AMERICAN

REHABILITATION

MERICAN

EHABILITATION

AUTUMN 2004

H O W E MPOWERMENT

C HANGED M Y L IFE

“I DON ' T HAVE TO LIVE

I N M Y CAR ANYMORE...”

E NHANCING P ERSONAL

E MPOWERMENT

O F P EOPLE W ITH

P SYCHIATRIC D ISABILITIES

SELF -DETERMINATION AND THE

E MPOWERMENT O F P EOPLE

W ITH D ISABILITIES

S LAYING D RAGONS :

BUILDING SELF -CONFIDENCE

AND RAISING EXPECTATIONS

T HROUGH O RIENTATION

C ENTER T RAINING

E MPOWERING P EOPLE

W ITH D ISABILITIES

T HROUGH V OCATIONAL

REHABILITATION COUNSELING
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 highquality 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 highquality employment and opportunity for persons with

disabilities.

Joanne Wilson

Commissioner

Rehabilitation Services

Administration

OUR COMMITMENT

TO THE EMPOWERMENT OF

INDIVIDUALS WITH

DISABILITIES

Photograph: Frank Romano, U.S. Department of Education
AMERICAN

REHABILITATION V OLUME : 2 8

N UMBER : 1

A UTUMN : 2004

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

ADMINSTRATION :Joanne Wilson, Commissioner

EDITORS : Frank Romano, Suzanne Mitchell

PRODUCTION EDITOR :Juliette Rizzo

DESIGN AND PRODUCTION : Geoffrey P. Rhodes

E DITORIAL 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

THE WEAKEST INK IS BETTER THAN THE STRONGEST MEMORY

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

Cover: Erik Weihenmayer — the first blind

climber in history to reach the summit of the

world's highest mountain, Mt. Everest — was

selected for our cover because he so completely embodies the spirit of empowerment,

which is the subject of this issue of American Rehabilitation. Despite losing his vision

at the age of 13, Erik Weihenmayer is a world

class athlete: acrobatic skydiver, long distance

biker, marathon runner, skier, mountaineer,

ice climber and rock climber. He is also a

prolific speaker and the author of Touch the

Top of the World: A Blind Man’s Journey to

Climb Farther than the Eye Can See.

Photo by Kevin Cherilla, rendering by

Geoffrey Rhodes.

3 HOW EMPOWERMENT CHANGED MY LIFE

“I DON'T HAVE TO LIVE IN

MY CAR ANYMORE...”

MARCIE KELLEY

10 ENHANCING PERSONAL EMPOWERMENT OF

PEOPLE WITH PSYCHIATRIC

DISABILITIES

PATRICK W. CORRIGAN, PSY.D.

22 SELF-DETERMINATION AND THE EMPOWERMENT OF

PEOPLE WITH DISABILITIES

MICHAEL L. WEHMEYER, PH.D.

30 SLAYING DRAGONS: BUILDING SELF-CONFIDENCE AND

RAISING EXPECTATIONS THROUGH ORIENTATION

CENTER TRAINING

SANDY TIGGES, PH.D.

40 EMPOWERING PEOPLE WITH DISABILITIES

THROUGH VOCATIONAL REHABILITATION

COUNSELING

JOHN F. KOSCIULEK, PH.D., CRC

48 COMMISSIONER’S MEMORANDUM

CONSUMER ORGANIZATIONS: IMPORTANT

RESOURCES FOR VR AGENCIES

JOANNE WILSON

54 FREEDOM FOR THE BLIND: THE SECRET IS EMPOWERMENT, A BOOK REVIEW

ALLEN HARRIS
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HOW EMPOWERMENT

CHANGED MY LIFE

“I don’t have to live in my car anymore...”

MARCIE KELLEY

HOW EMPOWERMENT

CHANGED MY LIFE

“I don’t have to live in my car anymore ...”

MARCIE KELLEY

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 fulltime 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 AntiStigma Task Force.

In 1990, I came to the

WNY Independent Living

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.
REHABILITATION

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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

I

am

writing

this for the

individuals,

and for people

who know

individuals,

who feel

disempowered

and

alone.
AUTUMN

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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 CenThe

advocacy

and empowerment

training opened

my eyes to the

disempowering care

systems for people

with psychiatric

disabilities.
REHABILITATION

5

2004

ter 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. L e a r n i n g s k i l l s ( 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 selfimage 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

Empowerment

must

begin with

the individual

and then expand

to the community

as a

whole.
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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

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?
REHABILITATION

7

2004

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 nondisabled 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 builtup 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

There

are many

good reasons

why a person with

a disability does

not want to

follow a

certain

plan ...
AUTUMN

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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,

As

the disability

rights movement

grew, more people

with disabilities

demanded more

out of life than

medication and

maintenance.
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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 selfesteem. 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 a

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 http://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

http://www.erie.gov/health/mentalhealth/

BehavHlthTFVocSummaryReport.pdf
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of

ENHANCING PERSONAL

EMPOWERMENT

PEOPLE WITH PSYCHIATRIC

DISABILITIES

PATRICK W. CORRIGAN, PSY.D.

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.

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 espe-
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• 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 &

Dr. Corrigan is Professor of

Psychiatry and Executive Director,

University of Chicago Center for

Psychiatric Rehabilitation,

Tinley Park, Illinois.

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 sericially 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 selfhelp 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.

“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
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ous 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). InterTABLE 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 careplans 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.
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nalizing 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, selfstigma 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.

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

Many

mental health

providers must

drastically reconceive

their viewpoint about

the consumer’s

relationship with

treatment for

empowerment to

occur.
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(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.

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 conTABLE 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).
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sumer 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.

The

preferred

way to handle

findings from

satisfaction

evaluations would

be to involve

participants in

focus groups ...
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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

The

lodge

program is

built on several

principles that

clearly reflect

the spirit of

personal

empowerment.
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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.
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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 consumercentered 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 chalHaving

consumers

as mental health

providers yields several

significant benefits for

the individual

consumer as well

as for people with

mental illness in

general.
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lenge 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 dropin 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 welldefined 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 mental-
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ity, 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.

This

kind of

research is

only going to be

accomplished when

people with disabilities

are full partners.

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
REHABILITATION

21

2004

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SELF-DETERMINATION

AND THE EMPOWERMENT

OF PEOPLE WITH

DISABILITIES

MICHAEL L. WEHMEYER, PH.D.

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

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 SelfDetermination Into the Vocational

Rehabilitation Process.”
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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,

Put

most simply,

the selfdetermination

construct refers

to both the right and

capacity of

individuals to exert

control over and

direct

their

lives.
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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

There

is a growing

body of evidence

in the field of

vocational

rehabilitation (VR)

that enhancing

choice opportunities

leads to better

VR-related

outcomes.
REHABILITATION

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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 selfdetermination 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 Reha-

... in

too many cases,

decisions about jobs

or careers are made

for people with

disabilities instead

of by people with

disabilities.
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bilitation 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 SelfDetermined 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 selfdetermination and thereby empower people with disabilities

through the rehabilitation process.

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

TABLE 1. PHASE 1, SELF-DETERMINED CAREER DEVELOPMENT MODEL

PROBLEM TO SOLVE: WHAT ARE MY CAREER AND JOB GOALS?

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

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.
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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 ”meansends 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.

TABLE 2. PHASE 2, SELF-DETERMINED CAREER DEVELOPMENT MODEL

PROBLEM TO SOLVE: WHAT IS MY PLAN

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

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.
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These steps are the basic steps in

any problem-solving process and

they form the means-end problemsolving 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

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.
REHABILITATION

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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 selfmonitor and evaluate their progress

toward the goals. Five of the six parAUTHOR’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.

ticipants 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.

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A follow-up study of youths with mental

retardation or learning disabilities.

Exceptional Children, 63, 245-255.

West, M.D. (1995). Choice, self-determination and VR services: Systemic barriers

for consumers with severe disabilities.

Journal of Vocational Rehabilitation,

5(4), 281-290.
AUTUMN

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AMERICAN

SLAYING DRAGONS

BUILDING

SELF-CONFIDENCE

AND

RAISING

EXPECTATIONS

THROUGH

ORIENTATION

CENTER

TRAINING

SANDY TIGGES, PH.D.

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.

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.

Saint George and the Dragon, Raffaello Sanzio (1493-1530)
REHABILITATION

31

2004

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 reWe 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.
AUTUMN

32

AMERICAN

habilitation 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

This

philosophy

further contends

that the real problem

of blindness is not

the physical loss of

eyesight but rather

society's

misconceptions

about it.
REHABILITATION

33

2004

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. SomeThrough

learning and

practicing their

problem-solving

skills, students

develop confidence in

themselves and a

more positive

attitude

about their

blindness.
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AMERICAN

times 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 selfconfidence 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,

Students

must learn

that they and not

their families, friends

or society as a whole

should control their

attitude about

themselves

and their

blindness.
REHABILITATION

35

2004

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

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.
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36

AMERICAN

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,

Our

students

are often

surprised to

learn that their

own behavior can

perpetuate or

help dispel

these

myths.
REHABILITATION

37

2004

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,

w e teach them such

s o - cial skills as

table etiquette, ballroom dancing and

communicating in social situations.

Fashion, makeup, hair styles 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

Center

training

helps students

build their

expectations

in a variety

of ways.
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AMERICAN

”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 fed-

... students

must carry

the long white

fiberglass cane —

better known as the

Iowa cane —

at all times.
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... the

center's

success can be

measured in the

long-term positive

effects the training

has had on the

lives of former

students.

eral 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.
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EMPOWERING

PEOPLE

WITH

DISABILITIES

THROUGH

VOCATIONAL

REHABILITATION

COUNSELING

JOHN F. KOSCIULEK, PH.D., CRC

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).

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.
REHABILITATION

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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 careerrelated 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,

The

ever-changing

nature of work

presents new

problems for people

with disabilities

in finding and

maintaining

suitable

employment.
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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.

VOCATIONAL REHABILITATION

COUNSELING EMPOWERMENT

FRAMEWORK

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

FIGURE 1. VOCATIONAL REHABILITATION COUNSELING EMPOWERMENT FRAMEWORK
REHABILITATION

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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 foResearchers

estimate that as

much as 30 percent

of the variance in

counseling outcome

can be attributed to

the counselor-client

working

alliance
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cus 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

Promoting

self-determination

should be a primary

effort of VR counselors

working with

consumers with

disabilities.

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
REHABILITATION

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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 selfdetermination 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 oppor-
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tunities 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 shortand 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 informedchoice/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, lowincome 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, 1993a, p. 30).

Active

consumer

involvement

 is the key element

of successful VR

counseling

interventions.
REHABILITATION

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2004

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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

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.
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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 

participants to meaningful impact upon systemic issues, such as statewide planning and policy deVR

velopment. RSA considers the development of strong working relationships between S

agencies and grass-roots consumer organizations to be pivotal in ensuring that agency ef

tate VR

effective in meeting the needs of the various disability populations the agencies are serving and the

forts are

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 

frequently, 

VR process. All too

individuals create self-imposed limits based on poor role modeling, lack of disabilityspecific information, and negative misconceptions about their disability

self-imposed limits negatively affect their employment outcomes and quality of life. Connecting in-

. Ultimately, these

dividuals 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 

make positive choices regarding their programs and their lives.

guide VR participants to

Furthermore, while all students encounter difficulties during their school years, many of the challenges encountered by students with disabilities are wholly unique. S

are unable to find summer and part-time employment, struggle with social acceptance and negative

tudents with disabilities often

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 

is a natural and necessary component of any complete package of transition services in light of

VR program, it

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

mentoring initiative for transition-aged youth and young adults with disabilities. Projects funded

 has developed a
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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 disabilityspecific 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
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particular individuals with disabilities. In addition, consumer or

perience and knowledge concerning the providers of adjustment services; thus, they are well

ganizations possess a wealth of exprepared 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, 

high-quality employment and independence. It is a planning tool by which individuals identify

ultimately, achieve

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 

lors or other persons.

VR counseIn 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 

selors employed by the agency, qualified VR counselors not employed by the agency

VR coununspecified "resources" (34 CFR 361.45(c)(1)).

, and other

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 

program and its processes, service providers, and, most importantly

VR

tional needs of persons with disabilities. By accessing this important resource, both 

, the disability-related and vocaand individuals can utilize the expertise of consumer or

VR counselors

ganizations 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 

practices as they affect applicants and individuals 

a State VR agency's policies, procedures and

eligible for VR services. 

productive dialogue between VR agencies and these organizations can lead to better programming,

Strong partnerships and

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
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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
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rehabilitation training programs. Consumer organizations can work with VR agencies to identify

and coordinate those activities most appropriate for the needs of their staf

ers. VR staff who have engaged in a variety of immersion activities report: an increased

f and individual consumunderstanding 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 

books simply cannot offer.

agency staff that professional educators, trainers, or

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 of

valuable assistance in reaching culturally diverse or underserved groups to familiarize them with

fer inthe 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 

ganizations, and suggests several methods for fostering ef

VR agency and consumer orfective 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 

gram, these organizations can offer persons with disabilities support, opportunities, and hope.

VR proWhether through peer mentoring, leadership opportunities, role modeling, or disability-specific

training, consumer organizations are invaluable resources for 

viduals with disabilities alike. VR agencies can draw upon the collective talent of these

VR agencies, their partners, and indiorganizations 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.
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FREEDOM FOR THE BLIND:

THE SECRET IS EMPOWERMENT

A BOOK REVIEW

ALLEN HARRIS

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 resi-
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dential 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.

The

blind

customer who

has received cuttingedge VR services has

a markedly higher

chance for vocational

success than the

norm, according

to Omvig.
AUTUMN

56

AMERICAN

RSA R EGIONAL O FFICES

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 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

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

I

II

III

IV

V

VI

VIII VII

IX

X
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

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
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