Chapter 7 Empowerment and Community Partners Introduction Much thought and attention have focused on what needs to change in vocational rehabilitation (VR) in order to ensure that services are empowering to persons with disabilities. Discussions in this document have covered the full gamut from policies and procedures (including payment processes and counseling techniques and strategies) to what the consumer can do to be empowered. For all the worthiness of the discussion, it is limited without some thought being given to how community rehabilitation programs (CRPs) and the numerous systems consumers must orchestrate impact empowerment. Empowerment is an internal process that is felt and defined by each consumer. Yet every one of us knows how systems can make people feel powerless and insignificant, regardless of how empowered they might be in other situations. This chapter will examine how CRPs and other systems impact empowerment. It will identify some of the elements that impact VR consumers being empowered and what needs to change. Control A key element to being empowered is the ability to believe that a person has control over his/her life, choices and environment. Viktor E. Frankl illustrates this in his book Man’s Search for Meaning as he creates control of his experience in the Nazi concentration camp by framing it in terms of “am I worthy of this suffering?” (1984) The ability to feel that one has control is a critical component of human dignity regardless of the environment. The independent living movement understood this concept long before empowerment was part of the wider VR vocabulary. Current VR regulations prescribe the type of information a consumer must receive when choosing a provider, but they do not specifically address how to help customers take control of their decisions (Cooper, 1998). As a rehabilitation system, we need to think collectively how to structure the system so that consumers can take control of the process. This is difficult because it not only demands that control traditionally held by professionals is placed back in the hands of consumers, but it also assumes that all consumers want that control. Many consumers are not empowered when they seek rehabilitation services. They are at a fragile point in their lives. Making choices in their rehabilitation and being empowered can feel overwhelming. The fear of making a decision and taking responsibility for one’s action is scary for many people, not just individuals with disabilities. In Fyodor Dostoevsky’s The Brothers Karamazov, the Grand Inquisitor suggests that people are afraid of choice and invent systems to avoid having to take responsibility for their own actions. They find it easier to follow a ritual or have someone tell them what to do. When consumers allow providers to control the choices, it is the provider’s fault if things do not work out. Whereas if consumers make their own decisions and something goes wrong, then consumers must accept the responsibility. Choice and empowerment can be a double edged sword (Cooper, 1998). Information Information is power. It is one of the foundations of informed choice. If consumers have the information they need, then they will make decisions that work for their lives and the issues they face. Access to the information is one of the seven principles underlying the WorkForce Investment Act. Every system that consumers deal with, from disability-related services to generic services to private for-profit services, understands the importance of clear, accurate information. Advanced degrees are offered in how to market information. Yet being sure a person understands the information is rarely an integral part of any systems process. At best, information is provided in a variety of formats. Perhaps due to time constraints, little thought is given to how consumers process information. The assumption is that they understand the information unless it is overwhelmingly clear they do not. Many consumers, rather than being empowered, have learned that they get more from the system when they act like “good clients.” A necessary component of understanding information is being able to process it, question and check other sources. Consider our common reaction when someone gives us information with which we disagree. We often question the source or ask someone else. This is rarely a behavior of “good clients,” but it is a behavior of empowered consumers. It should be an essential function of the VR counselor’s job to help consumers structure how they are going to get the information they need from VR and other systems. Consumers should be encouraged to question information until they understand it. Community Rehabilitation Providers State VR agencies often spend up to half their budgets on purchasing services from providers (Cooper, 1998). CRPs are defined as individuals or organizations that sell their services to public VR agencies. They do this by providing services such as job development, job coaching, travel training, assistive technology, vocational evaluation, independent living services, etc. They have a contractual relationship with the public VR agency. Due to the intensity of their services, CRP staff are frequently more familiar with the consumer than is the counselor. Their contact is usually more hands-on, in close proximity and often occurs in a variety of situations that allow the provider to obtain a daily working knowledge of the consumer. As a result, consumers often identify the provider as the professional who assists them in achieving their vocational goal. These factors place the CRPs in an influential position. A CRP’s policies and philosophy about empowerment of consumers and who the true customer is greatly impact the extent of power and control that CRP places with the consumer. In the current system, VR personnel contract with CRPs to purchase services or outcomes (i.e: job placement). “Empowerment” currently is not a purchased service or outcome, and public VR has offered limited direction to CRPs in this arena. Certainly many CRPs are in a position to make conscious choices on how they will facilitate empowerment. The expectations over the last ten years have slowly changed. Empowerment and self-determination have become buzz words. CRPs are questioning what part of empowerment is their responsibility. They are starting to implement strategies that can help empower consumers. The strategies may be as simple as providing information about the organization’s services and staff in a format that consumers can easily understand. For example, Washington Vocational Services, a job placement provider in Washington State, implemented strategies to help consumers be empowered. Rather than assigning the consumer to a staff person, consumers can choose who will provide their services. A staff profile was created for consumers. Each profile includes the staff person’s education, experience, expertise and philosophy of working with consumers. The profiles provide consumers with a basic level of information. It helps consumers to frame questions they will want answered to choose the right staff person for them. This method places the consumer in the position of being a customer. Being viewed as the customer is an important element in being empowered. Being a customer creates a different set of expectations than does being a recipient of services. Consider how evaluation or community assessment information is frequently shared with consumers. The information is usually prepared for the VR counselor, making him or her the customer. It is rarely an empowering experience for the consumer. Instead, it can feel like the professionals talk to each other and then tell customers what is wrong, even if it is in a very professional, neutral manner. Often, consumers withdraw from the process and only hear what is wrong with them. Imagine empowered consumers in the above scenario. They would expect the provider to listen to and answer to them. They might even demand a different type of evaluation, one that was customized to highlight the contributions they could offer. A number of people with significant disabilities can do very little in a traditional evaluation and need a customized tool to highlight their talents. VR needs to develop tools that highlight consumers’ strengths and are tailored to the unique needs of the individual. When the consumer is truly the customer, a paradigm shift will occur. Traditionally, CRPs have built their businesses by establishing vocational counselors as their customer base. The relationships between CRPs and vocational counselors create interdependence that can exclude the consumer. In reality, each of the three needs the others to succeed. Many CRPs perceive the VR counselor as the true customer, rather than the consumer, because the counselor is the one who authorizes the services, negotiates the cost, and pays the bills. There is a direct correlation between power and money regardless of the field: business, politics or rehabilitation. The one who pays the bills gets attention. Not to say that one must have money to be empowered, but it does help in our society. This PSG believes a primary strategy for empowering consumers is to place the purchasing power with the consumer. For example, once an IPE has been agreed upon by the consumer and the counselor, give the control of the agreed upon case service dollars to the consumer. The consumer can then pay the provider or school with their case service dollars. The consumer would negotiate with the provider for service costs and become the paying customer. This levels the playing field by placing the real control and power with the consumer. If the consumer pays a school directly, the relationship between the consumer and the school changes. No longer will individuals be identified as public VR consumers by the school. It will be the consumers’ choice to reveal such information. They will choose whether or not to use the services of the Office of Disabled Students. Having control over one’s own information and when to reveal it is an important element of empowerment. One-Stops In FY 2004, of the 80 State VR agencies, 40 were on an order of selection, compared to 39 agencies in FY 2003 and 37 in FY 2002. Eligible individuals who do not meet the State VR agency’s order of selection criteria, i.e., individuals on waiting lists, must be referred to other appropriate Federal and State programs, including other components of the statewide workforce investment system (Section 101(a)(5)(D) of the Act and 34 CFR 361.37. During the past several years, many State VR agencies have developed Memoranda of Understanding relating to the operation of the one-stop service delivery system that includes a description of services, how the costs for services and operating costs of the system will be funded, and methods for referrals. In some states, collaborative relationships have evolved that may prove to be beneficial in assisting individuals with disabilities to achieve employment outcomes without entering the State VR program. There is an ongoing need for cross training of all one-stop partners on the unique mission, purpose and service delivery system of the public VR program. Individuals with disabilities must be afforded the choice as to whether they want to receive services through the generic employment services program offered through the one-stop center, or the more structured and comprehensive State VR agency service delivery system. Personnel employed by both the generic employment programs and the State VR program need to discuss how they might best empower individuals with disabilities so that they may make an informed choice as to where they would like to receive services. Below are a few examples of strategies that could be implemented: • The VR counselor could provide the consumer with information about the one-stop. Consumers need to know what to expect from the services the one-stop offers. The VR counselor should provide information that describes the one-stop environment to consumers. The information could include how busy the center is, noise level, any accessibility issues that exist, classes that are available and software programs that could assist in a job search. • The VR counselor could provide consumers with a checklist or script that walks them through the steps they could take at the one-stop and how to request any needed accommodation. • The one-stop could hire and train greeters to direct individuals as they come through the door so that every person coming into the one-stop receives personal contact. • VR Staff and the one-stop staff could jointly teach classes that focus on being an empowered consumer, career planning, interviewing. Conclusion Those working in public VR have an opportunity and a responsibility to expand and facilitate empowerment. We in VR must look beyond our current system to not only the services we contract for but the services that consumers use in conjunction with public VR, such as one-stop centers, schools, public assistance, Section Eight housing, etc. Creating a VR system that empowers consumers is not easy and demands using the creativity of those working in the system and the willingness to make mistakes in the effort. We know that it requires public VR to be holistic and have a global perspective. We can begin empowering consumers by implementing some or all of the following strategies: • View empowerment as an integral part of our outcomes, as employment is. In other words, empowerment should drive services as much as employment. • A common language around empowerment must be developed. Everyone in the rehabilitation field must understand what it means to empower a consumer and how it is accomplished. • Have consumers, rather than the VR counselor, contract with CRPs. • Have consumers pay for their own CRP services with their case service dollars. • Have the CRP write reports to the consumer and send those reports directly to the consumer with a copy to the VR counselor. • The Rehabilitation Services Administration should award demonstration dollars to design new service models and determine how to measure empowerment. • Make empowerment part of the standards and indicators for the VR program since we all respond to the criteria by which we are measured. • Improve and expand Public VR’s ability to collaborate with other systems. Establish strong relationships so that other systems listen to our suggestions on how to improve the ability of all services to empower consumers across agencies. Creating a VR Service delivery system where all elements of the system empower consumers will require careful thought and commitment from everyone. It demands that public VR take the lead in helping create a system where consumers are in control of their services. Study Questions 1. A key element to being empowered is believing: (a) You have control over your life, choices and environment (b) That you can spend your plan dollars on your dreams (c) That you as the customer have the final say in all decisions   2. It is common place for public VR to buy tailored assessments that are customized to the individual.  True        False   3. A primary strategy for empowering consumers is to place the purchasing power with the consumer. True        False   4. Creating a public VR system that empowers consumers demands: (a) A lot more money (b) A holistic approach (c) Creativity (d) All of the above (e) (b) & (c)   5. Some good strategies for empowering consumers are: (a) Give them whatever they say they need (b) Give the consumer the information and let them decided (c) Have consumers, instead of the VR counselor, pay for their CRP services with case service dollars (d) All of the above (e) None of the above