and Instagram. Apart from this, the campaigners would try to tie up different health websites and organisations, for promoting their message through their official websites. Incorporation of such social media platforms would help in reaching the word to a broader audience group. The budget allocated for the entire campaigning program is approximate $300-$350.

Campaign asset production: The main assets of the campaign would be the advocacy strategies, the concept and content of the social media campaigns, the physical and the human resources involved with the campaign program. It is evident that for dealing with such adversities of life, efficient advocacy strategies would be made by the healthcare practitioners, through which the affected population can regain their strength and desire of living. Apart from the care experts, it is also required to include some social media experts for developing the concept-based contents. The campaigners would also contact with the investors, who would provide monetary support to this program.

Campaign execution: The campaigners need to recheck all the deliverables, such as the advocacy strategies, the campaigning contents, and many other elements, before initiating the process of the campaign through their chosen social media platforms. Additional to this, the campaigners would also provide attention to maintaining the social media policies and ethics before the initiation of campaigning program.

As mentioned in the above table, through the social media campaign, the campaigners would explain different advocacy strategies for the affected population, by which they can understand that an event of miscarriage is not the end of hope in life. They can live adequately and healthy life by combining a little self-effort and a short amount of external support. However, the advocacy strategies reflected through the social media campaign would be as follows:

Ensuring about next period data: during the advocacy program, the healthcare experts would explain that after the miscarriage, the woman would experience her first period after about 4-6 weeks. Therefore, it is necessary to follow the periodic check-up routine for consulting with the healthcare experts about the stage of the uterus after six weeks.

Impacts of miscarriage on the next pregnancy: It is necessary to understand that, miscarriage does not enhance the possibility of second-time risk, as there is no apparent connection between these two periods. However, Saccone, Schoen, Franasiak, Scott Jr, & Berghella (2017) mentioned that there would be life risk for the women suffering from three consecutive incidents of miscarriage, and in these cases, the couples need to consult with their doctors before planning about the fourth baby.

Preparing for another pregnancy: There is no obstacle in planning for the next pregnancy after a miscarriage; however, most of the doctor state that couples at least need to wait for six weeks, until the occurrence of the first period. However, Wahabi, Fayed, Esmaeil & Bahkali (2018) reported that some couples want to take some times for overcoming the physical and mental adversities after the incident. Additional to this, it can be stated that although the exact reason behind miscarriage is not still invented, the couples need to focus on some specific aspects for ensuring the chances of successful and long-term fertility, which are as follows-

• Eliminating the habits of smoking
• Having an exercise regimen along with a balanced diet
• Reducing the level of depression and stress

Maintaining body weight (Health Promotion Strategies, 2019)

RH negative women: In many cases, if women retain RH-negative blood group, therefore, they need to consult with their physicians or gynaecologists, regarding taking the Anti-D Immunoglobulin injection, especially after a miscarriage. Through following this clinical strategy, the chance of Ectopic Pregnancy would become lower, and the possibilities of other complications would also be reduced.

Consumption of folic acid: The women planning next pregnancy should take Folic acid daily, for promoting the intellectual and functional development of their offspring’s nervous system. Woods‐Giscombé, Lobel & Crandell (2010) mentioned that it is necessary to take 0.5 mg Folic acid per day from 1 month before pregnancy initiation to 12 weeks during the gestation period

Nutritious requirements for preparing the body: In order to build the lost immunity level of body, the affected women require focusing on implementation of efficient diet plan, by including range of iron-rich, calcium-rich food, feel-good grains, fruits and lots of green vegetables, for example, beans, nuts, milk, dairy products, raisins, soybeans, brown rice, molasses, and so on (Miscarriage. 2019).

Attending counselling session: According to the report of WHO, since the affected mothers often undergo some transition mental phases; therefore, they become stressed, depressed, and anxious about their next pregnancy and other post-miscarriage stages. Consequently, it is required to participate in weekly counselling session arranged by different local healthcare organisations or community experts (HTSP 101, 2019).

Although the program does not include any direct personal involvement, however, it is necessary to provide attention to maintain the ethical considerations, before, during, and after the conduction of campaigning program. For example, the campaigners should maintain the privacy and confidentiality of the information shared by a different audience, who represent their interest after seeing the approaches of the social media campaign. Balogun et al. (2016) mentioned that the campaigners might require assessing the social media profiles of the different target audience; however, they would maintain the privacy and dignity, such as not posting any comment or another element on their social media pages, not disclosing any information without obtaining their permission and so on. If they acquire some information about the experiences of a miscarriage of some affected people and want to represent them on their campaigning page, proper informed consent would be positively sent to them. Gülmezoglu et al. (2017) reported that they would incorporate the policy of reporting and blocking, as if any one of the targeted population would find any disturbing element in their contents, they would have the rights of immediate reporting and blocking the page.

While preparing my first assignment, I have gathered ranges of information about miscarriage and its global prevalence statistics. The current Australian Health Department reflects that around 103,000 Australian families suffer from the adversities of Miscarriage each year, which become a form of silent trauma for all of them (Brancatisano, 2019). The reasons behind Miscarriage are still not clear, as there are ranges of causative agents or elements. For example, in most of the cases, women face spontaneous Miscarriage due to the chromosomal abnormalities. Additionally, as per the statement of Brancatisano (2019), stress factors, genetic condition, uterine and cervical conditions, internal infection, molar pregnancy, amniocentesis, and many others reasons might be associated with this unfortunate event.

As per the clinical evidence, it is evident that the highest risk of Miscarriage is associated with the 4-6 weeks of pregnancy, and this risk remains until the 8th week of pregnancy. After the 8th or 9th week, from when the heartbeat of the baby can be observed or measured, the risk of Miscarriage reduces to 4% to 5%. It is evident that in around 85% cases (Tommy’s – How common is Miscarriage?, 2019). Therefore, I think that planning and organising a health advocacy campaign becomes essential for dealing with such adverse health statistics regarding miscarriage.

Through considering the above deconstructive facts about Miscarriage, it can be stated that health department of Australia does not have any adequate precaution or intervention strategies, by which they can support the mothers in coping up this stressful condition. According to the statement of Bailey et al. (2015), Miscarriage is one of the most painful and stressful situations for the would-be mothers, as they suffer from both physical and mental deterioration and unexplained pain factors in most of the cases. The stressful condition might often spread among the other family members; therefore, sometimes this becomes a stressed condition for the entire family. Consequently, I have decided to achieve the following objectives through the health advocacy campaigning-

• To explain the consequences related to pre and post-miscarriage stages
• To identify the care services acquired by the majority of the women population after post-miscarriage
• To understand the physical and mental health requirements of the women after experiencing stages of a miscarriage
• To explore the significance of routine check-up and follow the instructions of care experts for preventing the chances of a further incident
• To evaluate the facts regarding miscarriage and eliminate the myths

I have designed the advocacy strategies based on some collective evidence obtained from some women, who have practical experience regarding miscarriage. They can effectively demonstrate their feelings, opinions, and post-miscarriage supports they require. The participants were chosen from different local hospitals’ patient list, and my project team and I had obtained permissions from the selected hospital authorities for this study. Before initiating the interview protocol, I had given consent forms to each of the participants, in which the original purpose, objectives, and possible outcomes were mentioned appropriately. The inclusion criterion for the sampling process was women lose their baby in the past five years.

However, during the first meeting with the women participants, I had analysed that around 7 out of the 10 participants had an inadequate conception about the process and reasons regarding Miscarriage; therefore, they also did not have much idea about the post-miscarriage issues. I included the questionnaire-based data collection process, in which I had a set of 10 questionnaires, and followed the principle of the face-to-face interview process. However, as per my evaluation ability, I understood that all of the participants had unique types of experiences after the occurrence of the unfortunate event. For example, participant 1 had experienced unsupportive clinical process, as the incident occurred on holiday; therefore, she did not get any emergency precaution during that time. On the other hand, participant 5 explained that she had experienced incomplete pregnancy, and due to this reason, she got into mental trauma for one year.

After designing the advocacy strategies in the campaigning program, I think it is necessary to measure the impacts of the applications over the affected group of women and the rest family members. In order to measure the effectiveness, the care practitioners would provide attention to the changed perceptions of the affected population after the successful campaigning conduction. Apart from this, I think that we always reflect the do’s and don’ts of women after the miscarriage; however, it is also necessary to explain the roles of other family members, whose support is extremely required in such cases (Miscarriage and loss, 2019).

Therefore, based on the entire discussion, it can be stated that although Miscarriage is not new and not dangerous as several other life-threatening illnesses, however, avoiding the consequences, symptoms, signs, and other issues related with Miscarriage might cause complications for the women, which might often lead to death. On the other hand, families often could not cope up such an unfortunate event, and became utterly depressed or mentally challenged until and unless they obtain proper supportive care. Therefore, the advocacy strategies can be implemented in the future intervention protocols, through which women can survive the physical and emotional stress level and achieve a better future in their lives.

Health Care

Discuss what is meant by advocacy and how the communication strategies used in your chosen scenario either support or present a barrier to the concept of advocacy being utilized. ‘Critically review a range of communication strategies that can enable the development of therapeutic relationships

This assignment will discuss the concept of advocacy and its importance and relevance to developing therapeutic relationships in health care. It will discuss barriers to effective communication and how these can be an obstacle to delivering person-centred care and consequently impacting negatively on the individuals being cared for.

Person-centered care is care that is ‘personalised, coordinated, and enabling’ (The Health Foundation, 2020). It is care that treats people with ‘dignity, compassion and respect’ (The Health Foundation, 2020). One way to enable this is through empowering a person so that they have a voice and control over their care. Empowerment can begin with advocacy. Advocacy requires excellent communication skills, both spoken and unspoken as it will be impossible to advocate on behalf of an individual if their needs are not truly understood. When communication skills are used effectively, they can nurture trusting relationships in which individuals feel safe, cared for and respected. Once trust is established health care workers can begin to safeguard and promote the rights of vulnerable patients and ensure that all work towards delivering person-centered care and an increased quality of life.

Nurses are viewed as ideal patient advocates due to their close proximity to patients and their skills, knowledge and expertise means that they are potentially in the best position to care, treat and advocate. The nursing and Midwifery code also states that nurses should ‘act as an advocate for the vulnerable’ . Graham (2012) notes that, nurses naturally care for their patient’s health and mental well being and so advocating is something that is inherent to nurses.

However, despite professional qualifications and experience, effective communication strategies are not always utilised resulting in neglect and negative health outcomes as were viewed in the short scenario.

John is a frail, elderly man who has been living in a residential care home since the death of his wife. He is awoken abruptly by a nurse who enters his room and draws the curtains harshly. There is no friendly acknowledgment and John who is clearly unwell and in some discomfort coughs. Another nurse enters the room and together they dress him and wheel him down to the dining room for breakfast with a urinary drainage bag in his lap. Both nurses showed a complete lack of sensitivity and empathy towards John and do nothing to conceal the bag and preserve his dignity. According to (Kim et al, 2004) the “empathetic communication skills of medical practitioners significantly and substantially influenced patient satisfaction and patient compliance”. Person centrered care should be empowering and driven by the person, however this was a dehumanizing experience that caused embarrassment and feelings of hopelessness.

In the clip the nurses are clearly on a busy schedule and facing conflicting demands on their time, which can lead to stress, poor communication with patients and an increased likelihood of work errors. Time constraints can have severe consequences for vulnerable groups such as the elderly who may already feel like a burden. John is instinctively aware of the demands when they receive a meeting reminder from a charge nurse. Demands on time will always exist but it is vital that care workers communicate clearly and sensitively so that vulnerable individuals do not feel neglected. John was not the focus of care provided which was clearly perfunctory.

Physical barriers such as noise, proximity to aids and body language can impact negatively on communication strategies. During the short time that the nurses were dressing John, they did not attempt any meaningful communication with him. They spoke animatedly with each other ignoring his multiple requests for his glasses. Their conversation drowned out his requests and it seemed like he was ‘getting in the way’ of their jobs. Had the nurses listened actively and responded appropriately, it would have helped to restore as sense of independence and self worth. Disempowering John by neglecting his pleas for his glasses, showed a complete disregard for his physical, social and emotional health. It resulted in him being unable to eat breakfast and as he was already unwell this could have serious implications on his health and well being. A worker in the dining area greeted him cheerfully, but then did not actively listen to what John had to say neglecting him and showing disregard to safeguarding. Had she sought clarification by pausing and listening to John she would have been able to empower him and enable his voice to be heard instead she made him feel silly and powerless.

Patients look for non verbal cues as a sign that they are being listened to; eye contact, a nod, a smile. In John’s case there were not any, as his care workers did not make eye contact and positioned themselves behind or besides him at all times. As John did not appear to have any connection with his care workers, it presents the serious issue of whether he would share any serious medical concerns with them. Research by (Montague et al 2018) revealed that ‘connectedness increased with social touch and eye contact’ This simple act of interpersonal communication can validate a person and provide a sense of worth when so often they feel as if the ‘are in the way’.

Observational skills are extremely important when working to develop therapeutic relationships particularly in settings such as care homes where patients may not be forthcoming with difficulties due to health, confidence or embarrassment. It provides health care workers an opportunity to gather useful information about patients, identify norms and routines so if something appeared out of the ordinary it could be investigated. Being able to identify these needs supports the facilitation of patient advocacy.

Discuss the importance of being aware of the potential need for advocacy within relationships in health care. Use relevant literature to comment on how and when advocacy can contribute to relationships in health care and the communication skills required to facilitate this.

Although the term advocacy appears to be a relatively new concept (40 years old), it is something that has always existed. Nurses such as Florence Nightingale were advocates who worked tirelessly to ensure that they acted in the best interests of their patients.

There is an abundance of research that shows the positives or the need for advocacy in health care such as (Black,2011) ‘who discovered hospital acquired infections increased due to nurses inability to advocate’ or (Kalaitzidis & Jewell, 2015) who stated that ‘safeguarding patients autonomy, acting on patients behalf and championing social justice in the provision of health care’ improved the safety and health outcomes of patients.

Illness can render the healthiest and most knowledgeable individuals vulnerable due to a lack of understanding, seriousness of illness and support. Therefore it should not be presumed that certain individuals will not benefit and advocacy should be a right for all. However, it is also accepted that the vulnerability experienced during illness is stronger for certain groups such as the elderly, individuals with disabilities and Special Educational Needs, individuals in care, those with mental health issues, serious illnesses and disease, and ethnic minorities to name a few. Reasons for vulnerability could include complex needs which require a multidisciplinary team to care for. An inability to look after ones interests, be unaware of the rights due to age or mental capacity. A lack of confidence due to barriers such as age, language and discrimination or to raise awareness about the needs, circumstances and opinions of the vulnerable. Many of these groups already face prejudices and stereotypes which are not always challenged by society.

Healthcare workers have made a commitment to be advocates for the vulnerable who will need the their right safeguarded…Despite this healthcare workers sometimes face conflicting priorities at work which mean that advocacy can sometimes be tricky to achieve. For example a lack of knowledge or training will significantly impact on the level of care that can be provided;

• Who is the best person to advocate- complex needs- consider needs- patient groups- support there. Signpost- communication…………..all unwell are vulnerable- all have right to advocacy.-
• ‘ PHYSICIANS LEADING the system’ – obstacle to advocacy- do not question as unsure what will happen to them- sometimes done in concealed manner..resource allocation, equality of patient care (conflicts relating to policies and practises)- limit adcocacy
• Limited communication- time constraints
• Job security, management conflicts…….advocates strength comes from co workers peers (sellin, 1995)
• Limited by real or perceived constraits, societal norms, organisation culture…quote rRUSHTON

·Today it is important to be aware of the strengths and limitations of advocacy with in healthcare settings.

Conclusion

It is widely accepted that advocacy in healthcare settings has the ability to empower all patients at their most vulnerable and this paves the path for patient-centered care where a patient is given autonomy, respect and . Healthcare professionals such as nurses advocate for the vulnerable as it is interwoven with their job but also a key requirement. It is also inevitable that as advocacy needs become more complex for some and more demands are made of nurses time that it will be beneficial to signpost individuals to organisations who are more qualified in trems of resources, skills and knowledge to support patients.

1. http://lightshopfilms.co.uk/port/if-you-dont-do-something-who-will/
2. https://uwaterloo.ca/centre-for-teaching-excellence/teaching-resources/teaching-tips/communicating-students/telling/effective-communication-barriers-and-strategies
3. https://participatorymedicine.org/journal/evidence/research/2013/08/14/nonverbal-interpersonal-interactions-in-clinical-encounters-and-patient-perceptions-of-empathy/
4. Montague, E., Chen, P., Xu, J., Chewning, B. and Barrett, B., 2018. Nonverbal Interpersonal Interactions In Clinical Encounters And Patient Perceptions Of Empathy. [online] Journal of Participatory Medicine. Available at: [Accessed 30 March 2020].
5. Sellin SC out on a limb: a qualitative study of patient advocacy in institutional nursing. Nursing Ethics 1995
6. The Health Foundation, 2016. Person-Centered Care Made Simple- What Everyone Should Know About Person-Centered Care. [online] The Health Foundation, p.5. Available at: [Accessed 2 April 2020].
7. Kim, S., Kaplowitz, S. and Johnston, M., 2004. The Effects of Physician Empathy on Patient Satisfaction and Compliance. Evaluation & the Health Professions, 27(3), pp.237-251. (Kim, Kaplowitz and Johnston, 2004)

I have been given the opportunity to do my final placement at Annecto in their Speakers Bank program. Annecto is a social not for profit organisation with community contacts throughout Australia. They offer and provide services that help individual feel safe and comfortable at home. They deliver these services to people with disabilities, older people, families and carers who want advice, advocacy and support. Annecto is an organisation who wants to point out the importance of awareness and understanding people with disability and their disabilities. It has been the organisations’ goal and advocacy to connect people and the communities to recognise an inclusive society. Speakers Bank has been a platform for people with disabilities to advocate for themselves, for others and for their rights by sharing their lived-in experiences, challenges and how they combat these challenges.

This essay will discuss Speakers Bank as an advocacy program of Annecto and how speakers help the organisation in raising awareness about disability and challenges faced by people with disability.

Speakers Bank as Advocacy Program

Speakers Bank is one of Annecto’s program which aims to ‘raise awareness, acceptance and understanding of people with disability and older people through the power of communication’ (“Annecto”, n.d). It has a pool of trained public speakers with personal experiences of disability and ageing. Speakers share with the community their experiences, challenges and the story of their lives. “They present through a positive lens their image to the community in order to deliver information about the challenges they face every day throughout their lives” (“Annecto”, n.d). It is a volunteer and advocacy program of Annecto which provides opportunity for people with disability to increase their confidence and self-esteem by giving them the platform and empowering them to share their stories to others especially those people who are facing the same challenges as the speakers. Speakers Bank helps its speakers whenever they are booked for speaking event or activity; the program helps them prepare their presentations and gives the speakers relevant information about the event or activity to make their presentations relevant with the target audience. When needed, team member from Speakers Bank assists them during their speaking event but must maintain the independence of the speaker.

Speakers become the ambassador of Annecto in their advocacy on spreading awareness, understanding and acceptance for people with disabilities. Speakers address community groups about their experiences relating to work, recreational pursuits, social topics and barriers to inclusion (“Annecto”, n.d). They become the voice of others and they make their views about disability known and heard. Annecto- Speakers Bank has been providing advocacy for people with disability, and their families for many years. Speakers Bank armed its speakers with the essential skills to become outstanding advocates not only for themselves but for others. It empowers and supports people living with disability to be confident and independent through self-advocacy.

Lee (2007, p. 7) said that “Advocacy promotes social justice and social inclusion. It can empower people to speak up for themselves. Advocacy can help people become more aware of their own rights, to exercise those rights and be involved in and influence decisions that are being made about their future”. With this, it can be seen that advocacy plays an important role for the speakers. It ensures that they are given the opportunity to voice their concerns which could help policy makers in drafting policies relating to their situations. It is also their way of challenging inequality and discrimination made against people with disability. Speakers from Speakers Bank likewise give relevant and important information that people needs to know about people with disability. Over the time, Speakers Bank help develop the skills of its speakers to advocate for themselves through training and engaging and/ or assisting them in speaking events. Through these speaking events and trainings, the speakers become active advocates for people with disability since there are experts by experience.

There are myriad of advocacy models that can be used but the advocacy model which is being used by the speakers is the self-advocacy which is defined as “people speaking for themselves and asserting their own rights, individually and in groups which share a common interest or face particular difficulties” (McNally, 1999 p. 47-48). Speakers from Speakers

Bank practice self- advocacy during speaking events wherein they are able to express their thoughts and feelings, they have clear knowledge about their disability and their rights. They convey these information to their audience to be able to make changes; help them understand and educate people about their disabilities. Another model of advocacy being used is the group advocacy which Weafer (2003, p.37) defined as “a group of people campaigning on behalf of themselves or others to try and change things”. Many of the speakers are doing speaking events in groups with the aim of raising awareness about disability and their rights. They inform people about their rights and what changes they think works for people with disability because they believe that not everyone is familiar with their rights which make it more challenging for people with disability.

Social Work Theories

Advocacy has been known to be “the heart of social work” (Sheafor and Horejsi, 2003 p. 57). Social workers use advocacy to amplify and promote the voice of the vulnerable individuals or groups. It is also their way of promoting empowerment, social justice and change which are core values of social work profession. As a social worker, we use advocacy as a means to influence and challenge the current system which are oppressive to vulnerable people like people with disability.

Empowerment theory is a well-known theoretical framework in social work which is closely associated with the concept of advocacy because it empowers individuals or advocates to improve their self-esteem. Shulman (2006, p.18) defines it as “the process of engaging the client, family, group, or community in developing strengths to personally and politically cope more effectively with systems that are important to them” while Gibson (1991 p. 354) as “a process of helping people to assert control over the factors which affect their lives”. Empowerment then is encouraging people to become self- confident and help them find the power they have within them; to use and maximise the use of these power they already have to create the change they desire. This theory enables the speakers of Speakers Bank to advocate for equality, inclusiveness and accessibility of services. As a social worker, my role is to support them in their advocacy making sure that their concerns are heard and by actively listening to them. Empowering the speakers can improve their confidence and increase their self-efficacy.

The anti-oppressive practice (AOP) is also applicable in Speakers Bank as a program. Anti-oppressive practices challenges inequalities that vulnerable groups are experiencing which force of h is the driving AOP. It is a concept that promotes the principles equality and social justice (Dalrymple and Burke, 1995; Dominelli, 2003). Anti-oppressive practice is a central idea being practice by the speakers through their speaking events and doing podcast. Through these events, they practice AOP by educating the community and raising awareness about disability. They likewise engaged themselves in discussions and workshop during their speaking events and activities wherein they share their thoughts on challenging oppression experienced by them. They connect and collaborate with their audience in identifying issues and challenge it to initiate change in the community.

The social model of disability is similarly associated with the advocacy program of Speakers Bank. According to Barnes, Mercer and Shakespeare (2010, p.163) “it is society which disables people with impairments, and therefore any meaningful solution must be directed at societal change rather than individual adjustment and rehabilitation”. This model states that ‘disability’ is created by the society. Social model of disability recognises the barriers that people with disabilities faces to fully participate in the society. This model aims to remove these barriers to create equality and for people with disabilities to be more independent to and to give them a more accessible environment. The social model of disability helps our speakers illustrate it in practice through their advocacy on accessibility of facilities, transport, services and how to make our community inclusive. Speakers aim to remove these barriers for them to be treated equal in the society.

Challenges, Limitations and Strengths

When I had my placement at Annecto, I am aware that I will be doing it at their Speakers Bank program. This made my placement limited to Speakers Bank program only. Although, I learned many things while I am at this program, it would also be great if we were involved in other programs of Annecto to be able to understand and learn more of their programs that help and assist people with disability aside from the advocacy program which is implemented by Speakers Bank.

On the micro level of concern, Speakers Bank is under staff and relies on volunteers. It is only the Program Coordinator who runs the program which to my observation is stressful on her part. While the Program Coordinator is passionate about her job, she sometimes feels overwhelmed because of the many activities she has to handle. The program runs with the fund raised from the social enterprise side of Speakers Bank. The program lacks support from other staff and they are more focused on the business side of the organisation which is being a service provider of National Disability Insurance Scheme (NDIS). Speakers Bank as the only advocacy program of Annecto should be supported and promoted by the different programs of the organisation. Likewise, allocating funds for more staff at Speakers Bank will help assist speakers as the ambassadors of Annecto.

Speakers Bank as a program known to do community works must include in their workshop and trainings different issues that affect people with disabilities like family violence, discrimination on employment and education and other issues that affects them. While raising awareness and understanding about disability is important, we must also stress the importance of these issues and must be included as part of the Speakers Bank program. Speakers could do a presentation to our community about how these issues impact the lives of people with disabilities experiencing these issues, how to increase awareness on these issues and how the community members help regarding these concerns.

On a macro level, Annecto’s program are siloed from each other which makes it difficult to navigate the programs that can help promote and assist Speakers Bank. Speakers Bank is the advocacy program of Annecto, however, it is being isolated from other program and gets little support from the management. As stated earlier, the organisation is engrossed in chasing clients as NDIS service provider rather than supporting its advocacy program which is essential to the objectives of the organisation. Likewise, the lack of allocation of funds from the government on advocacy program for people with disability is seen as one of the factor why programs like Speakers Bank gets little support. In this way, it is seen as an oppression not only on the program but to its speakers. An organisation like Annecto, who advocates for an inclusive community must give as much support for their speakers and the Speakers Bank program. While the speakers share their time and personal experiences to fight the barriers they faced, Annecto should also do their part by doing their best to give the much-needed fund, support and to advocate with them by including them in their other programs.

Conclusion

Advocacy is one of the important role of social workers. It has been a part of the profession to engage in advocacy works on behalf of groups, individuals, families and communities (Brawley, 1997). We, as social workers advocate for social change and to fight the oppression experienced by vulnerable groups or individuals. We strive for social justice and to magnify the concerns raised by these group of people and individuals through advocacy. My placement experience at Annecto- Speakers Bank was full of challenges and excitement but the best part was the opportunity to work with their speakers who are great advocates for people with disability. I learned a lot from them, from knowing the appropriate language and terms to be used to treating them like just like the others. As a supporter and ally of these speakers on their advocacy, I am lucky to be able to assist them and work with them during my placement. It also gave me the chance to reflect on my own practice as a social worker and to express my thoughts on how to address the assumptions and stigma that our society have about disability during supervision and group discussions.

Collaborating and Advocating for Diverse Clients: The Case of Jun

Context

Jun is a 15-year-old girl whose parents have contacted me to request that she enter counseling.  They indicated that they had concerns about her “plummeting grades” and shared that this decline in academic performance coincided with the death of a beloved grandmother who lived with them.  Jun has reportedly withdrawn from her usual activities and distanced herself from friends and has verbalized to her parents that she has been feeling self-conscious about being “different.” Her family emigrated from China to the United States when Jun was 2 years old and settled in New York State where her parents found stable employment. Jun has no siblings.  They live in an affluent school district that does not boast significant diversity (racial, ethnic, or economic). Before the start of 9th grade and her transition to the high school in their district, Jun had seemed happy, connected, and academically successful. It is now late November and Jun’s first quarter report card shows a sharp decline in grades and concerned comments from her teachers.  This, in combination with the behavioral and emotional changes they are seeing at home, prompted Jun’s parents to contact me for counseling and assistance in approaching Jun’s school for support.

I anticipate my work with Jun will be most effective if I intentionally involve her parents, and collaborate with her school counselor, and representatives from the CNY Chinese Culture Center and CNY Hope for Bereaved.

Attending To, Empowering, and Advocating for Jun

My approach to working with Jun will be from a primarily emic perspective, conceptualizing Jun as an individual within a larger cultural context (Erford, 2014).   Her Chinese culture, family system, stage of racial identity development, stage of human development, stage of grief processing, and the culture of her school community are all important to consider and incorporate in our discussions and treatment planning.  When I meet Jun, I will explore her interest in and openness to counseling (since her parents referred her and she did not initiate the counseling herself). I will strive to establish a trusting working relationship and pay special attention to nurturing an openness in our sessions, so Jun understands that it is okay and helpful, to share thoughts and feelings.  I will also tease out how much of her presenting issues are related to the common human experience, and what aspects are related to race/ethnicity or gender, for example. Let us assume for the sake of this case study that her presenting concerns stem from a combination of these possibilities. Given that Asian American culture often does not encourage open expressions of emotion, it will be important for me to give Jun options for how she feels most comfortable expressing herself.  This might include a combination of talk therapy, journaling, drawing, or other creative techniques to enable Jun to show how she is feeling.

In our initial meetings, I would want to explore several things.  One would be Jun’s stage of racial identity development. Based on her statements about feeling self-conscious and “different,” I would expect that she is in the encounter stage, pushing up against crisis or conflict due to an increasing awareness that racism exists (Erford, 2014).  I would also want to explore with Jun whether there have been any recent racial incidents at school or in the community that involved her or that she witnessed that brought this reality into clearer or more personal focus for her. I would also consider whether there have been any national events that have stoked fires of racism in the media or communities in the nation.  Another thing I would want to explore with Jun is the loss of her grandmother. In traditional Asian American families, there are strong familial bonds and there is great respect for elders. Given that Jun’s grandmother was living with them, it will be important to explore how close the two of them were, and help Jun articulate her feelings and reactions to her grandmother’s death.  In exploring both her POCRID and her grief reactions, I would incorporate psychoeducational information about identity development and the stages of grief to help educate Jun and normalize some of what she is experiencing.

To empower Jun to self-advocate, I would help her identify her existing coping skills and work on expanding those. I would see how she has dealt with grief in the past (if she has) and explore how she has successfully approached transitions and periods of adjustment in the past.  I would help her articulate her feelings of loss and grief, and her feelings surrounding the cultural identity issues she is struggling with currently. With the goal of Jun reaching out and opening up to her parents and school counselor herself, I would have her identify and express her feelings in session with me (either verbally or through writing) and then help her practice how she would share these feelings with her parents and her school counselor.  As a young Asian American woman, she may not be used to openly expressing her emotions or asking for what she needs. Her previously strong academic performance and apparent ability to “fit in” indicate that she may feel the pressure to be a “model minority” (Erford, 2014), introducing the possibility that her recent mental health and academic struggles may be sources of shame for her and making it even more difficult for her to express herself and reach out for help.  It will be important for Jun to learn about the psychological, physical, and emotional benefits of expressing one’s feelings and to determine for herself how she feels most comfortable doing that. Given that Jun’s academic performance has been affected by her mental health needs, part of our self-advocacy work will be geared toward helping her communicate her needs to her school counselor, and seeing her school counselor as an ally in approaching teachers to coordinate efforts to get back on top of her school work.  If Jun has had issues with her friends related to her race or culture, we will incorporate self-advocacy work that involves her communicating directly with these friends to express her concerns and needs.

My efforts to advocate for Jun will begin with conversations with her parents.  Initially, these may not involve June and might simply be psychoeducational meetings to help her parents understand what Jun may be experiencing and what might be helpful for them to do for her as her parents.  As they are the ones who contacted me, I assume that they would be open to me doing this with them. My larger goal would be to facilitate conversations between Jun and her parents in which Jun expresses herself directly to them and practices her self-advocacy. It would be important for me to empower Jun’s parents with the skills to self-advocate and advocate for Jun, so I would explore their reasons for feeling intimidated by the school counselor (is it based on cultural differences or norms, language barriers, etc.) and do what is necessary to educate/counsel them to a place of greater comfort.  I would then initiate a meeting with the school counselor for Jun, Jun’s parents, and myself, to establish a collaborative relationship that will provide support for Jun both in and out of school. I would also advocate for Jun with the school counselor by asking him or her to help coordinate with teachers to design a plan to help her get back on top of her school work in a way that feels comfortable for Jun and acceptable to the school.

It will be important for Jun and her parents to be made aware of the community resources that might be beneficial for her (and potentially all of them).  In their upstate NY community, there are two groups with which I would connect them: the CNY Chinese Culture Center and Hope for Bereaved. The former exists to enhance the livelihood of Chinese living in our area and seeks to build bridges between communities through community events, cultural classes, and civic engagement.  Through grassroots activities, CNYCCC’s mission is to provide opportunities for Chinese Americans to share their culture in the community and for the community to learn about and appreciate Chinese American culture.  Given the fact that Jun’s parents are first-generation immigrants, it is understandable that Jun might be experiencing cultural conflict, particularly at the time of adolescence when she is developmentally seeking belonging.  Connecting her to other youth in the community who may have shared experiences, and to a group that celebrates and spreads her cultural heritage in her community, may provide valuable connections for Jun and her family that help with her racial identity development.  Hope for the Bereaved offers support for people who experienced loss and has specific groups and services for youth who are struggling with grief. I would gather and provide information from this organization to Jun and her parents, with the understanding that they may need encouragement to seek help there directly.  It may be helpful to Jun to connect with other young people in the community who have suffered a loss and faced struggles during their grief.

Addressing Potential Barriers

Considering the full context of Jun’s presenting problems, I would need to pay attention to cultural and institutional barriers to her success.  In terms of cultural barriers, it is imperative to be sensitive to the norms of Asian American culture and explore with her the degree to which those norms exist in her family system.  I must explore whether her parents are very traditional, how or if shame is used as a tool to motivate or control, if the emotional expression is not acceptable or seen as a sign of weakness if youth and being female are treated as inferior, if family goals supersede personal wellness…all of these things are important to understanding Jun’s presenting issues and will inform how I work to empower Jun and advocate for her.  As a white woman, what feels comfortable to me in terms of self-advocacy, may not feel comfortable or acceptable to Jun, so we would have to identify what feels right for her. This might involve pushing against some of the cultural barriers that would have her remain stoic or keep her from asking for help or asserting herself, but we would come up with ways for her to do this that help her get what she needs without disrespecting the culture of which she feels a part.  Addressing these cultural barriers might involve Jun’s parents, as well, to help educate them about the conflicts Jun feels surrounding her racial identity and foster empathy between Jun and her parents for the others’ positions. (For the sake of this case study exercise, I am assuming that SES, religion, and sexual identity are not contributing factors to her presenting problems and that we don’t need to address associated barriers.)

Institutional barriers we might need to address include financial barriers (do Jun’s parents have access to insurance coverage or personal funds to pay for her mental health counseling, and are our sessions limited); social stigma (will Jun have to deal with negative judgment in her family or at school about her decision to seek counseling and will this impede her willingness to access services); access to services (is Jun able and willing to make arrangements to get to our sessions, is her school counselor accessible); school culture (is the school willing to collaborate with me in supporting Jun or are they unwilling or unable); discrimination (is there a culture of discrimination in the community or school, or is cultural difference acknowledged and celebrated).  

Of interest to me would be the current environment in the school that Jun attends.  Through collaboration with the school counselor, I would want to gather some information about the racial/ethnic diversity and the general culture at the school (is it accepting, is there excessive pressure to disidentify with one’s racial group to fit in, are their racial tensions or discriminatory incidents that the school is aware of and what does the school do to address these, if so, etc.).  I would want to find this out to identify whether there are any indications of systemic patterns or problems around race at the school. If there are, I can collaborate with the school counselor, and reach out to other counselors and administrators in the district to encourage or coordinate the provision of educational programs about cultural sensitivity, propose the establishment of a school club focused on cultural awareness and diversity, and look at district- or community-wide events like culture fairs that help individuals celebrate their culture and educate other about their culture in fun ways.  I would also want to see if there is an existing need for grief support at the school for students in addition to Jun. The loss of a loved one is a profoundly sad and life-changing experience, and, likely, Jun is not alone in this experience. If a group does not currently exist for young people at the school who are dealing with grief, this could be another area in which I could work with the school counselor to advocate for the establishment of this support network in the school system.

Policy Issues to Consider

In my work with Jun, my collaboration with Jun’s school counselor will be an important bridge to facilitating her healthy functioning. The current state of affairs with school counselors and their excessive, and often unmanageable, caseloads, may impede our efforts to establish support across settings: her school counselor may not be as accessible as I would hope.  Given the fact that some schools are not particularly accommodating for students who need regular in-school counseling interventions at the expense of instructional time and that some schools have what can feel like impossible requirements for making up work and improving grades, I would want to advocate for Jun, encourage her to advocate for herself, to get the support she needs at school.   I would also join my ACA and ASCA colleagues in their call for legislation to reduce the caseload of counselors and reinforce the importance and value of what school counselors provide. Finally, considering the current political climate and emboldened anti-immigrant sentiments, I would want to sensitively explore Jun’s family’s experience with citizenship in the U.S. and determine whether there is any instability or insecurity in that situation that might be affecting or impeding Jun’s racial identity development or exacerbating her feelings of or concerns about being “different.”  I would also seek to understand Jun’s experience in her school and community as an Asian American girl, particularly during a time when the undercurrent of racism seems to be flowing ever closer to the surface in the U.S.

Advocacy Strategies

As described throughout the narrative above, I would use client empowerment and advocacy as well as community collaboration and systems advocacy in my work with Jun and, to a lesser degree, with Jun’s parents. By, incorporating these strategies and infusing them with psychoeducational information about racial identity development, human development and stages of grief will help Jun normalize her experiences, feel a greater sense of belonging, and feel less helpless and overwhelmed. Collaborations with the school counselor (and, indirectly, the teachers), will be key.  Referrals to and utilization of community groups that offer relevant programs will expand Jun’s support system and give her a more diverse community in which to feel a part. Finally, advocating with and on behalf of Jun for a school culture that celebrates diversity will create a higher-level change that may mitigate some of the institutional challenges that Jun has become more aware of since starting high school.  

References

1. Central New York Chinese Culture Center. (2018). Retrieved from http://www.cnyccc.org
2. Erford, B. T. (2014). Multicultural counseling. In Orientation to the counseling profession: Advocacy, ethics, and essential professional foundations (2nd ed.) (pp. 240–272). Upper Saddle River, NJ: Pearson Inc.
3. Erford, B. T. (2014). Settings and counseling career choices. In Orientation to the counseling profession: Advocacy, ethics, and essential professional foundations (2nd ed.) (pp. 321–355). Upper Saddle River, NJ: Pearson Inc.
4. Hope for Bereaved. (2018). Retrieved from https://hopeforbereaved.com
5. Rudow, H. (2013). Collaborating with clients to remove barriers to treatment. Counseling Today.  Retrieved from https://ct.counseling.org/2013/10/collaborating-with-clients-to-remove-barriers-to-treatment/

 

Introduction

Social work advocacy aims to influence policies, practices and laws that affect all people in a specific class or group (Dalrymple & Boylan, 2013). This is a comprehensive analysis paper for creating a proposal for a social advocacy action plan to authorize grants for training and support services for families and caregivers of people with Alzheimer’s disease or a related dementia. Discussed will be the needs and concerns of Alzheimer’s caregivers and the policies affecting them. Also discussed will be related supportive and opposing factors and effective strategies to address these concerns based on theoretical and empirical evidence.

Community Needs and Gaps in Services

Alzheimer’s disease is a form of dementia that weakens the cognitive and physical abilities of a person. There are more than 5.8 million Americans with Alzheimer’s dementia and the numbers are steadily rising. Throughout the progression of the disease, Alzheimer’s caregivers play a crucial role in the lives of those with Alzheimer’s dementia. There are over 16 million unpaid caregivers in the US. One third of these caregivers are 65 years or older and two thirds are women. One fourth of these caregivers have a double duty to also care for their children under the age of 18. The unpaid care of 18.4 billion hours adds up to an economic value of over $232 billion (CDC, 2019). Informal caregiving is defined as unpaid care provided by family or friends to people with a chronic illness or disability (Scott, 2010).

Caregiving is a serious public health issue. Caregivers attend to the social, emotional and health needs of a person. Caregiving may include assistance with daily living tasks such as bathing and dressing, paying bills, shopping etc. It may also include helping with the coordination of medical care (Gaugler, James, Johnson, Marin, & Weuve, 2019). Caregivers feel emotional stress, guilt and depression, they often ignore their own health and suffer in the long run (ASC, 2014). Physicians and other healthcare professionals are often focused on the patient and fail to understand the needs of caregivers posing an imminent threat of a new public health crisis (Health Gap, 2019). Caregivers need support and downtime so they can recover from the stress of caregiving and look after their own health too. To be able to provide the best care, caregivers need respite and support in the form of educational and respite care programs, support groups, counseling and trainings. Evidence shows that caregivers who receive such additional support, report lower stress and better health. They report to feel better equipped for navigating through challenging behaviors of the person they care for and keep them safe at home longer (Reed, 2012). My experience of working with the elderly and a recent Alzheimer’s diagnosis in the family, prompted me to research about this issue. I have seen my client’s and my own family members suffer from the heavy demands of caregiving which piqued my interest in learning more about the difficulties of Alzheimer’s caregivers.

Formal and Informal Policies that Influence the Issues

Call for action and advocacy in support of Alzheimer’s caregivers has just started to receive attention. The concerns of caregivers in the US have long been ignored by policy makers and healthcare entities. Public policies by the federal and state governments help improve dementia care and support by promoting various standards and effective practices for providing high quality care. After relentless advocacy by the Alzheimer’s Association, the Congress passed the National Alzheimer’s Project Act in 2010, which became a law in 2011 for the creation of a strategic plan to improve care, support, and treatment for Alzheimer’s. Just as funds are allocated to medical research for Alzheimer’s, policymakers must seek funding in support of their caregivers too (Thornhill & Conant, 2018). The Alzheimer’s Impact Movement (AIM) in partnership with the Alzheimer’s Association has been instrumental in influencing the Congress for better policies to educate and raise awareness in medical providers and patients about the available care planning services from Medicare (AMI, n.d.).

Societal pressures and gender norms create greater restrictions on female caregivers who report higher levels of burden and depression compared to male caregivers (Alzheimer’s Disease International, 2019). The lesbian, gay, bisexual, and transgender (LGBT) caregivers face unique challenges such as being denied rights as health care proxies, right to make care decisions, scheduling time off with employers to care for an aging loved one. Additionally, many of them have no job protection or domestic-partner benefits (Osage, 2015). A research based on the review of multiple published studies found that racial and ethnic minority groups may not have more available support than Whites (Janevic & Connell, 2001). The National Association of Social Workers (NASW) has historically supported Alzheimer’s related legislations as they align with social work values and ethics of social justice, the dignity and worth of a person etc. Social workers treat people with respect by promoting self-determination and empower clients. NASW has worked diligently to get failed bills passed and support patients and families of Alzheimer’s at micro and macro levels (Hochreiter, Lesher, Rabatin & Reeves, 2015).

Theoretical Perspectives to Understand the Issues and Strategies of Change

Caregiver burden is defined as the strain and pressure experienced by a person who cares for their sick, disabled or elderly family member. There are many theories that explain caregiver burden. According to the social exchange theorists, informal caregiver burden is minimized when there is an equitable exchange. When recipients of care respond with gratitude for the care they receive, it creates a balance as the caregivers experience more satisfaction and less burden from caregiving. The Attachment Theory of caregiver burden says that caregivers feel less burden when providing care to people with whom they have a strong and secured emotional relationship (Scott, 2010). The Stress Process Model (SPM) is extensively used in research to understand stress and coping for family caregivers of people with Alzheimer’s Dementia. According to the SPM, the primary stressors- which are the impairment and symptoms of dementia, have an impact on the secondary strains, which again can have a direct or indirect impact on the outcomes of wellbeing of the caregiver (Judge, Menne & Whitlatch, 2009).

Research and Empirical Evidence

Caregivers of Alzheimer’s experience distress. A study involving a sample of 86 caregivers of patients with Alzheimer’s was conducted to evaluate the relationship between caregiver burden and coping strategies. The results revealed that caregiving burden is strongly correlated to dementia severity and is higher in women and elderly caregivers. The findings of the study also revealed that caregivers found coping strategies helpful in adapting better coping techniques (Iavarone, Ziello, Pastore, Fasanaro & Poderico, 2014). Another research at Mount Sinai Hospital in New York involving 555 men and women found that the medical care for Alzheimer’s in the last five years of a patient’s life costs far more than care for cancer and heart disease putting those households at a higher financial risk (Netzer, 2015). Another study in the state of Kentucky with 33 Alzheimer’s caregivers also found that caregivers with stronger attachments to their parents with Alzheimer’s had a positive perspective about caregiving. The findings of the study help therapists understand the importance of strong attachments on caregiving burden (Cornu, 2019).

Barriers and Facilitating Factors

Lack of care for caregivers continues to be a serious cause of concern. Very few interventions exist for routine clinical care for most family caregivers. To address this concern, an evidence-based program ‘the Caring for the Caregiver program’ was developed at UT Health San Antonio for better caregiver support. Evidence from several studies show that engaging stakeholders in planning and decision-making contributes to more relevant programs and improves health care quality and outcomes. The process of collaborating with community stakeholders such as family caregivers, people from community agencies and organizations like the Alzheimer’s Association, National Alliance for Caregiving, AARP, Family Caregiver Alliance, healthcare professionals, and researchers has proved to be a fruitful approach for developing supportive interventions for caregivers (White et.al., 2018). Organizations like the AARP, AA, National Alliance for Caregiving collaborate to invest funds towards disease cure and caregiver concerns.

At present, there have not been any publicly reported endorsements of or opposition to this bill. However, a previous iteration of the bill, S 3113 (114th Congress), received letters of endorsement from both the Alzheimer’s Association and the LEAD (Leaders Engaged on Alzheimer’s Disease) Coalition.

Proposed Social Action Plan

The social action plan aims to support the ‘Alzheimer’s Caregiver Support Act’ which was first introduced in 2016 as S 3113 in the 114th Congress by Senator Amy Klobuchar, reintroduced in 2017 in a previous session of Congress, but not enacted and currently introduced as S.740 in the 116th Congress in March 2019, read twice and referred to the committee. This social action plan would be a community-based advocacy with the recommended steps (i) defining the community (ii) developing goals of the organizing (iii) identifying a governance structure (iv) developing a strategy (v) planning and implementing strategy and (vi) evaluating outcomes and implementation. The initial step to this action plan would be to partner up with all concerned stakeholders, establish community needs, develop long term goals and impacts. Next, hold community meetings, assess needs and conduct surveys, perform comparison analysis to learn from other communities’ response to the caregivers’ issues. With the help of general and targeted campaigns educate public to raise awareness (Simmons Asynchronous Coursework). The success or failure of any public initiatives for changing rules and public policy issues is determined by working effectively with the policymakers and elected public officials like senators, representatives, mayors, city-county councilors, etc. Meeting local legislators, writing them letters, appealing them to vote for passing the bill would be essential to social action plan (GCPD, n.d.).

Conclusion

Institutional caregiving for Alzheimer’s is expensive. Caregivers who provide comfort and care to their loved ones at home play an important role in keeping costs low. However, these caregivers experience many challenges that impact their wellbeing in many ways. They often neglect their own health and experience increased physical, psychological and financial problems. Policy makers and practitioners are finding ways to better support Alzheimer’s dementia caregivers. Despite such attempts for additional support through different social programs, many caregivers continue to experience negative outcomes from the caregiving burden. There is a need for active social advocacy to raise awareness of caregiver problems by collaborating with all stakeholders, namely, social work professionals, researchers, elected officials etc. in order to support relevant bills and programs for caregivers.

References

1. Alzheimer’s Association, (2019). LGBT Caregiver Concerns. Important Considerations for LGBT Caregivers. Available Online at https://www.alz.org/national/documents/brochure_lgbt_caregiver.pdf
2. Alzheimer’s Disease International. (2019). World Alzheimer Report 2019: Attitudes to dementia. Alzheimer’s Disease International. London.
3. AMI. (n.d.). The Improving HOPE for Alzheimer’s Act. Alzheimer’s Impact Movement. Available online at https://alzimpact.org/priorities/improving_hope_for_alzheimers_act
4. CDC. (2019). Supporting Caregivers to Make Alzheimer’s Our Next Public Health Success Story. Alzheimer’s Disease and Healthy Aging. Available online at https://www.cdc.gov/aging/healthybrain/issue-maps/supporting-caregivers.html
5. Cornu, M. (2019). Caregivers of Parents with Alzheimer’s Disease: Quality of Life for Caregivers: Perspectives & Family Dynamics. Theses and Dissertations-Family Sciences. https://uknowledge.uky.edu/hes_etds/75
6. Dalrymple, J. and Boylan, J. (2016). Effective Advocacy in Social Work. Sage Publications Ltd. Los Angeles
7. Gaugler, J., James, B., Johnson, T., Marin, A., & Weuve, J. (2019). 2019 Alzheimer’s Disease Facts and Figures. Alzheimer’ Association. Available online at https://www.alz.org/media/Documents/alzheimers-facts-and-figures-2019-r.pdf
8. GCPD. (n.d.). The Indiana Governor’s Planning Council. Forming a Community-based Advocacy Group. Available online at https://www.in.gov/gpcpd/2356.htm
9. Health Gap. (2019). When Caregivers Need Care. Available online at https://closingthehealthgap.org/when-caregivers-need-care/
10. Hochreiter, K. M., Lesher, D., Rabatin, E. R., & Reeves, S. M. (2015). The Silent Struggle of Alzheimer’s. Available online at https://www.socialworker.com/feature-articles/practice/the-silent-struggle-of-alzheimers/
11. Iavarone, A., Ziello, A. R., Pastore, F., Fasanaro, A. M., & Poderico, C. (2014). Caregiver burden and coping strategies in caregivers of patients with Alzheimer’s disease. Neuropsychiatric disease and treatment. https://doi.org/10.2147/NDT.S58063
12. Janevic, M. R., & Connell, C. M. (2001). Racial, Ethnic, and Cultural Differences in the Dementia Caregiving Experience: Recent Findings. The Gerontologist. https://doi.org/10.1093/geront/41.3.334
13. Judge, K. S., Menne, H. L., & Whitlatch, C. (2009). Stress Process Model for Individuals with Dementia. The Gerontologist. 50. 294-302. doi:10.1093/geront/gnp162
14. Netzer, W. J. (2015). Alzheimer’s Care Costs Far More Than Heart Disease or Cancer Care. Fisher Center for Alzheimer’s Research Foundation at The Rockefeller University. Available online at https://www.alzinfo.org/articles/caregiving/alzheimers-care-costs-far-more-than-heart-disease-or-cancer-care/
15. Osage, P. (2015). Special Concerns of LGBT Caregivers. Family Caregiver Alliance. Available Online at https://www.caregiver.org/special-concerns-lgbt-caregivers
16. Reed, B. R., (2012). Alzheimer’s Disease and Caregiving. Family Caregiver Alliance. Available online at https://www.caregiver.org/alzheimers-disease-caregiving
17. Scott, C. B. (2010). Alzheimer ‘s Disease Caregiver Burden: Does Resilience Matter? PhD diss., University of Tennessee. https://trace.tennessee.edu/utk_graddiss/912
18. Simmons Asynchronous Coursework. Principles of Community-Based Advocacy and Change. Retrieved from https://2sw.socialwork.simmons.edu/ap/courses/828/sections/2c07c207-9b07-43dc-82b2-656c03768134/coursework/module/952fa50f-1256-4d30-82c9-6ddd1293c372/segment/5ba49052-f061-446b-b40a-5cf99798c45d
19. Thornhill, L., Conant, R. (2018). Improving Care Through Public Policy. The Gerontologist. https://doi.org/10.1093/geront/gnx181
20. White, C. L., Overbaugh, K. J., Pickering, C., Piernik-Yoder, B., James, D., Patel, D. I., Puga, F., Ford, L., & Cleveland, J. (2018). Advancing Care for Family Caregivers of persons with dementia through caregiver and community partnerships. Research involvement and engagement, 4, 1. https://doi.org/10.1186/s40900-018-0084-4

As children and young people are usually shunned from society due to their ‘age’ and ‘lack of experience in the real world’, they are considered powerless as they don’t have much room to voice their opinions on the decisions that impact their livelihoods, nor do they have an input when the decisions that are made for them go against their best interests. This is where advocacy comes in, in which it is defined as ‘any action that speaks in favour of, recommends, argues for a cause, supports or defends, or pleads on the behalf of others’ (Alliance for Justice 2008, section one). The Youth Affairs Council Victoria (YacVic) is a reputable peak body recognised as the ‘leading advocate for young people aged 12-25 in Victoria’ (YacVic, n.d.). The organisation acts to deliver services such as efficient advocacy, training, resources and support for young people in Victoria and to ultimately help them find their voice.

Types of Advocacy

There are specific types of advocacy in which YacVic and other organisations specifically caters to when working with young people. Citizen advocacy is a community driven push that targets to acknowledge, endorse and preserve the rights, interests and well-being of people of all ages, with all types of disabilities (Queensland Advocacy Incorporated, n.d). YacVic advocates for citizens by acting as a helping hand or often at times, acting as a companion, especially to vulnerable individuals without family or friends who can advocate for them.

Parent advocacy, contrary to its term, doesn’t focus on advocating on behalf of the parents, but rather the young person with disability and their parent(s). It pays special attention to the needs of the young person, and the advocating is done by parent groups. YacVic has made a submission to the Royal Commission into the Victorian Mental Health System (Beyond Access) to address the needs of young people and their families living in rural and regional areas of Victoria, in regards to their mental health.

Group advocacy ‘involves people with shared experiences, positions or values coming together in groups to talk and listen to each other and speak up collectively about issues that are important to them’ (Social Care Institute for Excellence, 2015). When it comes to YacVic, they will work with other organisations to cater to the needs of groups, such as working with the LGBTQI community.

Lobbying ‘involves activities that are in direct support of, or opposition to, a specific piece of introduced or proposed legislation’ (American Academy of Child & Adolescent Psychiatry n.d. para. 6), such as YacVic collaborating with other peak bodies across Australia to join the Australian Council of Social Service (ACOSS), to raise the rate of Newstart and Youth Allowance, and ultimately allow young people from marginalised communities to ‘live with security and gain meaningful long-term employment’ (Youth Affairs Council Victoria, 2019).

Advocacy writing means to discuss one’s objectives and priorities that replicates a person’s voice in a manner that conveys the message efficiently and clearly (Express Strategies n.d). YacVic has worked in partnership with Youth Disability Advocacy Service (YDAS) to write a submission that advocates ‘for tenancy rights of people living in specialist disability accommodation to be protected under an amendment to the Residential Tenancies Act’ (Youth Affairs Council Victoria, 2017).

Representation, Advocacy & Decision Making

Despite its similarity in definitions, representation and advocacy are vastly different to decision making on behalf of a client. Representation and advocacy focuses on supporting the client and encouraging them to speak up for themselves, rather than speaking for them. It allows for the young person to follow their own personal beliefs and choices, instead of depending too heavily on the advocate. YacVic assists in guiding young individuals to make their own decisions by providing them with resources and options, which can help them gain knowledge about the judgements they make and the results that follow. To do this, YacVic has implemented a ‘Young Thinker in Residence’ program which allows for two young people (aged 18-25) to speak about an issue that affects them which results in a ‘tangible outcome that positively impacts the issue they are thinking about’ (Youth Affairs Council Victoria, para. 4) and ultimately provides the support from YacVic as a part of policy or ‘practice advocacy’ (Youth Affairs Council Victoria, para. 4). This is in comparison to young people having the freedom to speak about these issues, though having no support or encouragement, due their age, to create change.

Individual Advocacy & Systems Advocacy

There are many types of advocating systems which represent the young person in a vulnerable state. Individual advocacy, agnate to its term, focuses on supporting the individual only to assist them in meeting their needs. System advocacy, on the other hand, focuses on supporting a whole group who are going through the same issues collectively. For example, if a young person expresses their need for transgender toilets at school, YacVic would represent the young person and assist them in finding other people at their school so that they can all collectively come together to encourage the school to install transgender toilets.

YacVic’s Challenges

YacVic advocates for many issues that are present in society which impacts a young person’s wellbeing. The challenges they tackle include, disability, mental health and wellbeing, environment, government and youth policy, media releases, youth participation, youth sector, NDIS, education, training and employment, youth justice, housing and homelessness, child protection, gender and sexuality, transport, family violence and Aboriginal and Torres Strait Islander. When focusing on mental health and wellbeing, YacVic advocates for a push to have adequate mental health programs at school which can ultimately promote good mental health for all young people. Similarly, YacVic promotes child protection by working with Victoria Police and other government authorities to ensure the safety of young people from the ages of 12-25, by implementing strategies that these government officials can administer in their work training and ultimately uphold the safety of young people.

YacVic, Young People & The Community

YacVic works collaboratively with young people and the community in all aspects of their organisation as they believe their advocacy would be a lot stronger as a result (Youth Affairs Council Victoria, n.d). This is done through formal means such as their ‘Board of Governance’, where they discuss the strategic path of the organisation under its governance structure and includes four young people under the age of 26. YacVic has also provided opportunities for young individuals aged 16-25 to work with the VicHealth CEO, Dr Sandro Demaio, to discuss the topics of mental health, obesity and the overall health of young people in Victoria. These discussions are done through weekly assessment panels and are open to any young person from a diverse range of ages and experiences.

YacVic’s Advocacy Strategies

YacVic follows strategies to actively advocate and represent their clients efficiently. These principles involve: empowerment, in which they allow for ‘young people to have greater control over their lives through participation’ (Youth Affairs Council Victoria, n.d para. 3), purposeful engagement which is ‘young people taking on valued role, addressing issues that are relevant to them and influencing real outcomes’ (Youth Affairs Council Victoria n.d, para. 3) and inclusiveness which is ‘ensuring all young people are able to participate, regardless of background, culture, where they live, their gender or sexuality’ (Youth Affairs Council Victoria n.d para. 3).

YacVic & Social Media

Social Media has become very prevalent in everyday society, and while it does have some detrimental effects on young people, it has been a useful tool in marketing YacVic’s advocacy work. The webpage is very youth friendly, with easy-to-access hyperlinks and bright colours to promote how their advocacy can positively impact a young individual’s life. YacVic are also active on other social media platforms, such as Facebook, Twitter and Instagram which are commonly used by youth and provide a visual reference of the work they do for young people.

Ultimately, YacVic upholds a holistic approach when advocating for young people by following their own established youth participation strategies. They consider the young person as their primary consideration and ensure their methods of advocating don’t diminish the young person’s capability to better their life their own way. Similarly their work is heavily promoted on all social media platforms to ensure that Victorian youth have access to their services and to demonstrate that without the assistance of young people, YacVic are unable to advocate for change and meet the needs of young people.

References

1. Redpath, M 2015, ‘Citizen Advocacy helps those with disabilities’, Stittsville News; Nepean, Ont, 17 Feb p. 1, viewed 21 October 2019, ProQuest database.
2. Queensland Advocacy Incorporated, n.d., ‘Types of Advocacy’, Queensland Advocacy Incorporated, viewed 21 October 2019, < https://www.qai.org.au/systems-advocacy/types-of-advocacy/>.
3. Department of Health, 2004, ‘6.2 Why young people need advocacy’, Department of Health, accessed 30 October 2019 < https://www1.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-front2-wk-toc~drugtreat-pubs-front2-wk-secb~drugtreat-pubs-front2-wk-secb-6~drugtreat-pubs-front2-wk-secb-6-2>
4. Citizen Advocacy South Australia Inc., n.d, ‘What Will I Need to Do?’, Citizen Advocacy South Australia Inc. accessed 31 October 2019
5. Social Care Institute for Excellence, 2015, ‘Care Act 2014: Types of Advocacy’, Social Care Institute for Excellence, accessed 28 October 2019
6. American Academy of Child & Adolescent Psychiatry, n.d. ‘Advocacy vs. Lobbying: What This Means for You and Your Regional Organisation’, accessed 28 October 2019
7. Express Strategies, n.d. ‘Advocacy Writing’ Express Strategies, accessed 28 October 2019 < http://www.express-strategies.com/advocacy-writing>
8. Fieldgrass L, 2017, ‘Concern about Victoria Police members’ training in working with young people’ Youth Affairs Council Victoria, accessed 30 October 2019 < https://www.yacvic.org.au/advocacy/concern-about-your-members-training-to-work-with-young-people/>
9. Youth Affairs Council Victoria, 2017, ‘Shaping Youth Participation: The Young Thinker in Residence program’ Youth Affairs Council Victoria, accessed 2 November 2019
10. Youth Affairs Council Victoria, 2019, ‘Youth Peak Bodies Across Australia Call on the Government to Raise the Rate’ Youth Affairs Council Victoria, accessed 2 November 2019
11. Rawet E, 2017, ‘A Submission in response to the Rights in Specialist Disability Accommodation Consultation Paper as distributed by the Victorian Government’, Youth Affairs Council Victoria, accessed 2 November 2019
12. Youth Affairs Council Victoria, n.d, ‘A Youth Roundtable with VicHealth CEO Dr Sando Demaio’, Youth Affairs Council Victoria, accessed 3 November 2019
13. Rowan J, 2019, ‘Smashing the mental health stigma in our small towns’, Youth Affairs Council Victoria, accessed 3 November 2019 < https://www.yacvic.org.au/blog/smashing-the-mental-health-stigma-in-our-small-towns/>