Improving Healthcare Through Advocacy: A Guide for the Health and Helping Professions

Preface xi

1 Embedding Advocacy in the U.S. Health System 1

Seven Problems Commonly Encountered by Healthcare Consumers 2

Advocacy 3

Scenarios and Vignettes 6

Resurgence of Interest in Case and Policy Advocacy 8

Advocacy From Outside the Health System 10

Advocacy as an Underground Activity 11

Advocacy as an Ethical Imperative 11

A Philosophical Premise 12

An Outline of This Book 13

Online Materials Relevant to This Chapter 13

2 How the U.S. Health System Contributes to Consumers' Seven Problems 15

The Poor Law Tradition 15

Emphasis on Technology 17

Entrepreneurialism 17

Insufficient Emphasis on Prevention 17

Lack of Diversity in Medical Personnel 18

Uneven Acceptance of a Biopsychosocial Framework 19

Medical Silos and Insular Care 19

From History to Case and Policy Advocacy 21

Online Materials Relevant to This Chapter 22

3 An Advocacy Practice Framework: Tasks, Skills, and Actions 23

Brief Overview of Case-Advocacy Interventions 23

Eight Case-Advocacy Tasks 24

Task #1 Reading the Context 24

Task #2 Triage 27

Task #3 Allocating Case-Advocacy Services 32

Task #4 Diagnosing Task 33

Task #5 The Strategizing Task 40

Task #6 Implementing Case-Advocacy Strategy 50

Task #7 Assessing Advocacy Interventions 50

Task #8 Progressing to Policy Advocacy 51

Case Advocacy for a Very Sick Child 51

Summary 56

4 Case Advocacy Skills 59

Four Skills for Reading the Advocacy Context (Task #1) 59

Four Skills for Case-Advocacy Triage (Task #2) 60

Four Skills for Allocating Case-Advocacy Services (Task #3) 61

Four Skills for the Diagnosing Task (Task #4) 61

Four Skills for the Strategizing Task (Task #5) 61

Four Skills for the Implementing Task (Task # 6) 62

Four Skills for the Assessing Task (Task #7) 62

Four Skills for the Progression Task (Task #8) 63

Two Skills in More Detail 63

The Nature of Influence 63

Empowering Consumers 65

Empowerment (Continued) 83

Advocacy With Respect to Seven Consumer Problems 96

5 Advocacy to Protect Consumers' Ethical Rights 97

Promoting Ethical Conduct in Healthcare 97

The Policy and Regulatory Thicket for Promoting Ethical Conduct 101

Obtaining Skills in Ethical Reasoning at the Case Level 106

Nineteen Scenarios Encountered by Case Advocates 115

Summary 137

Moving From Case-Advocacy Scenarios to Broader Policy Issues 141

Online Materials Relevant to This Chapter 142

6 Advocacy to Improve Consumers' Quality of Care 143

A Definition of ``Quality Healthcare'' 143

General Criticisms of the Success of U.S. Healthcare in Addressing Physiological Illnesses 144

The Policy and Regulatory Thicket as It Pertains to Quality of Care 146

Fifteen Scenarios Encountered by Consumers With Respect to Quality of Care 159

Online Materials Relevant to This Chapter 176

Progressing From Case Advocacy to Policy Advocacy to Enhance Quality of Care 176

7 Advocacy to Promote Culturally Competent Health Services 179

Conceptualizing Cultural Competency 180

What It Means to Be Culturally Competent: A Conceptual Framework 182

The Case for Providing Culturally Competent Services 185

The Policy and Regulatory Thicket 189

Ten Scenarios Pertaining to Culturally Incompetent Services 192

Policy Advocacy to Promote the Cultural Competency of the Health System 207

Moving From Case Advocacy Scenarios to Broader Policy Issues 210

8 Using Advocacy to Promote Prevention in Health 211

Defining Prevention 211

Threats to Health 213

Prevention Goals and Strategies 214

Why U.S. Consumers Particularly Need Prevention 219

Barriers to Prevention 221

The Policy and Regulatory Thicket 229

Twelve Scenarios of Consumers Regarding Preventive Services 239

Moving from Case Advocacy to Policy Advocacy 251

Summary 252

9 Using Advocacy to Help Consumers Finance Their Healthcare 253

Buck-Passing 260

Seniors' Angst 264

The Medical Wheel of Fortune 267

Some Effects of Poor Coverage on Health Outcomes 275

Ripple Effects of Health Costs and Coverage 276

The Policy and Regulatory Thicket Protecting

Consumers With Respect to Health Coverage 278

Twenty Scenarios Encountered by Advocates 280

Moving From Case Advocacy to Policy Advocacy 295

Fifteen Scenarios Presented in This Book 295

Online Materials Relevant to This Chapter 295

Summary 296

10 Advocacy for Healthcare Consumers Needing Mental Health Services 297

Why Many Consumers Turn to Health Settings for Help with Mental Conditions 297

Kinds of Mental Distress Often Experienced by Consumers 300

Who Attends to Consumers' Mental Health Needs? 303

Some Liabilities in the Policy and Regulatory Thicket 304

Assets in the Policy and Regulatory Thicket 306

The Policy and Regulatory Thicket: Laws, Regulations, and Staff That Facilitate Social and Mental Health Services 319

Twenty-Six Scenarios Encountered by Case Advocates 321

Online Materials Relevant to This Chapter 343

Moving from Case Advocacy to Policy Advocacy 343

11 Advocacy to Help Consumers Receive Community-Based Care 345

Consumer's Health Ecosystems 345

A Compendium of Community-Based Health Services 348

Assets and Liabilities in the Policy and Regulatory Thicket 349

Fifteen Advocacy Scenarios for Consumers Needing Community-Based Care 361

Moving From Case Advocacy to Policy Advocacy 374

Online Materials Relevant to This Chapter 374

Summary 375

12 A Framework for Policy Advocacy by Healthcare Professionals 377

The Importance of Policy Advocacy 377

A Policy Advocacy Framework 379

Surmounting Fatalism, Controversy, and Vested Interests 387

Policy Advocacy in Four Settings 390

13 Using Policy Advocacy to Embed Advocacy in Healthcare Organizations 391

What Advocates Seek to Change in Health Organizations 391

Using Policy Advocacy to Embed Advocacy in Health Organizations 395

Summary 420

14 Policy Advocacy in Community, Electoral, and Government Settings 421

Health Advocacy in Communities 421

Policy Advocacy in Electoral Settings 425

Policy Advocacy in Legislative and Regulatory Settings 426

Advocating for Regulatory Changes 429

Establishing a Policy Agenda in Specific Health Settings 430

Online Materials Relevant to This Chapter 431

Summary 431

References 433

Author Index 457

Subject Index 469