Psychology Week 8, Assignment

Psychological Services Advocates in Public Service Settings: Voices From the Field Margaret R. Rogers, Marisa E. Marraccini, Elisabeth C. O’Bryon, Jennifer A. Dupont-Frechette, and Anna G. Lubiner Online First Publication, May 23, 2019. http://dx.doi.org/10.1037/ser0000345

CITATION Rogers, M. R., Marraccini, M. E., O’Bryon, E. C., Dupont-Frechette, J. A., & Lubiner, A. G. (2019, May 23). Advocates in Public Service Settings: Voices From the Field. Psychological Services. Advance online publication. http://dx.doi.org/10.1037/ser0000345

Advocates in Public Service Settings: Voices From the Field

Margaret R. Rogers University of Rhode Island

Marisa E. Marraccini University of North Carolina at Chapel Hill

Elisabeth C. O’Bryon Family Engagement Lab, Oakland, California

Jennifer A. Dupont-Frechette Delta Consultants, Providence, Rhode Island

Anna G. Lubiner University of Rhode Island

Numerous conceptual pieces addressing the importance of advocacy within psychology have been published over the last 20 years. Most recently, that chorus of voices has increasingly focused on the needs of historically marginalized populations (Burney et al., 2009; Garrison, DeLeon, & Smedley, 2017; Nadal, 2017). Despite this attention, a dearth of research has explored the experiences of seasoned advocates who work with such populations. The present investigation drew from an interdisciplinary group of award-winning advocates to reveal how they define and conceptualize advocacy; the motivators and barriers they’ve experienced; and their recommendations about how to support newcomers to advocacy. Through semistructured face-to-face interviews that were content analyzed qualitatively, the 14 advocates describe important lessons about advocacy work. Participants’ desires to become an advocate were fueled mostly by personal interests and early formative experiences. They found collab- orations and building networks (i.e., building relationships with people on all sides of an issue) to be their chief advocacy strategies, and stressed the importance of interpersonal and communication skills (e.g., taking initiative, making connections with those in power) in their skill repertoire. The main barriers encountered included psychological resistance (i.e., intentional blindness toward hidden populations), funding constraints, and various other negative obstacles. Although most found creating a work-life balance elusive, they were energized by mentoring advocacy newcomers, by successes achieved in legislative/policy/program advances, and by creating systems that provide needed services. They shared wisdom about a host of issues for a new generation of advocates.

Keywords: advocates, interdisciplinary, strategies, barriers, mentoring

As individual and community needs become more diverse, psychologists are faced with the increasingly complex task of advocating effectively for improved conditions for individuals, organizations, and society (Melton, 2018). Given the range of settings in which psychologists are employed and their varied roles within those settings, advocacy takes many forms, and is delivered in different dosages and contexts, using a variety of methods

(DeLeon, Loftis, Ball, & Sullivan, 2006). The breadth of advocacy efforts is wide, focusing on direct and individual support, public policy decisions, advances in human welfare services, public health, systems of care, training and education, consultation, re- search, and funding (American Psychological Association, 2017).

Despite the growing and critical need for wide-ranging advo- cacy within the psychological community (Fox, 2008; Heinowitz et al., 2012; Lating, Barnett, & Horowitz, 2009), the extant liter- ature available to guide psychologists to serve as effective advo- cates is limited. Even less is known about the knowledge and skills needed to advocate effectively on behalf of marginalized and underserved populations, despite this being one of psychologists’ key professional responsibilities (Nadal, 2017). The focus on ad- vocacy aimed at marginalized and underserved populations is especially important in addressing systemic factors and societal inequities that limit people’s voices, opportunities, and impact. Advocacy that has a social justice mission has added layers of complexity because it combines individual and systemic advocacy and often requires that the psychologist be skilled in both. Indeed, the American Psychological Association clearly articulates this professional responsibility in its 2017 Multicultural Guidelines:

Margaret R. Rogers, Department of Psychology, University of Rhode Island; Marisa E. Marraccini, School of Education, University of North Carolina at Chapel Hill; Elisabeth C. O’Bryon, Family Engagement Lab, Oakland, California; Jennifer A. Dupont-Frechette, Delta Consultants, Providence, Rhode Island; Anna G. Lubiner, Department of Psychology, University of Rhode Island.

We would like to extend a warm thank-you to our participating advo- cates for their time, enthusiasm, and openness in sharing of themselves and their stories so that we can all learn from their experiences as advocates.

Correspondence concerning this article should be addressed to Margaret R. Rogers, Department of Psychology, University of Rhode Island, Chafee Hall, 142 Flagg Road, Kingston, RI 02881. E-mail: [email protected]

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Psychological Services © 2019 American Psychological Association 2019, Vol. 1, No. 999, 000 1541-1559/19/$12.00 http://dx.doi.org/10.1037/ser0000345

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An Ecological Approach to Context, Identity, and Intersectionality, as it provides parameters for multiculturally competent services and highlights the importance of advocacy on behalf of persons from disadvantaged and discriminated populations.

To improve psychologists’ ability to advocate effectively on behalf of underserved populations, it is critical to know and un- derstand how effective advocacy in this area is defined and con- ceptualized; the motivators and barriers experienced by effective advocates; and key insights from successful advocates on how to support future advocates committed to promoting positive out- comes for marginalized populations. An examination of the exist- ing research in these areas yields gaps in our knowledge base.

Defining and Conceptualizing Effective Advocacy

Although historically advocacy has been a ubiquitous feature within the field of psychology (Nadal, 2017), it is conceived of and applied in many different ways (Lating et al., 2009). To ground ourselves in a common definition that facilitates an understanding of advocacy on behalf of marginalized groups, we share Trusty and Brown’s (2005) summary of multiple descriptions of advocacy as “identifying unmet needs and taking actions to change the circum- stances that contribute to the problem or inequity” (p. 259). While this definition sheds light on the process and goal, additional research is needed to understand how and under what circum- stances psychologists can advocate effectively on behalf of under- served populations. An understanding of the specific definitions, skills, resources, and strategies used by effective, experienced advocates in different settings can provide an invaluable guide for psychologists who seek to be successful advocates. As aptly noted by Cohen, Lee, and McIlwraith (2012), the knowledge and skills needed to advocate effectively can be taught and it is a critical responsibility that psychologists learn them.

Key Motivators and Barriers

While essential for a comprehensive understanding of effective advocacy, the research literature provides limited insight regarding the factors that serve to activate and obstruct those who advocate on behalf of the underserved. Instead, research has examined advocacy-related motivators and barriers more broadly and, in some cases, examined advocacy aimed at advancing a professional group rather than advocacy to address clients’ needs (e.g., Myers & Sweeney, 2004). In other cases, research has looked at barriers to advocacy encountered by a largely preservice sample rather than by experienced advocates (e.g., Heinowitz et al., 2012). Most recently Kozan and Blustein (2018) provided key insights into 11 licensed counseling psychologists’ attempts to engage in social justice-focused advocacy following their graduation from pro- grams that specifically prepared them to engage in such advocacy. Social justice advocacy training supports psychologists’ ability to effectively address the social contexts that contribute to an indi- vidual’s marginalization (Mallinckrodt, Miles, & Levy, 2014). Kozan and Blustein (2018) found that the psychologists’ efforts at advocacy on behalf of clients were often stymied by systemic barriers, including working in settings that do not espouse and share justice-oriented values and priorities. The psychologists also found themselves hampered by a larger structural problem—that of working within a field that focuses almost exclusively on

helping individuals to improve intrapsychically without regard for the very real systemic contributions to people’s problems. Kozan and Blustein (2018) argue that this later issue is a problem endemic to the structure of our nation’s mental health care system. These findings are important because they begin to explore the barriers psychologists face when advocating for underserved clients. How- ever, what is still needed is a more complete picture of the full range of barriers and obstacles encountered by advocates for the underserved to fully understand the challenges they confront and grapple with.

Other research has focused on strategies advocates and the organizations that they work for have used when advocating. Mason (2015) surveyed 259 leaders of nonprofit organizations in California to study the relationship between the leaders’ political ideologies and the advocacy tactics used by their organizations to influence legislation. The leaders averaged about six years as advocates. The findings suggested that the more conservative the leaders, the more likely their organizations were to use a wide array of strategies including face-to-face lobbying, petition drives, boycotts, sit-ins, and media campaigns. In another study exploring advocacy strategies, Gee, McGarty, and Banfield (2015) inter- viewed nine advocates from two organizations representing the mentally ill in Australia. The advocates - relatively new to advo- cacy with an average of about four years’ experience—described the importance of building partnerships, establishing strong rela- tionships between their constituents and themselves, and finding ways to influence the mental health system (e.g., lobbying) (Gee et al., 2015). These findings help us to understand the types of strategies that early career advocates employ. What we do not yet know are the motivators, strategies, and barriers experienced by seasoned experts - that is, those with extensive and well- established careers - whose work focuses on a diverse array of marginalized populations, and how their experiences can inform and guide psychologists who advocate.

A study by Goodman, Wilson, Helms, Greenstein, and Medzhi- tova (2018) of recent graduates of a masters-level mental health counseling program provides unique insights specifically related to working with and advocating on behalf of underserved groups. Each of the advocates were within two and a half years of com- pleting their advocacy practicum. Interviews revealed that as ad- vocates’ relationships with individuals from marginalized commu- nities deepened, so did their experience of strong emotions—both pleasant and unpleasant (i.e., feeling frustrated, overwhelmed, angry, moved, and inspired). The positive feelings often countered the more disheartening ones, by highlighting the value of the work, deepening advocates’ commitment, and increasing their confi- dence as advocates (Goodman et al., 2018). The opportunity to learn about the experiences of leading advocates working on behalf of marginalized and underserved populations can shed additional, necessary light on the important skills, strategies and resources employed, and the barriers psychologists may face when advocating in this space.

Supporting Future Advocates

The need for intentional and ongoing advocacy training and support for psychologists is well represented in the literature. Scholars recognize that training and mentoring are essential in order to create a culture of advocacy involvement in psychology

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(Fox, 2008). A significant, positive relationship has been uncov- ered between hours spent in advocacy training and hours of sub- sequent advocacy involvement (Lyons et al., 2015). High quality training is especially critical when considering the unique knowl- edge and skills needed to effectively advance the needs of mar- ginalized groups who may be systematically disenfranchised or discriminated against. The preparation can be both complex and personal. Dragowski, McCabe, and Rubinson (2016) describe how self-awareness and an evaluation of one’s own social identity can interact with an awareness of larger societal systems, hierarchies, and inequalities to enable an ability to effectively work with marginalized groups. Importantly, advocacy training can lead to an increased awareness of specific biases and harassment against marginalized groups, as well as an awareness of the larger social norms that perpetuate systems and conditions that sustain the attitudes and behaviors that promote marginalization (Dragowski et al., 2016).

Advice and guidance from seasoned advocacy leaders is critical to the success of those just beginning advocacy work because it can provide examples that illustrate and illuminate how fledgling advocates should prioritize their time, focus their attention, and concentrate their efforts. Learning from accomplished advocates, particularly those recognized as doing stellar work and honored with awards and honors rather than from novices, may yield insights that can save new advocates energy in acquiring needed skills and areas of expertise. Experienced advocates have accumu- lated layers of relevant knowledge, wisdom from observing what works and what does not, and have practiced their skills in multiple contexts as well as with multiple audiences (Kilburg, 2016). Ac- complished advocates know what mistakes to avoid, strategies to eschew because they fail to achieve desired outcomes, and steps that take time but are minimally beneficial. Learning about these lessons can help advocacy newcomers to focus their energies and attention on those efforts most likely to achieve desired aims.

In one of the few studies that yielded advice for future advo- cates, Kozan and Blustein (2018) found that practicing psycholo- gists whose work involved social justice-oriented advocacy sug- gested that newcomers build a support system, pick one’s battles, and practice self-compassion. The challenges and complexities of dismantling systems that maintain marginalization are many and joining with others in such work while also being selective regard- ing one’s engagement is wise advice. Unfortunately, little else is known about the advice seasoned advocates have for newcomers to advocacy, nor about the suggestions they may have for those who wish to develop advocacy skills.

The Current Study

To guide psychologists in their efforts to advocate effectively on behalf of marginalized populations, the current study shines a light on the experiences, tools, and insights of an award-winning group of seasoned interdisciplinary advocate leaders committed to im- proving the lives of the underserved. To fill in key research gaps and to inspire and inform current and aspiring psychologist advo- cates, we explored the following three research questions with our expert advocates: How do you define and conceptualize effective advocacy? What are the key motivators and barriers you experi- ence as an effective advocate? How can we support future advo- cates? By unpacking the diverse experiences of these leading

advocates, the present study contributes to the scholarly efforts to empower a new generation of psychology advocates with the knowledge and skills needed to effectively advance equitable outcomes for marginalized and underserved populations.

Method

Participants

We recruited an interdisciplinary group of advocates committed to improving the lives of underserved and marginalized people in the United States. Advocates were eligible if they (a) engaged in work representing a social or sociopolitical, health, mental health, education, human rights, or civil rights issue (e.g., disability, low income, socially marginalized, etc.), (b) were renowned for their advocacy work and honored with a major award (i.e., national honor, etc.), and (c) held leadership positions. This combination of attributes was designed to capture those with extensive expertise as successful advocates. The advocates were identified for recruit- ment using purposive sampling—a technique employed to ensure that participants would have considerable knowledge and experi- ence in advocacy (Palinkas et al., 2015), as well as snowball sampling to reach hard-to-find participants. In addition, given that the interviews would be conducted face-to-face, the recruitment targeted advocates from the Northeastern and Mid-Atlantic regions of the United States to allow the interviewers to meet with the advocates in their locales. Seventeen advocates were recruited by e-mail and/or phone calls through publicly available information (e.g., work phone numbers, etc.). Fourteen advocates completed the semistructured face-to-face interviews. Each interview was conducted individually and was video- and audio-recorded with participants’ permission.

The participating advocates included 9 (64%) men and 5 (36%) women of whom 86% were European American, 7% African American, and 7% LatinX. Professionally, they held positions as directors/presidents/executive directors/chief executive officers of nonprofit organizations and associations (79%), educators (14%), and an outreach coordinator (7%). They had backgrounds in med- icine, law, psychology, social work, education, and community organizing. They were based in the Northeast and Mid-Atlantic regions of the United States, working in Maryland, Massachusetts, New York, Rhode Island, and Washington, DC. On average, they had worked as advocates for 18 years.

Measures

In addition to demographic and personal background questions (e.g., race/ethnicity, professional title, etc.), participants responded to 19 questions in the semistructured interview protocol as part of a larger investigation about advocacy practices and processes. The present study reports on a subset of 14 questions. The interview questions were developed by the authors to address gaps in the published literature about advocacy in psychology for underserved and marginalized groups. The open-ended interview questions cluster around the three main research questions. First, to deter- mine how the advocates define advocacy and conceptualize effec- tive advocacy, we asked for their definition of advocacy, skills they consider critical for effective advocacy, strategies they use to advocate, resources employed, and how they empower others

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through their work. Second, to learn about their key motivations and barriers, we asked what led them into advocacy, their greatest successes when advocating, the barriers and obstacles they’ve encountered, the mistakes they’ve made, and how they create balance in their lives. Third, to identify how to support future advocates, we probed them to talk about recommendations for others who want to develop their advocacy skills, advice they have for newcomers to advocacy, advice for bringing in a new gener- ation of advocates, and any additional information important that they wished to communicate to aspiring advocates. Each of the 14 questions included follow-up prompts that could be asked if rele- vant to issues mentioned by the interviewees. An average inter- view lasted 60 to 90 min. The interview protocol was piloted prior to data collection with two advocates to obtain feedback about the questions, leading to minor changes in their order and wording.

Qualitative Data Analysis

The study was approved by the university human subjects review board and all advocates completed written informed con- sents. The interviews were transcribed verbatim to allow for rich, thick description and improve credibility. The transcriptions were performed by two trained research assistants and then triple- checked for accuracy by the interviewer. A team of five research- ers conducted the qualitative content analysis of the 14 interview questions. The team was trained in qualitative content analysis by reading relevant literature (e.g., Denzin & Lincoln, 2005; Grane- heim & Lundman, 2004; Morse, 2008; Taylor-Powell & Renner, 2003; Zhang & Wildemuth, 2009), practicing on samples, and coding the samples until agreement was better than 80%. The training was guided by the first and third authors - both experi- enced qualitative scholars.

The research team engaged in two main phases of the data analysis process, each involving multiple steps (Leech & Onwueg- buzie, 2008). In the first phase, the researchers formed dyads to perform the inductive manifest content analysis. For each question, the dyads read the transcriptions independently and identified segments of the data addressing each question. From the segments, they developed codes inductively based on the ideas represented in participants’ responses. The dyads met to discuss their initial emergent codes and to group the codes into common coding categories by interview question. Once the categories that emerged from the data were agreed upon, the dyads independently applied them to each question in a recursive manner, proceeding back and forth between the raw data and the codes until all the questions and responses were coded, maintaining a codebook as they went along. The dyads met again to discuss their coding decisions, calculate agreement, and to share observations. This process was replicated for each question iteratively until all responses to each question were fully analyzed and consensus between the coders was reached. To establish intercoder agreement, agreements were divided by number of agreements plus the number of disagree- ments. Intercoder agreement across the questions was 80%–100%.

The second part of data analysis was ongoing, involving mul- tiple steps to ensure trustworthiness through dependability, credi- bility, and confirmability. To address dependability and confirm- ability (Lincoln & Guba, 2000), an audit trail was maintained throughout data collection and analysis to establish transparency in the research process. During the content analysis of the interview

data, the dyads were formed to independently analyze the data, providing investigator triangulation as a way to reduce bias. Cred- ibility was addressed with researcher reflexivity through notating and memos (Lincoln & Guba, 2000). The research team served as peer researchers, meeting regularly to ensure that decisions were grounded in the study objectives and methodology. The team communicated about each phase of the project, established con- sensus as needed, and debriefed. We also addressed credibility by incorporating quotations of the transcribed interviews in our report of the findings (Graneheim & Lundman, 2004). The Journal Article Reporting Standards for Qualitative Primary, Qualitative Meta-Analytic, and Mixed Methods Research in Psychology (Lev- itt et al., 2018) guided the reporting of our study findings.

Results

Defining Advocacy and Conceptualizing Effective Advocacy

Definition of advocacy. Definitions of the term “advocacy” offered by the advocates fell into five categories. Being a voice for others (n � 8, 57%) was the most common, followed by collab- orating with others (n � 5, 35.7%), raising awareness (n � 3, 21%), and not quitting (n � 2, 14%). Additionally, many of the definitions did not align to one category, emerging as a miscella- neous category (n � 8, 57%). Among those who defined advocacy as ‘being a voice for others’ was this definition “It is giving voice to an issue or to people who don’t have a voice.” Another stated that it was “Getting people’s voices heard equally—not accepting the status quo.” For those who saw advocacy as ‘collaborating with others’ were two who defined advocacy as “Being in conversations with those with resources, those with power” and “A group of people, or institutions, like coalitions, coming together with a common goal.”

Skills critical for effective advocates. The advocates identi- fied seven skill domains as critical for effective advocates. These included interpersonal skills (n � 7, 50%), communication skills (n � 7, 50%), being informed about issues (n � 6, 42.9%), strong personal qualities (n � 5, 35.7%), critical consciousness skills (n � 4, 28.6%), miscellaneous skills (n � 4, 28.6%), and creativity (n � 2, 14%). The advocates spoke about several important interpersonal skills such as being able to build relationships with others, make connections with those in power and those with resources, being a people person, being empathic, being positive, being affiliative, being kind, and taking initiative. They also de- scribed being able to share values and beliefs with others and joining with them to accomplish goals over the long term.

The communication skills they considered essential included active listening, creating consensus from multiple perspectives, writing documents, tactfully or directly speaking the truth, and having excellent verbal skills. The third most important skill was being informed about the issues. The advocates spoke about hav- ing data and facts, grounding their knowledge in their experiences and professional practices, understanding the legal and regulatory context of their work, knowing solutions to problems, and know- ing how to link funding with policy that leads to sound practice.

Strategies used to advocate. Six categories of strategies were described by the advocates as key to their work. These included collaborating and networking (n � 10, 71.4%), clearly and actively

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communicating (n � 6, 42.9%), educating others (n � 5, 35.7%), being persistent (n � 3, 21%), building public awareness (n � 3, 21%), and an assortment of strategies labeled “miscellaneous” (n � 7, 50%). Among those who discussed collaborating and networking was one advocate who stressed “Being able to meet with others that have a similar mindset and work in a collaborative way.” Another emphasized “The importance of building relation- ships with people on all sides of the conversation, I think, can’t be overstated.” A third said,

I try to listen to the viewpoints of people who have reservations about things that I might propose. I try to find out, okay, I’ve decided that such and such an issue would benefit folks with developmental disabilities. What are the barriers to that? Is there merit in the arguments of people who have put those barriers forward? Is there a reason why the barriers are in place? And if there is, then I try to find a solution that works for everybody.

Those who found that clearly and actively communicating was an important strategy discussed (a) using technology and social media sites to communicate and inform, (b) building relationships with media outlets, and (c) holding press conferences and releasing statistics. Another common category of strategies included a wide variety of approaches we labeled miscellaneous. This category included advocates who wrote books, engaged in legislative work, used their experiences in practice to inform their policy work, studied what “worked well,” and who, following victories, always made sure to have celebratory parties with fellow advocates. Another advocate described her strategy as using “empirically verifiable facts about the issue.”

Resources called upon to support advocacy work. Advo- cates’ responses about the resources they employ to help their advocacy work fell into seven categories. These included funding sources (n � 6, 42.9%), community members (n � 5, 35.7%), experts/other advocates/like-minded individuals/colleagues (n � 4, 28.6%), informational resources (n � 3, 21%), organizational resources (n � 3, 21%), family and friends (n � 2, 14%), and miscellaneous (n � 2, 14%). The funding sources the advocates relied on varied from philanthropic organizations, to foundations, to local fundraisers. In terms of the community members that advocates found to be important resources, they included law enforcement, local coalitions, schools, churches, businesses, fam- ilies, and schoolchildren. Several advocates spoke about their contacts with experts in the field - including like-minded advo- cates, people within coalitions, and colleagues across the country - as critical to their efforts. For example, one version of this came from a Washington, DC-based attorney who stated,

Coalition building is one of the most important things and the reason it’s so helpful is that there are limited resources, not only in time and money. When you have built up coalitions then you have other advocates and other people that can help join the group and help advance the cause. That’s really, that’s critical when working with small groups to move the issues along.

A second advocate stated, “So you have to have a network of advocates in all different areas across the country to help move the issue along,” while a third related,

There are a couple of people in other states that we know, and they know a lot about particular things around SNAP [Supplemental Nu-

trition Assistance Program] . . . that we use regularly, we’ll consult with.

How the advocates empower others. The advocates de- scribed four different ways they empower others through their advocacy work. They included mentoring and teaching (n � 8, 57%), engaging others through their personal qualities (n � 3, 21%), creating ownership (n � 3, 21%), and a miscellaneous category (n � 5, 35.7%). For those who saw mentoring as partic- ularly empowering were several who spoke about working with young adults to develop their leadership and advocacy skills. One example aptly illustrates this position:

Each year we have a legislative conference that I’m involved in where we teach the next generation how to address the issues I’ve been talking to you about—the ethics of how to present your case and be an advocate.

Another advocate weighed in with,

We created the Latina Leadership Institute, which is also a way of bringing up future leaders of people that have absolutely no skills, absolutely no idea what to do.

A handful of advocates felt that their own personal qualities facilitated the empowerment of others. The qualities they men- tioned included being persistent, being approachable, being hard to intimidate, and creating a sense of security in others so that they will speak up for themselves.

Key Motivations and Barriers

What led the advocates into advocacy. The advocates de- scribed five factors that led them into advocacy work. Most (n � 12, 85.7%) noted personal interests, followed by early childhood experiences (n � 11, 78.6%), early professional experiences (n � 7, 50%), a desire to change the status quo coupled with a com- mitment to fairness and justice (n � 7, 50%), and learning that there was value in helping others (n � 4, 28.6%). One advocate was personally motivated after learning that his son was being restrained at his group home. He stated,

He was pinned to the floor for several hours. And because he was getting banged up like that, we became very concerned . . . restraining in the disability community is supposed to be an emergency measure, how do you decide . . . ahead of time to restrain somebody if it’s only supposed to be done in emergencies? So that’s what sort of got me and my wife really concerned . . . conference was focused on the issue of seclusion and restraint . . . all this training was available to me . . . and that’s what got me to have a knowledge base that I could then bring back and start to use, not only with my son but also with other people who were experiencing similar things.

Among those with early formative personal experiences, several advocates were raised in the 1960s and witnessed the activism of the day, such as this advocate:

I am a baby boomer, which means that I grew up during the big social movements of our day: The civil rights movement, the antiwar move- ment, the women’s movement (laughs) . . . and so I really cut my teeth on, on social justice issues, I was born and raised in the nation’s capital, where, which was sort of the hub of this activity . . . And honestly there was a personal reason that I got involved in this, and

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5VOICES FROM THE FIELD

this is through my father, who was a really progressive minister at an urban church on Capitol Hill.

Greatest successes when advocating. The advocates’ great- est advocacy successes fell into four categories: legislative/policy/ program advances (n � 9, 64.3%), creating systems that provide needed services (n � 9, 64.3%), training new advocates (n � 4, 28.6%), and personal recognition (n � 3, 21%). Advocates spoke of legislative/policy/program advances that included a) creating programs that received public funding, b) authoring health care bills supported by legislators, c) successfully suing their state to reverse laws deemed unconstitutional, d) securing paid sick leave for contract health care workers in their state, and e) creating new offices within organizations to address socioeconomic inequities. Advocates also spoke about their successes building nonprofit organizations that improved people’s lives. In one case, the head of a nonprofit (aimed at those living in poverty) discussed helping previously homeless people find housing and provide necessary furnishings. In a second case, an executive director of a nonprofit discussed their efforts to restructure health care to allow access to poor inner-city families. The third most common success the advocates experienced was helping others become successful ad- vocates. Advocates characterized this work as “fostering new advocates” and building “a core of advocates.”

Barriers and obstacles the advocates faced when advocating. Six domains of barriers emerged from the advocates responses. The barriers included psychological resistance (n � 8, 57%), funding limitations (n � 6, 42.9%), political resistance (n � 3, 21%), lack of collaboration (n � 2, 14%), finding change is slow (n � 2, 14%), and a variety of miscellaneous negative experiences (n � 11, 78.6%). Within the category of miscellaneous, the advo- cates faced a litany of problematic situations from needing to confront people who engaged in sexist behavior, to being black- listed as a result of their advocacy work, to finding their work emotionally draining.

For those advocates who spoke about facing psychological resistance was one advocate who spoke about working for hidden populations of people:

No one wants to think about getting old, no one wants to think about what happens in terms of nursing homes, that are hidden away or where homecare that’s in the home . . . No one wants to think about or care about low-income workers and their issues are about mostly women of color. And all are low income, so this work has always been dismissed as if it’s paid attention to at all . . . so that societal kind of intentional blindness is the biggest obstacle.

Mistakes made and failures experienced while advocating. The advocates’ responses about their mistakes and failures clus- tered into four categories. These included self-perceived personal errors (n � 11, 78.6%), miscellaneous failures (n � 4, 28.6%), interpersonal errors (n � 3, 21%), and those who did not make any mistakes (n � 2, 14%). The advocates provided many different examples when describing personal mistakes. One advocate stated “The biggest mistake I ever made as an advocate was waiting so long to start.” Others spoke of their need to regulate their emo- tions:

I really had to learn how to balance emotion with professionalism, and as I’ve gotten older and have done the work longer I have to some- times balance professionalism with what should happen.

Another stated, “I did have to figure out how to balance that, to not take everything so personally.” A third advocate commented “I sometimes say things that other people would never say.”

For those advocates whose responses clustered into the miscel- laneous category were a variety of missteps. They included those whose mistakes involved using the wrong advocacy strategy, to overpromising what they could realistically deliver, to expecting their efforts would lead to quick results. This latter point was underscored by one advocate who said,

It takes time to present the issue to someone and for that issue to rise up to be of concern enough to have someone move it into legislation and move it forward.

How advocates create balance in their lives. The advocates provided five categories of responses in describing how they create balance in their lives. Most of the advocates (n � 10, 71.4%) revealed that they had difficulty achieving balance in their lives. They also spoke about the leisure activities they engaged in (n � 9, 64.3%), the time they spent with family and friends (n � 9, 64.3%), miscellaneous activities (n � 5, 35.7%), and trying to have boundaries between their work and personal lives (n � 3, 21%). Although about two thirds of the advocates lamented their failure at achieving a good work-life balance, they also spoke about a myriad of ways that they relax including sleeping, walking, martial arts, racquetball, windsurfing, paddle boarding, cutting firewood, reading, and going to plays and art exhibitions. Time spent with family and friends was also prominent in their efforts to achieve balance, and two thirds spoke with warmth about their interconnectedness with their friends and loved ones. Those advo- cates who spoke about their efforts to achieve balance that we categorized as ‘miscellaneous’ made a variety of comments. They described their use of mobile technology and their overbidding love of work as helping them to feel balanced.

Supporting Future Advocates

Recommendations to those who wish to develop their advo- cacy skills. The advocates’ responses led to five categories of recommendations. These included the need for systems level awareness (n � 8, 57%), specialized preparation in advocacy and advocacy topic (n � 6, 42.9%), miscellaneous (e.g., collaborate, seek support, obtain guidance from other professionals, etc.) (n � 6, 42.9%), development of communication and personal skills (e.g., empathy, compassion, persuasion, confidence, etc.) (n � 5, 35.7%), and advice to “think long term” (n � 4, 28.6%). Among those who discussed the need to understand systems and how they operate was one advocate who stressed the importance of seeing how “Environments impact people and then working to change the environment because changing the person doesn’t fix the problem often.” Several advocates talked about the need to develop excel- lent communication skills. One highlighted the need to “really listen to people’s issues and concerns, and be empathic, outgoing, and friendly.”

Advice to those just beginning advocacy work. When asked about advice they would give to newcomers to advocacy, the advocates’ responses fell into five categories. Many advised new- comers to educate themselves (n � 9, 64.3%), followed by mis- cellaneous advice (n � 7, 50%), to know thyself (n � 6, 42.9%), to reach out to others as resources (n � 4, 28.6%), and a few

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simply offered encouragement (n � 2, 14%). One advocate who spoke about becoming educated stated,

I think you have to be really informed in your area. I do think having that background and that information and that knowledge and that data is important. And then I think you listen. And you have to learn. So you have the information but you also have to listen and learn about how things work in whatever realm you’re in.

A second weighed in with,

You need to be able to get on even terms with people who are on the other side of the argument. So you need to know what their argument is and the shortcomings of their argument so that you can come back with a counter argument. And so that requires a depth of knowledge.

And a third advocate described how he was informed watching advocacy role models:

Just look at people that are effective advocates and see how they behave themselves, see how they speak, see how they communicate, see how they behave in their own personal lives, and emulate.

Within the group who offered miscellaneous advice were those who urged others, “Get out in the trenches,” and “Be honest. And know when to share, when not to share.” Still another advocate noted,

You really need the “bomb throwers,” and more importantly you need “bomb throwing” to happen strategically. That’s the thing! . . . I’m rooting for people getting arrested.

Among the third of advocates who advised newcomers to “know thyself” were some of the most moving pieces of advice. They included one who offered this:

You have got to figure out why you are in this work and how much of this is the issue of the people themselves and how much of this are you working on your own stuff.

A second advocate expanded on this idea, eloquently offering the following advice:

The advice I’d give someone who’s just beginning advocacy work is, first of all, understand your own story. How do you relate to this? Number one, what examples do you have in your own life where others advocated for you or you advocated for others? If you go back to your parents or your grandparents, however far back you can go, what stories do you have that would generally fit into the category of somebody advocating for someone else? The more you understand that story, I think, the more grounded you’re gonna be . . . the more you’re gonna be able to sort of stand outside of yourself a little bit and understand, what’s the dynamic for you? Why are you doing this? Why are you at the table? What do you get out of it? What are your strengths in it, what are some of your weaknesses? How should you try to . . . adapt . . . to . . . avoid your weaknesses?

And a third, the most senior of all the advocates, offered this tidbit:

I would say do what you think you really want to do. Do not get caught up in . . . the subjects that, where the dollars are . . . Be true to whatever it is brought you to the field in the first place.

What can be done to bring in a new generation of advocates. The advocates’ responses about bringing in a new generation of

advocates clustered into four categories. The categories included providing a support system (n � 5, 35.7%), improving education and training (n � 5, 35.7%), enhancing empowerment efforts (n � 4, 28.6%), and helping people to know their strengths (n � 3, 21%). One illustration of those who suggested offering a support system for new advocates was this comment:

There’s issues around money and supporting themselves, so what I think . . . is a couple things. I think that foundations and others need to think about how do you get these brilliant kids, who want to do good, who want to become advocates, how do you sort of support them in their work, because they’re, they’ve got debts, and so forth. It’s really, it’s very concrete, but I really think there’s something to that.

And a second spoke about the need to create healthy functioning work environments:

Figure out ways to insist on having healthier organizations . . . I think, again it is sort of forgotten how important it is that if you want to have true advocates in the field they have got to have, they’ve got to be supported. They’ve got to be working in organizations that will support them and where they are in some ways emblematic of what they are promoting. So it seems like having a stocked full system of support would be the most effective route rather than just trying to track a few bright, assertive young folks. It’s what system of support are you bringing them into? You know . . . keep them and help them stay there.

Several advocates spoke about the need to provide training for new advocates. Among those was a school psychologist who said,

So, during their training programs, making sure that they’re aware of ways in which they can become involved, to become better advocates. And to start early. And so I think it’s a lot easier to continue on with advocacy efforts if you’ve already started those ahead of time . . . Right in terms of the entry level graduate first-year students on to practicum and internship, making sure the message continues on through there. And exposing students to different ways of doing that, you know, there’s a lot of different ways to advocate, like we’ve been talking about. And, you know, there’s not just one definition of advocacy, there’s a lot of them. A lot of ways that we can influence the lives of others in a positive way.

A second advocate, a physician, stated,

It’s amazing how unprepared people feel that they are to be advocates. They feel that “Oh I don’t, that’s not me, that’s not something I can do” when in reality anybody can be an advocate. It’s just a matter of letting people know how to be one. And being an advocate doesn’t mean having to be in Congress or having to be testifying before some committee. You can be an advocate by just talking to your neighbors, by just participating in your school, you know, parent-teacher confer- ences, I mean you know, advocacy can be as small as talking to one person on the street or talking to a million.

Additional information important for aspiring advocates to know. When asked if there was anything else to add not already addressed in the interview questions but important for aspiring advocates to know, nine advocates weighed in. Their responses clustered into five categories: learn that success and failure are both part of the process (n � 3, 33.3%), advocacy is action oriented (n � 2, 22.2%), advocacy is a creative experience (n � 2, 22.2%), engage in community building (n � 2, 22.2%), and

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change takes time (n � 1, 11.1%). Among those who described appreciating both successes and failure was this comment from a school psychologist:

I think people being able to celebrate the people that they advocate for or with is pretty key. Standing back and seeing what’s been accom- plished. Because obviously the pool of human misery . . . is so much more vast than anything we can really . . . have an impact on, that it can be discouraging if you do not stand back and recognize all the accomplishments that have been made . . . in the lives of individuals, whether it’s school psychologists affecting . . . kids’ lives . . . I mean that’s to be celebrated.

Another advocate, an attorney, offered this perspective:

Learn from the people, you know, step on my back and the backs of other that are, that are out there that are willing to give and offer mistakes that they made so that you can learn from them . . . that would be I think the biggest thing . . . I spent a lot of time watching, and listening and looking at people, and saying “Gee, you know, that is really an approach that I’d like to take, or, I would never do that.”

In terms of being action-oriented, one of the advocates spoke movingly about his experience coming late to advocacy work:

Do not wait until something really bad happens to decide that you’re gonna become involved, but maybe just look around and see what part of the system do you have the power or influence to change in a positive direction? So that’s, actually when we talked about advocacy before and I said that the person is an advocate, well that’s true, but in another sense anybody can be an advocate . . . So you can take an issue and you can have a very powerful role in trying to make that issue disappear for many people. So you know, my advice or my hope would be that people just take the first step and get your feet wet, and see what we can do to make the system better. Make it better for everybody.

Discussion

The aim of the current study was to shed light on how an interdisciplinary group of professionals, with extensive expertise as advocates, successfully advocate on behalf of underserved and marginalized populations. The advocates represented a wide array of groups including people with disabilities, those living in pov- erty, those lacking health care, the homeless, and youth and fam- ilies of color. By elucidating how these advocates define and conceptualize effective advocacy, identifying their key motivators and barriers to success, and addressing the ways in which we can foster future advocates across fields, we aimed to demystify the mechanisms behind successful advocacy.

The first aim of our study was to garner an applied definition and conceptualization of advocacy by those advocating for under- served and marginalized populations. Advocates were asked how they define advocacy; the critical skills, strategies, and resources they call upon for advocacy; and how they empower others. The most commonly agreed upon definition for advocacy was “being a voice for others,” identified by 57% of the interviewees. This definition is consistent with previous literature broadly defining advocacy as working to enact change for vulnerable populations (Cohen et al., 2012; Lating et al., 2009). Yet, successful advocacy campaigns hinge on clear messages about improving the lives of those in positions of less power, that are informed by collaboration and strengthened through self-empowerment (Cohen et al., 2012).

Thus, it is encouraging to find that the second most commonly agreed upon definition of advocacy centered around the impor- tance of collaboration. For populations experiencing systematic oppression, collaborative efforts seem particularly important given these individuals and groups are often unheard. In order to be “a voice for others,” advocates must draw from the lived experiences of their clients and partners in advocacy, relying on trusting relationships. As an African proverb states, “If you want to go fast, go alone. If you want to go far, go together.”

The importance of collaborative relationships and communica- tion emerged as a consistently agreed upon framework for con- ceptualizing effective advocacy across other questions as well. When asked about the most important skills for effective advo- cacy, common ideas centered around interpersonal and communi- cation skills, over and above those of being informed or knowl- edgeable about the issues. The critical importance of collaboration and communication was also consistently identified as an impor- tant strategy for advocacy. This focus on collaboration is consis- tent with findings from Kozan and Blustein (2018) whose partic- ipants stressed the importance of joining with others to advocate. Additionally, most advocates identified networks of community members and like-minded professionals as an important resource for their advocacy work.

Although the collaborative nature of advocacy is not a new concept (Trusty & Brown, 2005), extending it to underserved and oppressed populations appears to be critically important. Indeed, previous research focused on relationship-centered advocacy high- lights that as advocates transcend simply witnessing oppression to working in partnership with their clients and facing barriers to- gether, their empathy is deepened (Goodman et al., 2018). Inter- estingly, when advocates in the current study were explicitly asked about the ways in which they empower others through their work, they primarily reported mentoring and teaching, with only a few suggesting that they try to instill ownership. Psychologists advo- cating in diverse community settings should focus on advancing these collaborative relationships that are interdisciplinary across professionals and a deepening relationship between advocates and underserved populations.

A second aim of our research was to identify key motivators supporting advocacy work and the barriers that get in the way. We asked advocates what led them into advocacy, about their greatest successes, the barriers or obstacles they faced, about their greatest mistakes or failures, and how they create or maintain balance in their day-to-day lives. The personal nature of becoming an advo- cate for marginalized and underserved populations is noteworthy, as most reported witnessing injustices or advocacy efforts during their development as a key experience that led to their work. Perhaps because advocacy is so strongly rooted in these personal experiences, advocates also spoke of incidents when their personal convictions and emotional reactions actually hindered their prog- ress.

It is probable that these rich and complex personal experiences deepened these advocates’ empathic understanding of the barriers, difficulties, and unjust experiences the populations they advocate for face, not only inspiring their work, but also supporting their efficacy as agents of change. For example, Goodman’s (2000) work suggests that cultivating empathy is an essential component toward successfully motivating privileged groups toward advo- cacy. Although here, advocates reflect on their personal experi-

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ences as convictions for making change, Goodman purports that advocates must extend beyond personal experiences to understand suffering from their client’s perspective to build an empathic understanding. Findings from Curry-Stevens’s (2011) study in- volving qualitative interviews with adult educators refine this issue further, explaining that empathy alone can act as a barrier to effective advocacy, potentially leaving the responsibility for change to the oppressed group. Instead, Curry-Stevens’ work highlights the critical need to share a common mission, without projecting the work onto underserved populations.

This message was reiterated in advice for those just beginning to advocate, as advocates recommended paying close attention to personal motives and separating them from professional ones. These issues also emerged when advocates discussed their practice for finding balance, where most reported facing difficulties in achieving balance. Thus, channeling these personal experiences into passion and a drive for advocacy appears to be an important catalyst, but should be maintained with clearly defined boundaries and adaptive work habits and lifestyles. These cautionary tales are especially important considering that psychologists, particularly early career psychologists, are at a high risk for burnout (Boccio, Weisz, & Lefkowitz, 2016; Rupert, Miller, & Dorociak, 2015). A common prevention method for burnout, utilized in the West, involves proactive approaches to boundary setting that include a balanced home and work lifestyle (Maslach, 2003; Rupert et al., 2015). Thus, for those entering advocacy who strive for a balance between home and work, particular attention needs to be paid toward monitoring one’s reasons for engagement and emotional status and ensuring dedicated time to self-care.

Many of the barriers reported by advocates were also personal in nature, with psychological resistance from others identified more frequently than funding issues as a main barrier to success. That is, the very nature of advocacy is contentious, because people are resistant to change, and often times fixed to a specific viewpoint. It is not surprising, then, that some of the most important skills identified by advocates focused on communication and interper- sonal aptitudes. This finding suggests that advocates need to ex- pect resistance from others and become savvy in the interpersonal and communication mechanisms that can be used to address it successfully.

Looking to the future, our final aim was to better understand how to support an upcoming generation of advocates. To achieve this aim, we inquired about advocates’ recommendations for build- ing advocacy skills, their advice to beginners, how they would recommend bringing in a new generation of advocates, and any additional information they wanted to share for aspiring advocates. Common advice by advocates included taking the time to build one’s knowledge base about the issues being advocated for and to attending to the processes involved in systemic change. Indeed, training models regarding advocacy in mental health (Green, Mc- Collum, & Hays, 2008), and counseling and psychology focus on teaching awareness, knowledge, and skills (Green et al., 2008).

Additional advice centered around remaining true to one’s be- liefs. With so many problems to tackle, beginners to advocacy could be very daunted or overwhelmed, but remaining focused on the particular problems advocates are passionate about not only helps new advocates remain focused, it also helps them build expertise. Many also called for better systems of support and improved education around advocacy in order to advance new

generations of advocates. Such systems appear essential to sup- porting new advocates as they navigate the natural successes and failures of the process. These findings are consistent with previous research by Kozan and Blustein (2018) who stressed the impor- tance of supportive systems for advocates and their need for explicit training in advocacy.

The importance of supporting the growth and skill sets of new generations of advocates was also reinforced by other comments advocates made. For example, a little more than a quarter of the advocates identified successfully training new advocates as one of their greatest successes, with the training focusing on advocating to change systems. In a field charged with treating symptoms and behaviors that are intertwined with the significant traumas and experiences of oppression faced by clients (Mallinckrodt et al., 2014), our training must move beyond treatment and intervention at the individual level, but also prepare psychologists to face systems and policy changes.

The ideas generated by these experts proffer direct implications for graduate programs wishing to embed advocacy training into their programs. As depicted in Figure 1, we present these recom- mendations based on their fit within (a) coursework and curricula; (b) practicum or externship; (c) supervision; and (d) programmatic structure. Although many of these domains are similar to calls by previous researchers—for example Mallinckrodt and colleagues (2014) outline strategies to support social action research, con- sciousness raising, public persuasion, and other critical skills to promote psychologists as advocates—the advice garnered here adds personal and professional details not found in previous work. For example, while it is agreed that trainees need to be knowl- edgeable in systematic inequities (Constantine, Hage, Kindaichi, & Bryant, 2007; Mallinckrodt et al., 2014), our findings suggest it may be most beneficial to support trainee knowledge development in areas that they are already personally or professionally moti- vated to changing. In a similar vein, applied experiences in the community are commonly called on to increase social justice awareness (Asta & Vacha-Haase, 2013; Burnes & Singh, 2010; Caldwell & Vera, 2010; Constantine et al., 2007; Goodman et al., 2004) and based on advocate feedback these experiences may also be important for cultivating community resources, building pro- fessional networks, and enhancing systems-level awareness. Fur- ther ideas for fostering department- or program-level frameworks that model how to advocate (Toporek & Vaughn, 2010) include nuances distilled from advocates’ greatest successes (e.g., provid- ing advocacy awards to local advocates).

Across all training mechanisms, advocates called for increased attention to systems-level problem analysis and partnerships with the community. Although shown as components to be adopted within curriculums and externships in Figure 1, these issues can be addressed across all training facets. Readers interested in instilling social justice advocacy into their program mission or developing advocacy programs or courses for the first time are encouraged to refer to work by Goodman and colleagues (2004) and Mallinckrodt and colleagues (2014). In sum, although psychologists should feel empowered to begin advocacy efforts at any stage in their career, training programs are well suited to foster agents of change by cultivating these skills in trainees early on.

Our findings are tempered by several limitations. First, the sampling strategy of the study used a purposive, snowballing technique that was exploratory in nature and keyed to advocates

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from the Northeastern and Mid-Atlantic regions of the United States. The sample size is small and inclusive of a wide range of advocates, thus the key patterns identified here are not necessarily specific to psychology, but instead represent the range of experi- ences advocates across disciplines may face. Still, the commonal- ities identified by the participating advocates help to provide a framework for how best to advocate and support marginalized populations. Additionally, our sample was predominantly White and are not representative of all careers advocacy can take, yet the purposive sampling technique we employed helped to draw from a relatively wide representation of advocacy work.

Conclusion

The present study aimed to distill how seasoned advocates of historically marginalized and underserved populations across diverse disciplines conceptualize and define advocacy, navigate the chal- lenges and successes of advocacy, and propose to support new gen- erations of advocates. We included a rich sample of leading advocates representative of multiple disciplines to distill the critical components of advocacy that are most applicable to psychologists working in a wide array of public service settings. Our aim was to provide specific examples and illustrations of major features of advocacy that occurs on behalf of marginalized groups. The findings suggest that trusting and supportive relationships across professionals and clients are crit-

ical to successful advocacy and are consistent with the findings of Goodman et al. (2018) in their description of a relationship-centered advocacy model. With a collaborative framework in mind, psychol- ogists working for change in community settings should transcend simply speaking for their clients but work as partners with their clients and colleagues to make change together, drawing on vast networks of professionals and community stakeholders. These processes, which are inherently personal, require advocates to reflect on their own stories, building self-awareness, and to draw clear lines between the issues they are advocating for that directly link to promoting the needs of their clients and their own storylines. Additionally, advocates need to build relationships with other advocates on all sides of issues to advance their work, to clarify and sharpen their arguments, and to extend the impact of their efforts. To expand and enhance advocacy activities, psychology graduate preparation programs need to provide mentoring and teaching that instills a social justice framework, so that new advocates who often dwell at the foot of walls of oppressive voices, can as Nadal (2017) exhorts, “advocate for the good of humanity” (p. 936).

References

American Psychological Association. (2017). Multicultural guidelines: An ecological approach to context, identity, and intersectionality. Retrieved from http://www.apa.org/about/policy/multicultural-guidelines.pdf

Figure 1. Training implications from key ideas reported by advocates. Question categories are shown in bold, with key ideas listed beneath each category; Training implications are shown in center of figure, showing question domains that recommendations emerged from in parentheses; ACA � American Counseling Association; Hage and Kenny, 2009; Pieterse et al., 2009; Ratts and Hutchins, 2009; Singh et al., 2010; Constantine et al., 2007; Mallinckrodt et al., 2014; Caldwell and Vera, 2010; Goodman et al., 2004; Ratts, DeKruyf, and Chen-Hayes, 2007; Asta and Vacha- Haase, 2013; Burnes & Singh, 2010; Glosoff and Durham, 2010; Toporek and Vaughn, 2010.

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Boccio, D. E., Weisz, G., & Lefkowitz, R. (2016). School psychologists’ management of administrative pressure to practice unethically. Journal of Applied School Psychology, 32, 313–348. http://dx.doi.org/10.1080/ 15377903.2016.1207737

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Received June 28, 2018 Revision received December 28, 2018

Accepted April 9, 2019 �

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12 ROGERS ET AL.