Alberta College of Social Work March 25, 2006 Putting Passion and Patience Into Poverty and Domestic Violence A Workshop on Advocacy Debra Carnat, MSW,

Alberta College of Social WorkMarch 25, 2006

Putting Passion and Patience Into Poverty and Domestic Violence

A Workshop on Advocacy

Debra Carnat, MSW, RSW

Alberta Children’s Hospital


Introduction: Personal Path to Advocacy


Introduction: Personal Path to Advocacy


Today’s Objectives

• Advocacy and social work

• Historical roots

• General overview of advocacy

• What is advocacy

• Kinds of advocacy

• Determinants of health and population

• Process of advocacy

• Small group exercise

• Risks, challenges & opportunities


Advocacy as Central Principle of Social Work

“Advocacy is a form of practice, a practical necessity, and an ethical imperative for the social work profession.” (McNutt, 2002).

Advocacy is a form of practice


Canadian Association of Social Workers Code of Ethics (2005)

Value 2 – Pursuit of Social Justice

Social workers believe in the obligation of people, individually and collectively, to provide resources, services and opportunities for the overall benefit of humanity and to afford them protection from harm. Social workers promote social fairness and the equitable distribution of resources, and act to reduce barriers and expand choice for all persons, with special regard for those who are marginalized, disadvantaged, vulnerable, and/or have exceptional needs. Social workers oppose prejudice and discrimination against any person or group of persons, on any grounds, and specifically challenge views and actions that stereotype particular persons or groups. (CASW, 2005).


Canadian Association of Social Workers Code of Ethics (2005) – cont’d

Value 2 – Pursuit of Social Justice

Principles

• Social workers uphold the right of people to have access to resources to meet basic human needs• Social workers advocate for fair and equitable access to public services and benefits• Social workers advocate for equal treatment and protection under the law and challenge injustices, especially injustices that affect the vulnerable and disadvantaged.• Social workers promote social development and environmental management in the interests of all people



Value 3 – Service to Humanity

The social work profession upholds service in the interests of others, consistent with social justice, as a core professional objective. In professional practice, social workers balance individual needs, and rights and freedoms with collective interests in the service humanity. When acting in a professional capacity, social workers place professional service before goals or advantage, and use their power and authority in disciplined and responsible ways that service society. The social work profession contributes to knowledge and skills that assist in the management of conflicts and the wide-ranging consequences of conflict. (CASW, 2005).



Value 3 – Service to Humanity

Principles

• Social workers place the needs of others above self-interest when acting in a professional capacity• Social workers strive to use the power and authority vested in them as professional in responsible ways that serve the needs of clients and the promotion of social justice• Social workers promote individual development and pursuit of individual goals, as well as the development of a just society. • Social workers use their knowledge and skills in bringing about fair resolutions to conflict and in assisting those affected by conflict


National Scope of Practice Statement (CASW, 2000, page. 8)

A social worker shall advocate change:• in the best interest of the client• for the overall benefit of society, the environment and the global community.


Historical Roots

Settlement Work: Evanglia House, Toronto 1902

Depression Era: Soup Kitchens

A shift from moral base to social reform to applied Social Science - from “helpers” to professionals.

• Early labor laws• Child welfare• Juvenile court (Trattner,1985)

Social Welfare System


Advocacy Is…

• active promotion of a cause or principle • an intervention that leads to a specific goal • taking a "rights" position • acting on the side of individual and/or collective human rights • standing up for the enforcement of existing rights to adequate services, decent treatment. • pressing for changes in policy, procedures, laws to protect existing rights and to create new ones .• using personal, agency and institutional power to make the case • may be an adversarial process where you are challenging authority and the decisions of professionals.

(Fay, Community Legal Worker, Dalhousie Legal Aid Services)


Kinds of Advocacy

Case advocacy – internal/external individual client/family, advocating for necessary resources.

It is important to be client focused, assess their ability to advocate for self, work to empower and teach skills, but do not hesitate to support. Resourcing is central to social work practice.

Cause advocacy – internal/external/system

• Sometimes is multiple case advocacy-similar work at a systemic level• Includes advocacy for the profession of social work


Supporting Advocacy for the Profession

• Within our organizations, educating other professionals regarding the role and scope of social work practice.

• Supporting professional practice by supporting social workers to do advocacy work and have time for both case advocacy and cause advocacy and discipline based committee work, eg. professional development and student education.

• Scope of Practice - Advocating for reasonable workload, adequate numbers of social workers, staff to be adequately qualified and trained (follow professional standards), and be provided with sufficient opportunities for professional development.

• Alberta Children’s Hospital (ACH) Social Work - Display for National Social Work Weeka) Provincially – ACSWb) Nationally – CASWc) Internationally - efforts to create change and address social justice issues from a global perspective


Determinants of Health & PopulationHealth Framework

Social Determinants of Health – “The economic and social conditions that influence the health of individuals, communities and jurisdictions as a whole.” (Raphael, 2004). They are “the conditions in which people live and work.” They are the “causes behind the causes of ill-health.” (World Health Organization, 2005). Finally, SDOH “refers to both specific features of and pathways by which societal conditions affect health and that potentially can be altered by informed action.” (Krieger, 2001).

Population Health – “Population Health is a social and political concept aimed at improving health, prolonging life and enhancing quality of life among whole populations through health promotion, disease prevention and other forms of health intervention.” (Chronic Disease Prevention Alliance of Canada, 2002).


Health – the state of complete physical, mental, emotional, spiritual and social well-being, not merely the absence of disease or infirmity.

Prevention – actions taken by social workers in collaboration with co-workers, agencies, clients and other participants to establish and to strengthen socioeconomic, social, psychological, or other conditions that contribute to health and enhance the opportunities for individuals, families, and communities to achieve well-being.

Preventive practices and health promotion focus on actions that address the determinants of health and all policies and practices that enhance health and well-being.

Determinants of Health & PopulationHealth Framework – cont’d


Determinants of Health & PopulationHealth Framework – cont’d

Health Promotion – the process of enabling people to increase control over and improve their health. It focuses on enhancing the capacities of individuals and communities to enable them to make healthy choices and to develop healthy and supportive environments (World Health Organization, 1998). It involves the development and implementation of policies and practices that create healthy living conditions.

The congruency between these determinants and the practice of social work is very strong. Key social work functions are directed at enhancing functioning in the very areas covered by the determinants. In addition, the philosophy behind them is consistent with social work principles, as expressed in the CASW Code of Ethics.

The determinants of health listed below represent the factors that influence and determine health.


Determinants of Health

Income and Social Status

The very roots of social work are founded in work with the impoverished and disenfranchised of society. The advocacy for improved social security benefits finds its rationale in our awareness that this determinant has life-long implications for the health of people. Many studies show that health status improves at each step up the income and social hierarchy. As well, societies which are reasonably prosperous and have an equitable distribution of wealth have the healthiest populations, regardless of the amount they spend on health care. Canadian Association of Social Workers (CASW) is a member of the Coalition Campaign 2000, which advocates an end to child poverty.


Determinants of Health – cont’d

Social Support Networks

Support from families, friends and communities is associated with better health. Some experts conclude that the health effect of social relationships may be as important as established risk factors such as smoking, physical activity, obesity and high blood pressure. The role of social work includes developing and maintaining these networks, as well as providing short term social support at times of crisis.



Education

Health status improves with level of education, including self-ratings of positive health or indicators of poor health such as activity limitation or lost work days. Education increases opportunities for income and job security, and equips people with a sense of control over life circumstances - key factors that influence health.



Employment and Working Conditions

Those with more control over their work circumstances and fewer stress related demands of the job are healthier. Workplace hazards and injuries are significant causes of health problems. Unemployment is associated with poorer health. Wilkinson particularly looked at physical environments.

Physical Environments

Physical factors in the natural environment such as air, water and soil quality are key influences on health. Factors in the human-built environment such as housing, workplace safety, community and road design are also important.



Biology and Genetic Endowment

The genetic endowment of the individual, the functioning of various body systems, and the processes of development and aging are fundamental. Biological differences in sex, and socially constructed gender, influence health on an individual and population basis.

Personal Health Practices and Coping Skills

Respect for the autonomy and self determination of the individual is the very foundation of social work practice. Empowering people to express their autonomy in ways which contribute to their health is a unique focus of social work practice. Social environments that enable and support healthy choices and lifestyles, as well as people's knowledge, intentions, behaviours and copying skills for dealing with life in healthy ways are key.



Healthy Child Development

The effect of prenatal and early childhood experiences on subsequent health, well-being, coping skills and competence is very powerful. For example, low birth weight often links with health and social problems throughout the life span; mothers at each step up the income scale have, on average, babies with higher birth weights than those on the step below. Campaign 2000 supports a spectrum of services to assist parents through the early childhood years, which are so crucial to the child’s development.

Health Services

Health services, particularly those designed to maintain and promote health and prevent disease, contribute to population health.



Gender

Gender refers to the array of society-determined roles, personality traits, attitudes, behaviours, values, relative power and influence that society ascribes to the two sexes on a differential basis.

"Gendered" norms influence the health system's practices and priorities. Many health issues are a function of gender-based social status or roles.

Culture

Some persons or groups may face additional health risks due to a socio-economic environment, which is largely determined by dominant cultural values that contribute to the perpetuation of conditions such as marginalization, stigmatization, loss or devaluation of language and culture and lack of access to culturally appropriate health care and services.


Macro Level Approach

A genuine primary health care approach will require governments to take into account the physical, social and economic factors that impact upon individuals and shift the focus away from treating illness to broader social health focus (WHO, Shapiro et al., 1994).

The World Health Organization identified five areas for action

a) build healthy public social policyb) create supportive environments - children’s resiliency literaturec) strengthen community actiond) develop individual personal skills e) reorient health services

(WHO, Shapiro et al., 2000)


Canadian Association of Social Workers Statement on Preventative Practices and Health Promotion 1998

CASW has, for ten years, been a member of the "Steering Committee on Enhancing Preventive Practices of Health Professionals", an inter-disciplinary committee on health promotion and disease prevention recently renamed as the "Canadian Coalition on Enhancing Preventive Practices of Health Professionals". (Health Canada,1974).

CASW Task Force on Preventative Practices and Health Promotion developed terms of reference and actions for the Task Force, utilizing CASW Code of Ethics (1994) re “Practice of Social Work, Best Interests of the Client, and Ethical Responsibilities”.


Case Advocacy and Case Management

Case advocacy and case management as facilitative

“Social workers in a variety of fields of practice are often viewed as “case managers”. This is a role that is described in the Romanow report as being pivotal to the future operation of the health care system: social work brings the perspective of understanding the whole person and the environment.” (CASW - Primary Health Care Paper).


ACH Social Action and Advocacy

Poverty work – to educate other professionals regarding the impact of poverty on children’s health.

Grand Rounds – 1999, Dr. Dan Offard, Social Psychiatrist, McMaster

University

Panel Discussion, Public Forum – 1999

Dr. Dan Offard

Professor Gayle Gilchrist James

Debra Carnat

Joan Evans

Ilona Boyce

Professional Forum – 2000, Mel Hurtig - Pay the Rent or Feed the

Kids


ACH Social Action and Advocacy – cont’d

Research

The Experience of Poverty of Client’s at Alberta Children’s Hospital, 2002

Impact of Poverty on Children’s Health – Poster PresentationChild Health Research Conference (ACH), 2003Canadian Association of Pediatric Health Care Centre, 2003Calgary Health Region (CHR) Diversity and Health Conference, 2004

Policy Input/Feedback

Support to Families of Children with Disabilities - feedback developed by ACH Social Work, Southern Alberta Child and Youth Health Network, and CHR Health Promotion.


Other Social Action and Advocacy

Poverty as a Determinant of Health Committee“Addressing Poverty as a Determinant of Health – A Literature Review” -Interagency Collaboration (included members of CHR, U of C, Bow Valley College, City of Calgary, Calgary Homeless Foundation, and others).

This collaboration morphed into the United Way Sustained Poverty Reduction Committee and then went on to become Vibrant Communities Calgary.

Vibrant Communities Calgary – educating Calgarians about the complex realities of poverty and influencing the development of responsive public policies

Fair Fares – reduced cost bus pass for low income Calgarians. Process not complete, needs broadening, and secure

commitment that it will continue beyond a pilot, but NB to celebrate.

Aish Review – living wage


Other Social Action and Advocacy – cont’d

Vibrant Communities CalgaryTheory of Change Summary – March 2006

VisionA substantial and sustained reduction in the number of Calgarians living in poverty.MandateVibrant Communities Calgary exists to ignite new community action to create and implement bold

solutions that reduce and prevent poverty through collaboration and education.CommitmentWe develop and support creative and innovative poverty reduction strategies in Calgary, knowing

that our combined diversity of experience and expertise will achieve results none of us could achieve individually.

Definition of PovertyPoverty is the condition of a human being who does not have sufficient economic and other

resources to live with the dignity, choices and power which support full participation in society. Root Causes of PovertyVCC has identified the lack of the following personal and financial assets as the roots causes of

poverty:Economic Security, including both employment income and public income supportsEducation and Skills TrainingBasic Supports such as housing, transportation, child care and food securityPhysical and Mental HealthFull Participation in Society



Vibrant Communities CalgaryTheory of Change Summary – March 2006 – cont’d

Shared LeadershipVCC believes that systemic change often begins with one individual’s commitment, and that

anyone has the capacity to be a leader and create change. Shared leadership is encouraged and VCC works to expand the number of people who are working to reduce poverty and improve quality of life for all.

We work with government, business, labour, faith communities, media, service providers, health and educational institutions and funders. This broad engagement builds community and creates space for mutual learning and growth. We believe that everyone benefits from poverty reduction. The benefits include a healthier, safer and more vibrant community where all Calgarians have opportunities to fully participate and positively contribute.

We believe collaboration works best with diverse participation from all sectors. We have faced the challenge of mediating between diverse viewpoints and considered at various stages the possibility of sector-specific reference groups. However, we strongly believe in the added value of healthy debate and the new ideas that emerge from people with diverse opinions struggling through complex issues together. For this reason, we will strive to be as inclusive as possible and encourage an environment of respect for diversity of beliefs.




Awareness and EngagementVCC believes the most effective way to achieve a significant and sustained reduction in poverty is

through positive changes to public and private policies and practices. There is evidence of a lack of awareness about poverty and its societal impact, and that the majority of the broader community believes that poverty is the result of behavioural, not structural, issues. Our central strategy is to shift this “bootstraps” ideology by facilitating a healthy dialogue about the depth, breadth and root causes of poverty, based on the belief that an informed community will take action.

Community OwnershipWe believe the entire community needs to take ownership for poverty and poverty reduction. We

will work from an understanding of community and individual asset building, engage community leaders in a public discussion about poverty, and facilitate an informed engagement process in the issues. Through this, we are creating the conditions for structural change.

There are already many organizations and community groups, including people living in poverty, working at a programmatic level who we will partner with. We are using this expertise at a systemic level because we identified a need to address the underlying causes of poverty as well as the barriers that prevent people from escaping it.




Signs of ProgressKey signs of progress will be the engagement of new partners, particularly from the business

community, and success in shifting public policy and increasing public awareness demonstrated through the following outputs:

Calgarians engage in meaningful conversations and public debate about poverty-related issuesCalgarians’ intolerance for poverty is increased, causing them to ask “why?”Calgarians shift thinking beyond the individual and towards the community-wide benefits of poverty

reductionPoverty and related social issues are more prominent on the political, health and education

agendasVCC and other community partners working to reduce poverty experience reduced opposition and

increased supportVCC is called upon to speak about poverty issuesSigns that the initiative is not making the desired progress are if volunteers are not fully engaged in

the work, or if we are seen to be working in an adversarial manner.



Domestic Violence Initiatives - CHR Social Work Protocols were developed in 1999, based on Calgary Domestic Violence Initiative.

• Identified key social workers at each hospital site for involvement• Development of protocols• Training of social workers across sites• Research on tracking forms• Provision of annual training for new social workers and students• Second training session currently being developed


Emergency Department Domestic Violence Interventions

Emergency Dept. Interventions – grew out of CHR Domestic Violence Committee, which grew out of social work protocols

• Developed domestic violence as a health issue posters

• Domestic violence as a health issue

• Presented to CHR Physicians Administration Committee – received

endorsement• Presented to CHR Patient Care Coordinator Committee – received

endorsement• Development of protocols – nurse involvement• Development of domestic violence posters -“You will be asked” and

card holders in 14 language cards produced by ACAV, supported by CHR

• Trained 400 ED nurses (10 sessions in total presented at each hospital, and at shelters

• Importance of involvement of nursing professionals and educators, community resources


Emergency Department Domestic Violence Interventions – cont’d

• Press Conference and Launch (August, 03)• Presented at Trauma Rounds (2004)• Provincial Grand Rounds (2005) in conjunction with Alberta Council

of Women’s Shelters• Work ongoing, includes research and evaluation broadening the

scope, increasing rates, staff retraining.


Other Social Action and Advocacy

KIDS Committee – kids impacted by domestic and sexual violence. Originated out of Homefront (specialized domestic violence court) as Children’s Treatment Committee (interagency committee of agencies treating children impacted by sexual and domestic violence).

• Developed standards and core components for children’s domestic violence treatment

• Obtained funding for children’s treatment.• Chaired for 3 years• Developed strategic plan and goals• Submitted Children’s Brief - Alberta Roundtable on Domestic

Violence and Bullying• Provided educational opportunities, ie advocacy workshop and

trauma workshop.



Community Safe Visitation Program (Sheriff King) – providing professionally supervised non-custodial access visits and exchange in domestic violence situations.

In their Own Voices – innovative new program providing independent legal representation for children in contentious custody and access cases, supported by assessment and counseling.


Process of Advocacy

Over the years social work advocates have developed an arsenal of tools and techniques. These have included, among other things, lobbying, grassroots organizing, using the traditional media, developing referenda, and running for office (Haynes & Mickelson, 2000; Jansson, 1999). Important new developments in technology, strategic communications, and political marketing and the rise of political consultants will add much to the effectiveness of social work advocates (McNutt, 2002).


Process of Advocacy – cont’d

Clearly identifying issue – defining problem, scope of problem, impact of problem.

Identifying allies – possible adversaries. Building support within and outside organization. Includes politicians, either party currently in power, or opposition. Setting up meetings to inform, persuade, and influence.

Creating collaboration – who needs to be at the table? Involvement of consumers or people affected is important! People in positions of authority and influence.



Importance of collaboration – within and interagency

Greater Whole Shares in the workload; both individuals and agencies/organizations bring a variety of skills and resources, e.g., writing, public speaking, conceptualizing, researching, proposals and fundraising.

Creates potential safety, other opportunities and offers support. Lessens potential for burnout.

Collaboration with other bodies strengthens initiatives, provides wider base of support, shares in the work.



Building the case – developing a knowledge base, NB of research, information gathering (both what currently exists, and what is needed). What’s been done already - don’t recreate the wheel unless you need to, e.g. building the business case re costs of poverty.

Laying the groundwork – never know who may get on board and carry it forth, this can be a lengthy process, difficult to measure (Sue Conroy, Carolyn Hatcher)



Setting goals/determining a course of action

Communication plan – how to influence public opinion-social marketing, developing media contacts, know your facts, identifying key targets, developing key messages, making the point from a variety of directions: justice, fairness, and cost-effective, ie. developing the business case.

Evaluating all your actions – measuring the steps. Evaluation process is not necessarily linear, sometimes it’s necessary to reconsider/revisit earlier steps.

Attending to the process – important to attend to process, involving consumers and those affected to keep work grounded, to empower and give voice, must be done respectfully and carefully.



Getting buy-in from bottom up – involving those who deliver the service, (eg., nurses to write ED protocols nurses, and nurse educators to train nurses ensuring that “the end doesn’t justify the means,” that the process stays fair, open and grounded. Avoid the “professionalization” of poverty.

Use of technology in utilizing the process – Global Information Economy. Use of computers and communication networks has had a vast impact on strategies in advocacy, given it’s implications to both distribute and collect information quickly. Intervene over wider areas, lower costs, and influence on research.

Celebrating each victory

Maintaining the momentum


Small Group Exercise

Refer to handout


Challenges, Risks, Opportunities and Lessons Learned

• Advocacy IS political work. At times it can feel isolating and

burdensome. • Acknowledge and say thank you when credit is deserved (sometimes

stretches us, but as political work, we are wise to acknowledge those

who contribute to the effort and move it forward, even if they belong

to political parties that might otherwise frustrate us.• Maintain the momentum, but give yourself time to rest• Balance cynicism and hope • Lack of resources and organizational support• Good advocacy work can be very costly, another reason to involve

big partners.• Advocacy and trying to effect change on a variety of levels can

reduce burnout, support working with others, not going it alone.• Delicacies, restrictions, gag orders


Challenges, Risks, Opportunities and Lessons Learned – cont’d

Laugh as often as possible

Emma Goldman: ”If I can’t dance I don’t want to be part of this revolution.”

Ladies Against Women

Social Work Week - importance of having fun together

Find time to play

Seize the Moment – unexpected opportunities

Celebrate every step forward. Just as we need to celebrate our client’s progress, for their sake and for ours, albeit sometimes slow, we need to celebrate the small victories in our work.


Issues Facing the Profession

The Romanow report regarding Primary Health Care doesn’t mention social work. The social work profession has a long tradition of working with a strong ‘person in environment’ orientation and demonstrating an understanding of how the social and economic lives of individuals, families and communities are directly linked to emotional and physical health. It is clear that this focus is essential to the transformation of our health care system from the treatment of illness to prevention and promotion of wellness.

• Privatization and commercialization of services• Outsourcing• Downloading responsibilities onto the community/faith groups


Issues Facing the Profession – cont’d

Building grounded work – links between clinical work, research, policy work, and program development.

Policy Work – Developing and influencing social policies that work, that are client centered IS advocacy work.

Trying to effect change on a variety of levels


Conclusion

If we think that advocacy work is hard sometimes, and it is, imagine the burden of those on whose behalf we advocate.

I want to thank those who have supported my efforts to effect change.

“Never doubt that a small group of thoughtful committed citizens can change the world; indeed, it’s the only thing that ever has.

Talmudic quote: (Ancient book of Jewish Commentary)“It is not our responsibility to complete the task, not are we free to drop it.

Documents

Alberta College of Social Work March 25, 2006 Putting Passion and Patience Into Poverty and Domestic Violence A Workshop on Advocacy Debra Carnat, MSW,