1
1
BECOMING A POLICY ADVOCATE
IN EIGHT POLICY SECTORS
In this chapter, you will learn to:
1. Engage social welfare policy whether you are micro or macro
2. Conceptualize policy practice
3. Understand how a multilevel policy advocacy framework was developed
4. Link the multilevel policy advocacy framework to eight policy sectors
5. Use this book as a road map for your student and professional caree
6. Contrast micro, mezzo, and macro policy advocacy with clinical practice
7. Understand how the social workers’ code of ethics requires micro, mezzo, and macro policy
advocacy
8. Use policy advocacy to help marginalized and vulnerable populations
9. Analyze a multilevel policy advocacy framework
10. Provide policy advocacy at three levels
11. Link three levels of advocacy for pregnant teens and teen mothers
12. Develop policy advocacy Red Flag Alerts at three levels
LEARNING OBJECTIVES
Social workers engage in humanitarian work in many kinds of social agencies. They work with people from all social classes, racial and ethnic groups, genders, ages, and nation-
alities. They work with active and retired military personnel. They work with residents of
u
an, subu
an, and rural areas. They work with people with myriad social problems.
Copyright ©2020 by SAGE Publications, Inc.
This work may not be reproduced or distributed in any form or by any means without express written permission of the publisher.
Do
no
t c
op
y,
po
st,
o
di
st
ibu
te
2 Social Welfare Policy and Advocacy
They often encounter obstacles as they engage in their work such as adverse social poli-
cies and difficult work environments that stem from insufficient funding, punitive policies,
and heavy workloads. Their clients, too, are often impacted by hardships, such as poverty,
mental illness, disability, excessive incarceration, deportation, and discrimination—and
large numbers of them live in the lower 50% of the economic distribution.
ENGAGE SOCIAL WELFARE POLICY
WHETHER YOU ARE MICRO OR MACRO
Because their clients are profoundly impacted by social policies that emanate from social
agencies, communities, states, the federal government, and courts, social workers often
engage in three kinds of policy advocacy:
helping their clients navigate social policies in eight sectors that personally
impact them (micro policy advocacy)
reforming dysfunctional agency and community policies in eight sectors (mezzo
policy advocacy)
changing policies that emanate from local, state, and federal governments as
well as courts (macro policy advocacy)
After providing orienting materials about social policy in its first three chapters, this
ook provides in-depth discussion of micro policy advocacy in Chapter 4, mezzo policy
advocacy in Chapter 5, and macro policy advocacy in Chapter 6. It applies the multilevel
policy advocacy framework to health, gerontology, safety net, mental health, child and
family, education, immigration, and criminal justice sectors in Chapters 7 through 14.
Because you will probably work in one or more of these sectors and will often refer clients
to programs in different sectors, this book provides a road map to your career.
Social policy was widely viewed not as a practice discipline but as a descriptive and analytic
discipline prior to the 1980s. Social work scholars described myriad policies at local, state, and
federal levels. They evaluated many of these policies by engaging in policy analysis. They
focused on government policies with little attention to agency policies or policies impacting
communities. These activities have merit, but they failed to make social policy sufficiently
elevant to many social work students. This book aims to open up social policy to all social
workers including to ones in direct service, community organization, and administration.
Three changes took place in social policy that expanded its relevance to all social
workers: conceptualizing policy practice, developing a multilevel policy advocacy frame-
work, and linking this framework to eight policy sectors.
CONCEPTUALIZING POLICY PRACTICE
The term policy practice first emerged in social work in 1984 to describe policy as a practice
discipline (Jansson, XXXXXXXXXXDiscussion of ways that social workers could participate in mak-
ing social policies hardly existed in the profession’s scholarly literature prior to 1984. Rather,
existing policy literature was mostly confined to defining social policy, studying the history
Copyright ©2020 by SAGE Publications, Inc.
This work may not be reproduced or distributed in any form or by any means without express written permission of the publisher.
Do
no
t c
op
y,
po
st,
o
di
st
ibu
te
Chapter 1 ■ Becoming a Policy Advocate in Eight Policy Sectors 3
of policy, analyzing the philosophical underpinning of policy choices, and policy analysis.
These topics are important, but do not sufficiently discuss how social workers work to
change policies in different venues, such as agencies, communities, and government entities.
Policy practice describes roles, tasks, skills, and strategies that policy practitioners need to
ead contexts as well as develop, propose, enact, implement, and evaluate policies in specific
settings. It describes different styles of policy practice, such as ones that involve social action,
ational deliberations, implementation of polices, or combinations of these and other styles.
Emerging policy practice literature discusses how social workers read the context to identify
constraints that can be surmounted or opportunities that they can seize. It discusses how
to place issues on policy agendas, develop policy proposals, engage in policy analysis, enact
policies, implement policies, and evaluate policies. It describes skills needed by policy prac-
titioners, including analytic, ethical, political, and interactional ones. It describes different
models of policy practice, such as ones that emphasize analytic skills (such as think tanks),
political skills (such as campaigns to pressure public officials to enact specific policies), inter-
actional skills (such as developing coalitions to develop and pressure public officials to enact
a policy), and ethical skills (such as developing policies that advance social justice).
This redefinition of policy as a practice discipline raised its stature in a profession
oriented to practice, whether direct service or clinical practice, administrative practice,
or practice of community organizers. It facilitated social workers’ engagement in policy
practice in community-based agencies; community boards; government agencies at local,
state, and federal levels; legislatures; and political campaigns. The Council of Social Work
Education mandated that schools of social work include policy practice in their cu
icu-
lums in the 1980s—a requirement that cu
ently exists in its accreditation standards for
schools of social work. A national organization of social work policy faculty, known as
Influencing State Policy, was established in the 1980s to encourage the teaching, research,
and practice of social policy. To clarify that important social policies are developed not
just at the level of states but also at levels of local and federal governments, this organiza-
tion changed its name to Influencing Social Policy (http:
www.influencingsocialpolicy
.org). It maintains a website and convenes an annual national conference where it awards
prizes to the best policy advocacy projects of BSW, MSW, and doctoral students.
Policy practice also includes involvement in political campaigns whether working on
campaigns, running for office, or voting. Elected officials develop policies that shape and
fund American social policies. Social workers need to work to improve these policies by
placing pressure on elected officials, helping elect promising ones, or running for office
themselves. The Nancy A. Humphreys Institute for Political Social Work at the School
of Social Work at the University of Connecticut, for example, trains hundreds of social
workers to work in campaigns, to run for political office, and to hold leadership positions
in local, state, and federal governments.
UNDERSTANDING HOW A MULTILEVEL POLICY
ADVOCACY FRAMEWORK WAS DEVELOPED
A multilevel policy advocacy framework was developed in a book that was published in
April 2015 but copyrighted in 2016 that describes the policy advocacy of social workers
no matter in which sector they are employed (Jansson, XXXXXXXXXXIt includes micro policy
Copyright ©2020 by SAGE Publications, Inc.
This work may not be reproduced or distributed in any form or by any means without express written permission of the publisher.
Do
no
t c
op
y,
po
st,
o
di
st
ibu
te
4 Social Welfare Policy and Advocacy
advocacy at the level of individuals and families, mezzo policy advocacy at the level of
organizations and communities, and macro policy advocacy at the level of government
agencies, legislative and executive
anches of government, and political campaigns.
This framework was developed in three stages. First, a review of 800 citations in health
care literature identified seven core issues that frontline health professionals address in
their professional work, including social workers, nurses, and medical residents:
protecting patients’ ethical rights
improving patients’ quality of care
helping patients receive culturally competent health care
helping patients receive preventive health care
helping patients finance their health care
helping patients obtain mental health services
helping patients link their health care to their households and communities
(Jansson, 2011)
Second, empirical research was initiated to measure the extent frontline health pro-
fessionals engage in micro, mezzo, and macro policy advocacy with respect to these seven
core issues with a grant obtained from the federally funded Patient-Centered Outcomes
Research Institute (PCORI). A research team surveyed 300 frontline health professionals
in eight major hospitals to measure the extent they engaged in micro policy advocacy
with respect to the seven core problems. These health professionals included 100 social
workers, 100 nurses, and 100 medical residents. It also measured their involvement in
mezzo policy advocacy because health literature frontline professionals and patients often
navigate and contend with hospital policies as well as policies of community agencies. It
also measured their involvement in macro policy advocacy to change policies of local,
state, and federal agencies, courts, and accreditation bodies.
The data obtained from the PCORI survey demonstrated that frontline professionals
help patients at the micro policy advocacy level frequently as can be seen in Table 1.1
(Jansson, Nyamathi, Heidemann, Duan, & Kaplan, 2015a). They frequently help patients
get their ethical rights honored; find evidence-based treatments; receive culturally respon-
sive care; receive preventive treatments; finance their medical bills; obtain mental health
services; and receive medical care linked to their households and neighborhoods.
Third, with assistance from an expert panel, the research team identified four
to seven manifestations of each of the core problems as can be seen in Table 1.1, in
which they are numbered from 1 to 33 (Jansson et al., 2015a). The expert panel iden-
tified five manifestations of Core Problem 1 (patients’ or clients’ rights), for example,
such as whether patients need assistance in obtaining “informed consent to a medical
intervention,” “accurate medical information,” protection of “confidentiality of (their)
medical information,” “advance directives,” and “care from professionals with com-
petence to make medical decisions” (see Items 1 through 5 in Table 1.1 where aster-
isks signify half or more of the 300 respondents selected “sometimes,” “frequently,”
or “always”).
Copyright ©2020 by SAGE Publications, Inc.
This work may not be reproduced or distributed in any form or by any means without express written permission of the publisher.
Do
no
t c
op
y,
po
st,
o
di
st
ibu
te
Chapter 1 ■ Becoming a Policy Advocate in Eight Policy Sectors 5
Item Mean (SD) Never Seldom Sometimes Frequently Always
Core Problem 1: Patients’
Rights
XXXXXXXXXX)
1. Informed consent to a medical
intervention
XXXXXXXXXX67 33
*2. Accurate medical
information
XXXXXXXXXX 78 51
3. Confidential medical
information
XXXXXXXXXX 50 42
*4. Advance directives XXXXXXXXXX XXXXXXXXXX
*5. Competence to make medical
decisions
XXXXXXXXXX63 44
Core Problem 2: Quality Care XXXXXXXXXX)
6. Lack of evidence-based health
care
XXXXXXXXXX41 8
7. Medical e
ors XXXXXXXXXX XXXXXXXXXX
8. Whether to take specific
diagnostic tests
XXXXXXXXXX 48 18
*9. Fragmented care XXXXXXXXXX XXXXXXXXXX
10. Non-beneficial treatment XXXXXXXXXX XXXXXXXXXX
Core Problem 3: Culturally
Competent Care
XXXXXXXXXX)
*11. Information in patients’
prefe
ed language
XXXXXXXXXX95 50
*12. Communication with
persons with limited literacy or
health knowledge
XXXXXXXXXX95 48
13. Religious, spiritual, and
cultural practices
XXXXXXXXXX XXXXXXXXXX
14. Use of complementary and
alternative medicine
XXXXXXXXXX68 22 9
Core Problem 4: Preventive Care XXXXXXXXXX)
15. Wellness exams XXXXXXXXXX