Childhood Onset Disorders: Applying the T/C Model of Case Conceptualization
Advocating for Advocacy: An Exploratory Survey on Student Advocacy Skills and Training in Counseling Psychology
Alyssa M. Ramírez Stege, Dustin Brockberg, and William T. Hoyt University of Wisconsin—Madison
Advocacy is considered a core competency within the field of counseling psychology, however more attention is needed to the training and assessment of advocacy competence for counselors-in-training. This study utilized Ratts and Ford’s (2010) Advocacy Competencies Self-Assessment survey to measure self-perceived advocacy competence of master’s and doctoral students within counseling (Council for Accreditation of Counseling and Related Educational Programs–accredited) and counseling psychology (American Psychological Association–accredited) programs. An exploratory factor analysis suggested 3 underlying factors in self-reported advocacy competence: Alliance Building and Systems Collaboration, Action and Assessment, and Awareness Building. Master’s and doctoral students displayed marginal differences in Advocacy Competencies Self-Assessment scores with doctoral students scoring slightly higher in the Awareness Building factor. Respondents’ perceived level of advocacy importance was a significant predictor of advocacy competence. Program characteristics (advocacy-related resources and opportunities to engage in advocacy activities) were also significant predictors of perceived competence. We propose a developmental model of advocacy competency acquisition as a basis for future research on assessment and training of advocacy skills.
Keywords: psychology training, advocacy, competence, social justice, assessment
Counseling psychologists and other counseling professionals have recognized the need to move beyond the confines of the traditional counseling space and into the communities in which they serve (Vera & Speight, 2003). Consequently, counseling professionals have made efforts to become agents of social change through advocacy—seeking to confront, challenge, and eliminate institutional and social barriers that harm clients’ well-being (Kiselica & Robinson, 2001; Ratts, 2009; Myers, Sweeney, & White, 2002; Smith, Reynolds, & Rovnak, 2009). Advocacy can be defined as “the process or act of arguing or pleading for a cause or proposal” to promote social change (Myers et al., 2002, p. 394) and is often linked to the social justice ideals of the counseling field.
Advocacy has been recognized as an important skill in the counseling profession (Myers et al., 2002; Ratts, D’Andrea, & Arredondo, 2004). At the master’s level of training, the American Counseling Association (ACA) has endorsed the advocacy com- petencies (Lewis, Arnold, House, & Toporek, 2003), considering advocacy happens at multiple levels (e.g., client, underprivileged groups, legislative) and is achieved by counselors acting with or on behalf of clients to increase their ability to utilize and access resources that impede their development (Lewis et al., 2003). There are six ACA advocacy competency domains within three levels that move from micro- to macrolevels of intervention (Lewis et al., 2003). In the client/student level, there are two domains: client/student empowerment and client/student advo- cacy. The school/community level includes community collabora- tion and systems advocacy. Finally, the public arena level includes public information and social/political advocacy (Lewis et al., 2003). At the doctoral level of training, advocacy is one of the American Psychological Association (APA) competency bench- marks and includes two components: empowerment and systems change. Each component is assessed within three levels of stu- dents’ professional development: readiness for practicum, readi- ness for internship, and readiness for entry to practice (Fouad et al., 2009). For the empowerment component, students are expected to move from an awareness of the factors that unjustly influence individuals, institutions, and systems, to an ability to intervene and promote direct action. In systems change, students are expected to move from an understanding of the differences between interven- tions at individual and institutional levels, to promoting change at multiple levels (Fouad et al., 2009).
Overall, the role of advocacy in counseling acknowledges the need for professionals to intervene at individual and systemic levels to promote change that positively influences clients’ well-
This article was published Online First April 6, 2017. ALYSSA M. RAMÍREZ STEGE is a doctoral student in the Department of
Counseling Psychology at the University of Wisconsin-Madison. Her re- search interests include counselor training in cultural competence, and development of culturally-grounded psychotherapeutic interventions.
DUSTIN BROCKBERG is a doctoral student in the Department of Counsel- ing Psychology at the University of Wisconsin-Madison. He is a member of APAGS and has served as the State Advocacy Coordinator of Wiscon- sin. His research interests include advocacy training, help-seeking decision making processes with veterans, and reintegration issues for student service members/veterans (SSMV’s).
WILLIAM T. HOYT is professor and chair of the Department of Counsel- ing Psychology at the University of Wisconsin-Madison. His research interests include relational processes related to psychological well-being; psychotherapy process and outcome; and research methods and measure- ment.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Alyssa M. Ramírez Stege. E-mail: ramirezstege@wisc.edu
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Training and Education in Professional Psychology © 2017 American Psychological Association 2017, Vol. 11, No. 3, 190 –197 1931-3918/17/$12.00 http://dx.doi.org/10.1037/tep0000158
190
being (Goodman et al., 2004). Yet despite general professional goals and objectives, there is still little known about what advo- cacy efforts actually look like (Goodman et al., 2004). In a national survey in 2004, Myers and Sweeney reported that most profes- sional counselors and counselor educator respondents believed that advocacy was a moderately to highly needed professional activity. Respondents reported implementing the following advocacy ef- forts: being on a committee or volunteering (68%), literature and information about advocacy (63%), coalitions with other profes- sional groups (59%), government relations liaisons (55%), media opportunities (48%), advocacy training packet (47%), paid staff (31%), paid consultants (24%), and other (10%). These efforts were rated by respondents to be only moderately successful (My- ers & Sweeney, 2004).
In a study by the National Council of Schools and Programs of Professional Psychology, a majority of faculty and student respondents (62%) reported that advocacy training was not offered (Lating, Barnett, & Horowitz, 2009). Nevertheless, data from this study suggested that issues related to community and public service were addressed in courses, and programs offered community service opportunities. Mallinckrodt, Miles, and Levy (2014) developed a tripartite scientist–practitioner– advocate model to address social justice advocacy training in graduate counseling programs. These authors propose that add- ing an advocate role to the currently widespread scientist- practitioner training model can help enhance the application of science and practice by facilitating students’ development of skills that help them intervene and advocate for clients’ needs at organizational and systemic levels. For example, students are encouraged to use advocacy goals to inform research questions and interventions. This model focuses on developing four main domains of competency to serve as advocate: knowledge, skills, attitudes, and values (e.g., equity, liberty). They base their curriculum on Bronfenbrenner’s (1979) ecological model, the ACA competencies (Lewis et al., 2003), the APA competency benchmarks (Fouad et al., 2009) and emerging research on students’ experiences in advocacy (Mallinckrodt et al., 2014). According to Mallinckrodt and colleagues (2014), this alterna- tive training model equips students with the skills needed to address and intervene on problems rooted in sociocultural con- texts of oppression and social injustice that affect mental health. These authors note students are generally very satisfied with this training, feel a commitment to doing social justice work, and social justice research has increased (Mallinckrodt et al., 2014).
Hof, Dinsmore, Barber, Suhr, and Scofield (2009) proposed the TRAINER model, an acronym for a 7-step collaborative process, to help counselors integrate social and professional advocacy into practice. The TRAINER model steps are (a) target advocacy needs, (b) respond by implementing an advocacy competency that can address the needs, (c) articulate a plan to accomplish advo- cacy, (d) implement the plan, (e) network for advocacy during training, (f) evaluate the training, and (g) retarget to meet other advocacy needs (Hof et al., 2009). This model provides instruction on how to implement social and professional advocacy efforts by collaboratively identifying steps toward action, and gaining feed- back on the success of the implementation (Hof et al., 2009). The authors note that this model has been implemented in three training settings, generating 52 plans to implement social and professional
advocacy, but do not provide specific outcome measures (Hof et al., 2009).
Although both training models previously described provide some preliminary evidence of their effectiveness in counselor advocacy training, there is little knowledge of what advocacy training, resources, and engagement is available in counseling programs nation-wide. Thus, the current study sought to under- stand how future clinicians are being trained and equipped with the necessary tools to become effective advocates. The authors con- ducted a nation-wide survey of master’s and doctoral students in counseling and counseling psychology to understand students’ self-evaluated advocacy competencies as measured by the Advo- cacy Competencies Self-Assessment (ACSA; Ratts & Ford, 2010). The ACSA has been designed to assess the multiple areas of advocacy as endorsed by the ACA. Because the ACSA has not been used on a large scale, we also sought to understand what dimensions of advocacy are represented on this scale through the use of factor analysis. Finally, we sought to understand students’ levels of self-assessed advocacy competency or self-efficacy ac- cording to different advocacy dimensions and whether there were differences according to program of study (master’s and doctoral) or year in the program. We hypothesized that the longer students were engaged in a program, the more opportunity they would have to develop advocacy competencies, consequently scoring higher on the ACSA.
Another goal of this study was to understand the possible contextual factors that might influence students’ self-assessed ad- vocacy competency such as the advocacy-related resources and training available to them, their current engagement in advocacy efforts, and the importance they ascribe to advocacy as part of their professional endeavors. We hypothesized that students who had more training and advocacy resources, and were engaged in more advocacy efforts would have higher self-assessed advocacy com- petency.
Method
Participants
Recruitment of participants was conducted through email cor- respondence with both APA-accredited counseling psychology doctoral programs (n ! 78), including programs with master’s- level programs of study, and Council for Accreditation of Coun- seling and Related Educational Programs (CACREP)–accredited master’s programs that listed clinical mental health counseling as a training focus (n ! 158). After obtaining Institutional Review Board approval from a Midwest university, we contacted doctoral programs through training directors listed on the website of the Council of Counseling Psychology Training Programs, and mas- ter’s programs through the program director listed on the CACREP website. Our invitation email included a link to an electronic survey, which outlined informed consent, purpose, and instructions to complete the survey. At their discretion, the email prompt was then circulated to current students affiliated with their academic program.
Of both APA and CACREP programs contacted (n ! 236), 297 graduate student participants partially or fully completed the on- line survey, of which 188 participants (106 master’s and 82 doc- toral students) completed the entire survey and were used for the
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191ADVOCATING FOR ADVOCACY
final analysis. The electronic survey consisted of a variety of questions including (a) demographic questions (ethnic identity, age, gender identity, geographical location) and (b) training pro- gram questions (type of counseling program: master’s level— CACREP, master’s level—non-CACREP, doctoral level—APA), as well as year in program.
Measures
Advocacy Competencies Self-Assessment (ACSA) survey. The ACSA survey is a 30-item questionnaire that uses a 3-point Likert scale (0 ! almost never, 2 ! sometimes, 4 ! almost always; Ratts & Ford, 2010). For three questions, higher scores reflect lower advocacy competence; these were reverse coded as recommended by the authors. The items were written to assess competency in six domains of advocacy: client/student empowerment, community collaboration, public information, client/student advocacy, systems advocacy, and social/political advocacy, based on the ACA’s advocacy competencies model (Lewis et al., 2003; Ratts & Ford, 2010). Each domain was assessed by five items. Domains and example items include (a) client/student empowerment (e.g., “It is difficult for me to identify clients’ strengths and resources”), (b) community col- laboration (e.g., “I develop alliances with groups working for social change”), (c) public information (e.g., “I disseminate information about oppression to media outlets”), (d) client/ student advocacy (e.g., “I am skilled at helping clients/students gain access to needed resources”), (e) systems advocacy (e.g., “I use data to demonstrate urgency for systemic change”), and (f) social/political advocacy (e.g., “I lobby legislators and poli- cymakers to create social change”). Total ACSA scores have a possible range between 0 and 120; higher scores indicate stron- ger advocacy competency.
Types of advocacy resources and training. To understand possible contextual factors influencing students’ self-assessed ad- vocacy competencies, we asked students whether their programs offered courses or specific training related to advocacy-based skills, and whether faculty in their program played an active role in advocacy efforts within their community. Each of these ques- tions was presented as a dichotomous item (1 ! yes; 0 ! no). Based on studies assessing student advocacy training (Hof et al., 2009; Lating et al., 2009; Lyons et al., 2015; Mallinckrodt et al., 2014; Myers & Sweeney, 2004) we also asked participants to identify the following advocacy resources available to them: (a) committees/volunteer opportunities, (b) advocacy literature/infor- mation, (c) advocacy training packet, (d) coalitions with profes- sional groups, (e) government relation liaisons, (f) media/presen- tation opportunities, (g) none, and/or (h) other (and describe). Each of these items was presented together and participants could select multiple items.
Types of advocacy engagement; level of importance. Based on previous literature on advocacy competencies and activities (Lewis, 2011; Lewis, Ratts, Paladino, & Toporek, 2011; Lyons et al., 2015; Myers & Sweeney, 2004), we asked participants to identify what types of advocacy efforts they had been involved in during their time within their academic program: (a) legislative policy writing, (b) community awareness building, (c) attending community meetings/committees, (d) attending a rally or protest for a social justice issue, (e) advocating for a client to receive
services, (f) leading an open discussion with community leaders about needed services, (g) participating in a professional group (APA, American Psychological Association of Graduate Students [APAGS], ACA, etc.) event around advocacy, (h) volunteering, (i) none, and/or (j) other (and describe). Each of these items was presented together and participants could select multiple items. We also asked participants to rate the level of importance they ascribed to advocacy within the counseling profession measured on a 4-point Likert scale (1 ! not important to 4 ! very important).
Results
The initial sample included N ! 296 participants; however, 108 participants were excluded from the final sample due to complet- ing fewer than 5% of the items in the survey. The final sample included N ! 188 counseling and counseling psychology students, of whom 56% (n ! 106) were pursuing master’s and 44% (n ! 82) were pursuing doctoral degrees. A majority of participants (52%) were enrolled in master’s programs with CACREP accreditation, a very small percentage (4%) in non-CACREP accredited master’s programs, and the rest (44%) in doctoral counseling psychology programs. Master’s students included 24.5% (n ! 26) first-year students, 69.8% (n ! 74) second-year students, and 5.7% (n ! 6) third-year students. Doctoral students included 22.9% (n ! 19) first-year students, 30.1% (n ! 25) second-year students, 15.7% (n ! 13) third-year students, 13.3% (n ! 11) fourth-year students, and 18.1% (n ! 14) fifth-year and other students. Most partici- pants (84%) identified as female, another 14% as male, and 2% identified outside of the gender binary. The mean age was 31.15 (SD ! 9.18; minimum ! 20; maximum ! 60). With regard to race/ethnicity, 8% of participants identified as Black, 7% as Asian or Pacific Islander, 6% as Hispanic or Latino, 1% as Native American, and 78% as White. The largest proportion of survey participants attended training programs in the Midwest region of the United States (45%), with 22% in the south, 19% in the northeast, 11% in the west, and 4% in the Pacific region.
Factor Structure of ACSA
We conducted a principal axis factor analysis of the 30 ACSA items using oblimin rotation (to allow for correlated factors). A scree plot (Cattell, 1966) suggested either three or four interpre- table factors, and parallel analysis (Horn, 1965) suggested a three- factor solution. We therefore focused on a three-factor solution, but also examined the four-factor solution to determine whether the fourth factor was meaningful.
Factor loadings for the three rotated factors are shown in Table 1. The first factor included moderate or high loadings (i.e., stan- dardized factor loading ".35) from 10 items describing systems- level advocacy, and was called Alliance Building and Systems Collaboration. Seven items loading on Factor 2 reflected Action and Assessment usually with individual clients, and five items loading on Factor 3 reflected the process of Awareness Building, by which counselors explore with their clients contextual or sys- temic factors that may affect the presenting problem. Three items cross-loaded on Factors 1 and 2, and one item cross-loaded on Factors 2 and 3. Four of the ACSA items did not load above .35 on any of the three factors. Correlations among the three factors ranged from .45 to .60.
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192 RAMÍREZ STEGE, BROCKBERG, AND HOYT
The four-factor model produced dimensions similar to Factors 1, 2, and 3 from the original model, with a fourth factor that was mainly defined by the three items that described use of data to influence social systems. These items were represented on Factor 1 of the three-factor solution, and did not in our view represented a particular technique rather than a distinct dimension of advocacy. Therefore, we focused on subscales derived from the three-factor solution for our analyses. Unit-weighted subscales based on items
with loadings above .35 on these factors showed acceptable reli- ability (# ! .86, .85, and .71 for Factors 1, 2, and 3, respectively) in our sample.
Table 2 shows the means and SDs for each of the three ACSA subscales separately for master’s and doctoral participants. The pattern of responses was similar for the two training levels, with participants rating themselves as most competent in awareness building and application of advocacy skills in the clinical context
Table 1 Factor Loadings for Advocacy Competencies Self-Assessment (ASCA) Survey Scale
Item (and ACSA domain)
Factor 1: Alliance Building and Systems
Collaboration
Factor 2: Action and Assessment
Factor 3: Awareness Building
24. Collaborate using data to promote social change (6) .738 .056 .001 4. Use data for systemic change (5) .678 –.100 .055
12. Join allies to confront oppression (6) .632 –.120 .313 9. Develop alliances with groups (2) .610 .071 .172 5. Presentation on environmental barriers influencing client/student (3) .605 .067 –.175
29. Assess own public influence (3) .548 .280 –.085 30. Lobby legislators/policymakers for social change (6) .544 –.089 –.097 17. Inform media about oppression (3) .504 –.013 –.233 10. Analyze sources of power in systems (5) .441 –.200 .320 3. Alert groups about concerns (2) .439 .117 .180
28. Assess systems advocacy effectiveness (5) .539 .369 –.150 22. Deal with systemic resistance (5) .405 .368 .142 23. Collaborate to inform public (3) .388 .367 .072 20. Develop action plan to confront barriers influencing client/student (4) –.113 .876 .024 16. Develop action plan for systems change (5) .270 .665 –.076 26. Identify allies who confront barriers influencing client/student (4) .161 .463 .274 8. Help client access resources (4) .068 .444 .191
21. Assess own effectiveness interacting with groups (2) .214 .436 .105 15. Identify community member strengths and resources (2) .249 .419 .192 27. Collaborate with diverse groups (2) .261 .390 .210 19. Help clients identify external barriers (1) –.078 .447 .448 14. Identify barriers to well-being (4) –.113 .228 .591 13. Recognize when concerns are due to oppression (1) .097 –.064 .552 7. Identify whether environmental conditions affect clients (1) .102 –.114 .498
11. Communicate ethically about oppression when speaking publicly (3) .099 .222 .470 18. Support movements for social change (6) .344 .139 .379 1. Identify client strengths –.034 .156 .178 2. Negotiate for services (4) .121 .278 .285 6. Distinguish when advocacy is needed (6) .304 .175 .276
25. Assist clients’ self-advocacy (1) .155 .336 .289 Correlations among factors
Factor 1 — Factor 2 .62 — Factor 3 .48 .59 —
Note. Factor loadings ".35 are displayed in boldface. Numbers in parentheses represent the ACSA survey domain: 1 ! client/student empowerment, 2 ! community collaboration, 3 ! public information, 4 ! client/student advocacy, 5 ! systems advocacy, and 6 ! social/political advocacy).
Table 2 Advocacy Competencies Self-Assessment (ASCA) Total and Subscale Scores for Doctoral and Master’s Students
Doctoral Master’s
Factor M SD M SD Cohen’s d 95% CI
Factor 1: Alliance Building and Systems Collaboration 2.04a .95 1.85a .93 .20 [$.09, .49] Factor 2: Action and Assessment 2.78b .94 2.70b 1.03 .08 [$.21, .37] Factor 3: Awareness Building 3.26c .76 2.95c .80 .40
!!! [.11, .69] ACSA Total 2.64 .73 2.45 .79 .25 [$.04, .54]
Note. CI ! confidence interval. Alphabetic subscripts are based on dependent samples t tests. Means in the same column that do not share a subscript differ significantly (p % .01). !!! p % .001.
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193ADVOCATING FOR ADVOCACY
(Factor 3: Awareness Building; Factor 2: Action and Assessment), and somewhat lower (near the midpoint of the scale) on the subscale reflecting systems-level advocacy (Factor 1: Alliance Building and Systems Collaboration). Our results show that overall self-assessed advocacy competencies decreased as participants moved from microlevel efforts (i.e., within the counseling rela- tionship such as the Awareness Building and Action & Assessment scales) to macrolevel systems-based efforts (i.e., Alliance Building and Systems Collaboration scale). The only statistically significant difference between master’s and doctoral participants in self- reported competency was on the Awareness Building subscale (d ! 0.40 95% CI [0.11, 0.69]). Dependent samples t tests show significant mean differences between factors (see Table 2). For master’s and doctoral participants, the Awareness Building (Factor 3) mean was significantly higher than the Action and Assessment (Factor 2) mean. Alliance Building and Systems Collaboration (Factor 1) was the significantly lowest mean for all participants.
We hypothesized that participants’ year in an academic program would significantly predict total ACSA score, with participants who have had more time in their master’s or doctoral program scoring higher on the ACSA scale presumably because they have had more time to develop advocacy skills. However, year in program was not a significant predictor of ACSA total score for either master’s (B ! 0.06 [$0.13, 0.25], p ! .55) or doctoral (B ! $0.06 [$0.28, 0.16], p ! .59) participants.
Advocacy Resources and Training
Figure 1 shows the percentage of participants who reported having access to each type of advocacy resources. These percent- ages are reported separately for master’s and doctoral participants, and odds ratios (OR) greater than 1.0 indicate that doctoral par- ticipants report greater access to a given resource than master’s participants. The 95% confidence intervals (CIs) for these odds ratios all include OR ! 1.0, which means that the odds of having access to each of these resources did not differ significantly for master’s and doctoral participants. A majority of participants (80%) reported that their program faculty engaged in some form of advocacy, and fewer than 1% (n ! 2) of participants reported not having any available advocacy-related resources in their program.
We also assessed whether having access to advocacy-specific training and/or resources predicted students’ self-assessed advo- cacy competencies. A measure of advocacy resources available was computed by counting all the types of advocacy resources reported per participant, excluding responses of “other.” The pos- sible range for this score was 0 to 6 (M ! 2.14; SD ! 1.40). When the ACSA total score was regressed onto this resources score, B ! 0.15 [0.08, 0.23]. This shows that each added resource accessible to a student predicts a 0.15-unit increase in ACSA total score (which is about 0.2 SDs on this scale—see Table 2). Participants with more training and/or resources available to them tended to report higher advocacy self-efficacy.
Engagement in Advocacy
Figure 2 shows the percentage of participants who reported having engaged in each type of advocacy activity. As in Figure 1, OR " 1.0 indicates that doctoral participants reported higher engagement levels than master’s participants. For three of these activity types, doctoral participants reported significantly higher engagement levels than master’s participants (as indicated by 95% CIs that exclude OR ! 1.0). Doctoral participants reported more than three times the odds of attending a rally or protest for a social justice issue, more than 2.5 times the odds of advocating for a client to receive services, and more than 2.5 times the odds of participating in a professional group or event around advocacy, compared with master’s participants (see Figure 2). All other odds ratio calculations indicate no differences between master’s and doctoral participants.
Most participants (50%) reported engaging in one to two types of advocacy activities, with 28% engaging in three to four types of activities, and 10% engaging in five or more. Thirteen percent of the total sample did not report engaging in any advocacy activities.
A measure of advocacy engagement was computed by counting all types of advocacy efforts participants reported they engaged in, excluding responses of “other.” The possible range for this score was 0 to 8 (M ! 2.15; SD ! 1.58). When ACSA total scores were regressed onto advocacy engagement, B ! 0.18 [0.11, 0.24]. This indicates that a 1-unit change in engagement in advocacy activities predicts a 0.18-unit change in ACSA (about 0.25 SDs; see Table
0.9
3.8
7.5
31.1
43.4
48.1
69.8
3.7
8.5
9.8
32.9
39
53.7
72
0 20 40 60 80 100
Other
Advocacy Training Packet
Government Relation Liasions
Media or Presentation Opportunities
Coalitions with Professional Groups
Advocacy Literature or Information
Volunteering Opportunities
Percentage of Types of Advocacy Resources Available
Doctoral Master's
OR = 1.09 [0.59, 2.09]
OR = 1.25 [0.70, 2.22]
OR = 2.38 [0.67, 8.41]
OR = 0.83 [0.46, 1.50]
OR = 1.32 [0.47, 3.69]
OR = 1.08 [0.58, 2.01]
Figure 1. Percentage of types of advocacy resources available to master’s and doctoral students in counseling assessed by self-report. For each category the calculated odds ratio is shown with the respective 95% confidence interval.
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194 RAMÍREZ STEGE, BROCKBERG, AND HOYT
2). Participants reporting greater levels of advocacy engagement also reported higher levels of advocacy competency.
Perceived Importance of Advocacy
A significant exploratory finding was related to the importance students place on advocacy as part of their professional activities. Most participants (68%) reported believing advocacy is “very important” for the counseling profession; 27% reported it was “important,” and only 5% “somewhat important.” An analysis of variance test revealed significant group differences in total advo- cacy scores according to the level of importance of advocacy reported by participants. Participants who reported that advocacy efforts were “very important” to the field had a significantly higher mean ACSA total score compared to those who said it was only “important,” d ! 0.80 95% CI [0.46, 1.14].
Discussion
The counseling profession has proposed advocacy as a neces- sary professional activity and skill needed to address social ineq- uities faced by the clients and populations counselors and coun- seling psychologists work with (Lewis et al., 2011; Ratts, 2009; Ratts et al., 2004; Vera & Speight, 2003). Indeed, most (68%) of our survey participants indicated that advocacy efforts are “very important” in the counseling field. Furthermore, perceived impor- tance significantly predicted self-reported advocacy competency, similar to previously reported results (Myers & Sweeney, 2004; Nilsson & Schmidt, 2005).
Some results of this study provide additional information on the resources and activities that help predict graduate counseling stu- dents’ self-reported advocacy competency. Participants who had access to more advocacy-related training and/or resources and who engaged in more advocacy-related activities reported higher levels of advocacy competency. The resources most commonly reported by participants in this study (e.g., volunteering) and activities most commonly engaged in (e.g., community awareness building) sug- gest students are aware of the challenges faced by communities and work with them to address these needs. The resources and activities less commonly reported (e.g., having access to govern- ment liaisons, legislative policy writing) suggest students have yet
to develop skills to intervene at organizational and societal levels. Training such as the TRAINER model (Hof et al., 2009) that directly targets students’ development of action-oriented imple- mentation plans could help further develop advocacy skills.
There were no differences between master’s and doctoral par- ticipants in the types of advocacy resources available to them, however, they did differ in a few areas of advocacy engagement, with a higher proportion of doctoral relative to master’s partici- pants reporting higher engagement in attending a social justice rally or protest, advocating for a client to receive services, and participating in a professional advocacy group or event. Although we hypothesized that more years in a training program could provide more opportunity for students to develop “advanced” advocacy skills, when assessed, year in program did not signifi- cantly predict self-reported advocacy competency. Therefore, the differences in advocacy engagement among master’s and doctoral students remains unclear. It could be that these results reflect substantive variations in training practices. Developmental differ- ences could also play a role as students enter doctoral programs later in life, possibly having already developed an identity working toward social justice and more readily identify and connect with advocacy activities.
Although the ACSA survey (Ratts & Ford, 2010) intended to measure advocacy competence in the six competency domains proposed by the ACA (Lewis et al., 2003), trainees’ responses suggest that the items represent three underlying factors: Alliance Building and Systems Collaboration, Action and Assessment, and Awareness Building. These factors indicate different levels of advocacy intervention, from a micro- (i.e., client-focused) to a macro- (i.e., systems-level) approach. This continuum is implicit in the ACA advocacy competencies (Lewis et al., 2003) moving from advocacy at the client level to advocacy in the public arena. Factor 1, Alliance Building and Systems Collaboration, is mainly defined by the items intended to capture the social-political advo- cacy, systems advocacy, and public information domains in which advocacy techniques are applied at a public, systems, or political level (ACSA Domains 6, 5, and 3). Factor 2, Action and Assess- ment, is primarily defined by the client/student advocacy and community collaboration domains intended to embody efforts to allot resources for a particular client or to connect with potential
1.9
5.7
9.4
9.4
13.2
26.4
27.4
36.8
47.2
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7.3
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34.1
36.6
50
59.8
51.2
0 20 40 60 80 100
Volunteering Other
Legislative policy writing Lead discussion w/ community leaders on needed services
Attend a rally or protest for a social justice issue Attend community meetings/committees
Participate in a professional group or event Advocating for a client to receive services
Community awareness building
Percentage of Types of Advocacy Engagement
Doctoral Master's
OR = 1.3 [0.18, 9.43]
OR = 0.49 [0.15, 1.63]
OR = 1.18 [0.66, 2.09]
OR = 1.61 [0.86, 3.00]
OR = 3.41 [1.65, 7.03]
OR = 2.55 [1.41, 4.61]
OR = 1.49 [0.60, 3.69]
OR = 2.65 [1.44, 4.88]
Figure 2. Percentage of types of advocacy master’s and doctoral students in counseling engaged in assessed by self-report. Survey respondents could choose more than one option. For each category the calculated odds ratio is shown with the respective 95% confidence interval.
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allies in the community (ACSA Domains 4 and 2). Factor 3, Awareness Building, is the least conceptually unified but the main items that define this factor can be interpreted as reflecting respon- dent sensitivity to the importance of context in affecting clients’ experience, and efforts to raise client awareness of these contextual factors (a few items from ACSA Domains 6, 4, 3, and 1). These results are consistent with how advocacy is conceptualized in the APA competency benchmarks (Fouad et al., 2009) in which be- ginning trainees (ready for practicum experiences) are expected to gain awareness of the systemic issues that influence clients, and later (ready for internship and entry to practice) develop skills to intervene at institutional and societal levels (Fouad et al., 2009).
Training Implications
Our factor analytic results suggest a developmental model of advocacy, revealed in the mean differences on the three ACSA factor scores. Overall, both master’s and doctoral participants scored highest on the Awareness Building factor, followed by the Action and Assessment factor, and scored lowest on the Alliance Building & Systems Collaboration factor. First, students may begin building awareness of the barriers faced by clients due to oppression and are able to recognize the environmental conditions that affect them (Awareness Building). Second, students may begin developing skills to intervene with clients to confront the barriers they face, connect them to appropriate resources, and assess their strengths (Action and Assessment). Third, students may begin broadening their intervention skills to other arenas to promote social change by developing alliances with groups and influencing policy (Alliance Building and Systems Collaboration).
This developmental model reflects traditional training models that often encourage students to build awareness of self and others to intervene effectively in the counseling relationship yet less commonly address how to develop broader interventions focused on seeking justice for oppressed groups. These conclusions are necessarily tentative and additional research is warranted on how and when students acquire skills in advocacy at these different levels, for example, incorporating data from new training models such as the scientist–practitioner–advocate (Mallinckrodt et al., 2014) that integrate advocacy into training. This theoretical devel- opment could be paired with efforts to devise advocacy measures that more robustly capture these different levels or dimensions of advocacy in practice.
Limitations
The field of psychology is at an early stage in its efforts to identify and measure advocacy competence among graduate stu- dents, and also among professionals. According to Kaslow et al. (2009), competency measures must focus on demonstrable ele- ments such as knowledge, skills, and attitudes, and their integra- tion to address specific client or group issues.
The ACSA survey (Ratts & Ford, 2010) is the only scale to date that measures students’ advocacy competencies, however, it has been used minimally in research. According to Ratts and Ford (2010), the ACSA survey is in early stages of development and no psychometric properties have been published to date. Conse- quently, further research and development of advocacy compe- tency assessments is needed. An additional barrier of this and other
self-report measures are the potential challenges to validity when self-report is used to assess competence. Therefore, we believe ACSA scores may best be interpreted as self-efficacy measures rather than direct measures of competence, with development of performance-based measures of advocacy competence as a fertile area for future research.
A possible limitation to this study relates to the characteristics of our participants. This was not a random sample and students who volunteered to respond to the survey may place a higher impor- tance on advocacy training than those declining to respond. More- over, the study did not collect data on the number of students enrolled in each institution. However, we recruited broadly from a national sample and our sample is representative of active students in both levels of study, with more master’s than doctoral students. Nevertheless, this is an important consideration relative to the generalizability of results.
The ACSA survey was used during one time-point in this study, thus limiting the ability to see changes in students’ competence over time, limiting our ability to interpret correlational findings. Although we offer a speculative developmental model for the acquisition of advocacy competence, this model is best tested using a longitudinal design in which cohorts of students are fol- lowed over their time in a training program.
Future Directions
Longitudinal data could increase our understanding of what, how, and when advocacy efforts are initiated, utilized and main- tained by counseling students, and tracked or evaluated by coun- seling programs. This could provide information needed for train- ing programs to follow the guidelines espoused by professional governing bodies, and help improve training efforts for students’ advocacy skills development (Jacobs et al., 2011; Jones, Sander, & Booker, 2013).
The results from this study provide important information on the current state of advocacy development and self-efficacy in grad- uate students in the counseling field. Generally, there is a need to clearly define and operationalize different types of advocacy and advocating. Future research could incorporate this study’s findings to develop new measures theoretically grounded in the three main factors found to characterize students’ advocacy competency de- velopment. The ability to assess students’ advocacy competency over time can help inform training methods, teaching practices, and future research initiatives to increase students’ self-efficacy implementing interventions at multiple levels to redress the mental health disparities their clients and communities face.
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Received October 18, 2016 Revision received March 19, 2017
Accepted March 20, 2017 !
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