Fostering Client Autonomy and Agency DT North, MS, CDMS, ABVE/D Kim North, MA, CDMS, ABVE/D Achieve Consulting Team, Inc.

Why this topic? Context DT…

What were these clients missing What were these clients missing? Motivation Empowerment Ownership of the process Independence Internal locus of control Ostensible freedom of choice Ability to make decisions on their own behalf

Definition of rehabilitation counseling – “…a process where the counselor works collaboratively with the client to understand existing problems, barriers and potentials in order to facilitate the client's effective use of personal and environmental resources for career, personal, social and community adjustment following disability.” Parker and Szymanski (1998)

Relevant history in rehabilitation: 1920’s Relevant history in rehabilitation: 1920’s Civilian Rehabilitation Act (Smith-Fess Act) (1920) Established federal-state VR programs. 195o’s Vocational Rehabilitation Act Amendments of 1954 Allocated funding for the development of widespread master’s-level rehabilitation counseling training programs. 1970’s The 1973 Rehabilitation Act Amendment Promote productivity and inclusion, enable individuals with disabilities to make informed choices and decisions…achieve personal goals consistent with individual preferences and capacities. 1980’s The 1986 Amendments to the Rehabilitation Act of 1973 Addressed barriers of persons with disabilities and provided program funding to try and increase the employability of persons with disabilities.

1990’s. Rehabilitation Act Amendments of 1992 1990’s Rehabilitation Act Amendments of 1992 Restated the priority placed on employment outcomes for people with disabilities and strengthen client involvement in the entire rehabilitation process. Described the manor which individuals with disabilities will be given choice and increased control in determining their vocational rehabilitation goals and objectives (Section 101). Stressed “the importance of empowering people with disabilities to be involved in selecting their own career goals and developing their own written rehabilitation plans” (Section 102). The Workforce Investment Act and the Rehabilitation Act Amendments of 1998 Increased client control of the vocational planning process. Reiterated the importance of using qualified rehabilitation providers. 2000 Revision of the Washington State Washington State Administrative Code Required vocational rehabilitation counselors obtain a professional certification from either CRC, CDMS, or ABVE.

The Certification of Disability Management Specialist Commission (CDMSC) Code of Professional Conduct (2015) “The fundamental spirit of caring and respect with which the Code was written is based upon five principles of ethical behavior. These include autonomy, beneficence, nonmaleficence, justice, and fidelity, as defined below: Autonomy: To honor the right to make individual decisions. Beneficence: To do good to others. Nonmaleficence: To do no harm to others. Justice: To act or treat justly or fairly. Fidelity: To adhere to fact or detail.

Commission on Rehabilitation Counselor Certification (CRCC) Code of Ethics (2017) “Rehabilitation counselors work in cooperation with their clients to promote client welfare and support them in developing and progressing toward their goals. Rehabilitation counselors understand that trust is the cornerstone of the counseling relationship…Rehabilitation counselors respect the rights of clients to make their own decisions about matters that affect their own lives. Rehabilitation counselors make reasonable efforts to ensure clients are able to make informed choices about every aspect of the rehabilitation counseling process… A.1 . WELFARE OF THOSE SERVED…. e. AUTONOMY. Rehabilitation counselors respect the rights of clients to make decisions on their own behalf in accordance with their cultural identity and beliefs. Decision-making on behalf of clients that limits or diminishes the autonomy of the client is made only after careful deliberation. Rehabilitation counselors advocate for the resumption of responsibility by clients as quickly as possible.”

Autonomy – The power to make one’s own decisions Autonomy – The power to make one’s own decisions. Agency – A person acting to produce a certain result. An autonomous agent acts on one’s own motives. I have a goal and I have the ability to reach it.

Client is not motivated and has no direction: Autonomy NOT Present Agency NOT Present Client is not motivated and has no direction: “I’ve tried nothing and I am all out of ideas.” Autonomy Present Client is motivated but has no vision, direction, or goals for the future: “I am ready but I don’t know what to do.” Agency Present No motivation but with ideas about what they want. “I expect to go back to my regular job but I am not doing anything to make that happen.” Motivated and empowered to make decisions. “I know what I want and I know how to get it.”

A key skill in counseling is that of understanding and working with client motivation and resistance. Resistance Motivation Willful Willing Disaffected Engaged Helpless Volition Disgruntled Pleased Contemptuous Respectful Inflexible Open

Autonomy:. “I plan to return to my regular job. ” Agency: Autonomy: “I plan to return to my regular job.” Agency: “I asked my doctor for a release.” Autonomy: “I want to start working.” Agency: “I talked to my employer about light duty.” Autonomy: “I know that I will need to find new work.” Agency: “I enrolled in GED classes to work on my education.” Autonomy: “I want to improve my strength.” Agency: “I am doing my home exercises everyday.”

“If you can’t fly, then run, if you can’t run, then walk, if you can’t walk, then crawl, but whatever you do, you have to keep moving forward.” ~Martin Luther King, Jr.