PAC 120 Module 6 Advocacy for Clients and Communities Example

Beyond the Session: An Advocacy Plan to Close the Treatment Completion Gap at a Milwaukee Recovery Program

Student Name

Psychology and Addiction Studies Program, Aspen University

PAC 120: Multicultural Advocacy

Instructor Name

Month Day, Year

Beyond the Session: An Advocacy Plan to Close the Treatment Completion Gap at a Milwaukee Recovery Program

Last year Northside Community Recovery, a made-up program on Milwaukee's north side, reviewed its completion data for the first time by race and ethnicity. Of white clients discharged, 61 percent completed treatment. Of Black clients, 44 percent did, and of Latino clients, 47 percent. Staff were troubled, and some explanations offered in the meeting, such as that some clients were less motivated, located the problem in the clients. This paper argues that the gap is better understood as a set of barriers that advocacy can address, and it proposes a plan. The program, its percentages and its clients were made up for this assignment, though the national studies it draws on are real.

What the National Research Shows

Saloner and Cook (2013) analyzed national data on discharges from publicly funded addiction treatment programs. Black and Hispanic clients were less likely than white clients to complete treatment for alcohol and drug problems. When the researchers accounted for socioeconomic factors, including unemployment, unstable housing and lack of insurance, much of the gap disappeared, particularly for Black clients. They concluded that disparities in treatment completion are driven largely by social and economic disadvantage rather than by differences in clients themselves, and they called for policies addressing housing, employment and coverage.

Mennis and Stahler (2016) examined completion in outpatient treatment specifically, using national discharge data, and found that racial and ethnic disparities varied by the substance being treated. Gaps were present for some substances and not for others, which suggests that the barriers clients face, such as the criminal legal consequences of particular drugs, differ across substances.

What Clients Told Us

Before drafting this plan, Northside held two listening sessions with current and former clients. Clients named five barriers repeatedly: evening groups that conflicted with second-shift jobs, two bus transfers to reach the program from the north side, drug court appointments scheduled without regard to treatment, no Spanish-speaking evening group and a sense that staff did not reflect the communities they served.

Two Advocacy Frameworks

Toporek et al. (2009) described the advocacy competencies adopted by the American Counseling Association. The framework distinguishes advocacy at three levels, the client or student, the school or community and the public arena, and at each level distinguishes acting with clients from acting on their behalf. The result is six domains: client empowerment, client advocacy, community collaboration, systems advocacy, public information and social or political advocacy. The authors argued that counselors have an obligation to address systemic barriers that affect their clients' well-being, not only to help clients cope with them.

Ratts et al. (2016) revised the multicultural counseling competencies into the multicultural and social justice counseling competencies. Their framework asks counselors to consider the privileged and marginalized identities of both counselor and client, and it extends counseling and advocacy interventions across levels from the individual to the institutional, community and public policy levels. It emphasizes that counselors should intervene with and on behalf of clients at whichever level the barrier lies.

The Plan

Why These Actions First

The plan starts with the barriers clients named and the research supports, not with the barriers easiest for staff to fix. Bus passes and schedule coordination come first because they cost little, can begin at once and respond directly to the two complaints clients raised most often. The morning and Saturday groups follow because second-shift work, common among Northside's Black and Latino clients, is one of the socioeconomic conditions Saloner and Cook link to dropout. The bilingual group depends on a partner that knows the community better than Northside does, which is why it is framed as collaboration rather than as a new Northside service. County testimony comes last in time but not in importance, because transit and coverage shape whether clients can reach any program at all.

Measures of Success

Northside will track completion by race and ethnicity every quarter, with the goal of reducing the gap by half within two years. It will also track intermediate measures: attendance at morning and Saturday groups, the number of drug court scheduling conflicts, enrollment in the bilingual group and client ratings of whether staff understand their community. Results will be shared with clients and the community.

Risks and Limits

The plan faces risks. Staff time for advocacy competes with clinical work. County testimony may not change bus routes. Some barriers, such as unemployment and housing, are beyond what one program can fix. The plan addresses them through partnerships and referrals, but the completion gap may narrow less than hoped. These limits are reasons to measure carefully, not reasons to stop.

The Counselor's Role

Advocacy is sometimes treated as an extra that counselors may take on if they have time. Both frameworks reject that view. When the barriers that keep clients from recovering lie in bus routes, court schedules and job shifts, helping clients requires addressing those barriers. The counselor's knowledge of clients' lives gives them standing to speak, and acting with clients, through the advisory board and client speakers, ensures that clients' voices lead.

Conclusion

Northside's completion gap reflects barriers more than motivation. Saloner and Cook show that socioeconomic conditions explain much of the national gap, Mennis and Stahler show that gaps vary by substance and Toporek, Lewis and Crethar and Ratts and colleagues provide frameworks for acting at every level. With clients leading where they can, Northside can address the barriers that stand between its clients and recovery.

References

Mennis, J., & Stahler, G. J. (2016). Racial and ethnic disparities in outpatient substance use disorder treatment episode completion for different substances. Journal of Substance Abuse Treatment, 63, 25-33. https://doi.org/10.1016/j.jsat.2015.12.007

Ratts, M. J., Singh, A. A., Nassar-McMillan, S., Butler, S. K., & McCullough, J. R. (2016). Multicultural and social justice counseling competencies: Guidelines for the counseling profession. Journal of Multicultural Counseling and Development, 44(1), 28-48. https://doi.org/10.1002/jmcd.12035

Saloner, B., & Cook, B. L. (2013). Blacks and Hispanics are less likely than whites to complete addiction treatment, largely due to socioeconomic factors. Health Affairs, 32(1), 135-145. https://doi.org/10.1377/hlthaff.2011.0983

Toporek, R. L., Lewis, J. A., & Crethar, H. C. (2009). Promoting systemic change through the ACA advocacy competencies. Journal of Counseling & Development, 87(3), 260-268. https://doi.org/10.1002/j.1556-6678.2009.tb00105.x