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Home""> Practice Center > Health Promotion Curriculum > Advocacy > Session 1

Health Promotion Curriculum: Advocacy


"" Advocating for Children, Families, and Communities


Session 1: Advocating for the Needs of an Individual


The objectives for this session are for the facilitator to:

  • Define advocacy as it applies to the child health professional.
  • Describe the four-step approach to advocacy.
  • Allow the learners to practice the four-step approach by planning how to advocate for a child and/or family.


The materials and teaching aids needed for this session are:


Facilitator Form:

Teaching Aids:

  • Display board, flip chart, or chalkboard
  • Markers or chalk


Preparing for Session

Beginning the Session

Discussion and Exercises

Ending the session

Facilitator's Script:

facilitator's script  

Throughout the module is a script, designated by the star icon, which can be used to introduce issues, ask reflective questions, prompt discussion, elicit feedback, and summarize important take-home messages. The script can be read or preferably paraphrased by the educator(s) facilitating the teaching sessions.


The time allocated for this session is 30 minutes.


Beginning the Session: Introductions

At the beginning of the session, the facilitator and learners should introduce themselves briefly. Ideas for creative introductions can be found in the introduction to the Facilitator’s Guide.


Setting the Context: The Bright Futures Concept

The facilitator introduces the learners to the Bright Futures concept of health by reading or paraphrasing the following:

facilitator's script  

The World Health Organization has defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Bright Futures embraces this broad definition of health — one that includes not only prevention of morbidity and mortality, but also the achievement of a child’s full potential. In the Bright Futures concept of health, providing the capacity for healthy child development is as important as ameliorating illness or injury. Recognizing and acknowledging the strengths and resources of the child, family, and community are essential to promoting healthy growth and development.

To build that capacity, the Pediatrics in Practice curriculum focuses on six core concepts: Partnership, Communication, Health Promotion, Time Management, Education, and Advocacy. The curriculum also includes a companion module (Health) and videotape that present an overview of Pediatrics in Practice and the Bright Futures approach.



Introducing the Session

Before introducing the session, the facilitator distributes the handout Advocacy: Advocating for Children, Families, and Communities to the learners. The facilitator then paraphrases the following:

facilitator's script  

Today’s session is the first of two that comprise the Pediatrics in Practice Advocacy module. Your Advocacy: Advocating for Children, Families, and Communities handout outlines the steps involved in advocating for children, families, and communities. We will cover these steps in more detail as we go through today’s session.

Child health professionals have the unique opportunity to practice advocacy each day they interact with children and families. They can be involved in child advocacy either at an individual level (accessing information or services for a child or family) or at a local or national level (sharing information with the community, disseminating information through the media, and speaking out in support of a legislative issue). Although the voices of child health professionals can have a profound impact on a child or family’s ability to obtain services, or on local and national policies, most pediatric providers lack formal training in advocacy.

In today’s session, our objectives will be to:

  • Define advocacy as it pertains to you, the child health professional.
  • Introduce the four-step approach to advocacy.
  • Practice using the four-step approach to advocate for a child or family.

The session will have two parts:

  • Deciding what to advocate for
  • Applying the four-step approach

When we have completed the session, you should be able to answer the following questions:

  • What are the essential elements of advocacy?
  • How do open-ended questions facilitate identification of child, parent, or family concerns?



Discussion and Exercises: Defining Advocacy

The facilitator distributes the Defining Advocacy and Other Related Terms handout
and asks:

facilitator's script  

How would you define “advocacy”? Suggest some words that come to mind when you hear the phrase “to advocate” or the word “advocacy.”

At the display board or flip chart, the facilitator begins a list from the learners’ suggestions. If suggestions are slow in coming, one or two of the following can be used to prompt further ideas from the learners.

A cause
An idea
Take a stand
A policy

After noting the suggestions, the facilitator continues:

facilitator's script  

The American Heritage Dictionary defines “advocacy” as “the act of pleading or arguing in favor of something, such as a cause, an idea, or a policy; active support.”


Deciding What to Advocate For

The facilitator should now paraphrase the following:

facilitator's script  

There are many ways to define the term “advocacy,” but in order to be an advocate for a child and family at any level, the child health professional must know for what he or she is advocating. In the case of an individual patient and family, the process begins by interviewing the child and family to elicit their true needs and concerns.



Gathering Information

The facilitator continues:

facilitator's script  

Some of you may already be familiar with the use of interview questions to elicit a child and family’s needs or concerns. For you, the following will be a brief refresher. For others, this will emphasize a few important points to remember when asking interview questions.

The facilitator writes the following on the display board:

  • All questions should be nonjudgmental.
  • Open-ended questions support a dialogue between the child and/or family and the pediatric provider, and often elicit the family’s needs and concerns.
  • Yes/no answers can provide important information, particularly in follow-up to open-ended questions.

The facilitator says:

facilitator's script  

Here are some questions that might prove useful when interviewing the child and family:

The facilitator reads or writes the following:

  • What are some of the main concerns in your life right now? Do they include transportation? Housing? Personal safety? What assistance would be helpful with these issues?
  • Tell me about your neighborhood. How safe is it?
  • How much time do you have for yourself? Who helps you with your child (children)?
  • What are some of the things you worry about?
  • When you ride your bicycle, rollerblade, or skateboard, what protective equipment do you use? Do you wear a helmet?
  • Does anyone in your home have a gun? How do you store it? Is it unloaded and locked up? Where is the ammunition stored? Have you considered removing the gun from your home?
  • Does anyone smoke in your house?
  • What concerns do you have about health insurance for your children?

The facilitator then says:

facilitator's script  

Open-ended questions like these help to elicit the child and/or family’s true needs and concerns. This is an important step in creating advocacy priorities. The next part of this session will provide a stepwise approach that can be used to navigate the advocacy process.


Stepwise: The Four-Step Approach to Advocacy

This part of the session introduces the four-step approach to advocacy. The facilitator can either present these four steps to the group, followed by a discussion of the case, or can introduce each step and apply the case as the discussion moves along.The facilitator distributes the following two handouts:

The facilitator begins as follows:

facilitator's script  

I have distributed two handouts. One outlines the four-step approach to answering the question “How do I advocate for a child, family, and/or community?”

The other handout is a case vignette. We will use the four-step approach to organize our response to the problem raised in the vignette. Would one of you please read the vignette aloud to the group?

Using the display board or flip chart, the facilitator introduces the first step in the Stepwise Approach and its supporting activities:


STEP 1: Identify Family Needs or Concerns

A. Use open-ended questions to identify specific family needs or concerns.

Facilitator's script  

Using open-ended question/comments, gather specific information about the learning difficulties that Taylor’s mother feels her daughter is having. What are some questions you might ask?


  • Please describe for me specifically what you have observed when Taylor reads and writes.
  • Please describe Taylor’s teacher’s assessment of her progress in school. Have you discussed your concerns with the teacher?
  • What was stated in her report card or end-of-year report from last year?
  • What support have you received from the school’s evaluation team?
  • Please describe any signs of stress that Taylor has shown lately. Has she been experiencing any other difficulties at school or at home?
  • Please describe the difficulties that Taylor may have paying attention at school. Have you noticed this at home?

B. Choose a specific area of focus.

Facilitator's script  

In this case, what is the primary problem that Taylor needs help with? (reading and writing) She and her family might also benefit from someone to advocate on their behalf with school personnel, such as the teacher or special education staff.

When advocating on an individual, community, or national level, identifying the specific problems is important to making effective change.


C. Clarify the family’s beliefs and expectations about the issue.

Facilitator's script  

What does the family believe is the cause of the problem? What expectations do they have for Taylor? What expectations do they have of you in helping them address this problem?

Understanding the child and parent’s beliefs and expectations helps to clarify how they view the problem.

You might ask the following:

  • What are you concerned about the most?
  • Why do you think Taylor is having more trouble with reading and writing?
  • How do the books that Taylor is reading compare with what other children in her class are reading?
  • What would you like to see Taylor reading or writing at this time?
  • What else can I do to assist you at this time?
  • Taylor, what do you enjoy about school?
  • How do you feel about your school work this year?

D. Determine what has been done to date and what has (or has not) worked.

Facilitator's script  

From your questions and information gathering, let us say you have determined:

  • Taylor’s reading and writing have not progressed from last year. In fact, her mother feels she is falling farther and farther behind. Her mother notes that she reads very slowly and is unable to recall what she has read. She has difficulty reading all but the simplest words.
  • Taylor is not getting any services through the school. The teacher suggested that Taylor’s issues were behavioral and not a learning disability.


E. Do some initial “fact finding” and obtain data.

Facilitator's script  

Your assessment of the situation should include gathering additional information. You might obtain the following “data” or “facts:”

  • Attention rating forms completed by Taylor’s teachers and parents
  • Taylor’s report card from last year
  • Her behavior at school and at home

According to her mother, Taylor has not demonstrated any behavioral problems or signs of inattention at school or at home, but her attention during reading declines.

Other factors that might affect Taylor’s reading or writing:

Facilitator's script  

You discover that her vision and hearing screening are normal.


F. Talk with others, determine progress to date on the issue.

Facilitator's script  

Speaking with others, such as Taylor’s teacher, may provide additional information.



STEP 2: Assess the Situation

A. Determine existing community resources.

facilitator script  

Based on the specific need or concern you have identified and explored, the next step is to develop a list of possible resources to address the need.


  • What remedial services are available from the school itself?
  • What are the possibilities for referrals to other professionals?
  • What might Taylor’s health plan provide?
  • What other child-focused services might be available?
  • What services are available in your own clinic?

B. Learn the laws.

facilitator script  

Is there a law that covers what you are advocating for? If so, what resources does the legislation provide? You might want to consult a local social worker or the legal aid society to learn about the laws that pertain to the issue you are advocating for.

For example, the Individuals with Disabilities Education Act requires public school systems to provide special education services to children with disabilities who are three years and older. Familiarity with laws regarding special education and other services can be very useful.

C. Review the data and resources.

facilitator script  

Document the problem to be sure it supports the issue.

In this case:

  • Verify that Taylor’s report card shows evidence of a remedial need.
  • Talk with Taylor’s teacher to determine if he/she might acknowledge that the problem is not a behavioral one.
  • Ask for the teacher’s support in seeking remedial services for Taylor.

D. Assess the political or service climate.

facilitator script  

Is this issue of interest to anyone else (a school administrator, the teacher, a local policymaker)?

Who or what might oppose you in your advocacy efforts and why?

For example, are the special education service providers underfunded and/or overwhelmed?


STEP 3: Develop a Strategy

A. Limit efforts to a specific issue.

facilitator script  

While there may be other patient or family issues that warrant attention, it is best to stay focused on one area at a time.

In this case, helping Taylor with reading and writing is the chosen issue.

B. Use existing resources.

facilitator script  

At this point, you should begin to develop your action plan using existing resources. In this example, what strategies might be used?

Efforts might include:Requesting services from the school

  • Write a letter to the school district documenting Taylor’s issues and request an evaluation for special education services.
  • Call the school to discuss Taylor’s needs with her teacher, and ask him/her to join in the request for an evaluation.
  • Attend Taylor’s special education evaluation meeting at the school.
  • Plan a follow-up visit in your office after the evaluation is complete.
  • Discuss the findings and the resources offered.

Making referrals to other community resources

  • Explore the option of obtaining an evaluation or support at a community based center (e.g., center for language and learning or communications disorder center).
  • Refer Taylor’s family to a social worker or case manager who can help the family access services in the community.
  • Discuss the possibility of Taylor’s family obtaining support (or an advocate) from a community or national support group (e.g., Federation for Children with Special Health Care Needs).

Using the health care system

  • Help the family obtain therapy and other services through their health coverage.
facilitator script  

Prioritize your action plan based on resources that are most easily attainable. In our example, what would be the best place to begin?

  • Seek services from the school.
  • Make referral to other professionals (this could take time based on case load and available resources).
  • Use the health care system (the family may have no or limited coverage)

C. Start with small steps and build upon success.

facilitator script  

In what order would you request services from the school?

1. Contact the teacher again.

2. Write a letter to the school district.

3. Attend the special education evaluation.


STEP 4: Follow Through

A. Be passionate about the issue.

facilitator script  

Commit yourself to the problem or need, but be willing to negotiate.

B. Review the outcome.

facilitator script  

Keep abreast of and reexamine the different steps in your action plan as you take them.

C. Evaluate your efforts.

facilitator script  

Reflect on your effort to date. Ask yourself the following questions:

  • Have I addressed the family’s primary concern?
  • What worked, what didn’t work, and why?
  • What else needs to be done?

D. Determine next steps in partnership with the family.

facilitator script  

Partner with the family to determine what the next steps might be.


  • Determine how you and the family will track Taylor’s progress following your intervention.
  • Using open-ended questions, ask Taylor and her family what they believe should be the next steps in providing support for Taylor’s reading and writing.

E. Recognize that child health professionals and families can learn from one another about effective advocacy.

facilitator script  

Accessing services for children and families, especially those outside the medical system, can be confusing for both the family and the pediatric provider. You and the family can learn from one another about how to effectively advocate for children and their needs.



Take-Home Message

The facilitator ends the session with the following:

facilitator script  

This session has provided a basic introduction to advocacy by defining it, teaching a four-step approach to advocacy, and applying these steps to a case. I hope this session has illustrated how a relatively small effort on your part can have a large impact on a child or family’s life.

Before we conclude, what questions remain about what we addressed today?



Answers to Guiding Questions

The facilitator continues:

facilitator's script  

Now that we have completed this session on Advocacy, you should be able to answer the following questions:

What are the essential elements of advocacy?

  • Identifying child or family needs or concerns, assessing the situation, developing a strategy, and following through with it.

How do open-ended questions facilitate identification of child/family concerns?

  • Open-ended questions support a dialogue between the child and/or family and the pediatric provider and often elicit the needs or concerns of the family.



Planning for the Next Session (if Session 2 is planned)

The facilitator continues:

facilitator's script  

At the next session, we will apply the four-step approach to either another vignette or an actual case to demonstrate how to effectively advocate for the needs of a group at the local/national level.




The facilitator now distributes the Session Evaluation Form and the Learner Self- Assessment Form.

The facilitator also completes the Facilitator Self-Assessment Form.