AMERICANREHABILITATIONAMERICANREHABILITATION

AUTUMN 2004

H O W E M P O W E R M E N T

C H A N G E D M Y L I F E

“ I D O N 'T H A V E TO L I V E

I N M Y C A R A N Y M O R E…”

E N H A N C I N G P E R S O N A L

E M P O W E R M E N T

O F P E O P L E W I T H

P S Y C H I A T R I C D I S A B I L I T I E S

SE L F -DE T E R M I N A T I O N A N D T H E

E M P O W E R M E N T O F P E O P L E

W I T H D I S A B I L I T I E S

S L A Y I N G D R A G O N S :BUILDING SE L F -CO N F I D E N C E

AND RAIS ING EXPECTATIONS

T H R O U G H O R I E N T A T I O N

C E N T E R T R A I N I N G

E M P O W E R I N G P E O P L E

W I T H D I S A B I L I T I E S

T H R O U G H V O C A T I O N A L

R E H A B I L I T A T I O N CO U N S E L I N G

Empowerment is multidimensional. It means, amongother things, having decision-making power, access toinformation, the opportunity to make meaningful choices,understanding of rights and responsibilities, a sense ofhope, raised self-esteem and control over the directionof one’s life. Since assuming my responsibilities as Com-missioner of the Rehabilitation Services Administration,I have traveled a great deal, speaking at length aboutempowerment, a concept that I believe is absolutelyfundamental to the future of our public rehabilitationprogram and our consumers. In the course of my con-versations with colleagues in the rehabilitation field, Ihave encountered varying responses to this priority. Manyprofessionals appear to be as committed as consumersthemselves to the goal of consumer empowerment. Oth-ers, however, have been less enthusiastic, claiming thatempowerment doesn’t work or that empowerment ofconsumers poses a threat to the professional relation-ship and role of the vocational rehabilitation counselorin providing effective services.

This edition of American Rehabilitation brings togethersome recent perspectives on the empowerment of peoplewith disabilities. It includes personal accounts from in-dividuals with disabilities about empowering people andthe events that have significantly shaped their lives. Inaddition, the implications of empowerment as it relates

to employment outcomes are explored from the profes-sional point of view, with research data, facts and fig-ures. And, to stimulate and provoke further thought anddiscussion, there are a few straight opinion pieces.

Admittedly, empowerment is not a totally new con-cept. It has guided recent amendments to the Rehabilita-tion Act and is a cornerstone of consumer advocacy. Aswe encounter and begin to embrace and value the pro-cess of empowerment, the nature of our professionalroles and the way we conduct our business will inevita-bly change. Strength is implied in the word empower-ment, and by empowering our consumers I believe weare strengthening our programs and efforts to secure high-quality employment and opportunity for persons withdisabilities.

As you read this edition of American Rehabilitation, Ihope that you will find some useful strategies and ideasthat will be empowering to you and our many rehabilita-tion partners — consumers, professionals, educators, ser-vice providers and advocates — as we work to maximizeopportunities and realize positive change in the lives ofpersons with disabilities.

By empowering our consumers I believe we arestrengthening our programs and efforts to secure high-quality employment and opportunity for persons withdisabilities.

Joanne WilsonCommissioner

Rehabilitation ServicesAdministration

OUR COMMITMENTTO THE EMPOWERMENT OF

INDIVIDUALS WITHDISABILITIES

Photograph: Frank Romano, U.S. Department of Education

A M E R I C A NREHABILITATION V O L U M E : 2 8

N U M B E R : 1A U T U M N : 2 0 0 4

U.S. DEPARTMENTOF EDUCATION :Rod Paige, Ph.D., Secretary

OFFICE OF SPECIAL EDUCATIONAND REHABILITATIVE SERVICES :Troy Justesen, Acting Deputy

Assistant SecretaryREHABILITATION SERVICES

ADMINSTRATION : Joanne Wilson, Commissioner

EDITORS : Frank Romano, Suzanne MitchellPRODUCTION EDITOR : Juliette Rizzo

DESIGN AND PRODUCTION :Geoffrey P. RhodesE DITORIAL REVIEW BOARD :Troy R. Justesen, Ed.D., Richard Melia,

Ph.D., Thomas Kelley, TimothyMuzzio, Ph.D., RoseAnn Ashby, LexFrieden, Connie Pledger, Ph.D., andCharlene Dwyer

T H E W E A K E S T I N K I S B E T T E R T H A N T H E S T R O N G E S T M E M O R Y

American Rehabilitation (USPS 463-610) isthe official publication of the RehabilitationServices Administration (RSA), PotomacCenter Plaza, 550 12th Street, S.W.,Washington, DC 20202-2800. Use of fundsfor printing was approved by the Office ofManagement and Budget on June 23, 1975.

Opinions expressed are those of the authors anddo not necessarily represent the policy of theDepartment of Education, the Office of SpecialEducation and Rehabilitative Services, theRehabilitation Services Administration, or theeditor, and you should not assumeendorsement by the federal government.Manuscript and article suggestions arewelcome.

Write to: Editor, American RehabilitationRehabilitation ServicesAdministrationRoom 5071 PCP550 12th Street, S.W.Washington, DC 20202-2800

Telephone: (202) 245-7500FAX: (202) 245-7592E-mail: frank.romano@ed.gov

POSTMASTER: Send address changes toAmerican RehabilitationRoom 5071 PCP550 12th Street, S.W.Washington, DC 20202-2800

Cover: Erik Weihenmayer — the first blindclimber in history to reach the summit of theworld's highest mountain, Mt. Everest — wasselected for our cover because he so com-pletely embodies the spirit of empowerment,which is the subject of this issue of Ameri-can Rehabilitation. Despite losing his visionat the age of 13, Erik Weihenmayer is a worldclass athlete: acrobatic skydiver, long distancebiker, marathon runner, skier, mountaineer,ice climber and rock climber. He is also aprolific speaker and the author of Touch theTop of the World: A Blind Man’s Journey toClimb Farther than the Eye Can See.Photo by Kevin Cherilla, rendering byGeoffrey Rhodes.

3 HOW EMPOWERMENT CHANGED MY LIFE“I DON'T HAVE TO LIVE INMY CAR ANYMORE…”

MARCIE KELLEY

10 ENHANCING PERSONAL EMPOWERMENT OFPEOPLE WITH PSYCHIATRICDISABILITIES

PATRICK W. CORRIGAN, PSY.D.

22 SELF-DETERMINATION AND THE EMPOWERMENT OFPEOPLE WITH DISABILITIES

MICHAEL L. WEHMEYER, PH.D.

30 SLAYING DRAGONS: BUILDING SELF-CONFIDENCE ANDRAISING EXPECTATIONS THROUGH ORIENTATIONCENTER TRAINING

SANDY TIGGES, PH.D.

40 EMPOWERING PEOPLE WITH DISABILITIESTHROUGH VOCATIONAL REHABILITATIONCOUNSELING

JOHN F. KOSCIULEK, PH.D., CRC

48 COMMISSIONER’S MEMORANDUMCONSUMER ORGANIZATIONS: IMPORTANTRESOURCES FOR VR AGENCIES

JOANNE WILSON

54 FREEDOM FOR THE BLIND: THE SECRET IS EMPOWERMENT,A BOOK REVIEW

ALLEN HARRIS

A U T U M N

2A M E R I C A N

HOW EMPOWERMENT

CHANGED MY LIFE“I don’t have to live in my car anymore…”

MARCIE KELLEY

HOW EMPOWERMENT

CHANGED MY LIFE“I don’t have to live in my car anymore …”

MARCIE KELLEY

It is through my personal and professional experiencethat I write this article on empowerment. I have thoughtabout empowerment a lot throughout the years. I haveresearched it, lived with it and lived without it. I haveshared empowerment with others. Without it, I have beenutterly alone. Empowerment is simple, yet complex. Itpertains to people with psychiatric disabilities and topeople with any disability. I learned this through work-ing at a center for independent living. People with dis-abilities face many obstacles that can be disempowering.It is evident that when the disability community unitesand rallies behind a cause, we become more empow-ered citizens.

I am writing this for the individuals, and for peoplewho know individuals, who feel disempowered andalone. I hope that presenting some of the ingredientsnecessary for empowerment will facilitate self-directedgrowth and freedom.

I am the director and systems advocate for the MentalHealth PEER Connection (MHPC), a member of the West-ern New York (WNY) Independent Living Project, Inc.,family of agencies located in Buffalo, New York. MHPCis a peer-driven advocacy organization dedicated to fa-cilitating self-directed growth, wellness and choicethrough genuine peer mentoring. MHPC employs 21 full-time employees who have a mental illness or haverecovered from a mental illness. Our peers are locatedin the state hospital, the county hospital, the county jail,the public mental health system and in vocational pro-grams. We represent fellow mental health consumers byperforming individual and systems advocacy to increasethe rights, freedom and independence of those with men-tal health disabilities. We advocate with mental healthhousing providers, the Social Security Administration(SSA), state and local legislatures, the New York StateDepartment of Vocationaland Education Servicesfor Individuals with Dis-abilities (VESID), publicmental health providersin Erie County, the ErieCounty Department of

Mental Health, the Erie County Department of Social Ser-vices and the City of Buffalo Mental Health Court andFamily Court. We conduct several self-help and mutualsupport groups weekly. In 2002, we provided indepen-dent living skills training, housing assistance, benefitsadvisement, advocacy and mobility training to over 350individuals with psychiatric disabilities. We work withmental health housing providers and the county mentalhealth department via the Community Services Board andadvocate for people who are being mandated into treat-ment under the Involuntary Outpatient Commitment Lawin the state of New York.

As the systems advocate, I have guided our center inadvocating for what our consumers want by holding sev-eral town meetings on consumer issues. This informationis disseminated to various stakeholders via position pa-pers. Based on the information gathered at these townmeetings, our agency has sponsored a freedom march,informational pickets, parity picnics and legislative break-fasts. We have demonstrated for greater freedom. Weheld letter-writing campaigns, call-ins, speak-outs, com-munity open houses, a self-help luncheon and a managedcare educational campaign. We helped to implementthe Consumer Advisory Council in the Buffalo Psychi-atr ic Center, the Er ie County Medical CenterPsychiatric Department, Gold Choice Family Medicine(a managed care health insurance for people with psy-chiatric disabilities) and a human service survey that“pokes a hole in West Side neighborhood group argu-ments that the community is over saturated with socialservice organizations“ (Tan, 2000).

We have directed over $70,000 for peer services toimprove the quality of life of Erie County, New York,mental health recipients. Through MHPC’s efforts, manypeople with mental health disabilities in Erie County have

improved their livingstandard. In addition, Iserve as the co-chair ofthe Erie County Anti-Stigma Task Force.

In 1990, I came to theWNY Independent Living

Ms. Kelley is Director and Systems Advocate, Mental HealthPEER Connection (MHPC), which is a member of theWestern New York Independent Living Project, Inc., familyof agencies, Buffalo, N.Y. Telephone: (716) 836-0822,Ext. 162. E-mail: mkelley@pc.wnyilp.org.

R E H A B I L I T A T I O N3

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Project for help. I was living out ofmy car in the streets of Buffalo. Ifeared everyone due to my mentalillness — multiple personality disor-de r (MPD) . When I t o ld theindependent living counselor this,she did not look down on me and shedid not seem to judge me. She ex-pressed concern that I was living onthe streets and that I feared that some-one was going to kill me for nological reason. She told me abouthousing that was available and con-vinced me to stay with a friend untilthe housing was arranged. Sheseemed to care. I listened. Sheshowed me respect. She told me ofother services that were availableto me because I had a disability.She said that she knew this becauseshe had a disability too. I did notunderstand it all. But she said thatit was OK and that I could comeback if I needed any other informa-tion or assistance. She gave mesomething that I had lost a longtime ago. It was something that Inever thought I would have again.She gave me hope.

I was severely abused as a child. Ideveloped personalities to deal withit. I could not run away physically,so I ran away in my head. The per-sonalities protected me from theabuse. As an adult, I was no longerbeing abused. But I still had the per-sonalities — over 280 of them. I didnot know that I had these personali-ties until I was 25 years old, when Iwas diagnosed with MPD while in apsychiatric hospital. Often, I was sui-cidal. I never knew why. I went topsychiatric hospitals for help. I havebeen in psychiatric facilities on 12different occasions, for months at atime. The more I went, the more Irealized that they were not helpingme. I felt increasingly disempowered.The hospital staff members were get-ting frustrated with me as well. Atone point, I was on 13 different typesof psychotropic medications: anti-de-p r e s s a n t s , a n t i - p s y c h o t i c s ,anti-anxiety, anti-everything. Eventu-al ly, I was on medications tocounteract the medications. I was

constantly looking outside of myselffor something to fix me: the hospi-tal, the doctor, the pill or the therapy.

Then the most disempoweringthing happened to me, changing mylife. Ironically, it led to my becom-ing empowered. Many people withdisabilities are driven into the disabil-ity rights movement due to their owndisempowering experiences. Thiswas true for me. I was hospitalizedfor the eleventh time. I was suicidaland a danger to myself and to oth-ers. I did not care if I lived or died. Iwas receiving disability benefits. Iwas not in contact with my familyand had no support network. I wasutterly alone. The hospital “recom-mended“ electro-convulsive therapy(ECT). This is when they shock thebrain to help a person overcome de-pression. As a trauma survivor, thisidea terrified me. The hospital staffdeveloped a treatment plan withoutmy participation. The plan consistedentirely of me making a decision toget ECT. In front of a room filled withhospital staff, I was asked to sign thetreatment plan. I signed the plan, butI was terrified. I wanted to leave thehospital because it was clear that theywanted to electrocute me. Most psy-chiatric hospitals are locked down.This hospital was no exception. Theywould not let me leave, so I tried toescape twice. The first time, I jumpedthrough a nurses’ station window.The second time, I pushed a doctorout of the way as she entered theward. Each time, I was “taken down,“shot up with Thorazine and put inrestraints in a seclusion room. I couldnot scratch my nose or go to the bath-room without help. This was the mostdisempowering time in my life. Icould not really figure out how I hadgotten to this point, but I had. I hadno control over my life. I had no de-cision-making power. I did notunderstand that I had rights. I felt to-tally alone. This was the turning pointin my life. I decided that I was sickof this and that I was not going to takeit anymore. I begged the hospital staffto let me out of the restraints. I prom-ised them that I would not try to

I

am

writing

this for the

individuals,

and for people

who know

individuals,

who feel

disempowered

and

alone.

A U T U M N

4A M E R I C A N

escape again. I pretended I washappy. I said that I did not feel sui-cidal anymore. I thanked them forhelping me to not hurt myself by try-ing to escape. I said I was ready tostart my life again. So they let me out.I was finally free.

But I was not better. I held ontothe hope that I found at the WNY In-dependent Living Project. But thatwas all I had. I wanted to get betterand I was ready to do what it took toget better. My outpatient counselortold me about a hospital in Texas thattreated trauma survivors, especiallythose with MPD. I was hesitant to goto another hospital, but I wanted toget better. I took the risk and went toTexas in 1994. This hospital was likeno other. They accepted Medicare.During previous hospitalizations, theonly activity was taking medication.It was very boring. But this hospitalwas very different. I saw a psycholo-gist for one hour, five times per week.My personalities worked out theirissues during these sessions. I at-tended group therapy, clay therapy,ange r t he r apy , occupa t iona ltherapy, cognitive therapy and arttherapy. I saw a psychiatrist everyday. I got better. I was with peoplejust like me. There was camarade-rie. We sang songs of hope. We hadprivileges to go outside.

I left with the desire for a newbeginning. I returned to Buffalowith the ambition to begin my life.Later that year, I saw a brochure foran advocacy and empowermenttraining event for people with psy-chiatric disabilities sponsored bythe WNY Independent L iv ingProject. I signed up and attended. Iwas scared. I did not know what toexpect. But it was great. The pre-senters spoke of their psychiatricdisabilities and hospitalizations andtheir current role as advocates.They talked about empowerment. Itwas like they lit a fire beneath me.I was not alone. So many peoplewith psychiatric disabilities werefighting for their rights. They hadlost their rights, as I had. I did notknow that others had gone through

it as well. As I looked at the pre-senters, another idea popped intomy head. If they could get paid toadvocate, I could do it too. I appliedfor a job as a peer advocate at theWNY Independent Living Projectand began employment in 1995.

To this day, my hospitalizationshave ended. The advocacy and em-powerment training opened my eyesto the disempowering care systemsfor people with psychiatric disabili-ties. And the WNY IndependentLiving Project opened my eyes to themany disempowering systems serv-ing the disability community. I beganto understand that the whole disabil-ity community is a civil rightsmovement. I saw this on many lev-els: through my own experience,through my employees’ experiences,through our consumers’ experiencesand through the communities’ attitu-dinal barriers.

Empowerment must begin withthe individual and then expand to thecommunity as a whole. I have wit-nessed many subtle (and not sosubtle) actions that take power awayfrom the disabled individual. How-ever, it is apparent that the ErieCounty Department of Mental Healthis trying to shift the pendulum ofpower from the professional mentalhealthcare provider to the consumerof services. The power of the psychi-atrically disabled individual is in thehands of the individual, with one ex-ception: When the individual is adanger to himself (or herself) or oth-ers, that person may lose his right tochoose, his right to freedom and hisright to decide what treatment is bestfor himself.

I met Judi Chamberlin at the 2001National Association for Rights Pro-tection and Advocacy (NARPA)Conference held in Niagara Falls,New York. I was very impressed byher insights on empowerment forpsychiatric survivors. Her article AWorking Definition of Empowerment(1999) is enlightening. She gathereda dozen leading American consumer/survivor self-help practitioners toform the advisory board of the Cen-

The

advocacy

and empowerment

training opened

my eyes to the

disempowering care

systems for people

with psychiatric

disabilities.

R E H A B I L I T A T I O N5

2 0 0 4

ter for Psychiatric Rehabilitation. Itsfirst task was to define empowermentfor psychiatric survivors, which it didas follows:1. Having decision-making power.2. Having access to information and

resources.3. Having a range of options from

which to make choices (not justyes/no, either/or).

4. Assertiveness.5. A feeling that the individual can

make a d i f f e rence (be inghopeful).

6. Learning to think critically,unlearning the conditioning,seeing things differently (e.g.,learning to redefine who we are[speaking in our own voice];learning to redefine what we cando; and learning to redefine ourrelationship to institutionalizedpower).

7. Learning about and expressinganger.

8. Not feeling alone, feeling part ofa group.

9. Understanding that people haverights.

10. Effecting change in one’s life andone’s community.

11. L e a r n i n g s k i l l s ( e . g . ,c o m m u n i c a t i o n ) t h a t t h eindividual defines as important.

12. Changing others’ perceptions ofone’s competency and capacityto act.

13. Coming “out of the closet.“14. Growth that is never ending and

self-initiated.15. Increasing one’s positive self-

image and overcoming stigma(Chamberlin, 1999).

I believe that these characteris-t ics are necessary for one tobecome empowered. Often, theseaspects are overlooked in govern-ment systems, health care systemsand the rehabilitation system. I seethis as a person who has used thesystem since the 1980s, as an em-ployer of 21 full-time staff withpsychiatric disabilities and as a sys-tems advocate for people withpsychiat r ic disabi l i t ies in mycounty. It is my experience that

these systems of care are not con-sciously aware of the fact that theyare disempowering. They are tryingto help individuals, their intentionsare good, but the results of theirpolicies, rules and regulations canbe devastating. This is due to mis-understanding, numerous waitinglists, piles of paperwork requirementsand budget cuts. The person with adisability gets left out of the picturewhen, in fact, he or she is supposedto be the center of the picture. Thatis why the 400 independent livingcenters throughout the United Stateswork so well. People with disabili-ties have “been there.“ Often, aperson needs a road map to navigatethese care systems. Independent liv-ing centers have the road maps andthey have gone the distance.

Having decision-making power. Thisis key for the person with a disabil-ity. Often, systems of care make de-cisions about what is best for theperson with a disability without eventalking to the person. Often, our so-ciety does not allow the person witha disability to make decisions. Once,I was helping an individual who wasdeaf to find an apartment. The land-lord decided that the individualwould not like living in his building.Taking away the decision-makingpower can be subtle, as well. WhileI was having dinner with a friend whouses a wheelchair, the waitress askedme what he wanted for dinner. Gov-ernment systems of care take awaydecision-making power as well.While on disability, I applied toVESID for services. My goal was tobecome a chef. They told me I wasunemployable. It was a good thingthat I did not listen to them!

Having access to information andresources. There is so much informa-tion available for people with disabili-ties that it is hard to access all of it.The opposite is true as well. Manypeople with disabilities live in utterpoverty and isolation. They have noaccess to information. For example,the Erie County Behavioral Health

Empowerment

must

begin with

the individual

and then expand

to the community

as a

whole.

A U T U M N

6A M E R I C A N

Vocational Task Force Final Reportstates that:

“Many individuals with disabili-ties can now work without theimmediate loss of cash benefitsor health insurance throughMedicaid or Medicare throughWork Incentives. Benefits Ad-visement is readily available inthe community. Agencies suchas Neighborhood Legal Servicesprovide this service and someBehavioral Health Agencies haveBenefits Advisors on staff. How-ever , many consumers andproviders are unaware of thesecurrent rules and are also un-aware of where to get accurateadvisement (2003, p. 11).”

Thus, many people with psychiatricdisabilities fear returning to work orgoing to work for the first time be-cause they fear losing their benefits(M. Weiner, Erie County Commis-sioner of Mental Health, personalcommunication, March 6, 2003). Ona more human rights level, manypeople with disabilities who live ininstitutions lack the information theyneed regarding their rights in that in-stitution, such as those stated in ad-vanced directives, the OlmsteadDecision, etc. As a systems advocatein Erie County, I have heard manypsychiatric survivors talk about beinginstitutionalized. They did not knowtheir rights because when they weregiven the sheet of paper with theirrights on it, the paper was throwninto a secured locker with all theirpersonal belongings.

SSA causes difficulty in access-ing information and resources aswell. When I returned to work af-t e r be ing on Soc ia l Secur i t yDisability Insurance (SSDI), I knewthat I had a nine-month trial workperiod; but I was not sure when thetrial period started and when its topped. I just kept receivingchecks. Then, I received a letterfrom SSA that stated that they over-paid me by $10,080. They askedthat I return the overpayment by acertain date. That letter almost sentme back into the hospital.

Having a range of options fromw h i c h t o m a k e c h o i c e s(not just yes/no, either/or). Mostadults in life make informed deci-sions by weighing the consequencesof their choices. Why can’t peoplewith disabilities have that right aswell? When I was homeless, I had todecide to spend my disability checkon either medicine or food. When Iwas in the psychiatric hospital, I wasgiven no option other than ECT.Many housing providers offer hous-ing under the condition that the per-son with the disability continues totake his (or her) medication or he willbe kicked out. In Buffalo, the winterscan be very cold, and medicationscan have serious side effects. I be-lieve that there is always room towork things out, to find out whatpeople with disabilities want and todiscover what their hopes, dreamsand aspirations are. It is not neces-sary to threaten to take them away ifthey do not cooperate. There is noneed to manipulate. It is better tocontribute to the conspiracy of hope,to problem solve and negotiate, toobtain a win/win solution.

Assertiveness. Standing up for one’srights without fear of retribution is avery empowering act for a person witha disability. When necessary, peoplewith disabilities must depend on oth-ers. When people with disabilitiesthink for themselves, it is a wonderfulprocess. Many have lived their liveswith caretakers who have made deci-sions and plans without asking for in-put from the person with a disability.When that person becomes assertiveand determines what he or she wants,new freedom exists. Many care provid-ers do not understand this. In the men-tal health system, when people withpsychiatric disabilities assert them-selves, they are often called “non-com-pliant.“ It is important to discuss withthe person with the disability what he(or she) wants and to understand whyhe wants it. Communication is key.There are many good reasons why aperson with a disability does not wantto follow a certain plan, especially

Most

adults

in life make

informed decisions

by weighing the

consequences of their

choices. Why can’t

people with

disabilities have

that right as

well?

R E H A B I L I T A T I O N7

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when the plan was developed withoutthe involvement and consent of thatperson.

F e e l i n g t h a t t h e i n d i v i d u a lc a n m a k e a d i f f e r e n c e(being hopeful). When I was on dis-ability, I was ashamed of not contrib-uting to society. I was ashamed tosocialize with others, in fear that theywould ask me what I was doing for aliving. I was embarrassed at the su-permarket when I used food stampsto pay for my groceries. I felt totallyuseless. When I started working atthe Independent Living Project, I be-gan to feel like I was making a differ-ence. People with disabilities do notwant to be a burden, no matter howmoderate or severe the disability; butoften others see the individual withdisability as a burden. All disabled in-dividuals have something to offer,can make a difference in someone’slife (if not many lives) and can becontributing members of society.

Learn ing to th ink c r i t i ca l l y ,unlearning the conditioning, see-i n g t h i n g s d i f f e r e n t l y(e.g., learning to redefine who weare [speaking in our own voice];learning to redefine what we cando; learning to redefine our rela-tionship to institutionalized power).Often, people with disabilities andthe people who work with individu-als with disabilities only see the dis-ability, not the person. For years, Isaw myself as a “multiple,“ not asanything else. And that kept medown. I saw no recovery. I saw nolife outside of therapy. I had no natu-ral supports. My supports were basedon group and individual therapy. Ihad no passion and no desires. WhenI became an advocate, I began to seemyself as something other than mydisability. In Erie County, the Depart-ment of Mental Health encouragesrepresentation of people with psychi-atric disabilities in the planning andimplementation of services forpeople with mental health issues. Ihave been attending such planningmeetings since 1995. At first I was

very intimidated to be in a planningmeeting with professionals and non-disabled individuals. But, over theyears, I have noticed that they havetheir quirks too. I have as much rightto say what needs to be said as theydo. I noticed that they did not viewme as a mental case but as a personwith insight and experience regard-ing what people with psychiatric dis-abilities want.Learning about and expressinganger. I have learned that anger is ahealthy and natural emotion. Peoplewith disabilities have many things tobe angry about: Americans with Dis-abilities Act violations, reducedhealth insurance coverage for du-rable medical equipment or personalcare attendants, no state health insur-ance parity legislation, housingdiscrimination, stigma, and all of thepersonal issues that people in generalget angry about. When a person witha disability gets angry, some find thisunacceptable. I remember gettingangry in a hospital because a nursewould not give me a nighttime medi-cation so I could go to sleep. I lostmy privileges for three days. Somepeople with disabilities have been in-stitutionalized all their lives or livedin sheltered environments. Somewere never taught appropriate waysto express angry feelings. This built-up anger and explosive energysometimes results in their institution-alization in a psychiatric hospital (forevaluation) or jail. It is important toremember that people with disabili-ties have feelings too, and one ofthose feelings is anger. They shouldbe taught appropriate ways to expressit.

I think that “Not feeling alone, feel-ing part of a group” is one of themost important qualities of empow-erment that Chamberlin cites. Manyindividuals with disabilities are iso-lated through living alone, in specialhousing, with family or in institutionssuch as psychiatric hospitals or nurs-ing homes. Institutionalized peopleare often separated from each otherby a door or wall, which allows for

There

are many

good reasons

why a person with

a disability does

not want to

follow a

certain

plan ...

A U T U M N

8A M E R I C A N

little contact with the outside world.I remember living in a one-roomapartment while I was receiving SSDIbenefits. I spent my days going totherapy. I felt totally alone. I did notknow that there were others just likeme. It is very important to networkwith other people. The IndependentLiving Project provides opportunitiesfor this on a continuous basis: first,by constantly updating the mailinglist and asking everyone served ifthey want to be on the mailing list;and second, by mailing notices ofself-help groups, workshops, townmeetings, special events, actionalerts, etc. During events and presen-tations, I introduce myself by sayinga little bit about my past, and thenthe group participants talk about is-sues that concern them. Friendshipsare formed, support is developed andthat feeling of loneliness disappears.

Understanding that people haverights. MHPC has an educationalprogram on mental health recipi-ents’ rights. It is amazing to see howmany people with psychiatric dis-abilities do not know about theirrights. This is most clearly seen re-garding housing r ights in ourcounty. Many people with psychi-atric disabilities do not realize thatthey can leave their current hous-ing. However, if they do leave,their standard of housing would de-crease dramatically. New YorkState has a law called the Involun-tary Outpatient Commitment Law,or Kendra’s Law, which can forcenon-compliant mental health con-sumers into outpatient treatment ifthey have had many recent hospi-talizations or incarcerations and aredeemed unable to survive in thecommunity by themselves. ErieCounty has successfully avoidedtaking people to court by encour-aging the recipient to agree to theprogram. Recipients are put into the“Diversion Program,” which pro-vides increased case managementservices. Basically, it is the sameprogram recipients would get ifthey went to court but without the

legal representation. MHPC is con-cerned that some of these peopleare forfeiting their rights and maynot meet the criteria because theydo not have proper legal represen-tation. Because we have found thatmany mental health consumers donot know their rights, we devel-oped a workbook, we go to placeswhere mental health consumerscongregate and we provide educa-tion on their rights.

We also have rights regarding ourvocational and rehabilitation goals.VESID assists those with disabilitiesin becoming more productive mem-bers of society. However, VESID haslimitations and budgetary restraints.When they told me I was unemploy-able, I did not know that I had theright to seek help from the Client As-sistance Program (CAP).

Effecting change in one’s life andone’s community is another qualityfor empowerment. In past years,many disabled people simply existed;they were warehoused and overlymedicated, with no expectations ofrecovery or improvement. As the dis-ability rights movement grew, morepeople with disabilities demandedmore out of life than medication andmaintenance. They had goals, aspi-rations and dreams. They wanted tochange and improve their lives. Aspeople with disabilities accomplishthese goals and continue to effectchange, their communities changeslowly. When people in my life ex-pected change in me, I did change.But if the expectation was not there,I did not change. Because of thechanges in my life, I am effectively al-tering the community in which I livetoday. I am affecting understanding andattitudes toward people with mental ill-ness in Erie County, New York.

Chamberlin includes learningskills (e.g., communication) that theindividual defines as important. Itis crucial to communicate with theperson who is disabled to find outwhat skills the individual wants tolearn and what help he or shewants. During one hospitalization,

As

the disability

rights movement

grew, more people

with disabilities

demanded more

out of life than

medication and

maintenance.

R E H A B I L I T A T I O N9

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I was painting a stained plastic win-dow (they did not allow glass). I putthe window away and moved to an-other part of the ward. I did notpaint the item well, but I tried.When I returned to the room, anurse was painting my window. Isaid, “What are you doing? That’smine.“ She said, “I was just help-ing.“ I did not want her help. Iwanted to learn it myself. But, she

did not communicate with me. Atthe Independent Living Project, Ihave learned that we do not do forothers what they can do for them-selves, unless they ask. It is crucialnot to assume what the individualwants to learn. It is important toknow what the individual’s goalsare and how he or she wants toachieve them.

Changing others’ perceptions ofone’s competency and capacity toact is a quality that Chamberlincites. I believe this is directed to-

ward the people working with theperson with a disability. Just be-cause I acted irrationally or de-com-pensated last week does not meanthat I am always that way. Those ofus with disabilities want to bejudged on our abilities today, onour record and on our integrity, noton our weakest moment. Like allpeople, we change, grow and learnfrom our experiences.

Coming out of the closet. I thinkthis quality pertains exclusively topeople with hidden disabilities,such as people with mental disabili-ties. The surgeon general reportsthat one in five Americans is af-fected by mental illness during hisor her lifetime. Many people areashamed to have a mental illnessand fear the discrimination andstigma that occurs regularly. But asmore people share their disabilities,the more commonplace it will be-come. The more people talk aboutit, the more acceptable it becomes.The more acceptable it becomes,the more people will get help. Thismay result in fewer deaths by sui-cide each year.

Growth that is never ending andself-initiated is cited by Chamberlinas an empowering quality. Peoplewith disabilities should have the

same rights asany otherperson to

pursue theirdreams to the full-

est extent possible. As providers ofservices to people with disabilities,we should be facilitators of suchdreams and potential.

Increasing one’s positive self-imageand overcoming stigma. This isChamberlin’s final quality of em-powerment . Throughout E r ieCounty, people with mental illnesssuffer from stigma that they have in-ternalized, and by internalizingthey affect their self-image and self-esteem. They become the disabil-ity. This is often exhibited in their

vigilance about confidentiality —about anyone finding out that theymight have a mental illness. Thereare many good social and internalreasons for this. I have dealt withparents who lost their children incustody battles with their spousesbecause the judge found out thatthey have a mental illness. Peoplewith mental illness have lost theirjobs because they spent time in apsychiatric hospitals. In our region,there is a shelter for batteredwomen, but they will not acceptwomen with mental illness. Theshelter managers say that they donot have the staff to deal with thisissue. But if everyone who has amental illness spoke out, maybe,just maybe, discrimination woulddecrease. As par t o f the Er ieCounty Anti-Stigma Task Force,we launched an advertising cam-paign with the following message:“Mental Illness Is Treatable, TreatIt That Way.“ We must overcomestigma in order to improve thecultural and civil rights barriersthat the disabled community inAmerica faces today.

What has been my most empow-e r i n g e x p e r i e n c e s o f a r ? I nDecember 2000, I purchased ahouse in the suburbs of Buffalo. Itis my first house. Ten years ago, Iwas homeless. I became a bona fidehomeowner with all the rights andresponsibilities that come with it. Inspring 2001, I had a barbeque forthe entire MHPC staff at my house.If I can do this, so can others. Thatis what empowerment is all about:achieving goals and sharingthem with others.

REFERENCESTan, S. (2000, August 22). Human services

survey finds support. The Buffalo News,City & Region Section , p. 1.

Chamberlin, J. (1999). A working definitionof empowerment. Retrieved May 28,2003, from http://www.power2u.org/bobby/empower/working_def.html.

Erie County Department of Mental Health.(2003, March). Erie County BehavioralHealth Vocational Task Force FinalReport. Retrieved May 27, 2003, fromhttp://www.erie.gov/health/mentalhealth/BehavHlthTFVocSummaryReport.pdf

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10A M E R I C A N

ofENHANCING PERSONAL

EMPOWERMENT

PEOPLE WITH PSYCHIATRICDISABILITIES

PATRICK W. CORRIGAN, PSY.D.

For most of recorded history, people with psychiatric dis-abilities have struggled with maintaining personal powerover their lives. The centuries-old battle against stigmais the best example of this struggle. The ancient Greeksfirst gave voice to the concept of stigma noting that thosewho were marked with mental illness were oftenshunned, locked up or, on rare occasions, put to death(Simon, 1992). During the Middle Ages, people withmental illness were viewed as living examples of theweakness of humankind, what goes wrong when peopleare unable to remain morally strong (Mora, 1992). Thiskind of attitude led families to hide away those with psy-chiatric disabilities from public view. Not until the 18thcentury did asylums and treatment centers emerge formental illness. Before that time, those with serious andpersistent mental illness were often locked up with crimi-nals. Although the struggle for personal power has vastlyimproved during the last century, people with mental ill-ness still encounter stigma and disempowerment. The re-

cently released report by President George W. Bush’sNew Freedom Commission for Mental Health (2003) is-sues a clarion call for practices that facilitate consumerempowerment.

The goals of this paper are threefold:1. Provide a working definition of empowerment as

applied to the lives of people with psychiatricdisabilities.

2. Identify community and service systems barriers toempowerment.

3. Describe guidelines and other system enhancementsthat facilitate personal empowerment.

UNDERSTANDING PERSONAL EMPOWERMENTEmpowerment has been defined as personal control overall domains of life, not just mental health care but alsodecisions related to such important areas as vocation, resi-dence and relationships (McLean, 1995; Rappaport,1987; Segal, Silverman & Temkin, 1995). This is espe-

R E H A B I L I T A T I O N11

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• The impact of empowerment onthe community is manifested bythe consumer’s desire to affecth i s o r h e r s t i g m a t i z i n gcommunity. Consumers believethey have some power withinsociety, are interested in affectingchange and wish to promotecommunity action.

Readers may note that terms like em-powerment and disempowermentare frequently interchanged in the re-mainder of this article. In part, thisinterchange represents empower-ment as a continuum (Corrigan, Faberet al., 1999; Rogers et al., 1997). Atthe positive end of the continuum arepeople with psychiatric disabilitywho, despite their disability, havepositive self-esteem and are not sig-nificantly encumbered by a stigma-tizing community. At the negativeend are people who report being un-able to overcome all the pessimisticexpectations about mental illness.One might think that a paper aboutempowerment would be presentedin the affirmative voice (e.g., Whatmight people with mental illness, ser-vice providers and the community atlarge do to promote personalpower?). Unfortunately, much of theresearch and literature on empower-ment looks at the negative impact ofits absence (What happens when aperson with mental i l lness i sd i sempowered? ) (Cor r i gan &Garman, 1997; Rapp, Shera &

Dr. Corrigan is Professor ofPsychiatry and Executive Director,University of Chicago Center forPsychia t r ic Rehabi l i ta t ion ,Tinley Park, Illinois.

K i s t h a r d t ,1993). Hence, I

have chosen to inter-twine what is known about

disempowerment with what is thevision of empowerment to addressthe themes of this article.

BARRIERS TO EMPOWERMENTStigma is the societal embodiment ofdisempowerment; it promotes expec-tations in both the public at large andindividual consumers that peoplewith mental illness are incapable ofthe responsibilities commensuratewith living independently. Results oftwo factor analyses on more than2,000 English and American partici-pants revealed three common themesto stereotypic attitudes about mentalillness that endorse this assertion(Brockington et al., 1993; Taylor &Dear, 1981):• Fear and Exclusion. Persons with

severe mental illness should bef e a r e d b e c a u s e t h e y a r edangerous. As a result, they shouldbe kept out of the community andhoused in institutions.

• Authoritarianism. Persons withsevere mental illness areirresponsible; life decisionsshould be made for them byothers.

• Benevolence. Persons with severemental illness are childlike andneed to be cared for.

These kinds of widespread attitudeshave two effects on the power of per-sons with mental illness. First, they robpeople of the opportunities that arecentral to recovery and a quality life(e.g., good jobs, comfortable income,nice housing and good friends). Per-haps of equal concern are the effectsthat stigma has on some people withmental illness. People living with seri-

cially impor-tant in societiesthat stigmatize per-sons with psychiatric disabili-ties. Western cultures, for example,seem to rob these persons of author-ity over treatment plans and life de-cisions (Brockington, Hall, Levings &Murphy, 1993; Link, Cullen, Frank &Wozniak, 1987). Research on theconstruct of empowerment leads toa better understanding of effectiveservices and their impact on qualityof life (Corrigan & Garman, 1997).Rosenfield (1992), for example,found a measure of consumer em-powerment correlated with quality oflife. Rogers, Chamberlin, Ellison andCrean (1997) completed a more com-prehensive series of studies on men-tal health consumer empowermentwith their Empowerment Scale . Itemsfor the Empowerment Scale were firstidentified by a panel of 10 leaders inthe consumer movement and thenvalidated by participants in six self-help programs. An unpublishedanalysis of 261 responses to the scale,conducted by Rogers et al. (1997),yielded seven factors that describethe construct:• self-efficacy,• powerlessness,• self-esteem,• effecting change,• optimism/control over future,• righteous anger and• group/community action.These factors are intercorrelated andseem to correspond with twosuperordinate factors that describethe impact of empowerment on per-sons with schizophrenia and on theircommunity (Corrigan, Faber, Rashid& Leary, 1999). These are:• The impact of empowerment on

the self is such that, despitesocietal st igma, empoweredconsumers endorse posit iveattitudes about themselves. Theyhave good self-esteem, believethemselves to be self-efficaciousand are optimistic about thefuture.

“There is no medicine like hope, no incentive so great,and no tonic so powerful as expectation of

something tomorrow.”

O.S. Marden1850-1924

A U T U M N

12A M E R I C A N

ous mental illness who are immersedin a culture that endorses psychiatricstigma begin to believe this stigma andquestion their own capabilities for in-dependent living (Wahl, 1995). Be-cause self-stigma has such an insidiousimpact, its effects on empowerment areexamined first.

Some people experience stigma asa private shame that diminishes theperson’s self-esteem (Corrigan, 1998;Corrigan & Watson, 2002). This kindof shame leads to self-doubt aboutwhether the person is able to live in-

dependently, hold a job, earn a liveli-hood or find a life mate. Even thoughthey may have mastered their symp-toms and disabilities, people withmental illness must also overcome stig-matizing reminders that they still havea disability or are not useful membersof society. One recent study showedthe breadth of discrimination experi-enced by mental health consumers(Wahl, 1999). The majority of 1,300 re-spondents reported discouragement,hurt, anger and lowered self-esteem asa result of their experiences. An ear-

lier study by Link (1982) showed theloss of self-esteem that results fromstigma also has practical consequences.Participants in their study reported thatbeing publicly labeled with a psychi-atric illness had a negative impact onwork and income.

ACTIVITIES THAT FACILITATEEMPOWERMENTResearch has yet to examine strate-gies for overcoming self-stigma, butseveral candidates show promise(Corrigan & Watson, in press). Inter-

TABLE 1: SEVEN WAYS TO FOSTER EMPOWERMENT.NOTE: These are arrayed from those that minimally foster empowerment to those that more fully enhance

personal empowerment.

1. From Noncompliance to CollaborationA change in perspective from expecting consumers to passively comply with treatment to making care-plans that are user-friendly.

2. Consumer Satisfaction and Other Input on ServicesAt the absolute minimum, programs that empower participants need to be satisfactory to those partici-pants. Moreover, these programs need to obtain input from consumers to ensure that program designreflects their interests.

3. Lodges and ClubhousesFor more than three decades, the mental health system has supported treatment programs that were largelyoperated by persons with mental illness. Lodges are residential programs in this mold; clubhouses aresocial and work programs.

4. Supported Housing and EmploymentInstead of the consumer going to the professional, the best treatment occurs when the professional travelsto the consumer and all the places in which consumers need assistance. Provision of services in theperson's home or community is the hallmark of Assertive Community Treatment (or ACT). Services inreal-world job sites is supported employment.

5. Consumers as ProvidersMany persons with mental illness are deciding to return to school, obtain necessary credentials, and assumejobs in the mental health system as providers. In this way, they can change the system from the inside.

6. Self-Help, Mutual Assistance and Other Consumer-Operated ServicesThere is almost a 50-year history of programs developed by persons with mental illness to help peers.These programs provide places where people can provide and receive help from individuals with similarconcerns.

7. Participatory Action ResearchMuch of the current research on psychiatric disability and rehabilitation reflects the perspective of theexisting mental health system. Persons with mental illness must be equal partners in the research enter-prise for future studies to represent the differing interests of consumers.

R E H A B I L I T A T I O N13

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nalizing the kind of messages embod-ied in recovery may help to dimin-i s h s e l f - s t i g m a . C o g n i t i v erestructuring may also prove usefulin helping people learn to challengestigmatizing views they may hold ofthemselves (Corrigan, 1998; Haaga &Davison, 1991). Alternatively, self-stigma will diminish as a person’ssense of empowerment improves.Seven sets of strategies have someempirical support for facilitating em-powerment of people with mental ill-ness (Corrigan & Lundin, 2001). Eachof these is discussed more fully in theremainder of this article.

Empowerment may be construednarrowly in terms of control over theservices that help people deal withtheir disabilities (e.g., problems re-lated to mental illness). It may alsobe understood more broadly in termsof command over all spheres of one’slife, such as succeeding at work, inrelationships, during play, spirituallyand in as many other domains as pos-sible. Table 1 lists seven strategiesthat facilitate empowerment. Theseare loosely ordered from those thatshould now be obviously acceptedby the mental health system — theyrepresent the base of empowermentapproaches (like issues about col-laboration and consumer satisfaction)— to those that are visionary andneed to be more widely acceptedand disseminated, such as consumeroperated services and participatoryaction research.

1. From Noncompliance toCollaboration

Many mental health providers mustdrastically reconceive their viewpointabout the consumer’s relationshipwith treatment for empowerment tooccur (Fenton, Blyler & Heinssen,1997; Ruesch & Corrigan, 2002). Theold notion was that persons withmental illness should comply with allaspects of treatment: Professionalsknew best; anything that strayed fromthe prescribed treatment programrepresented unclear thinking due tothe illness. Failure to comply was in-dicative of unconscious motivations

to resist health. Mandatory treatmentsand a coercive system rested on theseassumptions. Research evidenceseemed to clearly support these con-clusions. Depending on the study,anywhere between two-thirds andthree-quarters of persons did not taketheir psychiatric medications as pre-scribed. More than half of all partici-pants in rehabilitation and similarpsychosocial programs did not com-plete the treatment plan as agreed(Cramer & Rosenbeck, 1998). Thesedata suggest resistance is rampantand significantly undermines treat-ment of serious psychiatric illness.

Considered another way, how-ever, these data might be perceivedto yield completely different conclu-sions. Rather than 66 to 75 percentof persons taking their medicationincorrectly, perhaps two-thirds tothree-quarters of all mental healthproviders are prescribing drugspoorly. Lack of compliance may notrepresent resistance by a person withpsychosis as much as meager treat-ment by the mental health team.Equally sobering statistics suggest thatmore than 70 percent of all personswho are prescribed any kind of medi-cine (not just psychoactive drugs) donot take it the way the doctor ordered(Rogers & Bullman, 1995). Clearly,incorrect use of medication is notsolely a problem of persons withmental illness.

Rather than expecting persons topassively comply with care — be it psy-chiatric care or general medicaltreatment — what is needed is moreenlightened practice that calls for col-laboration between providers andconsumers. An equal partnership oc-curs when each party learns from theother: Providers learn about the natureof specific symptoms and correspond-ing disabilities from the personchallenged by these problems; con-sumers learn the range of treatmentsand services that address these prob-lems. How do prov iders andconsumers foster a collaborative work-ing relationship? More than a decadeago, we wrote a paper that outlinedstrategies for answering this question

Many

mental health

providers must

drastically reconceive

their viewpoint about

the consumer’s

relationship with

treatment for

empowerment to

occur.

A U T U M N

14A M E R I C A N

(Corrigan, Liberman & Engel, 1990),which are summarized in Table 2. Asoutlined in our earlier paper, thesestrategies have some empirical supportfor fostering the collaboration amongproviders and consumers.

2. Consumer Satisfaction andOther Input on Services

One of the assumptions of empower-ment and collaboration is that treat-ment teams will design interventionsand programs that are pleasing to par-ticipants. Hence, assessing consumersatisfaction is a minimal requirementfor establishing programs that em-power consumers (Corrigan, 1990;Dickey & Sederer, 2001). Although

one might think this to be a straightfor-ward process, assessing consumer sat-isfaction is more difficult in actuality.Hence, some rules for developing auseful consumer satisfaction scale areprovided. Unfortunately, concern withconsumer empowerment frequentlyends with the assessment phase. Pro-grams collect data on satisfaction butsubsequently fail to use it in improv-ing services. A second important partof this process is to consider ways touse information from satisfaction evalu-ations to further improve the setting.

What goes into a consumer satis-faction scale? When evaluatingconsumer satisfaction, satisfactionscales should consider four catego-

ries or domains: the service environ-ment, the service providers, specificinterventions and preparation for au-tonomy (Corrigan, 1990; LeBow,1982). What is the quality of the ser-vice environment? Are the roomspleasant, including the decor, light-ing, furniture and temperature? Iffood is provided, is it tasty and plen-tiful? How are the service providers?Are they knowledgeable and compe-tent in their specific jobs? Are theyapproachable , respect fu l andfriendly? Can the consumer interactwith them informally? How useful arespecific interventions themselves? Dothey provide the consumer with theneeded skills? Do they help the con-

TABLE 2: BARRIERS TO COLLABORATION AND WAYS TO OVERCOME THEM

BARRIERS WAYS TO OVERCOME BARRIERS

TREATMENT TECHNIQUES

NASTY SIDE EFFECTS OF

MEDICATION.· Use new generation of medications that reduce side effects.

· Use low-dose medication strategies.

· Educate consumer to side effects and teach self-tracking strategies.

COMPLEX TREATMENT PLANS. · Engage consumers in central role in designing treatment plan.

· Use simple language.

· Clearly explain steps of treatment

· Begin simply and slowly; add more complex steps gradually.

LONG-TERM TREATMENT. · Regularly assess goals and relevance of treatments to these goals.

· Provide treatment holidays.

· Consider place-train options.

TREATMENT DELIVERY SYSTEM

DEPRESSING AND DINGY

ATMOSPHERE OF CLINICS.· Improve clinic decor and ambience.

· Offer coffee and refreshments.

· Require all staff (including clerks) to be courteous and respectful.

· Move most services to the consumer's home or other setting.

LONG WAITS AT CLINICS. · Maintain realistic schedules.

· Send reminders to consumers.

PROVIDER-CONSUMER RELATIONSHIPS

PROVIDER'S POOR INTERPERSONAL

STYLE AND LACK OF INTEREST IN

CONSUMER FEEDBACK.

· Alert administrators about poor provider style.

· Educate providers about the importance of "collaborative" roles.

· Educate providers about the need for consumer satisfaction.

· Pair provider with mentor for remediation.

FAMILY-CONSUMER CHARACTERISTICS

LACK OF KNOWLEDGE OF OR

UNREALISTIC EXPECTATIONS ABOUT

TREATMENT.

· Educate consumers and family members to treatment options.

· Provide opportunities for consumers and family members to share concerns.

Adapted from Corrigan, Liberman & Engel (1990).

R E H A B I L I T A T I O N15

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sumer better understand his or hergoals? Do they provide the resourcesand support needed for goals? Is theservice preparing the consumer forautonomy? After finishing the pro-gram, is the consumer better able tolive independently? Is he or she morehopeful about the future?

Unfortunately, this approach to as-sessing satisfaction can lead to ”halo”or ”devil” effects (Corrigan & Jakus,1993a,b). Halo effects occur whenthe consumer rates everything as sat-isfactory: The program was great, thestaff were great, the food was great,the building was great, everythingwas great. Research has shown thathalo effects are very common in con-sumer satisfaction studies. Althoughsome services may indeed be satis-factory, rating everything highly doesnot help to identify those compo-nents that need to be changed.Service providers would not knowwhere to put their efforts in improv-ing services. Devil effects are providedby people who are angry with the pro-gram. They rate all components ashighly dissatisfactory. The program waspoor, the staff was lousy, the food wasrotten, the building was dingy, every-thing really stunk. Like the halo effect,rating everything alike (in this case,poorly) does not help providers focuson specific aspects of the program.

To avoid this problem, consumersmay be encouraged to compare a spe-cific program to another similar servicein which the person has been involvedin the past (Corrigan & Jakus, 1993b).For example a counselor might requestthe following from a client:

“Currently, you are participatingin the Opportunities Program onSupported Employment. Tell meanother similar program youhave participated in the past.Write it here ________________.Now answer the following ques-t ions by compar ing yourexperience in Opportunities withthis other program.”

Research has shown this kind of com-parative approach yields to better dif-ferentiation among components of aprogram (Corrigan & Jakus, 1993a,b).

Having input on services. The fullbenefit of evaluating consumer satis-faction will only be realized whenproviders use the results from theseevaluations to actually change ser-vices. Unfortunately, this kind ofprogram improvement is frequentlydone without consumer input. In-stead, treatment providers take thefindings and decide how to improveprogram aspects on their own. Thiskind of approach fails to promote em-powerment. The preferred way tohandle findings from satisfactionevaluations would be to involve par-ticipants in focus groups where theydiscuss their concerns about aspectsof the program and, more impor-tantly, provide recommendations forways that the program might improve(Rogers & Palmer-Erbs, 1994).

There are two essential roles to fillin these kinds of focus groups: theleader and participating members(Morgan, Krueger & King, 1998). Thebest leaders for these groups are otherconsumers who are trained to facilitatethese kinds of groups. Although tradi-tional service providers may have skillsfor running discussion groups likethese, members might be hesitant tospeak freely because they believe theprovider will be biased in favor of theestablished program. Many consumersare able to lead these groups after onehour of training. We do not have thespace here to consider the skills for afocus group leader; the interestedreader should consider such resourcesas Bernard Bass’s and R.M Stogdill’sHandbook of Leadership (1990).

Focus groups should comprise sixto eight members. A good mix ofpeople with different opinions shouldbe invited to the focus group. Includeconsumers at both ends of the scale —persons who are fully satisfied with theprogram and those who are highly criti-cal — as well as individuals in themiddle. In this way, a polite contrastof opinions is possible. Prior to themeeting, leaders should develop a se-ries of questions to guide thediscussion. These questions should bebased on the results of the consumersatisfaction evaluation.

The

preferred

way to handle

findings from

satisfaction

evaluations would

be to involve

participants in

focus groups ...

A U T U M N

16A M E R I C A N

3. Lodges and ClubhousesConsumers have obtained furthercontrol of the mental health systemand their world in two kinds of pro-grams: lodges and clubhouses. Inboth settings, people with mental ill-ness have equal authority to that ofthe professional staff in operating theprogram. Lodges were started in the1960s by George Fairweather as resi-dential and work communities forpersons recently transferred fromlong-term hospitals. Clubhousesspontaneously emerged in New YorkCity as a meeting place for peoplerecently discharged from the statehospital. Both of these models repre-sent consumer dissatisfaction with theway mental health providers actedtowards persons with mental illness.This dissatisfaction led to a philoso-phy that clearly echoes the impor-tance of empowerment.

The Fairweather Lodge: Living andworking together. The lodge is madeup of persons with psychiatric dis-abilities who live and work together(Fairweather, 1969). Typically,lodges form real-world businesses tomaintain themselves (e.g., janitorialservices, bulk mailing, copy centers,or temp agencies). Sometimes, lodgeshire non-disabled people who dem-onstrate expertise in areas needed tomaintain the business. They may alsoseek professional help to serve as”consultants” to lodge members, toprovide assistance in those psychiat-ric and rehabilitation strategiesneeded to help members managetheir symptoms and disabilities.

The lodge program is built on sev-eral principles that clearly reflect thespirit of personal empowerment(Fairweather, 1969). These principleshave been divided into two sets:• those that help the consumer fill

the role of lodge member (livingand working with peers); and

• those that help the lodge developnorms which make it a thrivingcommunity (or what Fairweathercalled “a social subsystem”).

People are more willing to embrace arole when they have a stake in it. Inother words, living and working with

others has to satisfy what the personwants and needs in his or her life now.This means the person needs to haveautonomy in his or her role within thelodge. At the minimum, a person’s roleneeds to be voluntary. People cannotbe court-ordered to a lodge or sentagainst their will. In addition, peopleneed the right to self-determination:namely, the opportunity to decide forone’s self how to meet his or her re-sponsibilities in the lodge community.

It is the nature of interaction thatthere be some hierarchy among so-cial roles. Some people need to besupervising others to make sure allneeds of the lodge are met. Anotherprinciple of lodge programs is that allmembers have the opportunity to bepromoted to leadership jobs andthereby experience the benefits, aswell as the demands, of differentroles throughout the hierarchy. At thesame time, all roles within the lodgemust be filled. In this way, the com-munity is assured that all tasks of thelodge are covered.

There is an interesting contradic-tion between the goals of autonomyand the demands of operating a resi-dential and work community. Howdoes the lodge balance each person’sright to self-determination with thecommunity’s need to get all its workdone? The second set of principlessuggests development of communitynorms that seek this balance. One ofthe major rules of the FairweatherLodge is ”Members are encouragedto do things as a group” (Fairweather,1969). Proponents of the lodge pro-gram believe that its strength lies insharing both good times and toughdecisions among all members. Groupdiscussion is central to the empow-e rmen t and pe r sona l g rowthexperienced in this setting. Unfortu-nately, a second principle of thelodge recognizes that this group mustbe limited in size. The communitycan only serve a small number ofpeople in order to meet their workand home needs satisfactorily. Thiscan be a sobering thought for somelodge members; namely, that theircommunity is closed to many others

The

lodge

program is

built on several

principles that

clearly reflect

the spirit of

personal

empowerment.

R E H A B I L I T A T I O N17

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like themselves who are also in need(Corrigan & Garman, 1997).

The success of the community oc-curs in a complicated balancebetween norms. On one hand, thenorms of the program must corre-spond with those of the larger societyin which the lodge finds itself. Bas-ing lodge rules on those in the largersociety makes sense because theseare the rules with which communitymembers are likely to already be fa-mil iar . For example, “respectprivacy” and “do not steal” should betwo familiar rules to most Americansand therefore be incorporated intothe norms of lodges in the UnitedStates. The lodge also needs to de-velop norms that reflect the uniquecharacter of its community. For ex-ample, the prime rule, “Members areencouraged to do things as a group,”is not reflected in Western society asa whole. However, proponents of thelodge program believe this kind ofnorm is essential for the unique at-mosphere needed to develop acommunity of living and workingpeers. In like manner, each commu-nity needs to consider as a groupwhat other particular rules it willadopt to meet the individual needsof its members.

The Fountain House: A club-house for persons with mentalillness. During the years after theend of World War II, many peoplewere released from Rockland StateHospital, located outside of NewYork City, with no community con-nections. In order to survive, theywould meet on the steps of the NewYork Public Library to provide oneanother with resources and support.Soon, the group gained notorietyand other persons released fromRockland joined them in this make-shift society they called WANA: WeAre Not Alone. In 1948, the groupbought a building through the gen-e rous dona t ions o f a J ewi shwomen’s philanthropic group. Thebuilding had a fountain in the backyard; hence its name, FountainHouse. It was built around a funda-mental philosophy:

“Men and women with mental ill-ness have the right to a life whichincludes access to meaningful,gainful employment; a decentplace to live; a community of sup-por t ; the oppor tuni t ies fo reducation and recreation offeredby the communities in which theylive; and the chance to be needed,wanted and expected somewhereeveryday” (International Center forClubhouse Development, 1948).

Several values characterize the club-house. In some ways, these principlesoverlap with the lodge model; in otherways, they reflect the special charm ofsocial clubhouses (Macias, Barreira,Alden & Boyd, 2001). Persons belong-ing to the clubhouse are membersrather than consumers. They haveequal power with the professional staffhired to support clubhouse activities,not only in daily operations but also indecisions about budgetary issues. Withmembership comes responsibility. Allmembers are expected to contribute tosome aspect of the clubhouse’s opera-tions. Clubhouses are designed so thateach member is essential for efficientoperation. The fully collaborative natureof staff and consumer leads to all mem-bers being considered co-providers.

Clubhouses are open every day ofthe year. Unlike mental health centers,which typically close for holidays,clubhouses are open for their membersto celebrate. Clubhouses also providea wide variety of opportunities, includ-ing housing, education, social support,recreation and vocational training andplacement. Services are never pressedupon members. Rather, they are usedas the individual sees fit. Clubhousesoperate according to a work-orderedday with normal 9 to 5 schedules(Besancon & Zipple, 1995). Each day,members (consumers and staff alike)decide among a variety of work unitsthat comprise the necessary tasks tokeep the clubhouse running effectively.Work activities at Fountain Househave included horticulture, thriftshop, snack bar and dining room,clerical work, education, and re-search. Participation in this kind ofactivity reacquaints members with

the demands of the work world aswell as its many benefits.

4. Supported Housing andEmployment

Even though lodge and clubhouseprograms have many values thatpromote empowerment, they stillrequire consumers to go outsidetheir home “turf” to receive ser-vices. Programs of Assertive Com-munity Treatment (PACT) turnedthe service world upside down(Bond, McGrew & Fekette, 1995;Mueser, Bond, Drake & Resnick,1998; Stein & Test, 1980). Insteadof demanding that consumers goout of their way to the offices ofproviders, why not bring services tothe consumers where they need it,such as in their homes or anywherethat the consumers might deemnecessary for resources and sup-port? PACT proponents believe theentire range of services — medica-tions, psychotherapy, skills training,money management and the rest —can be and should be provided inthe person’s home or community.A variation of this idea is supportedemployment, where a job coachprovides services alongside theconsumer at his or her place ofwork (Bond, Drake, Mueser &Becker, 1997; Drake et al., 1999).

PACT and supported employmentfacilitate empowerment in severalways. First, these programs are con-sumer-centered. Services are definedby the needs of the consumer, not bythe provider. Although this may seemobvious now, this value was revolu-tionary when first proposed. In the past,treatment plans reflected what was bestfor the consumer AND the provider.Hence, a person would not be referredto an independent housing program ifit were outside the case manager’s dis-trict. A consumer would not begincompetitive work until the agencyhad an available job coach. Con-sumer-centered services remind theprovider that it is up to the agency tofind the necessary resources and sup-ports to help consumers achieve theirgoals on their timeline.

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PACT and supported employmentare also strengths-oriented (Rapp,1998). This view differs from the dis-ease model that dominates traditionalservices. Proponents of the diseaseviewpoint believe that people are de-fined by their symptoms and otherweaknesses that need to be fixedthrough treatment. The strengthsmodel recognizes that people aredescribed by their skills, not theirshortcomings. Awareness of theseskills is essential; these are the toolsthat people use to accomplish theirgoals. Providers who are consumer-centered make interventions asconvenient and efficient as possible.Hence, PACT is comprehensive andcross-sectional. That is to say, it pro-vides services across all domains ofneed: housing, finances, family,health care, spiritual matters and rec-reation.

PACT and supported employmentare also longitudinal. By this wemean that the needed service is pro-vided by a single team as long as theperson needs it. In the past, mentalhealth providers used to have the badhabit of ending services at times notconvenient for the consumer. Today,PACT and supported employmentcontinue as the person changeshomes or moves in and out of insti-tutions. Sometimes, services areprovided indefinitely. Mental healthsystems of the past had the unwisepractice of discontinuing communityservices for those individuals whohad to be hospitalized because ofshort-term psychiatric emergencies.Unfortunately, these people had tostart over with a new team when re-leased a few weeks later. The PACTand supported employment teamcontinue to offer support and re-sources even while the person ishospitalized or involved in the crimi-nal justice system (Bond, Drake,Mueser & Becker, 1997; Mueser,Bond, Drake & Resnick, 1998).

Effective PACT and supported em-ployment is accessible and available.This means services are provided inplaces that are convenient to the con-sumer, typically in his or her home

or place of work. Moreover, serviceis provided at times that make senseto the consumer. The provider doesnot ask the person to stay home fromwork so that the provider may cometo the consumer’s apartment to dis-cuss shopping. Instead, the providercomes in the evening when the per-son is home from work and has eatendinner.

5. Consumers as ProvidersWhat better way to influence the sys-tem that provides services than forpeople with mental illness to assumejobs as providers in these services?In this spirit, consumers have filledalmost every conceivable position inthe mental health system (Mowbray,Moxley, Jasper & Howell, 1997;Solomon & Draine, 2001). Consum-ers have become job coaches, theyhave worked on assertive communitytreatment teams and they have runsupport groups. Consumers have alsoworked at all the professional levelsthat comprise the treatment team, aspsychiatrists, psychologists, socialworkers and psychiatric nurses. Sev-eral well-known consumer advocateshave cut their teeth as mental healthprofessionals. Daniel Fisher is a psy-chiatrist; Fred Frese is a psychologist.Each of these gentlemen has gonethrough more than 20 years of strug-gling with the psychiatric disabilitiesresulting from schizophrenia.

Having consumers as mentalhealth providers yields several signifi-cant benefits for the individualconsumer as well as for people withmental illness in general. At thebroadest level, consumers as provid-ers challenge stigmatizing notionsabout people with mental illness.Public understanding of consumersreaches beyond the simple idea thatthey are psychiatric diagnoses. De-spite their disabilities — or perhapsbecause of them — people with men-tal illness are able to support peerswith mental illness by providingthem with knowledge about psychi-atric symptoms, skills to deal withthese symptoms and resources tomeet their goals. These abilities chal-

Having

consumers

as mental health

providers yields several

significant benefits for

the individual

consumer as well

as for people with

mental illness in

general.

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lenge the notion that people withmental illness are incompetent.

Consumers assume roles that tra-ditional providers frequently will notdo or are not able to do well. Manyjobs related to supported employ-ment and programs of assertivecommunity treatment require longhours and travel into places that areless than desirable. Most people arenot willing to meet these challengesunless they have experienced thesame struggles. There are some tasksthat only consumers can provide.One of these is the ”I’ve been theretoo” kind of support. Those in thethroes of depression or anxiety re-ceive immeasurable benefits byhearing from a peer who has beenin the same situation, survived thechallenge and thrived to become amental health provider. There is onelast aspect to consumers becomingproviders which must be highlighted:Providing help to others reaps signifi-cant benefits for the helper. This isthe principle of mutual help that isdiscussed more in the next section.

6. Self-Help, MutualAssistance and OtherConsumer-OperatedServices

Consumer-operated services differfrom the earlier service model in thatthey are entirely developed, operatedand provided by and for people withmental illness (Davidson et al., 1999;Solomon & Draine, 2001). Con-sumer-operated services are not justanother form of clinical treatment(Luke, Roberts & Rappaport, 1994).Clinical treatment reflects a medicalmodel: People seek out services toresolve symptoms (Corrigan & Penn,1997). Clinical treatment features ahierarchy between healer and personin clinical settings; healers have somespecial power that they use to helppatients resolve problems. The rela-tionship between healer and patientis expected to end when symptomsremit. Consumer-operated programshave been likened more to commu-nities with life-long histories (Maton,Leventhal, Madara & Julien, 1989) or

to grassroots information and supportsystems (Meisen, Gleason & Embree,1991). Mental illness may be thecommon experience that drawspeople to consumer-operated ser-vices. But unlike traditional clinicaltreatment, this is not where the im-pact of consumer-operated servicesends. Consumer-operated servicesplace an extraordinary value on peersupport, hope and recovery (VanTosh & Del Vecchio, 2000). Con-sumer-operated services seek to pro-vide safe settings where a person canfind the necessary understanding andrecognition that society at large is notable to give. In the ideal, there is nohierarchy of roles in consumer-oper-ated programs; members are peersbenefiting from interactions withequals. There are no limits placed onthe amount of time a person can beinvolved in a program. Dependingon personal needs, some memberscome and go from consumer-oper-ated programs, while others may stayconnected for years (Durman, 1976;Luke et al., 1994).

Types of Consumer-Operated Services.Three kinds of programs comprisethe consumer-operated services: con-sumer-run drop-in centers; peersupport programs; and education andadvocacy programs.Consumer-run drop-in programs

provide an open venue forconsumers to receive a variety ofservices as needed in a specificlocation that is open at set timesdu r ing the day and week .Individuals participate in drop-inactivities on a voluntary, at-willand non-coercive basis. Servicecomponents parallel the gamut oftraditional mental health activitiesand may include assistance withe n t i t l e m e n t s , m e d i c a t i o neducation, clothing, bus ortransportation passes and moving.

Peer support programs are typicallyind iv idua l o r g roup -ba sedassistance and encouragementorganized around a worldview or12-step approach that is consistentwith empowerment and recovery.

Peer support programs, like drop-in centers, may tackle a broadrange of work, housing, health andrelationship goals that are neededby participating consumers.

Education and advocacy programsoperate under the belief thatconsumers with knowledge aboutmental illness and psychiatricservices are best able to addresstheir own disabilities as well as tofix what is wrong with the mentalhealth system. Education andadvocacy programs use well-de f ined cur r i cu la to t eachc o n s u m e r s t h i s k i n d o finformation, usually in short-termclassroom settings. The educationand advocacy program model alsor e l i e s o n p e e r s u p p o r t t oaccomplish its goals (Corrigan &Lundin, 2001).

7. Participatory ActionResearch

The purpose of research is to discoverwhat kind of outcomes result fromproviding a specific intervention pro-gram (for example, Programs of As-sertive Community Treatment) in acertain way (e.g., using a team of pro-viders instead of individual case man-agers) with a specific group ofconsumers (e.g., persons with men-tal illness recently released fromprison). Research is meant to answerquestions about programs. Tradition-ally, this kind of research is com-pleted by academic experts, peoplewith many years of education lead-ing up to a doctorate in social scienceor medicine and working as a pro-fessor in a university. There is wide-spread belief that social sciencerequires many years of study in sta-tistics and research methodology andcan, hence, only be completed bythese kinds of experts.

Many consumers believe thatthis kind of ”scientist as expert”view actually causes problems of itsown and diminishes empowerment(Rogers & Palmer-Erbs, 1994). Theydescribe a ”blame the victim” men-t a l i t y t h a t p e r m e a t e s m u c hresearch. According to this mental-

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ity, traditional research shows howpersons with serious mental illnesslack skills, lack work histories, lackmotivation, lack family ties, and soon (Rapp et al., 1993). It is theseperson-centered deficits that ac-count for a l l the individual ’sproblems and hence should be thefocus of research and services.

This point may be better under-stood if we consider how researchin other disabilities — blindness forexample — has developed overtime (Whyte, 1991). As the result offorceful input from persons who areblind, researchers realized thatteaching people how to live withtheir impairment is not enough. Wealso need to change the environ-ment so that those who are blindcan get around more easily. Re-search in this area led to Braille inelevators, crosswalks that beep, andbetter use of dog guides. This kindof research is only going to be ac-complished when people withdisabilities are full partners.

Participatory Action Research(PAR) describes how researchers andconsumers become partners in study-ing mental illness and appropriatetreatment (Rogers & Palmer-Erbs,1994). PAR calls for a significantchange in the roles of consumers andprofessionals, calling for consumersto actively investigate research hy-potheses themselves and enlisttrained researchers as consultants totheir projects. The goal of PAR is toadvance research that supports thefundamental assertions of consumerempowerment. Instead of asking typi-cal research questions (e.g., Howdoes the consumer fit into society?),PAR examines questions such as:What must society provide in termsof resources and accommodations inorder to enable the consumer to alsobe one of society’s resources?

Participatory Action Research isno longer a pipe dream. Many fed-erally funded research efforts haveincorporated the priorities of PARinto their guidelines. For example,several large-scale projects fundedby the U.S. Substance Abuse and

Mental Health Services Administra-tion (SAMHSA) require a consumeradvisory panel to have an activepartnership in planning and imple-menting its research projects. As aresult, most decisions that governthe projects are made through asometimes tortuous exchange be-tween the consumers on theproject and the science investiga-tors . The resul t i s a researchproject that represents the bestinterests and insights of consumerempowerment.

SUMMARYWhen President George W. Bushreleased the final report of the NewFreedom Commission on MentalHealth in 2003, the commission’scharge was to evaluate the state ofthe American mental health systemand propose a guiding vision for theyears to come. Central to its mes-sage was the idea of empowerment;that a successful service systemmust rest on personal decision mak-ing by the individual who is to ben-e f i t f r o m s e r v i c e s . T h ecommissioners also noted that evi-dence-based practices are essentialfor America to enjoy a high-qualitycare system. This article contains areview of seven evidence-based ap-proaches promoting individual em-powerment fo r consumers o fmental health services. With thecharge of the president’s commis-sion and the continuing researchand development that its report willhopefully generate, empowermentand the greater achievement of lifegoals for people with mentalillness will only blossom.

This

kind of

research is

only going to be

accomplished when

people with disabilities

are full partners.

Please send all correspondence to:

Patrick CorriganUniversity of Chicago Center for

Psychiatric Rehabilitation7230 Arbor DriveTinley Park, IL 60477Telephone (V): (708) 614-4770Fax: (708) 614-4780E-mail: p-corrigan@uchicago.edu

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SELF-DETERMINATIONAND THE EMPOWERMENT

OF PEOPLE WITHDISABILITIES

MICHAEL L. WEHMEYER, PH.D.

The usage note in the American Heri-tage Dictionary of the English Lan-guage (2000) states the followingwith regard to the word empower:

”Although it is a contemporarybuzzword, the word empower is notnew, having arisen in the mid-17thcentury with the legalistic meaning ‘toinvest with authority, authorize.’Shortly thereafter it began to be usedwith an infinitive in a more generalway meaning ‘to enable or permit.’Both of these uses survive today buthave been overpowered by theword’s use in politics and pop psychol-ogy. Its modern use originated in thecivil rights movement, which soughtpolitical empowerment for its follow-ers” (2000, pp. 586-587).

Leaving aside a discussion as towhether empowerment is merely abuzzword (when one is not empow-ered, it probably does not sound verymuch like a buzzword), it is worth not-ing the meaning shift or drift that has

occurred with use of the term since its17th century origination and the cur-rent linkages between empowermentand issues of control over one’s life.However, despite the American Heri-tage Dictionary’s indication that theterm’s meaning has shifted, it remainsless than convincing that the way inwhich many people use the term is notcloser to the original sense of the term.The problem with that meaning withregard to people with disabilities is, of

course, that in the end, when one hasthe power to invest someone else withauthority, one also has the power, pre-sumably, to withhold granting that au-thority. Power and control remain,fundamentally, with the granter in thatcircumstance. Similarly, the more cur-rent meaning, ”to enable or permit,”seems to offer two synonyms that, inthe end, are not equally effective insolving the ”granting authority” prob-lem (American Heritage Dictionary,2000). That is, the act of ”permitting”implies authority on the part of oneperson to allow another to do some-thing, or not. The meaning of empow-erment (or more accurately, empower),”to enable,” is, in my mind, closer tothe sense of the term as used when as-sociated with social movements, par-ticularly the disability rights movement,which typically uses the term in refer-ence to actions that ”enhance the pos-sibilities for people to control theirlives” (Rappaport, 1981, p. 15). Enable

Dr. Wehmeyer is AssociateProfessor, Department of SpecialEducation, and Director, KansasU n i v e r s i t y C e n t e r o nDevelopmental Disabilities, at theUniversity of Kansas, Lawrence,Kansas, and Principal Investigatorfor the RSA-funded project “Makingit More Than a Job: Infusing Self-Determination Into the VocationalRehabilitation Process.”

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means ”to supply with the means,knowledge, or opportunity; to makefeasible or possible” (American Heri-tage Dictionary).

Consideration of what it means toempower someone with a disabilityis more than just a semantic exercise.Well-intentioned professionals acrossmany disciplines mistake empower-ment as something that someonegrants or gives to someone else, tothe end that the effort falls short ofthe standard of enhancing the possi-bilities for people to control theirlives. There is a bit of a Catch 22 toissues pertaining to empowermentand professionals in rehabilitation, inthat many such professionals genu-inely want to do whatever they canto empower people with disabilitiesbut, similarly, don’t want to err inassuming that any ultimate authorityto grant power or control lies withinthose very same people. The way outof this conundrum is through effortsto enable people with disabilities toexert control in their lives and, as afunction of such actions, to becomeempowered to do so to a greater ex-t e n t . A s p r o f e s s i o n a l s i nr e h a b i l i t a t i o n , t h e r o u t e t o”enablement” is by providing oppor-tunities and supports that promoteand enhance the self-determinationof people with disabilities.

That this is both an appropriate andimportant focus is illustrated in the find-ings of Congress from the 1992Amendments to the Rehabilitation Act(and in the subsequent 1998 reautho-rization), which state ”disability is anatural part of the human experienceand in no way diminishes the right ofindividuals to:a. live independently;b. enjoy self-determination;c. make choices;d. contribute to society;e. pursue meaningful careers; andf. enjoy full inclusion and integration

in the economic, political, social,cultural and educational mainstreamof American society” (RehabilitationAct of 1973, as amended).

The 1998 amendments to the Rehabili-tation Act of 1973 strengthened and

emphasized the importance of self-de-termination by strengthening the roleof informed choice in the rehabilitationprocess. Indeed, there is a nationaltrend toward residential and vocationalservices that are delivered in a moreconsumer-driven manner (Callahan,Shumpert & Mast, 2002; Kilsby &Beyer, 2002; West, 1995). In the end,the intent of Congress in the Rehabili-tation Act and the impact of the choicemandates will depend on the capacityof rehabilitation professionals to dobusiness in such a way as to genuinelyenable people with disabilities to be-come more self-determined.

WHAT IS SELF-DETERMINATION?Put most simply, the self-determinationconstruct refers to both the right andcapacity of individuals to exert controlover and direct their lives. Theconstruct’s use in reference to a rightis grounded in its meaning referring tothe political right of people or peoplesto self-governance. Disability advo-cates and activists have stressed the in-herent right of people with disabilitiesto assume responsibility for and con-trol over their lives (Kennedy, 1996;Ward, 1996). In the 1990s, promotingand enhancing the self-determinationof students with disabilities, particularlyas a function of the transition planningprocess, became best practice(Wehmeyer, Agran & Hughes, 1998).These efforts focused primarily on en-hancing student capacity to becomeself-determined and exert control inone’s life by promoting goal setting,problem-solving, decision-making andself-advocacy skills; they also focusedon efforts to promote opportunities forstudents to use these skills.

A variety of definitions of the con-struct have emerged from efforts inspecial education (see Wehmeyer,Abery, Mithaug & Stancliffe, 2003).Field, Martin, Miller, Ward andWehmeyer (1998) summarized thesevarious definitions of self-determinationby stating that self-determined peopleapply ”a combination of skills, knowl-edge and beliefs” that enable them ”toengage in goal-directed, self-regulated,

Put

most simply,

the self-

determination

construct refers

to both the right and

capacity of

individuals to exert

control over and

direct

their

lives.

A U T U M N

24A M E R I C A N

autonomous behavior. An understand-ing of one’s strengths and limitationstogether with a belief in oneself as ca-pable and effective are essential inself-determination. When acting on thebasis of these skills and attitudes, indi-viduals have greater ability to takecontrol of their lives and assume therole of successful adults in our society”(p. 2). Field et al. (1998) further delin-eated the common components ofself-determined behavior identifiedacross multiple self-determinationmodels or frameworks. These include:a. awareness of personal preferences,

interests, strengths and limitations;b. ability to

i. differentiate between wantsand needs,

ii. make choices based on prefer-ences, interests, wants and needs,

iii. consider multiple options andanticipate consequences fordecisions,

iv. initiate and take action whenneeded,

v. evaluate decisions based onthe outcomes of previous de-cisions and revise futuredecisions accordingly,

vi. set and work toward goals,vii. regulate behavior,viii. use communication skills such as

negotiation, compromise andpersuasion to reach goals, and

ix. assume responsibility for ac-tions and decisions;

c. skills for problem-solving;d. a striving for independence while

recognizing interdependence withothers;

e. self-advocacy and self-evaluationskills;

f. independent performance andadjustment skills,

g. persistence;h. self-confidence;i. pride; andj. creativity.

IS SELF-DETERMINATIONIMPORTANT FOR CONSUMERSOF VOCATIONALREHABILITATION SERVICES?There are several indicators to suggestthat the answer to this question is ”yes.”

First, as mentioned previously,promoting choice and self-determina-tion is mandated by federal disabilitypolicy and legislation.

Second, people with disabilitieshave been unequivocal in their de-mands for enhanced self-determination(Kennedy, 1996; Ward, 1996).

Third, there is compelling evi-dence from the special educationliterature that enhanced self-determi-nation leads to more positive adultoutcomes, outcomes that are equallyvalued by the field of rehabilitation.Wehmeyer and Schwartz (1997)measured the self-determination sta-tus of 80 students with mild mentalretardation or learning disabilities intheir final year of high school andone year after high school. Studentswith higher self-determination scoreswere more likely to have expresseda preference to live outside the fam-ily home, have a savings or checkingaccount, and be employed for pay.Eighty percent of students in the highself-determination group worked forpay one year after graduation, whileonly 43 percent of students in the lowself-determination group did like-wise. Among school-leavers whowere employed, youths who were inthe high self-determination groupearned significantly more per hour(M=$4.26) than their peers in thelow se l f -de terminat ion group(M=$1.93)(where “M” represents“mean.”)

Wehmeyer and Palmer (2003)conducted a second study, examin-ing the adult status of 94 youngpeople with cognitive disabilities(mental retardation or learning dis-ability) one and three years afterhigh school. These data were con-sistent with results from Wehmeyerand Schwartz (1997). One year af-ter high school, students in the highself-determination group were dis-proportionately l ikely to havemoved from where they were liv-ing during high school, and by thethird year they were still dispropor-tionately likely to live somewhereother than their high school homeand were significantly more likely

There

is a growing

body of evidence

in the field of

vocational

rehabilitation (VR)

that enhancing

choice opportunities

leads to better

VR-related

outcomes.

R E H A B I L I T A T I O N25

2 0 0 4

to live independently. Young adultsin the high self-determination groupwere more likely to maintain a bankaccount by year one, an outcomemost likely attributable to the em-ployment status of students in thetwo groups. Students in the highself-determination group were dis-proportionately likely to hold a jobby the first-year follow-up, to beworking either full- or part-time,and to have held a job or have re-ceived job training by year three.For those students across the com-plete sample who were employed,students scoring higher in self-de-terminat ion made stat is t ical lysignificant advances in obtainingjob benefits, including vacation andsick leave and health insurance, anoutcome not shared by their peersin the low self-determination group.Overall, there was not a single areain which the low self-determinationgroup fared more positively thenthe high self-determination group.German, Martin, Marshall and Sale(2000) found that instruction in self-determinat ion could improvestudent goal setting and enhanceparticipation in educational plan-ning. Sowers and Powers (1995)showed that instruction on multiplecomponents related to self-determi-nation increased the participationand independence of students withsevere disabilities in performingcommunity activities.

Finally, there is a growing bodyof evidence in the field of voca-t ional rehabil i tat ion (VR) thatenhancing choice opportunitiesleads to better VR-related out-comes. For example, Farley, Boltonand Parkerson (1992) evaluated theimpact of strategies to enhance con-sumer choice and involvement inthe VR process and found that con-sumers who were actively involvedin VR planning had better voca-t i o n a l c a r e e r d e v e l o p m e n toutcomes. Similarly, Hartnett,Collins and Tremblay (2002) com-pared costs, services received andoutcomes achieved between onegroup served through the typical VR

system and another group involvedin a Consumer Choice Demonstra-tion Project in Vermont. They foundthat the Choice group was twotimes more likely to have com-pleted rehabilitation and that theirmean income was 2.7 times higher.

PROMOTING THE SELF-DETERMINATION OFVR CONSUMERSIf the means by which rehabilitationprofessionals contribute to the em-powerment of VR consumers withdisabilities is to provide opportunitiesand supports to enable people to be-come more self-determined, what aresome of the specific strategies thatrehabilitation professionals can use toachieve this outcome? It is temptingto take a ”skills remediation” ap-proach to ”teach” VR consumersskills they do not have that wouldenhance self-determination. How-ever, it is important that adults withdisabilities not be treated as if theyare eternal students, which equatestoo closely with being eternal chil-dren. Thus, it is important that effortsto promote skills such as career andjob goal setting, decision making,problem solving and self-manage-ment be done within a context inwhich the consumer is in charge ofthe process. Like other disability sys-tems, traditional vocational servicestend to have been ”other-directed.”That is, in too many cases, decisionsabout jobs or careers are made forpeople with disabilities instead of bypeople with disabilities. There aremany reasons for this, including thefact that many customers of VR ser-vices simply have not had the expe-riences and opportunities necessaryto enable them to be more self-di-rected. VR counselors may experi-ence frustration because they want tosupport individuals to make theirown decisions or take greater controland responsibility for their career ad-vancement, yet the individual’s lim-ited capacity and experiences arebarriers to those outcomes.

Under the auspices of a specialdemonstration project of the Reha-

... in

too many cases,

decisions about jobs

or careers are made

for people with

disabilities instead

of by people with

disabilities.

A U T U M N

26A M E R I C A N

bilitation Services Administration,we at the University of KansasBeach Center on Disability havebeen involved in the developmentand evaluation of a model for usewith adults specific to the career de-cision-making and job-placementprocesses of VR services in the stateof Kansas (Wehmeyer, Lattimore etal., in press). This model — the Self-Determined Career DevelopmentModel — is designed to enable VRconsumers to engage in a self-regu-l a t e d p r o b l e m - s o l v i n g a n dgoal-setting process leading to jobplacement. The remainder of thisarticle describes this model as anexample of how to promote self-

determination and thereby em-power people with disabilitiesthrough the rehabilitation process.

The Self-Determined Career De-velopment Model evaluated in thisarticle was based on the team’s pre-vious work with a model of teachingfor students with disabilities. It is sim-plest to describe the adult version ofthis model for VR by first describingthe school-based model.

The Self-Determined LearningModel of Instruction (SDLMI) was de-signed to enable educators to teachstudents to self-direct the instructionalprocess and, at the same time, enhancetheir self-determination (Mithaug,Wehmeyer, Agran, Martin & Palmer,

1998; Wehmeyer, Palmer, Agran,Mithaug & Martin 2000). The SDLMIis based on the component elementsof self-determination (Wehmeyer,1999, 2001), the process of self-regu-lated problem solving and on researchon student-directed learning. It is ap-propriate for students with and withoutdisabilities across multiple content ar-eas, and it enables teachers to engagestudents in their educational programsby increasing opportunities to self-di-rect learning. Implementation of theSDLMI consists of a three-phase pro-cess. Each phase presents a problemthe student must solve by posing andanswering a series of four StudentQuestions (per phase), which students

TABLE 1. PHASE 1, SELF-DETERMINED CAREER DEVELOPMENT MODEL

PROBLEM TO SOLVE: WHAT ARE MY CAREER AND JOB GOALS?

Adapted from Wehmeyer, Lattimore et al. (2003).

QUESTION 1: What career and job do I want?OBJECTIVES OF VR COUNSELING:· Enable person to identify career/job preferences/interests/beliefs/values.

· Enable person to identify strengths and needs related to jobs/careers.

· Enable and support person to prioritize career and jobs options andselect preferred option(s).

QUESTION 2: What do I know about it now?OBJECTIVES OF VR COUNSELING:· Enable person to identify his or her current status in relation to

prioritized job and career option(s).

· Enable person to identify knowledge/skills/needs of job/career option.

· Assist person to gather information about opportunities and barriers in hisor her environments pertaining to prioritized job and career option(s).

QUESTION 3: What must change for me to getthe job and career I want?

OBJECTIVES OF VR COUNSELING:· Support person to prioritize needs related to job/career preference(s).

· Enable person to choose primary need and decide if action needs to befocused toward capacity building, modifying the environment or both.

QUESTION 4: What can I do to make this happen?OBJECTIVES OF VR COUNSELING:· Teach person to state his or her career/employment goals/objectives.

EMPLOYMENT SUPPORTS

· Awareness Training.

· Self-Assess Job or CareerPreferences/Abilities.

· Career and Job Exploration.

· Job Shadowing and Sampling.

· Organizational Skills Training.

· Problem Solving Instruction.

· Choice-Making Instruction.

· Decision-Making Instruction.

· Goal-Setting Instruction.

R E H A B I L I T A T I O N27

2 0 0 4

learn, modify to make their own andapply to reach self-selected goals. Eachquestion is linked to a set of TeacherObjectives. Each instructional phaseincludes Educational Supports identi-fied for teachers to use to enablestudents to self-direct learning in a va-riety of areas including, but not limitedto, problem solving, choice making,goal development, self-evaluation andself-monitoring.

The problem to solve in Phase 1is ”What is my goal?” In Phase 2, theproblem to be solved is ”What is myaction plan?” and in Phase 3, theproblem is ”What have I learned?”The Student Questions direct the stu-dent through a problem-solving

sequence in each instructional phase.The solutions to the problem in eachphase lead to the problem-solvingsequence in the next phase. Questionconstruction was based on theory inthe problem-solving and self-regula-tion literature that suggests there is a”means-ends” problem-solving se-quence that must be followed for anyperson’s actions to produce results tosatisfy his or her needs and interests.Teachers implementing the modelteach students to solve a sequence ofproblems by constructing a ”means-ends chain,” a causal sequence thatmoves them from where they are towhere they want to be, a goal state(Mithaug, et al., 1998).

By answering the questions in thissequence, students are supported toregulate their own problem solvingby setting goals to meet needs, con-structing plans to meet goals, andadjusting actions to complete plans.The questions differ from phase tophase, but represent identical stepsin the problem-solving sequence.That is, students answering the ques-tions must:• identify the problem,• identify potential solutions to the

problem,• identify barriers to solving the

problem, and• identify consequences of each

solution.

TABLE 2. PHASE 2, SELF-DETERMINED CAREER DEVELOPMENT MODEL

PROBLEM TO SOLVE: WHAT IS MY PLAN

Adapted from Wehmeyer, Lattimore et al. (2003).

QUESTION 1: What actions can I taketo reach my career or employment goal?

OBJECTIVES OF VR COUNSELING:· Enable person to identify alternatives to achieve career/employment

goal.

· Assist person to gather information on consequences of alternatives.

· Enable person to select best action alternatives.

QUESTION 2: What could keep me from taking action?OBJECTIVES OF VR COUNSELING:· Support person to identify barriers to implementing action alternatives.

· Support person to identify actions to remove barriers.

QUESTION 3: What can I do to remove these barriers?OBJECTIVES OF VR COUNSELING:· Assist person in identifying appropriate employment supports to

implement selected action alternative.

· Teach person knowledge/skills needed to implement selected supports.

QUESTION 4: When will I take action?OBJECTIVES OF VR COUNSELING:· Enable person to determine schedule for action plan to remove barriers

and implement supports.

· Support and enable person to implement the action plan.

· Enable person to self-monitor his or her progress.

EMPLOYMENT SUPPORTS

· Exploration of CommunityResource/Support.

· Problem Solving Instruction.

· Self-Scheduling Training.

· Self-Instruction Training.

· Picture-Cue Training.

· Decision-Making Instruction.

· Self-Advocacy Instruction.

· Assertiveness Training.

· Self-Monitoring Instruction.

A U T U M N

28A M E R I C A N

These steps are the basic steps inany problem-solving process andthey form the means-end problem-solving sequence represented bythe Student Questions in eachphase. The first time a teacher usesthe model with a student, the ini-tial step in the process is to readeach question with or to the stu-dent, discuss what the questionmeans and then, as needed, changethe wording to enable that studentto better understand the intent. Inwording changes, the problem-solv-ing intent of the question must re-main intact. Going through thisprocess several times as the studentprogresses through the model shouldresult in a set of questions that a stu-dent accepts as his or her own.

The Teacher Objectives within themodel provide suggestions for teach-ers to enable and support students towork through the Student Questions byscaffolding instruction1, using directteaching strategies, or collaboratingwith students to determine the beststrategies to achieve goals. The Educa-tional Supports are educational andinstructional activities to enable teach-ers to support students’ efforts toanswer questions. The emphasis in themodel on the use of educational sup-ports that are student-directed providesanother means of teaching students tosupport themselves.

By using the Student Questions, stu-d e n t s l e a r n a s e l f - r e g u l a t e dproblem-solving strategy to use in goalattainment. Concurrently, teaching stu-

dents to use self-directed learning strat-egies provides skills that enable themto begin to become the causal agentin their lives.

The Self-Determined Career Devel-opment Model is equivalent to theSDLMI, except that it has been modi-fied for use to support adults and it isspecific to the career decision-makingprocess. The three phases of the modelare depicted in Tables 1, 2 and 3. Theproblem to solve in Phase 1 is ”Whatare my career and job goals?” Withinall three phases, supports focus uponjob and career issues. Objectives havebeen reframed from teacher objectivesto VR counselor or other VR person-nel objectives. Supporting the VRconsumer to answer each of the ques-tions in Phase 1 leads to the second

Adapted from Wehmeyer, Lattimore et al. (2003).

TABLE 3. PHASE 3, SELF-DETERMINED CAREER DEVELOPMENT MODEL

PROBLEM TO SOLVE: WHAT HAVE I ACHIEVED?QUESTION 1: What actions have I taken?OBJECTIVES OF VR COUNSELING:· Enable person to self-evaluate and articulate progress toward goal.

QUESTION 2: What barriers have been removed?OBJECTIVES OF VR COUNSELING:· Assist person to compare progress with his or her desired outcomes.

QUESTION 3: What has changed to enable me to get the job andcareer I want?

OBJECTIVES OF VR COUNSELING:· Support person to re-evaluate goal if progress is insufficient.

· Assist person to decide if goal remains the same or changes.

· Collaborate with person to identify if the action plan is adequate orinadequate given revised or retained goal.

· Assist person to change action plan if necessary.

QUESTION 4: Have I achieved what I want to achieve?OBJECTIVES OF VR COUNSELING:· Enable person to decide if progress is adequate, inadequate, or if goal

has been achieved.

· If this goal has been achieved, enable person to decide if a differentgoal is needed to achieve his or her employment or career goals.

EMPLOYMENT SUPPORTS

· Self-Evaluation Instruction.

R E H A B I L I T A T I O N29

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phase, where the problem to solve is”What is my plan?” The problem in thefinal phase, Phase 3, is ”What have Iachieved?”

Wehmeyer, Lattimore et al. (2003)conducted a pilot evaluation of the ca-reer development model using asingle-subject research design with sixVR consumers identified by a counse-lor as needing more support withcareer decision making than was tra-ditionally available in the VR system.Within this pilot evaluation, all partici-pants were able to set career andjob-specific goals, to assist in the de-sign and implementation of an actionplan to achieve those goals and to self-monitor and evaluate their progresstoward the goals. Five of the six par-

AUTHOR’S NOTEPreparation of this article was supported, in part, by Rehabilitation Services Administration (RSA) Special Demon-stration Projects PR/Award Number H235H000059, awarded to the University of Kansas Center for Research, Inc.,Beach Center on Disability. However, the content of this article does not necessarily represent the policy of RSA orthe U.S. Department of Education, and the reader should not assume endorsement by the federal government.

ticipants showed progress towardachieving that self-set goal. All partici-pants were able to engage with thefacilitator to address questions in themodel and to self-set an employmentor job-related goal. The VR counselorwho referred participants to this pilotevaluation conducted an informal as-sessment in consumer satisfaction. Allexcept one participant indicated thatthey had benefited from their partici-pation in the process. Perhaps the mostsuggestive indicator of the potential forthe process to empower people withdisabilities involved one woman whomade considerable progress toward hergoal and, after nine years of unemploy-ment, obtained a job shortly after herinvolvement with the model. This per-

son expressed her satisfaction with herparticipation in the process and men-tioned her improved confidence to thefacilitator. She was, we suggest, em-powered not by the professionals withwhom she worked but by the skills andpositive attitudes she gained byher use of the model.

NOTE1. Instructional scaffolding is the

provision of sufficient supports topromote learning when conceptsand skills are being first intro-duced to students. Retrieved July2 3 , 2 0 0 4 , f r o m h t t p : / /encyclopedia.thefreedictionary.com/Instructional_scaffolds.

REFERENCESAmerican Heritage Dictionary of the English

Language. (2000). New York: HoughtonMifflin Company.

Rehabilitation Act Amendments. (1992).Section 2 (29 U.S.C. 701.)

Callahan, M., Shumpert, N., & Mast, M.(2002). Self-employment, choice andself-determination. Journal of VocationalRehabilitation, 17(2), 75-85.

Farley, R.C., Bolton, P., & Parkerson, R.(1992). Effects of client involvement inassessment on vocational development.Rehabilitation Counseling Bulletin, 35(3),146-153.

Field, S, Martin, J., Miller, R., Ward, M., &Wehmeyer, M. (1998). A practical guideto teaching self-determination. Reston,VA: Council for Exceptional Children.

German, S.L., Martin, J.E., Marshall, L. H., &Sale, R.P. (2000). Promoting self-determination: Using Take Action to teachgoal attainment. Career Development forExceptional Individuals, 23, 27-38.

Hartnett, J.T., Collins, M., & Tremblay, T.(2002). Longitudinal outcomes inVermont’s Consumer Choice Demonstra-tion Project (1993-1999). Journal ofVocational Rehabilitation, 17(3), 145-154.

Kennedy, M. (1996). Self-determination and trust:My experiences and thoughts. In D.J. Sands &M.L. Wehmeyer (Eds.), Self-determinationacross the life span: Independence andchoice for people with disabilities (pp. 35-47).Baltimore: Paul H. Brookes.

Kilsby, M.S., & Beyer, S. (2002). Enhancingself-determination in job matching insupported employment for people with

learning disabilities: An interventionstudy. Journal of Vocational Rehabilita-tion, 17(2), 125-135.

Mithaug, D., Wehmeyer, M. L., Agran, M.,Martin, J., & Palmer, S., (1998). The self-determined learning model of instruc-tion: Engaging students to solve theirlearning problems. In M. L. Wehmeyer &D. J. Sands (Eds.), Making it happen:Student involvement in educationalplanning, decision-making and instruc-tion (pp. 299-328). Baltimore: Paul H.Brookes.

Rappaport, J. (1981). In praise of a paradox:A social policy of empowerment overprevention. American Journal ofCommunity Psychology, 9, 1-25.

Rehabilitation Act of 1973, as amended,29 USC §701(a)(3). (1992, 1998).

Sowers, J., & Powers, L. (1995). Enhancingthe participation and independence ofstudents with severe physical andmultiple disabilities in performingcommunity activities. Mental Retarda-tion, 33 , 209-220.

Ward, M.J. (1996). Coming of age in the ageof self-determination: A historical andpersonal perspective. In D.J. Sands &M.L. Wehmeyer (Eds.), Self-determina-tion across the life span: Independenceand choice for people with disabilities(pp. 1-16). Baltimore: Paul H. Brookes.

Wehmeyer, M. L. (1999). A functionalmodel of self-determination: Describingdevelopment and implementinginstruction. Focus on Autism and OtherDevelopmental Disabilities, 14, 53-61.

Wehmeyer, M. L. (2001). Self-determina-tion and mental retardation. In L. M.Glidden (Ed.), International Review of

Research in Mental Retardation, 24, 1-48. San Diego, CA: Academic Press.

Wehmeyer, M.L., Abery, B., Mithaug, D.E.,& Stancliffe, R.J. (2003). Theory in self-determination: Foundations foreducational practice. Springfield, IL:Charles C. Thomas Publisher, LTD.

Wehmeyer, M.L., Agran, M., & Hughes, C.(1998). Teaching self-determination tostudents with disabilities: Basic skillsfor successful transition. Baltimore:Paul H. Brookes.

Wehmeyer, M., Lattimore, J., Jorgensen, J.,Palmer, S., Thompson, E., &Schumaker, K.M. (2003). The self-determined career development model:A pilot study. Journal of VocationalRehabilitation, 19 , 79-88.

Wehmeyer, M.L., & Palmer, S.B. (2003). Adultoutcomes for students with cognitivedisabilities three years after high school:The impact of self-determination.Education and Training in DevelopmentalDisabilities, 38, 131-144.

Wehmeyer, M. L., Palmer, S.B., Agran, M.,Mithaug, D.E., & Martin, J. (2000).Teaching students to become causalagents in their lives: The self-determin-ing learning model of instruction.Exceptional Children, 66, 439-453.

Wehmeyer, M. L., & Schwartz, M. (1997). Self-determination and positive adult outcomes:A follow-up study of youths with mentalretardation or learning disabilities.Exceptional Children, 63, 245-255.

West, M.D. (1995). Choice, self-determina-tion and VR services: Systemic barriersfor consumers with severe disabilities.Journal of Vocational Rehabilitation,5(4), 281-290.

A U T U M N

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SLAYING DRAGONSBUILDING

SELF-CONFIDENCE

AND

RAISING

EXPECTATIONS

THROUGH

ORIENTATION

CENTER

TRAINING

SANDY TIGGES, PH.D.

In his 1919 fable, ”The 51st Dragon,” Heywood Broun describes the ex-ploits of Gawaine, a young student in knight school who is so timid andfearful that he is in danger of being expelled. Instead, the school’s headmas-ter decides to take Gawaine under his wing and train him to slay the count-less dragons plaguing the countryside that year. In preparation, Gawainestudies all about dragons and their habits, and he practices beheading paperand wooden ones on the practice field.

When the faculty feels he is ready to confront real dragons, Gawaine isgiven a diploma and a new battle-ax. The headmaster calls him to his officefor a few words of advice: ”Here you have learned the theories of life but,after all, life is not a matter of theories. Life is a matter of facts. It calls on theyoung and the old alike to face these facts, even though they are sometimesunpleasant. Your problem, for example, is to slay dragons.” Unconvinced,the whimpering Gawaine asks for an enchanted cap to make himself invis-ible. The headmaster offers him something better: a magic word. All Gawainehas to do is say ”rumplesnitz” and he can lop off the heads of dragons easilyand fearlessly.

D r . T i g g e s i s P r o g r a mAdminis t ra tor in the Adul tOrientation and AdjustmentCenter, Iowa Department for theBlind, 524 4th St., Des Moines,I o w a 5 0 3 0 9 . T e l e p h o n e :( 5 1 2 ) 2 8 1 - 1 3 1 3 . E - m a i l :tigges.sandy@blind.state.ia.us.

Saint George and the Dragon, Raffaello Sanzio (1493-1530)

R E H A B I L I T A T I O N31

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The magic word works, at leastfor the first 49 dragons. Gawainegrows so brave that he even slaysone with his right hand tied behindhis back. He becomes so confidentthat, at night, he engages in longdrinking bouts at the village tavern.On the day he confronts his fiftiethdragon, his mind has become sosluggish that he cannot rememberthe magic word. As the beastcharges, the word flashes into hismind, but he has no time to utter itbefore swinging his battle-ax andchopping off the dragon’s head.

Puzzled, Gawaine goes to theheadmaster’s office for an expla-nation. The headmaster laughs,believing that Gawaine has finallyfigured out that his own braveryand not the word rumplesnitz isresponsible for his success: ”Itwasn’t magic in a literal sense,but it was much more wonderfulthan that. The word gave you con-fidence. It took away your fears.If I hadn’t told you that, you mighthave been killed the very firsttime. It was your battle-ax that didthe trick.”

Convinced that Gawaine justneeds to kill another couple of drag-ons to get his confidence back, theheadmaster drags him out of bed andinto the forest the next morning andshoves him into a thicket where asmall dragon is hiding. But Gawainenever returns. All that is later foundof him are his medals.

Like the knight school’s head-m a s t e r , w e a t t h e I o w aDepartment for the Blind’s AdultOrientation and Adjustment Cen-ter give students magic words bywhich to l ive: ” I t ’ s OK to beblind.” Unlike those of the knightschool headmaster , however ,these words do not disguise hol-low confidence and insufficientpreparation. Instead, we backthem with ef fect ive blindnesstraining based on an approachthat will give students a solidfoundation in the skills, positiveattitude and self-confidence theyneed to slay the many dragons

they will encounter as they striveto live independently and workcompetitively.

We use the words, ”It’s OK to beblind,” to help students to progressthrough the three stages of adjust-ment to their blindness: dependence,rebellion and interdependence. LikeGawaine when he first began hisknight school training, students en-ter the center with a great manyinsecurities, fears and low expecta-tions, ranging from being afraid tocross the street alone to worryingabout ever holding a job, having afamily or being accepted socially.They will often accept more helpthan necessary and will avoid such”dragons” as going up and downstairs and crossing streets alone.Once they have overcome some ofthese fears and have slain a few drag-ons of their own, they begin to gainconfidence and to realize that theycan get about safely and efficientlyand perform day-to-day living activi-ties competently. Proud of theiraccomplishments, they often asserttheir independence by rebelliouslyswinging their battle-axes against anysighted person who might offer assis-tance. When students reach the endof their training, however, they seethat the magic words take on the sub-stance of truth, reinforced with theskills and self-confidence they needto slay any dragon they may everencounter. They come to understandthe natural interdependence that ex-ists in society and begin to view anoffer of help not as an insult but asan opportunity to educate.

The training we provide at theorientation center is based on apositive philosophy of blindness. Infact, this philosophy is the founda-tion for all of the Department forthe Blind programs, including Vo-c a t i o n a l R e h a b i l i t a t i o n ,Independent Living, Transition, theBusiness Enterprises Program andthe Library for the Blind and Physi-cally Handicapped. The departmentis committed to the belief that cen-ter training must be an integral partof the rehabilitation process, for re-

We use

the words,

“It's OK to be

blind,” to help

students to progress

through the three

stages of adjustment

to their blindness:

dependence,

rebellion and

interdependence.

A U T U M N

32A M E R I C A N

habil i tat ion can only be trulyachieved when consumers havereached their fullest potential inpersonal independence, employ-ment and integration into thecommunity. This approach is pow-er fu l , because i t g ives b l indpeople control over their ownlives as well as responsibility fortheir own successes and failures.This philosophy further contendsthat the real problem of blindnessis not the physical loss of eyesightbut rather society’s misconcep-tions about it.

The majority of orientation cen-ters in this country base theirtraining on the notion that the indi-vidual who has become blind is”broken” and therefore must be”fixed,” both physically and psy-chologically. The training theyprovide is based upon the beliefsthat the problems of blindness areinherent in the blindness itself, thatblindness imposes upon a personsevere limitations that cannot beovercome, that visual techniquesare intrinsically better than non-vi-sual ones and that the degree ofone’s success is inextricably tied tothe degree of one’s visual acuity.Nurses and a psychologist are oftenon staff, and emphasis is placed onthe teaching of skills, avoidingblindness techniques as much aspossible and maximizing residualvision through the use of low visionaids.1

The training we provide at theIowa center, on the other hand, issuccessful because we recognizethat the problems of blindness stemnot only from the blindness itselfbut, again, also from public miscon-ceptions about its true nature.Center students must not only learnthe blindness skills needed to copewith the physical loss of eyesight,but they must also adopt new posi-tive attitudinal concepts to replacethe stereotypes that both they andsociety accept about blindness. Toaccomplish these goals, students re-c e i v e t r a i n i n g t h a t h a s f o u robjectives:

• Learn efficient and effectiveblindness techniques.

• Develop self-confidence and apositive attitude about blindness.

• Learn how to deal with publicmisconceptions about blindness,including those of family, friendsand employers.

• Develop strong work habits andappropriate social skills.

TRAINING IN EFFICIENT ANDEFFECTIVE BLINDNESSTECHNIQUESTo learn the skills they need to func-tion competently, efficiently andcomfortably, our students take eighthours of classes each day coveringhome and personal management,cane travel, communications and in-dustrial arts. They learn non-visualtechniques for cooking, cleaning,doing laundry and sewing. Theylearn to use a long white fiberglasscane to go up and down stairs, walkalong sidewalks, cross busy streetsand take public transportation towherever they wish to go. They prac-tice reading Braille and writing it witha slate and stylus, and they becomeacquainted with such assistive tech-nology as computers equipped withspeech synthesizers. They becomecomfortable with tactile measuringdevices and power tools, and thenthey choose a project of their ownthat could involve woodworking,metalworking, welding or enginerepair.

The training provided in each ofthese classes is rooted in the struc-t u r e d - d i s c o v e r y m e t h o d o finstruction. First developed to pro-vide more effective instruction in thearea of independent cane travel toblind persons, this approach has beenproven to be superior to the guidedlearning approach used by traditionalorientation and mobility instructors,who themselves are usually sightedpersons.1 In guided learning — com-monly called route or point-to-pointtravel — the instructor continuallyprovides very specific instructionsand feedback while closely monitor-ing the student visually. Teachers

This

philosophy

further contends

that the real problem

of blindness is not

the physical loss of

eyesight but rather

society's

misconceptions

about it.

R E H A B I L I T A T I O N33

2 0 0 4

place strong emphasis on rote learn-ing, ensuring safety and maximizingthe use of residual vision. As a result,students do not develop the abilityto generalize what they have learnedand become too dependent on the in-structor for help. Students are notexpected to solve the problems theyencounter independently or to applywhat they have learned in one les-son to another.

The structured-discovery ap-proach to travel training, on theother hand, is based upon the con-cept of training teachers of the blindto teach their students the samenon-visual techniques that haveproven to be most successful byblind persons. Cane-travel studentsare first given specific instructionsthat will allow them to master suchbasic techniques as holding andarcing the cane. The focus thenquickly shifts to generalized instruc-t ion that emphasizes problemsolving by providing the studentswith only minimal information,forcing them to rely upon them-selves to explore their environmentand gather and process the informa-tion they need to move aboutsa fe ly , f reely and ef f ic ient ly .Through this method, students learnmore, retain it better and developgreater confidence in their ownability to travel independently.

Through the implementation ofthe structured-discovery method ofteaching, the center emphasizes theuse of alternative techniques of blind-ness, high expectations and thedevelopment of self-confidence andproblem-solving skills. Blind studentswith residual vision and sighted stu-dents training to be instructorsreceive lessons under sleepshades, orblindfolds, from instructors who areeither blind or who have also re-ceived intensive blindness trainingunder sleepshades. Students are en-couraged to rely upon their owningenuity when they encounter anew problem or situation instead ofturning repeatedly to the instructorfor guidance and reassurance. Afterbeing taught a basic set of tech-

niques, they are asked to experiment,explore, solve problems and applywhat they have learned in oneproject to another as they movethrough a progressive series of moreand more challenging activities.Once shown how to boil and drainpasta for one recipe, for example,they are expected to figure out howto apply that training to the cookingof not only pasta but of any food thatmust be boiled and drained. As a re-sult, they develop confidence in theirown ability to solve problems and touse techniques that will be effectiveno matter what level of vision theyhave.

DEVELOPING SELF-CONFIDENCEAND A POSITIVE ATTITUDEABOUT BLINDNESSThrough learning and practicing theirproblem-solving skills, students de-velop confidence in themselves anda more positive attitude about theirblindness. As a result, they raise theexpectations they hold about theirown capabilities, leading to voca-tional goals that are more fulfillingand more likely to be achieved. Thelearning of skills and the develop-ment of self-confidence and a posi-t ive a t t i tude are inex t r icablyintertwined. A student who walksaround the block alone for the firsttime becomes eager not only to ad-vance to crossing streets but also totake his or her children to the parkafter completing the center’s trainingprogram.

Developing self-confidence and apositive attitude about blindness arecritical to a student’s progress. With-out self-confidence, students will notuse the blindness skills they havelearned, and without a positive atti-tude they will cling to the negativemisconceptions and stereotypesabout blindness. The vast majority ofstudents begin their training with verynegative attitudes about their visionloss. Often, many of them sat at homefor years — cared for by their friendsand families — rather than admit thatthey are blind, especially if they stillhave some remaining vision. Some-

Through

learning and

practicing their

problem-solving

skills, students

develop confidence in

themselves and a

more positive

attitude

about their

blindness.

A U T U M N

34A M E R I C A N

times they will refuse to recognizethat blindness has had any detrimen-tal effect on their lives, even thoughthey no longer read, drive, work, goout or take care of their homes. Manybelieve that the adjustments theyhave made — limited as they are —are the best that can be made underthe circumstances. Others look for aquick fix, usually through technol-ogy, so that they can ignore thedevastating effects blindness has hadon their lives. Lacking self-confi-dence, they avoid taking risksbecause they fear failure and do notexpect success.

Self-confidence is a difficult con-cept to define. Self-confident peoplehave positive, yet realistic, views ofthemselves and their situations. Theytrust their own abilities, have a gen-eral sense of control in their lives andbelieve that, within reason, they willbe able to do what they wish, planand expect. They take risks and re-main positive even when they fail.Because they accept themselves, theydo not feel the need to conform justto be accepted by others.

Adult students at our center havedefined self-confidence in a varietyof ways, as evidenced in a group dis-cussion held on September 15, 2003.One student said that it is what al-lows you to walk instead of crawlthrough life. Another said that self-confidence is knowing that you arecapable of doing things with dignity,like taking public transportation andgoing through a buffet line without amishap. A third said that it is whatallows you to participate fully inschool, work and the other things inlife. A fourth student put it best: ”Youknow you have self-confidence whenyou can trust yourself to figure outhow to overcome successfully thefears and challenges you must faceevery day.”2

The development of self-confi-dence and a positive attitude aboutblindness are linked. Students mustlearn that they and not their families,friends or society as a whole shouldcontrol their attitude about them-selves and their blindness. In his

1982 book, Strengthening Your Grip,Charles Swindoll described the im-portance of attitude this way:

”The longer I live, the more I real-ize the impact of attitude on life.Attitude, to me, is more importantthan the past, than education, thanmoney, than circumstances, thanfailure, than successes, than whatother people think or say or do. It ismore important than appearance,giftedness or skill. It will make orbreak a company, a church, ahome. The remarkable thing is wehave a choice every day regardingthe attitude we will embrace for thatday. We cannot change our past.We cannot change the fact thatpeople will act in a certain way. Wecannot change the inevitable. Theonly thing we can do is play on theone string we have, and that is ourattitude. I am convinced that life is10 percent what happens to me and90 percent how I react to it. And soit is for you ... we are in charge ofour attitude!” (p. 126).

The development of self-confidenceand a positive attitude about blind-ness are the focus of every class inthe center. This process is a lengthyone, because it requires students tomake a 180-degree turnaround intheir attitude. For this reason, stu-dents train in the center for an aver-age of six months. They must cometo trust the teachers who are demand-ing so much of them, and teachersmust learn to gauge the right levelsof sensitivity, encouragement, prod-ding and confrontation that will helpeach student achieve this objective.

The story of Janice is typical.Throughout her training, she struggledwith the notion that she could becomecompetent as a blind person and as aresult had to be told constantly to keepher sleepshades down. For their finalcooking project — a seven-course din-ner — students are expected to writetheir menus and recipes in Braille, takethe city bus to the grocery store, pur-chase their groceries from lists theyhave written in Braille, and prepare andserve the meal for their families andfriends. As she confronted this dragon,

Students

must learn

that they and not

their families, friends

or society as a whole

should control their

attitude about

themselves

and their

blindness.

R E H A B I L I T A T I O N35

2 0 0 4

a tearful Janice became paralyzed withfear and threatened to pack her bagsand go home. Letting her avoid thisdragon was not an option, since itwould undermine any self-confidenceshe had acquired and make it easierfor her to hide from the next dragonsshe would inevitably encounter. Rea-soning, encouragement, and proddinghad no effect on her. Finally, taking therisk that she might run, as the programadministrator I resorted to confronta-tion and called her a quitter. At first shewas angry, but after thinking about itfor awhile she decided that she had toprove me wrong. She unpacked herbags and successfully went to the store,bought her groceries and prepared andserved a wonderful dinner to almost 50people.

A variety of center activities helpstudents build self-confidence and apositive attitude about their blind-ness. We tell students that ”a class isa class is a class” — that everythingthey do while at the center, day andnight, contributes to their training.We expose them to many ordinaryexperiences that they thought nolonger possible, like grilling steaks,shopping, going to a museum or play,bowling, camping, hiking and canoe-ing. Just as important as formalclasses are their walks to a local res-taurant for dinner and their longconversations in the evening abouttheir blindness, fears and plans. Vet-e r a n s t u d e n t s g i v e t o u r s t oprospective students and serve asmentors to new ones. By participat-ing in speaking engagements atschools, clubs and service groups,students become comfortable talkingabout their blindness and develop theself-confidence they need to educatethe public.

In a discussion group we call the”Business of Blindness,” we deal di-rectly with the subjects of ourphilosophy and of skill and attitudedevelopment. An essential part ofcenter training, the group discussionprovides students with an open en-vironment where they can talk abouttheir hopes, fears and problems andwhere they can challenge the prevail-

ing negative myths about blindnessand the devastating impact thesemyths can have on their lives. ”Busi-ness class,” as one student put it, is”the glue that holds everything to-gether.”2 Most important, it is wherethey will come to accept their blind-ness and truly believe those magicwords: ”It’s OK to be blind.”

As the center’s program adminis-trator, I serve as facilitator for theclass. I liken my role to that of an or-chestra conductor, but sometimes Ifeel more like I’m sitting on the lidof a pot ready to boil over. I mustmaintain an atmosphere of opennessand respect so that students feel com-fortable talking freely and sharingsome of their most intimate feelingswith each other. Through questions,comments and active listening, Iguide the discussion of that day’stopic. My goal is not to give them the”right answer” but to teach them howto discover it for themselves. After all,when they complete their centertraining, they must be able to solvesimilar problems on their own.

To achieve this goal and main-tain interest, I use a variety offormats and media. I invite compe-tent blind persons to talk about theirjobs and the effect center traininghas had on their lives. We watchmovies and go to plays featuringblind characters and we read ar-ticles and short stories that I havegathered from magazines, journals,newspapers and the Internet. Toexpose students to a variety ofblindness techniques for reading, Iread to them in Braille, use readersand play cassette tapes.

The subjects we discuss comefrom a variety of sources. I maintaina large outline of resources and amalways on the lookout for new itemsto add to it. While I try to plan ahead,a topic may come up that needs tobe discussed immediately, such as astudent’s negative encounter with asighted family member. We mayhave an expert explain Social Secu-rity incentives or a blind person talkabout consumer organizations. EachOctober, we talk about Iowa’s White

Just

as important

as formal classes

are their walks to a

local restaurant for

dinner and their long

conversations in the

evening about their

blindness, fears

and plans.

A U T U M N

36A M E R I C A N

Cane Law and the effect of similarlegislation on their lives. We explorethe purpose of center training so stu-d e n t s w i l l h a v e a b e t t e runderstanding of the program andtheir involvement in it.

Gradually, students come to un-ders tand that once they havedeveloped self-confidence, a posi-tive attitude and good blindnessskills, the real problem of blindnessis not the loss of vision but, again,the misconceptions both they andthe public hold about it. Blindnessis no longer the controlling factorin their lives, and they begin tomake important life decisions basednot on it but on their interests, tal-ents and abilities. Instead of beingashamed of their vision loss and theblindness skills that represent it,they view their blindness as anotherone of their personal characteris-tics, like their height, their age orthe color of their hair.

DEALING WITH PUBLICMISCONCEPTIONS ABOUTBLINDNESSAs students begin to learn effectiveand efficient blindness skills, developself-confidence and overcome theirown misconceptions about theirblindness, they become frustrated bythe negative treatment they receivefrom family members, friends and thegeneral public. They grow angrywhen their spouses do not let themgo down the basement stairs to dothe laundry, a friend asks them notto take their cane on an outing or awaitress speaks to their companionsrather than directly to them. Studentscome to recognize that there is notonly a need to change these notionsand their manifestations but that theyshare in the responsibility to helpbring that change about.

In the center, we provide studentswith a variety of ways to learn howto deal appropriately with negativeattitudes and reactions toward theirblindness. In Business Class, we ex-p l o r e t h e o r i g i n s o f t h e s emisconceptions and talk about thebest ways to deal with them. Our stu-

dents are often surprised to learn thattheir own behavior can perpetuate orhelp dispel these myths. We encour-age family members to visit andsometimes even to attend classesunder sleepshades. Giving tours ofthe center and participating in speak-ing engagements gives studentsopportunities to practice educatingthe public about their blindness.Training is frequently provided insuch public settings as malls, restau-rants and parks so that students willbecome skilled at handling negativepublic reactions to their blindness.

The ability to cope with these un-comfortable situations tactfully iscritical to future success in job inter-views and in workplace situations.Most of the students who come to thecenter are vocational rehabilitationconsumers of the Iowa Departmentfor the Blind and will either go toschool or to work upon completionof their training. At least twice a yearwe hold a ”Job-Seeking Skills Semi-nar” for students to explore careersthat meet their talents, interests andabilities. They also learn techniquesfor dealing appropriately with blind-ness issues in the resume, in the jobinterview and on the job itself.

THE DEVELOPMENT OF STRONGWORK HABITS ANDAPPROPRIATE SOCIAL SKILLSMany students come to the centerwith low expectations about them-selves and what they will be able toaccomplish as a blind person. Lack-ing self-confidence, they sometimesavoid the risk of failure by procrasti-nating, getting too involved in theproblems of other students or refus-ing to try at all. Burdened by the lowexpectations of their families andteachers, students who have beenblind since an early age have oftennot been expected to support them-selves at all and so were never taughtthe strong work habits and socializa-tion skills necessary for them to be-come fully integrated into the livesof their families, workplaces andcommunities. Unless they receivetraining that raises their expectations,

Our

students

are often

surprised to

learn that their

own behavior can

perpetuate or

help dispel

these

myths.

R E H A B I L I T A T I O N37

2 0 0 4

students will leave the center only tolive on the edge of life, going throughcollege with few or no friends, sur-viving on Supplemental Security In-come or Social Security DisabilityInsurance, and unable to develop thesocial contacts so important for suc-cess in the workplace.

Center training helps studentsbuild their expectations in a varietyof ways. We constantly remind them,both subtly and overtly, that they willnot just work but that they will do sosuccessfully and at their fullest poten-tial. We treat them like adults, givingthem keys to their own private roomsand to the building that houses thecenter. We teach them how to man-a g e t h e i r o w n b u d g e t s a n dmedications and to contact staff thatlive in the building only for emergen-cies. We expect them to attend theirclasses on time and to do their bestin them. When necessary,w e teach them suchs o - cial ski l ls as

table etiquette, ballroom dancing andcommunicating in social situations.Fashion, makeup, hair styles andother aspects of grooming may alsobe covered.

We also raise expectations for stu-dents through what we call ”the threehave-to’s” of the orientation center.In order to participate in training, stu-dents must agree to take all of theclasses, wear sleepshades if theyhave any residual vision and carrytheir canes at all times. Students whodo not agree to these requirementscan choose from other training op-tions, such as individual and grouptraining in their home communitiesor attendance at another orientationcenter that they feel better meets theirneeds. These have-to’s are designedto help students confront and over-come the biggest dragons they faceas a result of their blindness: the fearof injury, the fear of failure and the

fear of being identified byothers as blind. If students

are not given opportuni-ties to overcome theirdeepest fears, they will

never believe they canand they will sufferthe fate of Gawaine— being eaten by asmall dragon thatleaves only their

meaningless medalsbehind.Students are required

to take all of the classes.Orientation center train-ing is l ike a jigsaw

puzzle — the piecesmus t a l l be inplace before thewhole picture canbe seen. Not tak-ing a class is likelosing one of thepuzzle pieces andtherefore losingthe total effect ofthe training. If stu-d e n t s w e r eallowed to picktheir classes, theywould choose the

Center

training

helps students

build their

expectations

in a variety

of ways.

A U T U M N

38A M E R I C A N

”safe” ones, like Braille and com-puter. They would avoid the classeswhere they fear injury, like burningtheir hands on a hot stove, cutting offtheir fingers with a power saw or los-ing their lives to a speeding car.Students receive individualized in-struction within each class to meettheir needs. A young blind man whohas never been in the kitchen mustlearn both how to cook and how touse the blindness techniques forcooking. A newly-blind woman whohas prepared meals for her family foryears, on the other hand, needs onlyto learn the relevant blindness skills. Adiabetic student who has been seden-tary for years may need frequent restperiods as he builds up his stamina.

To help dispel the ”can’t see, can’tdo” fallacy, students who have any re-sidual vision must receive their trainingunder sleepshades. In order to deter-mine the effectiveness and efficiencyof the blindness techniques they arelearning, students must practice themconstantly under sleepshades untilthese skills become habitual. Whenthey take their sleepshades off, they canthen combine the non-visual tech-niques they have mastered with visualones to their greatest efficiency. Theywill also come to understand that theproblems faced by the partially andtotally blind do not differ signifi-c a n t l y . W i t h o u t t h e u s e o fsleepshades, they will constantlywant to rely on and attribute any suc-cesses they may have to theirremaining vision, no matter howpoor and inefficient it may be. Thosestudents who have the most successare the ones who have the maturityto see the relevance of sleepshadetraining to their lives, come to under-stand that the degree of their successis not contingent on the degree oftheir vision and replace ”can’t see,can’t do” with ”I can do it — I justhave to figure out how.”

Finally, students must carry thelong white fiberglass cane — betterknown as the Iowa cane — at alltimes. To become proficient travel-ers, students must constantly practiceusing their canes. By doing so, they

also become desensitized to publicreactions to their blindness and tobeing identified as a blind person.The cane then becomes for themboth a tool for safe travel and a sym-bol of pride and independence.Because they can be easily hiddenaway, folding canes and cane hol-sters are not permitted.

Students do not receive trainingat the center for any fixed length oftime. While the average stay is sixto eight months, some students stayfewer months and some stay more.Students themselves are responsiblefor evaluating their progress and fordetermining when their training iscomplete. As the center’s programadministrator, I meet with studentsand their vocational rehabilitationcounselors at critical times duringtheir stay to discuss their progressand goals and to determine if anymodifications in their program needto be made. Students usually decideto leave the center when they cancompetently and efficiently usetheir blindness skills, when theyhave the self-confidence to putthose skills into practice, when theythoroughly understand and have apositive attitude about their blind-ness, and when they are aware ofand able to deal effectively withpublic misconceptions.

THE BOTTOM LINEThe success of the orientation cen-ter and its program can be mea-sured through statistics, throughcontinued relationships with thecenter and through the long-termpositive effects the training has hadon the lives of former students. Af-ter completing their training, stu-dents may attend college or avocational training program, entera new career or return to a formerjob. The center is an integral partof the services offered by the IowaDepartment for the Blind, and thedepartment’s success in providingmeaningful services that lead tojobs for consumers is also the suc-cess of the center itself. The figuresfor the 2000, 2001 and 2002 fed-

... students

must carry

the long white

fiberglass cane —

better known as the

Iowa cane —

at all times.

R E H A B I L I T A T I O N39

2 0 0 4

... the

center's

success can be

measured in the

long-term positive

effects the training

has had on the

lives of former

students.

eral fiscal years tell the story. Inthose years, 171, 175 and 140 vo-cational rehabilitation cases respec-tively were closed successfullyrehabilitated (Status 26). Consumerswho developed IndividualizedPlans for Employment during thoseyears had an over 83 percentchance of successfully getting a job.They could expect to earn an aver-age of over $12.40 an hour, andabout 68 percent of them wouldbecome the primary source of sup-port for their families.

The program’s success can alsobe seen in the relationships that de-velop when students begin theirtraining and continue long after thattraining has ended. New studentsnotice quickly that, when they en-ter the center, they soon becomemembers of the orientation center’s”family.” This membership contin-ues a f ter they complete theirtraining. Center staff often contactsformer students to see how they aredoing, and former students fre-quently contact staff to talk abouttheir latest news or get some ad-vice. Students who have shared thecenter experience sometimes be-come lifelong friends. The centeritself promotes this unity through aquarterly newsletter detailing theactivities of the center and its gradu-a tes and th rough the annua lOrientation Alumni Day. Each fall,students host a day of activities forformer students culminating in anevening banquet and dance. An av-erage of 200 people attend eachyear, and many of these are someof the center’s strongest supporters.

Most important, though, thecenter’s success can be measuredin the long-term positive effects thetraining has had on the lives offormer students. Participation in theorientation center is a life-alteringexperience for most students. Whenthey complete the program, theyfind that blindness is no longer thecontrolling factor in their lives.They have internalized the truththat ”It is OK to be blind,” and theyknow they are well equipped to

slay any dragons they might en-counter. One former student put itthis way:

”I had decided to come to theOrientation Center after completingmy high school education. I was ledto understand that by attending thisprogram, it would help me to raisemy GPA [grade point average] incollege. After being in orientationfor a few weeks, however, I had dis-covered that my motives were inthe wrong place. This program’spurpose is not to prepare me forcollege, but to prepare me for lifeand how to live it as a confidentblind person. This program workson the attitudes of blind people,helping them to become confident,capable people by letting themknow there is life after blindness.Although I have been blind sincebirth due to cataracts, this programhas helped me form a different atti-tude about my own blindness, aswell as other blind people. I havelearned that it is OK to be blind, be-cause I know that it does not makeme any less of a person. The classesin the orientation center are madeup of Braille, home ec [economics],shop, technology and travel. All ofthese classes combined are notmerely to teach the techniques ofblindness, but to build confidence bythe use of them. My stay at the cen-ter has not been an easy one, but itwill be one I will take with me anduse for the rest of my life.”2

NOTES1. This information is based on the author’s

understanding from years of experiencetouring orientation centers for blindadults and studying the subject; thus, nospecific source is given.

2. For reasons of confidentiality, the authoris unable to give the names of centerstudents who are quoted in this article.

REFERENCESBroun, H. (April 13, 1919). ”The Fifty-First

Dragon.” New York Tribune.Swindoll, C.R. (1982). Strengthening Your

Grip. Waco, TX: Word Books.

A U T U M N

40A M E R I C A N

EMPOWERING

PEOPLE

WITH

DISABILITIES

THROUGH

VOCATIONALREHABILITATIONCOUNSELINGJOHN F. KOSCIULEK, PH.D., CRC

As a result of systemic “castification”1 processes and the rapidly changing world of work, assisting peoplewith disabilities with obtaining and maintaining high-quality employment is an increasingly difficult task.Vocational rehabilitation (VR) counseling thus can be instrumental for enhancing the career success and qual-ity of life of consumers with disabilities. In this article, a framework that describes how effective VR counsel-ing promotes the empowerment of consumers with disabilities is presented. Following a description of theprimary model constructs of working alliance, informed choice, self-determination, and empowerment, theimplications of the framework for VR counselor training and practice are discussed.

The world of work is changing at a rapid pace, and the changes are likely toaccelerate during the 21st century. Employment arrangements such as tempo-rary employment, short-term hires, contractual positions, leased workers, andon-call and part-time workers have and will continue to influence the careerdevelopment of all workers (Institute on Rehabilitation Issues, 1999). Thesechanges are having a substantial impact on the life roles of individuals withdisabilities, the settings in which they live and work and the events that occur intheir lives. At the same time, current disability policy in the United States fo-cuses on the inclusion, independence and empowerment of people with dis-abilities (Kosciulek, 2000). Thus, vocational rehabilitation (VR) counseling withpeople with disabilities must be a dynamic, creative and highly individualizedprocess. Effective VR counseling can be instrumental for empowering thelife choices, inclusion and independence of people with disabilities. In turn,empowerment, inclusion and independence will lead to high-quality em-ployment and fulfilling careers for individuals with disabilities (O’Day, 1999).

Dr. Kosciulek is an AssociateProfessor and Coordinator oft h e M . A . P r o g r a m i nRehabi l i ta t ion Counse l ing ,Office of Rehabilitation andDisability Studies, Departmentof Counsel ing, Educat ionalP s y c h o l o g y , a n d S p e c i a lEducation, 237 Erickson Hall,Michigan State University, EastL a n s i n g , M I 4 8 8 2 4 .Te l ephone: 517 -353 -9443 .E-mail: jkosciul@msu.edu.

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EMPLOYMENT AND CAREERCHALLENGES ENCOUNTERED BYPEOPLE WITH DISABILITIESThe ever-changing nature of work pre-sents new problems for people withdisabilities in finding and maintainingsuitable employment. Major trendssuch as globalization of the Americaneconomy, technology and populationshifts are changing the nature of workand worker skill requirements (Ryan,1995). Despite rehabilitation efforts, amajority of Americans with disabilitiesbetween the ages of 16 and 64 are notemployed and that disparity has notchanged since 1986, despite the factthat a majority of non-employedpeople with disabilities in the workingage population want to work (NationalOrganization on Disability, 2000). Ingeneral, the vocational adjustment ofpeople with disabilities has been char-acterized by limited salable work skills,low income, underemployment andunemployment (Bruyere et al., 2002;Curnow, 1989).

In addition, according to Harrington(1997), high school students with dis-abilities frequently leave schoolwithout marketable skills or the abilityto function independently. Given thatwork is a central force in people’s lives,dramatically high rates of unemploy-ment and underemployment canadversely affect not only the economicand social status of individuals withdisabilities, but also their self-image. Adistinct set of employment and careerchallenges encountered by manypeople with disabilities that can beused as a reference point for VR coun-selors includes:• l i m i t a t i o n s i n e a r l y l i f e

experiences,• c a r e e r d e c i s i o n - m a k i n g

difficulties, and• a negative worker self-concept

(Kosciulek, 2003).Limitations in Early Experiences.

Frequently, people with disabilities ar-rive at adulthood with few career op-tions (Chubon, 1995). Limited earlyvocational and social experiences en-countered by people with disabilitiesrestrict the array of career options theyperceive, impede decision-making

ability and impair future vocationaldevelopment. The effect of limitedearly vocational experiences has beendescribed by Holland (1985) as a pre-cursor to the development of career-related problems. Such problems mayinclude failing to develop a consistentand differentiated personality patternand a clear vocational identity and try-ing to make a career of a job that doesnot match their abilities or experiences(Holland, 1985). Unfortunately, suchdevelopmental patterns are not unusualamong people with disabilities.

Decision-Making Ability. Lack ofopportunities to participate in decisionmaking, to form a perception of one-se l f a s a worke r and to t e s tself-competencies can be the outcomeof limited early experiences and canimpede career development. Thepoorly defined self-concept, ambiva-lence about obtaining work and limitedoccupational information reported bypeople with disabilities is indicative ofdistortions that could result in unreal-istic vocational aspirations or decisions.Harrington (1997) and Parent (1993)have aptly described how many indi-viduals with disabilities have had littleopportunity for successful experiencein decision making and, therefore, lackcompetence in making decisions.

Negative Worker Self-Concept Re-sulting from Castification Processes.Lack of experience and difficulty indecision making are not solely the re-sult of disability, but also an outcomeof social attitudes and stereotypes. So-cial attitudes toward disability may beas important as the disability itself inthat the negative attitude of others playsa part in shaping the life role of the in-dividual with disability (Fitch, 2002).The outcome of this long-term expo-sure to prejudicial attitudes may resultin a negative self-appraisal and a nega-tive worker self-concept.

Society generally holds diminishedexpectations for people with disabili-ties (Schroeder, 1995). These attitudesare pervasive; they influence all of usto some degree. As a class, people withdisabilities have suffered discrimina-tion. Individuals with disabilities facecommon social problems of stigma,

The

ever-changing

nature of work

presents new

problems for people

with disabilities

in finding and

maintaining

suitable

employment.

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marginality and discrimination, similarto those faced by members of racialand ethnic minority groups (Fine &Asch, 1988). Further, given that disabil-ity rates among racial and ethnic minoritygroup members are proportionally higherthan rates in the U.S. population overall,many individuals with disabilities facedouble jeopardy (Trueba, 1993).

Szymanski and Trueba (1994) main-tained that at least some of thedifficulties faced by people with dis-abilities are not the result of functionalimpairments related to the disability,but rather are the result of castificationprocesses embedded in societal insti-tutions for rehabilitation and educationand enforced by well-meaning profes-sionals. Castification processes havetheir roots in a determinist view inwhich people who are different areviewed as somehow less ”human” orless capable (Trueba, Cheng & Ima,1993). Problems of castification plagueservices to people with disabilities be-cause the same categories of impairmentand functional limitation (constructedmostly by people without disabilities) areused to determine eligibility for services,to prescribe interventions and, on occa-sion, to explain failure. The constructsand those who use them becomeagents of castification.

The disempowering nature of theseclassification systems is often all tooapparent to people with disabilitiesapplying for rehabilitation services inan effort to enhance self-sufficiency andpersonal independence (Scotch, 2000).Rather than being treated as adults with

free or equal status, they may be con-fronted by persons asserting a right todetermine what kinds of services theyneed. Thus, it is critically important thatVR counselors reject paternalisticcastification processes and activelywork to foster empowerment amongconsumers with disabilities during theVR process (Kosciulek, 2003). To ac-complish this important task, we needconceptual frameworks useful for un-derstanding and guiding empoweringVR counseling approaches.

VOCATIONAL REHABILITATIONCOUNSELING EMPOWERMENTFRAMEWORKIn this section, a framework that de-scribes how VR counseling engendersthe empowerment of consumers withdisabilities is presented. The key con-structs in this model include the VRcounselor-consumer working alliance,informed choice, self-determinationand empowerment. Figure 1, a visualdepiction of the empowering VR coun-seling framework, illustrates the follow-ing conceptualization:

A consumer with a disability entersthe state-federal VR system. Thelevel and quality of the working alli-ance formed between the VRcounselor and consumer determinesthe level and quality of consumer in-formed choice and self-determinationduring the VR process. Together, in-formed choice and self-determinationinfluence the level and quality of con-sumer empowerment resulting fromthe VR process.

In this model, it is hypothesized thatthe development of an effective coun-selor-consumer working alliance is aprerequisite for facilitating consumerinformed choice and self-determinationduring the VR process. Further, theframework posits that proficient in-formed choice and self-determinationare necessary for increasing consumerempowerment. In order to enhancereader understanding and applicationof the VR counseling empowermentframework, each of the model con-structs is defined and described in de-tail below.

Counselor-Client Working Alliance.The central factor in all successfulcounseling processes, including VRcounseling, is an effective working al-liance. Researchers estimate that asmuch as 30 percent of the variance incounseling outcome can be attributedto the counselor-client working alliance(Lambert, 1992). As one of the essen-tial components for success incounseling, an effective working alli-ance is represented by a positivecollaboration between a consumer anda counselor (Kosciulek, Chan, Lustig,Strauser & Pichette, 2001). The work-ing alliance is comprised of thefollowing components: tasks, bondsand goals (Horvath, 1994).

Tasks are those in-counseling be-haviors and cognitions that form thesubstance of the counseling process.

Goals are the outcomes or target ofthe counseling process. In VR counsel-ing, the goal aspect of the working

FIGURE 1. VOCATIONAL REHABILITATION COUNSELING EMPOWERMENT FRAMEWORK

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alliance is clear and specific: the attain-ment of an employment outcome.

Bonds are the positive interper-sonal a t tachments between aconsumer and counselor that includesuch aspects as mutual trust, accep-tance and confidence.

Consistent with the working allianceconcept, counseling in VR is the col-laborative process between theindividual consumer and counselor inwhich they assess the individual’sstrengths, resources, priorities, abilities,capabilities, interests and rehabilitationneeds. In this process, the counselorand consumer also explore, clarify andassess employment and career options,address barriers to be overcome, anddevelop and carry out a plan of actionthat will result in meaningful employ-ment for the individual based on hisor her informed choice. In discussingthe working alliance in the VR process,Lustig, Strauser, Rice and Rucker(2002) noted that the two most signifi-cant factors in this realm are the qualityof the consumer’s participation and thedegree to which the consumer is mo-tivated, engaged and joined in the VRprocess. Consumers with disabilitieswho are engaged and connected withcounselors will benefit most from VRcounseling (Chan, Shaw, McMahon,Koch & Strauser, 1997).

The working alliance can be mostbeneficial and an excellent predictorof outcome for consumers with dis-abilities when:• counselors and consumers agree

on goals and preferred outcomes,• counselors collaborate with

consumers on tasks to accomplishtho se goa l s and p re f e r r edoutcomes (Lustig et al., 2002), and

• consumers have a favorable viewof the counse lor -consumerr e l a t i o n s h i p ( B e r t o l i n o &O’Hanlon, 2002).

An empowerment approach to form-ing an effective VR counselor-con-sumer working alliance includeselements that both consumers andcounselors bring to the relationship.Primary elements for consumers in-clude taking responsibility for theirown decision making and for their

own actions and consequences oftheir actions. Key elements for coun-selors include the following: know-ing and admitting their limitations(e.g., lack of knowledge of a specificdisability condition) and displayingunconditional positive regard for theconsumers they serve (National Insti-tute on Disability and RehabilitationResearch [NIDRR], 1994).

Specific counseling techniques thatcontribute to the development of an ef-fective working alliance and consumerempowerment include the following:• treating all consumers as adults

regardless of the severity of thedisability,

• using age-appropriate languageand techniques,

• placing emphasis on consumerstrengths, and

• respecting consumer values andbeliefs.

Consumer Informed Choice.As employment is a key to indepen-dence and improved quality of life forpeople with disabilities, choice in theselection of employment goals andrehabilitation services necessary tomeet those goals is a critical elementfor empowering persons with dis-abilities (Kosciulek, 2000). In the VRcounseling empowerment frame-work it is hypothesized that an effec-tive counselor-consumer workingalliance leads to productive informedchoice in the VR process. Consumerchoice in vocational goals and ser-vices emerged as an important com-ponent of VR in the 1990s. However,choice is not a new concept in thefield. Over 40 years ago, Levine(1959) described the partnership be-tween the consumer and counselorand the counselor's role in assistingthe individual in making choices anddecisions. During this same time pe-riod, Patterson (1960) encouragedcounselors to facilitate independenceby helping consumers "go throughthe process" of deciding what theyshould have and should do. Henoted, "The counselor can have nostereotypes of occupational choices"(p. 115). Both of these examples fo-

Researchers

estimate that as

much as 30 percent

of the variance in

counseling outcome

can be attributed to

the counselor-client

working

alliance

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cus on vocational choice and, al-though they go back more than 40years, they are consistent with cur-rent principles related to enhancingthe counselor-consumer partnership,facilitating empowerment and foster-ing choice and independence in therehabilitation process.

The philosophy behind informedchoice is that people with disabilitiesshould have control over the processesand services that affect their lives, andthat those who have control over theirown VR planning will experience bet-ter employment outcomes than thosewho do not. Informed choice is prac-ticed when VR counselors giveconsumers with disabilities• the tools to learn how to make

choices, and• the information they need to make

their own choices.Informed choice is the process bywhich individuals participating in VRprograms make decisions about theirassessment services, vocational goals,the services and the service provid-ers that are necessary to reach thosegoals and how those services will beprocured. The informed choice pro-cess begins with the individual’s val-ues, interests and characteristics andproceeds to an evaluation of avail-ability of resources and alternatives,including the labor market. Imple-menting informed choice requiresthat the VR counselor listens care-fully, communicates clearly and gath-ers and analyzes information withoutbias. The VR counselor works with theconsumer to make choices and toevaluate their impact. Finally, in an in-formed-choice model of VR, the coun-selor supports the individual in settinggoals, making plans and followingthrough with decisions, with the aimof achieving meaningful employment.

It is presumed that a consumer’sskills and abilities to exercise informedchoice can be developed through useof self-assessment techniques, trainingand experience in goal setting and de-cis ion making, and consumereducation. In this manner, skills in ex-ercising informed choice could growin a parallel fashion along with growth

Promoting

self-determination

should be a primary

effort of VR counselors

working with

consumers with

disabilities.

of specific vocational and employmentskills, enabling the individual to con-tinue making important, informed lifedecisions following the completion ofVR services. The application of the con-cept of consumer informed choice inthe context of VR services involves aconscious process of choice makingwith the following typical elements:• analyzing needs,• gathering information,• evaluating the information,• describing options,• 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 informationi n f u t u r e c h o i c e - m a k i n gexperiences.

Consumer Self-Determination. Inaddition to facilitating informed choicein the VR process, an effective VRcounselor-consumer working alliancewill enable the development of con-sumer self-determination skills. Self-de-termination, a concept and process thathas emerged from the fields of reha-bilitation counseling, special educationand disability studies, provides the ba-sis for an empowerment approach toVR counseling. Field, Hoffman andSpezia (1998) have defined self-deter-mination as a multidimensional con-cept that includes:• attitudes, abilities and skills that lead

people with disabilities to definegoals for themselves and to take theinitiative to reach these goals,

• the capacity to choose and to havethose choices be the determinantsof one’s actions,

• determination of one’s own fate orc o u r s e o f a c t i o n w i t h o u tcompulsion, and

• the ability to define and achievegoals based on a foundation ofknowing and valuing oneself.

Promoting self-determination shouldbe a primary effort of VR counselorsworking with consumers with disabili-ties. Self-determination can be en-hanced by helping consumers develop

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greater self-awareness and by teachingdecision making, goal-setting and ne-gotiation skills, which will enable themto exercise greater control during theVR counseling process (Kosciulek,Bruyere & Rosenthal, 2002). The stepsin the self-determination developmentprocess for consumers include con-sumers knowing and valuing them-selves, consumer planning, consumeraction, experiencing outcomes andlearning, and making adjustments.Consumer self-knowledge can be facili-tated by encouraging individuals toexpand their thinking about the possi-bilities in their life, deciding what istruly important to them, having a keensense of their strengths, limitations andpreferences and knowing what optionsare available. VR counselors can pro-mote consumer self-valuing by assist-ing consumers with acceptingthemselves as they are, admiring theirstrengths that come from uniqueness,and recognizing and respecting theirrights and responsibilities.

The next step in the consumer self-de te rmina t ion process i s thedevelopment of effective planningskills. Effective planning involves aprocess of setting goals, identifyingaction steps to meet goals, anticipat-ing results and visually and orallyrehearsing potentially stressful eventssuch as job interviews. In addition toplanning, VR counselors can facilitateconsumer self-determination by en-couraging indiv iduals to ac t .Consumer self-determined actionmay include dealing directly withconflict and criticism (e.g., with afamily member or coworker) and ac-cessing resources and supports suchas assistive technology devices andrecreation and leisure services.

As a result of planning and acting,consumers with disabilities will havethe opportunity to experience posi-tive outcomes and to learn moreabout themselves. VR counseling thatpromotes self-determination can en-ab le ind iv idua l s to compareperformance and outcomes to theirexpectations and realize successes. Inthe final step toward enhancing con-sumer se l f -determinat ion, VR

counselors can assist individuals withdisabilities to adjust their self-percep-tion and expectations with regard tofuture planning and actions.

Consumer Empowerment. As illus-trated in the VR counseling empow-erment f ramework (Figure 1) ,informed choice and self-determina-tion influence the level and qualityof consumer empowerment resultingfrom the VR process. Emener (1991)described the philosophical tenets nec-essary for an empowerment approachto rehabilitation. These tenets providea useful foundation for the provisionof VR counseling services to peoplewith disabilities. The four tenets areparaphrased as follows:• Each individual is of great worth

and dignity.• Every person should have equal

opportunity to maximize his or herpotential and is deserving of societalhelp in attempting to do so.

• Most people strive to grow andchange in positive directions.

• Individuals should be free to maketheir own decisions about themanagement of their lives.

Definition of empowerment. Em-powerment is the process by whichpeople who have been renderedpowerless or marginalized developthe skills to take control of their livesand their environment (Lee, 1997).As such, in order to begin to improverehabilitation services and outcomes,empowerment has become the op-erative term in disability policy de-velopment and rehabilitation servicedelivery. The field of rehabilitationcontinues to place an increasing em-phasis on the construct of empower-ment as a conceptual cornerstone ofidentity (Banja, 1990; Zimmerman &Warschausky, 1998) and critical vari-able in rehabilitation research (NationalInstitute on Disability and Rehabilita-tion Research [NIDRR], 1991).

Empowerment is conceptualized asinvolving both internal or psychologi-cal aspects and situational or socialaspects. Internal or psychological fac-tors include a sense of control,

competence, confidence, responsibil-ity, participation, solidarity andcommunity. Additional psychologicalaspects of empowerment include flex-ibility, initiative and future orientation(Stein, 1997). In this manner, the psy-chological facet of empowermententails the acquisition of values andattitudes that are incorporated intothe individual’s worldview and con-stitute a foundation for action (Bolton& Brookings, 1996).

Situational or social aspects of em-powerment include control overresources; interpersonal, work andorganizational skills; decision-makingpowers; self-sufficiency; mobility;and ”savvy” or an ability to ”getaround” in society (Stein, 1997). Ad-ditional situational factors includeimproved living conditions, in-creased social status, financial andsocial support, autonomy, access toinformation and income. The situ-ational aspects of empowerment areconcerned with the interdependencebetween people’s behaviors and theirenvironment. These situational or so-cial factors also suggest that the lackof social, economic, or political re-sources in the environment is a majorcontributor to human dysfunction(Rappaport, 1987). Thus, it is arguedhere that when people with disabili-ties have control over importantresources, they are better able to de-termine the course of their lives,solve their problems and developadaptive social networks.

Empowering VR counseling. Em-powerment of individuals with disabili-ties means that they have the samedegree of control over their lives andthe conditions that affect them as isgenerally possessed by people withoutdisabilities (Harp, 1994). It entails thetransfer of power and control over theirlives from external entities, such as VRcounselors, to the individuals them-selves (Bolton & Brookings, 1996).Thus, as hypothesized and tested byKosciulek and Merz (2001), the VRcounselor committed to an empower-ment approach to service deliveryshould facilitate and maximize oppor-

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tunities for individuals with disabilitiesto have control and authority over theirown lives.

From an empowerment perspec-tive, VR counseling is not somethingthat can be done to or for a consumer.Rather, it is a process in which consum-ers must become active, informedparticipants who learn and control aplanning process that they use for short-and long-term career development(Szymanski, Hershenson, Enright &Ettinger, 1996). In addition, the life-long, developmental nature of theprocess means ”unless we plan towork with an increasingly dependentconsumer again and again across thedecades, our professional responsibil-ity is to assure that each person learnsthe [career planning] process”(Mastie, 1994, p. 37).

Active consumer involvement is thekey element of successful VR counsel-ing interventions (Ettinger, Conyers,Merz & Koch, 1995). In an empower-ment approach to VR counseling,consumers are actively involved in:• gathering information, including

self-assessment, and learning aboutoccupations and the labor market;

• generating alternative courses ofac t ion and weighing thosealternatives; and

• formulating a plan of action.

IMPLICATIONS FOR VOCATIONALREHABILITATION COUNSELORTRAINING AND PRACTICEThe VR counseling empowermentframework suggests three importantimplications for VR counselor trainingand practice.

First, in both pre-service counseloreducation and in-service counselortraining programs, curricula must focuson the development of effective voca-tional counseling techniques. In thismanner, new and practicing VR coun-selors will possess the tools necessaryfor developing effective working alli-ances with consumers with disabilities.

Second, both new and experiencedVR counselors must be knowledgeableof the state-federal VR system informedchoice mandates. Further, counselorsmust be fully informed regarding those

models demonstrated to be useful forenhancing informed consumer choicein the VR process. The informed-choice /bes t -prac t ice methodsdescribed in the Choice Demonstra-tions Projects Operations Manual(InfoUse, 1999) may be helpful in thisregard.

Third, in accordance with the VRcounseling empowerment framework,the development of consumer self-de-termination skills must be a goal of theVR counseling process. As such, VRcounselor training programs of all typesshould direct resources toward increas-ing counselor knowledge and skill inthe area of consumer self-determina-tion. As described earlier in thediscussion of Consumer Self-Determi-nation, Field et al. (1998) provided avaluable guide that outlines the stepsin the self-determination developmentprocess.

CONCLUSIONDue to the ever-changing nature of theworld of work and service-systemcastification processes, assisting peoplewith disabilities to achieve positive,meaningful and stimulating career de-velopment can be a challenging task.Effective VR counseling can be instru-mental for enhancing the career suc-cess and quality of life of consumerswith disabilities. Full implementationof the VR counseling empowermentframework presented in this article willenable consumers with disabilities tobecome active, informed participantswho learn and control a planning pro-cess that they use for both short- andlong-term career development. In thismanner, VR counseling will promotethe empowerment of individualswith disabilities.

NOTE1. Castification is fundamentally an

institutionalized way of exploiting onesocial group (ethnic, racial, low-income or other minority group), thusreducing this group to the status of alower caste that cannot enjoy the samerights and obligations possessed by theother groups (Trueba, 1993a, p. 30).

Active

consumer

involvement

is the key element

of successful VR

counseling

interventions.

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Pat terson, C. H. (1960). Thecounselor’s responsibi l i ty inrehabil i tat ion. In C. H. Patterson(Ed. ) , Readings in rehabil i tat ioncounseling (pp. 113-116).Champaign, IL: St ipes.

Rappaport, J. (1987). Terms ofempowerment/exemplars ofprevention: Toward a theory forcommunity psychology. AmericanJournal of Community Psychology,15 , 121-148.

Ryan, C. P. (1995). Work isn’t what itused to be: Implications, recommen-dations and strategies for vocationalrehabilitation. Journal of Rehabilita-tion, 61, 8-15.

Schroeder, F. K. (1995, November).Philosophical underpinnings ofeffective rehabilitation. Paperpresented at the Sixteenth Mary E.Switzer Lecture, Worcester, MA.

Scotch, R. K. (2000). Disabil i typolicy: An eclectic overview.Journal of Disabil i ty PolicyStudies, 11 (1) , 6 -11.

Stein, J . (1997). Empowerment andwomen’s health: Theory, method,and pract ice. London: Zed Books.

Szymanski, E. M., Hershenson, D. B.,Enright, M. S., & Ettinger, J. M.(1996). Career developmenttheories, constructs and research:Implications for people withdisabilities. In E. M. Szymanski &R. M. Parker (Eds.), Work anddisability: Issues and strategies incareer development and jobplacement (pp. 79-126). Austin,TX: Pro-ed.

Szymanski, E. M., & Trueba, H. T.(1994). Castification of people withdisabilities: Potential disempoweringaspects of classification in disabilityservices. Journal of Rehabilitation,60 , 12-20.

Trueba, H. T. (1993a). Cast i f icat ionin mult icultural America. In H. T.Trueba, C. Rodriguez, Y. Zou &J. Cintron (Eds.) , Healingmult icultural America: Mexicanimmigrants r ise to power in ruralCal i fornia (pp. 29-51). Philadel-phia: Falmer.

Trueba, H.T., Cheng, L. & Ima, K.(1993). Myth or real i ty: Adaptivestrategies of Asian Americans inCal i fornia. London, England:Falmer.

Zimmerman, M. A., & Warschausky, S.(1998). Empowerment theory forrehabilitation research: Conceptualand methodological issues. Rehabili-tation Psychology, 43 (1), 3-16.

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MEMORANDUM UNITED STATES DEPARTMENT OF EDUCATION

REHABILITATION SERVICES ADMINISTRATION

CENTRAL OFFICE

COMMISSIONER'S MEMORANDUMCM 04-01Date: October 3, 2003

TO: RSA Senior Management Team

FROM: Joanne WilsonCommissioner

SUBJECT: Consumer Organizations: Important Resources for VR Agencies

BACKGROUND

Consumer organizations, whose membership and officers are comprised of a majority of individu-

als with disabilities, are an invaluable resource for State vocational rehabilitation (VR) agencies.

These organizations provide a network of individuals whose knowledge and experiences can sig-

nificantly supplement the efforts of a VR agency in meeting its mission and in empowering persons

with disabilities to achieve their employment and independent living goals. Consumer organiza-

tions can provide experience-based information, technical assistance, access to role models and

mentors, disability-specific training, job matching, advocacy on behalf of persons with disabilities

and the needs of the public VR program, and a variety of other services that VR agencies would

find useful in working with persons with disabilities. Whether representing individuals with mental

illness, cognitive disabilities, physical disabilities, or individuals from a combination of these

groups, consumer organizations specialize in empowering individuals with disabilities to achieve

independence and self-sufficiency.

The Rehabilitation Services Administration (RSA) is committed to leveraging the contributions of

community organizations comprised of individuals with disabilities. To this end, RSA is develop-

ing initiatives to draw upon the contributions of consumer organizations by making their services a

more integral resource to the VR program. These initiatives are designed to enhance the effective-

ness of the VR system with the practical expertise and knowledge of persons with disabilities who

CONSUMER ORGANIZATIONS:IMPORTANT RESOURCES FOR VR AGENCIES

Periodically, the commissioner of the Rehabilitation Services Administration (RSA) disseminates memoranda tothe RSA Senior Management Team to provide information and guidance on the implementation of priority initia-tives or strategies. Last fall, Joanne Wilson, RSA commissioner, distributed the following Commissioner's Memo-randum (CM 04-01) regarding the importance of consumer organizations as valuable resources for vocationalrehabilitation (VR) agencies. The memorandum clearly articulates the potential role of consumers in empoweringpersons with disabilities and the agencies that serve them.

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have successfully overcome barriers in achieving their goals. For example, RSA is funding amentoring initiative in which students with disabilities will be connected with mentors with dis-abilities, who possess the practical knowledge and personal experiences requisite to help thestudents effectively transition to adulthood. These mentors can offer transition-age youth informa-tion, support, and hope derived from first-hand and personal experiences that enable them to serveas real-life examples of what people with disabilities can achieve.This Commissioner's Memorandum (CM) more fully describes both this mentoring initiative andother available opportunities for State VR agencies to utilize the unique contributions that con-sumer organizations can make throughout the VR process ranging from direct interaction with VRparticipants to meaningful impact upon systemic issues, such as statewide planning and policy de-velopment. RSA considers the development of strong working relationships between State VRagencies and grass-roots consumer organizations to be pivotal in ensuring that agency efforts areeffective in meeting the needs of the various disability populations the agencies are serving and therealization of successful outcomes.

MENTORING

The expectations and beliefs that individuals with disabilities have about their own abilities, poten-tial, and competence inevitably influence their choices throughout the VR process. All toofrequently, individuals create self-imposed limits based on poor role modeling, lack of disability-specific information, and negative misconceptions about their disability. Ultimately, theseself-imposed limits negatively affect their employment outcomes and quality of life. Connecting in-dividuals being served by the VR program with mentors who have disabilities, who possesspractical knowledge and firsthand experience, and who have achieved high-quality employmentand independence through their participation in the VR process will help guide VR participants tomake positive choices regarding their programs and their lives.Furthermore, while all students encounter difficulties during their school years, many of the chal-lenges encountered by students with disabilities are wholly unique. Students with disabilities oftenare unable to find summer and part-time employment, struggle with social acceptance and negativestereotypes about their disabilities, are not encouraged or fail to participate in extracurricular ac-tivities, and are not always taught the disability-specific skills and techniques they need to succeedat school and life. As a result, dropout rates among students with disabilities are significantlyhigher than those of the non-disabled population, and their college enrollment is approximatelyfive times less than the general public's. The lack of opportunity to gain the experience and confi-dence through job training and summer employment combined with low expectations and minimalsocial skills or disability-specific techniques leave them ill-prepared to enter the workforce.

While mentoring can greatly enhance the experiences of all participants in the VR program, itis a natural and necessary component of any complete package of transition services in light ofthe significant impact role models can have on youth as they mature. Mentoring provides stu-dents with disabilities increased opportunities to explore vocational interests and developwork habits, skills, and attitudes necessary for meaningful careers. Mentors, or role models,with whom students can identify, and who have shared interests, can have a positive impactthat will last a lifetime. Thus, providing mentoring services to students with disabilities shouldbe considered in the development of both the Individualized Education Program (IEP) and theIndividualized Plan for Employment (IPE).To highlight the important role of mentoring in the transition process, RSA has developed amentoring initiative for transition-aged youth and young adults with disabilities. Projects funded

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under this initiative will focus on providing mentoring services to students with disabilities to gain

the necessary skills, confidence, and education to effectively transition from school to high-quality

employment and independence. The mentoring program established under this initiative will ac-

complish this goal through the development of collaborative partnerships between State VR

agencies and consumer-controlled organizations. From the ranks of these organizations, mentors

will be identified and matched with students with disabilities. These mentors will possess the prac-

tical knowledge and personal experience requisite to help students effectively transition to

adulthood and overcome the barriers that typically are associated with a particular disability. The

mentors will not only serve as powerful role models, but will support students by assisting them

with career and professional development, helping them to develop their life skills and disability-

specific techniques that enhance independence, assisting them to attain their academic goals, and

providing them with encouragement and moral support.

The initiative focuses on the following objectives:

• Increasing academic achievement and participation in post-secondary education.

• Assisting students to navigate through service delivery systems that may assist them in

their transition.

• Developing and improving the self-confidence, community integration, work, self-determina-

tion, advocacy and decision-making skills of the students.

• Increasing high-quality employment outcomes achieved by the students.

This effort has begun with a few, small demonstrations and will grow into a national network of

mentoring programs. In fiscal year (FY) 2002, RSA funded two mentoring demonstration projects.

In FY 2003, RSA funded one project in the amount of $1 million over a five-year period to develop

an information base on promising mentoring models upon which the proposed effort in FY 2004

can build. The Administration, through its FY 2004 budget request, proposes a more expansive ef-

fort that will focus on activities to diffuse mentoring programs within State VR agencies.

ADJUSTMENT TO DISABILITY

Adjustment-to-disability services (or adjustment services) are critically important to empowering

many individuals with significant disabilities to pursue, achieve, and sustain high-quality employ-

ment outcomes in integrated settings. Adjustment services are a comprehensive and integrated set

of services, including counseling, mentoring and other services, designed to provide individuals

with disabilities with confidence, interpersonal and disability-specific skills, and a positive attitude

toward disability that they may require to achieve competitive employment, community integra-

tion, and independence. This set of services, which differs from medical rehabilitation services,

may consist of teaching orientation and mobility to individuals who are blind, or training in the use

of communication aids for those who are blind, deaf, or unable to speak. The provision of such ser-

vices through the VR program directly assists individuals in adjusting to living and working with a

disability, thus greatly enhancing their capabilities to achieve long-term success in the workplace.

Through collaboration with consumer organizations and accessing their expertise, VR agencies can

ensure that sufficient and appropriate adjustment services are made available to individuals with

disabilities as integral components of their rehabilitation planning. Consumer organizations are ex-

cellent resources for information regarding the specific adjustment services required by individuals

with disabilities, especially with respect to the development of IPEs appropriate to the needs of

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particular individuals with disabilities. In addition, consumer organizations possess a wealth of ex-perience and knowledge concerning the providers of adjustment services; thus, they are wellprepared to assist VR counselors and individuals in the selection of the providers best suited to de-liver these essential services.

DEVELOPMENT OF THE IPE

The IPE is the vehicle by which individuals participate in the VR program and, ultimately, achievehigh-quality employment and independence. It is a planning tool by which individuals identifytheir employment goals, as well as the specific services and providers needed to achieve thosegoals. In developing an IPE, individuals require accurate information and perspective in order tomake informed and empowering choices. To this end, the State VR agency is required to provideindividuals with options for developing the IPE, including the assistance of qualified VR counse-lors or other persons.

In setting forth the options available to individuals for the development of the IPE, section102(b)(1)(A) of the Rehabilitation Act of 1973, as amended (Act) states that "…the designatedState unit shall provide the eligible individual or the individual's representative…with informationon the individual's options for developing an individualized plan for employment, including - (A)information on the availability of assistance, to the extent determined to be appropriate by the eli-gible individual, from a qualified vocational rehabilitation counselor in developing all or part ofthe individualized plan for employment for the individual, and the availability of technical assis-tance in developing all or part of the individualized plan for employment for the individual"(emphasis added). The implementing regulations reinforce the option of the individual to use alter-native sources for assistance with IPE development by permitting eligible individuals to developtheir IPEs without assistance, or with help from a variety of sources, including qualified VR coun-selors employed by the agency, qualified VR counselors not employed by the agency, and otherunspecified "resources" (34 CFR 361.45(c)(1)).Consumer organizations are an ideal resource from which VR agencies and individuals can seekassistance when preparing IPEs. Consumer organizations possess extensive knowledge of the VRprogram and its processes, service providers, and, most importantly, the disability-related and voca-tional needs of persons with disabilities. By accessing this important resource, both VR counselorsand individuals can utilize the expertise of consumer organizations in order to develop IPEs thatbest meet the needs of the individuals. Such collaboration will serve to connect individuals withpeople who have firsthand knowledge of disabilities and the VR process, enabling them to makefully informed and effective choices.

PROGRAM EVALUATION

Because consumer organizations represent the collective voice of their members, they are able tooffer experience-based input on the effectiveness of a State VR agency's policies, procedures andpractices as they affect applicants and individuals eligible for VR services. Strong partnerships andproductive dialogue between VR agencies and these organizations can lead to better programming,better agency performance, and, ultimately, better outcomes for persons with disabilities.In addition to being significant contributors to a VR agency's efforts to evaluate itself and its ef-forts to empower persons with disabilities to achieve high-quality employment outcomes,consumer organizations can play important roles in the conduct of the comprehensive statewide tri-ennial assessment of the rehabilitation needs of individuals with disabilities required by section101(a)(15)(A) of the Act. The input of these organizations can be particularly helpful with respect

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to the identification of the nature and scope of the needs of individuals who are minorities or who

have been unserved or underserved by the State VR agency.

POLICY DEVELOPMENT

Prior to the adoption of any new or revised policies or procedures governing the provision of ser-

vices under the State's VR program, section 101(a)(16)(A) of the Act requires a State VR agency to

conduct public meetings throughout the State to provide the public, including individuals with dis-

abilities, the opportunity to comment on the proposed policies or procedures. In this regard, the

agency is also required to actively consult with the director of the Client Assistance Program

(CAP), and, as appropriate, Indian tribes, tribal organizations, and Native Hawaiian organizations.

Since the information gathered from these public meetings can be useful to a State VR agency's re-

finement and improvement of a proposed policy or procedure, the agency should make special

efforts to inform consumer organizations of these meetings so that they have the opportunity to ex-

press their views, thus ensuring the voice of the larger disability community is heard.

In addition to soliciting public input prior to the adoption of any new or revised policies or proce-

dures at the required public meetings, section 101(a)(16)(B) of the Act also requires a State VR

agency to take into account, in connection with matters of general policy relating to the administra-

tion of the VR State plan, the views of individuals who are receiving VR services or, as

appropriate, their representatives; providers of VR services; the CAP director; and the State Reha-

bilitation Council (SRC), if the agency is required to have a SRC.

To address this statutory requirement, a VR agency can obtain the perspectives of individuals with

disabilities through a variety of other mechanisms. For example, a VR agency can engage in ongo-

ing consultation with consumer organizations by conducting regularly scheduled meetings between

agency and organization leadership. Additionally, through participation on policy development

committees or focus groups established to study specific areas of interest to the agency, representa-

tives of consumer organizations can provide the agency with additional insight during the various

stages of planning and policy development, by participating in initial discussions of the issues,

commenting on proposed language, and, finally, by providing information on the effects of the

implementation of policy changes on individuals.

IMMERSION ACTIVITIES

Individuals with disabilities can be truly empowered and in control of their futures only when they

possess the information, education, training, confidence, and high expectations needed to make ef-

fective employment and life-related decisions. VR counselors play a vital role in the empowerment

of individuals with disabilities. Counselors and other VR staff can achieve a unique perspective of

the capabilities and employment potential of persons with disabilities through participation in ac-

tivities through which they interact for extended periods of time directly with persons with

disabilities in situations other than traditional professional counselor to consumer relationships. In

addition, individuals with disabilities also can benefit immensely from participation in these same

intensive and experiential "immersion" activities, as they learn from their peers and develop posi-

tive attitudes toward their disabilities.

Consumer organizations are ideal resources through which VR agencies can provide immersion ac-

tivities for their staff and consumers alike. Immersion activities can range in duration and may

include attendance at conferences sponsored by these organizations; ongoing participation in meet-

ings and other activities conducted by local chapters and affiliates; and participation in

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rehabilitation training programs. Consumer organizations can work with VR agencies to identifyand coordinate those activities most appropriate for the needs of their staff and individual consum-ers. VR staff who have engaged in a variety of immersion activities report: an increasedunderstanding of and sensitivity to disability culture; a greater knowledge of successful accommo-dation methods; a more positive view of the employment potential of individuals with disabilities;an increased comfort level in working with individuals with significant disabilities; and deeper in-sight into their own preconceptions of disability. By interacting for an extended period of time withpersons with disabilities who function naturally and successfully in the performance of both lifeand employment skills, VR counselors and consumers can enrich their understanding of the lives ofpersons with disabilities, the barriers to employment which they have overcome, and those ob-stacles which they still face, either individually or collectively, on a daily basis.STATE AGENCY IN-SERVICE TRAININGConsumer organizations can assist a State VR agency in conducting relevant in-service training ef-forts that focus on particular disabilities. With their "real world" experiences in addressing variousissues resulting from their disabilities with respect to preparing for and obtaining high-quality em-ployment outcomes, representatives of consumer organizations can provide experience-basedinsight, information, and guidance to State VR agency staff that professional educators, trainers, orbooks simply cannot offer.

COMMUNICATION AND OUTREACHConsumer organizations provide established networks for dissemination of information and com-munication about services, special projects, proposed changes and trends in service delivery orresources, and profiles of agency successes. They are a ready source of referrals and can offer in-valuable assistance in reaching culturally diverse or underserved groups to familiarize them withthe services that the VR program has to offer. Finally, they can add a significant voice topolicymakers on agency requests related to service provision.

SUMMARY

This CM describes various opportunities for collaboration between a VR agency and consumer or-ganizations, and suggests several methods for fostering effective partnerships. VR agencies areencouraged to develop their own innovative practices that utilize the knowledge, expertise, andskills found within these organizations for the benefit of the individuals the agencies serve, therebyenhancing and strengthening the VR program itself.Consumer organizations play a crucial role in the lives of people with disabilities. Consequently,their involvement in the VR program is fundamental to its success. In partnership with the VR pro-gram, these organizations can offer persons with disabilities support, opportunities, and hope.Whether through peer mentoring, leadership opportunities, role modeling, or disability-specifictraining, consumer organizations are invaluable resources for VR agencies, their partners, and indi-viduals with disabilities alike. VR agencies can draw upon the collective talent of theseorganizations and the expertise of their individual members as they work to achieve high qualityemployment and full independence for persons with disabilities.

Any questions concerning this Commissioner's Memorandum should be addressed toCarol Dobak, at (202) 245-7325 or Carol.Dobak@ed.gov.

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FREEDOM FOR THE BLIND:THE SECRET IS EMPOWERMENT

A BOOK REVIEW

ALLEN HARRIS

FREEDOM FOR THE BLIND:THE SECRET IS EMPOWERMENT

A BOOK REVIEW

ALLEN HARRIS

Available at no cost, except for a fee of $5 for shipping, from the Regional Rehabilitation Continuing EducationProgram at University of Arkansas, P.O. Box 358, Hot Springs, AR 71902. Telephone: (501) 623-7700. The entirebook is also available online, at: www.nfb.org/books/books1/free.htm

James H. Omvig’s book, Freedomfor the Blind, which was commis-sioned by the U.S. Department ofEducation’s Rehabilitation ServicesAdministration (RSA), has just beenreleased. According to Omvig, thebook offers ”a non-traditional per-spective on the methods and issuesthat a truly successful employmenttraining program for the blindshould embrace.”

Freedom for the Blind points outthat, as America begins the 21st cen-tury, between 70 and 80 percent ofits working-age blind people are un-employed. Of those who areemployed, far too many are severelyunderemployed or are destined to belocked in at entry-level jobs for a life-time. Omvig asks, ”Why?”

The author contends that, puttingto one side all of the rationalizations,there can be but two possible expla-nations for this dismal statistic: First,either people who are blind, no mat-ter how thoroughly trained andadjusted to their blindness they maybe, are inherently incompetent; or,second, there is something inherentlywrong with America’s blindness sys-tem — the complex of programs foreducating or rehabilitating peoplewho are blind.

Omvig concludes that the problemis not with the people who are blind.The evidence that properly trainedblind people can live independent,successful, competitive, normal andhappy lives and can assume their right-ful position of full membership insociety is too overwhelming to con-clude that, as a class, people who areblind are inherently incompetent.Therefore, Omvig reluctantly and cau-tiously draws the conclusion that theproblem has been with the blindnesssystem itself — that educational andvocational rehabilitation (VR) programsfor people who are blind historicallyhave not been what they could andshould be.

Also, he says that the blind havebeen thought of by society — andhave learned to think of themselves— as a group apart, a helpless andhopeless lot, having neither theright nor the ability to work for theirdaily bread or to earn their self-re-spect. As a group, people who areblind have thought of themselvesnot as unemployed but as inferiorswho are unemployable: He sums itup by describing the blind as a ”vis-ible minority!”

Omvig believes that there are ad-ditional facts and circumstances at

the root of the unemployment prob-lem: Too many VR programs orresidential orientation and adjust-ment (O&A) centers have alsounwittingly embraced society’s nega-tive view of people who are blindand have perpetuated these mythsand misconceptions in the minds oftheir VR customers or students, andthose customers have been the los-ers. Such programs have utilizedwhat one might call the enablermodel of service delivery.

However, Freedom for the Blindcontends that there is good news! Theage of enlightenment is here, and anew model — a proven cutting-edgeformula for success — exists. It is theempowerment model.

The book proffers the view that ev-ery blind person — man or woman,young or old, educated or not —needs personal empowerment to bewhole; and with empowermentcomes the freedom people who areblind have the right to expect. It sug-gests that every progressive VRprogram or residential O&A centershould therefore adopt the empow-erment model and do its best toempower every VR customer or stu-dent whom it serves. In regard toO&A centers, Omvig says that a resi-

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dential training center’s overarchingpurpose should be to function as an”empowerment station.”

The empowerment-station modelof an O&A center is one that recog-nizes that all offered services must beaimed at teaching its students a newand constructive set of attitudes aboutblindness and ”unlearning’ prevailingviews that are wrong and harmful.Further, such a center will help eachblind student strive to achieve thefollowing four personal objectives:• The person who is blind must come

to know emotionally, not justintellectually, that he or she can trulybe independent and self-sufficient.

• The person who is blind must learnand become competent in thoseskills — the alternative techniquesof blindness — that will make itpossible for him or her to be trulyindependent and self-sufficient.

• The person who is blind must learnto cope on a daily basis with thepublic attitudes about blindness —how he or she will be treated byother people because of theirm i s u n d e r s t a n d i n g s a n dmisconceptions.

• Even when the individual who isblind has adjusted emotionally toblindness, mastered alternativetechniques and learned to copeeffectively with the demeaningthings other people do or say, theperson who is blind must alsolearn to ”blend in” and to beacceptable to others in order to besuccessful. He or she must bepunctual, reliable, neat andappropriate in appearance andpossessed of good social and tablemanners and the like. Thus theschools and agencies must do thebest that they can to achieve thisdesired result.

Omvig’s thesis is that freedom shouldbe accessible to everyone and that itis possible, with a willingness to thinkoutside the box, for the traditional VRprogram to learn to empower and tomove its customers toward success-ful, high-quality employment and in-creased integration into society. Aproven cutting-edge formula for suc-

cess exists and is available for the tak-ing. The blind customer who has re-ceived cutting-edge VR services hasa markedly higher chance for voca-tional success than the norm, accord-ing to Omvig.

The book details the philosophies,training techniques and the methodsthat go into the empowerment modeland also explains the role a state’sseparate agency for the blind couldplay in the process. Given the rightkind of training, the average blindperson — not merely those whomsome observers mistakenly perceiveas the ”superblind” — can competeon terms of true equality with his orher sighted peers and can become ataxpayer rather than a tax user.Omvig believes that, far from want-ing to whimper, ”I wonder what itwould feel like to be free,” the em-powered blind person will want toclimb the highest mountain andshout, ”I am free! I know what it feelslike to be free!”

Omvig is a blind attorney and re-habil i tat ion professional f romTucson, Arizona. He spent most ofhis professional career workingwith the blind, and in retirement hecontinues to do consulting, evalu-ating, writing and teaching in thisfield today.

He became blind as a teenagerdue to Retinitis Pigmentosa (a degen-erative, retinal disease referred to asRP). After several years of strugglingwith extremely limited vision whilein the public school system, he trans-ferred to a residential school, theIowa School for the Blind. He gradu-ated from high school in 1953.

Eight years of idleness followedOmvig’s high school graduation.Then, in 1961, he became one of theearly students in the Adult Orienta-tion and Adjustment Center newlycreated and directed by Dr. KennethJernigan at the Iowa State Commis-sion for the Blind. He went on tocomplete college and law school, andthen he worked in Washington, D.C.,and New York City as the first blindattorney ever hired by the Na-tional Labor Relations Board.

The

blind

customer who

has received cutting-

edge VR services has

a markedly higher

chance for vocational

success than the

norm, according

to Omvig.

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R S A R E G I O N A L O F F I C E S

Region I(Connecticut, Maine,Massachusetts, New Hampshire,Rhode Island, Vermont)Rehabilitation Services AdministrationJ.W. McCormack Post Office and

Court House, Room 232Boston, MA 02109

Region II(New Jersey, New York, PuertoRico, Virgin Islands)Rehabilitation Services Administration75 Park Place, Room 1236New York, NY 10007

Region III(Delaware, Maryland,Pennsylvania, Virginia, WestVirginia, District of Columbia)Rehabilitation Services Administration100 Penn Square East, Suite 512Philadelphia, PA 19107

Region VIII(Colorado, Montana, North Dakota,South Dakota, Utah, Wyoming)Rehabilitation Services Administration1244 Speer Boulevard, Suite 310Denver, CO 80204

Region IX(American Samoa, Arizona,California, Commonwealth of theNorthern Mariana Islands, Guam,Hawaii, Nevada)Rehabilitation Services Administration50 United Nations Plaza,

Room 215San Francisco, CA 94102

Region X(Alaska, Idaho, Oregon,Washington)Rehabilitation Services Administration915 Second Avenue, Room 2848Seattle, WA 98174-1099

Region IV(Alabama, Florida, Georgia,Kentucky, Mississippi, NorthCarolina, South Carolina,Tennessee)Rehabilitation Services Administration61 Forsyth Street, S.W., Room 18T91Atlanta, GA 30303

Region V(Illinois, Indiana, Michigan,Minnesota, Ohio, Wisconsin)Rehabilitation Services Administration111 North Canal Street, Suite 1048Chicago, IL 60606

Region VI(Arkansas, Louisiana, New Mexico,Oklahoma, Texas)Rehabilitation Services AdministrationHarwood Center1999 Bryan Street, Room 2740Dallas, TX 75201-6817

Region VII(Iowa, Kansas, Missouri, Nebraska)Rehabilitation Services Administration10220 North Executive Hills BoulevardKansas City, MO 64153-1367

I

II

III

IV

V

VI

VIIVIII

IX

X

Sec. 2. (b) Purpose

The purposes of this Act are -

(1) to empower individuals with disabilities to maximizeemployment, economic self-sufficiency, independence, andinclusion and integration into society ...

(2) to ensure that the Federal Government plays a leadershiprole in promoting the employment of individuals withdisabilities, especially individuals with significantdisabilities, and in assisting States and providers of servicesin fulfilling the aspirations of such individuals withdisabilities for meaningful and gainful employment andindependent living.

- The Rehabilitation Act of 1973, as amended

Sec. 2. (b) Purpose

The purposes of this Act are -

(1) to empower individuals with disabilities to maximizeemployment, economic self-sufficiency, independence, andinclusion and integration into society ...

(2) to ensure that the Federal Government plays a leadershiprole in promoting the employment of individuals withdisabilities, especially individuals with significantdisabilities, and in assisting States and providers of servicesin fulfilling the aspirations of such individuals withdisabilities for meaningful and gainful employment andindependent living.

- The Rehabilitation Act of 1973, as amended

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