A.
Final Report directed to those who have stakes in the issue of
Persons with disabilities and their legitimate
representatives are in general far more interested than others in a
demonstration of the potential of “choice.”
This is not only true historically with respect to those who were the
driving forces to achieve the special authorizing legislation, but it is the
overwhelming result of experience by Career Choice project personnel.
Almost all participants, in group after group, at every site, expressed
appreciation of Career Choice’s central focus on helping them make their own
decisions; many volunteered in discussions (without prompting) the contrast with
prior contacts they had had at VR offices.
There was a widespread understanding among participants that the extent
of paperwork they did was partly to document/prove to Congress and others that
people with disabilities can make good decisions for themselves.
Project staff contacts with state VR agency personnel were usually
cooperative with respect to participants, but ranged widely from cooperative to
interested to not even curious with respect to program outreach/collaboration.
This report is formally the required “final
report” to RSA, but it is purposely more broadly oriented toward all those who
have interests and stakes in the primary and central questions.
The primary question to be answered by this project,
in accord with the legislation is: Is it possible that a process with (greatly)
enhanced “choice” by participants will have good employment related
outcomes?
The answer from Career Choice is unequivically yes,
it is possible, at least for those who want to have substantial control of these
decisions and are willing to do the work that taking responsibility entails –
thus making choice “ informed.”
That this is the seriously posed primary question
illustrates the degree to which it is generally believed that the currently
dominant systems have restrained “choice,” and that there is genuine
uncertainty about whether employment outcomes would decrease if persons with
disabilities were more extensively making their own decisions about program
options, employment/ career/ entrepenurial options, needed services/products and
where to obtain them, etc. Implicit
(sometimes explicit) in the underlying assumptions about those systems which
have restrained choice is the view, however charitably held, that persons with
disabilities are not able to make judgments about their own future as well as
others are able to do for them. There
was a time when this perspective of some may have been partially based on the
view that persons with disabilities are not fully human.
Our observations lead us to believe that today the “do for”
perspective is deeply imbedded in federal/state structures, professional
training programs and much of the caring general public.
Moreover, the dominant current system is in part a
derivative of the medical model where the prescriber is the expert.
It is a professional counselor – individual client model that is
dominant. Careers and organization
and professional status of the employees of the current model are challenged by
a participant-facilitator model.
One question the legislation did not really ask is whether enhanced
“choice” is an independent value in addition to employment outcomes; the
Declaration of Independence and other basic government decisions answered that a
long time ago for this nation. But,
even many of those who appreciate the independent values of both 1) employment
outcomes and 2) “choice”, believe most of the system resources should be
tightly focused on outcomes and are willing to be patient with the incremental
manner in which “choice” is implemented – in accord with the new
legislation – among the major services systems.
Persons with disabilities who were participants did not express patience.
So, part of the challenge of these demonstrations was
to prove (if it be true) that program approaches with real and informed
“choice” can help persons achieve appropriate (good) outcomes.
And, it was important in our view to demonstrate that this could be done
at relatively similar (or lesser) costs. (We
did not build a model in which “choice” components were add-ons to an
existing system, as was the basic strategy of some other demonstrations where
“choice” inevitably costs more.)
So, the answer this demonstration gives is that it is
possible…but that the scale of change required of the major existing systems
to embrace, construct and manage comprehensive “choice” programs is very
extensive. It is unlikely this can
be done without substantial conflict between the legislative and executive/
administrative systems and unlikely it will be done unless persons with
disabilities and their representatives make it a crusade.
Demonstration Project.
We began the demonstration project fully believing it
was possible; that is, assuming a positive answer to the above discussed primary
question. Thereafter, the real
central question becomes what are the principles, methods, techniques,
attitudes, etc. which will facilitate participants making their own decisions,
facilitate participants being “informed” concerning their choices, and which
will cause the program to work efficiently and effectively.
Almost all of the major methods were described in the application, but
experience made for substantial improvements and refinements and an overall
final model which is far more broadly applicable/ workable.
The different settings for most of the seven
“choice” demonstration projects certainly broadens the available insight
about implementing “choice.” One
strength (with obvious limitations) of the Career Choice project was that it was
a mostly stand-alone model able to implement, without resistance from other
parts of the overall “rehabilitation” system, whatever it believed would
work – and it did so. There are
very different techniques, etc., but essentially the same measurements of
employment outcomes. In contrast,
most other demonstrations which were closely linked to or actually part of state
VR agencies had to concentrate more extensively on how to make their model work
despite the differences; several other Project Directors in numerous conference
calls described the various difficulties they had with the systems in which they
were working and the efforts they made to persuade or compromise or give it more
time.
Career Choice had the luxury and burden of creating
and testing a whole internally integrated system. It was not obligated by law, as major systems are, to
implement specific techniques/methods, etc.
The insight that gradually became more clear is that helping to
facilitate for participants a process through which they more fully “inform”
the employment related choices they must make is the first core design
principle.
A second design principle was to structure a helping
process so that program leadership persons had no authority over individual
participants including no control of potentially available resources, and so
that program leadership persons had a stake in assuring that the program was
conducted as was promised, but did not have even an assumed responsibility for
the employment outcomes of participants.
Likewise, program entry by participants was a
carefully designed gradually more specific three stage process culminating in
each participant formally signing a Participant Commitment which included a
description of the work he/she would do and a clear understanding that
obtaining/retaining appropriate employment is the participant's responsibility.
This is the mainstream way and it had mainstream results.
Some participants chose to use various forms of “placement” services;
most did not.
It is helpful that a model such as this have a
history – group after group – of good employment outcomes in order to
convince leadership that they can facilitate the process with integrity, and
believe that if they do so most participants themselves will ultimately take
responsibility for their future and achieve results. This worked well, but those leadership persons with the
strongest prior experiences of “case management” generally had the most
difficulty with Career Choice - which purposely “lets go” in order to
stimulate participants to more quickly take control of their future.
This is a wholly different approach to that which VR systems call “case
management” and concludes with “closure.” Career Choice contacted each
participant every six months for two years, collecting data on employment
status, etc., but did not have a developed system to provide more services if
needed. Instead, it simply informed
such individuals where they might obtain specific additional services.
Strikingly, only a few needed more help; this suggests that a
comprehensive system fully embracing choice would have program options such as
the Career Choice model which are chosen at the beginning and which are
relatively inexpensive, but also have more extensive follow up options for those
for whom the initial programs prove to be insufficient.
The central method for Career Choice was a group
program. The Development Team, Inc.
had extensive prior experience since 1984 in similar group programs, but this
model was more comprehensive, it included additional services, and it was tested
among a much broader span of participants.
The group model is certainly not thought to be the only viable method to
enhance choice, but it is a marvelously fitting process to facilitate:
empowerment, self-development of a comprehensive plan, putting the
“informed” into “informed choice”, and distributing insight in a
non-authoritarian fashion through group dialogue.
Moreover, it is a genuine way in which participants engage in helping
others as well as being helped – almost always in a deeply caring fashion. A carefully planned sequence of subjects and activities, all
with employment opportunities as the ultimate purpose, schedules and structures
the remarkable adaptability of real groups to be relevant to their members.
In the initial application, the Project reserved the
option of not admitting a person to a group after interview even though the
person desired to participate. That
option was never exercised, although it is still felt that some unique set of
circumstances could make its use legitimate.
Those who could benefit greatly from a program like
Career Choice are a far broader population of persons with disabilities than is
usually assumed. We structured an
outreach and self assessment process so that we were not dependent on referral,
but on the informed choice of those exploring whether they thought Career Choice
would help them achieve their choice of employment/career.
If, after reading material about the program, a telephone discussion, and
a face to face interview they believed they would benefit, and were willing to
commit to the work, they were eligible and invited on a first-come, first-served
basis. While we envisioned the need for some persons to decide to
obtain various types of professional evaluation prior to deciding whether to
participate, very few and very modest additional tests, etc. were ever needed to
make the decision whether to participate. There
is a strong view jointly held by most of the leadership of “choice” projects
that traditional VR eligibility and evaluation processes are at best not better
than the ones we employed even though VR processes are essentially too costly,
too long, and too anti-choice.
Career Choice involved as participants, persons who
were at least as “severely” impacted as similar disability clients in VR –
probably more so because higher percentages in Career Choice were on SSI or SSDI.
(We did not deal extensively with those who are mentally retarded or
mentally ill and, therefore comparing overall average statistics is misleading.)
There is a widespread underlying assumption among many in the
professionally dominated systems which, to simplify is: the more complicated and
extensive and impacting the impairments and symptoms of disability, the more
necessary to have professional expertise to assess and counsel in order to
determine an appropriate plan for employment.
Apart from those whose brain disease or permanent impairment severely
prevents cognitive function (but including most persons with diseases of the
brain or brain injury or brain limitations), it is unlikely that experts, even
very sensitive expertise with all the right attitudes, can make overall
decisions for individuals which are better than those individuals – under good
circumstances, such as participating in a Career Choice program - can make for
themselves.
Choice is not simply a value alongside of employment
outcomes; it is a key principle guiding the methods of achieving employment
outcomes. (And, when implemented
choice is the basis of the joy and satisfaction a young disabled female artist
finds in now doing that which the primary rehabilitation system earlier told her
was frivolous.)
Overall, the key leadership function which underlies
the workability of “choice” is to construct a system which does not
purposely or consciously compromise the choice concept, and then manage and lead
in a way which fully honors the underlying policy.
Neither participants nor leaders will trust half hearted or phony
commitments to this principle. If
you are going to try to make it work you must embrace it.
The potential long term value of this choice demonstration project is that it documents a group program model, very strong in informed choice, which could stand alongside other services options offered to persons with disabilities, and it demonstrates that local sponsorship options are broad. Especially, it demonstrates how CIL’s could perform a vital role, wholly within their philosophy, related to employment of persons with disabilities.