UNITED STATES DEPARTMENT OF EDUCATION

OFFICE OF SPECIAL EDUCATION AND

REHABILITATIVE SERVICES

REHABILITATION SERVICES ADMINISTRATION

WASHINGTON, DC 20202

INFORMATION MEMORANDUM

RSA-IM-98-03

DATE: November 4, 1997

ADDRESSEES: STATE VOCATIONAL REHABILITATION AGENCIES (GENERAL) STATE
VOCATIONAL REHABILITATION AGENCIES (BLIND) STATE REHABILITATION ADVISORY
COUNCILS

CLIENT ASSISTANCE PROGRAMS

REGIONAL REHABILITATION CONTINUING EDUCATION

PROGRAMS

RSA SENIOR MANAGEMENT TEAM

SUBJECT: Advice, Information and choice

CONTENT: The attached paper discusses concepts on the roles of advice
and information in helping individuals with disabilities become informed
and make effective decisions in the selection of their vocational goals,
services, and service providers. The paper was developed by the
directors of the RSA Choice Demonstration Projects.

The opinions expressed in the paper are those of the project directors
and not necessarily those of RSA. The paper is being disseminated as
part of RSA\'s efforts to facilitate the exchange of information about
informed choice between the Choice Projects, State vocational
rehabilitation agencies, and other relevant parties.

INQUIRIES: The attached paper provides contact information for each of
the Choice Projects. Within the Rehabilitation Services Administration,
for matters related to choice the contact person is Suzanne Tillman at
202-205-8303.

Fredric K. Schroeder, Ph.D.

Commissioner

CC: CSAVR

NAPAS

RSA Regional Offices

(Regions II, IV, V, VIII, and X)

*Advice, Information and Choice*

Advice and Information: Helping people to become informed and to make
effective

decisions concerning employment

*A paper by:*

*Michael Callahan*

*United Cerebral Palsy Associations*

*Choice Access Project*

*(601) 497-6999*

*With assistance ftom:*

*Abby Cooper, Washington Division of Vocational Rehabilitation*

*(206) 587-4444 T7D:(206) 587-4439*

*Teny Herkimer, Berkeley Independent Living Center*

*(510) 841-4776 TDD:(510) 848-3101*

*Lee Lanning, SWBIRA*

*(602) 275-0180*

*Nancy Sullivan & Sterling Hughes, Arkansas Rehabilitation Services*

*(501) 661-940 7 & (501) 534-13 72*

*Hany Hall, 7he Development Team, Inc.*

*(904) 247-4640*

*Michael Collins, Vermont Division of Rehabilitation*

*(802) 241-2186*

*Prepared for:*

*Rehabilitation Services A&ninistration*

*Office of Special Education and Rehabilitative Services*

*U.S. Department of Education*

*Grant #H235D30067*

*1997*

Advice, Information and *Choice*

**Advice and Information: Helping people to become informed and to make
effective**

**decisions concerning employment**

**advice:** (from Latin, to look at); opinion given as to what to do.
*[Webster\'s Neu) World]{.underline}*

*[Dictionary]{.underline}*

**information:** something told or facts learned; news or knowledge.
*[Webster\'s New World]{.underline}* [Dictionary]{.underline}

The underpinning of the Choice Demonstration Authority in the
Rehabilitation Act of 1973, as ammended in 1992, is for projects to
insure that customers not only make individualized choices concerning
their employment goals, the types of services received and the providers
of those services, but that those choices should meet a higher standard
\-- that is, \"informed\" choice. Each of the seven national
demonstration sites uses some form of advice and/or information as
primary tools to assure that the choices made by customers are informed.
However, just as Webster\'s struggles with the difference between the
derivation of the word \"advice\", which alludes to information, and
it\'s definition, w1iich is based on opirn,on, so too have the projects
realized that advice and information are separate, but intertwined
components of informed choice.

It is critical to recognize the distinction between these facets of
choice. Information is usually considered to be based on the unbiased
facts concerning an issue. Opinion is inherently subjective, someone\'s
personal perspective, even if that opinion is based on fact. However,
even though information and opinion are different, they are both
necessary migredients of informed choice.

In traditional rehabilitation, information and advice have been
fundamental aspects of the counselor/customer relationship. The
counselor has been responsible for gathering facts and offering opinions
on the customer\'s efforts to become employed as well as defining the
questions,

I

*Advice,* **Information and** *Choice*

issues and barriers which need to be addressed. The provision of
counselor-centered advice and information has been an area of concern
voiced by many persons with disabilities. Each of the seven choice
demonstration projects address this issue in unique ways with designs
intended to shift the focus away from counselor ownership of advice and
information to a broader, more natural and customer-centered basis.

it is important to distinguish between these two aspects of informed
choice. *Information* *relates to the body of knowledge or facts
associated with an issue or a decision. It would seem* that by this
definition, information would be free of opinion or personal bias.
However, since most rehabilitation personnel work for systems with rules
and traditional responses to certain situations, it is often difficult
to know whether an interaction concerning informed choice is factual or
biased in some way.

Since the opinion aspect of advice is almost inherently biased, good
advice should contain alternate avenues for customer consideration, as
well as the opinion of those offering the opinion. *Indeed, good advice
is an individualized blend of* **information, opinion** *and workable*
**options** *offered to a customer in a manner which can be understood
and utilized.*

In the implementation of the choice-driven projects, a number of
factors, considerations or influences affecting informed choice have
been identified. The following headings provide an overview of these
factors, along with a brief discussion of each.

**[Understandine how an individual processes information and
opinion]{.underline}**

Just as with other aspects of employment, individualization is
critically important in the delivery of information and advice.
Regardless of the relationship with one\'s advisor, it is necessary for
the person(s) offering input to understand the experiences, the
tendencies and support needs of the customer. This is to say that it is
not sufficient simply to give accurate and unbiased advice and
information. It is also necessary to get to know the individual well
enough to gauge the person\'s reaction both to the input given and to
the source of that input . While it may seem that a customer is making
an informed decision based on the information and opinion of an advisor,
the reality may be that the customer is seeking to please or to simply
follow any advice offered. Understanding the difference requires those
giving advice and information to closely

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***Advice, Information and*** Choice

monitor all decisions and to consider subtle ways to insure that the
customer owns and understands the decision as much as possible. It is
important to consider that technology, interpretation services and
accessible information formats may need to be available to assure that
an individual understands and processes opinions of others. When
confronted with new and complex decisions people with disabilities,
especially persons with significant intellectual disabilities, may need
support and feedback from those most closely concerned about them in
order for information and advice to be understood and processed.

**[Gatekeeping issues]{.underline}**

Gatekeeping involves the limitations, inevitable whenever public funds
are used by individuals, which are placed on the choices of customers.
Since the intention of the choice demonstration authority is to examine
the effectiveness of achieving employment outcomes through funds
controlled by the individual with a disability, the role of gatekeeping
is dynamic and challenging.

When the sole source of information and advice is from a representative
of the system, it is easy for that input to become infused with the
gatekeeping responsibilities which are a part of any system\'s policies.
Even the choice projects have gatekeeping issues which affect the
customer\'s choices and which often require a blend of information and
advice to assist them to make successful, informed decisions.
Representatives of the system must recognize the limits of their advice
and the possible bias of their information in light of their gatekeeping
responsibilities and they communicate those limits to customers. The
limits referred to here typically involve monetary issues such as the
cost, value or individual\'s need relative to a service or product.
These considerations will arise as gatekeeping issues in any funded
relationship \-- public or private. The choice projects have sought to
reduce any arbitrary and limiting rules on the use of funds by placing
the customer\'s needs and satisfaction as first line considerations.

However, there are thorny gatekeeping issues which go beyond money and
which can compromise the effectiveness of advice and the validity of
information. If physical or emotional harm is considered to be likely,
it is often necessary to impose limits as opposed to offering
information, options and opinion. Counselors and other gatekeepers must
decide if and when it is

3

*Advice, Information* **and** *Choice*

appropriate to intervene if it seems that harm may occur. Of course,
each situation will vary, depending upon specific factors, but decisions
to constrain choice cut to the heart of the effort to honor the
customer\'s decisions. In those instances when it is felt to be
necessary to not support a customer\'s decision, we are responsible for
accepting a level of discomfort concerning the necessity for placing the
restriction, for seeking a wide variety of acceptable options and input
and for explaining (possibly even apologizing) to the customer for the
necessity of the restrictions which are to be applied.

**Belivability/reputation**

Since one of the traditional counselor roles has been that of a
gatekeeper, many customers have questioned the degree to which advice
and information serve their needs or the system\'s needs. In order for
professional input to be perceived as believable, it is necessary for
the counselor or advisor to build a reputation of honestly
distinguishing between advice and the limiting reality of the
gatekeeping needs of the system. To resolve this potential conflict,
some projects have separated the roles of gatekeeping and advice while
others have sought to provide clear distinctions for customers who
receive their advice from sources tied to the funding system.

**Ownership of the decision**

Perhaps the most important consideration relating to good advice and
information is that responsible, viable and final decisions are made by
the customer, or by a designated family member, as appropriate. In order
to accomplish this, all those in informing and advising roles must
strive to provide unbiased advice and information which relates directly
to the customer choosing and pursuing a realistic employment objectives.
This advice should be adequate for the customer to make an informed
decision based on accurate information. The role of system personnel is
to provide information, but not usurp ownership by the customer. To
enable the customer to make an informed choice that meets their personal
needs and wishes while remaining realistic is one of the most
challenging aspects of assuring informed choice.

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*Advice,* **Information and** *Choice*

In order to accomplish this, all those in advisor and information roles
must consciously give up their prerogative to sway and to direct the
decisions made by the customer. This separation is at the core of the
changes addressed by the choice projects. It is also one of the most
difficult and challenging aspects of choice. The challenge to assure
maximum ownership by customers is felt most keenly in regards to
gatekeeping. There will always be guidelines and restrictions placed on
the use of public funds. Rehabilitation counselors are required by the
Rehabilitation Act of 1973, as amended in 1992 (Section 361.52, page
6357), to \"ensure that each individual receives, through appropriate
modes of communication, information concerning the availability and
scope of informed choice, the manner in which informed choice may be
exercised and the availability of support services for individuals with
cognitive or other disabilities who require assistance in exercising
informed choice.\" This clause in the Act clarifies the duties of
rehabilitation personnel, however it does not clearly indicate the
limits of the

availability and scope of informed choice.\" These decisions will
likely be made at the state and district level, therefore care must be
taken so as to maximize the opportunity for ownership of decisions by
individuals.

**[Factors which affect how customers make decisions]{.underline}**

There is a family of factors which impact the decisions made by
customers. The relationship between the customer and sources of
information and advice will vary, depending upon the relative importance
of each factor and the combined importance of how the factors work
together to impact the customer and the outcomes.

**Complexity**

Complexity relates both to the issue under consideration and to its
relationship with other issues. It also refers to a degree of
anticipated or apparent difficulty that the customer is expected to have
in understanding and addressing an issue. The more truly complex the
issue, the more likely it is that the customer will feel the need
professional/technical information and advice. It is important to
consider the distinction of whether a decision is truly complex \-- one
that is beyond the ability of people to

5

***Advice, Information and*** Choice

understand without a significant investment of time and effort \-- from
one which can be made understandable by a reasonable degree of effort on
the part of the informer or advisor to break the issue down into clear,
accessible components. If the information can be offered in a form which
is understood by the customer, the opinion of the advisor can be
minimized. If the decision is truly complex, the opinion of one or more
persons who are familiar with the issue is often necessary to assure
informed choice.

It is likely that customers will make decisions regarding truly complex
situations by relying more on professional opinion rather than on an
understanding of the information about the issue. However, because of
this dependence on professional opinion, there is an increased chance of
professional \"steering\" of the customer. In order to assure ownership
by the customer, information and advice offered on complex issues must
be as free from bias and influence as possible. The use of a \"second
opinion\" from a variety of sources can assist customers to deal with
complex information. The need for additional supports rises as the
complexity of the information to be considered increases.

**Risk**

Risk is a factor which relates to the impact or degree of harm to the
customer -­physical, emotional, monetary \-- that is a possible
consequence of a decision. Risk and impact can also be felt by the
counselor, service provider or others. Informing and advising issues
here are similar to those described in complexity. The intervention
related to reducing risk is a gatekeeping issue covered earlier in this
paper. Rehabilitation personnel must first identify the party(ies) at
risk. If the risk is to the customer, it is necessary to distinguish
between risk related to personal harm or personal impact and the risk of
losing money. Decisions which can bring physical or emotional harm and
significant life impact to the customer, require intervention and
support by the system. If the risk is primarily to staff, an agency or
the system, the restrictions placed as a part of gatekeeping must be
carefully examined. If a such a decision is not covered by the
restrictions of the funding, we must allow the decision to be made.

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*Advice, Information* **and** *Choice*

Cost

The cost attached to a decision is one of the most traditional concerns
of advisors in rehabilitation. The roles of gatekeeper and advisor are
more likely to be confused and crossed on this factor than any other.
Effective feedback in this area should focus on a clear analysis of the
possible consequences of different levels of spending on the customers
resources and on an effort to get value for the money spent.

**Impact on others**

Good advice and information helps customers see how their decisions will
affect the fives of those who are important to the customer. This is an
area in which clear information will probably weigh more heavily than
the advisor\'s opinion.

**Reversibility**

The degree to which a decision is reversible, will affect the manner in
which advice is offered. For those decisions which can be re-directed or
re-considered after problems occur, it is likely that information or
options will be all that is desired by the customer.

However, for those decisions which seem to be less reversible, clear
opinion might be needed from the advisor as to the best direction in
which to proceed.

**[Bias/impartiality]{.underline}**

One of the thorniest issues concerning information and advice is for the
customer to deal with the degree of self-interest and bias on the part
of system personnel. Virtually all information, opinion and options
offered to customers will contain some bias, even on feedback based on
what is presumed to be \"factual\" information. Since the traditional
source of information and advice in rehabilitation has been from the
counselor, the bias felt by customers was a result of the influence and
policies of the rehabilitation system. The choice projects have
responded to this by broadening the scope of sources of input to include
the family, fiiends and independent advisors. The role of the counselor
has been limited to providing and analyzing information and offering
options, with the opinion aspect coming from those chosen by the
customer.

There is an inherent conflict between advice and service delivery. The
conflict occurs due to the significantly increased bias which arises
from the self-interest of advisors who suggest that

7

*Advice,* **Information and** *Choice*

a customer buy their services. Some projects have implemented policies
which constrain advisors from offering services.

In addition to the natural conflicts which often occur between
individuals and systems, it is important to recognize the bias conflicts
which occur among spouses, family members, friends and advocates. These
biases are usually different from those of service providers (but not
always) and usually seem to have the interests of the participant at
heart. The opinions of those closest to the individual are also likely
to be the hardest to reject, if the advice is not in line with the
participant\'s wishes. It is important for support personnel to become
aware of those biases, to balance them by gathering information from
differing viewpoints, to gather as much information as possible and to
suggest a method to weigh the pros and cons of different viewpoints.

**[Variety of sources]{.underline}**

An effective way to reduce bias in information and advice is to broaden
the scope of those offering advice. It is common throughput the choice
projects to urge customers to seek input from a variety of sources. Even
though the downside of this approach may be to overload customers with
conflicting information, the gains available from hearing a number of
perspectives on an issue far outweighs any possible confusion. In fact,
by viewing advice and information as coming fi7om multi-sources rather
than a single, system-provided source, it is possible to include
counselors in the mix without violating the principle of impartiality,
In those instances where there is significant conflict between the
sources of advice, most projects advise customers to rely on sources
which are closest to them and who know them best.

There is a reasonable expectation that the advice available to customers
be effective to meet their needs and that it be as accurate or \"true\"
as possible. The role of monitoring accuracy is complex. In fact, a new
role for the traditional counselor may be to offer opinion to customers
not on what to do, but rather, on which sources of advice and
information seem the most accurate or useful. The finesse of this
counselor role would be to assure that the principle of customer
ownership of advice be upheld.

A way to manage this role is to assure that the customer has access to
information from a variety of sources. However, when advice is sought
from a variety of sources, particularly from

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*Advice,* **Information and** *Choice*

non-professional sources such as family members and friends, there is
likely to be a conflict between accuracy of information and the
effectiveness of a suggestion. It is necessary to recognize this
conflict as natural in many life dilemmas. Professionals often have
viewpoints based on their experience and education which from which they
apply facts and theories to the fives of customers. Family and ffiends
often make suggestions based on their intimate knowledge of the life of
the customer. A blending of Professional knowledge and personal
perspective can provide customers with advice that is both accurate and
effective to meet their needs.

**[Education]{.underline}**

In a given advice relationship there is an array of interactions which
might exist between the system and the customer. The endpoints of a
triangular model might be thought of as information, opinion and
options. The information area is often associated with an educational
aspect of advice \-- teaching the customer to understand both the facts
surrounding the decision and their responsibilities in the process of
decision-making. A number of the choice projects have implemented formal
and informal opportunities for customers to receive training in dealing
with advice.

**[Exverience]{.underline}**

Possibly the most common strategy used throughout the choice projects is
to place customers in the position of receiving advice and to urge them,
to allow them and to support them to make decisions. Variously, these
decisions will result in success and they will result in problems. The
repetitive experience of behaving as a person in control of one\'s life
and responsible for making the decisions which affect that life is the
most universally accepted approach to the issue of advice in the choice
demonstrations.

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***Advice, Information and*** Choice

**Strategies used by various projects to deal with advice**

**Arkansas Rehabilitation Services**

This project uses Consumer Connectors, who are private vendors paid
through the project, to offer advice to customers. The connectors
facilitate the project\'s person-driven career planning process and
assure that the customer\'s voice is heard throughout their entire
effort to become employed. This project also encourages customers to
involve parents, friends and other trusted persons to assist with advice
and offers empowerment training to all customers.

**Berkeley Center for Independent Living**

This project trains service counselors to act as resource clearinghouses
for customers. All of the sources of information in the national and
local community \-- calendars, newspapers, brochures, junk mail,
resource directories, etc. \-- are collected and offered as input.
Counselors urge customers to take control of all aspects of
decision-making and will offer advice only if asked. Generic sources of
advice are encouraged over system sources: consumer reports, Better
Business Bureau, personal opinions of other customers, site visits etc.
Empowerment seminars are offered twice a month to support
decision-making by customers.

**The Development Team**

This project prefers to use information, rather than advice. as a
category of service. This multi-site project uses a variety processes
for enhancing information with group dialog with peers as the
centerpiece. All customers attend weekly meetings where they belong to a
peer group of approximately twelve persons with whom they develop
relationships and share responsibility for decision-making. Detailed
manuals are available to customers which contain information, along with
that provided by guest presenters and business volunteers. Project
facilitators are not formally expected to offer advice but they may be
called on voluntarily by customers for input and perspective. The
project also uses self-assessment interviews as a technique to determine
whether someone will join the group. The interviewer offers advice to
the customer based on the results of the interaction. Customers may
purchase advice from outside sources if they feel that they want that
perspective.

1 0

***Advice, Information and*** Choice

**Southwest Business, Industry and Rehabilitation Assn.**

The case managers in this project provide an array of options throughout
the customer\'s journey toward employment. The case manager further
offers various options and their impact and encourages the customer to
choose the one that best suits the individual. Customers are informed
during the intake process as to who will be available to provide advice
and who has the authority to make and approve decisions.

**United Cerebral Palsy Associations Choice Access Project**

This project primarily recommends that customers use an independent
Employment Advisor who is paid by the customer on a retainer basis.
Employment advisors are recruited by the project for a pool of advisors
held by each site. Advisors may also be identified.by the customer from
family, ftiends and advocates in the community. In order to qualify as
an employment advisor, the individual must agree to attend at least one
free training offered through the project and not to offer service
provision to that customer. The role of the employment advisor is
conceptually based on a cross between a generic financial advisor and a
personal assistant, typically used by persons with physical
disabilities. Customers are also urged to broaden sources of advice by
seeking out the perspective of family, friends, community advocates and
business people.

**Vermont Division of Vocational Rehabilitation**

This project encourages customers to seek advice from a array of natural
sources. Since this project is a choice-focused replication of the
state\'s Vocational Rehabilitation I 10 program, counselors interact
with customers and may offer advice from their perspective. However, the
emphasis is for customers to make their own decisions. The counselor\'s
role is to determine how to assist the customer to get effective and
accurate advice and to own the responsibility to make decisions.
Counselors also teach customers to be accountable and responsible for
their decisions.

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***Advice, Information and*** Choice

**Washington State Vocational Rehabilitation PEP Project**

PEP also encourages customers to seek advice from a variety of sources.
However, the project\'s central strategy for advice involves the use of
a Rehabilitation Team which is developed by and available to the
customer to assist with the advice needed to make decisions. This team
removes decision-making and advice from the traditional
counselor-centered perspective by welcoming input from an array of
individually-determined sources. Regular classes are offered to
customers on topics which span the gamut of employment issues, including
advice. Customers work with both natural and professional supporters to
help them identify what information and opinion is needed and where that
information can be found.

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