Transcript Effective Advocacy: Knowledge, Tools & Attitude

Effective Advocacy:
Knowledge, Tools &
Attitude
Presented by Carol Neidenberg
January 25, 2012
Legal Aid Society of San Diego:
Who Are We?
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Has provided legal services to eligible lowincome individuals and families of San Diego
County since 1953.
Mission is to provide equal access to justice for
residents through quality legal services. Staff
answer 250 calls each day related to housing,
family law, welfare, consumer law and
immigration issues and SSI.
Consumer Center
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Since March 1999 helps clients & family members make
informed health care decisions & access services.
Over 3,600 clients assisted last year to resolve denials,
terminations or other issues with health programs
including Medi-Cal, mental health, County Medical
Services and LIHP.
A Medicare team also helps eligible individuals enroll in
the Extra Help, Medicare Savings Programs & Part D.
Works closely with the County and state agencies to
track and resolve systemic problems.
County-designated
Patients’ Rights Advocate
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Has a unique insight & understanding of public
behavioral health services as the designated advocate
for outpatient mental health for more than 12 years.
Works collaboratively with agencies and providers to
resolve issues at the lowest level possible.
JFS Patient Advocacy Program investigates and
resolves inpatient and residential grievances/appeals.
Skills Needed for Advocates
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Knowledge of legal rights and health programs
Familiarity with health care systems especially
local ones
Ability to remain neutral and focused
Emphatic yet active listening
Goals: Improve access to health care,
empower clients and protect rights
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Understand and use the health care system
Learn about and exercise their rights
Become educated advocates for themselves and their families
Denied, terminated or reduced services or told they do not
qualify for a program or service
Having problems getting medications
Dissatisfied with health services
Advocacy
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The act of leading or arguing in favor of
something such as a cause, idea or policy; active
support
Investing client with power to communicate
effectively with their providers about their needs
by walking them through the needed steps. . .
without fear of retribution
Why is Advocacy Needed?
Obstacles facing clients & family members:
 Being unaware of their rights
 Medical model vs. recovery model
 Fear of retaliation
 Economic realities of reduced services
Examples of How Advocates Help
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Provide training and inform consumers of their
rights including assistance with applying for new
benefit programs such as LIHP
Advocate for granting appeals for denied or
reduced outpatient psychotherapy sessions
Use Title 9 and the Beneficiary and Client
Problem Resolution Process to resolve issues
Most Commonly Filed Grievances
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Quality of Care issues related to service, staff
behavior or appointment scheduling
Confidentiality
Medication or diagnosis disagreement
Resolving Grievances & Appeals
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Listen to issues either with client and/or family
member (if authorized)
Review issues with supervisor or QI manager
Obtain records
Request and review records including
medication & diagnosis, progress notes also by
an independent Board-certified psychiatrist
Reach resolution within prescribed timelines
Examples of Rights
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Seniors and Persons with Disabilities (SPDs) on
Medi-Cal managed care have a right to request
an exemption and ask for continuity of care.
SSI eligibles have a right to apply for disabled
Medi-Cal; be represented at hearings and appeals
Clients have a right to review their records
Under Medi-Cal, beneficiaries have a right to a
State Fair Hearing after going through the
grievance/appeal process
How Advocacy Helps
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Understanding HIPAA & their rights to privacy
Referring to and collaborating with NAMI, e.g.,
Peer-to-Peer, Support Groups, Family to Family
Providing referrals and training to clientoperated programs such as RICA, clubhouses,
housing and Creative Arts Consortium
Encouraging clients to be active committee
members and helping them understand the
mental health system
Self-Advocacy Skills
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Understanding the system including public
mental health and managed care choices
Encouraging clients to take WRAP classes and
use the tools learned
Participating in treatment options including
updating client plans as needed
Encouraging active involvement in health care
decisions