## Archived Information

## 

## AMERICAN REHABILITATION

Autumn 2004

## Empowerment

How Empowerment Changed My Life

"I don\'t have to live in my car anymore..."

Enhancing Personal Empowerment of People With Psychiatric Disabilities

Self-Determination and the Empowerment of People With Disabilities

Slaying Dragons: Building Self-Confidence and Raising Expectations
Through Orientation Center Training

Empowering People With Disabilities Through Vocational
Rehabilitation Counseling

**Our Commitment to the Empowerment of Individuals With Disabilities**

Joanne Wilson

Commissioner

Rehabilitation Services Administration

Empowerment is multidimensional. It means, among other things, having
decision-making power, access to information, the opportunity to make
meaningful choices, understanding of rights and responsibilities, a
sense of hope, raised self-esteem and control over the direction of
one's life. Since assuming my responsibilities as Commissioner of the
Rehabilitation Services Administration, I have traveled a great deal,
speaking at length about empowerment, a concept that I believe is
absolutely fundamental to the future of our public rehabilitation
program and our consumers. In the course of my conversations with
colleagues in the rehabilitation field, I have encountered varying
responses to this priority. Many professionals appear to be as committed
as consumers themselves to the goal of consumer empowerment. Others,
however, have been less enthusiastic, claiming that empowerment doesn't
work or that empowerment of consumers poses a threat to the professional
relationship and role of the vocational rehabilitation counselor in
providing effective services.

This edition of American Rehabilitation brings together some recent
perspectives on the empowerment of people with disabilities. It includes
personal accounts from individuals with disabilities about empowering
people and the events that have significantly shaped their lives. In
addition, the implications of empowerment as it relates to employment
outcomes are explored from the professional point of view, with research
data, facts and figures. And, to stimulate and provoke further thought
and discussion, there are a few straight opinion pieces.

Admittedly, empowerment is not a totally new concept. It has guided
recent amendments to the Rehabilitation Act and is a cornerstone of
consumer advocacy. As we encounter and begin to embrace and value the
process of empowerment, the nature of our professional roles and the way
we conduct our business will inevitably change. Strength is implied in
the word empowerment, and by empowering our consumers I believe we are
strengthening our programs and efforts to secure high-quality employment
and opportunity for persons with disabilities.

As you read this edition of American Rehabilitation, I hope that you
will find some useful strategies and ideas that will be empowering to
you and our many rehabilitation partners --- consumers, professionals,
educators, service providers and advocates --- as we work to maximize
opportunities and realize positive change in the lives of persons with
disabilities.

By empowering our consumers I believe we are strengthening our programs
and efforts to secure high-quality employment and opportunity for
persons with disabilities.

**AMERICAN REHABILITATION**

Volume: 28

Number: 1

Autumn: 2004

# The weakest ink is BETTER than the strongest memory

-   How Empowerment Changed My Life

> "I don\'t have to live in my car anymore..."
>
> Marcie Kelley

-   Enhancing Personal Empowerment of People With Psychiatric
    Disabilities

> Patrick W. Corrigan, Psy.D.

-   Self-Determination and the Empowerment of People With Disabilities

> Michael L. Wehmeyer, Ph.D.

-   Slaying Dragons: Building Self-Confidence and Raising Expectations
    Through Orientation Center Training

> Sandy Tigges, Ph.D.

-   Empowering People With Disabilities Through Vocational
    Rehabilitation Counseling

> John F. Kosciulek, Ph.D., CRC

-   Commissioner's Memorandum

> Consumer Organizations: Important Resources for VR Agencies
>
> Joanne Wilson

-   Freedom for the Blind: The Secret is Empowerment, a book review

> Allen Harris

American Rehabilitation (USPS 463-610) is the official publication of
the Rehabilitation Services Administration (RSA), Potomac Center Plaza,
550 12th Street, S.W., Washington, DC 20202-2800. Use of funds for
printing was approved by the Office of Management and Budget on June 23,
1975.

Opinions expressed are those of the authors and do not necessarily
represent the policy of the Department of Education, the Office of
Special Education and Rehabilitative Services, the Rehabilitation
Services Administration, or the editor, and you should not assume
endorsement by the federal government. Manuscript and article
suggestions are welcome.

Write to:

Editor, American Rehabilitation

Rehabilitation Services Administration

Room 5071 PCP

550 12th Street, S.W.

Washington, DC 20202-2800

Telephone: (202) 245-7500

FAX: (202) 245-7592

E-mail: frank.romano@ed.gov

POSTMASTER:

Send address changes to American Rehabilitation

Room 5071 PCP

550 12th Street, S.W.

Washington, DC 20202-2800

U.S. Department of Education: Rod Paige, Ph.D., Secretary

Office of Special Education and Rehabilitative Services: Troy Justesen,
Acting Deputy Assistant Secretary

Rehabilitation Services Administration: Joanne Wilson, Commissioner

Editors: Frank Romano, Suzanne Mitchell

Production Editor: Juliette Rizzo

Design and Production: Geoffrey P. Rhodes

Editorial Review Board: Troy R. Justesen, Ed.D., Richard Melia, Ph.D.,
Thomas Kelley, Timothy Muzzio, Ph.D., RoseAnn Ashby, Lex Frieden, Connie
Pledger, Ph.D., and Charlene Dwyer

**How Empowerment Changed My Life**

**"I don't have to live in my car anymore ..."**

Marcie Kelley

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

It is through my personal and professional experience that I write this
article on empowerment. I have thought about empowerment a lot
throughout the years. I have researched it, lived with it and lived
without it. I have shared empowerment with others. Without it, I have
been utterly alone. Empowerment is simple, yet complex. It pertains to
people with psychiatric disabilities and to people with any disability.
I learned this through working at a center for independent living.
People with disabilities face many obstacles that can be disempowering.
It is evident that when the disability community unites and rallies
behind a cause, we become more empowered citizens.

I am writing this for the individuals, and for people who know
individuals, who feel disempowered and alone. I hope that presenting
some of the ingredients necessary for empowerment will facilitate
self-directed growth and freedom.

I am the director and systems advocate for the Mental Health PEER
Connection (MHPC), a member of the Western New York (WNY) Independent
Living Project, Inc., family of agencies located in Buffalo, New York.
MHPC is a peer-driven advocacy organization dedicated to facilitating
self-directed growth, wellness and choice through genuine peer
mentoring. MHPC employs 21 full-time employees who have a mental illness
or have recovered from a mental illness. Our peers are located in the
state hospital, the county hospital, the county jail, the public mental
health system and in vocational programs. We represent fellow mental
health consumers by performing individual and systems advocacy to
increase the rights, freedom and independence of those with mental
health disabilities. We advocate with mental health housing providers,
the Social Security Administration (SSA), state and local legislatures,
the New York State Department of Vocational and Education Services for
Individuals with Disabilities (VESID), public mental health providers in
Erie County, the Erie County Department of Mental Health, the Erie
County Department of Social Services and the City of Buffalo Mental
Health Court and Family Court. We conduct several self-help and mutual
support groups weekly. In 2002, we provided independent living skills
training, housing assistance, benefits advisement, advocacy and mobility
training to over 350 individuals with psychiatric disabilities. We work
with mental health housing providers and the county mental health
department via the Community Services Board and advocate for people who
are being mandated into treatment under the Involuntary Outpatient
Commitment Law in the state of New York.

As the systems advocate, I have guided our center in advocating for what
our consumers want by holding several town meetings on consumer issues.
This information is disseminated to various stakeholders via position
papers. Based on the information gathered at these town meetings, our
agency has sponsored a freedom march, informational pickets, parity
picnics and legislative breakfasts. We have demonstrated for greater
freedom. We held letter-writing campaigns, call-ins, speak-outs,
community open houses, a self-help luncheon and a managed care
educational campaign. We helped to implement the Consumer Advisory
Council in the Buffalo Psychiatric Center, the Erie County Medical
Center Psychiatric Department, Gold Choice Family Medicine (a managed
care health insurance for people with psychiatric disabilities) and a
human service survey that "pokes a hole in West Side neighborhood group
arguments that the community is over saturated with social service
organizations" (Tan, 2000).

We have directed over \$70,000 for peer services to improve the quality
of life of Erie County, New York, mental health recipients. Through
MHPC's efforts, many people with mental health disabilities in Erie
County have improved their living standard. In addition, I serve as the
co-chair of the Erie County Anti-Stigma Task Force.

In 1990, I came to the WNY Independent Living Project for help. I was
living out of my car in the streets of Buffalo. I feared everyone due to
my mental illness --- multiple personality disorder (MPD). When I told
the independent living counselor this, she did not look down on me and
she did not seem to judge me. She expressed concern that I was living on
the streets and that I feared that someone was going to kill me for no
logical reason. She told me about housing that was available and
convinced me to stay with a friend until the housing was arranged. She
seemed to care. I listened. She showed me respect. She told me of other
services that were available to me because I had a disability. She said
that she knew this because she had a disability too. I did not
understand it all. But she said that it was OK and that I could come
back if I needed any other information or assistance. She gave me
something that I had lost a long time ago. It was something that I never
thought I would have again. She gave me hope.

I was severely abused as a child. I developed personalities to deal with
it. I could not run away physically, so I ran away in my head. The
personalities protected me from the abuse. As an adult, I was no longer
being abused. But I still had the personalities --- over 280 of them. I
did not know that I had these personalities until I was 25 years old,
when I was diagnosed with MPD while in a psychiatric hospital. Often, I
was suicidal. I never knew why. I went to psychiatric hospitals for
help. I have been in psychiatric facilities on 12 different occasions,
for months at a time. The more I went, the more I realized that they
were not helping me. I felt increasingly disempowered. The hospital
staff members were getting frustrated with me as well. At one point, I
was on 13 different types of psychotropic medications: anti-depressants,
anti-psychotics, anti-anxiety, anti-everything. Eventually, I was on
medications to counteract the medications. I was constantly looking
outside of myself for something to fix me: the hospital, the doctor, the
pill or the therapy.

Then the most disempowering thing happened to me, changing my life.
Ironically, it led to my becoming empowered. Many people with
disabilities are driven into the disability rights movement due to their
own disempowering experiences. This was true for me. I was hospitalized
for the eleventh time. I was suicidal and a danger to myself and to
others. I did not care if I lived or died. I was receiving disability
benefits. I was not in contact with my family and had no support
network. I was utterly alone. The hospital "recommended"
electro-convulsive therapy (ECT). This is when they shock the brain to
help a person overcome depression. As a trauma survivor, this idea
terrified me. The hospital staff developed a treatment plan without my
participation. The plan consisted entirely of me making a decision to
get ECT. In front of a room filled with hospital staff, I was asked to
sign the treatment plan. I signed the plan, but I was terrified. I
wanted to leave the hospital because it was clear that they wanted to
electrocute me. Most psychiatric hospitals are locked down. This
hospital was no exception. They would not let me leave, so I tried to
escape twice. The first time, I jumped through a nurses' station window.
The second time, I pushed a doctor out of the way as she entered the
ward. Each time, I was "taken down," shot up with Thorazine and put in
restraints in a seclusion room. I could not scratch my nose or go to the
bathroom without help. This was the most disempowering time in my life.
I could not really figure out how I had gotten to this point, but I had.
I had no control over my life. I had no decision-making power. I did not
understand that I had rights. I felt totally alone. This was the turning
point in my life. I decided that I was sick of this and that I was not
going to take it anymore. I begged the hospital staff to let me out of
the restraints. I promised them that I would not try to escape again. I
pretended I was happy. I said that I did not feel suicidal anymore. I
thanked them for helping me to not hurt myself by trying to escape. I
said I was ready to start my life again. So they let me out. I was
finally free.

But I was not better. I held onto the hope that I found at the WNY
Independent Living Project. But that was all I had. I wanted to get
better and I was ready to do what it took to get better. My outpatient
counselor told me about a hospital in Texas that treated trauma
survivors, especially those with MPD. I was hesitant to go to another
hospital, but I wanted to get better. I took the risk and went to Texas
in 1994. This hospital was like no other. They accepted Medicare. During
previous hospitalizations, the only activity was taking medication. It
was very boring. But this hospital was very different. I saw a
psychologist for one hour, five times per week. My personalities worked
out their issues during these sessions. I attended group therapy, clay
therapy, anger therapy, occupational therapy, cognitive therapy and art
therapy. I saw a psychiatrist every day. I got better. I was with people
just like me. There was camaraderie. We sang songs of hope. We had
privileges to go outside.

I left with the desire for a new beginning. I returned to Buffalo with
the ambition to begin my life. Later that year, I saw a brochure for an
advocacy and empowerment training event for people with psychiatric
disabilities sponsored by the WNY Independent Living Project. I signed
up and attended. I was scared. I did not know what to expect. But it was
great. The presenters spoke of their psychiatric disabilities and
hospitalizations and their current role as advocates. They talked about
empowerment. It was like they lit a fire beneath me. I was not alone. So
many people with psychiatric disabilities were fighting for their
rights. They had lost their rights, as I had. I did not know that others
had gone through it as well. As I looked at the presenters, another idea
popped into my head. If they could get paid to advocate, I could do it
too. I applied for a job as a peer advocate at the WNY Independent
Living Project and began employment in 1995.

To this day, my hospitalizations have ended. The advocacy and
empowerment training opened my eyes to the disempowering care systems
for people with psychiatric disabilities. And the WNY Independent Living
Project opened my eyes to the many disempowering systems serving the
disability community. I began to understand that the whole disability
community is a civil rights movement. I saw this on many levels: through
my own experience, through my employees' experiences, through our
consumers' experiences and through the communities' attitudinal
barriers.

Empowerment must begin with the individual and then expand to the
community as a whole. I have witnessed many subtle (and not so subtle)
actions that take power away from the disabled individual. However, it
is apparent that the Erie County Department of Mental Health is trying
to shift the pendulum of power from the professional mental healthcare
provider to the consumer of services. The power of the psychiatrically
disabled individual is in the hands of the individual, with one
exception: When the individual is a danger to himself (or herself) or
others, that person may lose his right to choose, his right to freedom
and his right to decide what treatment is best for himself.

I met Judi Chamberlin at the 2001 National Association for Rights
Protection and Advocacy (NARPA) Conference held in Niagara Falls, New
York. I was very impressed by her insights on empowerment for
psychiatric survivors. Her article A Working Definition of Empowerment
(1999) is enlightening. She gathered a dozen leading American
consumer/survivor self-help practitioners to form the advisory board of
the Center for Psychiatric Rehabilitation. Its first task was to define
empowerment for psychiatric survivors, which it did as 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 just
yes/no, either/or).

4\. Assertiveness.

5\. A feeling that the individual can make a difference (being hopeful).

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 can do; and learning to
redefine our relationship to institutionalized power).

7\. Learning about and expressing anger.

8\. Not feeling alone, feeling part of a group.

9\. Understanding that people have rights.

10\. Effecting change in one's life and one's community.

11\. Learning skills (e.g., communication) that the individual defines
as important.

12\. Changing others' perceptions of one's competency and capacity to
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 characteristics are necessary for one to become
empowered. Often, these aspects are overlooked in government systems,
health care systems and the rehabilitation system. I see this as a
person who has used the system since the 1980s, as an employer of 21
full-time staff with psychiatric disabilities and as a systems advocate
for people with psychiatric disabilities in my county. It is my
experience that these systems of care are not consciously aware of the
fact that they are disempowering. They are trying to help individuals,
their intentions are good, but the results of their policies, rules and
regulations can be devastating. This is due to misunderstanding,
numerous waiting lists, piles of paperwork requirements and budget cuts.
The person with a disability gets left out of the picture when, in fact,
he or she is supposed to be the center of the picture. That is why the
400 independent living centers throughout the United States work so
well. People with disabilities have "been there." Often, a person needs
a road map to navigate these care systems. Independent living centers
have the road maps and they have gone the distance.

Having decision-making power.

This is key for the person with a disability. Often, systems of care
make decisions about what is best for the person with a disability
without even talking to the person. Often, our society does not allow
the person with a disability to make decisions. Once, I was helping an
individual who was deaf to find an apartment. The landlord decided that
the individual would not like living in his building. Taking away the
decision-making power can be subtle, as well. While I was having dinner
with a friend who uses a wheelchair, the waitress asked me what he
wanted for dinner. Government systems of care take away decision-making
power as well. While on disability, I applied to VESID for services. My
goal was to become a chef. They told me I was unemployable. It was a
good thing that I did not listen to them!

Having access to information and resources.

There is so much information available for people with disabilities that
it is hard to access all of it. The opposite is true as well. Many
people with disabilities live in utter poverty and isolation. They have
no access to information. For example, the Erie County Behavioral Health
Vocational Task Force Final Report states that:

"Many individuals with disabilities can now work without the immediate
loss of cash benefits or health insurance through Medicaid or Medicare
through Work Incentives. Benefits Advisement is readily available in the
community. Agencies such as Neighborhood Legal Services provide this
service and some Behavioral Health Agencies have Benefits Advisors on
staff. However, many consumers and providers are unaware of these
current rules and are also unaware of where to get accurate advisement
(2003, p. 11)."

Thus, many people with psychiatric disabilities fear returning to work
or going to work for the first time because they fear losing their
benefits (M. Weiner, Erie County Commissioner of Mental Health, personal
communication, March 6, 2003). On a more human rights level, many people
with disabilities who live in institutions lack the information they
need regarding their rights in that institution, such as those stated in
advanced directives, the Olmstead Decision, etc. As a systems advocate
in Erie County, I have heard many psychiatric survivors talk about being
institutionalized. They did not know their rights because when they were
given the sheet of paper with their rights on it, the paper was thrown
into a secured locker with all their personal belongings.

SSA causes difficulty in accessing information and resources as well.
When I returned to work after being on Social Security Disability
Insurance (SSDI), I knew that I had a nine-month trial work period; but
I was not sure when the trial period started and when it stopped. I just
kept receiving checks. Then, I received a letter from SSA that stated
that they overpaid me by \$10,080. They asked that I return the
overpayment by a certain date. That letter almost sent me back into the
hospital.

Having a range of options from which to make choices

(not just yes/no, either/or). 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? When I was homeless, I
had to decide to spend my disability check on either medicine or food.
When I was in the psychiatric hospital, I was given no option other than
ECT. Many housing providers offer housing under the condition that the
person with the disability continues to take his (or her) medication or
he will be kicked out. In Buffalo, the winters can be very cold, and
medications can have serious side effects. I believe that there is
always room to work things out, to find out what people with
disabilities want and to discover what their hopes, dreams and
aspirations are. It is not necessary to threaten to take them away if
they do not cooperate. There is no need to manipulate. It is better to
contribute to the conspiracy of hope, to problem solve and negotiate, to
obtain a win/win solution.

Assertiveness.

Standing up for one's rights without fear of retribution is a very
empowering act for a person with a disability. When necessary, people
with disabilities must depend on others. When people with disabilities
think for themselves, it is a wonderful process. Many have lived their
lives with caretakers who have made decisions and plans without asking
for input from the person with a disability. When that person becomes
assertive and determines what he or she wants, new freedom exists. Many
care providers do not understand this. In the mental health system, when
people with psychiatric disabilities assert themselves, they are often
called "non-compliant." It is important to discuss with the person with
the disability what he (or she) wants and to understand why he wants it.
Communication is key. There are many good reasons why a person with a
disability does not want to follow a certain plan, especially when the
plan was developed without the involvement and consent of that person.

Feeling that the individual can make a difference

(being hopeful). When I was on disability, I was ashamed of not
contributing to society. I was ashamed to socialize with others, in fear
that they would ask me what I was doing for a living. I was embarrassed
at the supermarket when I used food stamps to pay for my groceries. I
felt totally useless. When I started working at the Independent Living
Project, I began to feel like I was making a difference. People with
disabilities do not want to be a burden, no matter how moderate or
severe the disability; but often others see the individual with
disability as a burden. All disabled individuals have something to
offer, can make a difference in someone's life (if not many lives) and
can be contributing members of society.

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 can do; learning to redefine our
relationship to institutionalized power). Often, people with
disabilities and the people who work with individuals with disabilities
only see the disability, not the person. For years, I saw myself as a
"multiple," not as anything else. And that kept me down. I saw no
recovery. I saw no life outside of therapy. I had no natural supports.
My supports were based on group and individual therapy. I had no passion
and no desires. When I became an advocate, I began to see myself as
something other than my disability. In Erie County, the Department of
Mental Health encourages representation of people with psychiatric
disabilities in the planning and implementation of services for people
with mental health issues. I have been attending such planning meetings
since 1995. At first I was very intimidated to be in a planning meeting
with professionals and non-disabled individuals. But, over the years, I
have noticed that they have their quirks too. I have as much right to
say what needs to be said as they do. I noticed that they did not view
me as a mental case but as a person with insight and experience
regarding what people with psychiatric disabilities want.

Learning about and expressing anger.

I have learned that anger is a healthy and natural emotion. People with
disabilities have many things to be angry about: Americans with
Disabilities Act violations, reduced health insurance coverage for
durable medical equipment or personal care attendants, no state health
insurance parity legislation, housing discrimination, stigma, and all of
the personal issues that people in general get angry about. When a
person with a disability gets angry, some find this unacceptable. I
remember getting angry in a hospital because a nurse would not give me a
nighttime medication so I could go to sleep. I lost my privileges for
three days. Some people with disabilities have been institutionalized
all their lives or lived in sheltered environments. Some were never
taught appropriate ways to express angry feelings. This built-up anger
and explosive energy sometimes results in their institutionalization in
a psychiatric hospital (for evaluation) or jail. It is important to
remember that people with disabilities have feelings too, and one of
those feelings is anger. They should be taught appropriate ways to
express it.

I think that "Not feeling alone, feeling part of a group" is one of the
most important qualities of empowerment that Chamberlin cites. Many
individuals with disabilities are isolated through living alone, in
special housing, with family or in institutions such as psychiatric
hospitals or nursing homes. Institutionalized people are often separated
from each other by a door or wall, which allows for little contact with
the outside world. I remember living in a one-room apartment while I was
receiving SSDI benefits. I spent my days going to therapy. I felt
totally alone. I did not know that there were others just like me. It is
very important to network with other people. The Independent Living
Project provides opportunities for this on a continuous basis: first, by
constantly updating the mailing list and asking everyone served if they
want to be on the mailing list; and second, by mailing notices of
self-help groups, workshops, town meetings, special events, action
alerts, etc. During events and presentations, I introduce myself by
saying a little bit about my past, and then the group participants talk
about issues that concern them. Friendships are formed, support is
developed and that feeling of loneliness disappears.

Understanding that people have rights.

MHPC has an educational program on mental health recipients' rights. It
is amazing to see how many people with psychiatric disabilities do not
know about their rights. This is most clearly seen regarding housing
rights in our county. Many people with psychiatric disabilities do not
realize that they can leave their current housing. However, if they do
leave, their standard of housing would decrease dramatically. New York
State has a law called the Involuntary Outpatient Commitment Law, or
Kendra's Law, which can force non-compliant mental health consumers into
outpatient treatment if they have had many recent hospitalizations or
incarcerations and are deemed unable to survive in the community by
themselves. Erie County has successfully avoided taking people to court
by encouraging the recipient to agree to the program. Recipients are put
into the "Diversion Program," which provides increased case management
services. Basically, it is the same program recipients would get if they
went to court but without the legal representation. MHPC is concerned
that some of these people are forfeiting their rights and may not meet
the criteria because they do not have proper legal representation.
Because we have found that many mental health consumers do not know
their rights, we developed a workbook, we go to places where mental
health consumers congregate and we provide education on their rights.

We also have rights regarding our vocational and rehabilitation goals.
VESID assists those with disabilities in becoming more productive
members of society. However, VESID has limitations and budgetary
restraints. When they told me I was unemployable, I did not know that I
had the right to seek help from the Client Assistance Program (CAP).

Effecting change in one's life and one's community is another quality
for empowerment.

In past years, many disabled people simply existed; they were warehoused
and overly medicated, with no expectations of recovery or improvement.
As the disability rights movement grew, more people with disabilities
demanded more out of life than medication and maintenance. They had
goals, aspirations and dreams. They wanted to change and improve their
lives. As people with disabilities accomplish these goals and continue
to effect change, their communities change slowly. When people in my
life expected change in me, I did change. But if the expectation was not
there, I did not change. Because of the changes in my life, I am
effectively altering the community in which I live today. I am affecting
understanding and attitudes toward people with mental illness in Erie
County, New York.

Chamberlin includes learning skills (e.g., communication) that the
individual defines as important. It is crucial to communicate with the
person who is disabled to find out what skills the individual wants to
learn and what help he or she wants. During one hospitalization, I was
painting a stained plastic window (they did not allow glass). I put the
window away and moved to another part of the ward. I did not paint the
item well, but I tried. When I returned to the room, a nurse was
painting my window. I said, "What are you doing? That's mine." She said,
"I was just helping." I did not want her help. I wanted to learn it
myself. But, she did not communicate with me. At the Independent Living
Project, I have learned that we do not do for others what they can do
for themselves, unless they ask. It is crucial not to assume what the
individual wants to learn. It is important to know what the individual's
goals are and how he or she wants to achieve them.

Changing others' perceptions of one's competency and capacity to act is
a quality that Chamberlin cites.

I believe this is directed toward the people working with the person
with a disability. Just because I acted irrationally or de-compensated
last week does not mean that I am always that way. Those of us with
disabilities want to be judged on our abilities today, on our record and
on our integrity, not on our weakest moment. Like all people, we change,
grow and learn from our experiences.

Coming out of the closet.

I think this quality pertains exclusively to people with hidden
disabilities, such as people with mental disabilities. The surgeon
general reports that one in five Americans is affected by mental illness
during his or her lifetime. Many people are ashamed to have a mental
illness and fear the discrimination and stigma that occurs regularly.
But as more people share their disabilities, the more commonplace it
will become. The more people talk about it, the more acceptable it
becomes. The more acceptable it becomes, the more people will get help.
This may result in fewer deaths by suicide each year.

Growth that is never ending and self-initiated is cited by Chamberlin as
an empowering quality. People with disabilities should have the same
rights as any other person to pursue their dreams to the fullest extent
possible. As providers of services to people with disabilities, we
should be facilitators of such dreams and potential.

Increasing one's positive self-image and overcoming stigma.

This is Chamberlin's final quality of empowerment. Throughout Erie
County, people with mental illness suffer from stigma that they have
internalized, and by internalizing they affect their self-image and
self-esteem. They become the disability. This is often exhibited in
their vigilance about confidentiality --- about anyone finding out that
they might have a mental illness. There are many good social and
internal reasons for this. I have dealt with parents who lost their
children in custody battles with their spouses because the judge found
out that they have a mental illness. People with mental illness have
lost their jobs because they spent time in psychiatric hospitals. In our
region, there is a shelter for battered women, but they will not accept
women with mental illness. The shelter managers say that they do not
have the staff to deal with this issue. But if everyone who has a mental
illness spoke out, maybe, just maybe, discrimination would decrease. As
part of the Erie County Anti-Stigma Task Force, we launched an
advertising campaign with the following message: "Mental Illness Is
Treatable, Treat It That Way." We must overcome stigma in order to
improve the cultural and civil rights barriers that the disabled
community in America faces today.

What has been my most empowering experience so far? In December 2000, I
purchased a house in the suburbs of Buffalo. It is my first house. Ten
years ago, I was homeless. I became a bona fide homeowner with all the
rights and responsibilities that come with it. In spring 2001, I had a
barbeque for the entire MHPC staff at my house. If I can do this, so can
others. That is what empowerment is all about: achieving goals and
sharing them with others.

References

Tan, S. (2000, August 22). Human services survey finds support. The
Buffalo News, City & Region Section, p. 1.

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

Erie County Department of Mental Health. (2003, March). Erie County
Behavioral Health Vocational Task Force Final Report. Retrieved May 27,
2003, from
www.erie.gov/health/mentalhealth/BehavHlthTFVocSummaryReport.pdf

**Enhancing Personal Empowerment of People with Psychiatric
Disabilities**

Patrick W. Corrigan, Psy.D.

Dr. Corrigan is Professor of Psychiatry and Executive Director,
University of Chicago Center for Psychiatric Rehabilitation,
Tinley Park, Illinois.

For most of recorded history, people with psychiatric disabilities have
struggled with maintaining personal power over their lives. The
centuries-old battle against stigma is the best example of this
struggle. The ancient Greeks first gave voice to the concept of stigma
noting that those who were marked with mental illness were often
shunned, locked up or, on rare occasions, put to death (Simon, 1992).
During the Middle Ages, people with mental illness were viewed as living
examples of the weakness of humankind, what goes wrong when people are
unable to remain morally strong (Mora, 1992). This kind of attitude led
families to hide away those with psychiatric disabilities from public
view. Not until the 18th century did asylums and treatment centers
emerge for mental illness. Before that time, those with serious and
persistent mental illness were often locked up with criminals. Although
the struggle for personal power has vastly improved during the last
century, people with mental illness still encounter stigma and
disempowerment. The recently released report by President George W.
Bush's New Freedom Commission for Mental Health (2003) issues a clarion
call for practices that facilitate consumer empowerment.

The goals of this paper are threefold:

1\. Provide a working definition of empowerment as applied to the lives
of people with psychiatric disabilities.

2\. Identify community and service systems barriers to empowerment.

3\. Describe guidelines and other system enhancements that facilitate
personal empowerment.

"There is no medicine like hope, no incentive so great, and no tonic so
powerful as expectation of something tomorrow."

> O.S. Marden
>
> 1850-1924

Understanding Personal Empowerment

Empowerment has been defined as personal control over all domains of
life, not just mental health care but also decisions related to such
important areas as vocation, residence and relationships (McLean, 1995;
Rappaport, 1987; Segal, Silverman & Temkin, 1995). This is especially
important in societies that stigmatize persons with psychiatric
disabilities. Western cultures, for example, seem to rob these persons
of authority over treatment plans and life decisions (Brockington, Hall,
Levings & Murphy, 1993; Link, Cullen, Frank & Wozniak, 1987). Research
on the construct of empowerment leads to a better understanding of
effective services and their impact on quality of life (Corrigan &
Garman, 1997). Rosenfield (1992), for example, found a measure of
consumer empowerment correlated with quality of life. Rogers,
Chamberlin, Ellison and Crean (1997) completed a more comprehensive
series of studies on mental health consumer empowerment with their
Empowerment Scale. Items for the Empowerment Scale were first identified
by a panel of 10 leaders in the consumer movement and then validated by
participants in six self-help programs. An unpublished analysis of 261
responses to the scale, conducted by Rogers et al. (1997), yielded seven
factors that describe the construct:

• self-efficacy,

• powerlessness,

• self-esteem,

• effecting change,

• optimism/control over future,

• righteous anger and

• group/community action.

These factors are intercorrelated and seem to correspond with two
superordinate factors that describe the impact of empowerment on persons
with schizophrenia and on their community (Corrigan, Faber, Rashid &
Leary, 1999). These are:

• The impact of empowerment on the self is such that, despite societal
stigma, empowered consumers endorse positive attitudes about themselves.
They have good self-esteem, believe themselves to be self-efficacious
and are optimistic about the future.

• The impact of empowerment on the community is manifested by the
consumer's desire to affect his or her stigmatizing community. Consumers
believe they have some power within society, are interested in affecting
change and wish to promote community action.

Readers may note that terms like empowerment and disempowerment are
frequently interchanged in the remainder of this article. In part, this
interchange represents empowerment as a continuum (Corrigan, Faber et
al., 1999; Rogers et al., 1997). At the positive end of the continuum
are people with psychiatric disability who, despite their disability,
have positive self-esteem and are not significantly encumbered by a
stigmatizing community. At the negative end are people who report being
unable to overcome all the pessimistic expectations about mental
illness. One might think that a paper about empowerment would be
presented in the affirmative voice (e.g., What might people with mental
illness, service providers and the community at large do to promote
personal power?). Unfortunately, much of the research and literature on
empowerment looks at the negative impact of its absence (What happens
when a person with mental illness is disempowered?) (Corrigan & Garman,
1997; Rapp, Shera & Kisthardt, 1993). Hence, I have chosen to intertwine
what is known about disempowerment with what is the vision of
empowerment to address the themes of this article.

Barriers to Empowerment

Stigma is the societal embodiment of disempowerment; it promotes
expectations in both the public at large and individual consumers that
people with mental illness are incapable of the responsibilities
commensurate with living independently. Results of two factor analyses
on more than 2,000 English and American participants revealed three
common themes to stereotypic attitudes about mental illness that endorse
this assertion (Brockington et al., 1993; Taylor & Dear, 1981):

• Fear and Exclusion. Persons with severe mental illness should be
feared because they are dangerous. As a result, they should be kept out
of the community and housed in institutions.

• Authoritarianism. Persons with severe mental illness are
irresponsible; life decisions should be made for them by others.

• Benevolence. Persons with severe mental illness are childlike and need
to be cared for.

These kinds of widespread attitudes have two effects on the power of
persons with mental illness. First, they rob people of the opportunities
that are central to recovery and a quality life (e.g., good jobs,
comfortable income, nice housing and good friends). Perhaps of equal
concern are the effects that stigma has on some people with mental
illness. People living with serious mental illness who are immersed in a
culture that endorses psychiatric stigma begin to believe this stigma
and question their own capabilities for independent living (Wahl, 1995).
Because self-stigma has such an insidious impact, its effects on
empowerment are examined first.

Some people experience stigma as a private shame that diminishes the
person's self-esteem (Corrigan, 1998; Corrigan & Watson, 2002). This
kind of shame leads to self-doubt about whether the person is able to
live independently, hold a job, earn a livelihood or find a life mate.
Even though they may have mastered their symptoms and disabilities,
people with mental illness must also overcome stigmatizing reminders
that they still have a disability or are not useful members of society.
One recent study showed the breadth of discrimination experienced by
mental health consumers (Wahl, 1999). The majority of 1,300 respondents
reported discouragement, hurt, anger and lowered self-esteem as a result
of their experiences. An earlier study by Link (1982) showed the loss of
self-esteem that results from stigma also has practical consequences.
Participants in their study reported that being publicly labeled with a
psychiatric illness had a negative impact on work and income.

Activities That Facilitate Empowerment

Research has yet to examine strategies for overcoming self-stigma, but
several candidates show promise (Corrigan & Watson, in press).
Internalizing the kind of messages embodied in recovery may help to
diminish self-stigma. Cognitive restructuring may also prove useful in
helping people learn to challenge stigmatizing views they may hold of
themselves (Corrigan, 1998; Haaga & Davison, 1991). Alternatively,
self-stigma will diminish as a person's sense of empowerment improves.
Seven sets of strategies have some empirical support for facilitating
empowerment of people with mental illness (Corrigan & Lundin, 2001).
Each of these is discussed more fully in the remainder of this article.

Empowerment may be construed narrowly in terms of control over the
services that help people deal with their disabilities (e.g., problems
related to mental illness). It may also be understood more broadly in
terms of command over all spheres of one's life, such as succeeding at
work, in relationships, during play, spiritually and in as many other
domains as possible. Table 1 lists seven strategies that facilitate
empowerment. These are loosely ordered from those that should now be
obviously accepted by the mental health system --- they represent the
base of empowerment approaches (like issues about collaboration and
consumer satisfaction) --- to those that are visionary and need to be
more widely accepted and disseminated, such as consumer operated
services and participatory action research.

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 Collaboration
>
> A 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 Services
>
> At the absolute minimum, programs that empower participants need to be
> satisfactory to those participants. Moreover, these programs need to
> obtain input from consumers to ensure that program design reflects
> their interests.
>
> 3\. Lodges and Clubhouses
>
> For more than three decades, the mental health system has supported
> treatment programs that were largely operated by persons with mental
> illness. Lodges are residential programs in this mold; clubhouses are
> social and work programs.
>
> 4\. Supported Housing and Employment
>
> Instead of the consumer going to the professional, the best treatment
> occurs when the professional travels to the consumer and all the
> places in which consumers need assistance. Provision of services in
> the person\'s home or community is the hallmark of Assertive Community
> Treatment (or ACT). Services in real-world job sites is supported
> employment.
>
> 5\. Consumers as Providers
>
> Many persons with mental illness are deciding to return to school,
> obtain necessary credentials, and assume jobs 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 Services
>
> There 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 similar
> concerns.
>
> 7\. Participatory Action Research
>
> Much of the current research on psychiatric disability and
> rehabilitation reflects the perspective of the existing mental health
> system. Persons with mental illness must be equal partners in the
> research enterprise for future studies to represent the differing
> interests of consumers.

1\. From Noncompliance to Collaboration

Many mental health providers must drastically reconceive their viewpoint
about the consumer's relationship with treatment for empowerment to
occur (Fenton, Blyler & Heinssen, 1997; Ruesch & Corrigan, 2002). The
old notion was that persons with mental illness should comply with all
aspects of treatment: Professionals knew best; anything that strayed
from the prescribed treatment program represented unclear thinking due
to the illness. Failure to comply was indicative of unconscious
motivations to resist health. Mandatory treatments and a coercive system
rested on these assumptions. Research evidence seemed to clearly support
these conclusions. Depending on the study, anywhere between two-thirds
and three-quarters of persons did not take their psychiatric medications
as prescribed. More than half of all participants in rehabilitation and
similar psychosocial programs did not complete the treatment plan as
agreed (Cramer & Rosenbeck, 1998). These data suggest resistance is
rampant and significantly undermines treatment of serious psychiatric
illness.

Considered another way, however, these data might be perceived to yield
completely different conclusions. Rather than 66 to 75 percent of
persons taking their medication incorrectly, perhaps two-thirds to
three-quarters of all mental health providers are prescribing drugs
poorly. Lack of compliance may not represent resistance by a person with
psychosis as much as meager treatment by the mental health team. Equally
sobering statistics suggest that more than 70 percent of all persons who
are prescribed any kind of medicine (not just psychoactive drugs) do not
take it the way the doctor ordered (Rogers & Bullman, 1995). Clearly,
incorrect use of medication is not solely a problem of persons with
mental illness.

Rather than expecting persons to passively comply with care --- be it
psychiatric care or general medical treatment --- what is needed is more
enlightened practice that calls for collaboration between providers and
consumers. An equal partnership occurs when each party learns from the
other: Providers learn about the nature of specific symptoms and
corresponding disabilities from the person challenged by these problems;
consumers learn the range of treatments and services that address these
problems. How do providers and consumers foster a collaborative working
relationship? More than a decade ago, we wrote a paper that outlined
strategies for answering this question (Corrigan, Liberman & Engel,
1990), which are summarized in Table 2. As outlined in our earlier
paper, these strategies have some empirical support for fostering the
collaboration among providers and consumers.

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).

2\. Consumer Satisfaction and Other Input on Services

One of the assumptions of empowerment and collaboration is that
treatment teams will design interventions and programs that are pleasing
to participants. Hence, assessing consumer satisfaction is a minimal
requirement for establishing programs that empower consumers (Corrigan,
1990; Dickey & Sederer, 2001). Although one might think this to be a
straightforward process, assessing consumer satisfaction is more
difficult in actuality. Hence, some rules for developing a useful
consumer satisfaction scale are provided. Unfortunately, concern with
consumer empowerment frequently ends with the assessment phase. Programs
collect data on satisfaction but subsequently fail to use it in
improving services. A second important part of this process is to
consider ways to use information from satisfaction evaluations to
further improve the setting.

What goes into a consumer satisfaction scale? When evaluating consumer
satisfaction, satisfaction scales should consider four categories or
domains: the service environment, the service providers, specific
interventions and preparation for autonomy (Corrigan, 1990; LeBow,
1982). What is the quality of the service environment? Are the rooms
pleasant, including the decor, lighting, furniture and temperature? If
food is provided, is it tasty and plentiful? How are the service
providers? Are they knowledgeable and competent in their specific jobs?
Are they approachable, respectful and friendly? Can the consumer
interact with them informally? How useful are specific interventions
themselves? Do they provide the consumer with the needed skills? Do they
help the consumer better understand his or her goals? Do they provide
the resources and support needed for goals? Is the service preparing the
consumer for autonomy? After finishing the program, is the consumer
better able to live independently? Is he or she more hopeful about the
future?

Unfortunately, this approach to assessing satisfaction can lead to
"halo" or "devil" effects (Corrigan & Jakus, 1993a,b). Halo effects
occur when the consumer rates everything as satisfactory: The program
was great, the staff were great, the food was great, the building was
great, everything was great. Research has shown that halo effects are
very common in consumer satisfaction studies. Although some services may
indeed be satisfactory, rating everything highly does not help to
identify those components that need to be changed. Service providers
would not know where to put their efforts in improving services. Devil
effects are provided by people who are angry with the program. They rate
all components as highly dissatisfactory. The program was poor, the
staff was lousy, the food was rotten, the building was dingy, everything
really stunk. Like the halo effect, rating everything alike (in this
case, poorly) does not help providers focus on specific aspects of the
program.

To avoid this problem, consumers may be encouraged to compare a specific
program to another similar service in which the person has been involved
in the past (Corrigan & Jakus, 1993b). For example a counselor might
request the following from a client:

"Currently, you are participating in the Opportunities Program on
Supported Employment. Tell me another similar program you have
participated in the past. Write it here
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_. Now answer the following questions by
comparing your experience in Opportunities with this other program."

Research has shown this kind of comparative approach yields to better
differentiation among components of a program (Corrigan & Jakus,
1993a,b).

Having input on services. The full benefit of evaluating consumer
satisfaction will only be realized when providers use the results from
these evaluations to actually change services. Unfortunately, this kind
of program improvement is frequently done without consumer input.
Instead, treatment providers take the findings and decide how to improve
program aspects on their own. This kind of approach fails to promote
empowerment. The preferred way to handle findings from satisfaction
evaluations would be to involve participants in focus groups where they
discuss their concerns about aspects of the program and, more
importantly, provide recommendations for ways that the program might
improve (Rogers & Palmer-Erbs, 1994).

There are two essential roles to fill in these kinds of focus groups:
the leader and participating members (Morgan, Krueger & King, 1998). The
best leaders for these groups are other consumers who are trained to
facilitate these kinds of groups. Although traditional service providers
may have skills for running discussion groups like these, members might
be hesitant to speak freely because they believe the provider will be
biased in favor of the established program. Many consumers are able to
lead these groups after one hour of training. We do not have the space
here to consider the skills for a focus group leader; the interested
reader should consider such resources as Bernard Bass's and R.M
Stogdill's Handbook of Leadership (1990).

Focus groups should comprise six to eight members. A good mix of people
with different opinions should be invited to the focus group. Include
consumers at both ends of the scale --- persons who are fully satisfied
with the program and those who are highly critical --- as well as
individuals in the middle. In this way, a polite contrast of opinions is
possible. Prior to the meeting, leaders should develop a series of
questions to guide the discussion. These questions should be based on
the results of the consumer satisfaction evaluation.

3\. Lodges and Clubhouses

Consumers have obtained further control of the mental health system and
their world in two kinds of programs: lodges and clubhouses. In both
settings, people with mental illness have equal authority to that of the
professional staff in operating the program. Lodges were started in the
1960s by George Fairweather as residential and work communities for
persons recently transferred from long-term hospitals. Clubhouses
spontaneously emerged in New York City as a meeting place for people
recently discharged from the state hospital. Both of these models
represent consumer dissatisfaction with the way mental health providers
acted towards persons with mental illness. This dissatisfaction led to a
philosophy that clearly echoes the importance of empowerment.

The Fairweather Lodge: Living and working together. The lodge is made up
of persons with psychiatric disabilities who live and work together
(Fairweather, 1969). Typically, lodges form real-world businesses to
maintain themselves (e.g., janitorial services, bulk mailing, copy
centers, or temp agencies). Sometimes, lodges hire non-disabled people
who demonstrate expertise in areas needed to maintain the business. They
may also seek professional help to serve as "consultants" to lodge
members, to provide assistance in those psychiatric and rehabilitation
strategies needed to help members manage their symptoms and
disabilities.

The lodge program is built on several principles that clearly reflect
the spirit of personal empowerment (Fairweather, 1969). These principles
have been divided into two sets:

• those that help the consumer fill the role of lodge member (living and
working with peers); and

• those that help the lodge develop norms which make it a thriving
community (or what Fairweather called "a social subsystem").

People are more willing to embrace a role when they have a stake in it.
In other words, living and working with others has to satisfy what the
person wants and needs in his or her life now. This means the person
needs to have autonomy in his or her role within the lodge. At the
minimum, a person's role needs to be voluntary. People cannot be
court-ordered to a lodge or sent against their will. In addition, people
need the right to self-determination: namely, the opportunity to decide
for one's self how to meet his or her responsibilities in the lodge
community.

It is the nature of interaction that there be some hierarchy among
social roles. Some people need to be supervising others to make sure all
needs of the lodge are met. Another principle of lodge programs is that
all members have the opportunity to be promoted to leadership jobs and
thereby experience the benefits, as well as the demands, of different
roles throughout the hierarchy. At the same time, all roles within the
lodge must be filled. In this way, the community is assured that all
tasks of the lodge are covered.

There is an interesting contradiction between the goals of autonomy and
the demands of operating a residential and work community. How does the
lodge balance each person's right to self-determination with the
community's need to get all its work done? The second set of principles
suggests development of community norms that seek this balance. One of
the major rules of the Fairweather Lodge is "Members are encouraged to
do things as a group" (Fairweather, 1969). Proponents of the lodge
program believe that its strength lies in sharing both good times and
tough decisions among all members. Group discussion is central to the
empowerment and personal growth experienced in this setting.
Unfortunately, a second principle of the lodge recognizes that this
group must be limited in size. The community can only serve a small
number of people in order to meet their work and home needs
satisfactorily. This can be a sobering thought for some lodge members;
namely, that their community is closed to many others like themselves
who are also in need (Corrigan & Garman, 1997).

The success of the community occurs in a complicated balance between
norms. On one hand, the norms of the program must correspond with those
of the larger society in which the lodge finds itself. Basing lodge
rules on those in the larger society makes sense because these are the
rules with which community members are likely to already be familiar.
For example, "respect privacy" and "do not steal" should be two familiar
rules to most Americans and therefore be incorporated into the norms of
lodges in the United States. The lodge also needs to develop norms that
reflect the unique character of its community. For example, the prime
rule, "Members are encouraged to do things as a group," is not reflected
in Western society as a whole. However, proponents of the lodge program
believe this kind of norm is essential for the unique atmosphere needed
to develop a community of living and working peers. In like manner, each
community needs to consider as a group what other particular rules it
will adopt to meet the individual needs of its members.

The Fountain House: A clubhouse for persons with mental illness. During
the years after the end of World War II, many people were released from
Rockland State Hospital, located outside of New York City, with no
community connections. In order to survive, they would meet on the steps
of the New York Public Library to provide one another with resources and
support. Soon, the group gained notoriety and other persons released
from Rockland joined them in this makeshift society they called WANA: We
Are Not Alone. In 1948, the group bought a building through the generous
donations of a Jewish women's philanthropic group. The building had a
fountain in the back yard; hence its name, Fountain House. It was built
around a fundamental philosophy:

"Men and women with mental illness have the right to a life which
includes access to meaningful, gainful employment; a decent place to
live; a community of support; the opportunities for education and
recreation offered by the communities in which they live; and the chance
to be needed, wanted and expected somewhere everyday" (International
Center for Clubhouse Development, 1948).

Several values characterize the clubhouse. In some ways, these
principles overlap with the lodge model; in other ways, they reflect the
special charm of social clubhouses (Macias, Barreira, Alden & Boyd,
2001). Persons belonging to the clubhouse are members rather than
consumers. They have equal power with the professional staff hired to
support clubhouse activities, not only in daily operations but also in
decisions about budgetary issues. With membership comes responsibility.
All members are expected to contribute to some aspect of the clubhouse's
operations. Clubhouses are designed so that each member is essential for
efficient operation. The fully collaborative nature of staff and
consumer leads to all members being considered co-providers.

Clubhouses are open every day of the year. Unlike mental health centers,
which typically close for holidays, clubhouses are open for their
members to celebrate. Clubhouses also provide a wide variety of
opportunities, including housing, education, social support, recreation
and vocational training and placement. Services are never pressed upon
members. Rather, they are used as the individual sees fit. Clubhouses
operate according to a work-ordered day with normal 9 to 5 schedules
(Besancon & Zipple, 1995). Each day, members (consumers and staff alike)
decide among a variety of work units that comprise the necessary tasks
to keep the clubhouse running effectively. Work activities at Fountain
House have included horticulture, thrift shop, snack bar and dining
room, clerical work, education, and research. Participation in this kind
of activity reacquaints members with the demands of the work world as
well as its many benefits.

4\. Supported Housing and Employment

Even though lodge and clubhouse programs have many values that promote
empowerment, they still require consumers to go outside their home
"turf" to receive services. Programs of Assertive Community Treatment
(PACT) turned the service world upside down (Bond, McGrew & Fekette,
1995; Mueser, Bond, Drake & Resnick, 1998; Stein & Test, 1980). Instead
of demanding that consumers go out of their way to the offices of
providers, why not bring services to the consumers where they need it,
such as in their homes or anywhere that the consumers might deem
necessary for resources and support? PACT proponents believe the entire
range of services --- medications, psychotherapy, skills training, money
management and the rest --- can be and should be provided in the
person's home or community. A variation of this idea is supported
employment, where a job coach provides services alongside the consumer
at his or her place of work (Bond, Drake, Mueser & Becker, 1997; Drake
et al., 1999).

PACT and supported employment facilitate empowerment in several ways.
First, these programs are consumer-centered. Services are defined by the
needs of the consumer, not by the provider. Although this may seem
obvious now, this value was revolutionary when first proposed. In the
past, treatment plans reflected what was best for the consumer AND the
provider. Hence, a person would not be referred to an independent
housing program if it were outside the case manager's district. A
consumer would not begin competitive work until the agency had an
available job coach. Consumer-centered services remind the provider that
it is up to the agency to find the necessary resources and supports to
help consumers achieve their goals on their timeline.

PACT and supported employment are also strengths-oriented (Rapp, 1998).
This view differs from the disease model that dominates traditional
services. Proponents of the disease viewpoint believe that people are
defined by their symptoms and other weaknesses that need to be fixed
through treatment. The strengths model recognizes that people are
described by their skills, not their shortcomings. Awareness of these
skills is essential; these are the tools that people use to accomplish
their goals. Providers who are consumer-centered make interventions as
convenient and efficient as possible. Hence, PACT is comprehensive and
cross-sectional. That is to say, it provides services across all domains
of need: housing, finances, family, health care, spiritual matters and
recreation.

PACT and supported employment are also longitudinal. By this we mean
that the needed service is provided by a single team as long as the
person needs it. In the past, mental health providers used to have the
bad habit of ending services at times not convenient for the consumer.
Today, PACT and supported employment continue as the person changes
homes or moves in and out of institutions. Sometimes, services are
provided indefinitely. Mental health systems of the past had the unwise
practice of discontinuing community services for those individuals who
had to be hospitalized because of short-term psychiatric emergencies.
Unfortunately, these people had to start over with a new team when
released a few weeks later. The PACT and supported employment team
continue to offer support and resources even while the person is
hospitalized or involved in the criminal justice system (Bond, Drake,
Mueser & Becker, 1997; Mueser, Bond, Drake & Resnick, 1998).

Effective PACT and supported employment is accessible and available.
This means services are provided in places that are convenient to the
consumer, typically in his or her home or place of work. Moreover,
service is provided at times that make sense to the consumer. The
provider does not ask the person to stay home from work so that the
provider may come to the consumer's apartment to discuss shopping.
Instead, the provider comes in the evening when the person is home from
work and has eaten dinner.

5\. Consumers as Providers

What better way to influence the system that provides services than for
people with mental illness to assume jobs as providers in these
services? In this spirit, consumers have filled almost every conceivable
position in the mental health system (Mowbray, Moxley, Jasper & Howell,
1997; Solomon & Draine, 2001). Consumers have become job coaches, they
have worked on assertive community treatment teams and they have run
support groups. Consumers have also worked at all the professional
levels that comprise the treatment team, as psychiatrists,
psychologists, social workers and psychiatric nurses. Several well-known
consumer advocates have cut their teeth as mental health professionals.
Daniel Fisher is a psychiatrist; Fred Frese is a psychologist. Each of
these gentlemen has gone through more than 20 years of struggling with
the psychiatric disabilities resulting from schizophrenia.

Having consumers as mental health providers yields several significant
benefits for the individual consumer as well as for people with mental
illness in general. At the broadest level, consumers as providers
challenge stigmatizing notions about people with mental illness. Public
understanding of consumers reaches beyond the simple idea that they are
psychiatric diagnoses. Despite their disabilities --- or perhaps because
of them --- people with mental illness are able to support peers with
mental illness by providing them with knowledge about psychiatric
symptoms, skills to deal with these symptoms and resources to meet their
goals. These abilities challenge the notion that people with mental
illness are incompetent.

Consumers assume roles that traditional providers frequently will not do
or are not able to do well. Many jobs related to supported employment
and programs of assertive community treatment require long hours and
travel into places that are less than desirable. Most people are not
willing to meet these challenges unless they have experienced the same
struggles. There are some tasks that only consumers can provide. One of
these is the "I've been there too" kind of support. Those in the throes
of depression or anxiety receive immeasurable benefits by hearing from a
peer who has been in the same situation, survived the challenge and
thrived to become a mental health provider. There is one last aspect to
consumers becoming providers which must be highlighted: Providing help
to others reaps significant benefits for the helper. This is the
principle of mutual help that is discussed more in the next section.

6\. Self-Help, Mutual Assistance and Other Consumer-Operated Services

Consumer-operated services differ from the earlier service model in that
they are entirely developed, operated and provided by and for people
with mental illness (Davidson et al., 1999; Solomon & Draine, 2001).
Consumer-operated services are not just another form of clinical
treatment (Luke, Roberts & Rappaport, 1994). Clinical treatment reflects
a medical model: People seek out services to resolve symptoms (Corrigan
& Penn, 1997). Clinical treatment features a hierarchy between healer
and person in clinical settings; healers have some special power that
they use to help patients resolve problems. The relationship between
healer and patient is expected to end when symptoms remit.
Consumer-operated programs have been likened more to communities with
life-long histories (Maton, Leventhal, Madara & Julien, 1989) or to
grassroots information and support systems (Meisen, Gleason & Embree,
1991). Mental illness may be the common experience that draws people to
consumer-operated services. But unlike traditional clinical treatment,
this is not where the impact of consumer-operated services ends.
Consumer-operated services place an extraordinary value on peer support,
hope and recovery (Van Tosh & Del Vecchio, 2000). Consumer-operated
services seek to provide safe settings where a person can find the
necessary understanding and recognition that society at large is not
able to give. In the ideal, there is no hierarchy of roles in
consumer-operated programs; members are peers benefiting from
interactions with equals. There are no limits placed on the amount of
time a person can be involved in a program. Depending on personal needs,
some members come and go from consumer-operated programs, while others
may stay connected for years (Durman, 1976; Luke et al., 1994).

Types of Consumer-Operated Services. Three kinds of programs comprise
the consumer-operated services: consumer-run drop-in centers; peer
support programs; and education and advocacy programs.

Consumer-run drop-in programs provide an open venue for consumers to
receive a variety of services as needed in a specific location that is
open at set times during the day and week. Individuals participate in
drop-in activities on a voluntary, at-will and non-coercive basis.
Service components parallel the gamut of traditional mental health
activities and may include assistance with entitlements, medication
education, clothing, bus or transportation passes and moving.

Peer support programs are typically individual or group-based assistance
and encouragement organized around a worldview or 12-step approach that
is consistent with empowerment and recovery. Peer support programs, like
drop-in centers, may tackle a broad range of work, housing, health and
relationship goals that are needed by participating consumers.

Education and advocacy programs operate under the belief that consumers
with knowledge about mental illness and psychiatric services are best
able to address their own disabilities as well as to fix what is wrong
with the mental health system. Education and advocacy programs use
well-defined curricula to teach consumers this kind of information,
usually in short-term classroom settings. The education and advocacy
program model also relies on peer support to accomplish its goals
(Corrigan & Lundin, 2001).

7\. Participatory Action Research

The purpose of research is to discover what kind of outcomes result from
providing a specific intervention program (for example, Programs of
Assertive Community Treatment) in a certain way (e.g., using a team of
providers instead of individual case managers) with a specific group of
consumers (e.g., persons with mental illness recently released from
prison). Research is meant to answer questions about programs.
Traditionally, this kind of research is completed by academic experts,
people with many years of education leading up to a doctorate in social
science or medicine and working as a professor in a university. There is
widespread belief that social science requires many years of study in
statistics and research methodology and can, hence, only be completed by
these kinds of experts.

Many consumers believe that this kind of "scientist as expert" view
actually causes problems of its own and diminishes empowerment (Rogers &
Palmer-Erbs, 1994). They describe a "blame the victim" mentality that
permeates much research. According to this mentality, traditional
research shows how persons with serious mental illness lack skills, lack
work histories, lack motivation, lack family ties, and so on (Rapp et
al., 1993). It is these person-centered deficits that account for all
the individual's problems and hence should be the focus of research and
services.

This point may be better understood if we consider how research in other
disabilities --- blindness for example --- has developed over time
(Whyte, 1991). As the result of forceful input from persons who are
blind, researchers realized that teaching people how to live with their
impairment is not enough. We also need to change the environment so that
those who are blind can get around more easily. Research in this area
led to Braille in elevators, crosswalks that beep, and better use of dog
guides. This kind of research is only going to be accomplished when
people with disabilities are full partners.

Participatory Action Research (PAR) describes how researchers and
consumers become partners in studying mental illness and appropriate
treatment (Rogers & Palmer-Erbs, 1994). PAR calls for a significant
change in the roles of consumers and professionals, calling for
consumers to actively investigate research hypotheses themselves and
enlist trained researchers as consultants to their projects. The goal of
PAR is to advance research that supports the fundamental assertions of
consumer empowerment. Instead of asking typical research questions
(e.g., How does the consumer fit into society?), PAR examines questions
such as: What must society provide in terms of resources and
accommodations in order to enable the consumer to also be one of
society's resources?

Participatory Action Research is no longer a pipe dream. Many federally
funded research efforts have incorporated the priorities of PAR into
their guidelines. For example, several large-scale projects funded by
the U.S. Substance Abuse and Mental Health Services Administration
(SAMHSA) require a consumer advisory panel to have an active partnership
in planning and implementing its research projects. As a result, most
decisions that govern the projects are made through a sometimes tortuous
exchange between the consumers on the project and the science
investigators. The result is a research project that represents the best
interests and insights of consumer empowerment.

Summary

When President George W. Bush released the final report of the New
Freedom Commission on Mental Health in 2003, the commission's charge was
to evaluate the state of the American mental health system and propose a
guiding vision for the years to come. Central to its message was the
idea of empowerment; that a successful service system must rest on
personal decision making by the individual who is to benefit from
services. The commissioners also noted that evidence-based practices are
essential for America to enjoy a high-quality care system. This article
contains a review of seven evidence-based approaches promoting
individual empowerment for consumers of mental health services. With the
charge of the president's commission and the continuing research and
development that its report will hopefully generate, empowerment and the
greater achievement of life goals for people with mental illness will
only blossom.

Please send all correspondence to:

Patrick Corrigan

University of Chicago Center for Psychiatric Rehabilitation

7230 Arbor Drive

Tinley Park, IL 60477

Telephone (V): (708) 614-4770

Fax: (708) 614-4780

E-mail: p-corrigan@uchicago.edu

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**Self-Determination and the Empowerment of People with Disabilities**

Michael L. Wehmeyer, Ph.D.

Dr. Wehmeyer is Associate Professor, Department of Special Education,
and Director, Kansas University Center on Developmental Disabilities, at
the University of Kansas, Lawrence, Kansas, and Principal Investigator
for the RSA-funded project "Making it More Than a Job: Infusing
Self-Determination Into the Vocational Rehabilitation Process."

The usage note in the American Heritage Dictionary of the English
Language (2000) states the following with regard to the word empower:

"Although it is a contemporary buzzword, the word empower is not new,
having arisen in the mid-17th century with the legalistic meaning 'to
invest with authority, authorize.' Shortly thereafter it began to be
used with an infinitive in a more general way meaning 'to enable or
permit.' Both of these uses survive today but have been overpowered by
the word's use in politics and pop psychology. Its modern use originated
in the civil rights movement, which sought political empowerment for its
followers" (2000, pp. 586-587).

Leaving aside a discussion as to whether empowerment is merely a
buzzword (when one is not empowered, it probably does not sound very
much like a buzzword), it is worth noting the meaning shift or drift
that has occurred with use of the term since its 17th century
origination and the current linkages between empowerment and issues of
control over one's life. However, despite the American Heritage
Dictionary's indication that the term's meaning has shifted, it remains
less than convincing that the way in which many people use the term is
not closer to the original sense of the term. The problem with that
meaning with regard to people with disabilities is, of course, that in
the end, when one has the power to invest someone else with authority,
one also has the power, presumably, to withhold granting that authority.
Power and control remain, fundamentally, with the granter in that
circumstance. Similarly, the more current meaning, "to enable or
permit," seems to offer two synonyms that, in the end, are not equally
effective in solving the "granting authority" problem (American Heritage
Dictionary, 2000). That is, the act of "permitting" implies authority on
the part of one person to allow another to do something, or not. The
meaning of empowerment (or more accurately, empower), "to enable," is,
in my mind, closer to the sense of the term as used when associated with
social movements, particularly the disability rights movement, which
typically uses the term in reference to actions that "enhance the
possibilities for people to control their lives" (Rappaport, 1981, p.
15). Enable means "to supply with the means, knowledge, or opportunity;
to make feasible or possible" (American Heritage Dictionary).

Consideration of what it means to empower someone with a disability is
more than just a semantic exercise. Well-intentioned professionals
across many disciplines mistake empowerment as something that someone
grants or gives to someone else, to the end that the effort falls short
of the standard of enhancing the possibilities for people to control
their lives. There is a bit of a Catch 22 to issues pertaining to
empowerment and professionals in rehabilitation, in that many such
professionals genuinely want to do whatever they can to empower people
with disabilities but, similarly, don't want to err in assuming that any
ultimate authority to grant power or control lies within those very same
people. The way out of this conundrum is through efforts to enable
people with disabilities to exert control in their lives and, as a
function of such actions, to become empowered to do so to a greater
extent. As professionals in rehabilitation, the route to "enablement" is
by providing opportunities and supports that promote and enhance the
self-determination of people with disabilities.

That this is both an appropriate and important focus is illustrated in
the findings of Congress from the 1992 Amendments to the Rehabilitation
Act (and in the subsequent 1998 reauthorization), which state
"disability is a natural part of the human experience and in no way
diminishes the right of individuals to:

a\. live independently;

b\. enjoy self-determination;

c\. make choices;

d\. contribute to society;

e\. pursue meaningful careers; and

f\. enjoy full inclusion and integration in the economic, political,
social, cultural and educational mainstream of American society"
(Rehabilitation Act of 1973, as amended).

The 1998 amendments to the Rehabilitation Act of 1973 strengthened and
emphasized the importance of self-determination by strengthening the
role of informed choice in the rehabilitation process. Indeed, there is
a national trend toward residential and vocational services that are
delivered in a more consumer-driven manner (Callahan, Shumpert & Mast,
2002; Kilsby & Beyer, 2002; West, 1995). In the end, the intent of
Congress in the Rehabilitation Act and the impact of the choice mandates
will depend on the capacity of rehabilitation professionals to do
business in such a way as to genuinely enable people with disabilities
to become more self-determined.

What Is Self-Determination?

Put most simply, the self-determination construct refers to both the
right and capacity of individuals to exert control over and direct their
lives. The construct's use in reference to a right is grounded in its
meaning referring to the political right of people or peoples to
self-governance. Disability advocates and activists have stressed the
inherent right of people with disabilities to assume responsibility for
and control over their lives (Kennedy, 1996; Ward, 1996). In the 1990s,
promoting and enhancing the self-determination of students with
disabilities, particularly as a function of the transition planning
process, became best practice (Wehmeyer, Agran & Hughes, 1998). These
efforts focused primarily on enhancing student capacity to become
self-determined and exert control in one's life by promoting goal
setting, problem-solving, decision-making and self-advocacy skills; they
also focused on efforts to promote opportunities for students to use
these skills.

A variety of definitions of the construct have emerged from efforts in
special education (see Wehmeyer, Abery, Mithaug & Stancliffe, 2003).
Field, Martin, Miller, Ward and Wehmeyer (1998) summarized these various
definitions of self-determination by stating that self-determined people
apply "a combination of skills, knowledge and beliefs" that enable them
"to engage in goal-directed, self-regulated, autonomous behavior. An
understanding of one's strengths and limitations together with a belief
in oneself as capable and effective are essential in self-determination.
When acting on the basis of these skills and attitudes, individuals have
greater ability to take control of their lives and assume the role of
successful adults in our society" (p. 2). Field et al. (1998) further
delineated the common components of self-determined behavior identified
across multiple self-determination models or frameworks. These include:

a\. awareness of personal preferences, interests, strengths and
limitations;

b\. ability to

> i\. differentiate between wants and needs,
>
> ii\. make choices based on preferences, interests, wants and needs,
>
> iii\. consider multiple options and anticipate consequences for
> decisions,
>
> iv\. initiate and take action when needed,
>
> v\. evaluate decisions based on the outcomes of previous decisions and
> revise future decisions accordingly,
>
> vi\. set and work toward goals,
>
> vii\. regulate behavior,
>
> viii\. use communication skills such as negotiation, compromise and
> persuasion to reach goals, and
>
> ix\. assume responsibility for actions and decisions;

c\. skills for problem-solving;

d\. a striving for independence while recognizing interdependence with
others;

e\. self-advocacy and self-evaluation skills;

f\. independent performance and adjustment skills,

g\. persistence;

h\. self-confidence;

i\. pride; and

j\. creativity.

Is Self-Determination Important for Consumers of Vocational
Rehabilitation Services?

There are several indicators to suggest that the answer to this question
is "yes."

First, as mentioned previously, promoting choice and self-determination
is mandated by federal disability policy and legislation.

Second, people with disabilities have been unequivocal in their demands
for enhanced self-determination (Kennedy, 1996; Ward, 1996).

Third, there is compelling evidence from the special education
literature that enhanced self-determination leads to more positive adult
outcomes, outcomes that are equally valued by the field of
rehabilitation. Wehmeyer and Schwartz (1997) measured the
self-determination status of 80 students with mild mental retardation or
learning disabilities in their final year of high school and one year
after high school. Students with higher self-determination scores were
more likely to have expressed a preference to live outside the family
home, have a savings or checking account, and be employed for pay.
Eighty percent of students in the high self-determination group worked
for pay one year after graduation, while only 43 percent of students in
the low self-determination group did likewise. Among school-leavers who
were employed, youths who were in the high self-determination group
earned significantly more per hour (M=\$4.26) than their peers in the
low self-determination group (M=\$1.93)(where "M" represents "mean.")

Wehmeyer and Palmer (2003) conducted a second study, examining the adult
status of 94 young people with cognitive disabilities (mental
retardation or learning disability) one and three years after high
school. These data were consistent with results from Wehmeyer and
Schwartz (1997). One year after high school, students in the high
self-determination group were disproportionately likely to have moved
from where they were living during high school, and by the third year
they were still disproportionately likely to live somewhere other than
their high school home and were significantly more likely to live
independently. Young adults in the high self-determination group were
more likely to maintain a bank account by year one, an outcome most
likely attributable to the employment status of students in the two
groups. Students in the high self-determination group were
disproportionately likely to hold a job by the first-year follow-up, to
be working either full- or part-time, and to have held a job or have
received job training by year three. For those students across the
complete sample who were employed, students scoring higher in
self-determination made statistically significant advances in obtaining
job benefits, including vacation and sick leave and health insurance, an
outcome not shared by their peers in the low self-determination group.
Overall, there was not a single area in which the low self-determination
group fared more positively then the high self-determination group.
German, Martin, Marshall and Sale (2000) found that instruction in
self-determination could improve student goal setting and enhance
participation in educational planning. Sowers and Powers (1995) showed
that instruction on multiple components related to self-determination
increased the participation and independence of students with severe
disabilities in performing community activities.

Finally, there is a growing body of evidence in the field of vocational
rehabilitation (VR) that enhancing choice opportunities leads to better
VR-related outcomes. For example, Farley, Bolton and Parkerson (1992)
evaluated the impact of strategies to enhance consumer choice and
involvement in the VR process and found that consumers who were actively
involved in VR planning had better vocational career development
outcomes. Similarly, Hartnett, Collins and Tremblay (2002) compared
costs, services received and outcomes achieved between one group served
through the typical VR system and another group involved in a Consumer
Choice Demonstration Project in Vermont. They found that the Choice
group was two times more likely to have completed rehabilitation and
that their mean income was 2.7 times higher.

Promoting the Self-Determination of VR Consumers

If the means by which rehabilitation professionals contribute to the
empowerment of VR consumers with disabilities is to provide
opportunities and supports to enable people to become more
self-determined, what are some of the specific strategies that
rehabilitation professionals can use to achieve this outcome? It is
tempting to take a "skills remediation" approach to "teach" VR consumers
skills they do not have that would enhance self-determination. However,
it is important that adults with disabilities not be treated as if they
are eternal students, which equates too closely with being eternal
children. Thus, it is important that efforts to promote skills such as
career and job goal setting, decision making, problem solving and
self-management be done within a context in which the consumer is in
charge of the process. Like other disability systems, traditional
vocational services tend to have been "other-directed." That is, in too
many cases, decisions about jobs or careers are made for people with
disabilities instead of by people with disabilities. There are many
reasons for this, including the fact that many customers of VR services
simply have not had the experiences and opportunities necessary to
enable them to be more self-directed. VR counselors may experience
frustration because they want to support individuals to make their own
decisions or take greater control and responsibility for their career
advancement, yet the individual's limited capacity and experiences are
barriers to those outcomes.

Under the auspices of a special demonstration project of the
Rehabilitation Services Administration, we at the University of Kansas
Beach Center on Disability have been involved in the development and
evaluation of a model for use with adults specific to the career
decision-making and job-placement processes of VR services in the state
of Kansas (Wehmeyer, Lattimore et al., in press). This model --- the
Self-Determined Career Development Model --- is designed to enable VR
consumers to engage in a self-regulated problem-solving and goal-setting
process leading to job placement. The remainder of this article
describes this model as an example of how to promote self-determination
and thereby empower people with disabilities through the rehabilitation
process.

Table 1. Phase 1, Self-Determined Career Development Model

> Problem to Solve: What are my career and job goals?
>
> 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 and
> select 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 his or her environments pertaining to prioritized job and career
> option(s).
>
> Question 3: What must change for me to get the 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
> be focused 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 Career Preferences/Abilities.
>
> · Career and Job Exploration.
>
> · Job Shadowing and Sampling.
>
> · Organizational Skills Training.
>
> · Problem Solving Instruction.
>
> · Choice-Making Instruction.
>
> · Decision-Making Instruction.
>
> · Goal-Setting Instruction.

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

Table 2. Phase 2, Self-Determined Career Development Model

> Problem to Solve: What is my plan
>
> Question 1: What actions can I take to 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 Community Resource/Support.
>
> · Problem Solving Instruction.
>
> · Self-Scheduling Training.
>
> · Self-Instruction Training.
>
> · Picture-Cue Training.
>
> · Decision-Making Instruction.
>
> · Self-Advocacy Instruction.
>
> · Assertiveness Training.
>
> · Self-Monitoring Instruction.

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 and career 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
> or inadequate 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
> different goal is needed to achieve his or her employment or career
> goals.
>
> Employment Supports
>
> · Self-Evaluation Instruction.

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

The Self-Determined Career Development Model evaluated in this article
was based on the team's previous work with a model of teaching for
students with disabilities. It is simplest to describe the adult version
of this model for VR by first describing the school-based model.

The Self-Determined Learning Model of Instruction (SDLMI) was designed
to enable educators to teach students to self-direct the instructional
process and, at the same time, enhance their self-determination
(Mithaug, Wehmeyer, Agran, Martin & Palmer, 1998; Wehmeyer, Palmer,
Agran, Mithaug & Martin 2000). The SDLMI is based on the component
elements of self-determination (Wehmeyer, 1999, 2001), the process of
self-regulated problem solving and on research on student-directed
learning. It is appropriate for students with and without disabilities
across multiple content areas, and it enables teachers to engage
students in their educational programs by increasing opportunities to
self-direct learning. Implementation of the SDLMI consists of a
three-phase process. Each phase presents a problem the student must
solve by posing and answering a series of four Student Questions (per
phase), which students learn, modify to make their own and apply to
reach self-selected goals. Each question is linked to a set of Teacher
Objectives. Each instructional phase includes Educational Supports
identified for teachers to use to enable students to self-direct
learning in a variety of areas including, but not limited to, problem
solving, choice making, goal development, self-evaluation and
self-monitoring.

The problem to solve in Phase 1 is "What is my goal?" In Phase 2, the
problem to be solved is "What is my action plan?" and in Phase 3, the
problem is "What have I learned?" The Student Questions direct the
student through a problem-solving sequence in each instructional phase.
The solutions to the problem in each phase lead to the problem-solving
sequence in the next phase. Question construction was based on theory in
the problem-solving and self-regulation literature that suggests there
is a "means-ends" problem-solving sequence that must be followed for any
person's actions to produce results to satisfy his or her needs and
interests. Teachers implementing the model teach students to solve a
sequence of problems by constructing a "means-ends chain," a causal
sequence that moves them from where they are to where they want to be, a
goal state (Mithaug, et al., 1998).

By answering the questions in this sequence, students are supported to
regulate their own problem solving by setting goals to meet needs,
constructing plans to meet goals, and adjusting actions to complete
plans. The questions differ from phase to phase, but represent identical
steps in the problem-solving sequence. That is, students answering the
questions must:

• identify the problem,

• identify potential solutions to the problem,

• identify barriers to solving the problem, and

• identify consequences of each solution.

These steps are the basic steps in any problem-solving process and they
form the means-end problem-solving sequence represented by the Student
Questions in each phase. The first time a teacher uses the model with a
student, the initial step in the process is to read each question with
or to the student, discuss what the question means and then, as needed,
change the wording to enable that student to better understand the
intent. In wording changes, the problem-solving intent of the question
must remain intact. Going through this process several times as the
student progresses through the model should result in a set of questions
that a student accepts as his or her own.

The Teacher Objectives within the model provide suggestions for teachers
to enable and support students to work through the Student Questions by
scaffolding instruction1, using direct teaching strategies, or
collaborating with students to determine the best strategies to achieve
goals. The Educational Supports are educational and instructional
activities to enable teachers to support students' efforts to answer
questions. The emphasis in the model on the use of educational supports
that are student-directed provides another means of teaching students to
support themselves.

By using the Student Questions, students learn a self-regulated
problem-solving strategy to use in goal attainment. Concurrently,
teaching students to use self-directed learning strategies provides
skills that enable them to begin to become the causal agent in their
lives.

The Self-Determined Career Development Model is equivalent to the SDLMI,
except that it has been modified for use to support adults and it is
specific to the career decision-making process. The three phases of the
model are depicted in Tables 1, 2 and 3. The problem to solve in Phase 1
is "What are my career and job goals?" Within all three phases, supports
focus upon job and career issues. Objectives have been reframed from
teacher objectives to VR counselor or other VR personnel objectives.
Supporting the VR consumer to answer each of the questions in Phase 1
leads to the second phase, where the problem to solve is "What is my
plan?" The problem in the final phase, Phase 3, is "What have I
achieved?"

Wehmeyer, Lattimore et al. (2003) conducted a pilot evaluation of the
career development model using a single-subject research design with six
VR consumers identified by a counselor as needing more support with
career decision making than was traditionally available in the VR
system. Within this pilot evaluation, all participants were able to set
career and job-specific goals, to assist in the design and
implementation of an action plan to achieve those goals and to
self-monitor and evaluate their progress toward the goals. Five of the
six participants showed progress toward achieving that self-set goal.
All participants were able to engage with the facilitator to address
questions in the model and to self-set an employment or job-related
goal. The VR counselor who referred participants to this pilot
evaluation conducted an informal assessment in consumer satisfaction.
All except one participant indicated that they had benefited from their
participation in the process. Perhaps the most suggestive indicator of
the potential for the process to empower people with disabilities
involved one woman who made considerable progress toward her goal and,
after nine years of unemployment, obtained a job shortly after her
involvement with the model. This person expressed her satisfaction with
her participation in the process and mentioned her improved confidence
to the facilitator. She was, we suggest, empowered not by the
professionals with whom she worked but by the skills and positive
attitudes she gained by her use of the model.

Note

1\. Instructional scaffolding is the provision of sufficient supports to
promote learning when concepts and skills are being first introduced to
students. Retrieved July 23, 2004, from
http://encyclopedia.thefreedictionary.com/Instructional_scaffolds.

Author's Note

Preparation of this article was supported, in part, by Rehabilitation
Services Administration (RSA) Special Demonstration 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 or the U.S.
Department of Education, and the reader should not assume endorsement by
the federal government.

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**Slaying Dragons**

Building Self-Confidence and Raising Expectations Through Orientation
Center Training

Sandy Tigges, Ph.D.

Dr. Tigges is Program Administrator in the Adult Orientation and
Adjustment Center, Iowa Department for the Blind, 524 4th St., Des
Moines, Iowa 50309. Telephone: (512) 281-1313. E-mail:
tigges.sandy@blind.state.ia.us.

In his 1919 fable, "The 51st Dragon," Heywood Broun describes the
exploits of Gawaine, a young student in knight school who is so timid
and fearful that he is in danger of being expelled. Instead, the
school's headmaster decides to take Gawaine under his wing and train him
to slay the countless dragons plaguing the countryside that year. In
preparation, Gawaine studies all about dragons and their habits, and he
practices beheading paper and wooden ones on the practice field.

When the faculty feels he is ready to confront real dragons, Gawaine is
given a diploma and a new battle-ax. The headmaster calls him to his
office for 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 the young and the old alike to face these facts,
even though they are sometimes unpleasant. Your problem, for example, is
to slay dragons." Unconvinced, the whimpering Gawaine asks for an
enchanted cap to make himself invisible. The headmaster offers him
something better: a magic word. All Gawaine has to do is say
"rumplesnitz" and he can lop off the heads of dragons easily and
fearlessly.

The magic word works, at least for the first 49 dragons. Gawaine grows
so brave that he even slays one with his right hand tied behind his
back. He becomes so confident that, at night, he engages in long
drinking bouts at the village tavern. On the day he confronts his
fiftieth dragon, his mind has become so sluggish that he cannot remember
the magic word. As the beast charges, the word flashes into his mind,
but he has no time to utter it before swinging his battle-ax and
chopping off the dragon's head.

Puzzled, Gawaine goes to the headmaster's office for an explanation. The
headmaster laughs, believing that Gawaine has finally figured out that
his own bravery and not the word rumplesnitz is responsible for his
success: "It wasn't magic in a literal sense, but it was much more
wonderful than that. The word gave you confidence. It took away your
fears. If I hadn't told you that, you might have been killed the very
first time. It was your battle-ax that did the trick."

Convinced that Gawaine just needs to kill another couple of dragons to
get his confidence back, the headmaster drags him out of bed and into
the forest the next morning and shoves him into a thicket where a small
dragon is hiding. But Gawaine never returns. All that is later found of
him are his medals.

Like the knight school's headmaster, we at the Iowa Department for the
Blind's Adult Orientation and Adjustment Center give students magic
words by which to live: "It's OK to be blind." Unlike those of the
knight school headmaster, however, these words do not disguise hollow
confidence and insufficient preparation. Instead, we back them with
effective blindness training based on an approach that will give
students a solid foundation in the skills, positive attitude and
self-confidence they need to slay the many dragons they will encounter
as they strive to live independently and work competitively.

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. Like Gawaine when he first began his
knight school training, students enter the center with a great many
insecurities, fears and low expectations, ranging from being afraid to
cross the street alone to worrying about ever holding a job, having a
family or being accepted socially. They will often accept more help than
necessary and will avoid such "dragons" as going up and down stairs and
crossing streets alone. Once they have overcome some of these fears and
have slain a few dragons of their own, they begin to gain confidence and
to realize that they can get about safely and efficiently and perform
day-to-day living activities competently. Proud of their
accomplishments, they often assert their independence by rebelliously
swinging their battle-axes against any sighted person who might offer
assistance. When students reach the end of their training, however, they
see that the magic words take on the substance of truth, reinforced with
the skills and self-confidence they need to slay any dragon they may
ever encounter. They come to understand the natural interdependence that
exists in society and begin to view an offer of help not as an insult
but as an opportunity to educate.

The training we provide at the orientation center is based on a positive
philosophy of blindness. In fact, this philosophy is the foundation for
all of the Department for the Blind programs, including Vocational
Rehabilitation, Independent Living, Transition, the Business Enterprises
Program and the Library for the Blind and Physically Handicapped. The
department is committed to the belief that center training must be an
integral part of the rehabilitation process, for rehabilitation can only
be truly achieved when consumers have reached their fullest potential in
personal independence, employment and integration into the community.
This approach is powerful, because it gives blind people control over
their own lives as well as responsibility for their own successes and
failures. This philosophy further contends that the real problem of
blindness is not the physical loss of eyesight but rather society's
misconceptions about it.

The majority of orientation centers in this country base their training
on the notion that the individual who has become blind is "broken" and
therefore must be "fixed," both physically and psychologically. The
training they provide is based upon the beliefs that the problems of
blindness are inherent in the blindness itself, that blindness imposes
upon a person severe limitations that cannot be overcome, that visual
techniques are intrinsically better than non-visual ones and that the
degree of one's success is inextricably tied to the degree of one's
visual acuity. Nurses and a psychologist are often on staff, and
emphasis is placed on the teaching of skills, avoiding blindness
techniques as much as possible and maximizing residual vision through
the use of low vision aids.1

The training we provide at the Iowa center, on the other hand, is
successful because we recognize that the problems of blindness stem not
only from the blindness itself but, again, also from public
misconceptions about its true nature. Center students must not only
learn the blindness skills needed to cope with the physical loss of
eyesight, but they must also adopt new positive attitudinal concepts to
replace the stereotypes that both they and society accept about
blindness. To accomplish these goals, students receive training that has
four objectives:

• Learn efficient and effective blindness techniques.

• Develop self-confidence and a positive attitude about blindness.

• Learn how to deal with public misconceptions about blindness,
including those of family, friends and employers.

• Develop strong work habits and appropriate social skills.

Training in Efficient and Effective Blindness Techniques

To learn the skills they need to function competently, efficiently and
comfortably, our students take eight hours of classes each day covering
home and personal management, cane travel, communications and industrial
arts. They learn non-visual techniques for cooking, cleaning, doing
laundry and sewing. They learn to use a long white fiberglass cane to go
up and down stairs, walk along sidewalks, cross busy streets and take
public transportation to wherever they wish to go. They practice reading
Braille and writing it with a slate and stylus, and they become
acquainted with such assistive technology as computers equipped with
speech synthesizers. They become comfortable with tactile measuring
devices and power tools, and then they choose a project of their own
that could involve woodworking, metalworking, welding or engine repair.

The training provided in each of these classes is rooted in the
structured-discovery method of instruction. First developed to provide
more effective instruction in the area of independent cane travel to
blind persons, this approach has been proven to be superior to the
guided learning approach used by traditional orientation and mobility
instructors, who themselves are usually sighted persons.1 In guided
learning --- commonly called route or point-to-point travel --- the
instructor continually provides very specific instructions and feedback
while closely monitoring the student visually. Teachers place strong
emphasis on rote learning, ensuring safety and maximizing the use of
residual vision. As a result, students do not develop the ability to
generalize what they have learned and become too dependent on the
instructor for help. Students are not expected to solve the problems
they encounter independently or to apply what they have learned in one
lesson to another.

The structured-discovery approach to travel training, on the other hand,
is based upon the concept of training teachers of the blind to teach
their students the same non-visual techniques that have proven to be
most successful by blind persons. Cane-travel students are first given
specific instructions that will allow them to master such basic
techniques as holding and arcing the cane. The focus then quickly shifts
to generalized instruction that emphasizes problem solving by providing
the students with only minimal information, forcing them to rely upon
themselves to explore their environment and gather and process the
information they need to move about safely, freely and efficiently.
Through this method, students learn more, retain it better and develop
greater confidence in their own ability to travel independently.

Through the implementation of the structured-discovery method of
teaching, the center emphasizes the use of alternative techniques of
blindness, high expectations and the development of self-confidence and
problem-solving skills. Blind students with residual vision and sighted
students training to be instructors receive lessons under sleepshades,
or blindfolds, from instructors who are either blind or who have also
received intensive blindness training under sleepshades. Students are
encouraged to rely upon their own ingenuity when they encounter a new
problem or situation instead of turning repeatedly to the instructor for
guidance and reassurance. After being taught a basic set of techniques,
they are asked to experiment, explore, solve problems and apply what
they have learned in one project to another as they move through a
progressive series of more and more challenging activities. Once shown
how to boil and drain pasta for one recipe, for example, they are
expected to figure out how to apply that training to the cooking of not
only pasta but of any food that must be boiled and drained. As a result,
they develop confidence in their own ability to solve problems and to
use techniques that will be effective no matter what level of vision
they have.

Developing Self-Confidence and a Positive Attitude About Blindness

Through learning and practicing their problem-solving skills, students
develop confidence in themselves and a more positive attitude about
their blindness. As a result, they raise the expectations they hold
about their own capabilities, leading to vocational goals that are more
fulfilling and more likely to be achieved. The learning of skills and
the development of self-confidence and a positive attitude are
inextricably intertwined. A student who walks around the block alone for
the first time becomes eager not only to advance to crossing streets but
also to take his or her children to the park after completing the
center's training program.

Developing self-confidence and a positive attitude about blindness are
critical to a student's progress. Without self-confidence, students will
not use the blindness skills they have learned, and without a positive
attitude they will cling to the negative misconceptions and stereotypes
about blindness. The vast majority of students begin their training with
very negative attitudes about their vision loss. Often, many of them sat
at home for years --- cared for by their friends and families --- rather
than admit that they are blind, especially if they still have some
remaining vision. Sometimes they will refuse to recognize that blindness
has had any detrimental effect on their lives, even though they no
longer read, drive, work, go out or take care of their homes. Many
believe that the adjustments they have made --- limited as they are ---
are the best that can be made under the circumstances. Others look for a
quick fix, usually through technology, so that they can ignore the
devastating effects blindness has had on their lives. Lacking
self-confidence, they avoid taking risks because they fear failure and
do not expect success.

Self-confidence is a difficult concept to define. Self-confident people
have positive, yet realistic, views of themselves and their situations.
They trust their own abilities, have a general sense of control in their
lives and believe that, within reason, they will be able to do what they
wish, plan and expect. They take risks and remain positive even when
they fail. Because they accept themselves, they do not feel the need to
conform just to be accepted by others.

Adult students at our center have defined self-confidence in a variety
of ways, as evidenced in a group discussion held on September 15, 2003.
One student said that it is what allows you to walk instead of crawl
through life. Another said that self-confidence is knowing that you are
capable of doing things with dignity, like taking public transportation
and going through a buffet line without a mishap. A third said that it
is what allows you to participate fully in school, work and the other
things in life. A fourth student put it best: "You know you have
self-confidence when you can trust yourself to figure out how to
overcome successfully the fears and challenges you must face every
day."2

The development of self-confidence and a positive attitude about
blindness are linked. Students must learn that they and not their
families, friends or society as a whole should control their attitude
about themselves and their blindness. In his 1982 book, Strengthening
Your Grip, Charles Swindoll described the importance of attitude this
way:

"The longer I live, the more I realize the impact of attitude on life.
Attitude, to me, is more important than the past, than education, than
money, than circumstances, than failure, than successes, than what other
people think or say or do. It is more important than appearance,
giftedness or skill. It will make or break a company, a church, a home.
The remarkable thing is we have a choice every day regarding the
attitude we will embrace for that day. We cannot change our past. We
cannot change the fact that people will act in a certain way. We cannot
change the inevitable. The only thing we can do is play on the one
string we have, and that is our attitude. I am convinced that life is 10
percent what happens to me and 90 percent how I react to it. And so it
is for you \... we are in charge of our attitude!" (p. 126).

The development of self-confidence and a positive attitude about
blindness are the focus of every class in the center. This process is a
lengthy one, because it requires students to make a 180-degree
turnaround in their attitude. For this reason, students train in the
center for an average of six months. They must come to trust the
teachers who are demanding so much of them, and teachers must learn to
gauge the right levels of sensitivity, encouragement, prodding and
confrontation that will help each student achieve this objective.

The story of Janice is typical. Throughout her training, she struggled
with the notion that she could become competent as a blind person and as
a result had to be told constantly to keep her sleepshades down. For
their final cooking project --- a seven-course dinner --- students are
expected to write their menus and recipes in Braille, take the city bus
to the grocery store, purchase their groceries from lists they have
written in Braille, and prepare and serve the meal for their families
and friends. As she confronted this dragon, a tearful Janice became
paralyzed with fear and threatened to pack her bags and go home. Letting
her avoid this dragon was not an option, since it would undermine any
self-confidence she had acquired and make it easier for her to hide from
the next dragons she would inevitably encounter. Reasoning,
encouragement, and prodding had no effect on her. Finally, taking the
risk that she might run, as the program administrator I resorted to
confrontation and called her a quitter. At first she was angry, but
after thinking about it for awhile she decided that she had to prove me
wrong. She unpacked her bags and successfully went to the store, bought
her groceries and prepared and served a wonderful dinner to almost 50
people.

A variety of center activities help students build self-confidence and a
positive attitude about their blindness. We tell students that "a class
is a class is a class" --- that everything they do while at the center,
day and night, contributes to their training. We expose them to many
ordinary experiences that they thought no longer possible, like grilling
steaks, shopping, going to a museum or play, bowling, camping, hiking
and canoeing. 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. Veteran students give tours to
prospective students and serve as mentors to new ones. By participating
in speaking engagements at schools, clubs and service groups, students
become comfortable talking about their blindness and develop the
self-confidence they need to educate the public.

In a discussion group we call the "Business of Blindness," we deal
directly with the subjects of our philosophy and of skill and attitude
development. An essential part of center training, the group discussion
provides students with an open environment where they can talk about
their hopes, fears and problems and where they can challenge the
prevailing negative myths about blindness and the devastating impact
these myths can have on their lives. "Business class," as one student
put it, is "the glue that holds everything together."2 Most important,
it is where they will come to accept their blindness and truly believe
those magic words: "It's OK to be blind."

As the center's program administrator, I serve as facilitator for the
class. I liken my role to that of an orchestra conductor, but sometimes
I feel more like I'm sitting on the lid of a pot ready to boil over. I
must maintain an atmosphere of openness and respect so that students
feel comfortable talking freely and sharing some of their most intimate
feelings with each other. Through questions, comments and active
listening, I guide the discussion of that day's topic. My goal is not to
give them the "right answer" but to teach them how to discover it for
themselves. After all, when they complete their center training, they
must be able to solve similar problems on their own.

To achieve this goal and maintain interest, I use a variety of formats
and media. I invite competent blind persons to talk about their jobs and
the effect center training has had on their lives. We watch movies and
go to plays featuring blind characters and we read articles and short
stories that I have gathered from magazines, journals, newspapers and
the Internet. To expose students to a variety of blindness techniques
for reading, I read to them in Braille, use readers and play cassette
tapes.

The subjects we discuss come from a variety of sources. I maintain a
large outline of resources and am always on the lookout for new items to
add to it. While I try to plan ahead, a topic may come up that needs to
be discussed immediately, such as a student's negative encounter with a
sighted family member. We may have an expert explain Social Security
incentives or a blind person talk about consumer organizations. Each
October, we talk about Iowa's White Cane Law and the effect of similar
legislation on their lives. We explore the purpose of center training so
students will have a better understanding of the program and their
involvement in it.

Gradually, students come to understand that once they have developed
self-confidence, a positive attitude and good blindness skills, the real
problem of blindness is not the loss of vision but, again, the
misconceptions both they and the public hold about it. Blindness is no
longer the controlling factor in their lives, and they begin to make
important life decisions based not on it but on their interests, talents
and abilities. Instead of being ashamed of their vision loss and the
blindness skills that represent it, they view their blindness as another
one of their personal characteristics, like their height, their age or
the color of their hair.

Dealing With Public Misconceptions About Blindness

As students begin to learn effective and efficient blindness skills,
develop self-confidence and overcome their own misconceptions about
their blindness, they become frustrated by the negative treatment they
receive from family members, friends and the general public. They grow
angry when their spouses do not let them go down the basement stairs to
do the laundry, a friend asks them not to take their cane on an outing
or a waitress speaks to their companions rather than directly to them.
Students come to recognize that there is not only a need to change these
notions and their manifestations but that they share in the
responsibility to help bring that change about.

In the center, we provide students with a variety of ways to learn how
to deal appropriately with negative attitudes and reactions toward their
blindness. In Business Class, we explore the origins of these
misconceptions and talk about the best ways to deal with them. Our
students are often surprised to learn that their own behavior can
perpetuate or help dispel these myths. We encourage family members to
visit and sometimes even to attend classes under sleepshades. Giving
tours of the center and participating in speaking engagements gives
students opportunities to practice educating the public about their
blindness. Training is frequently provided in such public settings as
malls, restaurants and parks so that students will become skilled at
handling negative public reactions to their blindness.

The ability to cope with these uncomfortable situations tactfully is
critical to future success in job interviews and in workplace
situations. Most of the students who come to the center are vocational
rehabilitation consumers of the Iowa Department for the Blind and will
either go to school or to work upon completion of their training. At
least twice a year we hold a "Job-Seeking Skills Seminar" for students
to explore careers that meet their talents, interests and abilities.
They also learn techniques for dealing appropriately with blindness
issues in the resume, in the job interview and on the job itself.

The Development of Strong Work Habits and Appropriate Social Skills

Many students come to the center with low expectations about themselves
and what they will be able to accomplish as a blind person. Lacking
self-confidence, they sometimes avoid the risk of failure by
procrastinating, getting too involved in the problems of other students
or refusing to try at all. Burdened by the low expectations of their
families and teachers, students who have been blind since an early age
have often not been expected to support themselves at all and so were
never taught the strong work habits and socialization skills necessary
for them to become fully integrated into the lives of their families,
workplaces and communities. Unless they receive training that raises
their expectations, students will leave the center only to live on the
edge of life, going through college with few or no friends, surviving on
Supplemental Security Income or Social Security Disability Insurance,
and unable to develop the social contacts so important for success in
the workplace.

Center training helps students build their expectations in a variety of
ways. We constantly remind them, both subtly and overtly, that they will
not just work but that they will do so successfully and at their fullest
potential. We treat them like adults, giving them keys to their own
private rooms and to the building that houses the center. We teach them
how to manage their own budgets and medications and to contact staff
that live in the building only for emergencies. We expect them to attend
their classes on time and to do their best in them. When necessary, we
teach them such social skills as table etiquette, ballroom dancing and
communicating in social situations. Fashion, makeup, hairstyles and
other aspects of grooming may also be covered.

We also raise expectations for students through what we call "the three
have-to's" of the orientation center. In order to participate in
training, students must agree to take all of the classes, wear
sleepshades if they have any residual vision and carry their canes at
all times. Students who do not agree to these requirements can choose
from other training options, such as individual and group training in
their home communities or attendance at another orientation center that
they feel better meets their needs. These have-to's are designed to help
students confront and overcome the biggest dragons they face as a result
of their blindness: the fear of injury, the fear of failure and the fear
of being identified by others as blind. If students are not given
opportunities to overcome their deepest fears, they will never believe
they can and they will suffer the fate of Gawaine --- being eaten by a
small dragon that leaves only their meaningless medals behind.

Students are required to take all of the classes. Orientation center
training is like a jigsaw puzzle --- the pieces must all be in place
before the whole picture can be seen. Not taking a class is like losing
one of the puzzle pieces and therefore losing the total effect of the
training. If students were allowed to pick their classes, they would
choose the "safe" ones, like Braille and computer. They would avoid the
classes where they fear injury, like burning their hands on a hot stove,
cutting off their fingers with a power saw or losing their lives to a
speeding car. Students receive individualized instruction within each
class to meet their needs. A young blind man who has never been in the
kitchen must learn both how to cook and how to use the blindness
techniques for cooking. A newly-blind woman who has prepared meals for
her family for years, on the other hand, needs only to learn the
relevant blindness skills. A diabetic student who has been sedentary for
years may need frequent rest periods as he builds up his stamina.

To help dispel the "can't see, can't do" fallacy, students who have any
residual vision must receive their training under sleepshades. In order
to determine the effectiveness and efficiency of the blindness
techniques they are learning, students must practice them constantly
under sleepshades until these skills become habitual. When they take
their sleepshades off, they can then combine the non-visual techniques
they have mastered with visual ones to their greatest efficiency. They
will also come to understand that the problems faced by the partially
and totally blind do not differ significantly. Without the use of
sleepshades, they will constantly want to rely on and attribute any
successes they may have to their remaining vision, no matter how poor
and inefficient it may be. Those students who have the most success are
the ones who have the maturity to see the relevance of sleepshade
training to their lives, come to understand that the degree of their
success is not contingent on the degree of their vision and replace
"can't see, can't do" with "I can do it --- I just have to figure out
how."

Finally, students must carry the long white fiberglass cane --- better
known as the Iowa cane --- at all times. To become proficient travelers,
students must constantly practice using their canes. By doing so, they
also become desensitized to public reactions to their blindness and to
being identified as a blind person. The cane then becomes for them both
a tool for safe travel and a symbol of pride and independence. Because
they can be easily hidden away, folding canes and cane holsters are not
permitted.

Students do not receive training at the center for any fixed length of
time. While the average stay is six to eight months, some students stay
fewer months and some stay more. Students themselves are responsible for
evaluating their progress and for determining when their training is
complete. As the center's program administrator, I meet with students
and their vocational rehabilitation counselors at critical times during
their stay to discuss their progress and goals and to determine if any
modifications in their program need to be made. Students usually decide
to leave the center when they can competently and efficiently use their
blindness skills, when they have the self-confidence to put those skills
into practice, when they thoroughly understand and have a positive
attitude about their blindness, and when they are aware of and able to
deal effectively with public misconceptions.

The Bottom Line

The success of the orientation center and its program can be measured
through statistics, through continued relationships with the center and
through the long-term positive effects the training has had on the lives
of former students. After completing their training, students may attend
college or a vocational training program, enter a new career or return
to a former job. The center is an integral part of the services offered
by the Iowa Department for the Blind, and the department's success in
providing meaningful services that lead to jobs for consumers is also
the success of the center itself. The figures for the 2000, 2001 and
2002 federal fiscal years tell the story. In those years, 171, 175 and
140 vocational rehabilitation cases respectively were closed
successfully rehabilitated (Status 26). Consumers who developed
Individualized Plans for Employment during those years had an over 83
percent chance of successfully getting a job. They could expect to earn
an average of over \$12.40 an hour, and about 68 percent of them would
become the primary source of support for their families.

The program's success can also be seen in the relationships that develop
when students begin their training and continue long after that training
has ended. New students notice quickly that, when they enter the center,
they soon become members of the orientation center's "family." This
membership continues after they complete their training. Center staff
often contacts former students to see how they are doing, and former
students frequently contact staff to talk about their latest news or get
some advice. Students who have shared the center experience sometimes
become lifelong friends. The center itself promotes this unity through a
quarterly newsletter detailing the activities of the center and its
graduates and through the annual Orientation Alumni Day. Each fall,
students host a day of activities for former students culminating in an
evening banquet and dance. An average of 200 people attend each year,
and many of these are some of the center's strongest supporters.

Most important, though, the center's success can be measured in the
long-term positive effects the training has had on the lives of former
students. Participation in the orientation center is a life-altering
experience for most students. When they complete the program, they find
that blindness is no longer the controlling factor in their lives. They
have internalized the truth that "It is OK to be blind," and they know
they are well equipped to slay any dragons they might encounter. One
former student put it this way:

"I had decided to come to the Orientation Center after completing my
high school education. I was led to understand that by attending this
program, it would help me to raise my GPA \[grade point average\] in
college. After being in orientation for a few weeks, however, I had
discovered that my motives were in the wrong place. This program's
purpose is not to prepare me for college, but to prepare me for life and
how to live it as a confident blind person. This program works on the
attitudes of blind people, helping them to become confident, capable
people by letting them know there is life after blindness. Although I
have been blind since birth due to cataracts, this program has helped me
form a different attitude about my own blindness, as well as other blind
people. I have learned that it is OK to be blind, because I know that it
does not make me any less of a person. The classes in the orientation
center are made up of Braille, home ec \[economics\], shop, technology
and travel. All of these classes combined are not merely to teach the
techniques of blindness, but to build confidence by the use of them. My
stay at the center has not been an easy one, but it will be one I will
take with me and use for the rest of my life."2

Notes

1\. This information is based on the author's understanding from years
of experience touring orientation centers for blind adults and studying
the subject; thus, no specific source is given.

2\. For reasons of confidentiality, the author is unable to give the
names of center students who are quoted in this article.

References

Broun, H. (April 13, 1919). "The Fifty-First Dragon." New York Tribune.

Swindoll, C.R. (1982). Strengthening Your Grip. Waco, TX: Word Books.

**Empowering People with Disabilities Through Vocational Rehabilitation
Counseling**

John F. Kosciulek, Ph.D., CRC

Dr. Kosciulek is an Associate Professor and Coordinator of the M.A.
Program in Rehabilitation Counseling, Office of Rehabilitation and
Disability Studies, Department of Counseling, Educational Psychology,
and Special Education, 237 Erickson Hall, Michigan State University,
East Lansing, MI 48824. Telephone: 517-353-9443.
E-mail: jkosciul@msu.edu.

As a result of systemic "castification"1 processes and the rapidly
changing world of work, assisting people with 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 quality of life of
consumers with disabilities. In this article, a framework that describes
how effective VR counseling promotes the empowerment of consumers with
disabilities is presented. Following a description of the primary model
constructs of working alliance, informed choice, self-determination, and
empowerment, the implications 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 to accelerate during the 21st century. Employment arrangements
such as temporary employment, short-term hires, contractual positions,
leased workers, and on-call and part-time workers have and will continue
to influence the career development of all workers (Institute on
Rehabilitation Issues, 1999). These changes are having a substantial
impact on the life roles of individuals with disabilities, the settings
in which they live and work and the events that occur in their lives. At
the same time, current disability policy in the United States focuses on
the inclusion, independence and empowerment of people with disabilities
(Kosciulek, 2000). Thus, vocational rehabilitation (VR) counseling with
people with disabilities must be a dynamic, creative and highly
individualized process. Effective VR counseling can be instrumental for
empowering the life choices, inclusion and independence of people with
disabilities. In turn, empowerment, inclusion and independence will lead
to high-quality employment and fulfilling careers for individuals with
disabilities (O'Day, 1999).

Employment and Career Challenges Encountered by People With Disabilities

The ever-changing nature of work presents new problems for people with
disabilities in finding and maintaining suitable employment. Major
trends such as globalization of the American economy, technology and
population shifts are changing the nature of work and worker skill
requirements (Ryan, 1995). Despite rehabilitation efforts, a majority of
Americans with disabilities between the ages of 16 and 64 are not
employed and that disparity has not changed since 1986, despite the fact
that a majority of non-employed people with disabilities in the working
age population want to work (National Organization on Disability, 2000).
In general, the vocational adjustment of people with disabilities has
been characterized by limited salable work skills, low income,
underemployment and unemployment (Bruyere et al., 2002; Curnow, 1989).

In addition, according to Harrington (1997), high school students with
disabilities frequently leave school without marketable skills or the
ability to function independently. Given that work is a central force in
people's lives, dramatically high rates of unemployment and
underemployment can adversely affect not only the economic and social
status of individuals with disabilities, but also their self-image. A
distinct set of employment and career challenges encountered by many
people with disabilities that can be used as a reference point for VR
counselors includes:

• limitations in early life experiences,

• career decision-making difficulties, and

• a negative worker self-concept (Kosciulek, 2003).

Limitations in Early Experiences. Frequently, people with disabilities
arrive at adulthood with few career options (Chubon, 1995). Limited
early vocational and social experiences encountered by people with
disabilities restrict the array of career options they perceive, impede
decision-making ability and impair future vocational development. The
effect of limited early vocational experiences has been described by
Holland (1985) as a precursor to the development of career-related
problems. Such problems may include failing to develop a consistent and
differentiated personality pattern and a clear vocational identity and
trying to make a career of a job that does not match their abilities or
experiences (Holland, 1985). Unfortunately, such developmental patterns
are not unusual among people with disabilities.

Decision-Making Ability. Lack of opportunities to participate in
decision making, to form a perception of oneself as a worker and to test
self-competencies can be the outcome of limited early experiences and
can impede career development. The poorly defined self-concept,
ambivalence about obtaining work and limited occupational information
reported by people with disabilities is indicative of distortions that
could result in unrealistic vocational aspirations or decisions.
Harrington (1997) and Parent (1993) have aptly described how many
individuals with disabilities have had little opportunity for successful
experience in decision making and, therefore, lack competence in making
decisions.

Negative Worker Self-Concept Resulting from Castification Processes.
Lack of experience and difficulty in decision making are not solely the
result of disability, but also an outcome of social attitudes and
stereotypes. Social attitudes toward disability may be as important as
the disability itself in that the negative attitude of others plays a
part in shaping the life role of the individual with disability (Fitch,
2002). The outcome of this long-term exposure to prejudicial attitudes
may result in a negative self-appraisal and a negative worker
self-concept.

Society generally holds diminished expectations for people with
disabilities (Schroeder, 1995). These attitudes are pervasive; they
influence all of us to some degree. As a class, people with disabilities
have suffered discrimination. Individuals with disabilities face common
social problems of stigma, marginality and discrimination, similar to
those faced by members of racial and ethnic minority groups (Fine &
Asch, 1988). Further, given that disability rates among racial and
ethnic minority group members are proportionally higher than rates in
the U.S. population overall, many individuals with disabilities face
double jeopardy (Trueba, 1993).

Szymanski and Trueba (1994) maintained that at least some of the
difficulties faced by people with disabilities are not the result of
functional impairments related to the disability, but rather are the
result of castification processes embedded in societal institutions for
rehabilitation and education and enforced by well-meaning professionals.
Castification processes have their roots in a determinist view in which
people who are different are viewed as somehow less "human" or less
capable (Trueba, Cheng & Ima, 1993). Problems of castification plague
services to people with disabilities because the same categories of
impairment and functional limitation (constructed mostly by people
without disabilities) are used to determine eligibility for services, to
prescribe interventions and, on occasion, to explain failure. The
constructs and those who use them become agents of castification.

The disempowering nature of these classification systems is often all
too apparent to people with disabilities applying for rehabilitation
services in an effort to enhance self-sufficiency and personal
independence (Scotch, 2000). Rather than being treated as adults with
free or equal status, they may be confronted by persons asserting a
right to determine what kinds of services they need. Thus, it is
critically important that VR counselors reject paternalistic
castification processes and actively work to foster empowerment among
consumers with disabilities during the VR process (Kosciulek, 2003). To
accomplish this important task, we need conceptual frameworks useful for
understanding and guiding empowering VR counseling approaches.

Figure 1.

Vocational Rehabilitation Counseling Empowerment Framework

> Vocational Rehabilitation Counselor
>
> *and*
>
> Vocational Rehabilitation Consumer
>
> *which combine to*
>
> Counselor-Consumer Working Alliance
>
> *which leads to*
>
> Consumer Informed Choice
>
> *and*
>
> Consumer Self-Determination
>
> *which combine to*
>
> Consumer Empowerment

In this section, a framework that describes how VR counseling engenders
the empowerment of consumers with disabilities is presented. The key
constructs in this model include the VR counselor-consumer working
alliance, informed choice, self-determination and empowerment. Figure 1,
a visual depiction of the empowering VR counseling framework,
illustrates the following conceptualization:

A consumer with a disability enters the state-federal VR system. The
level and quality of the working alliance formed between the VR
counselor and consumer determines the level and quality of consumer
informed choice and self-determination during the VR process. Together,
informed choice and self-determination influence the level and quality
of consumer empowerment resulting from the VR process.

In this model, it is hypothesized that the development of an effective
counselor-consumer working alliance is a prerequisite for facilitating
consumer informed choice and self-determination during the VR process.
Further, the framework posits that proficient informed choice and
self-determination are necessary for increasing consumer empowerment. In
order to enhance reader understanding and application of the VR
counseling empowerment framework, each of the model constructs is
defined and described in detail below.

Counselor-Client Working Alliance. The central factor in all successful
counseling processes, including VR counseling, is an effective working
alliance. Researchers estimate that as much as 30 percent of the
variance in counseling outcome can be attributed to the counselor-client
working alliance (Lambert, 1992). As one of the essential components for
success in counseling, an effective working alliance is represented by a
positive collaboration between a consumer and a counselor (Kosciulek,
Chan, Lustig, Strauser & Pichette, 2001). The working alliance is
comprised of the following components: tasks, bonds and goals (Horvath,
1994).

Tasks are those in-counseling behaviors and cognitions that form the
substance of the counseling process.

Goals are the outcomes or target of the counseling process. In VR
counseling, the goal aspect of the working alliance is clear and
specific: the attainment of an employment outcome.

Bonds are the positive interpersonal attachments between a consumer and
counselor that include such aspects as mutual trust, acceptance and
confidence.

Consistent with the working alliance concept, counseling in VR is the
collaborative process between the individual consumer and counselor in
which they assess the individual's strengths, resources, priorities,
abilities, capabilities, interests and rehabilitation needs. In this
process, the counselor and consumer also explore, clarify and assess
employment and career options, address barriers to be overcome, and
develop and carry out a plan of action that will result in meaningful
employment for the individual based on his or her informed choice. In
discussing the working alliance in the VR process, Lustig, Strauser,
Rice and Rucker (2002) noted that the two most significant factors in
this realm are the quality of the consumer's participation and the
degree to which the consumer is motivated, engaged and joined in the VR
process. Consumers with disabilities who are engaged and connected with
counselors will benefit most from VR counseling (Chan, Shaw, McMahon,
Koch & Strauser, 1997).

The working alliance can be most beneficial and an excellent predictor
of outcome for consumers with disabilities when:

• counselors and consumers agree on goals and preferred outcomes,

• counselors collaborate with consumers on tasks to accomplish those
goals and preferred outcomes (Lustig et al., 2002), and

• consumers have a favorable view of the counselor-consumer relationship
(Bertolino & O'Hanlon, 2002).

An empowerment approach to forming an effective VR counselor-consumer
working alliance includes elements that both consumers and counselors
bring to the relationship. Primary elements for consumers include taking
responsibility for their own decision making and for their own actions
and consequences of their actions. Key elements for counselors include
the following: knowing and admitting their limitations (e.g., lack of
knowledge of a specific disability condition) and displaying
unconditional positive regard for the consumers they serve (National
Institute on Disability and Rehabilitation Research \[NIDRR\], 1994).

Specific counseling techniques that contribute to the development of an
effective working alliance and consumer empowerment include the
following:

• treating all consumers as adults regardless of the severity of the
disability,

• using age-appropriate language and techniques,

• placing emphasis on consumer strengths, and

• respecting consumer values and beliefs.

Consumer Informed Choice. As employment is a key to independence and
improved quality of life for people with disabilities, choice in the
selection of employment goals and rehabilitation services necessary to
meet those goals is a critical element for empowering persons with
disabilities (Kosciulek, 2000). In the VR counseling empowerment
framework it is hypothesized that an effective counselor-consumer
working alliance leads to productive informed choice in the VR process.
Consumer choice in vocational goals and services emerged as an important
component of VR in the 1990s. However, choice is not a new concept in
the field. Over 40 years ago, Levine (1959) described the partnership
between the consumer and counselor and the counselor\'s role in
assisting the individual in making choices and decisions. During this
same time period, Patterson (1960) encouraged counselors to facilitate
independence by helping consumers \"go through the process\" of deciding
what they should have and should do. He noted, \"The counselor can have
no stereotypes of occupational choices\" (p. 115). Both of these
examples focus on vocational choice and, although they go back more than
40 years, they are consistent with current principles related to
enhancing the counselor-consumer partnership, facilitating empowerment
and fostering choice and independence in the rehabilitation process.

The philosophy behind informed choice is that people with disabilities
should have control over the processes and services that affect their
lives, and that those who have control over their own VR planning will
experience better employment outcomes than those who do not. Informed
choice is practiced when VR counselors give consumers 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 by which individuals participating in VR
programs make decisions about their assessment services, vocational
goals, the services and the service providers that are necessary to
reach those goals and how those services will be procured. The informed
choice process begins with the individual's values, interests and
characteristics and proceeds to an evaluation of availability of
resources and alternatives, including the labor market. Implementing
informed choice requires that the VR counselor listens carefully,
communicates clearly and gathers and analyzes information without bias.
The VR counselor works with the consumer to make choices and to evaluate
their impact. Finally, in an informed-choice model of VR, the counselor
supports the individual in setting goals, making plans and following
through with decisions, with the aim of achieving meaningful employment.

It is presumed that a consumer's skills and abilities to exercise
informed choice can be developed through use of self-assessment
techniques, training and experience in goal setting and decision making,
and consumer education. In this manner, skills in exercising informed
choice could grow in a parallel fashion along with growth of specific
vocational and employment skills, enabling the individual to continue
making important, informed life decisions following the completion of VR
services. The application of the concept of consumer informed choice in
the context of VR services involves a conscious process of choice making
with 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 information in
future choice-making experiences.

Consumer Self-Determination. In addition to facilitating informed choice
in the VR process, an effective VR counselor-consumer working alliance
will enable the development of consumer self-determination skills.
Self-determination, a concept and process that has emerged from the
fields of rehabilitation counseling, special education and disability
studies, provides the basis for an empowerment approach to VR
counseling. Field, Hoffman and Spezia (1998) have defined
self-determination as a multidimensional concept that includes:

• attitudes, abilities and skills that lead people with disabilities to
define goals for themselves and to take the initiative to reach these
goals,

• the capacity to choose and to have those choices be the determinants
of one's actions,

• determination of one's own fate or course of action without
compulsion, and

• the ability to define and achieve goals based on a foundation of
knowing and valuing oneself.

Promoting self-determination should be a primary effort of VR counselors
working with consumers with disabilities. Self-determination can be
enhanced by helping consumers develop greater self-awareness and by
teaching decision making, goal-setting and negotiation skills, which
will enable them to exercise greater control during the VR counseling
process (Kosciulek, Bruyere & Rosenthal, 2002). The steps in the
self-determination development process for consumers include consumers
knowing and valuing themselves, consumer planning, consumer action,
experiencing outcomes and learning, and making adjustments. Consumer
self-knowledge can be facilitated by encouraging individuals to expand
their thinking about the possibilities in their life, deciding what is
truly important to them, having a keen sense of their strengths,
limitations and preferences and knowing what options are available. VR
counselors can promote consumer self-valuing by assisting consumers with
accepting themselves as they are, admiring their strengths that come
from uniqueness, and recognizing and respecting their rights and
responsibilities.

The next step in the consumer self-determination process is the
development of effective planning skills. Effective planning involves a
process of setting goals, identifying action steps to meet goals,
anticipating results and visually and orally rehearsing potentially
stressful events such as job interviews. In addition to planning, VR
counselors can facilitate consumer self-determination by encouraging
individuals to act. Consumer self-determined action may include dealing
directly with conflict and criticism (e.g., with a family member or
coworker) and accessing resources and supports such as assistive
technology devices and recreation and leisure services.

As a result of planning and acting, consumers with disabilities will
have the opportunity to experience positive outcomes and to learn more
about themselves. VR counseling that promotes self-determination can
enable individuals to compare performance and outcomes to their
expectations and realize successes. In the final step toward enhancing
consumer self-determination, VR counselors can assist individuals with
disabilities to adjust their self-perception and expectations with
regard to future planning and actions.

Consumer Empowerment. As illustrated in the VR counseling empowerment
framework (Figure 1), informed choice and self-determination influence
the level and quality of consumer empowerment resulting from the VR
process. Emener (1991) described the philosophical tenets necessary for
an empowerment approach to rehabilitation. These tenets provide a useful
foundation for the provision of VR counseling services to people with
disabilities. The four tenets are paraphrased as follows:

• Each individual is of great worth and dignity.

• Every person should have equal opportunity to maximize his or her
potential and is deserving of societal help in attempting to do so.

• Most people strive to grow and change in positive directions.

• Individuals should be free to make their own decisions about the
management of their lives.

Definition of empowerment. Empowerment is the process by which people
who have been rendered powerless or marginalized develop the skills to
take control of their lives and their environment (Lee, 1997). As such,
in order to begin to improve rehabilitation services and outcomes,
empowerment has become the operative term in disability policy
development and rehabilitation service delivery. The field of
rehabilitation continues to place an increasing emphasis on the
construct of empowerment as a conceptual cornerstone of identity (Banja,
1990; Zimmerman & Warschausky, 1998) and critical variable in
rehabilitation research (National Institute on Disability and
Rehabilitation Research \[NIDRR\], 1991).

Empowerment is conceptualized as involving both internal or
psychological aspects and situational or social aspects. Internal or
psychological factors include a sense of control, competence,
confidence, responsibility, participation, solidarity and community.
Additional psychological aspects of empowerment include flexibility,
initiative and future orientation (Stein, 1997). In this manner, the
psychological facet of empowerment entails the acquisition of values and
attitudes that are incorporated into the individual's worldview and
constitute a foundation for action (Bolton & Brookings, 1996).

Situational or social aspects of empowerment include control over
resources; interpersonal, work and organizational skills;
decision-making powers; self-sufficiency; mobility; and "savvy" or an
ability to "get around" in society (Stein, 1997). Additional situational
factors include improved living conditions, increased social status,
financial and social support, autonomy, access to information and
income. The situational aspects of empowerment are concerned with the
interdependence between people's behaviors and their environment. These
situational or social factors also suggest that the lack of social,
economic, or political resources in the environment is a major
contributor to human dysfunction (Rappaport, 1987). Thus, it is argued
here that when people with disabilities have control over important
resources, they are better able to determine the course of their lives,
solve their problems and develop adaptive social networks.

Empowering VR counseling. Empowerment of individuals with disabilities
means that they have the same degree of control over their lives and the
conditions that affect them as is generally possessed by people without
disabilities (Harp, 1994). It entails the transfer of power and control
over their lives from external entities, such as VR counselors, to the
individuals themselves (Bolton & Brookings, 1996). Thus, as hypothesized
and tested by Kosciulek and Merz (2001), the VR counselor committed to
an empowerment approach to service delivery should facilitate and
maximize opportunities for individuals with disabilities to have control
and authority over their own lives.

From an empowerment perspective, VR counseling is not something that can
be done to or for a consumer. Rather, it is a process in which consumers
must become active, informed participants who learn and control a
planning process that they use for short- and long-term career
development (Szymanski, Hershenson, Enright & Ettinger, 1996). In
addition, the lifelong, developmental nature of the process means
"unless we plan to work with an increasingly dependent consumer again
and again across the decades, our professional responsibility is to
assure that each person learns the \[career planning\] process" (Mastie,
1994, p. 37).

Active consumer involvement is the key element of successful VR
counseling interventions (Ettinger, Conyers, Merz & Koch, 1995). In an
empowerment approach to VR counseling, consumers are actively involved
in:

• gathering information, including self-assessment, and learning about
occupations and the labor market;

• generating alternative courses of action and weighing those
alternatives; and

• formulating a plan of action.

Implications for Vocational Rehabilitation Counselor Training and
Practice

The VR counseling empowerment framework suggests three important
implications for VR counselor training and practice.

First, in both pre-service counselor education and in-service counselor
training programs, curricula must focus on the development of effective
vocational counseling techniques. In this manner, new and practicing VR
counselors will possess the tools necessary for developing effective
working alliances with consumers with disabilities.

Second, both new and experienced VR counselors must be knowledgeable of
the state-federal VR system informed choice mandates. Further,
counselors must be fully informed regarding those models demonstrated to
be useful for enhancing informed consumer choice in the VR process. The
informed-choice/best-practice methods described in the Choice
Demonstrations Projects Operations Manual (InfoUse, 1999) may be helpful
in this regard.

Third, in accordance with the VR counseling empowerment framework, the
development of consumer self-determination skills must be a goal of the
VR counseling process. As such, VR counselor training programs of all
types should direct resources toward increasing counselor knowledge and
skill in the area of consumer self-determination. As described earlier
in the discussion of Consumer Self-Determination, Field et al. (1998)
provided a valuable guide that outlines the steps in the
self-determination development process.

Conclusion

Due to the ever-changing nature of the world of work and service-system
castification processes, assisting people with disabilities to achieve
positive, meaningful and stimulating career development can be a
challenging task. Effective VR counseling can be instrumental for
enhancing the career success and quality of life of consumers with
disabilities. Full implementation of the VR counseling empowerment
framework presented in this article will enable consumers with
disabilities to become active, informed participants who learn and
control a planning process that they use for both short- and long-term
career development. In this manner, VR counseling will promote the
empowerment of individuals with disabilities.

Note

1\. Castification is fundamentally an institutionalized way of
exploiting one social group (ethnic, racial, low-income or other
minority group), thus reducing this group to the status of a lower caste
that cannot enjoy the same rights and obligations possessed by the other
groups (Trueba, 1993, p. 30).

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**Consumer Organizations: Important Resources for VR Agencies**

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

MEMORANDUM UNITED STATES DEPARTMENT OF EDUCATION

> REHABILITATION SERVICES ADMINISTRATION
>
> CENTRAL OFFICE

COMMISSIONER\'S MEMORANDUM

CM 04-01

Date: October 3, 2003

TO: RSA Senior Management Team

FROM: Joanne Wilson

Commissioner

SUBJECT: Consumer Organizations: Important Resources for VR Agencies

BACKGROUND

Consumer organizations, whose membership and officers are comprised of a
majority of individuals with disabilities, are an invaluable resource
for State vocational rehabilitation (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.

The Rehabilitation Services Administration (RSA) is committed to
leveraging the contributions of community organizations comprised of
individuals with disabilities. To this end, RSA is developing
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 effectiveness of the VR system
with the practical expertise and knowledge of persons with disabilities
who have successfully overcome barriers in achieving their goals. For
example, RSA is funding a mentoring initiative in which students with
disabilities will be connected with mentors with disabilities, who
possess the practical knowledge and personal experiences requisite to
help the students effectively transition to adulthood. These mentors can
offer transition-age youth information, support, and hope derived from
first-hand and personal experiences that enable them to serve as
real-life examples of what people with disabilities can achieve.

This Commissioner\'s Memorandum (CM) more fully describes both this
mentoring initiative and other available opportunities for State VR
agencies to utilize the unique contributions that consumer organizations
can make throughout the VR process ranging from direct interaction with
VR participants to meaningful impact upon systemic issues, such as
statewide planning and policy development. RSA considers the development
of strong working relationships between State VR agencies and
grass-roots consumer organizations to be pivotal in ensuring that agency
efforts are effective in meeting the needs of the various disability
populations the agencies are serving and the realization of successful
outcomes.

MENTORING

The expectations and beliefs that individuals with disabilities have
about their own abilities, potential, and competence inevitably
influence their choices throughout the VR process. All too frequently,
individuals create self-imposed limits based on poor role modeling, lack
of disability-specific information, and negative misconceptions about
their disability. Ultimately, these self-imposed limits negatively
affect their employment outcomes and quality of life. Connecting
individuals being served by the VR program with mentors who have
disabilities, who possess practical knowledge and firsthand experience,
and who have achieved high-quality employment and independence through
their participation in the VR process will help guide VR participants to
make positive choices regarding their programs and their lives.

Furthermore, while all students encounter difficulties during their
school years, many of the challenges encountered by students with
disabilities are wholly unique. Students with disabilities often are
unable to find summer and part-time employment, struggle with social
acceptance and negative stereotypes about their disabilities, are not
encouraged or fail to participate in extracurricular activities, and are
not always taught the disability-specific skills and techniques they
need to succeed at school and life. As a result, dropout rates among
students with disabilities are significantly higher than those of the
non-disabled population, and their college enrollment is approximately
five times less than the general public\'s. The lack of opportunity to
gain the experience and confidence through job training and summer
employment combined with low expectations and minimal social 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, it is a natural and necessary component of any
complete package of transition services in light of the significant
impact role models can have on youth as they mature. Mentoring provides
students with disabilities increased opportunities to explore vocational
interests and develop work 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 impact that
will last a lifetime. Thus, providing mentoring services to students
with disabilities should be considered in the development of both the
Individualized Education Program (IEP) and the Individualized Plan for
Employment (IPE).

To highlight the important role of mentoring in the transition process,
RSA has developed a mentoring initiative for transition-aged youth and
young adults with disabilities. Projects funded 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 accomplish 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 practical
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-determination, 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 effort 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 employment
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 integration, 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 services 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 excellent 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 particular individuals with disabilities. In addition, consumer
organizations possess a wealth of experience and knowledge concerning
the providers of adjustment services; thus, they are well prepared to
assist VR counselors and individuals in the selection of the providers
best suited to deliver these essential services.

DEVELOPMENT OF THE IPE

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

In setting forth the options available to individuals for the
development of the IPE, section 102(b)(1)(A) of the Rehabilitation Act
of 1973, as amended (Act) states that \"...the designated State unit
shall provide the eligible individual or the individual\'s
representative...with information on 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 eligible individual, from a qualified
vocational rehabilitation counselor in developing all or part of the
individualized plan for employment for the individual, and the
availability of technical assistance 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 alternative sources for assistance with IPE
development by permitting eligible individuals to develop their IPEs
without assistance, or with help from a variety of sources, including
qualified VR counselors employed by the agency, qualified VR counselors
not employed by the agency, and other unspecified \"resources\" (34 CFR
361.45(c)(1)).

Consumer organizations are an ideal resource from which VR agencies and
individuals can seek assistance when preparing IPEs. Consumer
organizations possess extensive knowledge of the VR program and its
processes, service providers, and, most importantly, the
disability-related and vocational needs of persons with disabilities. By
accessing this important resource, both VR counselors and individuals
can utilize the expertise of consumer organizations in order to develop
IPEs that best meet the needs of the individuals. Such collaboration
will serve to connect individuals with people who have firsthand
knowledge of disabilities and the VR process, enabling them to make
fully informed and effective choices.

PROGRAM EVALUATION

Because consumer organizations represent the collective voice of their
members, they are able to offer experience-based input on the
effectiveness of a State VR agency\'s policies, procedures and practices
as they affect applicants and individuals eligible for VR services.
Strong partnerships and productive 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 efforts to empower persons with disabilities
to achieve high-quality employment outcomes, consumer organizations can
play important roles in the conduct of the comprehensive statewide
triennial assessment of the rehabilitation needs of individuals with
disabilities required by section 101(a)(15)(A) of the Act. The input of
these organizations can be particularly helpful with respect 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 services 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 disabilities, 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 refinement 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
express 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 procedures 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 administration 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 Rehabilitation
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 ongoing 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,
representatives 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 effective
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 activities 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 positive
attitudes toward their disabilities.

Consumer organizations are ideal resources through which VR agencies can
provide immersion activities 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
meetings and other activities conducted by local chapters and
affiliates; and participation in rehabilitation training programs.
Consumer organizations can work with VR agencies to identify and
coordinate those activities most appropriate for the needs of their
staff and individual consumers. VR staff who have engaged in a variety
of immersion activities report: an increased understanding of and
sensitivity to disability culture; a greater knowledge of successful
accommodation 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 insight into
their own preconceptions of disability. By interacting for an extended
period of time with persons with disabilities who function naturally and
successfully in the performance of both life and employment skills, VR
counselors and consumers can enrich their understanding of the lives of
persons with disabilities, the barriers to employment which they have
overcome, and those obstacles which they still face, either individually
or collectively, on a daily basis.

STATE AGENCY IN-SERVICE TRAINING

Consumer organizations can assist a State VR agency in conducting
relevant in-service training efforts that focus on particular
disabilities. With their \"real world\" experiences in addressing
various issues resulting from their disabilities with respect to
preparing for and obtaining high-quality employment outcomes,
representatives of consumer organizations can provide experience-based
insight, information, and guidance to State VR agency staff that
professional educators, trainers, or books simply cannot offer.

COMMUNICATION AND OUTREACH

Consumer organizations provide established networks for dissemination of
information and communication about services, special projects, proposed
changes and trends in service delivery or resources, and profiles of
agency successes. They are a ready source of referrals and can offer
invaluable assistance in reaching culturally diverse or underserved
groups to familiarize them with the services that the VR program has to
offer. Finally, they can add a significant voice to policymakers on
agency requests related to service provision.

SUMMARY

This CM describes various opportunities for collaboration between a VR
agency and consumer organizations, and suggests several methods for
fostering effective partnerships. VR agencies are encouraged to develop
their own innovative practices that utilize the knowledge, expertise,
and skills found within these organizations for the benefit of the
individuals the agencies serve, thereby enhancing 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 program, these
organizations can offer persons with disabilities support,
opportunities, and hope. Whether through peer mentoring, leadership
opportunities, role modeling, or disability-specific training, consumer
organizations are invaluable resources for VR agencies, their partners,
and individuals with disabilities alike. VR agencies can draw upon the
collective talent of these organizations and the expertise of their
individual members as they work to achieve high quality employment and
full independence for persons with disabilities.

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

**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 Education Program at University of
Arkansas, P.O. Box 358, Hot Springs, AR 71902. Telephone: (501)
623-7700. The entire book is also available online, at:
www.nfb.org/books/books1/free.htm.

James H. Omvig's book, Freedom for the Blind, which was commissioned by
the U.S. Department of Education's Rehabilitation Services
Administration (RSA), has just been released. According to Omvig, the
book offers "a non-traditional perspective on the methods and issues
that a truly successful employment training program for the blind should
embrace."

Freedom for the Blind points out that, as America begins the 21st
century, between 70 and 80 percent of its working-age blind people are
unemployed. Of those who are employed, far too many are severely
underemployed or are destined to be locked in at entry-level jobs for a
lifetime. Omvig asks, "Why?"

The author contends that, putting to one side all of the
rationalizations, there can be but two possible explanations for this
dismal statistic: First, either people who are blind, no matter how
thoroughly trained and adjusted to their blindness they may be, are
inherently incompetent; or, second, there is something inherently wrong
with America's blindness system --- the complex of programs for
educating or rehabilitating people who are blind.

Omvig concludes that the problem is not with the people who are blind.
The evidence that properly trained blind people can live independent,
successful, competitive, normal and happy lives and can assume their
rightful position of full membership in society is too overwhelming to
conclude that, as a class, people who are blind are inherently
incompetent. Therefore, Omvig reluctantly and cautiously draws the
conclusion that the problem has been with the blindness system itself
--- that educational and vocational rehabilitation (VR) programs for
people who are blind historically have not been what they could and
should be.

Also, he says that the blind have been thought of by society --- and
have learned to think of themselves --- as a group apart, a helpless and
hopeless lot, having neither the right nor the ability to work for their
daily bread or to earn their self-respect. As a group, people who are
blind have thought of themselves not as unemployed but as inferiors who
are unemployable: He sums it up by describing the blind as a "visible
minority!"

Omvig believes that there are additional facts and circumstances at the
root of the unemployment problem: Too many VR programs or residential
orientation and adjustment (O&A) centers have also unwittingly embraced
society's negative view of people who are blind and have perpetuated
these myths and misconceptions in the minds of their VR customers or
students, and those customers have been the losers. Such programs have
utilized what one might call the enabler model of service delivery.

However, Freedom for the Blind contends that there is good news! The age
of enlightenment is here, and a new model --- a proven cutting-edge
formula for success --- exists. It is the empowerment model.

The book proffers the view that every blind person --- man or woman,
young or old, educated or not --- needs personal empowerment to be
whole; and with empowerment comes the freedom people who are blind have
the right to expect. It suggests that every progressive VR program or
residential O&A center should therefore adopt the empowerment model and
do its best to empower every VR customer or student whom it serves. In
regard to O&A centers, Omvig says that a residential training center's
overarching purpose should be to function as an "empowerment station."

The empowerment-station model of an O&A center is one that recognizes
that all offered services must be aimed at teaching its students a new
and constructive set of attitudes about blindness and "unlearning'
prevailing views that are wrong and harmful. Further, such a center will
help each blind student strive to achieve the following four personal
objectives:

• The person who is blind must come to know emotionally, not just
intellectually, that he or she can truly be independent and
self-sufficient.

• The person who is blind must learn and become competent in those
skills --- the alternative techniques of blindness --- that will make it
possible for him or her to be truly independent and self-sufficient.

• The person who is blind must learn to cope on a daily basis with the
public attitudes about blindness --- how he or she will be treated by
other people because of their misunderstandings and misconceptions.

• Even when the individual who is blind has adjusted emotionally to
blindness, mastered alternative techniques and learned to cope
effectively with the demeaning things other people do or say, the person
who is blind must also learn to "blend in" and to be acceptable to
others in order to be successful. He or she must be punctual, reliable,
neat and appropriate in appearance and possessed of good social and
table manners and the like. Thus the schools and agencies must do the
best that they can to achieve this desired result.

Omvig's thesis is that freedom should be accessible to everyone and that
it is possible, with a willingness to think outside the box, for the
traditional VR program to learn to empower and to move its customers
toward successful, high-quality employment and increased integration
into society. A proven cutting-edge formula for success exists and is
available for the taking. The blind customer who has received
cutting-edge VR services has a markedly higher chance for vocational
success than the norm, according to Omvig.

The book details the philosophies, training techniques and the methods
that go into the empowerment model and also explains the role a state's
separate agency for the blind could play in the process. Given the right
kind of training, the average blind person --- not merely those whom
some observers mistakenly perceive as the "superblind" --- can compete
on terms of true equality with his or her sighted peers and can become a
taxpayer rather than a tax user. Omvig believes that, far from wanting
to whimper, "I wonder what it would feel like to be free," the empowered
blind person will want to climb the highest mountain and shout, "I am
free! I know what it feels like to be free!"

Omvig is a blind attorney and rehabilitation professional from Tucson,
Arizona. He spent most of his professional career working with the
blind, and in retirement he continues to do consulting, evaluating,
writing and teaching in this field today.

He became blind as a teenager due to Retinitis Pigmentosa (a
degenerative, retinal disease referred to as RP). After several years of
struggling with extremely limited vision while in the public school
system, he transferred to a residential school, the Iowa School for the
Blind. He graduated from high school in 1953.

Eight years of idleness followed Omvig's high school graduation. Then,
in 1961, he became one of the early students in the Adult Orientation
and Adjustment Center newly created and directed by Dr. Kenneth Jernigan
at the Iowa State Commission for the Blind. He went on to complete
college and law school, and then he worked in Washington, D.C., and New
York City as the first blind attorney ever hired by the National Labor
Relations Board.

**RSA Regional Offices**

Region I

(Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island,
Vermont)

Rehabilitation Services Administration

J.W. McCormack Post Office and Court House, Room 232

Boston, MA 02109

Region II

(New Jersey, New York, Puerto Rico, Virgin Islands)

Rehabilitation Services Administration

75 Park Place, Room 1236

New York, NY 10007

Region III

(Delaware, Maryland, Pennsylvania, Virginia, West Virginia, District of
Columbia)

Rehabilitation Services Administration

100 Penn Square East, Suite 512

Philadelphia, PA 19107

Region IV

(Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South
Carolina, Tennessee)

Rehabilitation Services Administration

61 Forsyth Street, S.W., Room 18T91

Atlanta, GA 30303

Region V

(Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin)

Rehabilitation Services Administration

111 North Canal Street, Suite 1048

Chicago, IL 60606

Region VI

(Arkansas, Louisiana, New Mexico, Oklahoma, Texas)

Rehabilitation Services Administration

Harwood Center

1999 Bryan Street, Room 2740

Dallas, TX 75201-6817

Region VII

(Iowa, Kansas, Missouri, Nebraska)

Rehabilitation Services Administration

10220 North Executive Hills Boulevard

Kansas City, MO 64153-1367

Region VIII

(Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming)

Rehabilitation Services Administration

1244 Speer Boulevard, Suite 310

Denver, CO 80204

Region IX

(American Samoa, Arizona, California, Commonwealth of the Northern
Mariana Islands, Guam, Hawaii, Nevada)

Rehabilitation Services Administration

50 United Nations Plaza, Room 215

San Francisco, CA 94102

Region X

(Alaska, Idaho, Oregon, Washington)

Rehabilitation Services Administration

915 Second Avenue, Room 2848

Seattle, WA 98174-1099

***Inside Back Cover.***

Sec. 2. (b) Purpose

The purposes of this Act are -

\(1\) to empower individuals with disabilities to maximize employment,
economic self-sufficiency, independence, and inclusion and integration
into society \...

\(2\) to ensure that the Federal Government plays a leadership role in
promoting the employment of individuals with disabilities, especially
individuals with significant disabilities, and in assisting States and
providers of services in fulfilling the aspirations of such individuals
with disabilities for meaningful and gainful employment and independent
living.

-   The Rehabilitation Act of 1973, as amended

***Back Cover.***

American Rehabilitation (AR) will be available online.

If you or a colleague you know would like to receive an electronic
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> Editor, American Rehabilitation
>
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>
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