Issues Of Advocacy And Social Justice

Identifying Perceived Personal Barriers to Public Policy Advocacy Within Psychology

Amy E. Heinowitz, Kelly R. Brown, Leah C. Langsam, Steven J. Arcidiacono, Paige L. Baker, Nadimeh H. Badaan, Nancy I. Zlatkin, and Ralph E. (Gene) Cash

Nova Southeastern University

Public policy advocacy within the profession of psychology appears to be limited and in its infancy. Various hypothesized barriers to advocacy within the field are analyzed in this study. Findings indicate that those who advocate do so regardless of whether the issue is specific to the profession of psychology or specific to another field. Furthermore, several components, including disinterest, uncertainty, and unawareness, were identified as barriers to advocacy. However, all barriers were subsumed by a lack of awareness of public policy issues. By identifying barriers to advocacy in psychology, programs promot- ing advocacy could be fine-tuned to address the lack of knowledge, which inhibits students, profession- als, and clinicians from engaging in the essential role of public policy advocacy.

Keywords: advocacy, public policy, professional involvement

Supplemental materials: http://dx.doi.org/10.1037/a0029161.supp

There is an urgent and growing need for professional and social justice advocacy within the psychological community (Ratts & Hutchins, 2009; Kiselica & Robinson, 2001; Ratts, D’Andrea, & Arredondo, 2004; Toporek, Gerstein, Fouad, Roysircar, & Israel, 2006). Psychology, as a field as well as a profession, aims to reduce negative treatment outcomes and to enhance personal well- being through research and practice (Council of Specialties in Professional Psychology, 2009; American Psychological Associa- tion, 2010b). The viability of the profession and its capacity to provide fundamental and essential services are directly affected by legislation and regulations (Barnett, 2004). As a result, advocacy is integral to the roles of all psychologists, with the future and success of their profession and careers depending on their incor- poration of advocacy into their professional identity (Burney et al.,

2009). Despite the recognition and high appraisal of advocacy, little information is known about how, why, and to what degree individual professionals within the psychological arena participate in public policy advocacy.

The essential question is what does the advocacy role entail? That is the first concern that negatively influences advocacy rates—the vague, ill-defined, and at best multifaceted definition applied to this concept (Trusty & Brown, 2005). It is likely that the act of advocating is conceptualized in markedly distinct ways from one practitioner to the next and, in some cases, may even be inaccurate (Lating, Barnett, & Horowitz, 2009). Lating et al. (2009) describe advocacy as “a process of informing and assisting decision makers, [which] entails developing active ‘citizen psy- chologists’ who promote the interest of clients, health care sys-

This article was published Online First July 2, 2012. AMY E. HEINOWITZ is currently a fourth year PhD student at Nova Southeast- ern University. She previously received her Master of Arts in Psychology from Adelphi University. Her areas of professional interest are in developmental psychology, attachment theory, contextual approaches to trauma resolution, substance use, and professional issues in advocacy work. KELLY R. BROWN is currently a fourth year PhD student at Nova Southeastern University, where she previously received her Master of Science in Clinical Psychology. Her areas of professional interest include advocacy advancement and stigma reduction, child and family psychology, crisis intervention, peer victimization and youth violence, and suicide prevention. LEAH C. LANGSAM is a fifth year PsyD student at Nova Southeastern University, where she also received her Master of Science in Clinical Psychology. Her areas of professional interest are in child and adolescent trauma, the assessment of psychopathology in youth, and professional issues in advocacy work. STEVEN J. ARCIDIACONO is currently a fourth year PhD student at Nova Southeastern University where he also received his en route Master of Science in Psychology. His primary areas of research and practice include youth physical fitness, behavioral issues in adolescents, research method- ology, and advocacy in psychology.

PAIGE L. BAKER is currently a second year PsyD student at Nova South- eastern University. She previously received a Bachelor of Arts in Psychol- ogy and in Women & Gender Studies from Georgetown University. Her areas of professional interest include multicultural and diversity issues, military psychology, and professional issues in advocacy work. NADIMEH H. BADAAN is currently a third year PsyD student at Nova Southeastern University. She obtained her Masters of Arts in Forensic Psychology from John Jay College of Criminal Justice. Her professional interests are in forensic psychology, battered women syndrome, posttrau- matic stress, child sexual abuse, and the psychology of advocacy. NANCY I. ZLATKIN is a fifth year PsyD student at Nova Southeastern University. She holds her Master of Science degree from Nova Southeast- ern University as well. Her professional interests include substance abuse, bullying, solution focused therapies, telehealth, and professional advocacy. RALPH E. (GENE) CASH received his PhD in School Psychology from New York University. He is an associate professor and director of the School Psychology Assessment and Consultation clinic at Nova Southeastern University. His areas of research and practice include suicide prevention, the psychology of public advocacy, and school psychology. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Amy E. Heinowitz, Center for Psychological Studies, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33317. E-mail: ah916@nova.edu

Professional Psychology: Research and Practice © 2012 American Psychological Association 2012, Vol. 43, No. 4, 372–378 0735-7028/12/$12.00 DOI: 10.1037/a0029161

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tems, public health and welfare issues, and professional psychol- ogy” (p. 201). Trusty and Brown (2005) offer a streamlined summary of the various descriptions of advocacy as “identifying unmet needs and taking actions to change the circumstances that contribute to the problem or inequity” (p. 259). Regardless of definition, advocacy remains a necessary component of the psy- chology profession (Burney et al., 2009; Fox, 2008).

Advocacy can be divided into three sectors: public policy, social justice, and professional advocacy (see Figure 1). Public policy advocacy is defined as the attempt to influence practice, policy and legislation through education, lobbying and communication with legislators and elected officials. Social justice advocacy, most broadly, involves championing for the basic human and civil rights of all people regardless of race, class, gender, or socioeconomic status. In the context of psychology, however, social justice advo- cacy can more aptly be understood as the recognition “that fairness and justice entitle all persons to access to and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services being conducted by psychologists” (American Psychological Association Code of Ethics, 2010a). Lastly, professional advocacy is a synthesis of both public policy and social justice advocacy. Professional advocacy in the field of professional psychology demands that clinicians advocate not only for fair access to appropriate services but also for the important legislative changes necessary to enhance the quality of life of patients and at-risk populations.

The literature cites several important triumphs within the field (e.g., mental health parity) that can be attributed to the efforts of diligent advocates. Perhaps one of the greatest events was the combined advocacy effort of individual psychologists working with the National Association for the Advancement of Colored People (NAACP) in response to the Brown v. Board of Education Supreme Court case in 1954 (Benjamin & Crouse, 2002). Aware- ness of these accomplishments is important to understanding psy- chology’s roots in public and social advocacy and to provide

impetus for continuing advocacy efforts. However, it should be noted that a great deal more work is still necessary (DeLeon, Loftis, Ball, & Sullivan, 2006; Fox, 2008). Expanding and pro- tecting markets, maintaining funding, providing education and training, and disseminating important information to the public are just a few current initiatives requiring ongoing advocacy (Fox, 2008). Fox (2008) advised, “addressing such an agenda will re- quire efforts far beyond the scope and magnitude of all our past efforts put together” (p. 634).

Despite the acknowledgment of advocacy as an essential re- sponsibility for psychologists, many individuals remain unin- formed and uninvolved. With regard to financial support, psychol- ogists rank among the lowest contributors when compared with other medical professions (Pfeiffer, 2007). Furthermore, psychol- ogists have maintained poor political representation at the national level (DeLeon et al., 2006). Of utmost concern resulting from this lack of involvement is the forfeiture of opportunities to provide input on critical issues. This, in turn, would affect the overall future of the profession as well as the future careers of individual psychologists and the well-being of clients.

Previous research has identified a number of potential barriers to public policy advocacy, which reinforces the immediate need for further research, not only to identify obstacles, but also to pave pathways of enhanced efforts. Myers and Sweeney (2004) initially introduced an exploration of obstacles to professional advocacy via a survey of 71 professionals in the counseling community in local, regional, or national leadership positions. Fifty-eight percent of respondents cited inadequate resources as their primary obstacle to advocacy. Additionally, 51% indicated there was opposition by other providers, 51% noted a lack of collaboration, and 42% suggested a lack of training was responsible for insufficient advo- cacy efforts. While these findings highlight important structural and fiscal challenges, it is prudent to examine the personal barriers, which may further hinder psychologists’ participation in advocacy.

Individual experiences and personality traits may impede psy- chologists’ participation in advocacy in significant ways. Previous literature highlights the impact of awareness (Gronholt, 2009) and professional agendas (Lating et al., 2009) on psychologists’ par- ticipation in advocacy endeavors. More specifically, Gronholt (2009) revealed that despite active participation in academia, stu- dents and faculty cited an absence of interest in advocacy and inadequate awareness of advocacy issues and opportunities as the most significant factors inhibiting participation. These findings suggest that a lack of training or education is a considerable and consistent obstacle in advocacy participation.

When assessing the impact of awareness and training upon psychologists’ underrepresentation in the advocate role, it is nec- essary to evaluate the perceived personal sacrifices associated with some advocacy efforts. According to Chang, Hays, and Milliken (2009) there are numerous perceived personal costs. For example, they cite burnout, job loss, and harassment from other profession- als who may have the belief that client difficulties are not system- ically related. Additionally, psychologists are likely to contextu- alize their chosen advocacy issues as either inappropriate or incongruent with their professional agenda (Chang et al., 2009; Lating et al., 2009). Similarly Benjamin and Course (2002) suggest “psychologists’ aversions to political or social pronouncements have a long history in American psychology, grounded in part in the belief that science and application are separate activities and in

Professional advocacy

Public policy

advocacy

Social jus�ce

advocacy

Figure 1. Three facets of advocacy roles for professional psychologists. Social justice advocacy entails those efforts that are aimed at facilitating the fair, beneficent, and just treatment of all individuals. Public policy advocacy addresses the more legislative and governmental efforts. Lastly, professional advocacy encompasses both social and public policy advo- cacy.

373PERCEIVED BARRIERS TO PUBLIC POLICY ADVOCACY

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the long-standing prejudices held against applied work” (p. 46). In other words, some psychologists experience difficulty aligning their professional identities and values with larger, sociopolitical issues and may fear professional ramifications.

In addition to these perceived challenges, advocacy literature must articulate the personal attributes that influence effective in- volvement in public policy advocacy. Interestingly, an identified barrier to psychologists’ participation in advocacy relates to the nature of the person drawn to the profession. Psychologists are likely to focus their attention on the interpersonal issues that affect clients rather than considering the larger, systemic issues contrib- uting to pathology (Chang et al., 2009; Lating et al., 2009). In fact, it may be that psychologists view advocacy on an individual-level rather than global-level. For example, fostering development of self-advocacy skills and encouraging clients to be resourceful may be a primary focus rather than becoming an advocate for the clients or the field (Waldmann & Blackwell, 2010). Perhaps this tendency precludes psychologists from identifying or promoting the need for social change.

Despite the helpful studies previously conducted on advocacy, there are distinct limitations to the current state of advocacy research. The literature related directly to advocacy within psy- chology is underdeveloped. There is an immediate need for re- search assessing perceived barriers to participation in advocacy via the development of “rigorous assessment tools to evaluate practi- tioner awareness, knowledge, and skills related to advocacy coun- seling efforts” (Green, McCollum, & Hays, 2008, p. 26). This study not only moves forward the field of research assessing perceived barriers to psychologists’ involvement in public policy, but it also suggests important implications for guiding enhance- ment of professional advocacy efforts and directing training pro- grams.

Statement of Problem

Advocacy within the profession of psychology appears to be limited and in its infancy. Strikingly, research shows that other fields engage in high rates of advocacy. This study seeks to understand what the perceived barriers are to advocacy within the field of psychology. Further, it strives to elucidate whether there are differences between those who advocate specifically on behalf of psychological issues versus those who may advocate in other related domains.

Method