1. Effective Advocacy: Knowledge, Tools & Attitude Presented by Carol Neidenberg January 25, 2012

2. Legal Aid Society of San Diego: Who Are We? Has provided legal services to eligible low- income individuals and families of San Diego County since 1953. Has provided legal services to eligible low- income individuals and families of San Diego County since 1953. Mission is to provide equal access to justice for residents through quality legal services. Staff answer 250 calls each day related to housing, family law, welfare, consumer law and immigration issues and SSI. Mission is to provide equal access to justice for residents through quality legal services. Staff answer 250 calls each day related to housing, family law, welfare, consumer law and immigration issues and SSI.

3. Consumer Center Since March 1999 helps clients & family members make informed health care decisions & access services. Since March 1999 helps clients & family members make informed health care decisions & access services. Over 3,600 clients assisted last year to resolve denials, terminations or other issues with health programs including Medi-Cal, mental health, County Medical Services and LIHP. Over 3,600 clients assisted last year to resolve denials, terminations or other issues with health programs including Medi-Cal, mental health, County Medical Services and LIHP. A Medicare team also helps eligible individuals enroll in the Extra Help, Medicare Savings Programs & Part D. A Medicare team also helps eligible individuals enroll in the Extra Help, Medicare Savings Programs & Part D. Works closely with the County and state agencies to track and resolve systemic problems. Works closely with the County and state agencies to track and resolve systemic problems.

4. County-designated Patients’ Rights Advocate Has a unique insight & understanding of public behavioral health services as the designated advocate for outpatient mental health for more than 12 years. Has a unique insight & understanding of public behavioral health services as the designated advocate for outpatient mental health for more than 12 years. Works collaboratively with agencies and providers to resolve issues at the lowest level possible. Works collaboratively with agencies and providers to resolve issues at the lowest level possible. JFS Patient Advocacy Program investigates and resolves inpatient and residential grievances/appeals. JFS Patient Advocacy Program investigates and resolves inpatient and residential grievances/appeals.

5. Skills Needed for Advocates Knowledge of legal rights and health programs Knowledge of legal rights and health programs Familiarity with health care systems especially local ones Familiarity with health care systems especially local ones Ability to remain neutral and focused Ability to remain neutral and focused Emphatic yet active listening Emphatic yet active listening

6. Goals: Improve access to health care, empower clients and protect rights Understand and use the health care system Understand and use the health care system Learn about and exercise their rights Learn about and exercise their rights Become educated advocates for themselves and their families Become educated advocates for themselves and their families Denied, terminated or reduced services or told they do not qualify for a program or service Denied, terminated or reduced services or told they do not qualify for a program or service Having problems getting medications Having problems getting medications Dissatisfied with health services Dissatisfied with health services

7. Advocacy The act of leading or arguing in favor of something such as a cause, idea or policy; active support The act of leading or arguing in favor of something such as a cause, idea or policy; active support Investing client with power to communicate effectively with their providers about their needs by walking them through the needed steps... without fear of retribution Investing client with power to communicate effectively with their providers about their needs by walking them through the needed steps... without fear of retribution

8. Why is Advocacy Needed? Obstacles facing clients & family members: Being unaware of their rights Being unaware of their rights Medical model vs. recovery model Medical model vs. recovery model Fear of retaliation Fear of retaliation Economic realities of reduced services Economic realities of reduced services

9. Examples of How Advocates Help Provide training and inform consumers of their rights including assistance with applying for new benefit programs such as LIHP Provide training and inform consumers of their rights including assistance with applying for new benefit programs such as LIHP Advocate for granting appeals for denied or reduced outpatient psychotherapy sessions Advocate for granting appeals for denied or reduced outpatient psychotherapy sessions Use Title 9 and the Beneficiary and Client Problem Resolution Process to resolve issues Use Title 9 and the Beneficiary and Client Problem Resolution Process to resolve issues

10. Most Commonly Filed Grievances Quality of Care issues related to service, staff behavior or appointment scheduling Quality of Care issues related to service, staff behavior or appointment scheduling Confidentiality Confidentiality Medication or diagnosis disagreement Medication or diagnosis disagreement

11. Resolving Grievances & Appeals Listen to issues either with client and/or family member (if authorized) Listen to issues either with client and/or family member (if authorized) Review issues with supervisor or QI manager Review issues with supervisor or QI manager Obtain records Obtain records Request and review records including medication & diagnosis, progress notes also by an independent Board-certified psychiatrist Request and review records including medication & diagnosis, progress notes also by an independent Board-certified psychiatrist Reach resolution within prescribed timelines Reach resolution within prescribed timelines

12. Examples of Rights Seniors and Persons with Disabilities (SPDs) on Medi-Cal managed care have a right to request an exemption and ask for continuity of care. Seniors and Persons with Disabilities (SPDs) on Medi-Cal managed care have a right to request an exemption and ask for continuity of care. SSI eligibles have a right to apply for disabled Medi-Cal; be represented at hearings and appeals SSI eligibles have a right to apply for disabled Medi-Cal; be represented at hearings and appeals Clients have a right to review their records Clients have a right to review their records Under Medi-Cal, beneficiaries have a right to a State Fair Hearing after going through the grievance/appeal process Under Medi-Cal, beneficiaries have a right to a State Fair Hearing after going through the grievance/appeal process

13. How Advocacy Helps Understanding HIPAA & their rights to privacy Understanding HIPAA & their rights to privacy Referring to and collaborating with NAMI, e.g., Peer-to-Peer, Support Groups, Family to Family Referring to and collaborating with NAMI, e.g., Peer-to-Peer, Support Groups, Family to Family Providing referrals and training to client- operated programs such as RICA, clubhouses, housing and Creative Arts Consortium Providing referrals and training to client- operated programs such as RICA, clubhouses, housing and Creative Arts Consortium Encouraging clients to be active committee members and helping them understand the mental health system Encouraging clients to be active committee members and helping them understand the mental health system

14. Self-Advocacy Skills Understanding the system including public mental health and managed care choices Understanding the system including public mental health and managed care choices Encouraging clients to take WRAP classes and use the tools learned Encouraging clients to take WRAP classes and use the tools learned Participating in treatment options including updating client plans as needed Participating in treatment options including updating client plans as needed Encouraging active involvement in health care decisions Encouraging active involvement in health care decisions