The Advocate's Tool Kit:

The American Association of Spinal Cord Injury Psychologists and Social Workers Advocacy Guidelines for Professionals

• Goals
• Responsibilities
• Effective Communication With Legislators
  • Effective Letter Writing
  • Telephone Calls
  • Personal Contact
  • Congressional Visit Checklist
  • Federal Advocacy and E-mail Communication
• Influences On A Legislator's Vote
• The Legislative Process
  • Step 01: Referral to Committee
  • Step 02: Committee Action
  • Step 03: Subcommittee Review
  • Step 04: Mark Up
  • Step 05: Committee Action to Report a Bill
  • Step 06: Publication of a written Report
  • Step 07: Scheduling Floor Action
  • Step 08: Debate
  • Step 09: Voting
  • Step 10: Referral to Other Chamber
  • Step 11: Conference Committee Action
  • Step 12: Final Actions
  • Step 13: Overriding a Veto
• The Regulatory Process
• Media Relations
• General Guidelines for Interviews With the Media
• Op-Eds and Letters to the Editor
• Creating Opportunities for Media Contact
• Conclusion
• Useful Web Sites For Your Advocacy Work
• National And International Health Policy Centers And Associations
• Acknowledgments

Goals

As Tip O'Neal once stated, "all politics are local." To that end, the goal of this handbook is to provide you, the members of AASCIPSW, with the tools to be an effective advocate for both your profession and for the clients with whom you work daily. Specifically, the goals of this tool kit are:

• To encourage you to participate in advocacy activities in order to cultivate and strengthen consultative relationships with members of Congress in your state.
• To encourage you to identify yourself as an essential key contact in your state on mental health issues before Congress, but especially those affecting persons with disabilities.

Being effective as an advocate requires not only the motivation to do so, but also the knowledge of how and where to exert your efforts to accomplish change. With this handbook and a little practice, you should be feeling quite confident at doing your part as an advocate.

Responsibilities

Every job has its responsibilities; some explicit, some not. As a concerned professional and as a member of AASCIPSW, all members have a responsibility to be an advocate at some level. These responsibilities include the following:

• Staying informed and knowledgeable about the legislative issues that affect persons with spinal cord injury (SCI), their families, and health care providers.
• Promoting a regular exchange of information between you and key members of Congress.
• Communicating regularly with the Professional Issues Committee and AASCIPSW regarding issues that the organization is supporting or needs members of Congress to support.
• Organizing and conducting meetings within your state or professional groups to increase awareness of issues pertinent to the profession and to persons with disabilities.

As you will learn, advocacy does not have to be time consuming, expensive, or require an advanced educational degree. It does require a commitment to a cause. While there are certain do's and don'ts, this tool kit will guide you around some of those pitfalls.

Effective Communication With Legislators

This is the keystone to a successful advocacy program. Without effective communication, advocacy is going to be a battle hard won. There are three major methods of grassroots communication with elected officials and their staffers:

• Letter writing
• Telephone contact
• Personal visits

Effective Letter Writing

• Responding to constituent letters and e-mails is a major part of the congressional staffer's day. Given that congressional offices receive hundreds of letters and e-mails per day from constituents, one might think that writing a letter would have little impact. However, legislators do pay attention to what their constituents write. There is a direct correlation between the amount of mail that a legislator receives about an issue and the level of attention the legislator gives to the subject. For this reason, time permitting, regular mail may be more strategic than e-mail in terms of influencing policy, despite the speed and convenience of e-mail. Congressional staffers have suggested that a large stack of letters on a desk have more of a psychological impact than a computer mailbox full of e-mails. Moreover, e-mails are easy to delete without being read, and thus your message may never get heard. Thus, whenever possible, it is recommended that you use regular personal letters or faxes to communicate messages to your legislator. Fortunately, AASCIPSW helps make the letter-writing process much simpler for you. Whenever an "Action Alert" is released on the listserve, the Alert will typically contain sample language for a letter (template) that you can use.
• When writing your representative, remember to be brief (one page), polite, and legible! You should stick to one issue per letter rather than sending a "laundry list" of concerns. Remember, the more personal/"hometown" you make the letter, the more effective it can be. Don't expect an immediate response to your letter. However, if you haven't received a response to your letter within a month, you may want to follow up the letter with a phone call to the congressional office.

When writing to any legislator be sure you address the letter correctly. The proper form is as follows:

The United States Senate
The Honorable (insert full name)
United States Senate
Washington, DC 20510
Dear Senator (insert last name)

The United States House of Representatives
The Honorable (insert full name)
United States House of Representatives
Washington, DC 20515
Dear Representative (insert last name)

Telephone Calls

The strategies for effective telephone calls to legislators are similar to those in the letter-writing section above. To find your representative's phone number, you may use a free searchable online congressional directory, such as www.firstgov.com, or call the Senate at (202) 224-3121, or the House of Representatives at (202) 225-3121, and ask for your senator's and/or representative's office.

Before placing a call:

• Make certain you have a clear sense of the message that you wish to communicate.
• Write down the main points in a clear and coherent order, and make sure you have the bill number and name correct.
• Be prepared with facts and information close at hand, should the legislator/staffer ask you questions.
• Your goal is to make one strong point supported by three good reasons.

Do not be discouraged if you do not speak to the legislator directly. Be sure to identify yourself as a psychologist/social worker, as well as a constituent; the more legislators hear from AASCIPSW members, the more informed they will become about what we do and the importance of their support for legislation that benefits those whom we serve.

Remember that a staff member, not the member of Congress, often takes telephone calls. Ask to speak with the aide who handles the issue about which you wish to comment. After identifying yourself, tell the aide you would like to leave a brief message, such as: "Please tell Senator/Representative (last name) that I support/oppose (S.___/H.R.8___)." You will want to state reasons for your support or opposition to the bill. Ask for your senator's or representative's position on the bill. You may also request a written response to your telephone call.

If neither the legislator nor the legislative aide (LA) is available, you can leave a message asking for a return call, or you can leave a brief message stating your position and what action you would like the legislator to take. Leave your address as well, in case the legislator wants to respond with a letter.

Maintaining good working relationships with your legislator is vital to advocating successfully for the profession and for persons with SCIs. While you may have considerable experience in communication with patients, graduate students, and other professionals, you may feel somewhat apprehensive about calling, writing, or visiting with an elected official. This is a natural feeling that with practice will soon be overcome.

Personal Contact

Going to "The Hill" for a face-to-face meeting is the single most effective way to communicate your message. Below are some pointers about scheduling and participating in congressional meetings.

Arranging Your Visit: When you contact your legislator's office, ask to be connected to the appointment secretary. Indicate your profession and that you are a constituent (if applicable) and ask for 15 minutes or so of the legislator's time to discuss the issues. Be sure to book your visit several weeks in advance; legislators' calendars fill up very quickly.

Preparing for the Visit: Rule number one is do your homework! It is vitally important that you learn as much as you can, not only about the issue you will be discussing, but also about your legislator's voting record on the issues. Knowing your legislator's stance on an issue is crucial because it dictates the focus and objectives of your meeting. Some of the Web sites listed at the end of this tool kit will be useful in gaining background information on various issues. The federal advocacy coordinator or members of the Professional Issues Committee may be able to help you research an issue, plan the best strategy for your meeting, or provide you with information to leave with the legislator.

During the Meeting: When you meet the legislator or the LA, identify yourself as a psychologist or social worker and a constituent (if applicable). It is perfectly acceptable to mention prior occasions during which you met the legislator, such as previous legislative visits, meetings, or social or political functions. Any special connection you may have to the legislator is helpful to mention (e.g., you have a mutual friend, or you attended the legislator's alma mater). However, since your legislator is very busy, don't dwell too long on pleasantries and small talk.

State your points clearly and firmly, but don't argue. Never speak badly of other legislators or organizations. Ask your legislator to state a position, and if he or she is unwilling to do so, indicate that you will check back at a later time. You should strive to come across to the legislator as a nonpartisan health expert who is concerned about the welfare of your patients. To this end, you should always talk about the issue in regard to how it impacts the state, communities, or individual constituents.

Remember that vignettes are an effective way to communicate the message in a way that makes sense to the legislator. Newspaper articles, opinion-editorial (op-ed) pieces, or other press can be helpful to supplement your message. Always end the meeting on a courteous note. Thank the legislator for his or her time and leave him or her your business card. Follow up with a thank-you letter on your stationery. If you meet with an LA, it is a good idea to mention the LA by name in your letter and offer some complimentary words about the LA's professionalism, knowledge, and personable nature. Such praise can help develop a good working relationship with the LA for future visits. Below is a checklist of things to remember as you prepare to visit a congressional office.

Congressional Visit Checklist

• Plan your visit carefully
• Make an appointment
• Be prompt and patient
• Be prepared
• Be sensitive to political issues
• Be responsive

Follow up the meeting with a thank-you letter

Federal Advocacy and E-mail Communication

Since the events of September 11, 2001, and the threat of bio-terrorism, congressional offices are handling correspondence from constituents in a very different manner. This has increased the processing time of regular mail. The following highlight the changes that have occurred and should be taken into consideration when deciding when, where, and how to communicate with members of Congress:

• The trend to give e-mail more weight has been accelerated.
• Every member of Congress is required to have and carry a Blackberry (aka high-tech personal digital assistant) to receive and send e-mails.
• Regular mail now goes through special treatment and takes much longer to arrive (estimated to be at least a week).
• Only 10% of e-mail sent to Congress is responded to by e-mail. Although the current environment in Washington, DC, has made communication challenging, here are some tips that may help:
  • Include a street address in all communication. You want to demonstrate that you are a constituent, and that listening to your opinions may mean a vote.
  • Include a personal experience or story with your position. Personalizing your letter helps the representative or senator remember your position and why.
  • Don't be frustrated by long delays in response letters. Given that Washington, DC, is on alert following recent events, communication with the local district office is likely to be more efficient.

Influences on a Legislator's Vote

(©2002, AARP. Reprinted with permission) Part of being a good advocate and being able to influence your legislator's decision to vote is having an understanding of how and what factors are playing upon that decision. With the average legislator casting approximately 400 votes a year, this is an important issue. Simply put, there are three key rules to being a successful legislator:

1. Make good policy.
2. Gain the respect of your colleagues.
3. Get re-elected.

While these three rules may underlie decision-making, there appear to be seven major forces that impact the decision process. While most congresspersons will have their own order of parity, for most, constituents will have the greatest influence.

Constituents - All members ask themselves every time they vote, "where do my constituents stand on this issue?" On those issues where the constituents voiced a strong position, the member is going to certainly vote in that direction.

Colleagues - Fellow members of Congress are critical sources of information. They possess expertise. The information they hold is tailored to the congressperson's needs, and they're available at the time of the vote.

Lobbies - Lobbyists can be either a blessing or a curse to the work of a congressional member. They can provide members with easily understood information and innovative proposals or perspective on an issue.

Party Leadership - Leadership sets agendas for their parties. Seldom does leadership micromanage specific votes. As such, parties play less influence than may be commonly thought.

Executive Branch - The president historically holds tremendous power and is the ultimate legislator. He has a breadth of informational sources at his access, can initiate legislation, set agendas, and influence all Americans.

Media - The media have formidable power and influence by directing our attention on particular issues. Typically, what a voter knows about an issue is gleaned from the broadcast news, the newspaper, and increasingly, the Internet. In a nutshell, the media have the potential to set agendas.

Staff - Staff are the source of technical knowledge and research. They are well informed and available at the time of the vote. Don't underestimate their influence.

The Legislative Process

Anyone may draft a bill; however, only members of Congress can introduce legislation and, by doing so, become the sponsor(s). There are four basic types of legislation:

1. Bills
2. Joint resolutions
3. Concurrent resolutions
4. Simple resolutions

The official legislative process begins when a bill or resolution is numbered - "H.R." signifies a House bill and "S." a Senate bill-and is referred to a committee and printed by the Government Printing Office.

Step 1: Referral to Committee

With few exceptions, bills are referred to standing committees in the House or Senate according to carefully delineated rules of procedure.

Step 2: Committee Action

When a bill reaches a committee, it is placed on the committee's calendar. A bill can be referred to a subcommittee or considered by the committee as a whole. At this point, a bill is examined carefully and its chances for passage are determined. If the committee does not act on a bill, it is the equivalent of killing it.

Step 3: Subcommittee Review

Often, bills are referred to a subcommittee for study and hearings. Hearings provide the opportunity to put on the record the views of the executive branch, experts, other public officials, supporters, and opponents of the legislation. Testimony can be given in person or submitted as a written statement.

Step 4: Mark Up

When the hearings are completed, the subcommittee may meet to "mark up" the bill. This means that changes and amendments are made prior to recommending the bill to the full committee. If a subcommittee votes not to report legislation to the full committee, the bill dies.

Step 5: Committee Action to Report a Bill

After receiving a subcommittee's report on a bill, the full committee can conduct further study and hearings, or it can vote on the subcommittee's recommendations and any proposed amendments. The full committee then votes on its recommendation to the House or Senate. This procedure is called "ordering a bill reported."

Step 6: Publication of a Written Report

After a committee votes to have a bill reported, the committee chairman instructs staff to prepare a written report on the bill. This report describes the intent and scope of the legislation, impact on existing laws and programs, position of the executive branch, and views of dissenting members of the committee.

Step 7: Scheduling Floor Action

After a bill is reported back to the chamber where it originated, it is placed in chronological order on the calendar. In the House, there are several different legislative calendars, and the Speaker and Majority Leader largely determine if, when, and in what order bills come up. In the Senate, there is only one legislative calendar.

Step 8: Debate

When a bill reaches the floor of the House or Senate, there are rules or procedures governing the debate on legislation. These rules determine the conditions and amount of time allocated for general debate.

Step 9: Voting

After the debate and the approval of any amendments, the bill is passed or defeated by the members voting.

Step 10: Referral to Other Chamber

After the House or the Senate passes a bill, it is referred to the other chamber where it usually follows the same route through committee and floor action. This chamber may approve the bill as received, reject it, ignore it, or change it.

Step 11: Conference Committee Action

If only minor changes are made to a bill by the other chamber, it is common for the legislation to go back to the first chamber for concurrence. However, when the actions of the other chamber significantly alter the bill, a conference committee is formed to reconcile the differences between the House and Senate versions. If the conferees are unable to reach agreement, the legislation dies. If agreement is reached, a conference report is prepared describing the committee members' recommendations for changes. Both the House and the Senate must approve of the conference report.

Step 12: Final Actions

After both the House and Senate have approved a bill in identical form, it is sent to the president. If the president approves of the legislation, he signs it and it becomes law. If the president takes no action on the legislation within 10 days, while Congress is in session, the legislation automatically becomes law. If the president opposes the bill, he may veto it. If he takes no action after Congress has adjourned its second session, there is a "pocket veto" and the legislation dies.

Step 13: Overriding a Veto

If the president vetoes a bill, Congress may attempt to "override the veto." This requires a two-thirds roll call vote of the members who are present in sufficient numbers for a quorum.

The Regulatory Process

After a bill is passed and becomes a law, it is referred to the appropriate executive branch agency for the development of implementing regulations. Regulations are intended to specify the details of how the law will be applied. Laws of interest to members of AASCIPSW will generally be directed to Health and Human Services, the Department of Agriculture, the Environmental Protection Agency, or the Office on Management and Budget.

Typically the department or agency publishes a call for public comment in the Federal Register to solicit views of the public on how a law would be best implemented. The department or agency will develop their first rule, signaling an opportunity for the public to comment specifically on the federal agency's plan. The agency reviews the comments and repeats the process several times before a final rule is published. This final rule may or may not reflect public opinion.

Media Relations

A significant component of effective advocacy is through effective media relations. Legislators are quite concerned with how an issue is being discussed in the media and, as such, will tend to view frequently discussed issues in the media as a priority. This section contains pointers for dealing with all sorts of media, including print, television, and radio, which may generate positive exposure for our professions.

General Guidelines for Interviews With the Media

1. Allow yourself time to prepare. Before answering any questions, ascertain the reporter's organization, his/her purpose in interviewing you, publication plans for the story, what is his/her "spin" on the story, the reporter's plans for additional interviews, and the reporter's deadline. Don't feel pressure to answer the reporter's questions or conduct the interview on the spot; it is perfectly acceptable (and advisable) to set up a mutually convenient time to conduct the interview. Get the reporter's phone number and keep it in your files for future reference.
2. Plan your statement. Select a target audience for the interview and prepare for the interview accordingly. Gather the latest information and data to support your position. Try to have at least three "talking points" ready to go when you talk to the reporter. Think in terms of providing "headlines"; you are stating your conclusion FIRST, and then supporting your conclusion with arguments. If your interviewer starts to go in a different direction from your points, use your therapy skills to "bridge" the conversation back to your main points.
3. Avoid "psychobabble." Explain your points using layperson's language. Keep your answers short and simple. Use brief anecdotes whenever possible.
4. Ensure accuracy. Don't be tempted to provide an answer to a question for which you may not have the answer. Tell the reporter that you will call back after looking up the information. In the same regard, if an interviewer makes a statement that you know to be inaccurate, (politely) correct him or her while providing the right information. With print media, be sure to provide proper spelling for any unusual names (including your own) or terms that you use. If you present sensitive material that may be misunderstood/misquoted, make sure the interviewer is clear in his/her understanding of the material and the importance of reporting it accurately.
5. Avoid "absolute" statements. Comments with the words "always" or "never" can often backfire on you.
6. Use statistics sparingly. Too many numbers can confuse the issue and increase the likelihood for inaccuracy. If you must use numbers, round them off (e.g., "over 40,000," not "41,050").
7. Be on guard for manipulation by the reporter. Don't answer any hypothetical questions, but be polite about it (e.g., avoid saying "no comment" because it has a defensive, combative connotation). Be careful if the reporter asks you to comment on some facts and figures or someone else's remarks. You should ask to see/hear the source of such information before commenting. NEVER make an "off the record" comment to the reporter. Avoid criticisms that can be taken out of context and make you look bad. In sum, don't say anything that you wouldn't want broadcast or seen in print.
8. Avoid tabloid journalism. Although it seems unnecessary to say, make sure you know to whom you are talking and where you will be quoted. No matter how valuable your information is, its credibility will be judged, in part, by where it is printed.
9. Keep the interview brief. Set a time limit for the interview with the reporter in advance. A set time limit focuses the questions and it reduces the risk of getting into uncomfortable or awkward material. Use highlights to accentuate your key points (e.g., "The real issue here, Mary, is that . . ."). This gives the listener a clear sense of your priority.
10. Turn down certain types of interview requests. It is advisable to avoid an interview on subject matter that is out of your area of expertise, or is a live, debate-oriented broadcast, or includes psychologically vulnerable individuals, or in any way compromises you. A simple, polite "no, thank you" to an interview request can save you headaches down the road. Don't worry that such a decision will be used against you in the future; there will always be other opportunities.
11. Offer to follow up with additional information. By doing so, you are also sowing the seeds for the reporter to rely on you as a credible source for future stories. Offer to review the story before it runs, although such opportunities are uncommon.

Op-Eds and Letters to the Editor

Writing letters to the editor or editorial pieces in your local newspaper is another effective means to advocate for disability-related issues. The following recommendations should be kept in mind when composing such materials:

• Call your local papers and ask for submission instructions for letters and op-ed pieces.
• Send your letter/op-ed to the largest newspaper in your community first. If they don't print your piece, send it to the next largest publication.
• Readers are drawn to stories with a "human interest" and local flavor. Use specific examples and vignettes that will spark community interest.
• Your goal is to evoke emotions in the reader (e.g., pointing out an injustice in health care that needs to be rectified) while at the same time offering an accurate conceptualization of the problem and your rational solution to the problem.
• Submit the piece on your letterhead, and have the head of your organization proofread it. Include your contact information in case the editor has questions for you.
• Follow up your submission with a phone call to the editor asking about his or her plan to print your piece.

Creating Opportunities for Media Contact

You don't have to wait for the media to come to you; you can create an interest in a story with an effective press release. Journalists rely heavily on such releases to generate story lines, and a well-timed press release can greatly aid your grassroots advocacy efforts. You can use press releases to provide specific information about a specific issue, the latest research findings, or to advertise an upcoming event related to disability or chronic illness (often referred to as a "Media Advisory"). Here are some pointers for creating a press release:

• Identify your target audience. Find out the field reporters and television/radio reporters in your area who cover health care issues.
• A good press release should answer the following questions: who, what, where, when, why, and how?
• The beginning of the release should have a "hook" to grab reporters' attention. Try to write the release in the "inverted pyramid" format, with the most salient information included near the top.
• The release should be specific and brief. Avoid technical terms or unnecessary details. Sentences and paragraphs should be short and to the point.
• Check and double-check the accuracy of your information.
• Timing is critical. If your release coincides with other current events, you will have a greater impact. If you are announcing an event, make sure to send the release sufficiently in advance.
• If relevant, include a picture. Use high quality black-and-white photos if possible.
• Include contact information for you and/or your organization with the release.
• Follow up with any reporters who attend your event or utilize your press release in some way. Thank them for their efforts.

Conclusion

The key to effective media relations is maintaining control over the process. This goal is accomplished with strong, positive talking points, as well as your appearance and attitude in delivering your message. You should view every question in every media interaction as an opportunity to advance a positive message on behalf of disability-related issues (especially as it relates to issues pertinent to psychology and social work). This section was designed to help you become a more active participant in the interview process. By utilizing these pointers in conjunction with your skills as a therapist, you have the potential to make media relations a vital part of your work as an advocacy coordinator.

Useful Web Sites for Your Advocacy Work

Web sites for Federal Advocacy

http://www.congress.org
A good site for beginners. Provides pointers for communicating with Congress, an overview of the legislative process, and a congressional schedule. Also has a useful section called "Congressional Scorecard," which gives you various associations' official views on a given issue.

http://www.house.gov/
http://www.senate.gov/
Official sites of the U.S. Senate and House of Representatives. Provides links to members' e-mail addresses and Web pages, congressional schedules, information on current legislation being considered, and numerous links to other government Web sites.

http://thomas.loc.gov/
This Library of Congress site is the best way to track active legislation. You can download bill summaries from the current Congress back to 1973 (93rd Congress) or the full text of legislation from the present back to 1989 (101st Congress). It allows you to search for legislation either by bill number or by subject area. Also provides current and back issues of the Congressional Record back to 1989. This site also provides updates on committee activities and hearing schedules.

http://cq.com/
Congressional Quarterly's Web page, designed to help the average voter track what is happening in Congress. This site has an interesting link called "Rate Your Rep," which allows you to compare your own position on issues to where your legislators stand on those issues. Try it to see how well you "match" your elected officials!

http://www.mentalhealth.org
A good Web page for information about mental health parity, including actuarial analysis, current research about parity, and tracking of federal parity legislation and regulation.

Professional Health Sites

http://www.socialworkers.org/advocacy
A comprehensive Web page from the National Association of Social Workers with excellent links to finding "Hot Topics."

http://medlineplus.nlm.nih.gov/medlineplus/organizations.html
A fairly comprehensive page of links to various health care organizations.

http://maelstrom.stjohns.edu/archives/psyusa.html
A link page for various psychology-related Web sites.

http://www.apa.org/practice/prof.html
From the APA's Practice Directorate Web page, this site contains guidelines, practice pointers, and other information about mental health and the efficacy of psychotherapy that can be useful in your advocacy work. A great resource when you are writing position papers or preparing media materials.

http://nationalpsychologist.com/
The online version of the National Psychologist publication.

State Advocacy Sites

http://capwiz.com/asae/home
An excellent resource to identify state legislators by zip code. Also provides bill-tracking links in various state legislatures.

http://www.nytimes.com/
The New York Times on the Web: daily international, national, and local news coverage from the newspaper, breaking news updates, technology news, sports, reviews, crosswords, and classified ad listings.

National and International Health Policy Centers and Associations

National Health Policy Centers

http://www.hpolicy.duke.edu/
Duke University Center for Health Policy, Law and Management

http://jeffline.tju.edu/CWIS/OHP/index.html
Thomas Jefferson University-Office of Health Policy and Clinical Outcome

http://www.chcr.brown.edu/
Brown University, Center for Gerontology and Health Care Research

http://www.georgetown.edu/research/ihcrp/
Georgetown University, Institute for Health Care, Research and Policy

National Health Policy Associations

http://www.apha.org/
American Public Health Association

http://www.aahc.net/
American Association of Healthcare Consultants

http://www.nchc.org
National Coalition on Health Care

http://www.aamc.org/
Association of American Medical Colleges (AAMC)

http://www.hospitalconnect.com
American Hospital Association

http://www.aahp.org/
American Association of Health Plans (AAHP)

International Associations

http://www.who.int
World Health Organization

Acknowledgments