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Counselor advocacy: affecting systemic change in the public arena.

Article Excerpt
Deamonte was a 12-year-old student in a public school system in the Washington, DC, metropolitan area. One day he got a toothache. Deamonte's mother, who was a wage-reliant worker, had no health insurance, and the family's Medicaid coverage had temporarily lapsed. Because of their situation, she could not afford to pay the $80 dentist bill. By the time Deamonte was seen by a dentist, the bacteria from the abscess in his rotting tooth had spread to his brain. After two operations and 6 weeks of hospital care, Deamonte ultimately died. It was later revealed that Deamonte and his younger brother, DaShawn, never received dental attention at any time during their young lives (Otto, 2007).

This case, which received both national and international attention, did not happen in Darfur. It happened in one of the wealthiest regions in the richest country in human history. Deamonte's death underscores an overlooked concern in the debate over universal health coverage--dental care. It is a case of great social injustice, because no child in the United States in the 21st century should die of a toothache because his or her family cannot afford an $80 dentist bill.

Involvement in a case such as that of Deamonte would present a counselor with a major set of issues and challenges at a number of important levels. The first of these challenges is to meet the needs of Deamonte's family in the aftermath of his death. Such assistance might entail grief counseling for his mother and brother, which would address client empowerment at the microlevel. Certainly, this first level of intervention forms that crucial basis of counseling: helping clients solve problems or make decisions (Gladding, 2004; Kottler, 2003; Nugent & Jones, 2005). The second challenge might be ensuring that Deamonte's mother and brother get the services that they need from school and community representatives. In this case, the counselor may need to act as a systemic advocate for Deamonte's family. This systemic level of counselor intervention has received increasing attention within the profession as counselors have been called on to become agents of systemic change to challenge social, cultural, or economic (macrolevel) barriers to optimal psychosocial development (Dinsmore, Chapman, & McCollum, 2000; Lee, 2007; Lewis, Lewis, Daniels, & D'Andrea, 1998).

Perhaps the greatest challenge for a counselor is to move beyond the client and systems levels and translate his or her concern for Deamonte's family into action that will have far-reaching impact, because it is unrealistic and naive to think that Deamonte and his family would be the only ones facing a crisis in dental care. In thinking through such action, a counselor must decide whether he or she has the awareness, knowledge, and skills to engage in social/political advocacy for all socioeconomically disadvantaged children and their families who lack health care. Such advocacy encompasses the professional and moral responsibility that a counselor has to address the significant social, cultural, and economic challenges...

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