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Client Choice Program

Corinna Davies-McInteer
Oregon Division of Vocational Rehabilitation

I recently bought a brand new Toyota.  I have had both dreadful and relatively pleasant car buying experiences but this experience will certainly go down in my history as the best in procuring a vehicle. I was so completely satisfied from the moment I stepped onto the lot to the time that I drove off with my new vehicle. I felt respected and validated by every person on the lot from attendant to sales management.

Toyota has a good product and makes a concerted effort to train sales personnel in the art of consumer responsiveness and satisfaction.  Toyota knows that a car buyer can go anywhere to make a purchase. Toyota also knows that a car buyer will return to purchase another vehicle within a three to five year period.

The concept of pleasing customers is not new in private business practice and is certainly responsible for the success of businesses such as Nordstrom Department Stores and Les Schwab Tire Centers. On the other hand traditionally bureaucratic business has been under public scrutiny and accused of inefficient business practice. Consumers of bureaucratic service systems have often experienced feeling overlooked and under served. At the same time system workers have experienced disempowerment in serving consumers while bound by rules and regulations. Oregon Vocational Rehabilitation Division has trained every employee in the art of "delighting" customers. But it is the State of Vermont that should be considered as the forerunner and pioneer in truly assisting and delighting customers by utilizing their Client Choice Program.

Client Choice provides consumers education and encourages decision making and critical thinking. Consumers choose services that  best suit the success of their vocational plan.

The Client Choice concept has been utilized in six other pilot projects across the United States but Vermont DVR has implemented the most comprehensive Client Choice Program in the country. Vermont Department of Vocational Rehabilitation administrator Susan Wells told me that initially the Client Choice project was met by staff and administration with skepticism. Currently, she states, the entire division has embraced the Client Choice process.

Vermont DVR consumers are given the option at orientation as to whether they would like to partake in the project. Consumer incentives include timely service, choice of vendors and cash for their own purchases. Vermont DVR philosophy is to not obstruct consumer progress. Therefore some consumers are on a "fast track". Fast track clients possess solid skill levels and are versed in making informed decisions. Fast track services are often cost efficient because needs, costs and rationale have already been figured by the client and presented to the counselor.
Dependent and recurrent clients require sound counseling skills so that they may continue to modify defeating behavioral patterns that have led to poor decision making.

A counselor must provide assessment and implement professional judgement.  Some clients need to begin with small steps.  A counselor may ask, "what part of this do you want me to do; what do you want from me?" A consumer may not walk away from services a totally autonomous decision maker but may be more independent and higher functioning along the continuum.  One way to assist a client to assess and locate resources is by role playing.  Role playing provides a client with safe testing ground in which to practice new skills.

We noticed some of the same things that Vermont and other pilot project counselors noticed as we launched a small Client Choice project here in Southern Oregon.  These items include recognition that Client Choice is a golden opportunity for counselors to use good, solid counseling skills.  The process does not mean that a counselor must concede to the demands of an illogical or out of control person.  Rather a counselor can say, "no" to a client and use redirection techniques.  There is consensus among Vermont DVR counselors that the Client Choice process places more emphasis on the counselor role and less involvement with paper work than with traditional Vocational Rehabilitation.

The Client Choice concept has provided counselors and staff with better tools with which to conduct business.  For example, counselors can write a check to cover consumer needs towards vocational attainment, rather than wade through cumbersome bureaucratic purchase order process.  This gives consumers more freedom to evaluate and choose how their money will be spent.  In turn the individual feels respect from the system that trusts his or her ability to take charge.

Meanwhile the Client Choice approach supports the vocational counselor in the role of  teacher and coach.  Consumers take responsibility to research options, secure and purchase services and institute savvy decision making in terms of vendors and needed materials.  The counselor assesses the consumer's decision making abilities and skill level as they move through the rehabilitation process.  More education and support is offered if needed by the consumer.  The counselor must ask him or herself, "Am I doing this task for or with the consumer?  Is he or she able to do this for him or herself?"  The Bible sums this concept in this old adage, "Feed a man a fish...feed him for a day...teach a man to fish feed him for a lifetime."

Client Choice offers the consumer the opportunity to be delighted and satisfied with vocational rehabilitation services by experiencing adult treatment.  Vermont DVR Client Choice project found the effectiveness in the counselor/consumer relationship could only evolve if both sides experienced increased feelings of respect and control.  As a result, each DVR rule was analyzed to decipher if  the rule made it easier for the system or better for the consumer.  If the rule that didn't expedite consumer services, the rule was changed.  Questionnaires that required highly personal information were discarded.  As stated earlier, counselors utilized check books for accelerating services and this eliminated the need for receipts and vouchers.  Counselors also felt empowered by a system which encouraged creativity.

State of Vermont Client Choice is successful not only for it's respectful treatment of consumers and empowerment of counselors but also because everybody from administration to line staff gave this approach the opportunity to prove its validity in comparison to traditional services.   Revamping a system is not without work.

Effectively implementing a Client Choice program means transformation on many levels. Vermont's Center for Disability Rights and Education or Client Assistance Program (C.A.P.) recognizes the value of the project to the consumer.  It can be anticipated that disgruntled clients will work with C.A.P. whether the traditional or the Client Choice approach has been utilized.  The State of Vermont obtained waivers for Social Security/Social Security Disability Insurance and for Welfare so that money going directly to clients would not be considered income. An example of such a waiver is pictured below.



State of Oregon
Vocational Rehabilitation Division
Department of Human Resources

VR Waiver Agreement with ____________

A. VR Counselor

Client______________________Soc. Sec#______________________________

Client Choice related expenses
to facilitate vocational goal agreement:

_________________________________$______________________ date______________

_________________________________$_______________________date_____________

_________________________________$_______________________date_____________

Statement of release: I hereby authorize the release of all information relating to my application for social security benefits and/or welfare subsidy aid between VRD

and______________________________________________________________________
Agency of Appropriation

_________________________________________________________________________
Client Signature        Date

Appropriations Agency Use: Budget Period from________________to___________________
Above client is exempt from benefit discontinuation due to participation in VR Client Choice Program:

_________________________________________________________________________
Appropriations Agency/Entity Signature and date

Above client is ineligible from benefit discontinuation because______________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
 

Appropriations Agency/Entity signature and date   Client/VRD/Appropriations
 



In addition education needs to occur on many fronts starting from the moment that the client walks through the doors for services and is offered the choice to participate in traditional or non-traditional services. If a consumer is to make an informed choice than he or she needs as much information as possible.

A consumer orientation packet should contain a piece on historical perspective and origin as well as the differences between traditional and nontraditional or Client Choice services. Vermont was very clear with consumers about the amount of money that would and could be spent up front and through the process for attainment of the individual vocational goal. Anticipated consumer questions can also be addressed in an orientation packet.

In addition, a counseling professional should be available to answer consumer questions about such a project as consumer questions will arise.  This expertise availability for questions and information gathering could exist in an actual group orientation setting. Such a setting would benefit both consumers and counselors on several levels. First, a consumer would experience the foundation of informed decision making by gathering information and asking pertinent questions. Second, a counselor could begin the process of assessing client ability and comfort level to make choices.  In addition a counselor could continue to refine and fine tune program service distribution as he or she listens to consistent needs or concerns as voiced in the group setting. Each division office may choose form designs and format according to unique area population concerns. Conceptualization of a consumer orientation packet follows.


 
Southern Oregon Vocational Rehabilitation Client Choice Orientation

Introduction

For the past five years, seven VRD programs around the country have attempted to provide services to consumers seeking our services in a new way.  The concept of Client Choice was designed to enhance traditional service system in several ways that would encourage self-guidance and direction, hasten services and empower consumers and counselors.

We believe that if an individual is provided with sufficient information, resources and support, they will become better able to make informed decisions which will lead to the realization of their vocational goals.

If you choose to participate in this approach you can expect the following: To find out more please attend our Client Choice Orientation class scheduled for:

Date____________Day____________Time_________Location__________________________

We will spend a total of 22 hours in class examining this direction in VRD services.



 
We were surprised in Southern Oregon at the reaction consumers displayed in response to being a part of our version of a Client Choice approach.   Several people were not heard from again after they were offered the opportunity to orchestrate their vocational plan of action in the Client Choice fashion.  We deciphered many things including that these consumers may not have been ready for even the smallest steps in this independent approach.

Vermont and the six other pilot programs determined several program distribution changes needed to occur in order to more effectively implement the Client Choice approach.  These changes included expediting the consumer eligibility process; implementing monetary reform; emphasis and participation in staff development and training; providing friendly and inviting office environments; aligning all entities involved with Client Choice and ownership concept and implementing consumer and staff input regarding employee and program evaluations.    Key points resulted in staff surveys through Vermont and the six other pilot projects throughout the country.  These points included the creation and utilization of effective work teams; increased staff and management support; the creation of an environment that fosters the value of individual input and consistency in implementing policy and regulations.

Counselors, staff and consumers will need curriculum to begin the education process and continue along the lines of providing and implementing vocational accomplishment through the Client Choice approach.    This involves curriculum writing, teaching and facilitating.   The following is a consumer class curriculum outline that we developed in Southern Oregon.


 
Curriculum for Client Choice Project
Introduction:
 
  • A. The concept of client choice and how it differs from the traditional DVR program
  • B. Life skills and informed decision making
  • C. Consumer education
  • D. Roles and Responsibilities of the Counselor

  • The seven pilot programs also compiled several anticipated initiative changes including the rewriting of current policy; implementing a consumer evaluation project and consumer driven evaluations; change in business functioning with external organizational relationships and possible district reorganization.  In addition priorities for the next several years include "Choice" representation with collaborating agencies; staff development; structural changes; more employer focus and marketing.

    Additional finding and suggestions through Vermont include the provision and fostering of a friendly and caring environment which conveys a non-institutional place of business and supports the relationship between staff members and consumers.  All human resources are focused on collaboration with consumers and accountable to consumer feedback and satisfaction.  Procedure device and guidelines are in place for a multi-faceted and visionary consumer and staff budgeting decision making, training, program development, design and organizational evaluation.  Focus on developing and fostering strong relationships with other service entities.  Model effective service provision through an organization driven through consumer information and feedback.  Determine and direct activities of placement teams in order to foster effective relationships between VRD and the employer community.

    In addition clearly written principles, expectations for consumer and team relationships and for service provision can only work to clarify goals, expectations and program results.  Vermont gathers consumer and staff feedback consistently to update and up grade the Choice approach in that state. We have chosen to incorporate many of Vermont's guiding principles, major goals and practices into our philosophy  such as  the elimination of unnecessary waiting time.  The following is an addendum which illustrates the above.


    Guiding Principles
    (as adapted from guiding principles of Vermont DVR Vision 2000)

    Consumer and VRD Team Relationships

    VRD Service Provision Major Goals
    1. Enhanced skills and job satisfaction through staff development.
    2. VRD organizational structure will empower consumers with disabilities to experience success in chosen vocational endeavors.
    3. VRD emphasizes and adds value to employer business
    4. VRD will work in partnership with outside organizations to provide and ensure effective consumer  service and will promote by modeling a way of doing business and of working that is consumer information driven.
    5. Accentuate marketing as public awareness of VRD consumer driven business practices are emphasized.

    Vermont readily utilizes action teams in order to better implement the above goals.  The objective for each goal is determined through consumer and staff survey in put.  From there teams strategize how the objective of the goal will be met; what action will take place; who will do it and when it will be done.  The following provides an example of a goal that we have decided to adapt from the Vermont program.  This item illustrates goal design and objective format a work team can utilize when implementing a Client Choice plan of action.
     

    Goal 1:  Enhanced skills and job satisfaction through staff development.
    objective: Feedback from both staff and consumers will be utilized to develop and accomplish training.

    Plans:   Action    Who   When


    Client Choice emphasizes division and consumer ownership and accountability.  We live in a competitive time.  Clearly, political mandate summons change of the traditional vocational rehabilitation service provision.   We are discovering that in order to give this approach a proper attempt a team effort across the state needs to take place.  Hopefully by being successful in our pilot project, traditional service provision as it stands may transform to better meet consumer needs and long-range vocational attainment.  Given time we may find we had nothing to lose and everything to gain.
     


     Direct suggestions, comments, and questions about this page to:
    Cheryl D. Davis, Ph.D., Coordinator
    Northwest Outreach Center
    Regional Resource Center on Deafness
    Western Oregon University
    Monmouth OR 97361
    503-838-8642 (v/tty)
    503-838-8228 (fax)
    http://www.wou.edu/nwoc
    nwoc@wou.edu
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    Last modified 20AUG1999