Differing Priorities of Counselors and Customers to a Consumer Choice Model in Rehabilitation.
The 1992 Reauthorization of the Rehabilitation rehabilitation: see physical therapy. Act placed considerable emphasis on the empowerment em·pow·er
tr.v. em·pow·ered, em·pow·er·ing, em·pow·ers
1. To invest with power, especially legal power or official authority. See Synonyms at authorize.
2. of individuals with disabilities through informed choice, partnerships with their counselor in planning services, and selection of service providers. The increase in numbers in numbered parts; as, a book published in numbers.
See also: Number of people with developmental disabilities developmental disabilities (DD),
n.pl the pathologic conditions that have their origin in the embryology and growth and development of an individual. DDs usually appear clinically before 18 years of age. who are now working in the community (versus sheltered workshops shel·tered workshop
A workplace that provides a supportive environment where physically or mentally challenged persons can acquire job skills and vocational experience.
Noun 1. ) reflects this evolution, as individuals have routinely expressed interest in moving into regular apartments, holding community jobs, and having greater control over their futures (Klein Klein , Melanie 1882-1960.
Austrian-born British psychoanalyst who first introduced play therapy and was the first to use psychoanalysis to treat young children. , 1992).
The support for empowerment, as expressed through greater choice and partnership with professionals, is part of the evolving relationship between rehabilitation counselors and their clients. This trend is frequently referred to as consumerism consumerism
Movement or policies aimed at regulating the products, services, methods, and standards of manufacturers, sellers, and advertisers in the interests of the buyer. in rehabilitation services. Patterson and Marks (1992) describe the differences between customers (or consumers) and clients from the perspective of service industry marketers, and argue that service quality and customer satisfaction become critical considerations when rehabilitation clients are viewed as customers. In 1993, this journal published an exchange on the use of the word "consumer" (Thomas (language) Thomas - A language compatible with the language Dylan(TM). Thomas is NOT Dylan(TM).
The first public release of a translator to Scheme by Matt Birkholz, Jim Miller, and Ron Weiss, written at Digital Equipment Corporation's Cambridge Research Laboratory runs , 1993a; Nosek, 1993; Thomas, 1993b) in which the authors discussed the nature of the counselor/client or consumer relationship and the implications for shared control in the decision-making decision-making,
n the process of coming to a conclusion or making a judgment.
n a type of informal decision-making that combines clinical expertise, patient concerns, and evidence gathered from process. Rhoades, McFarland, and Knight (1995) describe the evolution of consumerism in rehabilitation counseling rehabilitation counseling,
n counseling started in the United States in 1920 to assist individuals disabled by industrial accidents; originally included physical, psychologic, and occupational training; expanded over the next 70 years and laid the as a shift toward a consumer-driven paradigm with emphases on quality and accessibility.
In discussing empowerment, Emener (1991) makes an important distinction between rehabilitation systems, counselors, and clients as areas in the rehabilitation process in which empowerment is critical. While systems factors (e.g. organizational philosophy, policies, effectiveness) certainly influence the experience of empowerment within rehabilitation services, so too do factors associated with counselors (e.g. competency COMPETENCY, evidence. The legal fitness or ability of a witness to be heard on the trial of a cause. This term is also applied to written or other evidence which may be legally given on such trial, as, depositions, letters, account-books, and the like.
2. , professional self-concept self-concept
An individual's assessment of his or her status on a single trait or on many human dimensions using societal or personal norms as criteria. , collegiality col·le·gi·al·i·ty
1. Shared power and authority vested among colleagues.
2. Roman Catholic Church The doctrine that bishops collectively share collegiate power. ) and with people who receive services (e.g. economic security, competency, healthy self-concept). Chan, Shaw, McMahon, Koch Koch , Robert 1843-1910.
German bacteriologist who discovered the cholera bacillus and the bacterial cause of anthrax. He won a 1905 Nobel Prize for developing tuberculin.
named after Robert Koch, a German bacteriologist. , and Strauser (1997) focus on the rehabilitation counselor-consumer relationship and offer a model for building a meaningful partnership. Their model includes the components of a working alliance (to ensure active consumer involvement), counseling expectations (to promote success of the partnership), and a conflict resolution approach to strengthening the relationship.
This article reports on an initiative in which a choice model for employment services was integrated into the service delivery of a state rehabilitation agency. This consumer choice model is grounded in the empowerment philosophy evolving in rehabilitation services. It includes person-centered planning, vocational profiling, employment advising, job carving carving,
n the shaping and forming with instruments. , and job support. The integration of the model within state rehabilitation agency services was an effort to fully realize the empowering partnership promoted in the 1992 Reauthorization of the Rehabilitation Act. At the end of the first year of this initiative, consumers and counselors were asked to evaluate the model and its components. The hypothesis for this study was: given the diverse abilities and needs of consumers and counselors operating within a highly structured, outcome-oriented rehabilitation system, consumers and counselors often have differing priorities within the rehabilitation process.
Collaboration: The project was developed collaboratively between a state vocational rehabilitation Noun 1. vocational rehabilitation - providing training in a specific trade with the aim of gaining employment
rehabilitation - the restoration of someone to a useful place in society agency and the local chapter of a national advocacy organization. This organization had, in the preceding three years, successfully demonstrated a choice model for employment support that operated independently of the state vocational rehabilitation agency. The purpose was to establish the choice model (Callahan & Garner, 1997) within a limited number of local vocational rehabilitation (VR) offices while working out the issues of model implementation and integration within the VR service system. Following the first year of collaboration, additional VR local offices would be added each year for five years. At the end of the five-year implementation phase, the proposed choice model would be available at all offices throughout the state.
Model Components: The model included the following elements:
* Employment Advisors: The advocacy organization recruited, trained and coordinated a cadre (company) CADRE - The US software engineering vendor which merged with Bachman Information Systems to form Cayenne Software in July 1996. of Advisors. Each customer selected and employed an Advisor. The Advisors provided support, advocacy, and information to the customer.
* Person-Centered Planning: This holistic Holistic
A practice of medicine that focuses on the whole patient, and addresses the social, emotional, and spiritual needs of a patient as well as their physical treatment.
Mentioned in: Aromatherapy, Stress Reduction, Traditional Chinese Medicine planning process involved the customer, the customer's family and friends, as well as project staff. This assisted the customer in developing and clarifying goals and priorities related to employment.
* Vocational Profile: This involved a broad, asset-based exploration of information regarding a customer's skills and interests, as well as his/her preferences and contributions to employers. Information useful to employment choices is gathered from a variety of settings and people.
* Vocational Profile Meeting: The profile meeting was the culmination of the entire process and the tool that ultimately lead to a job match. The purpose of the meeting was to clearly define the "ideal" employment situation based on the available information gathered from the vocational profile.
* Job Development/Carving: Job positions were developed using the information from the Vocational Profile. They were modified with employers to achieve the best match between a customer's assets and employers' needs, while minimizing the need for ongoing external support (i.e. job coaching) and building on the natural supports of the work place.
* Job Site Facilitation Facilitation
The process of providing a market for a security. Normally, this refers to bids and offers made for large blocks of securities, such as those traded by institutions. : This involved conducting a job assessment and working with the customer and employer to establish the necessary ongoing supports. Effectively making these decisions required an awareness of all of the conditions of the work culture and a full understanding of the job expectations of the employers.
* Customer Satisfaction: Customers determined acceptability of the services before authorizing payment to providers from their budgets of VR funds.
Having the Service Provider employed by the customer was a key element in the project design. To meet this demand, the project design stipulated that Service Providers were paid for services rendered only after the customer was completely satisfied. The VR counselors role included assisting customers to make informed choices about selecting participation in the project versus standard VR services, selecting Advisors and Service Providers, along with other decisions in the process. Counselors provided orientation to the project, assisted project customers with interviewing and hiring an employment advisor, and monitored services provided to the customer. The counselor's role frequently entailed directing the person-centered planning process, facilitating decision making, authorizing payments for services provided, and coordinating other support activities.
Employment Advisors were hired by project customers to assure that informed choice occurred. Roles included: assisting the customer to identify potential service providers; arranging meetings; assisting in deciding which providers might best meet customer needs and abilities; explaining contracts; verifying ver·i·fy
tr.v. ver·i·fied, ver·i·fy·ing, ver·i·fies
1. To prove the truth of by presentation of evidence or testimony; substantiate.
2. that services were provided satisfactorily; and resolving problems with service providers.
Support for Implementation: Staff from the advocacy organization provided initial training on the model to VR counselors as well as training for vocational service providers and others involved in the project, trained and coordinated Advisors, and provided training and technical assistance to interested VR counselors. The Coordinator from the advocacy organization additionally conducted joint staff meetings, provided technical assistance to the VR counselors, updated curricula, and supervised su·per·vise
tr.v. su·per·vised, su·per·vis·ing, su·per·vis·es
To have the charge and direction of; superintend.
[Middle English *supervisen, from Medieval Latin other project staff.
The Employment Advisor facilitated the use of Person-Centered planning, advocated for project customers, and monitored vocational profiles and job development activities. The Advisor Coordinator assisted state rehabilitation counselors to identify Employment Advisors, provided training, facilitated team building, and advocated for the customer.
Service Providers in the project's first year were individuals, agencies or companies the customer hired to provide employment services. Completion of training provided by the advocacy organization was a necessary condition for service providers to be eligible for hire.
Population and Sample
Fifty-seven individuals received project services from six state rehabilitation offices during the project's first year, with 43 customers involved at the time of data collection. Attempts were made to include all individuals in face-to-face or telephone interviews. Thirty-six of the identified active customers participated in either face-to-face or telephone interviews. All of the 22 counselors who voluntarily participated in the first year were contacted. Each had caseloads of one to eight project customers. Seventeen of the 22 state rehabilitation counselors from this accessible population responded to the mailed questionnaires.
Sixty percent of the customer sample was male. Sixty-four percent was white, 19% African American African American Multiculture A person having origins in any of the black racial groups of Africa. See Race. , 6% Asian, 3% Arabic, with 9% not identifying their ethnicity ethnicity Vox populi Racial status–ie, African American, Asian, Caucasian, Hispanic . A profile of the project population compared to the general VR population for the same service area included the following characteristics (Michigan Jobs Commission, 1997):
* no identified statistical difference in educational levels between project customers versus all state customers,
* significant differences in types of disability (e.g. 51% of project customers had an orthopedic orthopedic /or·tho·pe·dic/ (-pe´dik) pertaining to the correction of deformities of the musculoskeletal system; pertaining to orthopedics. disability),
* 94.7% of project customers were unemployed at intake, and project customers were more likely to have a severe disability.
Instrumentation instrumentation, in music: see orchestra and orchestration.
In technology, the development and use of precise measuring, analysis, and control equipment. , Data Collection, and Analysis
Two questionnaires were developed: one each for customers and counselors. To improve content and face validity face validity (fāsˑ v·liˑ·di·tē),
n , five counselors and five project customers participated in the development and the pretest pre·test
a. A preliminary test administered to determine a student's baseline knowledge or preparedness for an educational experience or course of study.
b. A test taken for practice.
2. of the questionnaires. Issues under review included ease of use, appropriateness of inquiry, and validity of content. Customer questionnaires were administered through interviews, either face-to-face or via telephone, according to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. each customer's preference. The counselor questionnaires were administered as paper and pencil instruments. Independent t-tests (alpha = .05) and a Spearman's rank correlation coefficient In statistics, Spearman's rank correlation coefficient, named after Charles Spearman and often denoted by the Greek letter ρ (rho), is a non-parametric measure of correlation – that is, it assesses how well an arbitrary monotonic function could describe the relationship were used in the data analysis.
The instruments included parallel items using both Likert Scale Likert scale A subjective scoring system that allows a person being surveyed to quantify likes and preferences on a 5-point scale, with 1 being the least important, relevant, interesting, most ho-hum, or other, and 5 being most excellent, yeehah important, etc and open-ended formats regarding satisfaction with the model, customer satisfaction with services, and counselor questions about the relative time required to implement each component. Trained graduate students and professionals who were in the disability services field but not involved in the project conducted the interviews. Some interviews were conducted in the presence of a family member or other person needed to assist with communication, as the customer desired. The questions to which counselors and customers responded regarding their perceived level of importance included:
1. Person-Centered Planning has been important in providing effective services in the project.
2. The Vocational Profile has been important in providing effective services.
3. Employment Advisors were important to providing effective services.
4. The use of Job Carving has been important in achieving rehabilitation goals.
5. The use of Job Support (e.g. job facilitation, co-worker support, assistive technology Hardware and software that help people who are physically impaired. Often called "accessibility options" when referring to enhancements for using the computer, the entire field of assistive technology is quite vast and even includes ramp and doorway construction in buildings to support ) has been important in achieving rehabilitation goals.
Customers and counselors reported a high level of agreement with positive statements concerning the model's components. On the six-point scale (1 = strongly disagree to 6 = strongly agree), each component for each group had a mean greater than 4.0, therefore indicating a positive response. Job carving was the only component of the model with a statistically significant difference between counselor and customer means. Counselors placed greater importance on this tool than did customers. However, a post hoc post hoc
adv. & adj.
In or of the form of an argument in which one event is asserted to be the cause of a later event simply by virtue of having happened earlier: ranking of the components based upon the group means showed the relative values to be nearly opposite between customers and counselors. Employment advising and Person-Centered Planning were rated highest by the customers; these same components were rated lowest by counselors.
Table 1 contains the rankings of the customers and counselors on their relative satisfaction on the various project components by the customers and counselors. The three items on which customers expressed their greatest agreement all focused on Employment Advisors. These included:
* Satisfaction with the services provided by his/her advisor.
* Their advisor's assistance in making good decisions.
* The advisor as an important part of the services.
Table 1: Customer and Counselor Ranking of Importance
Rank of Importance Customers Counselors 1st Employment Advising Job Carving 2nd Person-Centered Planning Job Support 3rd Job Support Profiling 4th Job Carving Employment Advising 5th Profiling Person-Centered Planning
When customers were asked what they liked most about the project, they cited the focus on obtaining employment (13 of 36 respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy. ) with five specifying the choice of their jobs. The quality of the experiences were identified by 13 individuals with seven reporting that they enjoyed working with the people on the project. Three described the process as positive, and three reported that they were given a chance by the project. Five individuals specifically said there were no negative aspects of the project. The most common complaint was the long wait for projected employment outcomes.
On the open-ended questions A closed-ended question is a form of question, which normally can be answered with a simple "yes/no" dichotomous question, a specific simple piece of information, or a selection from multiple choices (multiple-choice question), if one excludes such non-answer responses as dodging a , counselors most often cited the customer's enhanced role in services due to greater insight and involvement (4) as a positive measure. Three counselors cited time demands as the greatest drawback DRAWBACK, com. law. An allowance made by the government to merchants on the reexportation of certain imported goods liable to duties, which, in some cases, consists of the whole; in others, of a part of the duties which had been paid upon the importation. . The three closed-ended items on which counselors expressed their highest agreement were:
* Importance of job carving in achieving rehabilitation goals.
* High value of the ongoing assistance in implementing the rehabilitation model.
* Use of job supports as having been important in achieving rehabilitation goals.
Counselors were asked to compare the time needed for implementation of each model component with their typical methods for the same activity (e.g. Person-Centered Planning vs. typical planning methods). The importance of components were strongly correlated cor·re·late
v. cor·re·lat·ed, cor·re·lat·ing, cor·re·lates
1. To put or bring into causal, complementary, parallel, or reciprocal relation.
2. (.97 Rank Correlation In statistics, rank correlation is the study of relationships between different rankings on the same set of items. It deals with measuring correspondence between two rankings, and assessing the significance of this correspondence. Coefficient coefficient /co·ef·fi·cient/ (ko?ah-fish´int)
1. an expression of the change or effect produced by variation in certain factors, or of the ratio between two different quantities.
2. ) to the amount of time required for their implementation. As demonstrated in Table 2, the less time counselors believed they needed to use the tool, the greater the perceived importance of the tool.
Table 2: Counselor Rating of Importance vs. Time Required to Use Components Counselor Time Rank(*) Model Rating Required Component of Importance (by rank) 1st Job Carving 5.21 3.00 2nd Job Support 5.18 3.00 3rd Vocational Profile 4.94 3.94 4th Employment Advisors 4.59 3.62 5th Person-Centered Planning 4.41 4.38
(*) Rank Correlation Coefficient of .97 obtained.
Several components in the project model were used by counselors in providing services to consumers not enrolled in the project. These components included:
* Person-Centered Planning: Used by 42% of counselors with customers who are not in the project (22 instances).
* Profiling: Used by 24% of counselors with customers not in the project (19 instances).
* Job Carving: Used by 18% of counselors with customers not in the project (18 instances).
Results support the hypothesis that customers and counselors often have differing priorities within the rehabilitation process. While counselors and customers expressed overall positive responses to the model, the two groups expressed divergent di·ver·gent
1. Drawing apart from a common point; diverging.
2. Departing from convention.
3. Differing from another: a divergent opinion.
4. views regarding the most important components of the model. As rehabilitation counselors and other professionals continue integrating these components into their practice, it will be beneficial to assess the underlying reasons for this discrepancy DISCREPANCY. A difference between one thing and another, between one writing and another; a variance. (q.v.)
2. Discrepancies are material and immaterial. . Customers valued most the components that consumed con·sume
v. con·sumed, con·sum·ing, con·sumes
1. To take in as food; eat or drink up. See Synonyms at eat.
a. the greatest amount of the counselor's time. In the context of increasing caseloads, such conflicts need resolution. These issues may negatively affect the successful adoption of the model, and threaten the proposition that the customer and counselor act in partnership.
Although counselors identified Person-Centered Planning as tools they used with their general caseload case·load
The number of cases handled in a given period, as by an attorney or by a clinic or social services agency.
Noun , they rated it as the least important of the model's components and identified it as the most time consuming. Of particular interest for future research will be the strong relationship between the components that counselors found most important and the amount of time required to perform the tasks. Additional research would benefit from investigating time constraints In law, time constraints are placed on certain actions and filings in the interest of speedy justice, and additionally to prevent the evasion of the ends of justice by waiting until a matter is moot. placed on rehabilitation counselors and the partnerships they are able to develop with their customers.
In addition to the time involved in each component, there may also be an issue of the model's "fit" within the rehabilitation system. The vocational profile "fits" as a means of assessment, and Person-Centered planning "fits" as a planning method, with assessment and planning being fundamental components of rehabilitation counseling. However, employment advising, as an activity separate from what the counselor does, is different. Customers rated it highest among the components, while counselors rated it as fourth of the five components. If one of the benefits of adopting the project model is that it offers flexibility to meet the needs of people who historically have not "fit" into the rehabilitation system, then it will be important to effectively integrate the employment advisor role into the rehabilitation process. Both counselors and customers valued the model, yet each group valued the components differently. Customers valued more the components involving relationships (the employment Advisor, Person-Centered planning), while counselors valued more the outcome-oriented components (job carving and job support). This reflects the challenge that rehabilitation counseling faces in balancing the values of partnerships and empowerment with the conditions of large caseloads and outcome-based performance expectations.
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United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. , 1993. "Reauthorization of the Rehabilitation Act: The state vocational rehabilitation services program," Federal Register 58 38482.
Michael Wolf-Branigin Michael Daeschlein Wayne State University Wayne State University, at Detroit, Mich.; state supported; coeducational; established 1956 as a successor to Wayne Univ. (formed 1934 by a merger of five city colleges).
Barbara Cardinal United Cerebral Palsy United Cerebral Palsy (UCP), sometimes known as United Cerebral Palsy Associations, is a network of affiliated groups in the United States which works to "advance the independence, productivity and full citizenship of people with disabilities" (from UCP's mission statement), of Metropolitan Detroit
Mary Twiss Michigan Department of Career Development-Rehabilitation Services
Michael Wolf-Branigin, Developmental Disabilities Institute at Wayne State University, 268 Leonard Simons Building, 4809 Woodward Avenue, Detroit, MI 48202.