By: Donna McIntosh, MSW
YOU are the difference between case and cause advocacy. You, as the change agent, can make a difference through social work practice that embraces case to cause advocacy as a circular paradigm for change. It has to be in our mindset—the dual focus of social work—change for the individual and change in the system. The client with whom you work has experiences that reveal the need for systems change. The larger system of organizational, community, and societal policies and practices clearly has an impact not only on a client’s functioning, but also on the nature of the change relationship we, as social workers, have with clients. Influencing State Policy, an organization begun by social work educators in 1997, promotes case to cause advocacy through buttons, posters, and videos that espouse that policy has an impact on practice, and in turn, practice informs policy.
Often, when we think of case to cause advocacy, we think of large systems change through class action lawsuits and successful policy reform. This can scare most of us away from cause advocacy. However, case to cause advocacy is and should be in our daily social work practice with clients, compelling change in the agencies in which we work, the staff with whom we work, the recordkeeping we often lament, the training and professional development offered, and the forms we develop. It should be reflected in the organizational policies of outreach, referral, intake assessment, intervention, discharge, and aftercare. And the list goes on. We all know that a small change can make a big difference in someone’s quality of life.
In my undergraduate micro practice class, we examine intake forms from various field agencies. As we move through the intake questions to review how questions are shaped and how we pose them to clients, we also examine what kinds of data the questions will give us that affect how we operate the organization. For instance, the demographic information gathered tells us who we are serving. Do our staffing patterns, volunteers, and boards reflect similar demographics? If not, this data is useful in developing a diversity recruitment plan at all levels of the organization. In a 24-hour intake program for emergency shelter, noting the time of intakes can reveal the timing demands for services. This, in turn, can be useful in advocating for additional staff at peak demand hours or developing an outreach program for the hours and times of the week when demand falls short. I worked in a program once, right after graduating with my MSW, in which we used referrals denied data to make a case for increasing bed capacity. The same data were used by the community to examine unmet needs as we gathered the reasons for which referrals were denied.
A couple of years ago, a BSW student reported that the nursing home in which she was doing her field work could not admit a morbidly obese patient, because it did not have the proper equipment (lifts, bed size, for example). When we explored this further, several needs assessment questions emerged, such as: what was the outcome for this particular individual, what would it have taken to successfully house the client, could it be determined that there would be more elderly with obesity who would require nursing home care, were there any nursing homes in the area that were serving people with obesity, what home health care was available, and was there a network of long term care providers who were addressing this issue? This student was so concerned for this individual who was turned away, and intrigued by all the questions it raised, that she subsequently did an independent study project to gather data and make recommendations for organizational change. This constituted not only a natural progression of case to cause advocacy, but ethical social work practice.
At the macro social work practice level, we must always keep in mind the impact of policy and policy reform on individuals, families, groups, organizations, and communities. One way to ensure a consumer voice is to get consumer input on task forces, needs assessment projects, and policy evaluation. Recently, in my state, a statewide task force was assembled with an impressive list of experts, but it glaringly lacked consumer representation, and direct service provider representation was scarce. Although social workers may work to represent a consumer perspective in such venues, we must not come to accept that we are the consumer voice. We are not, and we must advocate for the consumer’s right to have a voice.
I did a workshop on case to cause advocacy a couple of years ago with direct care youth workers and administrators of runaway and homeless youth programs. As an example, to facilitate common advocacy ground, I chose the then recently passed 2006 federal Adam Walsh Child Protection and Safety Act. This Act includes a requirement for states to develop implementation plans for juvenile sex offenders, who potentially can be listed on the sex offender registry for life under this Act. As a group, we talked about what impact this will have on intakes, advocacy, and service provision for runaway and homeless youth shelters that may work with such youth to enroll in school, find permanent housing, and so forth. We also talked about strategies youth workers and administrators together could use to shape their state’s response to this federal law, so these youth could continue to be served in ways that helped them transition successfully to adulthood. This was a perfect example of the case to cause advocacy relationship as it potentially affects the individual, family, groups, organizations, and communities, as well as the very nature of our helping relationship with clients. It was interesting, too, that although some of the administrators in attendance had some knowledge of this recently passed federal legislation, direct care workers knew nothing of the Act. And yet, this Act was going to have major implications for their case management with young people who may have been labeled as juvenile sex offenders. It is important for direct care and administrative staff to recognize that case to cause advocacy is a shared responsibility and that knowledge of policy and practice must be part of every level of the organization. Case advocacy should not be relegated only to direct service staff, and cause advocacy is not solely a specialization of administrators and lobbyists.
You can make a difference through case to cause advocacy. If we practice social work only at the surface level and fail to see all the data, opportunities, questions, trends, and unmet needs, then change can slowly fade from our change agent role. If we see victory only as defeating or passing legislation, then we have forgotten that evaluation reveals the impact of that policy on the client system. Who has the time, you ask, in these days of doing too much with too little, high caseloads, and volumes of required paperwork? Who has time, you ask, in these days of too many seemingly unproductive meetings, partisan politics, turf wars, dwindling resources, and policy gridlock? John Mayer talks in his song, “Waiting on the World to Change,” from the CD entitled Continuum (a title strangely appropriate to this discussion), about wanting change but feeling disempowered, ill equipped, and somewhat overwhelmed to make it happen. As a social worker, you are educated and trained to have the skills and abilities to not wait around for change, but to be the change!
For Further Information
Adam Walsh Child Protection and Safety Act of 2006. http://www.govtrack.us/congress/billtext.xpd?bill=h109-4472.
Hepworth, D.H., & Larsen, J.A. (1993). Direct social work practice: Theory and skills (4th ed). Pacific Grove, CA: Brooks/Cole Publishing Company.
Influencing State Policy. http://www.statepolicy.org/
Mayer, John. (2006) Waiting on the World to Change on Continuum. Sony Records.
Donna McIntosh, MSW, is department chair and program director in the Social Work Department at Siena College in Loudonville, NY.