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 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.

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?

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

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.”

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.

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.

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

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.

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 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?

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.

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.

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.

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.

You discover that her vision and hearing screening are normal.

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

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.

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.

Document the problem to be sure it supports the issue.

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?

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

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

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

In what order would you request services from the school?

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

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

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?

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

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.

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?

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.

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.