Advocacy takes many forms. One way is to communicate formally with an elected official, a government agency, or a private entity on behalf of service users t

Psychological Services Advocates in Public Service Settings: Voices From the Field Margaret R. Rogers, Marisa E. Marraccini, Elisabeth C. O’Bryon, Jennifer A. Dupont-Frechette, and Anna G. Lubiner Online First Publication, May 23, 2019. http://dx.doi.org/10.1037/ser0000345

CITATION Rogers, M. R., Marraccini, M. E., O’Bryon, E. C., Dupont-Frechette, J. A., & Lubiner, A. G. (2019, May 23). Advocates in Public Service Settings: Voices From the Field. Psychological Services. Advance online publication. http://dx.doi.org/10.1037/ser0000345

Advocates in Public Service Settings: Voices From the Field

Margaret R. Rogers University of Rhode Island

Marisa E. Marraccini University of North Carolina at Chapel Hill

Elisabeth C. O’Bryon Family Engagement Lab, Oakland, California

Jennifer A. Dupont-Frechette Delta Consultants, Providence, Rhode Island

Anna G. Lubiner University of Rhode Island

Numerous conceptual pieces addressing the importance of advocacy within psychology have been published over the last 20 years. Most recently, that chorus of voices has increasingly focused on the needs of historically marginalized populations (Burney et al., 2009; Garrison, DeLeon, & Smedley, 2017; Nadal, 2017). Despite this attention, a dearth of research has explored the experiences of seasoned advocates who work with such populations. The present investigation drew from an interdisciplinary group of award-winning advocates to reveal how they define and conceptualize advocacy; the motivators and barriers they’ve experienced; and their recommendations about how to support newcomers to advocacy. Through semistructured face-to-face interviews that were content analyzed qualitatively, the 14 advocates describe important lessons about advocacy work. Participants’ desires to become an advocate were fueled mostly by personal interests and early formative experiences. They found collab- orations and building networks (i.e., building relationships with people on all sides of an issue) to be their chief advocacy strategies, and stressed the importance of interpersonal and communication skills (e.g., taking initiative, making connections with those in power) in their skill repertoire. The main barriers encountered included psychological resistance (i.e., intentional blindness toward hidden populations), funding constraints, and various other negative obstacles. Although most found creating a work-life balance elusive, they were energized by mentoring advocacy newcomers, by successes achieved in legislative/policy/program advances, and by creating systems that provide needed services. They shared wisdom about a host of issues for a new generation of advocates.

Keywords: advocates, interdisciplinary, strategies, barriers, mentoring

As individual and community needs become more diverse, psychologists are faced with the increasingly complex task of advocating effectively for improved conditions for individuals, organizations, and society (Melton, 2018). Given the range of settings in which psychologists are employed and their varied roles within those settings, advocacy takes many forms, and is delivered in different dosages and contexts, using a variety of methods

(DeLeon, Loftis, Ball, & Sullivan, 2006). The breadth of advocacy efforts is wide, focusing on direct and individual support, public policy decisions, advances in human welfare services, public health, systems of care, training and education, consultation, re- search, and funding (American Psychological Association, 2017).

Despite the growing and critical need for wide-ranging advo- cacy within the psychological community (Fox, 2008; Heinowitz et al., 2012; Lating, Barnett, & Horowitz, 2009), the extant liter- ature available to guide psychologists to serve as effective advo- cates is limited. Even less is known about the knowledge and skills needed to advocate effectively on behalf of marginalized and underserved populations, despite this being one of psychologists’ key professional responsibilities (Nadal, 2017). The focus on ad- vocacy aimed at marginalized and underserved populations is especially important in addressing systemic factors and societal inequities that limit people’s voices, opportunities, and impact. Advocacy that has a social justice mission has added layers of complexity because it combines individual and systemic advocacy and often requires that the psychologist be skilled in both. Indeed, the American Psychological Association clearly articulates this professional responsibility in its 2017 Multicultural Guidelines:

Margaret R. Rogers, Department of Psychology, University of Rhode Island; Marisa E. Marraccini, School of Education, University of North Carolina at Chapel Hill; Elisabeth C. O’Bryon, Family Engagement Lab, Oakland, California; Jennifer A. Dupont-Frechette, Delta Consultants, Providence, Rhode Island; Anna G. Lubiner, Department of Psychology, University of Rhode Island.

We would like to extend a warm thank-you to our participating advo- cates for their time, enthusiasm, and openness in sharing of themselves and their stories so that we can all learn from their experiences as advocates.

Correspondence concerning this article should be addressed to Margaret R. Rogers, Department of Psychology, University of Rhode Island, Chafee Hall, 142 Flagg Road, Kingston, RI 02881. E-mail: [email protected]

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an Ps

yc ho

lo gi

ca l

A ss

oc ia

tio n

or on

e of

its al

lie d

pu bl

is he

rs .

T hi

s ar

tic le

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

Psychological Services © 2019 American Psychological Association 2019, Vol. 1, No. 999, 000 1541-1559/19/$12.00 http://dx.doi.org/10.1037/ser0000345

1

An Ecological Approach to Context, Identity, and Intersectionality, as it provides parameters for multiculturally competent services and highlights the importance of advocacy on behalf of persons from disadvantaged and discriminated populations.

To improve psychologists’ ability to advocate effectively on behalf of underserved populations, it is critical to know and un- derstand how effective advocacy in this area is defined and con- ceptualized; the motivators and barriers experienced by effective advocates; and key insights from successful advocates on how to support future advocates committed to promoting positive out- comes for marginalized populations. An examination of the exist- ing research in these areas yields gaps in our knowledge base.

Defining and Conceptualizing Effective Advocacy

Although historically advocacy has been a ubiquitous feature within the field of psychology (Nadal, 2017), it is conceived of and applied in many different ways (Lating et al., 2009). To ground ourselves in a common definition that facilitates an understanding of advocacy on behalf of marginalized groups, we share Trusty and Brown’s (2005) summary of multiple descriptions of advocacy as “identifying unmet needs and taking actions to change the circum- stances that contribute to the problem or inequity” (p. 259). While this definition sheds light on the process and goal, additional research is needed to understand how and under what circum- stances psychologists can advocate effectively on behalf of under- served populations. An understanding of the specific definitions, skills, resources, and strategies used by effective, experienced advocates in different settings can provide an invaluable guide for psychologists who seek to be successful advocates. As aptly noted by Cohen, Lee, and McIlwraith (2012), the knowledge and skills needed to advocate effectively can be taught and it is a critical responsibility that psychologists learn them.

Key Motivators and Barriers

While essential for a comprehensive understanding of effective advocacy, the research literature provides limited insight regarding the factors that serve to activate and obstruct those who advocate on behalf of the underserved. Instead, research has examined advocacy-related motivators and barriers more broadly and, in some cases, examined advocacy aimed at advancing a professional group rather than advocacy to address clients’ needs (e.g., Myers & Sweeney, 2004). In other cases, research has looked at barriers to advocacy encountered by a largely preservice sample rather than by experienced advocates (e.g., Heinowitz et al., 2012). Most recently Kozan and Blustein (2018) provided key insights into 11 licensed counseling psychologists’ attempts to engage in social justice-focused advocacy following their graduation from pro- grams that specifically prepared them to engage in such advocacy. Social justice advocacy training supports psychologists’ ability to effectively address the social contexts that contribute to an indi- vidual’s marginalization (Mallinckrodt, Miles, & Levy, 2014). Kozan and Blustein (2018) found that the psychologists’ efforts at advocacy on behalf of clients were often stymied by systemic barriers, including working in settings that do not espouse and share justice-oriented values and priorities. The psychologists also found themselves hampered by a larger structural problem—that of working within a field that focuses almost exclusively on

helping individuals to improve intrapsychically without regard for the very real systemic contributions to people’s problems. Kozan and Blustein (2018) argue that this later issue is a problem endemic to the structure of our nation’s mental health care system. These findings are important because they begin to explore the barriers psychologists face when advocating for underserved clients. How- ever, what is still needed is a more complete picture of the full range of barriers and obstacles encountered by advocates for the underserved to fully understand the challenges they confront and grapple with.

Other research has focused on strategies advocates and the organizations that they work for have used when advocating. Mason (2015) surveyed 259 leaders of nonprofit organizations in California to study the relationship between the leaders’ political ideologies and the advocacy tactics used by their organizations to influence legislation. The leaders averaged about six years as advocates. The findings suggested that the more conservative the leaders, the more likely their organizations were to use a wide array of strategies including face-to-face lobbying, petition drives, boycotts, sit-ins, and media campaigns. In another study exploring advocacy strategies, Gee, McGarty, and Banfield (2015) inter- viewed nine advocates from two organizations representing the mentally ill in Australia. The advocates – relatively new to advo- cacy with an average of about four years’ experience—described the importance of building partnerships, establishing strong rela- tionships between their constituents and themselves, and finding ways to influence the mental health system (e.g., lobbying) (Gee et al., 2015). These findings help us to understand the types of strategies that early career advocates employ. What we do not yet know are the motivators, strategies, and barriers experienced by seasoned experts – that is, those with extensive and well- established careers – whose work focuses on a diverse array of marginalized populations, and how their experiences can inform and guide psychologists who advocate.

A study by Goodman, Wilson, Helms, Greenstein, and Medzhi- tova (2018) of recent graduates of a masters-level mental health counseling program provides unique insights specifically related to working with and advocating on behalf of underserved groups. Each of the advocates were within two and a half years of com- pleting their advocacy practicum. Interviews revealed that as ad- vocates’ relationships with individuals from marginalized commu- nities deepened, so did their experience of strong emotions—both pleasant and unpleasant (i.e., feeling frustrated, overwhelmed, angry, moved, and inspired). The positive feelings often countered the more disheartening ones, by highlighting the value of the work, deepening advocates’ commitment, and increasing their confi- dence as advocates (Goodman et al., 2018). The opportunity to learn about the experiences of leading advocates working on behalf of marginalized and underserved populations can shed additional, necessary light on the important skills, strategies and resources employed, and the barriers psychologists may face when advocating in this space.

Supporting Future Advocates

The need for intentional and ongoing advocacy training and support for psychologists is well represented in the literature. Scholars recognize that training and mentoring are essential in order to create a culture of advocacy involvement in psychology

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an Ps

yc ho

lo gi

ca l

A ss

oc ia

tio n

or on

e of

its al

lie d

pu bl

is he

rs .

T hi

s ar

tic le

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

2 ROGERS ET AL.

(Fox, 2008). A significant, positive relationship has been uncov- ered between hours spent in advocacy training and hours of sub- sequent advocacy involvement (Lyons et al., 2015). High quality training is especially critical when considering the unique knowl- edge and skills needed to effectively advance the needs of mar- ginalized groups who may be systematically disenfranchised or discriminated against. The preparation can be both complex and personal. Dragowski, McCabe, and Rubinson (2016) describe how self-awareness and an evaluation of one’s own social identity can interact with an awareness of larger societal systems, hierarchies, and inequalities to enable an ability to effectively work with marginalized groups. Importantly, advocacy training can lead to an increased awareness of specific biases and harassment against marginalized groups, as well as an awareness of the larger social norms that perpetuate systems and conditions that sustain the attitudes and behaviors that promote marginalization (Dragowski et al., 2016).

Advice and guidance from seasoned advocacy leaders is critical to the success of those just beginning advocacy work because it can provide examples that illustrate and illuminate how fledgling advocates should prioritize their time, focus their attention, and concentrate their efforts. Learning from accomplished advocates, particularly those recognized as doing stellar work and honored with awards and honors rather than from novices, may yield insights that can save new advocates energy in acquiring needed skills and areas of expertise. Experienced advocates have accumu- lated layers of relevant knowledge, wisdom from observing what works and what does not, and have practiced their skills in multiple contexts as well as with multiple audiences (Kilburg, 2016). Ac- complished advocates know what mistakes to avoid, strategies to eschew because they fail to achieve desired outcomes, and steps that take time but are minimally beneficial. Learning about these lessons can help advocacy newcomers to focus their energies and attention on those efforts most likely to achieve desired aims.

In one of the few studies that yielded advice for future advo- cates, Kozan and Blustein (2018) found that practicing psycholo- gists whose work involved social justice-oriented advocacy sug- gested that newcomers build a support system, pick one’s battles, and practice self-compassion. The challenges and complexities of dismantling systems that maintain marginalization are many and joining with others in such work while also being selective regard- ing one’s engagement is wise advice. Unfortunately, little else is known about the advice seasoned advocates have for newcomers to advocacy, nor about the suggestions they may have for those who wish to develop advocacy skills.

The Current Study

To guide psychologists in their efforts to advocate effectively on behalf of marginalized populations, the current study shines a light on the experiences, tools, and insights of an award-winning group of seasoned interdisciplinary advocate leaders committed to im- proving the lives of the underserved. To fill in key research gaps and to inspire and inform current and aspiring psychologist advo- cates, we explored the following three research questions with our expert advocates: How do you define and conceptualize effective advocacy? What are the key motivators and barriers you experi- ence as an effective advocate? How can we support future advo- cates? By unpacking the diverse experiences of these leading

advocates, the present study contributes to the scholarly efforts to empower a new generation of psychology advocates with the knowledge and skills needed to effectively advance equitable outcomes for marginalized and underserved populations.

Method

Participants

We recruited an interdisciplinary group of advocates committed to improving the lives of underserved and marginalized people in the United States. Advocates were eligible if they (a) engaged in work representing a social or sociopolitical, health, mental health, education, human rights, or civil rights issue (e.g., disability, low income, socially marginalized, etc.), (b) were renowned for their advocacy work and honored with a major award (i.e., national honor, etc.), and (c) held leadership positions. This combination of attributes was designed to capture those with extensive expertise as successful advocates. The advocates were identified for recruit- ment using purposive sampling—a technique employed to ensure that participants would have considerable knowledge and experi- ence in advocacy (Palinkas et al., 2015), as well as snowball sampling to reach hard-to-find participants. In addition, given that the interviews would be conducted face-to-face, the recruitment targeted advocates from the Northeastern and Mid-Atlantic regions of the United States to allow the interviewers to meet with the advocates in their locales. Seventeen advocates were recruited by e-mail and/or phone calls through publicly available information (e.g., work phone numbers, etc.). Fourteen advocates completed the semistructured face-to-face interviews. Each interview was conducted individually and was video- and audio-recorded with participants’ permission.

The participating advocates included 9 (64%) men and 5 (36%) women of whom 86% were European American, 7% African American, and 7% LatinX. Professionally, they held positions as directors/presidents/executive directors/chief executive officers of nonprofit organizations and associations (79%), educators (14%), and an outreach coordinator (7%). They had backgrounds in med- icine, law, psychology, social work, education, and community organizing. They were based in the Northeast and Mid-Atlantic regions of the United States, working in Maryland, Massachusetts, New York, Rhode Island, and Washington, DC. On average, they had worked as advocates for 18 years.

Measures

In addition to demographic and personal background questions (e.g., race/ethnicity, professional title, etc.), participants responded to 19 questions in the semistructured interview protocol as part of a larger investigation about advocacy practices and processes. The present study reports on a subset of 14 questions. The interview questions were developed by the authors to address gaps in the published literature about advocacy in psychology for underserved and marginalized groups. The open-ended interview questions cluster around the three main research questions. First, to deter- mine how the advocates define advocacy and conceptualize effec- tive advocacy, we asked for their definition of advocacy, skills they consider critical for effective advocacy, strategies they use to advocate, resources employed, and how they empower others

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an Ps

yc ho

lo gi

ca l

A ss

oc ia

tio n

or on

e of

its al

lie d

pu bl

is he

rs .

T hi

s ar

tic le

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

3VOICES FROM THE FIELD

through their work. Second, to learn about their key motivations and barriers, we asked what led them into advocacy, their greatest successes when advocating, the barriers and obstacles they’ve encountered, the mistakes they’ve made, and how they create balance in their lives. Third, to identify how to support future advocates, we probed them to talk about recommendations for others who want to develop their advocacy skills, advice they have for newcomers to advocacy, advice for bringing in a new gener- ation of advocates, and any additional information important that they wished to communicate to aspiring advocates. Each of the 14 questions included follow-up prompts that could be asked if rele- vant to issues mentioned by the interviewees. An average inter- view lasted 60 to 90 min. The interview protocol was piloted prior to data collection with two advocates to obtain feedback about the questions, leading to minor changes in their order and wording.

Qualitative Data Analysis

The study was approved by the university human subjects review board and all advocates completed written informed con- sents. The interviews were transcribed verbatim to allow for rich, thick description and improve credibility. The transcriptions were performed by two trained research assistants and then triple- checked for accuracy by the interviewer. A team of five research- ers conducted the qualitative content analysis of the 14 interview questions. The team was trained in qualitative content analysis by reading relevant literature (e.g., Denzin & Lincoln, 2005; Grane- heim & Lundman, 2004; Morse, 2008; Taylor-Powell & Renner, 2003; Zhang & Wildemuth, 2009), practicing on samples, and coding the samples until agreement was better than 80%. The training was guided by the first and third authors – both experi- enced qualitative scholars.

The research team engaged in two main phases of the data analysis process, each involving multiple steps (Leech & Onwueg- buzie, 2008). In the first phase, the researchers formed dyads to perform the inductive manifest content analysis. For each question, the dyads read the transcriptions independently and identified segments of the data addressing each question. From the segments, they developed codes inductively based on the ideas represented in participants’ responses. The dyads met to discuss their initial emergent codes and to group the codes into common coding categories by interview question. Once the categories that emerged from the data were agreed upon, the dyads independently applied them to each question in a recursive manner, proceeding back and forth between the raw data and the codes until all the questions and responses were coded, maintaining a codebook as they went along. The dyads met again to discuss their coding decisions, calculate agreement, and to share observations. This process was replicated for each question iteratively until all responses to each question were fully analyzed and consensus between the coders was reached. To establish intercoder agreement, agreements were divided by number of agreements plus the number of disagree- ments. Intercoder agreement across the questions was 80%–100%.

The second part of data analysis was ongoing, involving mul- tiple steps to ensure trustworthiness through dependability, credi- bility, and confirmability. To address dependability and confirm- ability (Lincoln & Guba, 2000), an audit trail was maintained throughout data collection and analysis to establish transparency in the research process. During the content analysis of the interview

data, the dyads were formed to independently analyze the data, providing investigator triangulation as a way to reduce bias. Cred- ibility was addressed with researcher reflexivity through notating and memos (Lincoln & Guba, 2000). The research team served as peer researchers, meeting regularly to ensure that decisions were grounded in the study objectives and methodology. The team communicated about each phase of the project, established con- sensus as needed, and debriefed. We also addressed credibility by incorporating quotations of the transcribed interviews in our report of the findings (Graneheim & Lundman, 2004). The Journal Article Reporting Standards for Qualitative Primary, Qualitative Meta-Analytic, and Mixed Methods Research in Psychology (Lev- itt et al., 2018) guided the reporting of our study findings.

Results

Defining Advocacy and Conceptualizing Effective Advocacy

Definition of advocacy. Definitions of the term “advocacy” offered by the advocates fell into five categories. Being a voice for others (n � 8, 57%) was the most common, followed by collab- orating with others (n � 5, 35.7%), raising awareness (n � 3, 21%), and not quitting (n � 2, 14%). Additionally, many of the definitions did not align to one category, emerging as a miscella- neous category (n � 8, 57%). Among those who defined advocacy as ‘being a voice for others’ was this definition “It is giving voice to an issue or to people who don’t have a voice.” Another stated that it was “Getting people’s voices heard equally—not accepting the status quo.” For those who saw advocacy as ‘collaborating with others’ were two who defined advocacy as “Being in conversations with those with resources, those with power” and “A group of people, or institutions, like coalitions, coming together with a common goal.”

Skills critical for effective advocates. The advocates identi- fied seven skill domains as critical for effective advocates. These included interpersonal skills (n � 7, 50%), communication skills (n � 7, 50%), being informed about issues (n � 6, 42.9%), strong personal qualities (n � 5, 35.7%), critical consciousness skills (n � 4, 28.6%), miscellaneous skills (n � 4, 28.6%), and creativity (n � 2, 14%). The advocates spoke about several important interpersonal skills such as being able to build relationships with others, make connections with those in power and those with resources, being a people person, being empathic, being positive, being affiliative, being kind, and taking initiative. They also de- scribed being able to share values and beliefs with others and joining with them to accomplish goals over the long term.

The communication skills they considered essential included active listening, creating consensus from multiple perspectives, writing documents, tactfully or directly speaking the truth, and having excellent verbal skills. The third most important skill was being informed about the issues. The advocates spoke about hav- ing data and facts, grounding their knowledge in their experiences and professional practices, understanding the legal and regulatory context of their work, knowing solutions to problems, and know- ing how to link funding with policy that leads to sound practice.

Strategies used to advo