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Jansson Details Better Advocacy for Better Healthcare

  • Research

With recent news that the state of California lost tens of millions of dollars in federal funding to provide health care to uninsured children – because it didn't enroll enough children to qualify for Medicaid and Medi-Cal – the importance of patient advocacy has become clearer than ever before.

Bruce Jansson, professor with the USC School of Social Work, has written a new book, Improving Healthcare Through Advocacy: A Guide for the Health and Helping Professions, to address problems just like this.

Using new case advocacy and policy frameworks, and more than 100 case studies, Jansson explains how health care professionals, including social workers, can better navigate the U.S. health care system for their clients and patients.

Situations such as that of the 24,000 uninsured California children could have been avoided, Jansson said, if there were more people advocating to get them in the state's health care system, which can be daunting to even the most seasoned professionals.

"What consumers obtain is ultimately determined by professionals on the ground and how they advocate for patients who aren't getting what they need," Jansson said. "Lots of people fall between the cracks – we need to go the next step to help them."

In "Improving Healthcare Through Advocacy," Jansson has determined the tasks that case and policy advocates need to perform to effectively help their clients. Both frameworks set forth eight tasks each.

Case advocates must read the context of the situation, determine which health care consumers would benefit from advocacy and prioritize the people who most need assistance. They then diagnose why specific people need advocacy, develop a planned intervention and implement advocacy with specific consumers. After that, advocates assess the outcomes to decide whether they need to continue with the same or different strategy, and they determine whether to progress from case to policy advocacy.

Should advocates decide that the best option in helping their clients is to change policy, they will encounter eight challenges.

Policy advocates will need to decide whether to proceed with policy advocacy in a specific situation and then determine what policy they wish to change and in what location. They must secure decision makers' attention, develop a base of support, develop a proposal and secure the enactment or approval of that proposal. Once they have accomplished this, advocates need to secure implementation and assess or evaluate the implemented policy.

"Case advocacy and policy advocacy should go together. I see them as companions," he said. "I view advocacy as a bottom-up approach that complements the top-down."

The inspiration for this book came to Jansson while he taught a health concentration class. His students helped contribute to the manuscript; those who had field placements in hospitals and clinics provided many of the case studies described in the book.

"Healthcare professionals need intervention, communication and influence skills to advocate effectively. Existing health literature doesn't tell you how to do it," Jansson said. "This book is geared toward health professionals who see patients, or consumers. I wanted to give them hands-on skills through frameworks and case examples. "

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