Preface xi
1 Embedding Advocacy in the U.S. Health System 1
Seven Problems Commonly Encountered by Healthcare Consumers 2
Advocacy 3
Scenarios and Vignettes 6
Resurgence of Interest in Case and Policy Advocacy 8
Advocacy From Outside the Health System 10
Advocacy as an Underground Activity 11
Advocacy as an Ethical Imperative 11
A Philosophical Premise 12
An Outline of This Book 13
Online Materials Relevant to This Chapter 13
2 How the U.S. Health System Contributes to Consumers' Seven Problems 15
The Poor Law Tradition 15
Emphasis on Technology 17
Entrepreneurialism 17
Insufficient Emphasis on Prevention 17
Lack of Diversity in Medical Personnel 18
Uneven Acceptance of a Biopsychosocial Framework 19
Medical Silos and Insular Care 19
From History to Case and Policy Advocacy 21
Online Materials Relevant to This Chapter 22
3 An Advocacy Practice Framework: Tasks, Skills, and Actions 23
Brief Overview of Case-Advocacy Interventions 23
Eight Case-Advocacy Tasks 24
Task #1 Reading the Context 24
Task #2 Triage 27
Task #3 Allocating Case-Advocacy Services 32
Task #4 Diagnosing Task 33
Task #5 The Strategizing Task 40
Task #6 Implementing Case-Advocacy Strategy 50
Task #7 Assessing Advocacy Interventions 50
Task #8 Progressing to Policy Advocacy 51
Case Advocacy for a Very Sick Child 51
Summary 56
4 Case Advocacy Skills 59
Four Skills for Reading the Advocacy Context (Task #1) 59
Four Skills for Case-Advocacy Triage (Task #2) 60
Four Skills for Allocating Case-Advocacy Services (Task #3) 61
Four Skills for the Diagnosing Task (Task #4) 61
Four Skills for the Strategizing Task (Task #5) 61
Four Skills for the Implementing Task (Task # 6) 62
Four Skills for the Assessing Task (Task #7) 62
Four Skills for the Progression Task (Task #8) 63
Two Skills in More Detail 63
The Nature of Influence 63
Empowering Consumers 65
Empowerment (Continued) 83
Advocacy With Respect to Seven Consumer Problems 96
5 Advocacy to Protect Consumers' Ethical Rights 97
Promoting Ethical Conduct in Healthcare 97
The Policy and Regulatory Thicket for Promoting Ethical Conduct 101
Obtaining Skills in Ethical Reasoning at the Case Level 106
Nineteen Scenarios Encountered by Case Advocates 115
Summary 137
Moving From Case-Advocacy Scenarios to Broader Policy Issues 141
Online Materials Relevant to This Chapter 142
6 Advocacy to Improve Consumers' Quality of Care 143
A Definition of ``Quality Healthcare'' 143
General Criticisms of the Success of U.S. Healthcare in Addressing Physiological Illnesses 144
The Policy and Regulatory Thicket as It Pertains to Quality of Care 146
Fifteen Scenarios Encountered by Consumers With Respect to Quality of Care 159
Online Materials Relevant to This Chapter 176
Progressing From Case Advocacy to Policy Advocacy to Enhance Quality of Care 176
7 Advocacy to Promote Culturally Competent Health Services 179
Conceptualizing Cultural Competency 180
What It Means to Be Culturally Competent: A Conceptual Framework 182
The Case for Providing Culturally Competent Services 185
The Policy and Regulatory Thicket 189
Ten Scenarios Pertaining to Culturally Incompetent Services 192
Policy Advocacy to Promote the Cultural Competency of the Health System 207
Moving From Case Advocacy Scenarios to Broader Policy Issues 210
8 Using Advocacy to Promote Prevention in Health 211
Defining Prevention 211
Threats to Health 213
Prevention Goals and Strategies 214
Why U.S. Consumers Particularly Need Prevention 219
Barriers to Prevention 221
The Policy and Regulatory Thicket 229
Twelve Scenarios of Consumers Regarding Preventive Services 239
Moving from Case Advocacy to Policy Advocacy 251
Summary 252
9 Using Advocacy to Help Consumers Finance Their Healthcare 253
Buck-Passing 260
Seniors' Angst 264
The Medical Wheel of Fortune 267
Some Effects of Poor Coverage on Health Outcomes 275
Ripple Effects of Health Costs and Coverage 276
The Policy and Regulatory Thicket Protecting
Consumers With Respect to Health Coverage 278
Twenty Scenarios Encountered by Advocates 280
Moving From Case Advocacy to Policy Advocacy 295
Fifteen Scenarios Presented in This Book 295
Online Materials Relevant to This Chapter 295
Summary 296
10 Advocacy for Healthcare Consumers Needing Mental Health Services 297
Why Many Consumers Turn to Health Settings for Help with Mental Conditions 297
Kinds of Mental Distress Often Experienced by Consumers 300
Who Attends to Consumers' Mental Health Needs? 303
Some Liabilities in the Policy and Regulatory Thicket 304
Assets in the Policy and Regulatory Thicket 306
The Policy and Regulatory Thicket: Laws, Regulations, and Staff That Facilitate Social and Mental Health Services 319
Twenty-Six Scenarios Encountered by Case Advocates 321
Online Materials Relevant to This Chapter 343
Moving from Case Advocacy to Policy Advocacy 343
11 Advocacy to Help Consumers Receive Community-Based Care 345
Consumer's Health Ecosystems 345
A Compendium of Community-Based Health Services 348
Assets and Liabilities in the Policy and Regulatory Thicket 349
Fifteen Advocacy Scenarios for Consumers Needing Community-Based Care 361
Moving From Case Advocacy to Policy Advocacy 374
Online Materials Relevant to This Chapter 374
Summary 375
12 A Framework for Policy Advocacy by Healthcare Professionals 377
The Importance of Policy Advocacy 377
A Policy Advocacy Framework 379
Surmounting Fatalism, Controversy, and Vested Interests 387
Policy Advocacy in Four Settings 390
13 Using Policy Advocacy to Embed Advocacy in Healthcare Organizations 391
What Advocates Seek to Change in Health Organizations 391
Using Policy Advocacy to Embed Advocacy in Health Organizations 395
Summary 420
14 Policy Advocacy in Community, Electoral, and Government Settings 421
Health Advocacy in Communities 421
Policy Advocacy in Electoral Settings 425
Policy Advocacy in Legislative and Regulatory Settings 426
Advocating for Regulatory Changes 429
Establishing a Policy Agenda in Specific Health Settings 430
Online Materials Relevant to This Chapter 431
Summary 431
References 433
Author Index 457
Subject Index 469
