Spindel (2021) - Chapter 10 - Advocacy as Empowerment - Case Management from an Empowerment Perspective.pdf

CHAPTER 10 Advocacy as an Empowerment Strategy First they ignore you. Then they ridicule you. And then they attack you and want to burn you. And then they build monuments to you. —Nicholas Klein, 1918 Copyright © 2021. Canadian Scholars. All rights reserved. THE DEFINITIONS OF INDIVIDUAL AND SYSTEMIC ADVOCACY Before determining whether or not to advocate, it is important to fully understand what advocacy and being an advocate means. Advocacy has often been described as “speaking or pleading for another,” but it is, in fact, much more than that. Individual advocacy is a means of amplifying a person’s voice and pursuing Individual advocacy: A means of a person’s objectives according to their amplifying a person’s voice and instructions, while transferring advopursuing a person’s objectives cacy skills to them, thereby promoting according to their instructions, while self-advocacy. transferring advocacy skills to them, When it is clear that policies, practhereby promoting self-advocacy. tices, laws, and systems are blocking not just one person’s quality of life and progress but many people’s, case manSystemic advocacy: The means by agers may decide to engage in systemic which oppressive systems, policies, advocacy—the means by which opprespractices, and laws that negatively sive systems, policies, practices, and laws affect labelled groups are challenged that negatively affect labelled groups are and changed. challenged and changed. Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. 214 CASE MANAGEMENT FROM AN EMPOWERMENT PERSPECTIVE MISCONCEPTIONS ABOUT ADVOCACY Many believe that simply helping another person, speaking up for them, or referring them to a resource or service is advocacy. Advocacy is a much more intensive, time-consuming process than that—one that involves very sophisticated skills and both intelligent and sometimes penetrating insights into people and situations. Others believe that advocacy is a good excuse to take a run at public officials and engage in power struggles because of a personal need to do so. Good advocacy work does not have its roots in unresolved personal issues with authority figures but in a firm and principled resolve that injustice should be resisted and that the instructions of those for whom we advocate are paramount in any advocacy initiative. Good advocates always remember that respect by adversaries is given because it is earned, not because it is demanded. WHY IS ADVOCACY NEEDED? Advocacy initiatives would not exist were it not for significant social injustices. Advocacy is difficult, draining work that requires intelligence, unshakeable ethics, a commitment to social justice, good strategy sense, excellent verbal and written communications skills, a high degree of critical thinking ability, creativity, the ability to motivate and influence others, and a lot of sheer grit and determination. That sounds like a tall order. Finding all of these qualities in one person is rare; hence, really effective advocates are rare. In addition to needing to possess many, or all, of the above characteristics, it helps if advocates have “thick skins”— the ability to handle insults and attacks from others with equanimity and still pursue their “clients’” goals. Copyright © 2021. Canadian Scholars. All rights reserved. UNSUNG HEROES The best advocates are rarely appreciated, especially by those in positions of authority who find themselves on the opposing side. People in authority have not traditionally recognized what important checks and balances good advocates are. On the contrary, the best advocates have been saddled with pejorative labels like “unguided missile,” “thorn in the side,” “professional protester or agitator,” or “anarchist.” All these labels express the frustration of those who defend the status quo against those who seek to change it. Sometimes good, effective advocates are on the receiving end of “friendly fire” from those who say they want change but are really frightened by it when it actually happens. Advocates have had to endure many challenges over the years by Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. Copyright © 2021. Canadian Scholars. All rights reserved. Chapter 10 Advocacy as an Empowerment Strategy 215 “means and ends” moralists who feel more comfortable arguing ideology or methods than they are in actually achieving justice for those who need it most. Sometimes, attacks by adversaries against effective advocates have taken on more serious proportions. Verbal and physical threats, illegal tapping of advocates’ phones, illegal surveillance, threats to family members, reprisals at work, attacks in the press, and intimidation are commonplace when an advocate effectively advances their “clients’” agendas. Where large amounts of money are involved or organizations’ funding could be threatened, there are likely to be attacks against any advocate who effectively threatens the cash flow or funding status quo. Ralph Nader is perhaps the most famous example of a very strong consumer advocate who has the qualities discussed above in abundance. Mr. Nader has also had to deal with the reprisals that come with advocacy work. Martin Luther King, Jr., is another high-profile example of someone who strongly advocated for civil rights. Gloria Steinem, Betty Friedan, and Germaine Greer are all high-profile advocates for women’s rights. All have been strongly criticized and attacked for their activities; King was ultimately murdered by those who opposed him. Yet all have contributed significantly to the creation of a more just society. It is not necessary for everyone who has thoughts of becoming an advocate to immediately reach the status of or possess all of the qualities of those mentioned above. It is necessary that the person possess many of the qualities mentioned or at least decide to develop these qualities before advocating for someone else. The decision to advocate should not be taken lightly. Even though we live in a democracy, where civil dissent and freedom of speech are considered sacred values, in actual practice, these values are often ignored when those in powerful positions in government or the corporate world feel threatened. Many advocates have found that they have needed to back up their right to advocate in the courts. Perhaps the most hurtful aspect of advocacy work is when good advocates are attacked by those who claim to be on the same side. Martin Luther King, Jr.’s insights about those who are more interested in order than in justice are valuable when this kind of criticism occurs. Good advocacy work is neither all adversarial nor is it all collaborative. The best advocates employ the necessary means to achieve their the objectives of those being represented, having discussed fully the objectives and the means, as well as the potential risks and benefits of undertaking an advocacy initiative with them. Good advocates are also careful not to take adversaries’ comments personally, always remembering that they are there to represent other individuals, not themselves. The best advocates observe “the rule of seven.” Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. 216 CASE MANAGEMENT FROM AN EMPOWERMENT PERSPECTIVE THE RULE OF SEVEN Seven things are fundamental to effective advocacy practice: 1. The advocate must never overreach their “client’s” instructions. 2. The advocate must have a clear sense of self and a reasonable idea of their personal motivations in undertaking advocacy work. 3. The advocate must not be overwhelmed, overly impressed by, or intimidated by people in positions of authority, or constantly feel the need to challenge authority for the sake of doing so. 4. The advocate must have very well defined ethics and be free of conflict of interest in representing someone. 5. The advocate must have extensive knowledge of the system in which they are advocating, and of the clinical, legal, and policy issues that most affect their the person they represent. 6. The advocate must have carefully scanned the individual’s environment, identified key decision-makers, allies, and possible adversaries, and their relative strengths and weaknesses. 7. The advocate must be articulate and feel comfortable with both spoken and written forms of communication. Copyright © 2021. Canadian Scholars. All rights reserved. EXAMINING THE ADVOCACY CONTEXT Case managers wishing to advocate should be fully aware of Saul Alinsky’s observations that they are operating in an “arena of power politics moved primarily by perceived immediate self-interests, where morality is rhetorical rationale for expedient action and self-interest” (Alinsky, 1971, pp. 12–13). In plain English, this means that they need to be aware that they are functioning in a milieu in which powerful interests seek to maintain their power and positions, often at the expense of those who are vulnerable or less powerful. Anyone seeking to advocate for another has a responsibility to first see clearly the kinds of power politics at play in an individual’s situation and to recognize how adversaries’ self-interests are likely to affect the outcome of the advocacy effort. The following case study illustrates the point. CRITICAL THINKING CASE STUDY: GERTRUDE Gertrude was 83 years old when she was placed in a nursing home operated by a large company. The home’s pleasant-sounding name disguised many Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. Copyright © 2021. Canadian Scholars. All rights reserved. Chapter 10 Advocacy as an Empowerment Strategy 217 of the issues that Gertrude would confront once she entered the facility. When she and her daughter viewed the home, both were impressed with the clean floors, the flowers at the front desk, the politeness of the administrator. Nothing prepared them for the ordeal that would follow. After less than two days in the home, Gertrude was not receiving the appropriate assistance at mealtimes, and the meals themselves were not what she had been used to. Gertrude had never eaten grilled cheese on bread and wieners for lunch, and she had no idea that these were the “cheese dreams” that were printed on the menu in the hall. She was also not receiving assistance in drinking several glasses of water during the day. After four days in the home, hungry and dehydrated, Gertrude became confused and wandered around. Feeling dizzy and disoriented, she walked into others’ rooms and finally fell in the hallway. After that, she was tied to her chair and given neuroleptic medications. Gertrude’s daughter became alarmed at her mother’s sudden deterioration, but found, when she raised her concerns with the administrator, that the woman who had been very polite when she and her mother visited the home had become much less polite now and much more forceful. Like so many others, she did not know which way to turn, until her friend suggested that she speak to a case manager attached to a local nonprofit community service for seniors. Gertrude found the case manager both helpful and very professional. She met immediately with Gertrude and her daughter and asked very specific questions about Gertrude’s current functioning, comparing it to her functioning immediately before entering the home. She checked Gertrude for dehydration by asking her if she might lightly pinch the skin on her forearm and see her tongue. Seeing that the skin on her forearm did not quickly go back into place when lightly pinched and that her tongue was swollen, the case manager asked Gertrude and her daughter if she might immediately see the director of nursing to have a “push fluids” order written up in her file and posted on her door. She explained that this would make both of them even less popular in the home but also explained that Gertrude appeared seriously dehydrated and needed immediate attention. The case manager gave Gertrude 10 ounces of water, repeating this a half-hour later. Next, she inquired about whether or not Gertrude and her daughter felt comfortable with her conducting regular visits, three times daily, over the next two days. Again, she explained that this would likely draw attention to her and also to Gertrude, and that this may mean that she and her daughter may be subject to possible reprisals from the home’s administration. She explained Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. Copyright © 2021. Canadian Scholars. All rights reserved. 218 CASE MANAGEMENT FROM AN EMPOWERMENT PERSPECTIVE the best- and worst-case scenarios of this and how they might best prepare for any eventuality. Both Gertrude and her daughter were well aware of what might happen as the case manager took up Gertrude’s case. The case manager stressed the importance of understanding the root causes of the problems that Gertrude was facing, including how the home was financed, who owned it, and how well it was staffed. She presented a range of options for dealing with Gertrude’s situation and left Gertrude and her daughter to discuss them, returning in a half-hour. Gertrude and her daughter agreed that the case manager would do the research on the home and discuss matters with the director of nursing but opted to leave a complaint to the government inspectors for now, pending the outcome of discussions with the nurse manager. The case manager explained the likely risks and potential benefits of taking this course of action, and Gertrude and her daughter agreed that this was the plan they preferred. The case manager logged her discussions and the agreed upon plan in her file, and Gertrude and her daughter both signed the notes at the bottom of the page. The case manager researched the home and found that it had already been cited for several violations of the care standards set by the government. She also found that it was owned by an offshore multinational company and was heavily “leveraged,” or financed by a bank located out of town. In her three-times-daily visits to this facility, the case manager observed how often Gertrude was assisted with eating and using the bathroom, how the staff interacted with her, and how often her bedding was changed. She also asked to see Gertrude’s chart after producing a consent form signed by both Gertrude and her daughter. When the director of nursing refused to allow her to see the chart, the case manager asked by what authority she was refusing legal access to the file, and she advised the nurse that she would wait while a call was made to the home’s lawyer. After the home continued to refuse access to Gertrude’s file, the case manager instituted “Plan B” and called a local geriatric physician of her acquaintance and requested that he visit Gertrude at the home. The case manager submitted a previously signed letter to the director of nursing, advising the home that Gertrude had “fired” her advisory physician and would now be using the services of her own physician. The physician arrived at the home and asked for Gertrude’s file, which the director of nursing turned over to him. He then saw Gertrude, removed her from the Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. Chapter 10 Advocacy as an Empowerment Strategy 219 Copyright © 2021. Canadian Scholars. All rights reserved. neuroleptic medication, ordered that she be “walked” three times daily and not restrained, placed a “push fluids” order in her file and asked that it be posted on her door, and ordered her food and fluid intake be monitored and charted for five days. Within three days, Gertrude was returning to normal, and her daughter was amazed at her progress. Gertrude could hardly remember the ordeal she had lived through. What this case illustrates is the importance of a case manager shedding their naiveté and recognizing the importance that power plays in human relationships. Gertrude became a vulnerable person the moment she entered this facility. Once she was dependent upon the home for all of her daily needs, she was at the home’s mercy. Gertrude and her daughter felt powerless to correct a situation that was leading to Gertrude’s steady deterioration, which could have led to her death had it been allowed to continue. The case manager took the time to research the power politics that she was up against. The results of her research indicated that the home was part of a multinational company with considerable financial and political clout. It was also heavily financed, which meant that the company was keeping both its staffing and supplies budgets low in order to maximize its profits, while paying its bills. This was borne out in her daily observations. There were not enough staff members to help very vulnerable residents. Bedsheets were left unchanged. The home was skimping on food costs by serving a lot of starch, cheap meats, and very few fruits and vegetables. The lack of staff meant that residents were not assisted to eat or drink enough. Residents who were “troublesome” were tied to their chairs because there was not enough staff to properly assist them. Others were drugged, so that they stopped being a problem for staff. Gertrude’s life- threatening difficulties could be tied directly to the profit motive of the company that ran the home. It was clear, however, that trying to take on this large multinational company might help all of the residents in the long run but would not do much for Gertrude in the short run. Taking this reality into account, the case manager presented an option that would bypass the power structure lined up against Gertrude and her daughter. By invoking the power of the biomedical model (through the use of a community physician), the case manager was able to address the more serious deficiencies in Gertrude’s care. Company officials, fearing a possible lawsuit or, Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. 220 CASE MANAGEMENT FROM AN EMPOWERMENT PERSPECTIVE worse yet, charges of negligence, instructed their staff to ensure that Gertrude was receiving enough food and fluids. In other words, they took “expedient action” moved by their “perceived self-interests,” as Alinsky would term it. As a follow-up to this case, the case manager advised Gertrude and her daughter to write a letter to the government inspection body, advising them of the steps that had been taken to secure better care for Gertrude and alerting them to Gertrude’s concerns about possible reprisals that might result because of the advocacy work done for her. This established a prior concern in the event that Gertrude was threatened with discharge or was treated badly in the future. It also set up the first step in a potential “paper trail.” The above is an example of what is really involved in advocacy work. Case managers wishing to advocate for the people they represent must recognize the amount of intensive work that needs to be done if advocacy is to be effective and not place individuals in more jeopardy. The case manager understood the power dynamics involved in this situation and developed a plan that took them into account. Copyright © 2021. Canadian Scholars. All rights reserved. TAKING INSTRUCTION AND DEFINING THE ISSUES In the above example, the case manager was very careful to take instruction from Gertrude. She understood that this was the most important aspect of her advocacy initiative. It is the person who will always live with the results of an advocacy effort—for better or worse. It is therefore the individual who must make a decision about what turn advocacy efforts will take. There is, however, a very big difference between a decision and an informed decision. Many states and Canadian provinces have consent to treatment legislation that requires that individuals give “informed consent” before treatment can be undertaken. Case managers practising advocacy are well advised to ensure that the people they represent are giving informed consent to their advocacy effort. This may take some time, depending upon how sophisticated an advocacy effort is being undertaken. In its most basic form, informed consent involves a discussion of the potential risks and benefits of a particular course of action, once a person has been presented with a range of options for their consideration. As the above case study illustrates, the case manager was very careful to discuss a range of options for dealing with Gertrude’s situation, and she was also meticulous about explaining the risks of possible reprisals and discussing ways of dealing with these potential risks. Taking this kind of careful and considerate approach minimizes risk to the person being represented but it does not eliminate it. That is why it is very important that a person be given some time to “mull over” Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. Copyright © 2021. Canadian Scholars. All rights reserved. Chapter 10 Advocacy as an Empowerment Strategy 221 their options and consider how comfortable they feel with the advocacy tactics being proposed, before agreeing to a particular advocacy strategy. This is where case managers practising advocacy can often get into trouble. Some, eager to help right a terrible wrong, will try to push their own advocacy agenda for personal reasons of which they may not be aware. Sometimes, it is people who have themselves been victimized or ill-treated who want to be advocates. Unbeknownst to them, it is their own anger at the way they were treated that is driving them to “right the wrongs of the world.” While this kind of motivation does not preclude someone becoming a good advocate, it should not be the driving factor in their decision to advocate. It should especially not be the unconscious driving factor in their desire to help others through advocacy work. It is imperative that case managers try to address unresolved personal issues in themselves so they do not propel them into a situation where they manipulate someone in order to address their own personal need to “set things right.” Not everyone is comfortable with some of the steps necessary to achieve the objectives they have. Some advocacy tactics seem ruthless to the uninformed observer. However, advocates who observe the “rule of seven” are unlikely to ever use what appear to be “ruthless” tactics without very careful consideration of power dynamics, the perceived self-interest of their adversaries, and the express informed consent of their “clients.” It is always the person being represented who defines the issue. Not all individuals understand at the beginning of a discussion with an advocate what the issue is. Most need to “talk things through” with a person who knows how to listen, in order to clarify their own thoughts and feelings. The best advocates are the ones who know how to listen and be open to what a person has to say, without feeling the need to direct the process. They have faith that the person sitting in front of them will, given the opportunity, act in their own best interests. Years of advocacy work underscore the innate wisdom of those being represented who know, far better than any case manager-advocate, what their real situations are. ROOT CAUSE QUESTIONING It is not enough to respond only to symptoms of what may be a larger problem confronting someone. It is necessary to get to the root causes of what is harming them. The case study above illustrates this point. It would have been easy to simply say that “untrained staff” was the problem in Gertrude’s case. But following a line of “root cause questioning,” the case manager came up with other possible explanations. Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. 222 CASE MANAGEMENT FROM AN EMPOWERMENT PERSPECTIVE Root cause questioning is a method of asking “why?” until there are no more “whys” to ask. Using the above case study as an example, a case manager might follow this process. Copyright © 2021. Canadian Scholars. All rights reserved. Why is Gertrude not being fed or given enough fluids? Because the staff is not trained to recognize that she is deteriorating because of that. Why is this home hiring untrained staff? Because hiring more professional staff costs more and would cut into its profit margin. Why can’t it afford to hire more professional staff? Because it is heavily mortgaged and operated for-profit. Why is it heavily mortgaged? It is heavily mortgaged because the corporate owners did not want to invest their own capital. Why did they not want to invest their own capital? Because then they would not get tax write-offs for the mortgage, and they would incur more risk by putting in their own money. Why do they need these kinds of tax write-offs and why do they want to avoid risk? Because that is how they maximize profits at the least risk to themselves and their shareholders. How else are they trying to maximize profits? By keeping staffing and supply costs to a minimum. So, why is Gertrude not being fed or given enough fluids? Because the company that owns the home is trying to maximize its profits by keeping its costs for staffing and supplies down, hence the low staff-to-resident ratios and the poor quality of food. Defining a person’s problem requires a process of root cause questioning. Addressing symptoms instead of root causes of problems will, in the short term, lead to ineffectiveness, and burnout in the long term. Advocates have a responsibility to take the time to sit with the people they represent and, after listening carefully, ask those root cause questions that will lead them to a more precise and a deeper definition of a problem, so that they can more effectively address it. RESEARCHING THE ISSUES Advocates have numerous research tools at their disposal now that were not in existence 30 years ago. Freedom of information laws, access to government libraries, Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. Copyright © 2021. Canadian Scholars. All rights reserved. Chapter 10 Advocacy as an Empowerment Strategy 223 and the Internet have all made it much easier for advocates to get information and network with others whose more extensive experience can help them to address the issues of the people they represent more effectively. There are also many older forms of research that are tried and true, which advocates can access to help them. Looking again at Gertrude’s case, the case manager was quick to recognize that Gertrude was suffering, at least in part, from dehydration. How did she know? Because the advocate worked for a community agency that served older adults, and she made sure that she kept up to date on gerontology literature. She did this by regularly reading journal articles that her agency had on file. She kept this information in a resource file for future use. She had read several journal articles that were specific to Gertrude’s case. Some had dealt with the effects of overmedication, others with the negative consequences of the use of restraints, and still others with symptoms of dehydration and malnutrition in older adults. She also regularly scanned law and medicine journals for case law and legal principles that might help her in her work. That was how she knew that the director of nursing had no authority to prevent her from seeing Gertrude’s file after a consent form had been presented. That was also how she knew that a faster route to file access was the implied threat that a nurse could be reported to her professional regulating body (i.e., College of Nurses) if she refused a doctor access to a patient’s file. This knowledge was vital in this case and, more than anything else, helped to resolve Gertrude’s problem. But even if the case manager had not read about these issues in journals, she could very quickly have searched the effects of overmedication and the use of restraints on the Internet. She could also have looked up information on gaining access to individuals’ files. Or she could have scoured libraries and sought the help of librarians in finding medical information about the symptoms of dehydration. She also could have used the Internet and research libraries with corporate information to look up the nursing home company’s profile. Sometimes less obvious methods of research are even more helpful than the usual research tools listed above. Had she wanted specific information on how well this home was staffed, she might have considered contacting the research department of the union that represented the staff. She may even have found an ally had she decided to take up the staffing issue with the home and the government. Some Canadian provinces grant open access to nursing home inspection reports. Advocates can find out about this by examining nursing home legislation in their state or province, by calling their elected representative, or by calling the library services associated with the department or ministry that regulates nursing Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. 224 CASE MANAGEMENT FROM AN EMPOWERMENT PERSPECTIVE homes. In Ontario, inspection reports for long-term care facilities are available online (http://publicreporting.ltchomes.net/en-ca/default.aspx). Freedom of information legislation may also have helped the case manager to find out if this home had been cited for previous care violations similar to those now affecting Gertrude. Going to a local legislator to find out if there is a government telephone directory or online staff directory that lists those responsible for inspecting nursing homes might also have yielded some useful information. In fact, staff in legislators’ offices can often be extremely helpful in obtaining inside government information. In Ontario, MPPs’ office locations can be found at http://www.ontla.on.ca/ web/members/members_current.do?locale=en. Information on how to find government officials can be found in the Ontario government’s online employee and organization directory (http://www.infogo. gov.on.ca/infogo/). Financial information on government ministries can be obtained at http:// www.fin.gov.on.ca/en/budget/estimates/. The best advocates have explored different methods of researching issues that those they represent are facing. All have used most or all of the tools listed below to find out information helpful to their “clients.” INFORMATION RESOURCES Copyright © 2021. Canadian Scholars. All rights reserved. Freedom of Information Legislation Most American states and Canadian provinces have freedom of information legislation that gives the public access to internal government information. By contacting freedom of information offices inside government, case managers can obtain information about what kinds of government documents they can access. In Ontario, individuals can make a freedom of information request for $5.00 (https:// www.ontario.ca/page/how-make-freedom-information-request). Reference Libraries Most states and provinces have at least one large research library where corporate and other information, including extensive lists of journals, can be found. Examples include the Toronto Reference Library in Ontario, one of the largest in Canada (http://www.torontopubliclibrary.ca/detail.jsp?R=LIB018). Reference libraries are also sometimes located on university campuses. For example, the University of Toronto has a large reference library, the Robarts Library (https://onesearch.library.utoronto.ca/robarts-reference-and-research-services). Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. Chapter 10 Advocacy as an Empowerment Strategy 225 Copyright © 2021. Canadian Scholars. All rights reserved. Examples in the US include the libraries of Michigan State University (https:// www.lib.msu.edu/about/ref/) and the University of Chicago (https://www.lib. uchicago.edu/law/services/reference/). Once an advocate has decided on a resource to use, they will need to locate the information they’re seeking. This often involves conducting a search. How to conduct a search will change based on what resource you are using. Internet Searches: Using search engines, advocates can type in keywords and phrases, such as the name of a home or government office, and explore information on the Internet. While most people know how to conduct a basic Internet search, there are many options and tools for conducting advanced searches. Many librarians are familiar with these more advanced methods and can help advocates. There are also helpful and free guides on the Internet itself. Excellent Internet search skills are invaluable to advocates. Advocates may also consider a legal search service such as LexisNexis or other specialized search services. These are very comprehensive databases of information, but they come with a price tag. It is also worthwhile checking to see if your organization pays for access to a specialized search service; universities, for example, often grant access for students and faculty. Literature Searches: Old-fashioned library searches—looking up books or journal articles on specific topics—can sometimes yield excellent information on health, law, and social services related topics. Local libraries and reference libraries can be very helpful here. Registry Offices/Inspection Bodies: By contacting registry offices or government inspection bodies, advocates can often obtain information about ownership, licensing, and quality evaluation information about specific services or organizations. One example is Long-Term Care Home Quality Inspection Program (LQIP) in Ontario (http://www.health.gov.on.ca/en/ public/programs/ltc/31_pr_inspections.aspx). Corporate Searches: Many states and Canadian provinces have departments or branches that have information about companies. This information can be searched by the public. Brokerage houses may also release company prospectuses to potential shareholders. Much of this can be found on the Internet. Newspaper Searches: Many libraries have rooms where advocates can do newspaper searches. These can be helpful in determining an agency’s, facility’s, or organization’s care record and for gaining information about Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. 226 CASE MANAGEMENT FROM AN EMPOWERMENT PERSPECTIVE high-profile individuals. Some newspapers also have searchable online archives, although this is often a paid service. Legal and Medical Libraries: Most universities have legal and medical libraries that members of the public can use. Some will not allow books to be taken out; however, many have copying facilities. These can be useful to research precedent-setting cases that are similar to what the advocate is handling or to examine detailed medical information about specific conditions, treatments, and so on. This can establish what best practice should have been used in a situation, but were, perhaps, not used and caused someone harm. HUMAN RESOURCES Perhaps the best way of getting accurate, up-to-date information is by cultivating a broad range of experts in particular fields and subjects. Medical doctors, nutritionists, nurses, social workers, gerontologists, public health officials, policy analysts, lawyers, academics, and many other professionals can be of considerable assistance to an advocate. The best advocates read and save articles related to their areas of advocacy work. Often, experts are quoted in these articles, and effective advocates generally follow up and introduce themselves to an expert quoted in an article, explaining that they advocate in this area, and asking if they can contact them occasionally to seek advice. Most experts are willing to assist, provided that an advocate does not abuse this free information source by calling on them too often or revealing a source. Copyright © 2021. Canadian Scholars. All rights reserved. CRITICAL THINKING CASE STUDY: ADVOCATING FOR A YOUNG MAN An advocate working with a young man who lived in a facility for people with developmental disabilities wanted to obtain information concerning his right not to be forcibly confined and his right not to be subjected to cruel and unusual punishment. This young man periodically became angry, yelling at staff and throwing furniture. When he did, staff would force him into a “side room” (a room with a mattress on the floor and bars on the window), where he was often left without toilet facilities for up to 24 hours. The advocate contacted a local legal service and asked to consult with one of the staff lawyers. He was happy to explain where in law these rights were found, and he also helped by citing case law (or legal precedents) that established these rights. Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. Copyright © 2021. Canadian Scholars. All rights reserved. Chapter 10 Advocacy as an Empowerment Strategy 227 The advocate also contacted an expert in dual diagnosis whom she had met at a conference and asked her about how else the outbursts of the person she represented could be handled. The expert recommended a neurological assessment to rule out possible medical causes of the outbursts, such as a seizure disorder, then suggested several more humane alternatives like prior direction from the person about how he wanted staff to help him regain control of himself. The advocate, individual, and his mother requested a case conference and asked that the facility invite a lawyer from the legal branch of the government body that funded the facility. When the facility balked, the administrator was given a choice by the advocate: “either you can invite the lawyer, or I will.” The facility official called the lawyer. At the case conference, the advocate asked the lawyer to explain to facility staff and the administrator what the law said about forcible confinement and cruel and unusual punishment. After the lawyer had explained it, she provided details of the mistreatment of the person she represented, citing dates, times, incidents, and who was involved. She asked the lawyer if, in his view, these could have been violations of the law. He did not want to answer the question, but the advocate insisted. He finally admitted that “they could be seen that way.” She then asked his office to write to all facility administrators advising them that these practices were against the law, and he agreed to do so. Next, she proposed that she, the person she represented, and staff draft a service contract that would include his wishes about how he wanted to be assisted to regain control during an angry outburst. Feeling stung by the legal rebuke, the administrator agreed, and the advocate and individual also agreed that he would seek a neurological assessment. The neurological assessment revealed that the person had a seizure disorder that was contributing to his outbursts. He agreed to try a low dose of an anti-seizure medication. The outbursts stopped. Six months after his last outburst, he returned to his home community to start his new job in a local florist’s shop. It had always been his wish to return home. This young man had spent years in a facility needlessly at great cost to himself and his family, and at great cost to the government. A positive side effect of this initiative was that every facility in this Canadian province was forced to remove the doors from their “side” or “isolation” rooms. Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. 228 CASE MANAGEMENT FROM AN EMPOWERMENT PERSPECTIVE This case study illustrates the importance of human resources—experts—in the design and implementation of an effective advocacy plan. Sometimes, it is wise to take an expert along to a case conference. CRITICAL THINKING CASE STUDY: ADVOCATING FOR REHABILITATION Copyright © 2021. Canadian Scholars. All rights reserved. When an advocate who was representing an elderly woman in a nursing home found she was getting nowhere with nursing home staff, who were not meeting her needs to be rehabilitated so that she could return home, she invited a rehabilitation expert to the case conference. The rehabilitation expert fired questions at the nursing home staff, in the presence of a corporate vice-president of the nursing home company. It became obvious that the nursing staff knew nothing about rehabilitation, so the expert offered to draw up a rehabilitative care plan. Wanting to avoid any unpleasant negative publicity, the vice-president agreed and then went a step further, asking the rehabilitation expert if she would be willing to conduct staff training in this and other facilities. She agreed. The resident got her care plan, and the advocate’s job was done. No advocate should ever approach an advocacy initiative without first doing extensive research concerning the person’s identified concerns. Failure to do research could jeopardize the individual. It is imperative that advocates address their own knowledge requirements before proceeding. After years of consulting experts and doing research, good advocates become experts themselves, and their reputations are greatly enhanced with their adversaries. Advocacy becomes much easier under these circumstances. A very fine advocate once commented, “I’m not here to be liked, but for the sake of the person I represent; it is important that I conduct myself in a way that I am respected.” Doing proper research, more than anything else, helps advocates to become respected, and, as in so many other areas, information is power. IDENTIFICATION OF KEY DECISION-MAKERS A key decision-maker is someone who can implement a “person’s wish,” reverse a decision that affects someone negatively, or just make things happen. Key decision- makers have an ability to act to address an individual’s or a group’s concerns. Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. Copyright © 2021. Canadian Scholars. All rights reserved. Chapter 10 Advocacy as an Empowerment Strategy 229 Usually, key decision-makers are located within the halls of power—in government, the private sector, the courts, or the public sector. When attempting to determine who the key decision-makers on an issue are, several strategies can be used, depending upon the advocacy initiative that is under way. If you are advocating for someone who is being denied a public benefit, find out what law or policy confers the benefit and who is responsible for ensuring that this law or policy is enforced. That will be the key decision-maker. If you are working on changing a law or policy that affects a whole group of people, try to determine who is responsible for the existing law or policy, then ask to whom that person reports. That will, very likely, be the key decision-maker. If you are dealing with a corporation, such as a nursing home corporation, and you want to ensure that changes are made to the way that care is provided in the home, do not approach the administrator. Write a letter to the vice-president in charge of operations and copy the administrator. The vice-president is likely to be the key decision-maker, not the administrator of the home. By having the vice- president refer the matter to the administrator, you are ensuring greater safety for the person you represent, with less concern about possible reprisals, and you are dealing with the person who can approve a change in the way the home operates— especially if that means extra expenditures. Generally speaking, the head of a department or office within a state government (e.g., a department of mental health, department of human services, or perhaps a division or office on aging) or the deputy minister of a government ministry in a Canadian province (e.g., the deputy minister of health or the deputy minister of community and social services) are the likely key decision-makers. Many advocates make the mistake of “going through channels,” meaning that they start at the bottom rung of power and work their way up. The difficulty with this course of action is that it often takes too long for the individual’s good, and it wears the advocate out. It is far better to write to or make a presentation to the key decision-maker, and copy their underlings or request that they be at the presentation. This is called “fast tracking” an advocacy initiative. It is never helpful to deal with someone who does not have the authority to do what you are asking. When approaching a key decision-maker, it is always wise to ask, “Do you have the authority to...” and state your demand. Sometimes, an apparent key decision-maker will have “paper authority,” meaning they are the designated key decision-maker under an act or statute, but they must nevertheless run their decision past a higher authority. Always try to find out ahead of beginning an advocacy initiative whether this is the case, or whether the decision is that of the decision-maker alone. Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. 230 CASE MANAGEMENT FROM AN EMPOWERMENT PERSPECTIVE Sometimes, key officials ask that the advocate meet with their designates. Advocates should only agree to such a meeting if the official is willing to say, in writing, that their designate has the authority to act for them. If not, advise the key official that you would feel “more comfortable” meeting with them. Copyright © 2021. Canadian Scholars. All rights reserved. HOW TO GET TO KEY DECISION-MAKERS Key decision-makers often have several layers of protection to prevent members of the public from reaching them. Voicemail, secretaries, aides, and a host of underlings see it as their special responsibility to protect the key decision-maker from the people they are supposed to be serving. Somewhere, the idea of public service got lost in this arrangement. To be effective, advocates must find a way through this morass. Some of the tactics outlined here may seem, at first glance, unethical or “ruthless.” Although advocates may feel more comfortable with “going through channels” or question tactics such as presenting themselves as someone else, it is important to recognize that timeliness is often of the utmost importance to an advocate’s “clients.” Going through the “proper channels” or deferring to underlings creates delays, which could allow unethical treatment of a person being represented to continue indefinitely; in some cases, these delays can be lethal. Advocates will recognize that meeting the needs of those being represented is far more important than always following proper protocol. If a case manager is concerned with the ethics of these tactics, they may prefer not to use them. It is important to understand that taking these sorts of steps should only be done in situations of life or death, or where irreversible harm may occur if the step is not taken. One way to get to key decision-makers is to learn to use voicemail effectively. By asking to leave a voicemail message, an advocate can often get through directly to a key decision-maker. The voicemail message should go something like this: “Hello, my name is _____________________, and I am representing _______________, who lives in a group home funded by your department. I am calling you as a courtesy to ask if we might be able to resolve this issue before 3:00 PM tomorrow afternoon when I will be forced to take it to a different forum. Please call me as soon as you are able before then. My number is ___________. Thank you.” Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. Chapter 10 Advocacy as an Empowerment Strategy 231 An underling may call you back. If they do, one approach is to say: Copyright © 2021. Canadian Scholars. All rights reserved. “I’m sorry, but the person I represent has instructed me to speak to no one but_________. Would you please ask _______________ to call me as quickly as possible? This matter is quite urgent. I will be taking it to a different forum if I do not hear from them by ______________.” The underling will be tempted to ask, “What do you mean by a different forum?” Your response? “That will, unfortunately, become evident in due course.” It is important to remain silent after this statement, to raise the pressure on the underling to get the key decision-maker on the phone. Do not under any circumstances continue the conversation beyond this point with the underling. Simply say: “I hope for everyone’s sake that _________will return my call before ________.” Then hang up. Ninety percent of the time, the key decision-maker will call before your deadline. If not, go through with your plan. Never threaten an action that you are unable to deliver. This will mean that you will have to arrange possible press ahead of time—a news conference, a call to a very senior official, a complaint to a formal body, a court action, or picketing or pamphleting of a politician’s constituency or an administrative office, among other tactics. It is important that key decision-makers get the message when dealing with an advocate, that the advocate will follow through, and that the result will be unpleasant for the key decision-maker. If you have managed to get a meeting with a key decision-maker and they have a landline phone on their desk, try to get a look at it. Usually, internal numbers appear on the phone that the advocate can copy down during the meeting. Some of these internal numbers are reserved only for important people in the key decision-maker’s department or agency. If you do manage to glean some information from the phone, you should only try calling one of these other lines, but only in instances where the matter is an issue of life or death or significant irreversible harm to a person. The key decision- maker may answer the phone expecting an internal call. It is important not to abuse this—only call if a matter is truly urgent. Sometimes, advocates get through by appearing quite casual. If you know a key decision-maker’s nickname, and the name of a close friend or associate or a Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. 232 CASE MANAGEMENT FROM AN EMPOWERMENT PERSPECTIVE lobbyist who has a “too close” relationship with the key decision-maker, you can try leaving that name and your number. Speak to the secretary, and casually ask if “Frank” is in, it’s “Jimmy” calling. Often, the secretary will put you through, not knowing you’re not that Jimmy. This accomplishes two things—it gets the advocate through to the key decision-maker, and it may prevent “Jimmy” the lobbyist from getting through quite as easily next time. This may seem an unethical approach to use because it involves misrepresentation of oneself, and some professional colleges may take a dim view of this kind of action. If that is the case, advocates should refrain from using it. However, it is important to mention that the press sometimes use approaches like this to gain entry to facilities or to tape conversations. If an advocate is not bound by other ethical or legal requirements, it is reasonable to use an approach like this in instances where serious harm might happen to someone being represented if this method is possible but is not used. It is often possible for advocates to do research on key decision-makers prior to an initial approach. Most departments, agencies, or offices, or, in Canada, government ministries have biographies on those in their employ. By calling the public relations or communications coordinators of these bodies, it is often possible to obtain a biography. One may also be available on the Internet. You may also be able to share information with other advocates who know a key decision-maker well. Most people in government are also keen to share information about their co-workers. One advocate always ate lunch in the government cafeteria and listened to the gossip. She found this an excellent way of gathering “intelligence” information about key decision-makers. Copyright © 2021. Canadian Scholars. All rights reserved. EXAMINING STRATEGY OPTIONS Power can be taken but not given. The process of the taking is empowerment in itself. —Gloria Steinem Not every strategy is useful for every advocacy initiative. A great deal will depend upon the personal style and wishes of your “client” or the wishes of the group you are representing. Some people will want to “go to the wall” on an issue, while others will be reticent about “rocking the boat” too hard. It is very important to have a clear idea of what the people you are representing feel comfortable with before considering various strategy options. Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. Chapter 10 Advocacy as an Empowerment Strategy 233 In evaluating the possible effectiveness of any strategy option, the advocate should consider: Can it be successfully delivered? Will it have the desired impact on the “target” decision-maker? Can it be sustained long enough to get results? Is it within the resources of the “client” or group? Does it convey the impression the “client” wishes to convey? Does the advocate have the expertise to implement it? Will it engender more support or lead to discord with possible supporters? Considering strategy options forces an advocate to think through and anticipate reactions from an adversary. This is often referred to as “thinking more than two moves deep.” If an advocate has no idea how to respond once an adversary has answered their strategy with one of their own, the advocate should not use that strategy until more careful thought has gone into it. Most actions will engender a reaction. It is always important to plan for the worst-case scenario in response to a particular strategy and to be ready to counter it. Not foreseeing an adversary’s response can be devastating to any advocacy initiative. This is an area where wishful thinking should be banished. Good advocates should put themselves in the shoes of their adversaries and think like they do. By having this skill, a good advocate can be prepared for an adversary’s response. Copyright © 2021. Canadian Scholars. All rights reserved. CRITICAL THINKING CASE STUDY: AN ADVOCATE’S “WILL SAY” PROCESS One particularly good advocate used a “will say” process to determine how his adversaries would respond. For every statement he made, he considered, based upon his knowledge of the adversary and what he had said in the past, what he “will say” when the press prints a particular article. By thinking this through, the advocate was able to brief the reporter on responses to anticipate from the adversary and supplementary questions to ask that might pin him down. The process worked well. The reporter was able to include some very telling quotes by the adversary in the article. This greatly strengthened the advocate’s case and led to a resolution of the problem. Fearing further embarrassment, the key decision-maker had his aide call the advocate and ask for a private meeting to resolve the issue. Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. 234 CASE MANAGEMENT FROM AN EMPOWERMENT PERSPECTIVE DEVELOPING THE ADVOCACY PLAN: SIX STEPS TO SUCCESS No advocate should ever begin an advocacy initiative without a game plan. To do so would be like driving down a dark road at night with no knowledge of landmarks and no sense of direction. Adversaries can be expected to attempt to derail advocacy initiatives or to send advocates scurrying down blind allies. In some cases, adversaries may launch personal attacks against the advocate. The game plan keeps the advocate focused on the person’s goal and how to reach it when these other distractions present themselves. Identify the Problem The advocate thoroughly discusses an individual’s or group’s issues, then goes through a process of root cause questioning to ensure that the underlying systemic issues are identified. Research the Facts Once the systemic issues have been identified, the advocate should thoroughly research all policies, procedures, regulations, and statutes that govern the issue. Now is the time to find out as much information about the issue as possible, using the strategies outlined in the “research” section of this manual. Identify the Key Decision-Makers Copyright © 2021. Canadian Scholars. All rights reserved. The advocate should next determine who has the power to act to address the person’s or group’s issue(s). The section on key decision-makers in this manual can be helpful here. Discuss Options with the Person No advocate should ever go out on a limb by beginning an advocacy initiative without first discussing what they know about the issue and the key decision- maker(s) with the person being represented, and laying out a range of options for the person to consider. In discussing each of these options, the advocate should also discuss the risks and benefits of undertaking any particular action, along with precautions that can be taken and safeguards that can be put in place to protect the person as much as possible. Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. Chapter 10 Advocacy as an Empowerment Strategy 235 It is important, however, to advise the person that no advocacy initiative is entirely risk free. Risks should be carefully discussed, not just benefits. This is where some advocates make a serious error. The advocate should not be trying to “sell” a strategy to someone. It is the stage where an advocate must create the context for a person being represented to empower themselves by being able to consider options, taking into account all of the information available. Receive Clear Instructions from the Person and Informed Consent to Take Action Once the person has considered their options and has a clear idea of the risks and benefits involved in any advocacy initiative, they can instruct the advocate. A person’s instructions should be in writing and signed by both them and the advocate. Where questions may be raised about a person’s competence, a substitute decision-maker may be identified by the individual. This represents a formal agreement that the advocate has been retained to assist the person in a very specific way. Instructions should include the person’s “bottom line” in any negotiation that is to take place. It is at this time that an individual will be asked to sign a consent form giving the advocate access to persons and records and authorizing the advocate to act on their behalf. It should be noted that, wherever possible, the person should have the opportunity to represent themselves with the advocate playing a supporting role. Implement the Agreed-Upon Strategies Copyright © 2021. Canadian Scholars. All rights reserved. It is at this stage that the advocate will, in a methodical way, start implementing the individual’s instructions. This should be done in the order that the person and advocate have agreed is best. After each initiative, it is important that the advocate report back to the person what the outcome was. IMPLEMENTING THE ADVOCACY PLAN In implementing an advocacy plan, an advocate should take care to attempt to anticipate the “worst-case scenario” outcome and plan for it. By anticipating what a key decision-maker may do, an advocate can have in place various safeguards and “fall-back” positions to protect the person being represented, as in the following case example. Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. 236 CASE MANAGEMENT FROM AN EMPOWERMENT PERSPECTIVE Copyright © 2021. Canadian Scholars. All rights reserved. CRITICAL THINKING CASE STUDY: PETER Peter was 86 years old and lived in a commercial nursing home. He had been receiving very poor care in the home: sparse, non-nutritious food; verbal abuse from staff; bullying; bedsheets not regularly changed; bedsores from not being turned often enough; and the over-exuberant “recreation director” in the home insisting that he take part in “activities” in spite of his refusals when he was not feeling well. He and his advocate had worked out a plan where the advocate would meet with the administrator, director of nursing, and recreation director to try to obtain agreement to ensure that his care plan accurately reflected his wishes, not those of his caregivers. Peter did not want to have to take part in this meeting and instead gave his advocate written authorization to do so for him. The advocate anticipated the worst-case scenarios for Peter, advising him that he may be threatened with discharge, or that the verbal abuse and bullying may get worse. To deal with these possibilities, the advocate and Peter did two things: the advocate called the inspection body responsible for enforcing standards in the home and explained that she had been retained to represent Peter. She faxed through a signed consent to the inspector with whom she was speaking. She asked the inspector’s advice about the best way of handling the situation with the home, thereby committing the inspector to a particular course of action. She asked what protections the inspection body could offer the resident in the event there were reprisals as a result of the meeting that was to take place. The inspector informed the advocate it was unlikely that there would be reprisals, but if there were, she would go in personally “to have a chat” with the administrator. In a worst-case scenario, the inspector said that she could help Peter to find a different nursing home that met his stated needs. To ensure that there was a record of the conversation between the inspector and the advocate, she wrote to the inspector confirming their conversation and the actions she should take, then copied it to Peter. At the meeting, the recreation director became quite defensive and then combative. She accused the advocate of trying to tell her how to do her job. The administrator sat silent and did not intervene when this occurred. The advocate told the recreation director that she had no authority to force Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. Chapter 10 Advocacy as an Empowerment Strategy 237 residents to do her bidding. The recreation director responded by threatening to exclude the resident from all further activities “if he felt that way.” The administrator then leaned forward and said, “Perhaps Peter would be happier living somewhere else.” The veiled threat had been delivered. The advocate asked the administrator and recreation director if they were prepared to make the same statement in front of a state inspector. The administrator replied, “This meeting is over” and left the room. The advocate left the meeting and immediately informed Peter of the outcome. Both agreed that an immediate call to the inspector was in order. The advocate used the resident’s phone to make the call. The inspector was not in, but her supervisor was. The advocate spoke to the supervisor, briefly recapped the conversation she had had with the inspector, and offered to fax the letter she had written to the inspector. The supervisor replied that would not be necessary, and she would personally call the administrator. Within one hour, the administrator appeared at the resident’s door to apologize. She offered to have the charge nurse on Peter’s floor rework the care plan to better reflect Peter’s wishes. Copyright © 2021. Canadian Scholars. All rights reserved. REVIEWING AND REVISING THE ADVOCACY PLAN At a time agreed upon by both the person and advocate, the effectiveness of the advocacy plan should be reviewed to determine whether or not it is producing the expected results. It is important to go back to determine whether or not other options that were discussed earlier and rejected should be resurrected and re- examined. It is also a time to celebrate successes and set new goals. By reviewing what worked and what did not work, it becomes clearer what kinds of actions are likely to be successful and which are not. If the advocacy plan is not producing the required results, revise it to improve its effectiveness or to move to a higher profile strategy to increase the pressure on key decision-makers. ADVOCACY TACTICS Advocacy tactics are generally classed under “low-,” “medium-,” and “high-”profile categories. Low-profile strategies are those that are accomplished behind closed doors, out of the public eye. These can include letters written to decision-makers, briefs presented to legislators, closed-door negotiations and meetings, phone calls to decision-makers, and quiet lobbying of legislators. Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. 238 CASE MANAGEMENT FROM AN EMPOWERMENT PERSPECTIVE Medium-profile strategies usually involve a higher level of pressure on key decision-makers, where an issue has the potential to become public. This can involve discussions with opposition political parties, public meetings or forums to give the public an opportunity to comment upon an issue in the presence of key decision-makers, community hearings, letter-w riting campaigns, meetings with elected representatives, filing formal complaints with public bodies like state or provincial ombudsmen or human rights bodies, filing freedom of information requests, and sending briefs to senior government officials with a request for a meeting. High-profile strategies can involve releasing a brief to the press after sending it to an entire state or provincial legislature, leafleting a legislator’s riding or constituency, picketing a constituency office, holding a high-profile lobby of a state or provincial capital, organizing a public demonstration, holding a news conference, or occupying a legislator’s office. These can also involve publicized legal strategies. Low-Profile Strategies Copyright © 2021. Canadian Scholars. All rights reserved. Writing Effective Letters of Complaint When writing a letter of complaint, first determine to whom it should be sent (the key decision-maker). Remember that the key decision-maker is the person who has the authority to act to change or reverse a decision, or to make a decision favourable to the individual. Always direct the letter to one person, and copy it to whoever else you think is appropriate. It is, however, important not to have a copy list that is too lengthy. This looks too desperate, as if the advocate is “copying the whole world,” and it may destroy the advocate’s credibility. It is better to copy the letter to one or two people—usually supervisors of the person to whom you are writing. Some Ground Rules When writing a letter of complaint, it is important to observe the following ground rules: do not go overboard with exaggerations; do not ramble on with endless details; state your facts clearly and concisely; be specific about what you want done (do not say “something has to be done”); provide a deadline for response from the party you are writing to; and ask for a response in writing. Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. Chapter 10 Advocacy as an Empowerment Strategy 239 Copyright © 2021. Canadian Scholars. All rights reserved. The Body of the Letter 1. Spell the name of the person to whom you are writing correctly, and address the letter correctly, using the person’s appropriate title. 2. Provide all relevant details, such as who you are (especially in relation to the event or “client” about whom you are writing); the time, date, and place where any incidents occurred; and the names of anyone else who can support your version of the facts (e.g., “This event was witnessed by Jane Smith, a local physiotherapist”). 3. Outline exactly what occurred in chronological order. Stick to the facts and do not include your feelings and impressions (e.g., “The nurse shouted obscenities at Mr. Davies, and this is a violation of the state bill of rights for nursing home residents,” not “The nurse screamed at Mr. Davies, and I think that is outrageous conduct for a professional”). 4. State your case, including your objections to what happened. 5. Outline the steps you are asking the official to take to rectify the situation. Where applicable, cite policies, procedures, or laws that have been violated. Make sure you have stated a direct request for action and say exactly what would satisfy you—this should be more than your fall-back position. 6. Ask for a written response by a deadline (so you can take things to the next level if necessary once the deadline has been reached). 7. Mark the envelope “Private and Confidential” if you only want the official or their immediate staff to see it, and “For Your Eyes Only” if you want only the official to see it. 8. Be sure to sign, date, and include a return address, telephone number, and fax number. Check for any spelling or grammar errors in the letter. Effective Presentation of a “Client’s” Case in Closed-Door Meetings Advocates are often called upon to present a person’s case at a case conference or other closed-door meeting. Presentations can be made very effectively if the following points are observed: Never read! You will be seen as being unsure of your facts. Write your material down in point form and refer to it periodically. Try to ad lib most of what you want to say, making eye contact with your listeners. Make your points one at a time. Refer to your notes, and organize your material under headings that are easy to read. Substantiate your points. Provide evidence or cite sources or authorities to support what you are saying. Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. 240 CASE MANAGEMENT FROM AN EMPOWERMENT PERSPECTIVE Copyright © 2021. Canadian Scholars. All rights reserved. Dramatize the situation of the person you represent. Put some emotion in your voice, but remain in control. Do not exaggerate, but do not shy away from graphic accounts of what the individual’s plight is. Bring pictures. Pass them around to illustrate what you are saying. Speak up! Speak in a slow (but not too slow), purposeful way. Take regular breaths. Project your voice. Do not squeak, mumble, or whisper. Do not put your hands in front of your mouth, or play with props like a pen or pencil. Look at each person in the room as you speak. Maintain eye contact longer with any key decision-makers. Involve your audience in your presentation. Ask them questions, and refer to them by name. Dress in a navy, black, khaki, or gray suit, and a white blouse or shirt. Men should wear a conservative tie. This kind of dress gives the impression of authority, power, and professionalism. Have copies available of any document you are reviewing. Ask the audience to review it with you and ask for questions. Never begin by apologizing for nervousness or inexperience. Your audience will fixate on your nervousness. Wind up your presentation with a direct request or appeal to the key decision-maker(s). Clearly identify what is at stake for the person you represent in the event that no action is taken. After the request, calmly sit down and say nothing more until you get a reply. How to Write a Public Policy Brief Many people are intimidated by having to write a brief to a legislator, but the process is actually not difficult. There are a few pointers to keep in mind when preparing a brief concerning your person’s situation, or when you wish to advance an agency’s case. If the brief is to a government official, try to put the brief in policy format. This means that you will follow the outline below: Outline the reason for the brief in a statement of the problem. Provide background information concerning the person, agency, or organization. Set out the options for addressing the problem, including at least three options, and discuss the pros and cons of each. State the preferred option, stating why it is preferred. Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. Chapter 10 Advocacy as an Empowerment Strategy 241 Wherever possible, use case examples or even photos to illustrate the problem. Where there is literature or evidence to support the position, cite it in the body of the brief or report. Each brief submitted should be accompanied by a covering letter requesting a response by a specific deadline. Copyright © 2021. Canadian Scholars. All rights reserved. Medium-Profile Strategies Meeting with Legislators It is useful to obtain a biography beforehand of the legislator with whom you are meeting. Once you are aware of the legislator’s experience and interests, it will be easier to “aim” your presentation in a way that the legislator will understand. Many of the same pointers that were listed in a previous section about presenting a case apply to meeting with a legislator. It is important to sit directly across from them, so that you can make eye contact. It is also important to leave the legislator with a written summary of the points you wish to make in the meeting. This will remove the pressure of having to remember each detail, allowing the advocate to speak to the main points of the case of the person they represent. Open the meeting informally, but quickly “cut to the chase”—get to the point of the meeting by acknowledging that you and the legislator are both busy people. Provide a brief synopsis of the situation, and state clearly what you would like the legislator to do. This can be write a letter on the person’s behalf, speak directly to another politician who is in a decision-making position, ask their research staff to locate documents that can be helpful to your case, or raise the issue publicly. Too often people leave legislators’ offices without a real commitment from them. This can be avoided by making a direct request of the legislator, then saying nothing until they respond to your request. If the response to your request is not what you would have liked, explain how it does not respond to the needs of the person you represent and ask what other options the legislator sees for responding to these needs. If you are to be referred elsewhere, make sure you ask the legislator if they would be willing to “call ahead” on your behalf. Make sure that you make it clear to the legislator that you will be back to them if the solution being proposed does not work out. Organizing a Letter-Writing Campaign Many advocates recognize the power and importance of launching a letter-w riting campaign, but few actually know how to do this successfully. If the advocate and Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. Copyright © 2021. Canadian Scholars. All rights reserved. 242 CASE MANAGEMENT FROM AN EMPOWERMENT PERSPECTIVE individual know of 10 or more people who are willing to write a letter to support the person’s case, ask them to meet together in one place, and to each bring one of their friends who may also be willing to write a letter. Make sure there is coffee and pastry or pop and pizza, depending upon what type of volunteers you have. It may be necessary to rent a hall or library meeting room if more than 10 people are involved. Begin the meeting by explaining the importance of the letter and a follow-up phone call to the key decision-maker within a week. Provide all of the necessary information, including the name, address, and phone number of the key decision- maker. You should also explain why it’s important for the letters to be sent within a specific timeframe. Provide paper and pens, and ask the volunteers to draft their letter in consultation with others at the meeting. The advocate can help by writing down the main points to make in the letters and what, specifically, the letter writers should be asking for. Remind the letter writers to include a date by which they would like to receive a written reply. Once the letters are written, ask the volunteers to address envelopes that the advocate supplies. The advocate can then keep the letters and mail them at specific times to ensure that they arrive on the key decision-maker’s desk at the appropriate times. It is also possible to draft a letter to send via email, although the advocate should ensure the letter writers have email addresses and regular access to their accounts to ensure follow-up. Physical letters are often still preferred, since they make more of an impact as they arrive on the key decision-maker’s desk. Email, although easy to leverage, might end up in someone’s spam folder, may be misdirected, and is often more easily ignored. Letter writers should be asked to add their names, addresses, and phone numbers to a sign-in sheet when they arrive, and the advocate should explain that this is to allow the advocate and person being represented to keep them informed of any developments. It is very important to advise letter writers of developments as they occur. This will keep them motivated to continue to support the person’s case and includes them on the advocacy team. It may also motivate them to work with the advocate in the future to support someone else. Filing a Formal Complaint Formal complaints are usually made to bodies such as a human rights commission, ombudsman’s office, inspection branch or service, or tribunal or appeal board. It is important to understand the ground rules before making a complaint to a body of this nature. Is there a law that governs the body? Is there public information about its policies and procedures? What can you learn about the people who Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. Chapter 10 Advocacy as an Empowerment Strategy 243 make up the appeal body? Do individuals usually represent themselves or do they have advocates or lawyers represent them? Are there formal rules of procedure? These questions must be answered before filing a formal complaint. Once an advocate has obtained information about the complaint body’s jurisdiction, what it can or cannot order, and information about what procedures to follow, it is important to follow these rules to the letter. Formal complaint bodies are notorious for throwing out cases on procedural or jurisdictional grounds. It is therefore vital to frame a complaint in a way that adheres exactly to a complaint body’s jurisdiction and procedural rules. Systemic Advocacy Systemic advocacy is a way to change oppressive systems, policies, and practices through a planned, strategic, focused method of moving power from those who currently exercise it to those over whom it is exercised. Effectively advocating can change laws, policies, and practices. Advocates may decide to embark on a systemic advocacy initiative when they learn that a person’s situation is related to structural issues in society or discriminatory or inequitable policies, practices, or laws that negatively affect a group or class of people. Case managers who practise using an empowerment approach must be knowledgeable in the use of systemic advocacy practices. Systemic advocacy is a process wherein: Copyright © 2021. Canadian Scholars. All rights reserved. systemic failures are addressed through changes in procedures, policies, and/or legislation; instructions are taken from an individual “client” wishing to challenge broader social issues or legislative or procedural practices or by a group representing a class of individuals negatively affected by a particular policy, procedure, or law; there is a thought-out, strategic “game plan” based upon a thorough knowledge of the system and key decision-makers, who are the targets of the advocacy campaign; and the pros and cons of undertaking the advocacy initiative have been carefully assessed, and contingency plans made. To be a systemic advocate, it is necessary to possess several important skills, including: a thorough knowledge of policies, procedures, formal complaint mechanisms, and legislation related to the issue being targeted; strong writing skills, including good grammar and spelling; Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. 244 CASE MANAGEMENT FROM AN EMPOWERMENT PERSPECTIVE persuasive presentation skills; a well-developed ability to analyze situations and determine key issues and arguments; an unshakeable commitment to equality and social justice; strong ethical principles, which dictate that the advocate will always advance a group’s goal rather than seeking personal gain; a strong ability to reason, to see others’ points of view, and to anticipate and deflect countermeasures by the opposition; and strategic thinking ability that leads to creative, effective tactics. Resources Required to Practise Systemic Advocacy Several types of resources are needed by systemic advocates if they are to practise successfully. These include the following: Copyright © 2021. Canadian Scholars. All rights reserved. Material Resources pertinent acts and regulations pertinent policies and procedures access to research information a government telephone directory issue and policy papers related to the advocate’s area of specialty internal government briefing documents received through government contacts or freedom of information legislation Technological Resources a computer, preferably with desktop publishing capability access to databanks and the Internet a fax machine an email address a photocopier a camera of some kind, such as one in a smartphone a device with recording capabilities, such as a smartphone or a small, handheld recorder Human Resources contact with people in key positions contact with people in specific areas of expertise (these will vary depending upon the issue) the support of a consumer advocacy organization Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. Chapter 10 Advocacy as an Empowerment Strategy 245 contact with individuals experiencing inequities or injustices the support of a large law firm with lawyers willing to do pro bono work The Process of Systemic Advocacy A systemic advocacy initiative usually unfolds in the following way: Copyright © 2021. Canadian Scholars. All rights reserved. Case advocacy occurs, and this identifies a broader social issue. An advocacy group identifies an issue and instructs a systemic advocate. Key issues or common problems are identified using a “root cause” questioning approach (who benefits and why from the current situation?). Inequities and injustices are carefully documented (through site observations, literature searches, interviews with key informants, the Internet, freedom of information requests, etc.). Goals are set (measurable with timeframes). A game plan is developed, which includes the arguments that will be used, who the key decision-makers being targeted are, the identification of potential allies and adversaries, a plan for anticipation of responses to adversaries’ positions, determination of where points of escalation will occur, and fall-back tactics. Key decision-makers are contacted. The issue is escalated to more senior levels. There is a movement to medium-and high-profile strategies. To launch a successful systemic advocacy campaign, it is usually necessary to maintain gradually escalating pressure on key decision-makers for two to three months. One tactic here and another there seldom leads to positive results. A concerted effort to use gradually escalating tactics over a period of months is the most effective way to win a systemic advocacy initiative. Any organization or group that is unwilling to commit its resources to a campaign for at least six months should not consider undertaking a systemic advocacy initiative. Systematic Advocacy Strategies Organizing a Public Meeting A particularly effective approach to publicize a particular issue and to bring those affected by the decisions together with the individuals who made the decisions is to organize a public meeting. Once low-profile strategies have failed to appropriately address an issue that negatively affects a “client” group, it is necessary to graduate to medium-profile Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. Copyright © 2021. Canadian Scholars. All rights reserved. 246 CASE MANAGEMENT FROM AN EMPOWERMENT PERSPECTIVE strategies. A public meeting is a medium-profile strategy that moves an issue into the public domain. To organize a public meeting, a systemic advocate would meet with their constituency group to determine two or three dates for a meeting, as well as a list of key decision-makers the group would like to see there. The advocate’s job is to contact the key decision-makers and ask them to attend. This should be done by phone and letter. If a key decision-maker balks, the advocate could ask if they would be willing to meet with the group in their office instead or have the group ask their supervisor to attend. This will usually result in the key decision-maker agreeing to take part in the meeting. It is usually wise to have someone holding an opposing view also appear at the meeting to stimulate debate. This gives those present the opportunity to assess both positions and come to their own conclusions about which position seems reasonable. Once the speaker list is finalized, a moderator should be chosen from the constituency group. The moderator should be someone who is a good speaker and who can chair without showing undue bias. A decision should be made by the constituency group about whether or not floor microphones will be used or whether marshals will carry microphones to participants. If there is concern about unruly behaviour, it is better to have marshals take microphones to participants, rather than use floor mikes, which can lead to one or two people attempting to dominate a meeting. The meeting should be held in a central location easily reached by all members of the constituency group, and that is accessible to all people, including those using assistive devices such as walkers or wheelchairs. There should be a warm atmosphere as guests arrive, with coffee and some light refreshments available. It is also a good idea to use sign-in sheets so that a mailing list can be generated to keep people informed of developments after the meeting. Official greeters should also be available to welcome people and invite them to have some refreshments. Often, volunteers will prepare or supply these items, such as cookies, coffee, or juice. Fewer chairs should be set up than are actually needed, so that more chairs can be put out as the “overflow” crowd arrives. This gives the appearance of considerable public interest in the event that has outstripped the organizers’ expectations. The meeting should also be recorded. The recording can be uploaded to a site like YouTube or the organization’s own website. Occasionally, it is possible to use recordings as a way to fundraise, such as by selling access to the video or distributing hardcopies to those who are interested. A YouTube video could contain links Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. Chapter 10 Advocacy as an Empowerment Strategy 247 Copyright © 2021. Canadian Scholars. All rights reserved. to an online fundraising campaign, such as one organized through GoFundMe or another service. It is helpful, if a meeting is expected to become quite heated, to have four or five volunteer marshals available to defuse situations. If necessary, unobtrusive security should be arranged. There should be a specific beginning and end time established for the meeting, and the meeting should begin and end at exactly the time stated. Handouts or other information brochures, membership information, and so on should be made available at the meeting. A meeting can be used for fundraising efforts, such as through the collection of donations, the sale of memberships or access to articles or other information briefs. At the end of the meeting, someone should be chosen to summarize what was said and thank the presenters. Gifts are optional, depending upon the group’s wishes. As a follow-up to the meeting, letters should be sent formally thanking the presenters. If a presenter did a particularly good job, it is always useful to write a complimentary letter and copy it to the person’s boss. Public Demonstration or Picket? There is ongoing debate among advocates about what is more useful in raising the profile of an issue: a public picket or a demonstration. In considering this, it is important to assess the resources available to the constituency group, as well as what objectives it has as it raises the profile of its issue. If one of the objectives is to energize and motivate its constituency and it has considerable resources to commit, a demonstration is probably the appropriate vehicle to launch an issue into the public domain. However, if it is not necessary to motivate or energize the constituency group and resources are quite limited, a group is just as likely to get news coverage if it organizes an interesting picket. In both cases, follow-up events are necessary if the issue is to remain at the forefront of legislators’ and the public’s minds. A demonstration or a picket does not have news value for very long, especially within the era of the 24-hour news cycle. This should be considered when deciding whether or not to organize either tactic. A Public Demonstration Organizing a public demonstration requires a great deal of effort. Groups considering a public demonstration should think about the following factors, which Spindel, Patricia. Case Management from an Empowerment Perspective, Fourth Edition : A Guide for Health and Human Services Professionals, Canadian Scholars, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=6425727. Created from humber on 2024-03-09 20:12:51. 248 CASE MANAGEMENT FROM AN EMPOWERMENT PERSPECTIVE contribute to the effectiveness of any demonstration. They should think about their capacity to: Copyright © 2021. Canadian Scholars. All rights reserved. gain commitments from other groups that support the issue to “deliver” at least 2,000 supporters to the demonstration; organize buses from out of town to bring people to the demonstration; order and print hundreds of picket signs; arrange food, beverages, and outdoor toilet facilities; obtain permits to demonstrate; make contact with the local police to assure them that the demonstration will be peaceful; arrange for trucks with speaker systems and microphones; have marshals with loudspeakers, if there is to be a march; arrange speakers and entertainment for the crowd; engage in fundraising activities during the demonstration, such as selling merchandise or collecting donations; have a quick action team to defuse any agitators who are otherwise not part of the demonstration; arrange to have lawyers present in case anyone gets arrested; have designated volunteers re

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