Working with Decision-Makers AAP ADVOCACY TRAINING Working with Decision-Makers

Introduction There are many problems that affect the lives of your patients and your ability to provide care and treatment. These individual problems are often part of a broader issue. Many of the broader issues that children and pediatricians face can be resolved through changing community norms or systemic policy change. For every issue you care about, there is a decision-maker who can affect or influence the outcome. Trainer Notes: After the first bullet point, ask pediatric residents what children’s health issues are important to them. Read the second bullet point and provide 1 – 2 examples that illustrate the connection between these issues and broader systemic change based on what the pediatric residents shared. For example, childhood obesity can be related to lack of safe and open spaces, physical education in the schools, and nutritious yet affordable food. Read the third bullet point and then ask the group could who makes decisions on the previous example (if using the childhood obesity example, this could include park board for open spaces, school board or state legislature on physical education requirements, federal legislature on food stamps and food assistance).

Motivating Decision-Makers to Act Effective advocacy involves identifying and persuading these decision-makers to act on behalf of your issue. It is important to understand what motivates decision-makers: Elected or appointed officials: Influenced by what their constituents think and value. Community leaders: Usually not elected, but their position and scope of influence depends on them being viewed as credible, well-liked, or fair. They are influenced by public opinion, but in a less direct way than an elected official. Trainer Notes: Mention that the AAP chapter is available to help provide pediatric residents with information about who represents them. In addition, this information can also be found by searching city, county, state, and federal Web sites.

Influencing Decision-Makers Decision-makers are influenced by personal contact and communication. There are many different ways to influence a decision-maker to act on behalf of a children’s health issue. When choosing how you want to contact your decision-maker, keep in mind that the more personal you can make your communication, the better.

The Contact Pyramid Trainer Notes: Ask pediatric residents what are the different ways to contact or communicate with a decision-maker. (Some examples could include petitions, letters, e-mails, fax, meetings, phone calls, rallies). Write these responses on a flip chart or white board. Then ask pediatric residents where these contacts fit on the contact pyramid (for example, personal visits would fall under highly personal, where as petitions would fall under less personal). Point out that pediatric residents should keep this model in mind when deciding how to contact their decision-makers. Mention that a personal meeting between them and a decision-maker has the potential to be more influential than many signatures on a petition. Mention that the next few slides will highlight tips and pointers to keep in mind when contacting decision-makers by phone, letter, e-mail, or in person. When choosing how you will contact your decision-maker consider: The degree to which the activity is personal The number of people you have to engage in the activity.

What is important to keep in mind when calling a decision-maker? Trainer Note: Ask the pediatric residents what they think is important to keep in mind when calling a decision-maker. If group is quiet, rephrase the question and ask them what’s important to keep in mind when meeting with a patient. Emphasize that the same skills they use when communicating with their patients and patients families are the same skills they can use when communicating with decision-makers. Collect responses from the group then move to the next slide.

When Calling Decision-Makers Plan: Before you make the call, plan what you are going to say. Your phone call will be very brief, so keep your message simple and to the point. Message: Be sure to tell your story succinctly, why you care about children’s health, and why you need their support. Think about the key point and how your story underscores your point of view. Call: Make the call! Tell the decision-maker that you are a pediatrician and a constituent of their legislative district and/or community. Staff or Message: If you are calling a decision-maker, you may not be able to reach them directly. Be prepared to talk to staff or to leave a succinct message instead. Trainer Notes: Emphasize that talking to a staff member is not an insult. In fact, often times staff have more time to talk. Educating and persuading staff is a great way to build relationships with them and get them to educate and persuade the decision-makers they work for.

What is important to keep in mind when writing a decision-maker? Trainer Note: Ask the pediatric residents what they think is important to keep in mind when writing to a decision-maker. Collect responses from the group then move to the next slide.

When Writing to Decision-Makers State that you are a pediatrician and a constituent: This matters because leaders are most interested in the opinions of people who live in their area. Personalize your letter: Research shows that personal letters have the most impact on decision-makers. If you are basing your letter on a form letter, rewrite it and consider using your personal stationery. This also gives you the chance to include your story, which is what will have the most impact. Local, local, local: Make a strong connection between children’s health and what you and the decision-maker see in your home community. Show restraint: Keep your letter brief—1 to 1 ½ pages at most. Trainer Notes: Remind residents that postal mail to the US Congress may take up to 3 to 4 weeks to be delivered because of post-9/11 securing screenings. Encourage residents to either fax the letter or mail it to their federal elected official’s home/district office.

Advocacy Letter: What to Include Dear Senator/Representative _________. Opening Paragraph: states the subject of the letter gives the bill number or name, if available identifies the writer and their connection to children’s health Body of Letter: explains the issue simply and factually gives a local example of potential effects clearly states support for or opposition to the bill is polite and non-threatening thanks the elected official for their attention to the issue. offers to provide more information on request and includes your contact information asks for a reply

What is important to keep in mind when e-mailing a decision-maker? Trainer Note: Ask the pediatric residents what they think is important to keep in mind when e-mailing a decision-maker. Collect responses from the group then move to the next slide.

When E-mailing Decision-Makers In the subject line of the message, state that you are a pediatric resident and member of their community: This strategy will increase the likelihood that your message is read. (eg, Subject: Message from a constituent and pediatric resident.) If the e-mail is mass-produced, modify it: It doesn’t take much time to insert your personal story and perspective, and it makes a big difference in making your e-mail credible rather than “canned.” Follow up: Because e-mail is a more casual and often a mass-produced mode of communication, be sure that you are using other methods to persuade decision-makers. Follow your e-mail with a phone call, personal letter or visit. Trainer Notes: Add that because quantity is critical with e-mails. If using e-mail, encourage pediatric residents to recruit like-minded friends, family members, and colleagues to send an e-mail as well.

What is important to keep in mind when meeting with a decision-maker? Trainer Note: Ask the pediatric residents what they think is important to keep in mind when meeting with a decision-maker. If group is quiet, rephrase the question and ask them what’s important to keep in mind when meeting with a patient. Emphasize that the same skills they use when communicating with their patients and patients families are the same skills they can use when communicating with decision-makers. Collect responses from the group then move to the next slide.

When Meeting with Decision-Makers Meeting with your elected official gives you the chance to interact with him or her in a way that is not possible through a letter or e-mail. Before the meeting: Plan out what you are going to share, including why you care about the issue and how it affects other people they represent. Be sure to include a direct “ask”. During the meeting: Allow time for dialogue and invite questions. After the meeting: Thank the decision-makers for their time and let them know how they can reach you should they have questions. Send a thank you note, e-mail, or fax. Trainer Notes: Emphasize that it is okay if a decision-maker asks the pediatric resident a question that they don’t know the answer to. Simply state you don’t know and contact your AAP chapter to find the answer and get back to them. Never make up an answer.

Additional Tips to Keep in Mind You don’t need to be an expert in all of the technicalities of your advocacy issue. You only need to be an expert in your story—how the problem affects your patients and/or your profession and how the solution can bring about meaningful and direct change. Communicating with a decision-maker is not much different from the communication you use every day. Follow-up and repeated contact makes a difference. Send your decision-maker supporting information or work with your chapter to get them what they need. Trainer Notes: Reiterate that every day pediatric residents are taking complex medical issues and explaining them in simple terms that their patients and their families can understand. Remind pediatric residents that these same people skills apply to working with decision-makers. Also, encourage pediatric residents to use their chapter as a resource when contacting their decision-makers. AAP chapters can provide pediatric residents with key messages and speaking points, helping reinforce strength in numbers by creating a consistent message. Briefly remind residents that to avoid working at cross-purposes with their fellow pediatricians and advocates, they should focus their state-level advocacy on the state they’re in, unless they are working directly with advocates in other areas.

SUMMARY Effective advocacy—or getting decision-makers to support your issue—is about letting decision-makers know what you think about the issues you care about. Through personal and ongoing contact, not only can you gain their attention, but you can ultimately build a relationship with your decision-maker that will make them more likely to support children’s health and well-being in the future.

Making a Difference Regardless of whether you are reaching out to your elected official through an e-mail, letter, phone call, or meeting, keep in mind the following: establish your credibility as a professional and your interest as a constituent make your contact personal tell your story include a concrete or “direct” ask in your communication thank them follow up and make repeated contact

Additional Resources and Information AAP Advocacy Guide (www.aap.org/moc/advocacyguide) AAP Chapters (www.aap.org/member/chapters/chapters.htm) AAP Division of State Government Affairs (www.aap.org/moc/stgovaffairs) AAP Department of Federal Affairs (http://federaladvocacy.aap.org ) AAP Community Pediatrics Training Initiative (www.aap.org/commpeds/CPTI)