NADD Bulletin Volume V Number 3 Article 3

Complete listing

Consumer Choice in Vocational Rehabilitation: Case Study Examples from the Connecticut “CHOICE” Project

Debora M. Presbie, M.A., Director, Innovations in Choice Project, A.J. Pappanikou Center for Excellence in Developmental Disabilities, Education, Research, and Service, University of Connecticut, Jacqueline Dunaway, MA, Educational Consultant

Abstract

Two major innovations in vocational rehabilitation (VR) service options were implemented and evaluated by the Connecticut Bureau of Rehabilitation Services: a peer-facilitated group for the development of employment plans and VR direct purchasing authority along with a credit card system. Participants in the six-session peer groups were 204 adult VR consumers. Purchasing innovations were implemented in five districts. Consumer partners in the VR process describe numerous advantages of these innovations. The following case study examples illustrate these advantages.

Background

The following article describes the experience of vocational rehabilitation consumers with two innovative VR procedures: a peer group model for employment planning and speedier and more flexible alternatives to traditional vendor contract/purchase order procedures. Case examples demonstrate the positive effect of these changes on the lives of individuals with disabilities.

These procedures were developed and tested during a four-year special programs and demonstration project. Innovations in Choice: Enhancing Consumer Involvement in the Vocational Rehabilitation Process (1997-2001) was a joint venture of the A.J. Pappanikou Center for Excellence in Developmental Disabilities Education, Research, and Service and the Connecticut Department of Social Services, Bureau of Rehabilitation Services (BRS).

Consumer Empowerment & Vocational Planning through the Group Process

As an alternative to the traditional 1:1 counselor-driven method of developing an employment plan, consumers were given the choice of participating in a group co-facilitated by two VR counselors, but driven by peer support. Four VR districts volunteered to assess the effectiveness of group methodology in vocational rehabilitation. The groups varied in size from two to ten and included consumers with a variety of types and severity of disability. The majority were individuals with severe learning disabilities and/or a history of mental illness. Three hundred twenty-one (321) consumers began the peer group option over the four-year period. Two hundred four (204 or 64%) BRS consumers completed the groups.

In addition to providing consumers a new service option, groups afforded other advantages including more interpersonal resources. According to Corey, the group model “has a number of advantages for all concerned: the group members can gain from the perspectives of two leaders&ldots;” and of their peers. “Groups provide the support and challenge necessary for honest self-exploration&ldots;.” (Corey, 1992, p.11). “Through feedback from other group members, individuals are encouraged to see themselves as others do” (ibid.). The following case studies illustrate these advantages. The groups also allowed counselors to observe consumers’ skills in social interaction. Occupational trends suggest interpersonal and team-building skills are increasingly important in today’s job market (NYDOL, 1999).

Another advantage was the curriculum itself, which relies on active learner participation, a strategy found effective in education and community rehabilitation programs (Field, Martin, Miller, Ward, & Wehmeyer, 1998). The group option is known as the “Career Options Workshop” (COW). COW includes interest identification activities such as the Holland Self-Directed Search, analysis of transferable skills, completion of a community-based vocational research activity, and a trip to the Department of Labor One Stop Resource Library. Groups typically meet twice a week, for 2-3 hours, over a three-week period, and end with a self-advocacy activity in which consumers defend their career choice and vocational needs before the group, two or more BRS counselors, and a video camera.

Group members report an overall high level of satisfaction with the process. Ninety seven percent (97%) of the participants reported that the group experience was highly positive. Project staff and BRS staff had anticipated that the group process might be “scary” for consumers. In fact, the majority of participants reported that the process made them feel better about themselves and made them more aware of their own strengths. Consumers commented:

“I’ve learned how other people view me and how I can compensate&ldots;.”

“&ldots;it gave me an opportunity to have people in my life who know what I’ve been through.”

Consumers also reported that they have a better understanding of their vocational needs and how BRS can assist them as a result of participating in the group.

The idea of the process was “scary” for some counselors. Over two-thirds of counselors surveyed reported that their greatest reservation was “keeping control” of the group. However, counselors also were positive in their review, reporting that they have a better understanding of the strengths and needs of the consumers as a result of watching them interact with others in the group. The co-facilitation and training model provided safety and support for the counselors.

The following case studies describe ways in which BRS consumers have benefited from peer support through the Career Options Workshop.

“Sarah”

Sarah came to the group with the goal of being trained as a data entry clerk. After 15 years as a light assembly worker, a back injury forced her to change occupations. Her best friend worked in data entry and loved the job. Sarah’s VR counselor noticed a doctor’s notes about mild, intermittent carpal tunnel syndrome. Sarah insisted this would not be a barrier.

In Session 4, Decision Making, participants begin to synthesize their strengths, obstacles, interests, and skills into preliminary goals. Consumers are encouraged to do their own vocational field research by interviewing or observing workers in their chosen fields. Sarah chose to shadow her friend on the job.

In the next session Sarah shared her experience shadowing her friend. She realized the data entry work would aggravate her carpal tunnel disease. In sessions 5 and 6 Sarah concentrated on her other skill areas and decided to focus on human services. Without this decision-making process, Sarah would have been unaware of the impact of her disability on her original career choice.

Comment. Sarah’s case illustrates the importance of vocational research as a component of employment planning. It also illustrates the advantage of teaching decision-making as a skill or process. Each group member shares his/her decision process from identifying strengths, obstacles, and transferable skills to identifying goals and intermediate steps.

“Mary”

Mary was a registered nurse with a successful job history, including many positions of responsibility. She was faced with gradual deterioration of both her mobility and her short-term memory as a result of multiple sclerosis.

Mary’s demeanor and skills were impressive. All were convinced she could handle light duty nursing responsibilities, perhaps in an office setting or as an intake coordinator. However, the group atmosphere and group activities revealed to Mary and the counselors obstacles she had not considered. She was unable to follow fast-paced group activities, and the banter and conversation of the group interfered with her thinking and irritated her. This new information helped Mary set more realistic goals and consider alternate settings where she might be successful.

Comment. Mary’s case illustrates the advantages of the group setting for vocational planning. Without the group experience, Mary and her counselors would not have had this additional insight into her inability to function well in a group setting. The varied personalities, tasks, noise levels, and irritations of a group setting bring out different aspects of each person’s personality. These reactions are important information for the VR counselor.

“Paul”

When Paul joined the group he had two vocational goals: become a job coach or an actor. BRS had already funded three training programs for Paul: 1) an Associates degree in theater arts – he dropped out; 2) Job Corps training to become a certified nurse assistant – he dropped out; and 3) Job Corps training in office skills, including computer training – he did well and completed the program.

Paul stuck to his goal of job coach for five sessions, during which time he researched the job requirements. He contacted his former job coach for an interview. Group members and staff facilitators asked about stresses leading him to mental illness and substance abuse relapses, and whether he would be able to complete another training program. Paul responded he was in better psychological shape and would do what it took.

 In session 6, the self-advocacy session, he arrived at group subdued and introspective. Paul realized how terrifying the thought of training was for him. He was not sure he was strong enough to take on the burdens of others. Since he had been successful with clerical training and enjoyed working with office machines, he would think about clerical work as a short-term goal and job coaching for the future.

Comment. The support of the group contributed to Paul’s ability to express his fears. His counselor’s presence in the group helped him commit to a plan of immediate vocational action that has the earmarks of success.

“Leo”

Leo had a successful career as a public relations executive and marketing promoter until a psychological breakdown in the early 1990s. With assistance from BRS, Leo established a home-based marketing business. Despite business success, the isolation of the home-based business was causing depression.

Leo’s goal was to become a part-time sales associate at a large firm. Given his psychological disabilities, he knew that he could not tolerate full-time work. However, applications for part-time sales associate positions were rejected on grounds he was over-qualified. To be viewed as a serious applicant, he would have to reveal his disability, something he did not want to do.

Leo was already aware of his skills and obstacles. He used the group to identify the steps needed to reach his goal. He developed a plan to “market” himself to potential employers, a resume that focused on the future and his goals, and a strategy to structure interviews to give a positive story of why he was out of work.

Comment. The group experience allowed Leo to explore and test his “marketing plan” and get feedback. It also provided Leo a chance to use his many skills to assist and teach others in the group. He realized through this experience that teaching or tutoring others might be part of his longer-term goal.

“Joe”

Joe is a man in his late forties who served in the military for many years. In his thirties he left the military after onset of manic depression and associated problems of alcoholism and behavioral issues. Joe had been a BRS client for many years, returning during episodes of depression.

Joe spoke of wanting to train to be a paralegal. Although his military record showed an aptitude for learning and applying himself, his schooling had been scattered and broken up by his illness. Knowing the choice sounded challenging and would involve schooling, he also explored the option of being a cook. Rather than “settling” on being a cook, group members encouraged him to explore the paralegal route. A group brainstorming session provided Joe with a list of “To Do’s” which included researching schools offering paralegal training and determining whether he could audit courses before enrolling. Joe gathered all this information, spoke to admissions personnel, and discovered there was an entry test for pre-qualification.

Joe finished the group with the intention of finding part-time temporary work until he could take the pre-qualification exam. He took the exam and did well. He worked with his BRS counselor to devise an employment plan that included the desired schooling. He successfully completed his first courses and intends to register for a heavier course load next semester.

Comment. The group provided Joe the support and encouragement to explore his “dream.” Without the encouragement and the requirement of vocational research, he would not have learned about the pre-qualifying exam. Taking the exam was an important step in his decision-making process, and the long-range plan he developed helped him articulate the many small steps he needed to take towards his goal.

Consumer Choice in Purchasing

The second initiative undertaken by BRS to increase consumer choice in the rehabilitation process included a review of VR purchasing policies and implementation of two purchasing strategies. In May 1999, Purchasing Policies in Public Vocational Rehabilitation Agencies: A review of national practices for promoting consumer choice was completed and disseminated to all state VR directors and University Affiliated Programs throughout the country. This publication was the culmination of a year’s worth of research to identify creative procurement policies that increase consumer involvement and result in flexible and timely service delivery. While this national study was in progress, Connecticut BRS began to look at its current purchasing strategies, analyzed strengths and weaknesses in its service delivery, and put in motion the mechanisms necessary to modify certain procedures. As an initial purchasing initiative, BRS was able to negotiate with the Department of Administrative Services for direct purchase authority (DPA). A second purchasing initiative involving a MasterCard purchase card was implemented in all five BRS districts.

Direct purchase authority

BRS consumer focus groups conducted in the mid-1990s indicated a number of systems issues and barriers relative to purchasing and consumer choice (Connecticut Department of Social Services, 1995, 1996). Lack of vendor choice for equipment or vehicle modifications, in conjunction with the length of time it took to receive services, were primary complaints of BRS consumers. State purchasing barriers, including long-term purchasing contracts with specific vendors and a lengthy competitive bid process, left many BRS consumers feeling powerless. Consumers often reported that they could purchase equipment cheaper at generic outlets such as CompUSA, Staples, Sears, etc. To reduce these barriers, BRS sought to obtain direct purchase authority for all rehabilitation technology and placement equipment needed to fulfill a BRS consumer’s individual employment plan.

Historically, many VR purchases had to go through the Department of Administrative Services (DAS), Connecticut’s central purchasing agency, for bidding and purchase award. In cases when a sole source approval was appropriate because the consumer was seeking to choose his/her own vendor for reasons of proximity, service, or a professional relationship, an elaborate DAS “standardization transaction” was required. This included the convening of a committee to “hear” the purchase request. On March 2, 1999, DAS granted direct purchase authority to BRS for all client purchases exceeding $10,000. BRS is now able to authorize purchases within hours of request. The following case examples represent the success of DPA in supporting consumer choice.

“Arthur”

A long-time employee of the Department of Revenue Services needed a vehicle modification. Arthur has muscular dystrophy and had had three other vehicles modified in the course of his employment life. His need for the next vehicle was immediate. His continued employment was dependent upon this transportation.

The previous three modifications had taken an average of nine months from the time of his initial request until the time his van was delivered. Under the traditional system, BRS would write a requisition to DAS. DAS either would solicit competitive bids or convene its standardization committee to determine if the service was exempt from bidding.

With DPA, BRS could evaluate and authorize this expenditure and arrange a sole-source purchase. The process took four months, less than half the previous time. Arthur was also able to customize his van as part of the same process. In the past, if he made a single request for equipment that was rejected, the entire request was rejected pending an appeal process. These new processes allowed him to pay for certain options (e.g., a telephone hook-up and a passenger seat for an individual with a disability) and get the vendors of his choice. He selected a vendor in New Jersey who specialized in the high- tech equipment he needed to compensate for his diminishing muscle control. He also selected a vendor in Connecticut to provide ongoing service to the vehicle.

Comment. The DPA process saved the consumer time and money. In addition to arranging or paying for interim transportation during the waiting period, Arthur also was making payments on the new van. Rather than nine months of payments before he took possession of the van, he faced only three. The process improved efficiency and saved administrative time, since BRS was able to review and approve this requisition without additional DAS review. It also enabled the consumer to advocate for his choice of services with a trained VR counselor, rather than a DAS employee who would have little understanding of VR needs.

“Carl”

Carl is a 20-year-old male with learning disabilities who applied for BRS services in March 1999. He wanted to own a lawn-care business. One item in the plan was a commercial lawnmower. It was authorized on April 12, 1999 and in his possession three days later. His plan to expand this business involved work with the CT Small Business Development Center, and that plan was completed by the end of May 1999. The completed plan called for the equipment purchase of a $15,000 John Deere tractor. The equipment was authorized, a consumer contribution was agreed upon (he paid $250 because he wanted “upgraded” tires), and it arrived in time for the summer season.

Comment. With the “old” way of purchasing, after determining consumer eligibility, it would have taken approximately six weeks to prepare a bid, send it on to DAS, place the ads, review the bids, and make an award. Then the purchase order process would have begun, with authorizations, etc. As a result of DPA, Carl was able to start his business in a timely manner. He earned $7,521.19 in three months and began building his customers base for fall leaf removal and snow plowing.

Purchase card program

Our research also revealed that a number of states, Connecticut among them, were using purchase cards for state agency operations. However, no agency in Connecticut was using the card for making client purchases. BRS negotiated to participate in the state’s purchasing card program, and was the first agency in Connecticut to use the card to make client purchases. Credit card purchasing was piloted in year three of the project with the following limitations on purchases: no single purchase over $1,000; no more than five transactions per day per card; no more than 20 purchases per month per cardholder; a total limit of $3,000 per month. To assure accountability, transactions for purchases are posted to the BRS account for review through an Internet connection within 48 hours of purchase.

Credit card use fostered consumer choice as well as accountability. For example, a consumer who needs work tools for employment can now go to a store, examine the inventory, choose the items they need, have the designated card holder (a BRS employee) charge the purchase, and leave with their tools right way. The cardholder may accompany the consumer to the store or may charge the purchase by phone. It was determined that issuing cards directly to consumers would not be efficient or economically prudent because most purchases were either on a one-time (equipment or clothing) or short-lived (training) basis. The following examples illustrate some of the uses of the BRS MasterCard.

“Joan”

Joan secured a job that required a uniform, including nursing shoes. In order to get the job, she needed to begin work immediately. She wore a size 13 shoe that would have been special-ordered on the purchase order system. Using the credit card, she located and purchased the shoes and was able to begin work on the assigned day.

“Mark”

Mark secured a job as a tile setter and needed his own tools to begin work. He purchased some using the credit card option while other tools that were available through state contracts were ordered for him. One week later he was notified that the ordered tools were not available. He was able to purchase those tools the same day with the credit card, thereby maintaining his agreement with his new employer.

“Phyllis”

Phyllis was planning to start a small business in her home. She required a transcriber and fax machine to start a home business as a transcriber. The type of fax machine needed by the consumer was not available through state contract. Through the purchase card option she was able to meet her counselor at the store, select a suitable product, and take it with her immediately.

Comment. Vendors are satisfied because the card provides prompt payment to them. Consumers are happy to make their own choices and receive merchandise speedily. In several cases, consumer ability to make quick purchases assured them a job.

Discussion

As these selected case studies illustrate, the peer group model affords many advantages to both consumers and counselors. The peer group support, sequential curriculum, and the diverse environment and circumstances created by a group setting provide the consumer with interpersonal and learning opportunities not typical of the traditional 1:1 counseling model. The group setting also provides the counselor with information about many facets of the consumer that would not be observed in the 1:1 setting.

A comparison group study contrasting 146 group participants with 140 1:1 participants indicated that more peer group participants than control group members reach the planning stage and slightly more become employed. The model described in this article can be replicated by any state VR program, service provider, or adapted for use by local school-to-career or transition programs.

The DPA and the credit card option both contributed to increased consumer choice and increased speed in purchasing necessary consumer supports. In some cases the ability to make immediate purchases with the credit card saved not only time but job opportunities.

More information on the purchasing options or Career Options Workshop described in this article can be found at http://www.ajp.uconn.edu/innovations.

References

Connecticut Department of Social Services, Bureau of Rehabilitation Services (1995). Consumer focus group proceedings. Windsor, CT: Connecticut Department of Social Services, Bureau of Rehabilitation Services.

Connecticut Department of Social Services, Bureau of Rehabilitation Services (1995). From “patient” to “worker” removing barriers to employment for people with severe mental illness. Windsor, CT: Connecticut Department of Social Services, Bureau of Rehabilitation Services

Connecticut Department of Social Services, Bureau of Rehabilitation Services (1996). Report summary of services provided to the African-American client. Windsor, CT: Connecticut Department of Social Services, Bureau of Rehabilitation Services.

Corey, M. S. & Corey, G. (1992). Groups process and practice (4th ed.). California: Brooks/Cole.

Field, S., Martin, J., Miller, R., Ward, M., & Wehmeyer, M. (1998). Self-determination for persons with disabilities: A position statement for the division on career development and transition. Career Development for Exceptional Individuals, 21, 113-128.

New York Department of Labor (NYDOL). (1999). Occupational trends. Albany: NYDOL.

Note: Funding for this project was provided by Grant #H235W970040, from the United States Department of Education, Office of Special Education and Rehabilitative Services awarded to the A.J. Pappanikou Center at the University of Connecticut.

For further information:

Debora Presbie
186 Loomis Street
North Granby, CT 06060
(860) 653-4658
dpresbie@aol.com.