CRPCRPCRPCRPCRPBRIEF Your Source for Issues and Trends in Community Rehabilitation This project is in part supported under a grant from the Department of Education. However, the contents do not necessarily represent the policy of the Department of Education and endorsement by the Federal Government should not be assumed. Vol. 1, No. 3 December 2002 The University of Wisconsin-Stout Rehabilitation Research and Training Center (RRTC) on Community Rehabilitation Programs conducts research funded by the National Institute on Disability and Rehabilitation Research* on behalf of Community-Based Rehabilitation Programs (CRPs). This report examines research related to the issue of informed consumer choice. Portions of this document are excerpted from: Consumer Choice, Satisfaction, and Outcomes: Are They Related? a paper presented at the Community- Based Rehabilitation: Research for Improving Employment Outcomes Conference, September 12-13, 2002 in Washington, DC (Hagen-Foley, et al, 2002). *U.S. Department of Education, grant number H133B30088. Self-determination as Experienced inSelf-determination as Experienced inSelf-determination as Experienced inSelf-determination as Experienced inSelf-determination as Experienced inCommunity Rehabilitation ProgramsCommunity Rehabilitation ProgramsCommunity Rehabilitation ProgramsCommunity Rehabilitation ProgramsCommunity Rehabilitation ProgramsFORWARD Informed choice is “a decision making process in which the individual analyzes relevant information and selects, with the assistance of the rehabilitation counselor or coordinator, a vocational goal . . . Implementing informed choice requires communicating clearly, gathering and understanding information, setting goals, making decisions, and following through with decisions” (Section 12(e)(2)(F) of the Rehabilitation Act of 1973, as amended, 34 CFR 361.52). As legislators were developing mandates for informed choice, disability-rights advocates were discussing the need for self-determination. Self- determination is a process that identifies the individual as the primary decision maker over the nature, extent and duration of services. It makes the individual with a disability the primary change agent in their lives. What is the role of CRPs in assisting persons with disabilities in achieving their vocational goals and how effective are CRP staff at assuring informed choice and/or self-determination? Does informed choice happen in CRPs? The prior sentence all but assumes it does, the question is how effectively do they do it? In the following pages, we try to provide partial answers to these questions by understanding the processes by which CRP staff encourage and support consumers’ self-determination. KEY FINDINGS The RRTC has conducted research to identify the extent to which informed choice occurs in CRPs. The project “How the CRP Industry and Persons with DisabilitiesAchieve Competitive Employment Outcomes” was undertaken to identify vocational rehabilitative services related to successful employment outcomes for individuals with disabilities. The sample includes 779 individuals with different disabilities including cognitive, physical and mental health needs and 65 organizations both rural and urban that provide different types of vocational services such as natural supports, supported employment, etc. This study included measures of informed consumer choice and satisfaction with services and outcomes from the perspective of the consumer. CRP staff were also asked to estimate the extent to which individual consumers were involved in planning their services or employment goals. Table 1 lists the percent of agreement among consumers and CRP staff regarding activities supporting informed choice. Consumers and CRP staff report fairly high levels of informed choice. It is apparent from these findings service providers are using different approaches to provide informed choice. It is clear that both consumers and CRP staff see themselves as being engaged in the informed choice/self-determination process. Nearly all indi CONSUMERS For some individuals, the availability of choices is a new experience. Many of our customers have never had the opportunity to make choices in their own lives. Someone or some system has made could be referred to a decision making informed the power to make their decisions is not informed choice. customer in the informed choice process. The staff needs to be very clear with the customer that they are not making the decisions for them but will provide them information to make their own decisions. Starting with small decisions and allowing the customer some experience with successful decision- making is a way to begin this process. The consumer may not know what services or employment options are available. They may not even be fully aware of their interests, skills and goals for employment or to have a long-term employment goal. It is important to be in tune with what the choice-making process, the service provider should “encourage the customer to strongly think about his/ her reasons for wanting to go in the direction that he/ she is choosing and talk about those reasons with think they do about this particular decision and by thoroughly discussing it he may get a better underhonest with the customer and any interested family or advocates about the risks and concerns they have about a particular job or employment site they are considering. If the person is simply unable to decide because they are conflicted, then we delay the decision. If I sense that the fears of the family/ advocate are interfering with the decision making of person is under 18.” The service provider is charged with both identifying options and presenting these to the consumer in a manner that truly respects the individuals’ needs, desires and goals. The role of the service provider involves gathering information, assisting in the decision making, and allowing time for the client to select the “best” possible choice for them. When the self-determination partnership between consumers and service providers is fully realized, vocational outcomes reflect the consumers’ interests, skills and goals, and consumers are likely more satisfied with services received and outcomes attained, maintain employment meaningful to them and experience career advancement and economic viduals report that their work interests and skills were discussed, and CRP staff clearly recognize the requirement to provide those circumstances that encourage self-determination. Underlying all of this, of course, is the assumption that the best employment outcomes balance individual needs and desires for employment with their skills, interests, aptitudes and abilities, meaningful and satisfying work, potential for career advancement and local economics. Table 1. % Agreement Consumer Staff The consumer’ s work interests were asked and talked about. 92.0 97.8 The consumer’s work skills were asked and talked about. 93.2 97.8 It was clear to this consumer how the CRP would help him/her get job. 89.4 96.3 This consumer was involved in developing his/her employment plan. 86.3 96.0 87.6 94.1 74.1 91.0 The consumer was able to try jobs to see how he/she liked them. 65.3 87.1 IMPLICATIONS FOR choices for them. With ideal resources, this customer choice class. Allowing the customer to give the staff In reality, it is our responsibility to engage the individual wants. To support an individual in the him/her. It is possible that they don’t know all they standing.” Another service provider states, “I am the customer, then I meet with the customer separately, unless there is a guardian involved or the self-sufficiency. The consumer understood how employment services would help him/her. When this consumer left the CRP, he/she was able to choose the job they wanted. RELEVANCE TO CRPS CRP staffs recognize the requirement to provide informed choice. Full implementation of the goals of informed choice requires the active participation of consumers and CRP staff. Barriers to implementing self-determination fully include the limitations placed by funders (i.e., type and/or hours of services allowed) and local economies (i.e., urban vs. rural, unemployment rates). Recognizing these limitations, CRP staff can and do encourage informed choice. Can we do more? Are we doing everything possible to foster informed choice and self-determination by our customers? What strategies might we employ to encourage greater levels of choice and self-determi- nation? How can we improve the rehabilitation partnership to empower consumers? Informed choice and self-determination emphasize person- centered planning, considering the specific attributes, needs, desires, goals of each individual through: analyzing needs, gathering information, describing options, evaluating the information, selecting from among the options and making a choice, accepting the risk of failure, assuming responsibility for the outcome of the choice, and evaluating the results of choice making and using the information in future choice making experiences. As a CRP, are you: • encouraging individuals through the employment process in exploring options, discussing needs, and identifying long-term career aspirations? What are their skills? Interests? Needs? Dreams? • creatively exploring and supporting employment options? What is important to them in a job? What motivates them to work? What kind of supports do they need on a job? What kinds of tasks do they want/not want to do on a job? What is their dream job? The sky is the limit! If the individual has an employment goal that seems unattainable, what aspects of that work are of primary interest to them? What is most appealing to them about their dream job? How can this apply to their career path? What other creative options for employment are available for them to pursue their interests? • providing information to each individual regarding programs and the opportunities and alternatives available in a manner understandable to the consumer, repeating the information regularly and verifying that the consumer has a clear understanding of their choices? Perceptions of the acceptability of a specific job may change after experience in the position. An example from the National Center on Self- Determination illustrates how identifying skills and interests and creatively considering employment options empowers individuals and benefits communities. A middle-aged man was served in a group home and adult day care center. He loved music and riding around in his car. There are many small car repair businesses in his neighborhood. Each requires the daily services of a courier who picks up car parts from warehouses and delivers them to the garages. He now has a business of his own delivering car parts and enjoys riding around in his car and lives in his own apartment. By identifying the skills, interests and abilities of this individual and considering the employment potential of these attributes, the service provider is focusing on the value of the individual and the importance of each person’s unique contribution to the community and the broader economy. In reality, many times jobs pop up and create pressure for us to fill them in our eagerness to serve our customers and our well-developed employers. However, we must not spread this anxiety/pressure onto the customer! That is the reality of practicing this model of informed choice. So, bottom line, our customers need to take the time necessary to make the decision for themselves. SUMMARY The research is evidence of the existence and extent of informed consumer choice in community rehabilitation programs. This research does not describe the specific processes by which informed choice occurs in CRPs. How do service providers assure informed choice/self-determination in services Region VI CRP-RCEP PO Box 311456 Denton, TX 76203-1456 71954 Meeting the continuing education needs of community rehabilitation providers The CRP Brief is published 3 times a year by the Region VI CRP-RCEP and is also available on our website: For more information contact: 940/565-4000 VISIT OUR WEBSITE!and employment goals for all consumers? How do service providers encourage consumers to look beyond a job and develop long-term employment goals with individuals who, perhaps due to their come to our website to continue the discussion: Address comments or questions regarding the Stout, Menomonie, WI 54751 or by e-mail to hagen-foleyd@uwstout.edu determination visit the following websites: www.crp.unt.edu Linda Holloway, Editor, University of North Texas - Region VI CRP-RCEP PO Box 311456, Denton, TX 76203-1456 disability, think only of the short-term future? Please http://www.rtc.uwstout.edu research of this RRTC or any of the information presented in this document to: Debra Hagen-Foley, Ph.D., Research Coordinator, RRTC on Community Rehabilitation Programs, University of Wisconsin Additionally, for more information on self- www.self-determination.org www.self-determinationohsu.org