advocating for change: persuading decision makers to act for better health

7/27/2019 Advocating for Change: Persuading Decision Makers to Act for Better Health

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Aa for Change

Persuading Decision

Makers to Act orBetter Health



Foreword

Te Caliornia Endowment places a strong emphasis on policy change activities,

including advocacy, with the belie that policy change is necessary to make meaningul

and lasting improvement in the health o Caliornians. Although no single policy or

system change will achieve the ultimate goal o a healthier Caliornia, Te Endowment

rmly believes that everyone has a role to play and that all organizations can participate

in the advocacy process.

o that end, Te Endowment’s Public Policy Department and the Center or Healthy

Communities have developed Advocating or Change as part o the Center’s HealthExChange Academy. Designed to provide you with the undamentals o advocacy

and the tools to put that knowledge into practice, Advocating or Change | Persuading

Decision Makers to Act or Better Health is the second in a series o trainings to

help sta at nonprot organizations become more eective leaders in improving

community health.

Special thanks are due to Harry Snyder, an advocate well-known or his prior work at

Consumers Union, and Carl Oshiro or writing this manual. Te training program itsel was developed by Harry and the team at the National Community Development Insti-

tute: Omowale Satterwhite, Shiree eng and Diana Lee.

It is our hope that this manual and training will help you in your work in advocating or

improved health outcomes in Caliornia’s most underserved communities.

Sincerely,

Robert K. Ross, M.D.

President and Chie Executive Ocer

Te Caliornia Endowment



1. AdvocAcy, PersuAsion And chAnge: An introduction 1

2. Who Are the heAlth Policy decision MAkers? 4

Changing the Law 4

Working with Government Agencies 4

Working with Private Companies 6

Working with Health Care Institutions 7

Using the Courts 7

Te Importance o Sta 8

3. identiying the key decision MAker(s) or your issue 9

4. the seven key PersuAsion Points 11

5. WhAt do decision MAkers resPond to? 12

Facts, Analysis and a Compelling Story 12

Strong Public Support 13

Media Attention 13

Accuracy and Principles 14

Follow-Trough and Commitment 15

Public Pressure 15

6. Meeting With decision MAkers 16

Pre-Meeting Communications 16

Planning or the Meeting 18

Attending the Meeting 20

Follow-Up and Follow-Trough 21

able o Contents



7. AdvocAcy styles 23

Te Harder Style 23

Te Soer Style 23

Hard and So 24

8. tiPs And trAPs 26

All Documents Are Potentially Public 26

Tere Is No Such Ting as “O the Record” 27

Treats Are Unnecessary and Counterproductive 27

Every Sta Member Is Important 27

Dirty ricks 28

Watch Out or Your Opponents rying to 28

Undermine Your Progress

9. reerences 30

10. Worksheets 37

able o Contents



Advocating for Change | Persuading Decision Makers to Act for Better Health 1

Aa, Pa aca: a i

Tis manual is one in a series o publications to help grantees o Te

Caliornia Endowment and others understand the world o health poli-

cy advocacy. Health policy consists o the rules governing health issues.

For example, these rules determine how a diverse population receives

appropriate health care, what worker saety protections will be in place

and how much pollution can be released into the air. Policy change is

a shi in the rules that allows or new ways o doing things, such as

more culturally and linguistically appropriate health services, stronger

measures to prevent repetitive stress injuries or stricter standards or

release o pollutants. Advocacy is a way to change both the health pol-icy rules and resource allocation decisions o government and private

institutions.

Te rst manual in this series, Understanding How to Impact Health

Policy , covers the basics o how to be an advocate or better health (get-

ting the acts, building support, making a plan, and communicating

your message to inorm the public and decision makers). Understand-

ing How to Impact Health Policy also describes dierent advocacy

places where decisions are made (working with health care institutions,

government agencies, and private businesses; changing the law; usingthe ballot box; using the courts; and taking direct group action) and

provides guidance on choosing among these dierent options.

Tis manual ocuses on how to persuade decision makers. Whether you

are trying to get the legislature to pass a new law, an agency to adopt a

new rule, or a company to change the way it is doing business, you will

need to persuade decision makers to take actions that will improve the

health o people in your community. Tis manual discusses how to:

• identify health policy decision makers

• nd the right decision makers for your issue

• frame key persuasion points

• gure out what decision makers respond to

“I you have an impor-

tant point to make,

don’t try to be subtle

or clever. Use a pile

driver. Hit the point

once. Ten come back

and hit it again. Ten

hit it a third time—a

tremendous whack.”

—Winston Churchill

1



2 Advocating for Change | Persuading Decision Makers to Act for Better Health

• determine what actions to take before, during

and aer meeting with decision makers

• avoid some traps in the advocacy process and

dene the best style for your campaign

Te Reerences listed in Chapter 9 provide addi-tional resources or in-depth guidance on specic

issues.

the goAl o AllAdvocAtes is to PersuAde

As you know, an advocate is one who is called

upon to speak or plead on behal o another. o be

eective, a health policy advocate must persuade

key decision makers to take certain actions thatwill improve the health o people in the commu-

nity. Depending on the problem you are trying to

solve, you may need to persuade:

• legislators to pass new or dierent laws

• agency heads to adopt new or dierent

regulations

• directors of health care institutions to provide

new or dierent services, or existing services

in new ways

• local ocials to work more closely with

community-based organizations in designing

programs, allocating resources and delivering

needed services

• executives to reduce toxic emissions, improve

working conditions or stop a harmful business

practice such as marketing unhealthy products

Restrictions on Legislative Advocacy

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Bringing about change, especially meaningul change, is not easy. Orga-

nizations that are doing well under existing laws and rules have no reason

to welcome any change in the status quo. Sometimes, even providers

who are struggling to survive may eel threatened by proposed changes

because o their precarious nancial position. New approaches, new pro-

cedures and community input may upset long-standing arrangements.As an advocate you don’t have the power to adopt solutions on your

own, but you do have the power (through research, planning, organi-

zation, communication, ollow-through and commitment) to persuade

people who have this power to take the needed actions. Understand-

ing How to Impact Health Policy describes how to dene the problem

by getting and understanding the acts, choosing an advocacy strategy,

and organizing your community. Te next step is to identiy the key

decision makers or your particular campaign.

Aa, Pa a ca: a i




2 A key strategic

decision or your

campaign is to agree

on the best possible

way to bring about

the health policy

change you seek.

W A haP d Ma?

A key strategic decision or your campaign is to agree on the best pos-

sible way to bring about the health policy change you seek. Will the

solution to the problem you identied require a new law or regulation

or does a health care institution need to change its procedures? Have

you tried everything else and now nd you must le a lawsuit to solve

the problem? Wherever you choose to ocus your campaign, success

requires hard work, thoroughness, clear communication among co-

workers, and attention to detail.

Keep in mind that when the policy change has been made there is

still work to be done. You will need to ollow up to see that the change

is implemented. Where appropriate, you may need to advocate or

enorcement and evaluation o the new policy. In the planning stages

o the campaign, be sure to acknowledge that the job will not be done

until the new health policy has been adopted and its implementation is

solving the problem you originally identied.

chAnging the lAW

One way to bring about change is to persuade the state legislature, city

council or county board o supervisors either to pass a new law or change

existing laws. o be eective in the legislature, you will need to per-

suade one or more legislators to introduce the measure and work hard

or its passage. ypically, proposed laws are assigned to committees, so

you will have to persuade a majority o the committee members to vote

in support o the law. As the measure progresses to the ull assembly or

senate, you will have to persuade more legislators to support your mea-

sure. I your measure passes the legislature, you may need to persuade

the governor to sign it into law. Te legislative process at the local gov-

ernment level ollows a similar process involving city council membersand county supervisors.

Working With governMent Agencies

At both the state and ederal levels, there are government agencies

(departments, commissions, boards, etc.) that either have general

responsibility or protecting the public at large or specic responsibil-




ity or overseeing parts o the health

care system. Tey also issue regulations

and implement or enorce laws. Estab-

lished by Congress, the state legislature,

a local city council or a county board o

supervisors, administrative agencies areusually given broad powers to address

problems in their designated areas.

Many agencies are headed by a single

person. Te head o an agency may

be called an agency secretary, director

or commissioner. Some agencies are

headed by several people who may

be called commissioners or board

members, one o whom serves as chair.Te executive branch (the governor or

mayor) usually appoints the heads o

agencies, sometimes with the approval

o the legislature.

Most agency heads serve “at the

pleasure” o the governor or mayor;

thereore, they can be removed at

any time. In these situations, agency

heads are likely to consult with thegovernor or mayor beore making a

controversial decision. o promote

agency independence, the heads o

some agencies are appointed or a set

term o years and some agency heads

are elected. However, even these

agencies are not totally independent.

All administrative agencies are subject

to legislative oversight, and every year

the legislative branch appropriates thebudget or each agency.

Depending on the size o the agency,

there will be various subunits (divisions,

sections, etc.) with more specialized

responsibilities. Tese subunits will be

headed by deputy directors, section

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chies, etc., who ultimately report to the agency head.

For example, San Francisco Department o Public

Health is organized into separate sections or Hospital

Systems, San Francisco General Hospital, Jail Health,

Community Health Programs, AIDS Services, and

Community Health & Saety, each with a section headreporting to the director o health.

Working With PrivAte coMPAnies

Private businesses have an enormous stake in improv-

ing the delivery o health care in Caliornia. Many

businesses either provide or would like to provide

health insurance or employees and their amilies.

Other businesses, such as pharmaceutical companies,

managed care companies, hospitals and nursing homechains, provide the products and services that make up

our health care system. Other companies may not be

directly related to health care but could have a nega-

tive impact on the health o Caliornians by producing

products that are harmul to consumers or using pro-

cesses that harm workers, the surrounding community

or the environment.

Working with private businesses could involve chang-

ing their policies to help solve a particular problem. Orit may involve urging a business to be part o a larger

alliance to reorm the system through new laws and

rules, structural changes, or incentives.

Working with a small, local business may simply mean

convincing the owner, partners or manager. For exam-

ple, amilies living in the enderloin area o downtown

San Francisco wanted to end disorderly conduct on

their streets. Community groups ormed a coalition

and convinced liquor-store owners in their neighbor-hood to stop selling ortied wines, which had become

a community plague. Te result was a cleaner and

healthier place to live. On the other hand, working with

a Fortune 500 company may mean getting the attention

o and persuading executives who are located hundreds

or possibly thousands o miles away.

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Coalition and Public Health

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Working With heAlthcAre institutions

In some cases, the problem may involve a or-prot or

nonprot institution that is providing a critical service

in your community (e.g., a hospital, health center orclinic) and the people you need to persuade are its

management (director, chie executive ocer, general

manager) and governing board (board o directors).

I the institution is accountable to a state or local

government agency or a local city council or board o

supervisors, you might seek help rom those bodies

as well.

using the courts

Another method o changing the status quo is to le

a lawsuit. ypically, lawsuits are brought either to stop

actions that violate existing law(s) or to require actions

that are mandated by existing law(s). In Caliornia, cas-

es are usually decided rst by a Superior Court judge.

Appeals o Superior Court decisions are decided by the

three-member panels made up o justices o the Court

o Appeal. Te seven justices o the Caliornia Supreme

Court decide appeals o Court o Appeal decisions. All judges and justices are appointed by the governor and

stand periodically or election.

Judges are not legislators or policymakers; they apply

existing law (constitutional law, statutes, ordinances,

common law). Sometimes, they apply the law to new

situations and, on occasion, appellate courts interpret

the law in a new or dierent way. Courts are not sup-

posed to make new policy (or example, deciding on

the “best” health policy). Instead, their job is to decidei a practice is “legal” under the existing law.

Aer a lawsuit is led, communications between the

parties and the court are usually conducted through

the attorneys and are subject to strict rules. In cases

with broad public importance, courts generally allow

nonparties to le amicus curiae (riend o the court)

bries. Tese bries can be highly persuasive, especially

Oregon Health Action Campaign

and Free Hospital Care

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when they are led by credible organizations and present the public

policy arguments or or against a particular decision in a compelling

manner.

I the court schedules a hearing or oral argument, be present i you can

and ask others to attend. Even though you will probably not have an

opportunity to speak, a respectul presence will show the judges that thisis a matter o broad public importance. You’ll also be able to hear rst-

hand the arguments made by the attorneys (yours and the other side’s)

and how they respond to the questions put to them by the judges.

the iMPortAnce o stA

In most cases, the decision maker will have one or more people on his

or her sta. Teir role is to assist the decision maker in carrying out his

or her responsibilities. Decision makers oen rely on sta members to

gather and analyze the acts, assess the arguments both in avor o and

against your proposals, make a recommendation on the course o action

to take, and ollow through with implementation. While the decision

maker is in charge, a strong recommendation rom a trusted sta mem-

ber will infuence the decision maker. Consequently, while they are not

decision makers per se, it is very important to identiy key sta mem-

bers and include them among the people you need to persuade.

Te good news about working with sta is that sta members are usually

more accessible than legislators, agency heads and other decision mak-

ers. Te bad news is that you must constantly gauge whether the views

communicated by a sta member accurately refect those o the deci-

sion maker. Sta can also be used to insulate the decision maker rom

contact with the public, and they may give you a alse sense o security

regarding the decision maker’s sympathy to your cause. For this reason,

working with members o a decision maker’s sta, however closely, is

no substitute or also being in contact with the decision maker.




3i k

d Ma() y i

Te person you need to convince depends on your particular issue

and the specic advocacy strategy you choose. For example, i you are

targeting an administrative agency, the decision maker is typically the

agency head. I you are targeting a health care provider, it is typically

the CEO. In the legislative process, the particular decision makers will

change aer a proposed law is introduced and makes its way rom com-

mittee to the ull legislative body and on through the process.

Be sure that the decision makers you are targeting have the power to

make the decisions you need to achieve your health policy goals. As part

o your planning, list all o the actions that you want the decision mak-

ers to take (e.g., introduce legislation, hold hearings, change company

policy, adopt new rules, enorce existing law, etc.). And, unless it’s obvi-

ous, write down the source o their authority or taking each action.

Aer you have identied the decision makers, conduct some research

to nd out:

• their backgrounds

• whether they have taken a position on this issue or related issues

• if the decision makers are elected ocials, what voters in their

district think about the issue or how people in their district are

aected by the issue

• who their key sta people are

• what the role of sta is likely to be

• what interests or motivates the decision makers

• whether there are people whose views or opinions they particularly value

• whether anyone in your coalition or among your supporters

knows the decision makers or their sta

Be sure that the

decision makers you

are targeting have

the power to make

the decisions you

need to achieve your

health policy goals.




Some o this inormation is readily available. For example, brie biogra-

phies o agency heads and legislators oen appear on Web sites. Other

inormation might be obtained by conducting a LexisNexis or other

database search o news articles. Find out as much as you can by asking

knowledgeable people who support what you are trying to accomplish.

I the decision maker is appointed, check who made the appointmentand whether it can be revoked. Consider all the inormation you’ve

gathered to plan your campaign strategy and guide your eorts as you

go orward.

➜You can use Identiying the Key Decision Maker(s) or Your Issue

on p. 38 of the Worksheets to guide your work.




4While the details will vary rom issue to issue, health policy advocates

need to convince decision makers o the ollowing seven points.

1. ere is a serious public health problem.

2. e decision maker is responsible for addressing this problem.

3. e decision maker has the power to take the actions you

are requesting.

4. e actions you are requesting are feasible and meaningful.

5. ere is broad public support for the actions you are seeking.

(Public support means reward or prot from positive public

recognition and safety from attack.)

6. e arguments (if any) against the requested actions should

be rejected.

7. e decision maker must act and follow through on any

promises made to address the problem.

Each o these points is critical. In planning your campaign, give thoughtto how you can make these points (in multiple ways, i possible). For

example, to convince decision makers that a serious health problem

exists you might have written and video statements rom doctors,

researchers, and community clinic directors. o show public support

or your campaign you could hold a large community meeting or deliv-

er letters o support rom local leaders.

t s kPa P

Health policy

advocates need to

persuade decision

makers to support

the community’s

position.




Wa d dMa rp t?5Decision makers are human. Tey are rational and emotional. Tey

act with courage, empathy and principle, but they also act out o

ear, ego and sheer calculation. Every decision maker will weigh the

consequences o taking the actions you are requesting against the con-

sequences o not doing so. Some o the questions they will be asking

themselves are:

• Will I gain or lose politically or economically?

• How will this hurt or help my supporters?

• What will my superiors and colleagues think?

• How will I look to the media?

• Will the public support this?

• Do I have to do something now?

• What will happen if I do nothing?

• Is there a better option?

While each decision maker is dierent, generally, all respond to theollowing.

Acts, AnAlysis And A coMPelling story

Solid acts, unassailable analysis and a compelling story are the best

ways to show that there is a serious problem that the decision maker

needs to address immediately. Tere are a number o tools available

to communicate your acts, analysis and story to decision makers,

including:

• fact sheets or Q&As that document the issue

• research papers

• data on successful solutions

• charts, graphs, photos and other visual material

• personal accounts

Every decision maker

will weigh the con-

sequences o taking

the actions you are

requesting against the

consequences o not

doing so.




Tese tools can also be used to convey inormation to supporters,

potential supporters and the media. It is a good idea to always have a

document to hand decision makers to make or reinorce your point.

It may be a one-page act sheet, letter rom a new supporter, editorial

cartoon or recent news article.

➜You can use What Decision Makers Respond o: Facts, Analysis

and a Compelling Story and Your Research Findings starting on

p. 42 of the Worksheets to guide your work.

strong PuBlic suPPort

Public support can make it easier or a legislator, governor, city council

member, mayor or agency head to take necessary action. Strong, ongo-

ing and mounting public support can be very powerul in overcominginternal resistance and external opposition to change. Some ways to

communicate public support or what you are seeking are:

• a list of supporters including inuential community leaders

• town hall meetings and community forums

• public hearings

• letters and phone calls

• e-mails and faxes

• pickets and demonstrations

➜You can use What Decision Makers Respond o: Strong Public

Support on p. 46 of the Worksheets to guide your work.

MediA Attention

Decision makers respond to media coverage in several ways. First,

newspaper articles and broadcast coverage validate the seriousness o

the problem, making it more dicult or opponents to dismiss you. Sec-

ond, media coverage shines a spotlight on the decision maker, making

it more dicult or him or her to avoid taking serious action on your

proposals.

Wa d d Ma rp t?




o be credible, what

you communicate

orally and in writing

to supporters, reporters

and decision makers

must be accurate.

Many o the tools that you develop to communicate your acts, analy-

sis and story also can be used to inorm reporters about your issue.

Some additional tools that you can use to get media coverage on your

issue are:

• news releases

• news conferences

• on-site briengs for reporters

• editorials and opinion editorials

➜ You can use Media Attention—Reaching Your Audience on p. 49

of the Worksheets to guide your work.

AccurAcy And PrinciPles

Decision makers respond to advocates who are credible. o be credible,

what you communicate orally and in writing to supporters, reporters

and decision makers must be accurate. I you make a mistake, be the

rst to correct it. I you aren’t sure about a certain act, you might say,

“Senator, I believe it’s ___, but I want to make sure so I’ll check it out

and get back to you.” Follow through. I you were wrong, get him or her

the correct answer or data. I you were right, let him or her know that

you did check it out and the inormation you gave was correct. Keep inmind that you will likely advocate or other issues and your credibility

will enhance your eectiveness now and in the uture.

Decision makers also respect and respond to advocates who seek solu-

tions with integrity and principles. Basing your campaign on acts rather

than eelings, putting orth a thoughtul set o solutions, being open to

other solutions i they are equally or more eective, bringing together

dierent parts o the community, ollowing through on promises, and

showing your commitment to solving the problem strengthens your

ability to persuade decision makers.




olloW-through And coMMitMent

Decision makers expect ollow-through and commitment. For exam-

ple, in the legislative process, legislators who agree to introduce your

legislation will expect you to help convince other legislators, gather the

broadest possible support, keep the issue in the news, and appear andspeak at committee hearings. I the measure ails in one session, they

may reintroduce it in the next session requiring the same eort (i not

more) again. I an agency head agrees to hold hearings as a prelude to

taking action on your issue, he or she will expect you to present a com-

pelling case or taking action, reute the opposition’s showing and keep

the issue in the public eye. I the agency head takes the actions you are

seeking, you will be expected to deend the agency’s decision against

criticism and attack. Change is dicult and you must be in it or the

long haul.

PuBlic Pressure

In some cases, direct group action can be an eective means o ocusing

media and the decision maker’s attention on the issue. Demonstrations,

sit-ins, protests, picketing and boycotts have brought about ar-reach-

ing changes when other strategies were unavailable or ineective. Tese

tactics must be used with great care and judgment. Tey can alienate

the public at large. Also, i your rhetoric is exaggerated or i you attack

an individual, you may anger decision makers to the point where they

are unwilling to work toward constructive solutions. But, i these direct

group actions are based on acts, present a compelling health prob-

lem and demonstrate strong public support, decision makers will pay

attention to you and your campaign.

Wa d d Ma rp t?




M wd Ma6At some point, it will be important to meet ace-to-ace with the deci-

sion maker. Te meeting is an opportunity to

• inform and educate the decision maker directly

• show public support and commitment

• respond to questions and concerns

• gauge the decision maker

• directly ask the decision maker for a commitment to take action

Be aware, however, that decision makers and their sta may have di-

erent reasons or meeting with you. Tese reasons might be to

• measure the strength, unity and resolve of your coalition

• give the appearance of action and ease public concern without

meaningful change

• discourage you from pressing forward

• deect your coalition to another issue that the decision maker isconcerned about

Pre-Meeting coMMunicAtions

Meetings can come about in two ways. First, you could request a meet-

ing with the decision maker. For example, i meeting with a legislator

would be useul, see i any members o your coalition know the leg-

islator and ask them to arrange a meeting. I no member knows the

legislator, choose someone who has some connection with the legisla-

tor (e.g., someone who lives, works or has a business in the legislator’sdistrict).

Beore anyone picks up the phone to make the call, give some thought

to and make some tentative decisions about:

Because ace-to-ace

meetings are impor-

tant opportunities to

convince the decision

maker and move

your issue orward,

they require careul

planning, disciplined

participation and

ollow-through.




• the purpose of the meeting

• when you would like the meeting (Is it important to meet right

away or can the meeting be held sometime in the next couple

of weeks?)

• who should be attending on your side

• how much time you will need with the decision maker (in some

cases, a few minutes may be enough)

• where you would like the meeting

Most meetings are held in the decision maker’s oce. In some instances,

you might want to invite the decision maker to a site within the com-

munity, such as a hospital, health center or clinic, so he or she can see

the problem and/or solutions rsthand. Some decision makers have

more than one oce; or instance, legislators have an oce in theirdistrict and another in the state Capitol. Consider the advantages and

disadvantages to meeting in each place.

Unless there is an overriding reason not to, be fexible. For example, i

the decision maker’s schedule makes it dicult to have the rst meet-

ing in the community, arrange the meeting or the decision maker’s

oce. Perhaps a subsequent meeting could be held in the community.

I all you can get with the decision maker is a short meeting, you might

want to take it. Tat meeting could lead to longer, more substantive

meetings with the decision maker or his or her sta.

Te second way is or the decision maker to initiate the meeting. For

example, i you led an administrative petition with an agency, the sta

o the agency might call and invite you to discuss the petition. In that

situation, you should nd out:

• the purpose(s) of the meeting as they see it

• the date, time, place and expected duration of the meeting

• the names, titles and aliations of people who will be at themeeting (Will the decision maker be present? Will there be other

sta members attending? Will representatives from the opposi-

tion be present? Has anyone else been invited?)

• if there is any specic information or a person who would be

helpful to bring to the meeting

M w d Ma




• if necessary, ask about logistics (directions, transportation, park-

ing, check-in procedures, how much time to allow)

Learning as much as you can about the meeting will help you prepare

and, i necessary, give you a chance to change any arrangement that

would place you at a serious disadvantage. For example, i this is your

rst and possibly only meeting with the decision maker and you learnthat a number o lobbyists or the opposition will be present, you may

want to request that your side be allowed to meet with the decision

maker rst. Te decision maker can meet with the opposition aer-

ward, i necessary. Tis will allow you to ocus on the decision maker

and make your case without hostile attacks rom the opposition. I the

decision maker insists on having the opposition present, you may want

to request certain ground rules so you have a air opportunity to pre-

sent your issue. For example, you could ask that the decision maker

limit the number o people the opposition can bring to the meeting,allow opponents to speak only aer you have completed your pre-

sentation, and provide you with the chance to rebut or correct what the

opposition presents.

➜ You can use Meeting with Your Decision Maker(s) on p. 55 of the

Worksheets to guide your work.

PlAnning or the Meeting

Because ace-to-ace meetings are important opportunities to convince

the decision maker and move your issue orward, they require careul

planning, disciplined participation and ollow-through. Every meeting

is also a chance to build an ongoing relationship with decision makers

and their sta. Use the ollowing list to help you prepare.

kw Wa y Wa

What do you want rom the meeting (e.g., a commitment to introduce

or support legislation, adopt or repeal regulations, change a specicbusiness practice, provide a new service or increase unding, hold hear-

ings, order an investigation, etc.)? Be specic. I you don’t have a good

idea o what you want, chances are decision makers won’t either.

s y Pa

How will you tell your story given the time that you will have? What

should come rst, second, third … last? Do not assume that the deci-




sion maker understands and accepts that there is a problem. Tis is an

opportunity to educate and convince the decision maker and to nd out

what he or she knows about the issue. You can oer additional acts and

analysis or attempt to correct any misconceptions. Anticipate and be

prepared to bring up and address arguments that opponents will raise.

A r

Who are the best people to present the inormation and arguments

to the decision maker? Depending on what has to be communicated,

one person may be the best because o his or her rsthand experi-

ence, expertise, moral authority, relationship with the decision maker,

or general speaking and persuasive ability. Decide who will take the

lead in certain situations (or example, getting the discussion back on

track). Assign one person the responsibility to ask or a commitment

rom the decision maker at an appropriate point in the meeting. Also,

assign someone the responsibility to take notes and briefy summarize

the outcome(s) and any item(s) that require ollow-up at the end o

the meeting. Make sure all participants know their role and what is

expected o them.

Ppa Maa

Prepare a one-page summary o the problem, the actions you are seeking

and a list o supporters. Make enough copies to distribute at the meet-

ing. Are there charts, graphs, photos or other visual materials that can

be used to present the inormation you are trying to communicate?

d a Ma sa M

Do you want to notiy the media about the upcoming meeting? Do

you plan to inorm the media about the outcome? I so, let the decision

maker know in advance so he or she does not eel ambushed.

kw P

I you are asking a decision maker to vote or or against a measure,

know who supports and who opposes your position and why.

Pa

Go over the plan. Prepare, rehearse and role-play so everyone on your

side understands his or her role and how it relates to what others will be

doing. Make trial runs o dierent situations (e.g., i someone on your

side is late to the meeting, i you have less time than you expected, i the

decision maker or sta asks questions, is hostile or evasive, etc.).

M w d Ma




Sometimes, meetings have to be rescheduled or legitimate reasons.

Stay ocused and be ready. Be prepared to wait or come back later in

the day or, i necessary, another day.

Attending the Meeting

I people will be going through a lot o trouble to attend the meeting,

conrm the day beore that the meeting is going orward as planned.

Let the people attending rom your side know that the meeting is on. I

possible, arrange to meet together beorehand at a nearby location and

walk or drive to the meeting together. Tis will allow you to exchange

any last minute inormation, minimize the possibility that people will

get lost or be late, and alleviate some anxiety or people who have never

been to the place where the meeting will be held.

Be on time, patient i you need to wait and gracious i you need to meet

with sta. Beore the meeting begins, make sure you know all o the

people who are there. I it is not clear why someone is there, ask how

they relate to what is going to be discussed at the meeting. Circulating

a sign-in sheet with names, titles and contact inormation will make

ollow-up easier.

Sometimes, decision makers (intentionally or not) will be present or

the beginning o the meeting, excuse themselves aer a while and leave

beore the advocates have had a chance to make their critical points

or ask or the decision maker’s position. o avoid this kind o sur-

prise, beore the discussion gets going in earnest, ask how much time

the decision maker has beore his or her next appointment. (“Senator,

thank you or taking the time to meet with us this morning. Te meet-

ing is scheduled to go to 10:30 a.m. Will you be able to be with us until

then?”) I necessary, adjust your presentation accordingly. Keep track o

the time. Cover the crucial points and ask or a commitment while the

decision maker is present.

During the meeting, stay ocused, keep the discussion on track and

implement the plan. Always present a united ront. Make sure that at

an appropriate point you or someone in your coalition directly asks or

a commitment. (“Senator, now that you understand the seriousness o

the problem, will you ____?”)

I the decision maker agrees, thank him or her and close the deal by

ocusing on the next steps that need to be taken. (For example, “Can we

inorm the media? What is going to be the process or setting strategy




and planning?”) At the conclusion o the meeting, the person assigned

the role o taking notes should briefy summarize the items requir-

ing ollow-up. (“My notes indicate that there are ve ollow-up items.

Item 1 is we will get the commissioner more inormation about the

extent o this problem in rural areas, including … Item 2 is we will

convene a meeting within the next two weeks with public healthocials and health proessionals to begin mobilizing those networks.

Item 3 is....”) Be sure there is a specic person that is responsible or

ollowing through on every item and include a deadline that is both

specic and realistic.

I the decision maker declines, says he or she will have to think about it

or says he or she will keep your points in mind in deciding the matter,

be gracious. Tank him or her or meeting with you, ask i there is any

more inormation that would be helpul and leave open the possibility

that he or she will support you in the uture. (“Tank you or letting usknow your position/thinking on this issue. We hope that you will be with

us especially aer learning more about how lack o adequate services is

hurting amilies in your county.”) Unless there are strong reasons to do

otherwise, don’t burn your bridges. Keep the lines o communication

open. A decision maker might not support you right now on this issue,

but he or she might help you later or on some other issue.

➜ You can use Meeting with Your Decision Maker(s): Planning or

the Meeting on p. 57 of the Worksheets to guide your work.

olloW-uP And olloW-through

It’s always a good practice to ollow up with a letter thanking the deci-

sion maker or the meeting. I the meeting was positive rom your

standpoint, the ollow-up letter is an opportunity to conrm any com-

mitments that were made; i not, it’s an opportunity to keep the door

open. Te ollow-up letter is another chance to get inormation to and

persuade the decision maker. For example, the letter might include arecent news story, editorial or newsletter piece on the issue.

Get back to the decision maker with any inormation that you said you

would provide. You want the decision maker and sta to receive the

additional inormation while the arguments and commitments made

at the meeting are still resh in their minds. Meet all deadlines that you

agreed to and i you nd you can’t, let the decision maker’s sta know

Unless there are strong

reasons to do other-

wise, don’t burn your

bridges. Keep the lines

o communication

open. A decision maker

might not support

you right now on this

issue, but he or she

might help you later or

on some other issue.

M w d Ma




Aa s 7Tere are dierent styles o advocacy and each has its advantages and

disadvantages.

the hArder style

Te harder style is a conrontational, make-no-concessions approach

to persuading decision makers. Generally, this approach:

• views the decision maker as an adversary

• personalizes the problem

• makes nonnegotiable demands

• applies pressure

• distrusts others

A harder style may be eective in motivating recalcitrant decision mak-

ers, but it may also make them distrustul, angry, hostile and rustrated.

Any o these emotions can make it signicantly more dicult or a

decision maker to agree that there is a problem and work construc-

tively with you to solve it.

the soter style

A soer style is more cooperative and assumes good aith on the part o

decision makers. Generally, advocates who use this approach:

• view the decision maker as neutral or on their side

• are willing to make concessions

• assume the decision maker will do the right thing

• will not rely on pressure tactics

A soer approach might work when there’s reason to believe a decision

maker will take the actions that advocates seek even without outside

pressure. For example, a member o your coalition may have a strong,

Tere are dierent

styles o advocacy and

each has its advantages

and disadvantages.




personal relationship with the decision maker and be able to achieve

results through quiet, one-on-one communication. Keep in mind that

these relationships are rare and, even when they do exist, may not be

enough to overcome strong opposition.

hArd And sot

While it requires skill and judgment, it is possible to adopt a style that is

both hard and so. Following are some ways to strike a balance between

the two approaches:

Aa Pbm

Be accurate and uncompromising in your description o the seri-

ousness and importance o the problem. For example, attacking the

problem o lack o inormation about ree hospital care, as described in

the sidebar on p. 7, Community Catalyst reported that “Callers to thehospitals invariably were told that ree care was not available. I there

was a ree-care policy, ront-line sta were almost universally unaware

o its existence, nor did they know who at the hospital the monitors

could be reerred to or inormation about ree care.” Have the acts to

back up your statements.

Pw/rpb d Ma

Without making a personal attack, show how the decision maker has

the power and responsibility to address the problem. For public ocials,

specically point to the law setting out their authority and the respon-

sibilities o their oce. Focus on the law and oce, not the person. For

business leaders, show how their businesses caused or contributed to the

problem or point out how they have a moral responsibility or improv-

ing the situation.

i s ta W B e

Put orward the solutions that you think are necessary but be open

to other solutions. I possible, set out objective, principled criteria or judging any set o solutions. For example, “Any solution should reach at

least __ percent o amilies in this district beore the onset o fu season

on December 1.” Stick to your principles and demand that any solution

adopted by the decision maker meet the objective criteria.




Be accurate and

uncompromising

in your description

o the seriousness

and importance o

the problem.

B tw B n naï

Communicate clearly and careully—especially about what you want,

what you will or will not accept and what you will or will not do. Follow

through on your commitments. Avoid dishonesty, deception or duplic-

ity. Many decision makers want to do the right thing even though there

are political, economic or institutional orces that oppose change. As anadvocate, your task is to counter those orces and convince the decision

maker (through acts, analysis, public support, media coverage and

other tools described in this manual) to take the necessary actions.

B s, t ha na

I you have reason to believe that a so approach might be successul,

try it rst. Tis may give the decision maker the chance to take the

actions and the public credit without appearing to have been pressured

into it. It is usually sound strategy to start by trying to work together.But i this approach does not succeed, you can take a harder, more

public approach.

Aa s




tp a tap8All docuMents Are PotentiAlly PuBlic

In the course o an advocacy campaign, you and your supporters will

prepare a number o documents (act sheets, brieng papers, newsletter

articles or updates, news releases, e-mails, letters) to communicate with

supporters, potential supporters, reporters, editorial writers, decision

makers and sta. Some o the inormation might even be posted on Web

sites so supporters can access it and keep track o upcoming events.

You should assume that anything you write down, circulate or post

on the Internet can and probably will nd its way to a wider audience.

Fact sheets meant or supporters may make their way to reporters.

Articles in newsletters may make their way to decision makers. Oppo-

nents as well as supporters will access inormation on the Internet.

Opponents will read letters and act sheets sent to decision makers

and highlight mistakes.

Beore distributing any document, ask whether there is anything in

the document that could be used to discredit, undermine or embar-

rass your campaign. Regardless o the document and audience with

whom you are communicating, make sure that your acts are accurate.

While it is entirely appropriate to highlight specic aspects or a given

audience, inaccurate, contradictory or inconsistent statements can ruin

your credibility.

Check the tone o your document. Tere’s a dierence between being

strong and being oensive, holding decision makers accountable and

attacking them personally, and applying pressure and making threats.

Review your documents constantly and update or remove any outdated

inormation, especially in documents posted on the Internet, because

opponents will use outdated documents to discredit a campaign. One

way to prevent this is to put the date on each version o a document.

You should assume

that anything you

write down, circulate

or post on the Internet

can and probably will

fnd its way to a wider

audience.




there is no such thing As“o the record”

Reporters, opponents and decision makers may want you to discuss

an issue “o the record.” Tis is a trap or the unwary. oo oen, “o

the record” statements appear in news stories, are repeated to decision

makers and are discussed in public hearings. Te only way to avoid

these problems is to be careul in what you say and treat all conversa-

tions as “on the public record.”

You may be asked “o the record,” “What will you settle or?” Your

answer will establish your position even i you think you are answering

“o the record.” A good way to handle this potential trap is to say, “We

have suggested a solution that we think is needed to address the prob-

lem. But there may be other solutions. ell us what you have in mind

and we will give it serious consideration.”

threAts Are unnecessAryAnd counterProductive

Making threats usually backres. Decision makers resent threats and

remember them or a long time. I you have done the research, prepared

a compelling story, marshaled public support and obtained media cov-

erage, the consequences o not taking the actions you are requestingwill be plain to the decision maker.

every stA MeMBer is iMPortAnt

While they are not decision makers, sta members are important. Tey

si and unnel inormation to the decision maker, schedule meetings,

recommend actions, and serve as a sounding board or issues, ideas

and concerns. reat all sta members with proessional respect. What-

ever their specic responsibilities, sta can help or hurt your cause. At

some point, the decision maker’s secretary may be the critical personwho decides whether or not you get a meeting with the decision maker.

Te sta person who opens and prioritizes the decision maker’s mail

may determine whether or not the inormation you sent gets to the

decision maker in time.

tp a tap




As an advocate, you represent a community o interests

on an important health issue. Trough your actions, try to

encourage everyone you contact to support your work and

treat your issue with respect.

dirty tricks

Opponents may resort to alsehoods, deception and other

dirty tricks to attack and undermine you, especially when

it looks as i you have a real possibility o winning. Respond

orceully. Expose the misrepresentations, trickery and scurri-

lous tactics or what they are. Document the truth to decision

makers, reporters and the public. Don’t all to the level o those

who play dirty tricks.

WAtch out or your oPPonentstrying to underMine your Progress

I you’re winning, watch out or your opponents trying to

undermine your progress. For example, i you are suc-

cessully persuading decision makers in an administrative

agency, your opponents might go to the legislature or the

courts to try to block the agency rom acting. I you’re win-

ning in the legislature, they may try to get an administrative

agency to take some sort o pre-emptive action (e.g., issue a

report, start a proceeding, take some ineective action, etc.).Oen, you can head o these types o maneuvers by paying

an early courtesy visit to key legislators or agency ocials to

inorm them o the problem, why it’s controversial and how

it is being addressed in another orum. Under these circum-

stances, many decision makers will be just as happy to stay

out o the ray and some may even be helpul. Aer the visit,

stay in touch. Don’t be outmaneuvered and, above all, don’t

be complacent.

Blocking the Repeal o SB 2

i 2003, caa la

a sB 2, w xpa

a a m a 1

m caa b q

b w 200 m

mp p a a

a w a

am b 2006

pa a a a . i

2007, mpa w 50 199

mp w b q

w. A

la, a a

b p m

a 600,000 a a

ba ma pa sB 2.

sp sB 2 w a a

a jb. t f

a pa . i

dmb 2003, saam

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.



n:





Getting the Facts

Alliance or Justice: Te Nonproft Advocacy Project

http://bolderadvocacy.org

Provides tax-exempt organizations a better understanding of the laws

that govern their participation in the policy process through workshops,

fact sheets, publications and more.

Bardach, Eugene. Te Eight-Step Path o Policy Analysis. Berkeley

Academic Press, 1996.

Berring, Robert C. Finding the Law . (11th ed.) St. Paul, MN. West

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Updates available at: http://www.law.berkeley.edu/aculty/berringr/

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Te Budget Process: A Citizen’s Guide to Participation. Senate Select

Committee on Citizen Participation in Government, 1996.

Caliornia Health Interview Survey (CHIS), UCLA Center or

Health Policy Research, the Caliornia Department o Health

Services, and the Public Health Institutewww.chis.ucla.edu

CHIS is an important source of information on health and access to

health care services. Its telephone survey of adults, adolescents and

children from all parts of the state is conducted every two years.

Data Center: Impact Research or Social Justice

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E-Te People

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Executive Ofce o the President. A Citizen’s Guide to the Federal

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http://www.netaction.org/

http://www.netaction.org/

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Te Worksheets outline tasks that will help to organize your

research, writing, decision making and actions. Your answers

will provide a convenient summary o your fndings and

strategy, and will orm the basis or your plan.

1. identiying the key decision MAker(s) or your issue 38

2.WhAt decision MAkers resPond to 42

Facts, Analysis and a Compelling Story 42

Your Research Findings 44

Strong Public Support 46

3.MediA Attention—reAching your Audience 49

4.Meeting With your decision MAker(s) 55

Te Meeting Arrangements 55

Pre-Meeting Communications 55

Planning or the Meeting 57

Marshal Support 60

5.Ater the Meeting: olloW-uP And olloW-through 61

6. i your solution is AdoPted 64

7. i your solution is denied 65

10W




1. i k d Ma() y i

1. Who do you need to persuade to achieve your health policy goals?

Decision maker 1:

Decision maker 2:

Decision maker 3:

2. What actions do you want the decision makers to take (e.g., introduce legislation, hold hearings,

change company policy, adopt new rules, enorce existing law, etc.)?

Decision maker 1:

Decision maker 2:

Decision maker 3:

3. What is the source o their authority or taking each action?

Decision maker 1:

Decision maker 2:

Decision maker 3:

4. Now that you have identied the decision makers, conduct some research to nd out

a. Teir background:

Decision maker 1:




1. i k d Ma() y i

Decision maker 2:

Decision maker 3:

b. Whether they have taken a position on this issue or related issues:

Decision maker 1:

Decision maker 2:

Decision maker 3:

c. I the decision makers are elected ocials, what do voters in their district think about the issue or

how are people in their district aected by the issue:

Decision maker 1:

Decision maker 2:

Decision maker 3:




d. Who their key sta people are:

Decision maker 1:

Decision maker 2:

Decision maker 3:

e. What the role o sta is likely to be:

Decision maker 1:

Decision maker 2:

Decision maker 3:

. What interests or motivates the decision makers:

Decision maker 1:

Decision maker 2:

Decision maker 3:

1. i k d Ma() y i




g. Whether there are people whose views or opinions they particularly value:

Decision maker 1:

Decision maker 2:

Decision maker 3:

h. Whether anyone in your coalition or among your supporters knows the decision makers or their sta:

Decision maker 1:

Decision maker 2:

Decision maker 3:

1. i k d Ma() y i




a, Aa a a cmp s

1. Te ollowing people are being hurt by the current situation:

a.

Because

b.

Because

c.

Because

2. Te people listed in No. 1 are able/unable to protect themselves because:

3. Tis is a serious problem because:

2. Wa d Ma rp t




2. Wa d Ma rp t

4. Te ollowing people and organizations are beneting rom the current situation:

a.

Because

b.

Because

c.

Because

5. How widespread is the problem?

6. I le unattended, the problem is likely to get worse/stay the same/get better because:

7. What has been done elsewhere to solve the problem?




2. Wa d Ma rp t

8. What could be done to solve the problem?

y ra

Note: Using credible sources (including inormation rom community organizations as well as individuals,

books, the Internet, government documents, databases and academic sources) is essential when getting

the acts. Proper reerencing is also important to build the case or why action should be taken.

1. Key acts about the problem:a.

Reerence source

b.




2. Wa d Ma rp t

Reerence source

c.

Reerence source

d.

Reerence source

e.




Reerence source

2. How will you present your research to the decision maker?

Fact sheets

Q&As

Research papers

Charts, graphs, photos and other visual material

Personal accounts

Data on successul solutions

s Pb spp

1. Te ollowing people/groups are likely to be interested in supporting your advocacy eorts:

a.

Because

b.

Because

c.

Because

2. Wa d Ma rp t




d.

Because

e.

Because

2. Te person(s) who will be responsible or contacting the above people/groups and asking or

their support is:

Name Date Will Contact By

a.

b.

c.

d.

e.

3. What do people/groups think about the problem as you describe it?

a.

Because

b.

Because

c.

Because

2. Wa d Ma rp t




d.

Because

e.

Because

4. What do they think should be done?

a.

b.

c.

d.

e.

5. Will they join in your eorts? How?

a.

b.

c.

d.

e.

2. Wa d Ma rp t




1. You need to reach the ollowing people because they are aected by the problem and need to be

aware o the issues and what can be done:

a.

b.

c.

d.

e.

.

g.

2. You also need to reach the ollowing people because they are likely to be infuential in persuading

decision makers:

a.

b.

c.

d.

e.

3. Who are the decision makers who need to take the action you want?

a.

b.

c.

d.

4. In this case, a broadly accepted value that will persuade this audience to take the action you recommend is:

3. Ma A—ra y A




5. What acts should be emphasized to your audience?

6. What is a simple and compelling story that can describe your broadly accepted value(s) and the acts

you have identied?

3. Ma A—ra y A




7. Te media that will reach your audience are:

a. Newspapers (daily, weekly, student, oreign language, neighborhood, etc.):

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

b. Radio stations (network, local, oreign language, university, public, etc.):

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

3. Ma A—ra y A




c. elevision stations (network, local, cable, oreign language, public, etc.):

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

d. Magazines (weekly, monthly, specialty):

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

3. Ma A—ra y A




e. Wire services:

1.

2.

3.

4.

5.

. Other (community organizations and church newsletters):

1.

2.

3.

8. Rank the previous media outlets in order o importance/eectiveness in reaching your audience.

Newspapers

Radio stations

elevision stations

Magazines

Wire services

9. Your media contact person will be:

3. Ma A—ra y A




10. Te story/case/study/problem(s) you will emphasize when communicating with the media is (are):

a.

b.

c.

11. o explain the issue to reporters you will use (check one or more):

News release

News conerence

Other

12. You will issue your news release/hold your news conerence

on

at a.m./p.m.

Note: Te inormation collected on your worksheet is the basis o your news release or press conerence.

Keep the worksheet beore you as you plan. Periodically review the worksheet to ensure that you have

not orgotten anything.

3. Ma A—ra y A




t M Aam

1. Te arrangements are satisactory/unsatisactory because:

2. I the arrangements are unsatisactory, the actions you should take are:

a.

b.

c.

d.

P-M cmma

1. I you are seeking a meeting with a decision maker:

a. What is the purpose o the meeting?

b. When would you like the meeting (is it important to meet right away or can the meeting be held

sometime in the next couple o weeks)?

c. Who should be attending on your side?

4. M w y d Ma()




d. Where would you like the meeting to be? (Most meetings are held in the decision maker’s oce; but in

some instances, it may be important to have a meeting in the community or at a specifc site [hospital,

health center, clinic] so the decision maker can see the problem and/or solutions frsthand.)

e. How much time will you need with the decision maker (in some cases, a ew minutes may be enough)?

2. I the decision maker is seeking a meeting with you:

a. What is the purpose(s) o the meeting as he or she sees it?

b. What is the date, time, place and expected duration o the meeting?

c. What are the names, titles and aliations o people who will be at the meeting? (For example: Will the

decision maker be present? Will other sta members be attending? Will representatives rom the opposition

be present? Has anyone else been invited?)

d. Is there any specifc inormation or a person that would be helpul to bring to the meeting?

4. M w y d Ma()




e. What are the logistics (directions, transportation, parking, check-in procedures, how much time to allow)?

Pa M

1. What do you want rom the meeting?

2. What will be the structure o your presentation? How will you tell your story and what will be the order?

3. During your meeting you will:

a. Bolster the ollowing points

1.

2.

3.

4.

5.

6.

4. M w y d Ma()




b. Present the ollowing changes in the acts, law or government policy since your last public statements:

1.

2.

3.

4.

5.

6.

c. Respond to opposing arguments as ollows:

Opposing argument

Your response

Opposing argument

Your response

Opposing argument

Your response

4. What are the dierent roles or the meeting participants?

a.

b.

c.

d.

e.

4. M w y d Ma()




5. Te people who will take on the dierent roles are:

Name

a.

b.

c.

d.

e.

6. What material(s) will you prepare or the meeting?

a.

b.

c.

d.

7. Te person(s) who will prepare the material(s) is (are):

Name

a.

b.

c.

d.

8. Your media contact person will be:

9. Te person responsible or taking notes, summarizing the items requiring ollow-up, and obtaining

copies o the meeting or hearing testimony is:

4. M w y d Ma()




Maa spp

1. You will ask the ollowing person(s)/groups to support your eort by attending the meeting and/or

by sending a letter o support:

a.

b.

c.

d.

e.

.

g.

h.

i.

2. Te person(s) responsible or contacting the above people/groups is (are):

4. M w y d Ma()




1. Te arguments raised in opposition are:

a.

b.

c.

d.

2. Tey are deective because:

a.

b.

c.

d.

3. Recent developments adding to your case are:

a.

b.

5. A M: w-up a w-t




c.

d.

4. Items you promised to supply the decision maker are:

a.

b.

c.

d.

5. Actions you promised the decision maker that you would take are:

a.

b.

c.

d.

6. Te person who is responsible or keeping in touch with the decision maker is:

5. A M: w-up a w-t




7. You will also monitor the decision maker’s action by:

a.

b.

c.

d.

8. Te person who is responsible or keeping your coalition and supporters up-to-date on the progress

o your action is:

9. Te person who is responsible or keeping the media up-to-date is:

5. A M: w-up a w-t




1. List the actions that must be taken beore the decision becomes eective:

a.

b.

c.

d.

e.

2. You will issue a news release/hold a news conerence

on

at a.m./p.m.

3. Tis decision will solve/alleviate the original problem by:

4. o solve the entire problem, you should:

5. You will express appreciation by:

6. i y s Ap




1. You should/should not try again in your chosen place where decisions are made because:

2. You should/should not go to the legislature or a bill, resolution or hearing because:

3. You should/should not try to work with or petition a government agency because:

4. You should/should not try to work with health care institutions or private companies because:

7. i y s i d




5. You should/should not try to get an initiative on the ballot because:

6. You should/should not pursue a court action because:

7. You should/should not try to take direct group action because:

7. i y s i d



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