Effective Effective Advocacy: Advocacy: 

Knowledge, Tools & Knowledge, Tools & AttitudeAttitude

Presented by Carol Presented by Carol Neidenberg Neidenberg

January 25, 2012January 25, 2012

Legal Aid Society of San Legal Aid Society of San Diego:Diego:

Who Are We?Who Are We? Has provided legal services to eligible Has provided legal services to eligible

low-income individuals and families of low-income individuals and families of San Diego County since 1953. San Diego County since 1953.

Mission is to provide equal access to Mission is to provide equal access to justice for residents through quality justice for residents through quality legal services. Staff answer 250 calls legal services. Staff answer 250 calls each day related to housing, family each day related to housing, family law, welfare, consumer law and law, welfare, consumer law and immigration issues and SSI.immigration issues and SSI.

Consumer CenterConsumer Center Since March 1999 helps clients & family Since March 1999 helps clients & family

members make informed health care decisions & members make informed health care decisions & access services. access services.

Over 3,600 clients assisted last year to resolve Over 3,600 clients assisted last year to resolve denials, terminations or other issues with health denials, terminations or other issues with health programs includingprograms including Medi-Cal, mental health, Medi-Cal, mental health, County Medical Services and LIHP. County Medical Services and LIHP.

A Medicare team also helps eligible individuals A Medicare team also helps eligible individuals enroll in the Extra Help, Medicare Savings enroll in the Extra Help, Medicare Savings Programs & Part D. Programs & Part D.

Works closely with the County and state agencies Works closely with the County and state agencies to track and resolve systemic problems.to track and resolve systemic problems.

County-designated County-designated Patients’ Rights AdvocatePatients’ Rights Advocate

Has a unique insight & understanding of public Has a unique insight & understanding of public behavioral health services as the designated behavioral health services as the designated advocate for outpatient mental health for more advocate for outpatient mental health for more than 12 years. than 12 years.

Works collaboratively with agencies and Works collaboratively with agencies and providers to resolve issues at the lowest level providers to resolve issues at the lowest level possible.possible.

JFS Patient Advocacy Program investigates JFS Patient Advocacy Program investigates and resolves inpatient and residential and resolves inpatient and residential grievances/appeals. grievances/appeals.

Skills Needed for Skills Needed for AdvocatesAdvocates

Knowledge of legal rights and health Knowledge of legal rights and health programsprograms

Familiarity with health care systems Familiarity with health care systems especially local onesespecially local ones

Ability to remain neutral and Ability to remain neutral and focusedfocused

Emphatic yet active listeningEmphatic yet active listening

Goals: Improve access to Goals: Improve access to health care, empower health care, empower

clients and protect rightsclients and protect rights Understand and use the health care system Understand and use the health care system Learn about and exercise their rightsLearn about and exercise their rights Become educated advocates for themselves and Become educated advocates for themselves and

their familiestheir families Denied, terminated or reduced services or told Denied, terminated or reduced services or told

they do not qualify for a program or servicethey do not qualify for a program or service Having problems getting medicationsHaving problems getting medications Dissatisfied with health servicesDissatisfied with health services

AdvocacyAdvocacy

The act of leading or arguing in The act of leading or arguing in favor of something such as a cause, favor of something such as a cause, idea or policy; active supportidea or policy; active support

Investing client with power to Investing client with power to communicate effectively with their communicate effectively with their providers about their needs by providers about their needs by walking them through the needed walking them through the needed steps. . . without fear of retributionsteps. . . without fear of retribution

Why is Advocacy Why is Advocacy Needed?Needed?

Obstacles facing clients & family Obstacles facing clients & family members:members:

Being unaware of their rightsBeing unaware of their rights Medical model vs. recovery modelMedical model vs. recovery model Fear of retaliation Fear of retaliation Economic realities of reduced Economic realities of reduced

servicesservices

Examples of How Advocates Examples of How Advocates HelpHelp

Provide training and inform consumers of Provide training and inform consumers of their rights including assistance with their rights including assistance with applying for new benefit programs such as applying for new benefit programs such as LIHPLIHP

Advocate for granting appeals for denied Advocate for granting appeals for denied or reduced outpatient psychotherapy or reduced outpatient psychotherapy sessionssessions

Use Title 9 and the Beneficiary and Client Use Title 9 and the Beneficiary and Client Problem Resolution Process to resolve Problem Resolution Process to resolve issues issues

Most Commonly Filed Most Commonly Filed GrievancesGrievances

Quality of Care issues related to Quality of Care issues related to service, staff behavior or service, staff behavior or appointment schedulingappointment scheduling

Confidentiality Confidentiality Medication or diagnosis Medication or diagnosis

disagreementdisagreement

Resolving Grievances & Resolving Grievances & AppealsAppeals

Listen to issues either with client and/or Listen to issues either with client and/or family member (if authorized)family member (if authorized)

Review issues with supervisor or QI managerReview issues with supervisor or QI manager Obtain recordsObtain records Request and review records including Request and review records including

medication & diagnosis, progress notes also medication & diagnosis, progress notes also by an independent Board-certified by an independent Board-certified psychiatristpsychiatrist

Reach resolution within prescribed timelinesReach resolution within prescribed timelines

Examples of RightsExamples of Rights Seniors and Persons with Disabilities Seniors and Persons with Disabilities

(SPDs) on Medi-Cal managed care have a (SPDs) on Medi-Cal managed care have a right to request an exemption and ask for right to request an exemption and ask for continuity of care. continuity of care.

SSI eligibles have a right to apply for SSI eligibles have a right to apply for disabled Medi-Cal; be represented at disabled Medi-Cal; be represented at hearings and appeals hearings and appeals

Clients have a right to review their recordsClients have a right to review their records Under Medi-Cal, beneficiaries have a right Under Medi-Cal, beneficiaries have a right

to a State Fair Hearing after going through to a State Fair Hearing after going through the grievance/appeal processthe grievance/appeal process

How Advocacy HelpsHow Advocacy Helps Understanding HIPAA & their rights to Understanding HIPAA & their rights to

privacy privacy Referring to and collaborating with NAMI, Referring to and collaborating with NAMI,

e.g., Peer-to-Peer, Support Groups, Family to e.g., Peer-to-Peer, Support Groups, Family to FamilyFamily

Providing referrals and training to client-Providing referrals and training to client-operated programs such as RICA, operated programs such as RICA, clubhouses, housing and Creative Arts clubhouses, housing and Creative Arts ConsortiumConsortium

Encouraging clients to be active committee Encouraging clients to be active committee members and helping them understand the members and helping them understand the mental health system mental health system

Self-Advocacy SkillsSelf-Advocacy Skills

Understanding the system including Understanding the system including public mental health and managed care public mental health and managed care choiceschoices

Encouraging clients to take WRAP classes Encouraging clients to take WRAP classes and use the tools learned and use the tools learned

Participating in treatment options Participating in treatment options including updating client plans as needed including updating client plans as needed

Encouraging active involvement in health Encouraging active involvement in health care decisionscare decisions