Chapter 5 Empowerment and State VR Administrators In this chapter, the Primary Study Group (PSG) will discuss the essential role of the Vocational Rehabilitation (VR) administrator in promoting consumer empowerment. The authors will also address issues that VR administrators must deal with to create an environment that helps consumers to discover and use their personal power to take control of their lives. In essence, the VR system has been incorporating the notion of empowerment for decades in the form of individualization of services leading to employment. Historically, however, the VR program has focused on the consumer outcome of “getting a job,” not “becoming empowered” as an outcome of this process. Changing the VR system to embrace the concept of empowerment and self-direction through informed choice will require changes in the practice and structure of the VR service delivery system. The role of the VR administrator in embracing and supporting these changes is critical to ensuring that they become “institutionalized” in the VR program. Creating a Vision As leaders of public rehabilitation, VR administrators must commit to the concept of empowerment not only in philosophy, but also in action. No change will occur unless VR administrators support the concept and have a clear vision for the future. This vision must include the belief that people with disabilities are capable of achieving whatever they want to achieve. When VR administrators truly believe this and incorporate this belief in agency operations, they will commit resources to helping consumers achieve goals based on elevated expectations. The first action VR administrators can take is to articulate a vision for empowerment which: • Makes empowering consumers a priority for the agency, • Describes what empowerment “looks like”, • Acknowledges and shares the values attached to empowerment, • Describes the changes that must occur to be an organization that empowers consumers, • Describes how staff members will participate in the changes, and • Describes how the agency would benefit from empowered consumers. The vision can best be articulated with input from consumers. It needs to be stated clearly and frequently. All staff members need to fully understand what it means to empower consumers and know the actions they can take to help consumers realize this goal. Most people embrace the concepts of control, personal power and authority to make decisions that are embedded in empowerment. Putting these concepts into action within a VR agency is more difficult than it appears on the surface. Empowering an individual is not a direct result of any specific action. Rather it is a concert of many possible actions that result in empowerment. Empowerment is individualized; the action is internal So if empowerment is internal to the individual, what must VR administrators do to create an environment that fosters empowerment? Holistic View Employment and economic self-sufficiency are facets of empowerment. Independence, inclusion and integration into society are also essential components of empowerment as noted in Section 102 (b)(1) of the Rehab Act as amended. A broader definition of empowerment challenges us to take another look at how we serve VR consumers and demands that we view each individual with a disability holistically. VR administrators must be willing to look at their systems to figure out what needs to change so that counselors can build empowering relationships from the moment that consumers walk through our doors. It is the responsibility of VR administrators to create a system that rewards a focus on consumer strengths from the outset. VR administrators must find ways to reinforce counselors’ roles as coaches and facilitators so they may help consumers discover their personal power to make and assume responsibility for their own choices. If the VR system is to empower consumers, it must change how customers are addressed when they initially come to VR. Dr. Martin Seligman, in his studies on learned helplessness (1991), highlights the connection of helplessness to the underlying belief by the individual that he or she has no control over his or her environment. How many public rehabilitation processes are structured to place the control in the hands of the consumer? To begin the empowerment process, counselors should start by asking consumers about their strengths, hopes and aspirations in the initial intake. Counselors should focus their discussion on the consumer’s skills and strengths. Potential barriers will be revealed in this process but will not be the focal point. This focus on strengths puts the consumer more on an equal footing and serves as a basis for an empowering relationship. The counselor becomes a facilitator, coach and resource coordinator and assists the consumer to explore solutions that he/she develops. This is very different from the more commonly understood role of the counselor as a problem solver. In many cases, counselors have not been trained to see the whole person and to help consumers figure out how to solve problems on their own, regardless of the stated need. Whether the consumer needs shelter, food and clothing or a high-level career, the counselor must facilitate informed choice and consumer problem-solving. Counseling staff will need support from VR leadership to make a shift from problem-solver to solution-facilitator. Consumer Partnerships One element of creating and sustaining an environment that empowers consumers is to view people with disabilities as more than just recipients or potential recipients of services. VR administrators can foster a view of people with disabilities as potential resources, partners and allies. Consumer organizations, a majority of whose membership and officers is comprised of individuals with disabilities, are an invaluable resource for State VR agencies. These organizations provide a network of individuals whose knowledge and experiences can significantly 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 organizations 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. See Chapter 8 for more information on consumer organizations. Real choice, the kind that people will find useful, must include contact with others who can translate options into real life experiences. In this way, the individual acquires skills and the self-confidence necessary to put those skills into action. To have choice consumers must have perspective. A person with a disability must have a clear vision of what is possible for persons with disabilities based on their own experiences within the broader context of the collective experiences of people with disabilities. —Schroeder, 1995, p. 6 Consumer organizations and centers for independent living can provide this broader context for VR consumers. VR administrators can take the lead in establishing contact with consumer organizations and developing partnerships. These partnerships might be formal or informal. They might involve actual contracts and fees for service, or they might involve simple cross referrals between the organizations. Whatever the structure, VR administrators can take the lead in making those connections and support staff members in using those resources. One way of developing partnerships with consumer organizations is to provide cross training or shared training opportunities for staff. Agencies might invite members of consumer organizations to participate in agency-sponsored training, both as students and as trainers. VR administrators can encourage staff members to attend training opportunities provided by consumer organizations and centers for independent living. Consumer organizations have proven that they can be a formidable political force and can be valuable as political allies and spokespersons on behalf of consumers, VR agencies, and the system. Many consumer organizations want to accomplish the same things people in VR agencies want to accomplish: more choices for people with disabilities, including more job opportunities, and integrated and accessible communities. By working together and supporting each other’s efforts we create win-win situations for everyone. Comprehensive System of Personnel Development The Rehabilitation Act addresses professional qualifications in its discussion of a Comprehensive System of Personnel Development (CSPD). Public VR has spent time and money to ensure that staff members are professionally trained. It is essential that staff members use their expertise to empower consumers. State VR agency leadership can take active steps to ensure that university or other training programs incorporate empowerment as a critical component to professionalism. The PSG recommends the following: • Work with higher education programs to ensure that counseling and guidance skills to empower consumers are priorities in the curricula. • Develop internal staff training that reinforces empowerment as an essential component to service delivery. • Develop scenarios reflecting pivotal empowering opportunities with consumers. Use these scenarios in interviews for VR counseling positions to show to candidates the importance the organization places on empowering consumers and to help identify candidates with relevant skills. (See Appendix B for suggestions.) • Utilize consumer organizations in pre-service and in-service training activities (for example, immersion experiences) to broaden the perspective and increase understanding of disability and the role that consumer organizations can play in promoting empowerment. Integrating Organizational Systems to Support Empowerment Integrating the concept of empowerment into any organization is not easy. VR administrators know that fundamental shifts or changes in organizational behavior do not happen without concerted effort. It takes hard work and a commitment of resources (time and money) to help staff members make necessary changes in business practices. To integrate empowerment into business practices, VR administrators will need to: • Empower and encourage staff members to use the flexibility of the Rehabilitation Act. • Restructure services to give consumers more control of their VR program. • Seek innovative ways to help staff members address the consumer holistically. • Conduct pilot projects to experiment with new methods. (For example, developing “mentors” or “coaches” that could assist consumers to be more empowered; giving the consumer control over the budget for planned case services; partnering with groups of consumers; facilitating peer support, etc.) • Provide staff training to highlight practical ideas that empower consumers, including experiential and immersion training to increase awareness and understanding of disability. • Promote staff interactions and customer referrals to consumer organizations. The above is by no means an exhaustive list. These are but a few of the ideas that will help consumers discover and use their personal power. There are many other potential ways to empower consumers This PSG believes the following systems must be carefully examined and revised to actively support consumer empowerment. Policies and Procedures Many policies and procedures can inhibit the counselor in helping consumers to exercise control of their VR program. Others may be so bureaucratic or confusing that they make little sense to the consumer. If the consumer is to be empowered, the VR program must be easy to use and understandable. Policies and procedures must be crafted to actively support consumer empowerment. Staff roles in empowering consumers must be clearly defined and understood. We must also take the time to review, analyze and eliminate those policies and practices that in any way inhibit consumers’ ownership of their own rehabilitation. For example, “public stewardship” for VR funds has often resulted in restrictive policies that place the counselor in charge of the Individualized Plan for Employment (IPE) and services. This diminishes the consumer’s power and elevates the counselor’s power in the consumer/counselor relationship. However, there are other ways to adhere to the concept of public stewardship and still give the consumer the control of how their VR dollars are spent. Counselors who are skilled at empowering consumers have proven that fiscal integrity and consumer empowerment are fully compatible. Many states have only one way of purchasing planned services; and more often than not, the counselor controls the budget for planned services. If VR agencies examine their purchasing policies they can find new and innovative ways that support the consumer’s control of how planned services are purchased. While there are many potential ways to address purchasing policies and procedures, the following are examples of some state agency experiences: • In certain offices in Arizona, the counselor and consumer agree on the cost of services in the IPE. Fiscal control of the budget for planned services is then removed from the counselor and control of the budget is placed with the consumer, who is responsible for authorizing the services and monitoring the budget. A fiscal support worker is assigned to the consumer. When the consumer wants to authorize a service or payment, he or she requests the fiscal worker to process the authorization or payment. • Vermont and Alaska have used systems in which vouchers or checks are given to consumers who then purchase services themselves. • The Nebraska Commission for the Blind, the New Mexico Commission for the Blind and the Iowa Department for the Blind, among others, allow blind consumers to choose their place of training in other states. Blind clients can go to other adjustment centers as part of their IPE. These methods place the consumer in control of the relationship with the vendor and give the consumer the responsibility for finding the best service provider for the money and the “biggest bang for the buck.” There are always alternative ways to do any task or accomplish any objective. VR programs must put less emphasis on controlling the services and greater emphasis on service delivery methods in which consumers direct their own rehabilitation. Production Naturally, VR programs try to serve as many persons as possible with limited resources and without sacrificing quality. The Rehabilitation Act requires that professionals embrace informed choice that will lead to quality employment outcomes, but current systems often demand that professionals control the process for efficiency and speed. Services are structured to give consumers options, but rarely are they structured to give consumers control. Control is therefore a tension point between empowerment and production/efficient case movement. It is a struggle to find the correct balance. To see the effect that empowerment has on case services, Washington State Division of VR (DVR) conducted a study. The study compared the Participant Empowerment Project (PEP), one of the seven national choice grants, to a local DVR office in the same geographic area. The study identified 80 individuals at PEP and selected a control subject for each within the DVR local office caseload. Each control was “matched” for age, gender, ethnicity, and disability. The study then examined the successful rehabilitations, consumer wages, cost of service, and overall time in service. The study found that PEP rehabilitated a greater proportion of cases than did the traditional program. PEP consumers received a significantly higher average wage than did the DVR consumers and PEP services cost less than DVR. Consumers in both programs spent about an equal amount of time in their respective programs. This data indicates that actively working to empower consumers does not adversely affect production. If there is any drop in production, it more likely occurs during the initial period when counselors seek efficiencies in new service delivery techniques. (Gallagher, Cooper, and Blair, in-house study, 1998) Provider Certification Chapter 7 will address in detail the role of community providers in empowering consumers. Here we will explore the impact of certification on consumer empowerment. The Federal regulations regarding service providers are surprisingly flexible. As a matter of fact, in the Amendments of 1998, Congress removed requirements pertaining to the development of standards for providers, leaving it up to the states to decide what standards to apply. Federal regulations only require states to use providers that are accessible, hire affirmatively, have the ability to serve individuals with limited English proficiency, and have alternative modes of communication. Additional requirements are left to a State’s discretion. Many State VR agencies have chosen to place additional requirements on service providers. Most have developed accreditation standards that are either state-based or national (such as Commission on Accreditation of Rehabilitation Facilities (CARF)) and have chosen to certify only those providers who have been accredited by such bodies. Does this guarantee that consumers will receive quality services that meet the unique needs of individuals? Do accrediting bodies ensure that organizations actively support consumer empowerment? Although VR agencies pride themselves on their ability to individualize services, most service provider systems have evolved to providing a menu of standard services. Providers often develop their services based on what state agencies will pay for, need or want. Consumer needs and wants are often not a large part of the equation. Consumers rarely have an active role in authorizing services in the provider relationship. They are left out of the negotiations and frequently are offered counselor requested services which may or may not meet their needs. Yet consumers frequently do not have the option to walk away from the deal and find another certified provider who will negotiate with the consumer and support consumer empowerment. Indeed, none of the available certified providers may actively support consumer empowerment. Often, in some rural areas, no other provider is available. The more empowered consumers become, the more likely they are to find the traditional provider system unacceptable. On the other hand, state agencies have a responsibility to consumers to have community providers that provide quality services. So, what is the correct balance a state agency should strive for? The PSG believes that there are criteria that could be put in place to help balance the responsibility for qualified providers with the consumer’s need for providers that view the consumer, not the state agency, as their customer. The following are some strategies and ideas that will help agencies and consumers find the right balance. These ideas include, but are not limited to: • Service outcomes are consistent with what the consumer requested. • Consumers are treated as the customer and as such receive copies of paperwork, as appropriate, that traditionally would be sent to VR counselors only. (Examples include reports of services provided, outcomes achieved, any data or observational notes taken during service delivery, etc.) • Agreed-upon work is performed in the targeted timeframes. • Providers willingly negotiate cost, timeframes and services with consumers. • Providers willingly tailor their services to meet the unique needs of the consumer and enhance the consumer’s options. • The consumer indicates satisfaction with the service as a condition of payment. • Information shared by providers about their services is clear, accurate and user friendly. The strategies and ideas outlined above are not meant to be an inclusive list but starting points. VR administrators must be willing to rigorously examine the areas that state VR agencies should control, the areas that consumers should control, and the areas that should be jointly controlled. The clarity of these decisions will demonstrate the state VR agency’s commitment to empowering its staff and consumers. The Challenge of Change Among the most recent challenges facing the public VR program are the folding in of the Rehabilitation Act into the Workforce Investment Act (WIA) of 1998 and the passage of the Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA). How public rehabilitation defines itself and its partners within these systems is at a crucial juncture. These new federally created structures pose daunting challenges for VR administrators and the consequences of any missteps in the collaboration process can seriously impact services to persons with disabilities. The PSG believes empowerment must be part of the VR identity. A holistic view and empowerment set VR apart from all other employment programs. It seems that public VR has sometimes felt threatened or has struggled to see the value in working with the workforce investment system. Some have expressed concern that the one-stop system will usurp public VR and replace it with a generic system that does not meet the needs of individuals with disabilities. On the other hand, some workforce system partners have not understood the specialized needs of the disability community and have seemed to reject the “uniqueness” claim in favor of “one size fits all.” The result of these divergent perspectives is a “dance” of pretending to cooperate with each other, yet not truly collaborating in the best interest of persons with disabilities. The well–established individualization of the VR program serves as a model for other workforce partners. Over time, the workforce system has the potential to meet the employment needs of many individuals with disabilities, particularly those whose disability is not significant enough to require the multiple and specific services offered by VR. As advocates for the inclusion of individuals with disabilities in all aspects of community life and public services, VR professionals must encourage the workforce system to build services that are not only accessible and user-friendly, but are empowering to consumers. It is a difficult balance for public VR administrators to work in partnership with the one-stop system to create empowering services for consumers while taking care that VR remains a unique entity that meets the employment needs of individuals with disabilities whom the one-stop system cannot adequately serve. Public rehabilitation is charged with serving persons with disabilities, particularly the most significant disabilities, but resources prevent the public rehabilitation program from being able to serve all the consumers who need employment services. The one-stop system offers an alternative in which VR can partner to ensure that individuals with disabilities are empowered to access the appropriate system to meet their needs. Ticket to Work legislation was designed by the Social Security Administration (SSA) to expand options for its benefit recipients. The “ticket,” which can be assigned to a specific provider within the employment network (EN), offers choice to an individual with a disability in the selection of his or her preferred provider. Each state public VR program has the option to be an EN provider along with other providers. Offering choice alone, however, does not lead to empowerment. The public VR program can set the standard for empowerment by providing quality services in a system that prioritizes the consumer’s “informed choice” and offers maximum opportunities for individuals to reach their optimal career goals and independence. The public VR system can serve as a leader and role model for EN providers to customize and structure their services to empower consumers. Both the WIA and TWWIIA have a potential impact on the future of public VR. In the current environment, Congress could take public VR in a variety of directions. VR administrators must make sure Congress understands the VR program and how it differs from other employment programs while working in partnership with them. This PSG believes that empowering VR consumers offers us the opportunity to re-examine and redefine rehabilitation. It is what distinguishes us from other employment programs. A focus on the individual and lifelong empowerment through a set of comprehensive and specialized services separates public VR from generic employment programs. If public VR is to remain viable in the future, we must emphasize and embrace this distinction with pride and sustain an environment that empowers VR consumers. Political support from a committed disability community will be important in marketing the ongoing success of this program. The PSG believes that a system designed to empower consumers will not only result in excellence of service, but also create a dedicated and loyal constituency; a constituency whose collective voice will magnify our advocacy efforts. Measuring Organizational Success The current methodology for measuring success of the public VR program is primarily based on the production of employment outcomes. This methodology contributes to placing control of the VR process with the counselor and the organization, rather than the consumer. Providing the right to take risks and the right to fail contributes to empowerment, but includes a disincentive to the counselor whose success and performance are measured in terms of employment outcomes. In order to create programmatic success measures that support empowerment, this study group recommends the addition of qualitative measures for increased self-direction to align the system’s needs with those of the consumer. This shift would require a change in how the performance of individual counselors is measured. Instead of the current system that relies heavily on statistical outcomes alone, this PSG recommends use of a system that measures increased capacity to be self-directed as a specific outcome measure. The PSG also recommends serious consideration of a 360-degree approach to counselor performance measurement. That is, the counselor’s performance assessment includes input from consumers, peers, service providers and the supervisor. Designing new ways to measure success to incorporate and emphasize empowerment will take new thinking. VR administrators and professionals have worked for some time in a system that traditionally looks at “26 closures” as the bottom line. While this study group did not have the time to devote to solving this issue, we believe finding new ways to measure success is critical to realizing the goal of empowering our consumers. We recommend a national task force be formed to examine and test new ways to measure success and ultimately reframe how we define success. Conclusion The current methodology for measuring success of the public VR Program is primarily based on legislative requirements and Office of Management and Budget (OMB) common measures. For VR counselors this equates to the production of employment outcomes. This methodology contributes to placing control of the VR process with the counselor and the organization, rather than the consumer. Providing the right to take risks and the right to fail contributes to empowerment, but includes a disincentive to the counselor whose success and performance are measured in terms of employment outcomes. In order to create programmatic success measures that support empowerment, this PSG recommends the addition of qualitative measures for increased self-direction to align the system’s needs with those of the consumer. This shift would require a change in how the performance of individual counselors is measured. Instead of the current system that relies heavily on statistical outcomes alone, the PSG recommends use of a system that measures increased capacity to be self-directed as a specific consumer outcome measure. We also recommend serious consideration of a 360-degree approach to counselor performance measurement. That is, the counselor’s performance assessment includes input from consumers, peers, service providers and the supervisor. Study Questions 1. Which of the following are important components of empowerment: (a) Employment (b) Economic self-sufficiency (c) Independence (d) Inclusion and integration (e) All of the above 2. Which of the following are not important for the VR counselor to consider in their efforts to empower a consumer: (a) Housing (b) Transportation (c) Food (d) Medical care (e) None of the above 3. To begin a counselor/consumer relationship in an empowering fashion, the counselor must: (a) Focus on the consumer’s problems or deficits (b) Take the lead as a problem-solver or resource manager (c) Focus on what the consumer can do, not what he cannot do (d) Be viewed as the expert (e) Always defer to the consumer 4. To integrate empowerment into everyday business practices, VR administrators must: (a) Encourage counselors to use the flexibility inherent in the Rehabilitation Act (b) Restructure service delivery systems to give more control to consumers (c) Seek innovative ways to help counselors view consumers holistically (d) Provide in-service training and innovative projects that highlights awareness of disability culture, rights and history (e) All of the above 5. Use of a counselor performance system that measures consumers’ increased capacity to be self-directed as a specific outcome measure aligns the system’s needs with those of the consumer. True False