What You Will Learn
Take action when you see a problem requiring advocacy on behalf of yourself, the people you serve, or your coworkers
Apply principles of thoughtful advocacy when advocating for one's self or others
Continue to advocate and report progress until the problem is solved
Being an advocate, for yourself, the people you serve, and your coworkers is an essential element of your job in any position with Accend. Being thoughtful advocate is how you will effective in carrying out this responsibility.
The simplest way to understand this responsibility is this: see the problem, be the solution.
Whenever you see a problem, a barrier to quality, a policy or procedure or process that prevents us from providing the highest quality services to the people we serve, or from supporting our team members as best we can, act. Identify the problem, and propose solutions.
As you advocate for yourself or others, consider the following probes that represent to help you decide whether or not you are following principles of thoughtful advocacy. In this list, agency might refer to any agency, whether is is Accend, or one of our community partners, such as another provider, the county, the state, an insurance provider, the legal system, a housing organization, or any other.
> Consider the action, decision, problem, or policy in the context of the agency's perspective
- Why has the agency take this position at this particular time?
- What is the history and rationale behind this position?
- What are the arguments for and against this position?
- What data support these viewpoints?
- What political, economic, and social forces gave rise to this position?
- Was it prompted by political and administrative expediency or was it rooted in principles of social justice and efforts to allocate scarce resources in a fair and responsible manner?
- If it was driven by a lack of financial resources, what actions were taken to secure additional resources or create other efficiencies?
- Does the action or policy fit the agency's stated management principles? For Accend, these principles include, but are not limited to:
- Fundamental fairness and equal treatment
- An effort to encourage individual staff self-management, accountability, and responsibility
- Providing tangible rewards for staff members who work effectively and efficiently
- Does the action, decision, problem, or policy further the agency's mission and is it consistent with other policies, procedures, and its stated operating philosophy?
- Is the action, decision or policy culturally sensitive and fair?
> Consider the action, decision, problem, or policy from a personal moral/ethical standpoint
- Which of my beliefs, values or standards is being threatened or violated?
- Are my concerns based on identifiable principles or possible arising from personal bias or differences in personal, professional, and/or administrative style?
- What other factors are influencing me to take my position on the issue at this time?
- Is my objection rooted in principle such as fairness, equality, respect for dignity, accountability,
quality, etc., or on purely personal economic or other factors?
- If I am personally impacted (favorably or otherwise) by the decision, have I considered the views and opinions of peers and others who may be more or less favorably impacted?
> Consider the action, decision, problem, or policy from a broad moral and ethical perspective
- Does the action or position in question recognize that every individual has worth and dignity, regardless of his or her strengths and limitations, successes and failings?
- Does it recognize that each person is unique and precious?
- Does the action or position recognize and respect the rights and responsibilities of each person?
- Does the position honor the principle that every mentally competent person has a right to self-determination, as long as his or her actions do not harm others?
- Does the position recognize that every competent person is also responsible for his or her own actions and must accept the consequences for violating legitimate laws and rules?
> Consider the action, decision, problem, or policy from the perspective of the broader mission and community and social responsibility
- Does the action or position in question promote the common good?
- Does the position enhance and strengthen the functioning of individuals, families, and the community?
- Does it recognize the obligation of individuals, communities, and society to expand social and economic opportunities and, where necessary, to provide direct assistance to persons who are at risk of harm, deeply troubled, adversely affected by a physical or mental limitation, or socially or economically depressed?
> Consider my own process as regards advocacy regarding the action, decision, problem, or policy
- For whom am I currently advocating: for myself or for others?
- Am I listening objectively or am I looking for proof of my own opinion or thesis?
- Am I seeking out opinions that are different from mine or am I seeking out opinions that differ as well as agree?
- Do I give equal weight to opinions that are different from my own or do I dismiss or devalue those that are not supportive of my original premise?
- Do I make broad statements based upon small amounts of data or opinions, or do I consider all facts, data and possibilities?
- In forming my opinions, have I considered the needs, interests and concerns of all my peers, or just those in my closest circle of friends?
> Consider whether or not I am proposing solutions, advocating in the right direction, and completing the circle
- Am I proposing solutions when I identify problems?
- Have I brought the problem and solutions to the attention of people who can help me solve the problem, or am I just venting to coworkers and making the problem worse?
- If I have a formal leadership role, do I advocate on behalf of myself and the people I lead in the right direction?
- Do I listen thoughtfully to those I lead, without promising results I cannot necessarily deliver?
- Do I follow through with promises to advocate or investigate on behalf of others?
- Do I bring my own needs, complaints problems and solutions to my superiors, rather than to the people I lead?
- When a solution has been identifed, but the problem remains unsolved, do I continue to advocate and report results until the problem is solved?
- When problems are solved, do I also celebrate and report success
When you support the people you serve in a health care advocacy role, you have one goal: to help them get the best health care services possible. To achive that goal, please keep the following tips in mind:
Arrive and Appear as a Professional
Appearing professional will go a long way in helping you appear credible and increase your skills as an advocate. Some things to consider in your professional appearance are:
- Dress professionally. Business casual is fine. Slacks or a dress, limited or no visible body piercings or tatoos, conservative skin exposure are just a few suggestions. (In the alternative, please don't wear short and flip-flops to a medical appointment.) While you may feel strongly that judging you on your appearance is not appropriate, remember, you're there for the success of the person you serve, not to make a political or social statement.
- Learn to understand and speak (and pronounce correctly) medical terminology. You don't have to be an expert, just have a modicum of competence. And remember that it is professional, and will likely increase your chances of success, to say, “I don't understand that term. Can you please explain what you mean by...”
- Be objective. We harp on this at Accend. Don't tell a medical professional how you feel, or give them your opinion. Stick to the facts that you know. And to help you with this, keep good records of the facts.
Arrive Prepared and Organized
Arriving at any healthcare appointment prepared is key to success in getting the needs of the person you serve met. By doing the following and teaching the people you serve to do the same, you will achieve better results. To be prepared, do the following:
- Understand fully the reason for the appointment. What problem are we trying to solve? What is the history of the problem?
- What records might you need to bring to the appointment to support you/the person you are supporting in defining the problem?
- Don't waste the provider's time with unpreparedness. Medical professionals are busy and often or always are overbooked. Fumbling with your iPhone or other device to find information they need will not go over well. Have the information you need at your fingertips.
- Some specific items to prepare to present ahead of time are:
- Information about the problem and history, as noted above.
- Medications the person you are supporting is currently taking.
- Other related history or related issues. (Consult with your supervising nurse about what might be relevant to the current problem.)
- Remember that if you are asked a question and cannot answer with extreme confidence, that is it ok to say "I don't know, but I will find out and get back to you."
- Take care of business ahead of time. (For example: have signed Release of Information forms prepared in advance if you will need to request records.)
Communicate Professionally
Communicating professionally includes the tips above in professionalism and these in addition:
- Good relationships are built on respect.
- While the current topic might be emotional, stick to the facts.
- Effective communication is grounded in active listening. Active listening means being attentive, reflective statements, and asking for clarification as needed.
- Healthcare providers are busy. Be factual and consise. Clarity and brevity are essential.
- Express your respect and appreciation regularly. (Say “please” and “thank you”).
- Be respectful in your address. Refer to medical professionals with their title (“Doctor”) or by the name with which they introduced themselves. (While some doctors and nurses actually do say, “Hi I am...” and use their first names, it is fine to use that name or the more formal, “Doctor [or other title]...” followed by the first or last name by which they introduced themselves.)
Question!
By Question!, we don't mean be combative. Rather, ask questions to make sure you understand, or if you're not perceiving that the person you support is being heard or understood, ask questions, respectfully. Some tips to do that are:
- Prior to the appointment, with the person you are supporting, develop a list of questions you have.
- During the appointment, if needed, say “Just so I understand correctly, could you explain what you mean by...?”
Be Tenacious and Resilient
Tenacity and resilience are the key to success. You may not always get the results you want, but your job is to see that the needs of the person you support are met.
- Keep the goal in mind: the best health care possible for the person you support.
- Stay informed: keep learning and being prepared. This includes getting to know what certain medical professionals need and want from you.
- Keep your attitude and emotions in check. You are passionate about the people you serve. Letting that passion harm them because you get emotional will not serve them well.
- Take care of yourself. Debrief with a supervisor or mentor when things go badly. (Avoid wasting time venting in the meantime.) Celebrate success and share these stories with others also.
- When you're having a problem with certain or specific providers, don't consider it your problem alone. Seek help from your supervisor (Team, Clinical Lead, or RN/Integration Specialist).
Occasionally, Accend staff are asked to provide testimony in court or legal hearings, sometimes by our clients and sometimes by legal representatives on either side (plaintiff or respondent). This is most often in civil cases, the most common being custody issues, but sometimes others that can include criminal cases.
Yoy may also be requested to provide information in an interview for an investigation of maltreatment, licensing board investigations of providers, or a variety of other reasons.
Follow the general guidelines below, while understanding that they are not comprehensive. Whenever unsure, seek guidance from the Executive Director.
General Guidelines
Prior to testifing, you may be interviewed. Make it clear what your testimony can include, and cannot include, during this interview and in the hearing, if called. Some examples are as follows:
Can Include
Citing records and not by memory, Please explain where you are out-of-scope or ability explaining medical records.
- Describing and defining services provided and your role.
- Explaining the type and purpose of medical records that might have been subpoenaed (from Accend) for the hearing to the best of your ability.
- Reporting client participation in services/treatment, including admission/discharge dates, frequency, duration, etc. of services and how long you have known/worked with the individual.
- The client's legal status for participation in services (voluntary, adjudicated, assigned by a guardian or legal representative, etc.).
- Describing (objectively) incidents or behavior you have witnessed and have previously reported, or to the best of your ability explaining incidents or reports from others.
- Your testimony can also include that you have not personally witnessed for example a particular specific behavior, explaining incidents or reports from others.
- Safety risks to the client or others only as previously reported in the client's records (such as in assessments or incident reports) not including your own opinion about safety risks.
- Diagnoses that exist in client records, without definition or description of the meaning of the diagnosis, unless you are a medical or mental health professional.
- The individual's progress in treatment as objectively reported in our records.
Must Not Include
- Anything you cannot confidently answer by memory alone, unless allowed to review records duing the interview.
- Your opinion, impressions or any other subjective data regarding client current or future behavior.
- Unless you are licensed professional, explanation or definition of a diagnosis and symptoms.
- Unless you are a licensed professional, your opinion about the accuracy of observations or diagnoses reported by others, and then only to the extent of your personal knowledge of the individual.
- Unless you are licensed professional, prognosis (prediction of the probable course of illness and outcome of treatment) and then extremely cautiously explaining that prognosis in mental health treatment is very difficult.
- Unless you are a licensed professional, your assessment of risk (of re-offending, of substance abuse, of harm or risk to self or others, etc.) and then extremely cautiously explaining that predicting risk is as unreliable as prognosis.
Avoid Intimidation or Bias
During a pre-interview hearing, or in a hearing, make it clear to what you can reliably testify and what you cannot (referencing the above guidelines). Explain the limits of your scope of practice.
Do not be afraid to answer that you do not know, cannot recall, or cannot answer a question because it is outside of your knowledge, scope of practice, or qualifications. Often, in the pre-hearing interview, you may be screened out for testimony when you explain your scope limits.
Avoid the temptation to testify outside of your knowledge or scope of practice, or offer opinions, because you want a certain result from the hearing or interview.
While this occurs with much less frequency over time due to their own training on Data Privacy law, law enforcement officials may try to obtain information from you based on their own ignorance of data privacy law or through brute force and intimidation. Law enforcement officials are increasingly well-trained on data privacy. This does not mean you may not encounter one who is not.
Questions from law enforcement may include any of the above listed in testimony and more.
Please do not be intimidated.
- Whenever questions from law enforcement go beyond directly observable behavior that you have witnessed, you must politely decline to answer. Explain that you cannot answer questions about behavior you have not directly observed as you cannot report hearsay.
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Explain that you can report direct observations you have made (a bruise, property damage, etc.)
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If at any time you become uncomfortable with a police interview, please explain that you are unsure about data privacy law and must seek guidance before continuing.
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Understand that when questioned about certain situations, you have nothing to fear when being cautious about data privacy. Data privacy is your mandate by state and federal law. You are protected by these laws.
This guide is a living document. We want to improve it with your help. Do you have questions? Found a typo? Find yourself wanting more information? Please send us your thoughts about anything in this chapter by tapping on the link below.
November 14, 2023
Insurance advocacy section removed as it is duplicated in Health Care Programs and Insurance Advocacy
October 29, 2024:
Guidance on Legal Advocacy: What to Consider if Asked to Testify in a Legal Hearing added.
October 29, 2024:
Guidance on Guidance on Responding to Law Enforcement Questions added.
