Chapter 5

Training of staff and clients is not only a statutory duty of advocates, it is an important tool for developing understanding of and compliance with patients' rights.

Training can be formally organized for groups or can be more informal technical assistance and advice offered in person or by phone or writing on how to handle a specific problem. Working one-to-one or in small groups can be one of the most effective ways of imparting information.

The key to effective training is to make it interesting and relevant to the particular audience. This requires variation in style, language, pacing, emphasis and materials.

A. Steps to Develop an Effective Training

Getting up in front of a group of people to provide a training is a challenging advocacy task. The more trainings you do, the more ease you will have in providing them.

First, make sure that you feel comfortable with your material. Remember that if you don’t know the answer to a question you can always get back to the person later. While you are reviewing your materials, look for potential handouts, case examples and visual aids to use in the training.

Second, assess your audience and their perspective. Identify their interests and incentives and direct your training to meet them. Modify language, examples and instructions according to audience characteristics.

Third, develop an outline for the training. Include the basic material you want to cover, case examples, questions to the audience and points where handouts are distributed. Decide whether or not to allow questions throughout the presentations or after each section. Rehearse the training out loud to yourself if it’s your first time.

Example: For a training on patients’ rights/denial of rights, provide an overview of patients’ rights and the proper procedure for denial. Use the Analysis of Denial of Rights from this manual as handouts. Lead a group discussion through specific rights denials using the handouts to determine if the legal requirements are met. Encourage your audience to share denial of rights situations that they have experienced and analyze them according to the handout. Try to include a client to speak about a denial of rights they experienced or read a client’s statement about the experience.

Sample Training Topics

  • The Commitment Process

  • Patients’ Rights: Observance and Denial

  • Informed consent and Capacity Hearings

  • Avoiding Seclusion and Restraint with Less Restrictive Interventions

  • Clients’ Rights to Participate in Assessment and Treatment Planning

  • The Use and Misuse of Mental Health Information

  • Conservatorship: Process and Protections

  • Medical Treatment Decisionmaking

  • B. Client Education and Self Advocacy

    In the same way that advocates promote client information and participation in the provisions of mental health services, they must also work to increase information and participation of clients in advocacy service.

    Advocates must keep their clients fully informed about advocacy activities which are undertaken, about information gathered in the course of advocacy activities and about alternatives, implications of actions and potential outcomes.

    Beyond increasing client participation in the individual advocacy process, advocates must seek to promote peer and self advocacy in their communities. Peer advocacy is clients supporting and assisting each other in advocacy activities. Self advocacy is the client taking on his/her own representation. Both processes recognize that clients’ unique expertise - their experience with the problems they are attempting to resolve and the energy and commitment built through personal experience - are valuable, special qualities of good advocacy work.

    The following is an excerpt from Lori Shepard - "Description of Self Advocacy" Introduction to Self Advocacy (PAI, 1998):

    "Self advocacy is different form the traditional form of advocacy services. In a regular advocacy program, you would give your complaint to the advocate and the advocate would take the issue to the appropriate authorities for you and follow whatever due process or appeals might be necessary to get you your desired goal, then report back to you when the issue has been resolved.

    In a self advocacy program the goal is for you to decide what it is you want, find out how to go about getting what you want, develop a plan and carry that plan out. This might include learning new skills, utilizing others to get what you want and seeking assistance from those in a position to assist you. You may learn some of the skills necessary to successfully advocate for yourself from a Patients’ Rights Advocate or another person who has experienced similar problems. In self-advocacy, the role of the advocate becomes a supportive one of helping you learn strategies and skills necessary to resolve your problem such as: "Who do you approach first?" "How do you negotiate?" The advocate may assist you to learn listening, negotiation, problem solving or assertiveness skills. A major goal of self-advocacy is to empower you to speak for yourself and participate in decisions effecting your life."

    C. Provider Education

    One of the most effective ways of preventing patients’ rights violations is through provider education. As mentioned above, advocates have a statutory duty to provide training and education to mental health providers in the area of patients’ rights and mental health law. By taking advantage of this role, advocates can be proactive rather than merely responding to complaints as they arise.

    Develop multiple perspective training programs that focus on both legal and clinical standards and procedures for staff. Make the training component on legal requirements concrete and how-to. Emphasize a few key points. Incorporate concepts and resources from other successful training programs. Use role playing and question/answer to illustrate standards, demonstrate techniques and involve the audience.

    Include the patient perspective; include a patient representative in presentations to staff. For patients and staff, refer to institutional and include practical strategies for problem resolution. Encourage that staff who work together are trained together. Allow for an opportunity for staff and patients to talk openly about their concerns and discuss their own attitudes, perceptions, opinions. Provide time for questions. Use consultants with expertise in the field to provide the training. Vary presenters. Provide materials and/or things to look at and work with.

    D. Training for Advocates

    The California Office of Patients’ Rights is responsible for providing training, technical assistance and support to county Patients’ Rights Advocates. The Office provides "New Advocate Materials" upon request to all counties experiencing a change in advocacy staff. The Office creates and distribute quarterly mailings containing a patients’ rights directory and other pertinent updates on patients’ rights issues to all county advocacy programs. The Office also conducts an annual statewide training in patients’ rights and mental health law with topics selected in consultation with county advocates and clients. Intensive on-site training is also available from the Office of Patients’ Rights at the request of the county advocate or local mental health director.

    Being an effective Patients’ Rights Advocate requires a good deal of self education as well. Advocates can increase their fund of knowledge by actively seeking out and reading materials related to patients’ rights and mental health law and creating their own library, observing other advocates, participating in regional advocacy coalitions and maintaining an exchange of information with other advocacy and client groups.

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