People with disabilities too often are denied the opportunity to exercise control over the most basic aspects of daily life. Consumer direction (CD) is a philosophy and an orientation whereby informed consumers have control over the policies and practices that directly affect their lives. It is a mechanism by which individuals with disabilities can develop the skills to take control of their lives and their environment. The primary tenet of this paper is that increased CD in disability policy development and rehabilitation service delivery will lead to increased community integration, empowerment, and quality of life for people with disabilities. In this paper, the concept is presented as a guide for disability policy development and rehabilitation service delivery. Consumer choice, the current status of people with disabilities in U.S. society, and the need for CD are discussed. An overview and definition of CD are presented, and the underlying assumptions are described. A conceptual framework, issues surrounding measurement and operationalization, and five examples of CD are presented. Finally, the implications of CD relative to consumer and service provider roles, the empowerment of people with disabilities, and potential benefits are discussed.
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References
1.
Al-Darmaki, F., & Kivlighan, D.M. (1993). Congruence in client-counselor expectations for relationship and the working alliance. Journal of Counseling Psychology, 40, 379-384.
2.
Bolton, B., & Brookings, J. (1996). Development of a multifaceted definition of empowerment . Rehabilitation Counseling Bulletin, 39, 256-264.
3.
Bruyère, S.M. (1993). Participatory action research: Overview and implications for family members of persons with disabilities. Journal of Vocational Rehabilitation, 3(2), 62-68.
4.
Callahan, M., & Skiba, J. (1997, April). Collaboration for choice. Paper presented at the 10th Annual Rehabilitation Services Administration, Region VII Issues Forum, Kansas City, MO.
5.
Campbell, J.F. (1991). The consumer movement and implications for vocational rehabilitation services. Journal of Vocational Rehabilitation , 1(3), 67-75.
6.
Chan, F., Shaw, L.R., McMahon, B.T., Koch, L., & Strauser, D. (1997). A model for enhancing rehabilitation counselor-consumer working relationships. Rehabilitation Counseling Bulletin , 41, 122-137.
7.
Condeluci, A. (1987). Social role valorization: A model for community reentry. Journal of Head Trauma Rehabilitation, 2(1), 49-56.
8.
Cornell Empowerment Group. (1989). Empowerment and family support. Networking Bulletin , 1, 1-23.
9.
Dart, J. (1992, September). Toward equality and empowerment. Paper presented at the IBM Conference on Full Participation in a Modern Society, Tokyo, Japan.
10.
Emener, W.G. (1991). An empowerment philosophy for rehabilitation in the 20th century. Journal of Rehabilitation, 57(4), 7-12.
11.
Estes, W.K. (1993). Mathematical models in psychology. In G. Keren & C. Lewis (Eds.), A handbook for data analysis in the behavioral sciences: Methodological issues (pp. 3-19). Hillsdale, NJ: Erlbaum.
12.
Graves, W. (1991, September). Participatory action research: A new paradigm for disability and rehabilitation research. ARCANewsletter, pp. 8-11.
13.
Hagner, D., & Marrone, J. (1995). Empowerment issues in services to individuals with disabilities. Journal of DisabilityPolicy Studies, 6(2), 17-36.
14.
Hahn, H. (1991, Oct./Nov./Dec.). Alternative views of empowerment: Social services and civil rights. Journal of Rehabilitation , 4, 17-19.
15.
Harp, H.T. (1994). Empowerment of mental health consumers in vocational rehabilitation. Psychosocial Rehabilitation Journal, 17, 83-90.
16.
Higgins, P.C. (1992). Making disability: Exploring the social transformation of human variation. Springfield, IL: Thomas.
17.
Holmes, G.E. (1993). The historical roots of the empowerment dilemma in vocational rehabilitation. Journal of DisabilityPolicy Studies, 4(1), 1-19.
18.
Kiernan, W.E., & Hagner, D. (1995). Rehabilitation counseling and the community paradigm . In O. C. Karan & S. Greenspan (Eds.), Community rehabilitation services for people with disabilities (pp. 255-276). Boston: Butterworth-Heinemann.
19.
Kosciulek, J.F. (1995). Impact of head injury on families: An introduction for family counselors. The Family Journal: Counseling and Therapy for Couples and Families, 3(2),116-125.
20.
Kosciulek, J.F. (1997, September). Improving rehabilitation service delivery by enhancing consumer direction among persons with disabilities. Paper presented at the 1997 International Conference on Disability , Seoul, Korea.
21.
Kosciulek, J.F. (1998). Empowering the life choices of people with disabilities through career counseling. In N. C. Gysbers , M. J. Heppner, & J. A. Johnston (Eds.), Career counseling: Process, issues, & techniques (pp. 109-122). Boston: Allyn & Bacon.
22.
Kosciulek, J.F. (1999a). The consumer-directed theory of empowerment. Rehabilitation Counseling Bulletin, 42(3), 196-213.
23.
Kosciulek, J.F. (1999b, April). Development of a theory and measure of consumer direction for rehabilitation counseling. Paper presented at the American Counseling Association World Conference, San Diego, CA.
24.
Kosciulek, J.F., Vessell, R., Rosenthal, D.A., Accardo, C.M., & Merz, M.A. (1997, April/May/June). Consumer satisfaction with vocational rehabilitation services. Journal of Rehabilitation, 2, 5-9.
25.
Leahy, M.J., & Szymanski, E.M. (1995). Rehabilitation counseling: Evolution and current status. Journal of Counseling & Development, 74, 163-166.
26.
McGrath, J.E. (1982). Dilemmatics: The study of research choices and dilemmas. In J. E. McGrath, J. Martin, & R. A. Kulka (Eds.), Judgment calls in research (pp. 69-102). Beverly Hills, CA: Sage.
27.
Mechanic, D. (1991, February). Adolescents at risk: New directions . Paper presented at the Annual Conference on Health Policy, Cornell University Medical College, Ithaca, NY.
28.
National Council on Disability. (1996). Achieving independence. Journal of Disability Policy Studies , 7(2), 57-65.
29.
National Institute on Consumer-Directed Long-Term Services. (1996a). The benefits of consumer direction . Consumer Choice News, 1(2), 1-3.
30.
National Institute on Consumer-Directed Long-Term Services. (1996b). Principles of consumer-directed home and community-based services. Washington, DC: Author.
31.
National Institute on Consumer-Directed Long-Term Services. (1997). Consumer direction linked to higher productivity. Consumer Choice News, 2(3),7.
32.
National Institute on Disability and Rehabilitation Research. (1998, October). NIDRR 1999-2004 long-range plan. Washington, DC: Author.
33.
Parent, W. (1993). Quality of life and consumer choice. In P. Wehman (Ed.), The ADA mandate for social change (pp. 19-33). Baltimore: Brookes .
34.
President's Committee on Employment of People with Disabilities. (1998). Opening doors to ability. Washington, DC: Author.
35.
Racino, J.A., & Williams, J.M. (1994). Living in the community: An examination of the philosophical and practical aspects. Journal of Head Trauma Rehabilitation, 9(2), 35-48.
36.
Ryan, C.P. (1995, Oct./Nov./Dec.). Work isn't what it used to be: Implications, recommendations, and strategies for vocational rehabilitation . Journal of Rehabilitation, 4, 8-15.
37.
Schroeder, F.K. (1995, November). Philosophical underpinnings of effective rehabilitation. Paper presented at the 16th Mary E. Switzer Lecture, Assumption College, Worcester, MA.
38.
Scotch, R.K., & Schriner, K. (1997). Disability as human variation: Implications for policy. Annals of the American Academy of Political and Social Science, 549, 148-159.
39.
Seelman, K., & Sweeney, S. (1995, Autumn/Winter). The changing universe of disability . American Rehabilitation, 2-13.
40.
Szymanski, E.M., & Parker, R.M. (1992). Low statistical power: A blight on research [editorial] . Rehabilitation Counseling Bulletin, 36, 2-5.
41.
Szymanski, E.M., & Trueba, H.T. (1994, July/Aug./Sept. ). Castification of people with disabilities: Potential disempowering aspects of classification in disability services. Journal of Rehabilitation, 3, 12-20.
42.
Taylor, S.J., Biklen, D., & Knoll, J. (1989). Community integration for people with severe disabilities . New York: Teachers College Press .
43.
Thomas, K.R., & Strauser, D.R. (1995, Jan./Feb./March). Rehabilitating the rehabilitation delivery system: A commentary on the voucher system. Journal of Rehabilitation, 1, 18-22.
West, M.D., & Parent, W.S. (1992). Consumer choice and empowerment in supported employment services: Issues and strategies. Journal of the Association for Persons with Severe Handicaps, 17(1),47-52.
46.
Whyte, W.F. (1991). Participatory action research. Newbury Park, CA: Sage.
47.
Zimmerman, M.A. (1990). Taking aim on empowerment research: On the distinction between psychological and individual conceptions. American Journal of Community Psychology, 18, 169-177.
48.
Zimmerman, M.A. (1995). Psychological empowerment: Issues and illustrations . American Journal of Community Psychology, 23, 581-599.
49.
Zimmerman, M.A., & Warschausky, S. (1998). Empowerment theory for rehabilitation research: Conceptual and methodological issues. Rehabilitation Psychology, 43(1),3-16.
