A Differential Model of Advocacy in Social Work Practice

Freddolino, Paul P

Abstract

Although advocacy is a central aspect of social work practice, there is considerable variation in its purpose, aims, and roles within human services, infusing it with a rich and diverse character. On the basis of a differentiation of who controls the ends or outcomes of advocacy and who controls its means or process, the authors offer a differential model that encompasses four major traditions of advocacy within the profession: protecting the vulnerable, creating supports to enhance functioning, protecting and advancing claims or appeals, and fostering identity and control. The authors then identify four forms of advocacy and examine the conditions under which social workers are likely to employ each of the four variants.

Although social workers cannot lay exclusive claim to advocacy as a practice method, they do assert that advocacy is a critical if not an essential feature of contemporary professional practice (Kaminski & Walmsley, 1995). Although major textbooks on generalist practice identify the importance of advocacy as a basic function of professional social work (Hepworth, Rooney, & Larsen, 1997; Kirst-Ashman & Hull, 2002; Miley, O'Melia, & DuBois, 1995), they do not highlight what is distinctive about advocacy. Ezell (2001) suggested that advocacy constitutes those purposeful activities social workers undertake to change policies, practices, and conditions on behalf of individuals or groups. Schneider and Lester (2001) indicated that the distinctiveness of advocacy lies in the efforts social workers undertake to represent clients or a cause in order to effect changes in decisions, particularly those that involve the control of resources and thereby reduce or eliminate injustice. From these perspectives, the distinctiveness of advocacy lies in the provision of representation and in efforts to influence decisions.

Although both engaging in representation and influencing decisions are important aspects of the social work advocacy process, from our perspective, the distinctiveness of advocacy within social work lies in its ultimate aim. The purpose of advocacy within the profession is to improve the social status of individuals who may be considered vulnerable or oppressed, thereby enhancing their standing within a specific social system whether it is a community, organization, service system, societal institution, or society itself.

Within the profession, portrayals of social work advocacy involve system level (e.g., case and class advocacy), type of service (e.g., family service, case management), form of advocacy (e.g., legislative advocacy, whistle blowing, rights representation), social reaction to recipients (e.g., people who experience oppression and people who are considered to be vulnerable), and diagnostic category of recipients (e.g., people with mental illness, people coping with HIV/AIDS). Portrayals of advocacy within social work also can involve service system setting. Still other agencies specialize in this kind of professional function (e.g., rights protection agencies helping persons with developmental disabilities), whereas others integrate advocacy into other helping tasks (e.g., community support systems for people coping with mental illness). Some agencies leave to the discretion of social workers whether they engage in advocacy and the extent to which they engage in this professional function. However, there really is no explicit model that organizes the essential features of this important social work function into a unified framework to guide the provision of advocacy under different circumstances or conditions.

Given the attention to this aspect of practice in generalist textbooks and in the profession's statement of practice ethics, social workers clearly recognize the importance of advocacy. In addition, most social workers likely endorse the importance of advocacy to the advancement or improvement of the social standing of the people they serve. Given these conditions, it is not enough to argue that professionals should engage in advocacy or even to assert that advocacy is an essential aspect of practice. It is clear that social workers must use different forms of advocacy to advance the status of their recipients, who themselves vary in their needs and in the issues they face. This offers an opportunity to place advocacy into a differential framework of practice. Failure to clearly organize this variation into a framework or model that illuminates the different forms of social work advocacy and its implications for practice obscures this area of social work practice unnecessarily. Given the importance of advocacy to social work practice, this lack of clarity is problematic. The framework we propose can help practitioners to differentiate which approach to advocacy is most appropriate in a given situation. Such a model would assist social workers to realize that some approaches to advocacy may be inappropriate under certain circumstances and can produce negative unintended consequences as a result.

The purpose of this article is to offer a model that delineates four different types or forms of social work advocacy. These four approaches capture the variation in how professionals currently view advocacy as a function of social work practice. The model illuminates the differential applications of advocacy. The article not only identifies the various activities of social workers who choose to serve as advocates but also organizes this variation into a model of social work advocacy that supports practice under different service and recipient conditions. The knowledge base of this framework comes from the our work in the demonstration and evaluation of advocacy programs (Hyduk & Moxley, 1997, 2000; Moxley & Freddolino, 1994) and from research on how advocates construct their practice (Moxley, 2001).

Four Traditions Underlying Advocacy in Social Work Practice

Definitions of advocacy based on its objectives within the social work profession abound, and they do share some consistent themes. These themes involve social workers championing the rights of others, defending others from abuse or dehumanizing circumstances, overcoming bureaucratic barriers to service or entitlements, and facilitating access to resources or opportunities (Kirst-Ashman & Hull, 2002). Such objectives themselves may vary by the conditions under which social workers undertake advocacy. For example, the social worker in direct service with highly vulnerable people may take what Zastrow (1999) referred to as "an active directive role" (p. 18), acting autonomously on behalf of people who cannot represent themselves because of limitations in communication, cognition, judgment, or other aspects of personal or social functioning. In other situations, the social worker may act in a nondirective role. This is achieved by respecting the choices and actions of recipients and by respecting or deferring to how they want to fulfill those needs they specify and prioritize (Freddolino & Moxley, 1992, 1993; Rose & Black, 1985).

Cutting through the sheer diversity in professionals' descriptions or portrayals of advocacy are several types or forms of advocacy that social workers can employ under different conditions of practice. Advocacy is not a uniform practice function social workers can approach in a homogeneous way. It is critical for social workers to understand that different types of advocacy involve different conceptions of the social issues that require advocacy, different social responses to problems, variations in factors that are assumed to create the need for advocacy, and different conceptions of the appropriate role of the social worker vis-a-vis the recipient of advocacy.

The best traditions of social work frame the model we propose, a model involving the responsiveness of social workers to people who are vulnerable and to people who cope with marginalization and oppression. Social workers in practice may differentiate between whether and to what extent recipients can control their situations and speak for themselves. As a result, the advocacy approach social workers take may be influenced by their assessment of the extent to which recipients have the capacity to exert control over-or otherwise influence-their situations, particularly in the identification of what they want to achieve for themselves. Indeed, these traditions influence how practitioners conceive of social work practice and how they define advocacy in relationship to the situations of recipients. These traditions suggest two principal dimensions of advocacy practice that together can be thought of as the situation of the recipient of advocacy. The first dimension involves whether the professional or the recipient controls the ends of advocacy, that is, the ultimate goals that recipients would achieve. The second dimension involves whether the professional or recipient controls the means of advocacy, that is, the manner in which the ends of advocacy are achieved. By integrating these two dimensions and linking them to the traditions of social work advocacy, we construct a model that more clearly delineates a differential model of advocacy than what current portrayals of social work advocacy allow.

Illustrated in Figure 1 are the two principal dimensions of the advocacy model (control over ends, control over means) and the traditions that populate the cells. The four traditions that are most relevant involve protecting the vulnerable (Cell 1), creating supports to enhance functioning (Cell 2), protecting and advancing claims or appeals (Cell 3), and fostering identity and control (Cell 4). The practice traditions that emerge as themes in social work advocacy demonstrate just how complex this area of practice can be and how important it is for social workers to recognize the underlying diversity of advocacy. Each tradition fosters a different form of social work advocacy that is applicable to different situations of practice.

Protecting the Vulnerable

Certainly a practice tradition that links advocacy to social work practice involves the protection of the members of vulnerable populations and the advancement of the well-being of the individuals who compose these populations. Gitterman's (1991) conceptualization of vulnerability within the context of the social work profession is useful here. He based his conception of vulnerability on two considerations: one he called environmental resources and the other personal resources. The former consideration involves the supports, opportunities, and resources a community or group offers to people, whereas the latter consideration involves the ability of people to care for themselves and to engage in self-direction. Individuals low in personal and environmental resources are highly vulnerable and likely need or would benefit from someone who is willing to advocate for them. Their ability to care for themselves, and the support available to them, is diminished and as a result the conditions to which they are exposed would likely produce negative consequences, bad outcomes, or perhaps physical damage or even death (Gelles, 1996). Advocacy in this context means that the social worker not only may speak on behalf of this individual but also would muster the resources needed to protect the individual and to advance his or her safety and well-being. The parent who has mental retardation, for example, may require considerable support in raising children. Furthermore, he or she may require a dedicated advocate who is willing to speak on his or her behalf vis-a-vis law enforcement personnel, child welfare professionals, or school officials who may be suspect of the person's ability to parent effectively.

This form of advocacy is well-established in the profession. Social workers practicing with people whose disabilities limit their capacities to communicate their desires or limit their ability to act with independence often serve as surrogate decision-makers. They must anticipate and judge what a person needs to have some semblance of a decent standard of living or quality of life. Often social workers practicing in this tradition make basic decisions about daily living, including housing, income, and health care as if these decisions were for themselves or for loved ones.

The advocate using this form of advocacy may be the only person that truly takes the side and the perspective of the person who is considered to be severely disabled, frail, or impaired. The underlying assumption is that people with these conditions cannot speak for themselves or do not have the functioning to otherwise fulfill their own needs, and therefore they must yield their decision-making authority to another person who may be legally sanctioned to assume this responsibility on their behalf. This form of advocacy may be highly prevalent in systems of guardianship, rights protection, and case management in which social workers have strong authority to oversee the care and treatment of people with severe impairments. These advocates are empowered to make critical life decisions, particularly those relating to financial status, health care, and the continuation or discontinuation of critical life support.

A social work advocate in this tradition literally seeks to protect the person from physical, emotional, or financial abuse, or neglect and unnecessary, restrictive, or inappropriate manipulation by others. Such advocates seek to make those decisions that are in the interests of the recipient even though the recipient may disagree or resist these decisions. Good advocacy here means offering the requisite protection to ensure the safety of the person. These advocates may see themselves as possessing a duty to act and, by virtue of this ethic, they must respond to the dependency of recipients to protect them from imminent or future harm even if this means abridging or abrogating their freedom.

In-depth interviews of 54 professional advocates offering a combined form of social advocacy and guardianship to people with developmental disabilities through an independent and autonomous agency reveal how these advocates assessed need and framed action (Moxley, 2001). They based their actions on assessments of the extent to which people could identify and judge for themselves what they needed juxtaposed against an assessment of the extent to which residential care environments and families could provide support.

These advocates followed Gitterman's (1991) concept of vulnerability. People who cannot exercise a great deal of self-direction and self-care, who have weak or nonexistent family supports or ties, and who reside in total institutions that objectify their needs and ration services are seen as the most vulnerable. These advocates felt that taking a stand for their clients and insisting on proper, timely, and effective care formed a cornerstone of advocacy practice. Such advocates conceive of themselves as standing for the interests of people with severe disabilities, and they seek to protect them in systems that could otherwise depersonalize, neglect, or abuse them. They represent the interests of people with serious impairments as if these interests were their own (Wolfensberger & Zauha, 1973).

Creating Supports to Enhance Functioning

In the tradition of creating supports to enhance functioning, the development of effective support systems or services, in partnership with the recipient, is a fundamental aim of advocacy. The social work advocate practicing in this tradition recognizes the important linkage between support systems and the manner in which people function. From the perspective of this tradition, people can become highly vulnerable if these supports are not available, particularly if service systems neglect to understand the broad scope of social supports people require to function effectively or appropriately. Alternatively, this tradition asserts that people often can function well if these supports are available, adequate, and suitable to their needs.

It is a basic tenet of social work within this tradition that functioning is optimized through a good match between what a person needs and relevant supports to meet these needs. Gitterman's (1991) concept of vulnerability underscores how deficits in environmental supports increase vulnerability and, as a consequence, can reduce functioning. The objective of this type of advocacy is to reduce vulnerability by increasing the support of the person. Unlike the previous tradition that emphasizes the protection of the individual, this tradition values environmental intervention often in the form of innovative service development. Advocacy is not a matter of protecting people but of advancing the functioning of people through high quality services and supports. In this tradition, the social work advocate demands service improvements or asks for a service system to increase the quality of care through the investment of more resources into the support of a particular individual or group of individuals. Social workers may advocate for families who need augmented services, such as skill training, environmental support, housing stabilization, and the enhancement of opportunities (e.g., education or employment), which must be organized on an individualized basis through a consideration of a multitude of variables, including the ethnicity, culture, and structure of the family. It is not unusual for social workers to see themselves not only as the advocates of particular families but also as advocates of good practice.

Three recent developments in social welfare validate this tradition. They illuminate the powerful role of social supports that are matched to the needs of people who are otherwise vulnerable without these kinds of environmental resources. The change in the definition of mental retardation in the early 1990s by the American Association on Mental Retardation (AAMR) indicated that mental retardation was not a result of subaverage intellectual functioning and deficits in adaptive behavior alone (AAMR, 1992). Labeling a person as having mental retardation also requires having an understanding of his or her support systems and the responsiveness of these supports to the functioning of the person. The implication is that a person's intellectual functioning and adaptive behavior could be enhanced under highly supportive conditions, a recognition of the influential role of environmental support in the development of individuals and in the enhancement of functioning and role performance.

The supportive living movement in human services is another development that demonstrates the linkage of environmental support to individual functioning. The arrangement of environmental supports to enhance outcome in the areas of education, housing, employment, and independent living can decrease vulnerability. This outcome occurs not only when people receive adequate support but also when there is a good match between the outcome a person is seeking to achieve and the arrangement of these supports. In other words, in this tradition, advocacy involves tailoring support to achieve a substantive functional outcome. Indeed, advocacy in the context of rehabilitation practice identifies the importance of positioning a support to weaken or remove a barrier or to enhance a skill so that a person achieves a substantive outcome as a result.

This matching of support to the functional needs of people to facilitate their health, particularly among people coping with severe illness and with disability as a result of illness, is another development in this decade that gives credence to this tradition in social work advocacy. As biomedical innovations support the extension of the lifespan of people coping with HIV/AIDS, new social supports emerge as people function better despite their illnesses. New aspirations for independent living can emerge among people who would otherwise be too ill to achieve those goals they value most. A very promising development among people coping with HIV/AIDS is the increasing return of many individuals to competitive employment, a change that is a product of better management and control of the illness as well as more enlightened attitudes about the disease itself. This option, in turn, requires new forms of supports, substantive accommodations to work environments, and the application of accessible design principles to facilitate participation of people with disabling conditions in mainstream institutions and the opportunities they afford. Fostering the creation and development of these supports is the basis of this approach to advocacy.

Advocacy within this tradition of practice involves social workers' efforts to advance, improve, and/or extend these environmental supports that often come in the form of concrete services, in-home supports, facilitation of community mobility, emotional sustenance, and supportive forms of decision making and problem solving. Typically, professionals remain in control of the ultimate ends of these supports, such as when a social policy requires people to seek and secure employment. However, the identification, choice, and use of environmental supports that people require to achieve this end are often left in the hands of the recipient. This type of advocacy typically requires that recipients get adequate, appropriate, and accessible supports to achieve an end that likely is not specified or prioritized by recipients themselves. Rather this end comes to them as a societal expectation (e.g., you will go to work; you will remain out of trouble; you will stop using substances).

With emphasis on advocating for better services and supports, highly valued in this tradition is the involvement of the recipient in the process of service provision, and it is likely that advocacy would be directed to the empowerment of the recipient in decisions pertaining to support. Social work advocates in this tradition often create new roles for recipients, and they promote extensive involvement of recipients in the identification of needs and in the planning and evaluation of environmental supports. Advocacy in this tradition seeks to strengthen the voice of recipients in service systems that typically value the perspective of professionals over those of consumers. Although recipients may not have much control over the actual ends of advocacy, they may have extensive involvement and control over the means (i.e., the services and supports) that result in the achievement of the ends, the establishment and specification of which are basically out of the hands of recipients.

Recent developments in psychiatric rehabilitation, vocational rehabilitation, and case management focus on expanding the roles of clients both as recipients and as providers of services through the articulation of mutual support and self-help arrangements as well as through new procedures that foster consumer involvement (Moxley & Mowbray, 1997). Service delivery models that foster wraparound, family support, and team-based service delivery can involve recipients in new ways of extending professional care and in helping their peers to achieve substantive goals pertaining to standard of living, quality of life, and behavioral health. However, the underlying aim of this type of advocacy remains consistent. It is to reduce the vulnerability of people through the creation and implementation of supports that are responsive to their needs. The identification of, prioritization of, and response to these needs typically are in the hands of professionals and not under the direct control of recipients.

Advocacy that results in consumer role innovation is most visible in innovations to the financing of human services. Investing recipients with the power to purchase services involves them increasingly in new roles as part of market systems of human services. Recipients as purchasers means that they are able to secure those services or supports that most likely express their own preferences even though these recipients may not be able to control the substantive outcome that is specified at higher levels of bureaucratic or institutional control. The advocate becomes a case manager who assists recipients to make the best choices possible about the form and substance of service and support. Thus, for example, recipients receive more control over their vocational rehabilitation benefits through voucher arrangements. Although they can choose providers they must ultimately comply with the expectation that they will secure and keep a job.

Protecting and Advancing Claims or Appeals

The tradition of protecting and advancing claims or appeals frames advocacy in a more legalistic and bureaucratic context than does the other traditions. In this tradition, the recipient of advocacy possesses substantive and procedural rights that he or she can potentially exercise as an enfranchised citizen. Unfortunately, often the exercise of these rights is not straightforward, as these rights can ensnare someone who does not have the technical or procedural knowledge they need in order to fulfill them in a given situation and to exercise them in a self-directed manner. The absence of this knowledge, as well as the operation of a number of social factors (e.g., social class, race, ethnicity, and gender), can create high levels of oppression (Baynton, 2001; Gil, 1976). In this context, oppression results in the placement of severe restrictions on a person or the denial of essential resources because of his or her social position and/or social characteristics resulting in the deprivation of rights, opportunities, and life sustaining necessities (Barnartt & Scotch, 2001). This tradition emerges when societies discriminate against individuals and can result in strong forms of representational advocacy that focus on the advancement or creation of rights.

In the greater society and its institutions, this oppression is exerted by diminishing the status of a person on the basis of his or her social characteristics and by diminishing a person's standard of living, quality of environment, and ultimately, the quality of life. In a society in which the social rights of a person are not strong or well-defined, or in which they are subject to bureaucratic control and/or interpretation, people can experience severe deprivation (Fleischer & Zames, 2001). In addition, they may not have the capacities to deal with the very social institutions or structures that control these rights and that allocate valued roles and statuses. In its extreme manifestation, oppression can result in victimization when people cannot access the resources they need, gain the benefits they require for a decent quality of life, or are treated in ways that negate their identity or that dehumanize them (Barnartt & Scotch, 2001; Kotlowitz, 1992, Kozol, 1996).

It is within this tradition that social work advocates may engage in the most adversarial form of advocacy. Social work advocates may actually operate in quasi-legal roles when they learn the substantive and procedural aspects of a particular social benefit system and then assume the representation of the person in those forums in which judicial or administrative personnel hear a person's case. Those social workers that serve as client advocates in housing, employment, or income maintenance situations likely understand the complexity of advocacy in these contexts and how these situations can overwhelm the people they represent. It may take a social worker years to master the substantive and procedural aspects of a benefit system and to maintain a strong vigilance in keeping abreast of new developments and changes in policies and procedures.

This tradition also may operate in other advocacy contexts as well. For example, rape counseling or domestic violence work requires social workers to represent clients in complex health and legal situations. Social workers represent their clientele vis-a-vis law enforcement personnel and prosecutors that may not be responsive or sensitive to the needs or situations of victims. They undertake this representation when their recipients are most damaged or immobilized, and they need to make systems respond in a manner that not only helps victims to address their primary concerns but also ensures that these systems do not induce further damage, a form of secondary victimization. In other contexts, social workers may advocate for the rights of a parent to retain custody of children, or to keep children within their natural families and out of foster care. Victims of rape, or parents who must deal with a child welfare authority, may not possess the motivation, stamina, or knowledge to guide themselves through a complex matrix of rules, regulations, and requirements. The social worker recognizes this incapacity (which may be temporary or permanent depending on circumstances) and chooses to manage the process independent of the recipient.

Advocacy in this tradition stands for the vigilant assertion of the rights of a person who experiences oppression within major societal institutions. Similar to their colleagues in law, social workers practicing advocacy within this tradition work with their recipients to define their desires or wishes in a given context. Once recipients express these desires and frame a goal or outcome, the social worker controls the means of advocacy most likely involving representational processes.

Social workers may invoke several reasons to justify the control they assert over the advocacy process. One important rationale lies in the complexity of the systems in which justice is sought. It is probably difficult for a newcomer to decipher how, for example, social security benefits operate, and if the person represents him- or herself in an administrative forum, it is likely that he or she would be overwhelmed by the sheer complexity of the system and by its procedural requirements.

A second rationale lies in the power of those actors who control the resources or benefits the recipient seeks. The power of decision-makers may frustrate the ability of even the most talented lay people to advance their claims or appeals. The layperson, who often is someone of diminished status vis-a-vis the bureaucratic actor, may be ignored, kept waiting, or rebuked. The system itself can communicate to petitioners that they hold little value. A dedicated advocate who represents the desires or wishes of recipients can strengthen the bargaining positions and empower the claims or appeals of the people they represent.

Finally, a third rationale lies in the amount of sustained and focused energy it can take for a person to break through to a decision regarding rights and benefits. Few recipients may have the time, energy, and resources to make this commitment, and they may easily withdraw from the process of pressing their issue or claim when they find their best efforts frustrated early in the process. The dedicated social work advocate who stakes out practice in a substantive rights or benefits area likely would not recede from involvement even though they may face seemingly intractable barriers. Vigilance in the face of frustrating and complex bureaucratic and social forces is the cornerstone of this tradition of social work advocacy.

Fostering Identity and Control

This form of advocacy takes place when people seek to gain control over their lives, and advocates support them in a manner that brings them the most satisfaction as they define it (Charlton, 1998). Forces of oppression may work against people who possess social, physical, or biological characteristics that people in the greater society do not value or even seek to devalue. Degradation or devaluation expresses itself as stigma and can result in discrimination and dehumanization (Linton, 1998). If there are weak social supports, benefits, and rights for these individuals, they may literally find themselves on the margins of the society without any representation and with little support. Devaluation can ultimately express itself as the segregation of members of these groups in total institutions, ghettos, and enclaves that are cut off from mainstream society and community life. Personal and environmental degradation goes hand-in-hand and results in heightened susceptibility to disease, disability, and death (Kozol, 1996).

There are several ways advocacy can foster identity and control. Paradoxically, a principal way is to facilitate positive segregation and withdrawal from the larger community in the name of individuals finding their own way, forming groups, and establishing their own community life (Lane, 1992). In this tradition advocates seek to help individuals identify and celebrate their differences as cultural strengths, foster meaningful relationships with those groups with which they identify, and muster symbols that identify the community as a positive force within the larger society (Jankowski, 1997). Those in the disability rights movement seek this kind of self-identity and control, as do Vietnam veterans and those in the gay and lesbian movements.

This tradition of advocacy can result in the establishment of indigenous institutions that represent and are under the control of the oppressed members of the greater community who bond together under the banner of their own values, symbols, and sentiments. In the realm of human services, this identity and control expresses itself through the founding of mutual support opportunities and self-help activities (Zinman, Howie the Harp, & Budd, n.d.). These are independent of formal human services, and often they take grassroots forms and likely are very informal in nature. The creation of clubhouses, drop-in centers, housing arrangements, crisis intervention projects, performing and visual arts projects, and business enterprises by and for oppressed persons exemplify this kind of institutional development.

These institutions may be counter-cultural in that they foster values that the established system of services may not legitimize. However, structural advocates (i.e., advocates that seek to change social arrangements) can foster these helping and support alternatives. Advocates based in this tradition seek to augment the power of individuals who are marginalized by the greater society through changes in their roles and statuses and through control over resources, decisions, and actions. They seek to change the relationship between those who need social benefits and those who control these benefits.

Individual recipients of this form of advocacy may receive support to invest their public benefits into self-help or mutual support alternatives. Or, individual recipients can engage case managers who are accountable directly to them and whose roles are designed to help recipients to create the service or support arrangements that are responsive to their needs, plights, or desires as they define them. Advocates in this tradition reframe what accountability historically means. They shift accountability from accounting for the use of resources to bureaucratic authority to accounting for the use of resources to the personal authority of consumers.

In situations in which recipients do not have control over monetary resources, this tradition can involve other ways of reinforcing identity and control. An advocate operating in this tradition can help people to define what they want and help them to gain the knowledge, skills, and motivation to achieve their own aims as they define them. This personal form of advocacy places great emphasis on the advocate's ability to support the self-help efforts of recipients, particularly when recipients do not want advocates to control either the process or the outcome of advocacy.

The principal outcomes of this from of advocacy are empowerment ones. Recipients get control of the apparatus that offers them service and supports. They become purchaser-clients who control expectations pertaining to service quality and service outcome. Ultimately, recipients within this tradition of advocacy strengthen their identity through the sheer control they gain over the benefits and resources they want to meet social needs as they define them. They become empowered by deciding what they want to achieve and by actualizing what they want through their own efforts with the support of a dedicated advocate.

A Model of Social Work Advocacy

These four traditions of advocacy practice coalesce into what social workers often characterize as advocacy. The traditions suggest four distinct types of advocacy independent of system level (e.g., policy advocacy versus individual advocacy) or service system (e.g., mental health or child welfare). In Figure 2, these traditions are organized into four forms of advocacy, two that are appropriate in situations in which social work advocates consider recipients to be vulnerable and two that are relevant when social work advocates consider recipients to be oppressed. The assessment of vulnerability essentially involves social work advocates determining whether recipients possess the cognitive and intellectual abilities to speak for themselves, recognizing that such abilities may be augmented through the use of assistive or enabling technologies and close observation of nonverbal or paraverbal behavior through which people can express preferences (Moxley, 2001). Given the stereotypic assumption that people with severe disabilities may not be able to speak for themselves, good advocates likely suspend their judgment about the capacities of recipients until they exhaust all opportunities for people to express their desires (Moxley, 2001). Thus, the determination of vulnerability should be a residual decision.

The assessment of oppression, on the other hand, focuses the attention of social work advocates on the extent to which a person is victimized by social reaction, stigma, and social exclusion, which can result in rejection or even physical harm. Recipients who experience oppression may respond with hostility, anger, and verbal or even physical retaliation. Advocates may quickly assess oppression by listening closely to recipients' narratives and perspectives about not being heard, not being taken seriously, and being essentially ignored or, under more extreme circumstances, being isolated, physically restricted in their movements, or deprived of basic rights on the basis of social reaction to their characteristics or qualities.

Certainly vulnerability and oppression can interact and coalesce. An example would be in situations in which people with limited cognitive and intellectual functioning engage in harmful or threatening behaviors that lead to negative social reaction, such as cases of sexual misconduct, infliction of physical harm on others, or the transmission of infectious disease. Such recipient situations may create very challenging contexts for the provision of advocacy, which may require careful balancing of recipient autonomy and public safety.

In Figure 2, we identify four different forms of advocacy by integrating the two dimensions that identify whether the professional or recipient controls the means (i.e., processes) of advocacy and whether the professional or recipient controls the ends (i.e., outcomes) of advocacy. By bringing these two dimensions together, we formulate a differential model of social work advocacy of four forms that cluster into two principal areas: advocacy under conditions of vulnerability and advocacy under conditions of oppression.

The first tradition (one of two focused on protecting the vulnerable) translates into a form of advocacy we refer to as best interests. Personal or environmental limitations recipients face demand that someone represent their interests because it is assumed that they cannot speak for themselves. This form of advocacy accepts the dependency of the person as quite real and as a threat to their well-being and to their being treated decently. The best advocate in this tradition is the one who is independent of the system and who operates as a watchdog. It is an approach to advocacy that may be ridden by conflict. It seeks to protect the person in systems in which bureaucracies want to control the recipient for their own ends or in which people who hold power may neglect or abuse the person. Providers may become quite put off by the fact that this advocate is dedicated to the interests of the person and not to those of the system. Advocates must be comfortable making critical decisions regarding the basic needs of their clients even though the recipients themselves may disagree vehemently with their interpretation of these needs and the actions they take to fulfill them.

Perhaps empowerment in this tradition means that the best decisions are made on behalf of people who cannot speak for themselves or assert their positions and that the care and treatment of these individuals are improved because there is vigilant, external oversight of their situation. However, this form of advocacy is easily compromised if the advocate fails to be vigilant or dedicated, as can occur when court-appointed advocates fail to act on their obligations to protect their wards.

The second tradition (the support of functioning) frames a form of advocacy that we identify as client-centered. In this form of advocacy, it is assumed that recipients can reduce their vulnerability through services that are state of the art and that are matched to the needs of recipients through professional insight, motivation, and skill.

In client-centered advocacy, the roles of professionals and their interaction in team structures, with the recipient ostensibly serving as a member of this team, become a critical aspect of improving the living circumstances and functioning of the person. Client-centered advocates watch this process carefully and work with diligence to ensure the best process possible, which means that each person has an exemplary personal program that meets individual needs (but most likely as professionals define them). Nonetheless, the advocate in this tradition asks for more and more service and support, and continues to try to escalate expectations of what the system needs to provide to the person.

Advocates in this tradition are very dependent on service systems. They are very susceptible to bureaucratizing values that place limits on how much each person can receive and how much responsiveness the bureaucracy can deliver to the individual whose interests and well-being must be balanced with those of the group and those of the institution. How can a client-centered advocate be so zealous as to achieve much for one person and, as a result, prevent others from enjoying the same level, scope, and quality of benefit? Advocates practicing this form may be susceptible to co-optation and paradoxically rationalize a lower standard of care for some people, or for all people, in the name of extending resources to as many people as possible. Client-centered advocates must be conscious of their dependencies and of the propensity for systems to co-opt their members. They must take a resolute stand on quality of care or support even though they may have an inherent conflict of interest as a member of the very system they are trying to make more responsive.

The third tradition (protecting and advancing claims) yields enabling advocacy. It is this form of advocacy that pushes at the most formalistic aspects of bureaucracy, administration, and rights. Indeed the principal focus of this form of advocacy is on bureaucratic justice, with the intent of cajoling an institution to produce the benefits a person claims as entitlements or as a right. The enabling advocate helps recipients to knock on the right doors, make claims and appeals, and navigate sometimes confusing and Byzantine venues to argue their position and present their case. Empowerment here means getting what one wants or deserves. It does not necessarily mean controlling the actual process because the recipient requires specialized help from an advocate who can decipher bureaucratic procedures and policies and take action on behalf of the recipient in complex situations. With hope, this advocate is not overloaded with numerous responsibilities and burdened by large caseloads. And, with hope this type of advocate is dedicated and tenacious. This form of advocacy is easily compromised if a person is without means, reluctant to persist, or simply exhausted.

We identify the fourth form of advocacy (fostering identity and control) as consumer-controlled. This form of advocacy seeks to increase the control of the recipient vis-a-vis providers of service, individual teams, the system, and ultimately the social institution that distributes or allocates resources, statuses, and roles. It is dedicated to helping recipients gain control through knowledge, skill development, motivational supports, and mastery, and it requires the advocate to support recipients in gaining control over their situations. Procedurally, it is the most difficult form of advocacy to accomplish because it takes time, patience, and sensitivity, qualities many of those in our human service systems may paradoxically lack. Indeed, those in some systems may foster other forms of advocacy (e.g., best interest advocacy and strong guardianship) merely to co-opt both recipients and advocates and to weaken the availability of consumer-controlled alternatives. Consumers themselves may opt for self-advocacy, invoking the support of social workers as technical consultants, or they may join together and engage in mutual support and, in the process, create their own cultures, programmatic alternatives, and service options independent of formal systems and mainstream communities.

Conclusion

Advocacy holds a time-honored position within the profession of social work and the profession's history is well-rooted in the practice of advocacy. Often, however, advocacy within the profession is framed more by system level (individual, class, policy) than it is by the substantive nature of what social work advocates seek to accomplish given the situations of the people that require or want advocacy. The very traditions of the profession hold different implications for the nature of advocacy practice, and they can be translated into four contrasting forms. However, what they hold in common is the aim of improving the status of people who are easily marginalized by total institutions, bureaucratic structures, hostile communities, and neglectful societies.

Variation in forms of advocacy suggest that social workers must reflect on the best match between the situations of recipients and the manner in which advocacy should be undertaken given these situations, recognizing that there also can be institutional constraints that may limit the type of advocacy social workers are able to operationalize. In addition, we indicate that variations in the forms of advocacy frame different roles for both advocates and recipients. Furthermore these variations require social workers to be mindful of what role they undertake within a particular form of advocacy and what role behaviors they must respect on the part of recipients.

The proposed model does not incorporate system level as a critical dimension of advocacy practice. The two dimensions it does incorporate-control over means and control over ends-can be undertaken at micro-, meso-, or macrosystem levels. The scope of activity may vary, but we feel that the basic principles of advocacy we propose remain relevant at whatever system level is chosen for the purposes of advocacy activity.

Advocacy continues to be an important practice method of professional social workers. The model we propose in this article expands the profession's conceptualization of advocacy based on traditions that define American social work as a distinctive profession. Given the conceptual level of the proposed model, research into each type of social work advocacy should be undertaken to document promising practices, examine differential outcomes, document ethical challenges, and identify unexpected consequences, including both positive and negative ones. Basing such research on contrasting theoretical forms can facilitate insight into the relative strengths and limitations of each approach, and such research can expand the profession's understanding of the relative merits of differential advocacy practice.

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Paul P. Freddolino, PhD, is professor, School of Social Work, Michigan State University, 214 Baker Hall, East Lansing, MI 48824. E-mail: [email protected]. David P. Moxley, PhD, is professor, School of Social Work, Wayne State University. Christine A. Hyduk, PhD, is associate professor, Department of Social Work, Marygrove College.

Manuscript received: July 2, 2002

Revised: September 24, 2003

Accepted: September 24, 2003

Copyright Families in Society Jan-Mar 2004
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