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Brian Martin's publications on citizen advocacy
Advocacy for people with disability can take many forms, including self-advocacy, family advocacy, systems advocacy and citizen advocacy. In many ways these forms of advocacy are complementary. Nevertheless, comparisons can be useful. This article compares two types of individual advocacy: paid and citizen advocacy.
Advocacy involves taking action in defence of a person's interests. An advocate can provide emotional support, offer advice, arrange referrals, alert agencies about needs, appear on another's behalf and any number of other actions. An advocate needs to understand the needs of the person being advocated for and to be able to act in ways that help meet those needs. It may involve the advocate taking direct action, the advocate trying to get others to take action, or the advocate helping the person to develop skills for personal achievement.
In paid advocacy - sometimes called independent advocacy - the advocate receives a salary or a fee per client. The amount and quality of advocacy that can be done thus depends on the available hours and skill of the advocate. For example, a full-time advocate might be expected to do 35 hours of advocacy per week, minus any administrative overheads, though some workers no doubt do unpaid overtime. The work might be composed of short interactions with numerous clients or longer interactions with a smaller number of clients, or some combination.
In citizen advocacy (O'Brien and Wolfensberger, 1978), a coordinator receives a salary but does no direct advocacy. Instead, the coordinator seeks out clients (called, within citizen advocacy, protégés or partners) - desirably those individuals with greatest unmet needs - and then, for each one, seeks a suitably matched citizen advocate. The citizen advocate performs advocacy for their protégé without pay, course credit or other compensation. After the relationship is established, the citizen advocacy office provides regular support to the relationship, normally through offering support and training to the citizen advocate.
We have described these two forms of advocacy as ideal types; the reality of advocacy practice may be less clear-cut. The two forms of advocacy are similar in one vital aspect: advocacy is carried out on behalf of people with disability (or another group needing advocacy). There are also a number of key differences. I look first at qualitative differences before turning to a quantitative assessment.
This is not an assessment of or reflection on the efforts of individual advocates, most of whom are highly committed. My aim is not to criticise any form of advocacy but rather to show that citizen advocacy can be more effective, in particular cost-effective, than usually recognised.
An ideal paid advocate brings to the job a wide knowledge of different types of clients and their needs, a wealth of experience in how best to serve the interests of clients, and an extensive network of contacts who can provide assistance. A paid advocate has the advantage of seeing a wide range of clients and, through experience, building up a repertoire of effective responses. On meeting a new client, the advocate can effectively deploy knowledge, experience and networks.
Of course, not every advocate measures up to the ideal. Training can provide preparation for doing the work but, like most occupations, most learning occurs on the job. New advocates typically have limited knowledge, experience and contacts.
An ideal citizen advocate has developed, over time, a deep knowledge of their protégé, long experience in how best to serve the interests of their protégé, and an extensive network of contacts who can provide assistance to their protégé. A citizen advocate has the advantage of being able to spend a lot of time getting to know their protégé and experience in helping them to deal with problems.
Not every citizen advocate measures up to the ideal. New advocates typically have limited knowledge, experience and contacts.
The key difference between experienced advocates is that an experienced paid advocate has wide-ranging knowledge, experience and contacts that are highly useful for dealing with a diversity of clients, whereas an experienced citizen advocate has highly specific knowledge, experience and contacts that are highly useful for dealing with their protégé.
There seems to be no research that compares the effectiveness of paid and citizen advocates. Some people assume that paid advocacy must be more effective because the advocate has formal training and is a "professional," namely does advocacy as an occupation. The counter argument is that a person who does advocacy voluntarily may be equally or more effective because they have a greater personal commitment.
In many arenas, voluntary efforts can be equally or more effective than paid ones. A friend often can provide as much help as a therapist. In treatment of mental illness, there is evidence that support from nonprofessionals can be more beneficial than professional interventions (Mosher, 1999). Many students learn as much from their peers as from highly paid lecturers. Free software, produced entirely through voluntary contributions, is typically more reliable than expensive commercial software.
A paid advocate usually has a considerable number of clients and thus finds it necessary to meet them according to a set schedule. A citizen advocate, with only one protégé, is more likely to be available whenever needed. (In both cases, the advocate's availability will be constrained by personal factors such as private lives.)
A paid advocate is accountable to the agency that provides funding. Often there are guidelines that must be followed. The risk for a paid advocate is that a commitment on a case-by-case basis moves the advocate towards being more like a case worker. In contrast, a citizen advocate's primary loyalty is to their protégé. The greater risk for a citizen advocate is to become "just a friend" and less of an advocate.
To do the job of advocacy well, it can be necessary to continually apply pressure to services or even to file complaints, with the risk of a backlash. It is a delicate matter to know when and how much pressure to apply. For paid advocates, there is an additional risk: since they are constantly pestering the same services on behalf of different clients, sometimes services may react negatively to the advocate without any relation to the particular client in question. For a citizen advocate, there is only one protégé and less risk of "resistance by association."
The problems of a client or protégé seldom can be solved by a short, sharp, cheap intervention. In the long run, it is more effective to deal with all the issues in a person's life, being proactive rather than reactive, as is recognised in employment services. This applies to both paid and citizen advocacy and is an argument against burdening paid advocates with too many clients.
How is an advocate seen by the client/protégé? Many people with serious disability see one worker after another, often with little continuity. A paid advocate may be seen as one more worker in the endless parade. In contrast, a citizen advocate is there voluntarily, a qualitative difference from the presence of paid workers. Sometimes a citizen advocate is the first person in a protégé's life who is not paid to be there. The continuity of a citizen advocate's role has great significance for many protégés. In some cases when a citizen advocate exits from a relationship, the citizen advocacy office may decide not to find another advocate to avoid contributing to the "circus" of ever-changing relationships.
Of course many paid advocates have a genuine concern for their clients, often well beyond the call of duty. Nevertheless, a citizen advocate's long-term loyalty often has great significance to their protégé.
Table 1: Some qualitative differences between paid and citizen advocates.
|
|
Paid advocate |
Citizen advocate |
|
knowledge |
wide-ranging knowledge |
highly specific knowledge |
|
experience |
experience with many clients |
intensive experience with protégé |
|
networks |
networks relevant to many clients |
networks relevant to protégé |
|
accessibility |
usually set schedule, sometimes as needed |
schedule by agreement, plus often as needed |
|
accountability/loyalty |
to clients and funding agency |
to protégé |
|
commitment |
case basis |
personal basis |
|
training/support |
formal qualifications; ongoing support through professional networks |
ongoing training/support from citizen advocacy office |
|
significance to client/protégé |
advocate is a professional |
advocate is there voluntarily |
No one seems to have investigated how much advocacy, in total, is carried out by all the advocates in a citizen advocacy programme. To find out for one programme, the advocates in Illawarra Citizen Advocacy were surveyed. This programme was set up in 1989 and has had the same full-time coordinator, Julie Clarke, since 1990. Also employed are a part-time administrative assistant and sometimes a part-time assistant coordinator.
Like most citizen advocacy programmes in Australia, all protégés recruited in Illawarra Citizen Advocacy have an intellectual disability; some have another disability as well. The programme covers the city of Wollongong and nearby regions, a population of over 250,000 to the south of Sydney. Wollongong is a heavily working-class area with high unemployment.
By the usual performance criteria, Illawarra Citizen Advocacy has been highly successful. By mid 2002, 185 new protégé-advocate matches had been made, an average of more than 14 per year. Though most relationships are intended to be long-term or lifelong, only some continue for many years. In an unpublished study by Martin Elks of citizen advocacy matches in six programmes (five in the US plus Illawarra Citizen Advocacy), the average duration of matches was 5.4 years. The most common reasons for relationships ending are that the advocate is unable to continue (often due to demands in their personal life), the protégé dies, or the advocate or protégé moves away. In some cases, the protégé no longer feels the need for an advocate. In 2002, there were about 70 current relationships in Illawarra Citizen Advocacy, a very high number for a programme of its size and longevity.
The seven key activities in a citizen advocacy programme are protégé recruitment, advocate recruitment, orientation of new advocates (explaining to them what their role entails), protégé-advocate matching, follow-along and support of existing relationships, advocate training and recruitment of advocate associates (people with specialist skills, such as dentists and lawyers, who offer to give advice to advocates). The follow-along process provides the most suitable opportunity to obtain information from advocates. Every month or so, each of the advocates is contacted by one of the coordinators to see how things are going and, as appropriate, offer suggestions for dealing with challenging issues. But advocates need not wait to hear from the office. Many of them contact the coordinator seeking support and advice. Illawarra Citizen Advocacy has a reputation for recruiting many protégés who have high support needs, which in turn often means that advocates need a correspondingly high level of support.
In March 2002, I wrote, as chair of the board of Illawarra Citizen Advocacy, to all advocates telling them about this research project and that the coordinator, Julie Clarke, would be asking them how much contact they had had with their protégé in the previous month. The letter stated "Please answer as honestly as you can. We want accurate results. If you haven't been in touch with your protégé over the previous month, that's okay. We want the results to be realistic, not exaggerated." The advocates were told that their participation in the survey was voluntary.
In practice, nearly all advocates were quite willing to provide the information requested. How accurate are the figures? There is no easy way to verify them. The preliminary letter cautioned against exaggeration, but on the other hand some figures could be underestimates because of advocates' modesty about their own role. Indeed, many advocates play down their contributions or comment that they get as much out of the relationship as their protégé. This is commonly reported in citizen advocacy programmes. Julie Clarke, through her long experience with citizen advocacy and familiarity with the relationships, judges that the figures provided by the advocates seem quite realistic.
Table 2 gives the number of hours per month that advocates reported spending with or on behalf of their protégés.
Table 2. Time that advocates in Illawarra Citizen Advocacy reported spending with or on behalf of their protégés.
|
Time spent (hours per month) |
Number of advocates |
|
2-3 |
7 |
|
4-5 |
8 |
|
6-7 |
5 |
|
8-9 |
12 |
|
10-11 |
6 |
|
12-15 |
8 |
|
16 |
4 |
|
20 |
3 |
|
24-140 |
3 |
|
relationship at a distance |
3 |
|
no response |
7 |
|
relationship discontinued |
2 |
|
total |
68 |
The most commonly reported forms of advocacy action were social outings, meetings (on behalf of the protégé) and phone calls (with the protégé and on their behalf). The information was collected during the coordinator's first convenient (non-urgent) contact with the advocate in the period April through June 2002. In three cases, the advocate was living interstate or overseas but reported contact by writing letters. In seven cases, it was not possible to contact the advocate. In these cases it is impossible to know what level of advocacy occurred. In two cases it appeared that the relationship had dissolved. Given that the programme seems to have reached a "steady state," with new matches being roughly equal to the number of discontinuations or completions of existing relationships, this number of discontinuations in the period is not surprising.
Adding up all the hours reported (assuming none when no information was available) gives a total of more than 650 hours per month. This is more than four times what a paid advocate could provide if doing advocacy 35 hours per week.
Note that a relatively small number of relationships are responsible for a disproportionate number of contact hours, with the time in one relationship alone, 140 hours, being one-fifth the total. This sort of unequal distribution is not surprising, being observed in a wide range of data sets, and would be expected for paid advocates too.
A direct comparison of hours between paid and citizen advocacy would require additional information. In a citizen advocacy programme, a significant proportion of the budget is spent on rent, administrative assistance and expenses such as travel, phone and insurance. But the same would apply for a paid advocate, though the proportions might be different. The evidence strongly suggests that in terms of advocacy hours per dollar, Illawarra Citizen Advocacy gives a much higher return than paid advocacy.
This conclusion is not a reflection on paid advocates, many of whom are extremely dedicated. The point is that citizen advocacy, as a form of advocacy, has the potential to mobilise voluntary effort by citizens to generate more total advocacy than equivalent expenditure on paid advocacy.
At this point it is necessary to emphasise that advocacy hours should not be the sole criterion and that quality can be as significant as quantity. Citizen advocates offer many examples of when a small intervention makes an enormous difference. The same can be true of paid advocacy.
The results here are specific to Illawarra Citizen Advocacy and should not be taken as a normal expectation for a citizen advocacy programme, but they do suggest that citizen advocacy is more cost-effective than usually recognised. Even with only half as many relationships and with many fewer high-intensity relationships than in Illawarra Citizen Advocacy, the total advocacy hours might still be comparable to paid advocacy.
On the basis of this study, the following conclusions can be drawn.
1. A high-functioning citizen advocacy programme can lead to more advocacy, dollar for dollar, than even the most conscientious paid advocacy.
2. On a qualitative basis, citizen advocacy and paid advocacy each have strengths and weaknesses. Overall, there is reason to believe that citizen advocacy can be equally or more effective than paid advocacy. Further research would be required to say much more than this.
3. The present performance targets for citizen advocacy programmes are inappropriate. Programmes are normally funded to achieve a specified number of new matches per year, perhaps 8 to 15. However, as seen here, the actual advocacy is carried out through existing relationships. A new match is an indicator only of the potential for advocacy, analogous to the appointment of a new paid advocate. It would be more appropriate to fund programmes primarily for supporting relationships, since that is where the advocacy is carried out. Experience at Illawarra Citizen Advocacy indicates that high-intensity relationships often require high-intensity support from the coordinator. Current funding arrangements give no encouragement for creating such high-intensity relationships. Consideration should be given to a significant reformulation of citizen advocacy performance targets.
4. Choosing the right advocate is crucially important. For paid advocacy, this can make a huge difference for numerous clients. For citizen advocacy, it can make the difference between short-term or low quality advocacy and a long-lasting, highly beneficial relationship. Consideration should be given to assessing citizen advocacy programmes more on the quality and duration of matches rather than just numbers of new matches.
Mosher, Loren R. (1999) "Soteria and other alternatives to acute psychiatric hospitalization," Journal of Nervous and Mental Disease, Vol. 187, pp. 142-149.
O'Brien, John & Wolf Wolfensberger (1978) CAPE: Standard for Citizen Advocacy Program Evaluation (Downsview, Ontario: Canadian Association for the Mentally Retarded).
My thanks go to advocates in Illawarra Citizen Advocacy for providing data, Martin Elks, Bob Lee and several members of the Board of Management for helpful discussions, and above all Julie Clarke for collecting the data and offering numerous insights.