Two Lives: A Mandate for Quality Customer Service in Community Rehabilitation

By Cary Griffin, Director of Training
The Rural Institute
The University of Montana

Introduction

Although most of us would agree that life and services for people with disabilities have improved in recent years, there remains a great gulf between what is and what should be. The tendency to recount the many good things that have occurred minimizes the very prevalent failures that contribute to an 80% unemployment rate along with a home ownership rate that is nearly non-existent for people with the most significant disabilities. By looking at what does not work, we sometimes can create the sense of urgency so desperately needed to efficaciously address the many challenges facing consumers, families, and systems.

This chapter contrasts the stories of two people, illustrating what contributes to successful lives. These factors include:

• staff development and personnel investment by rehabilitation organizations,
• state and federal policy,
• the absence of "cost-response" behavioral approaches, and
• increased connectedness of the rehabilitation field to the general community.

The chapter also shows how, with a little effort, positive outcomes can be achieved without massive systems change or new appropriations. The second profile demonstrates that success happens when staff receive intensive training in customer-centered approaches to support development, and the system avoids the negative behaviors of a self-perpetuating system established to "need" such people to justify its existence. One person was viewed as a "client" in need of structure; the other was viewed as a "person" capable, with support, of directing her life. The intent of this short study is to point out real, inexpensive, low-tech approaches to getting on with the work many of us are charged with doing. In fact, it was a vocational provider's sincere interest in improving a life that brought the details of this first story to light. Focusing on customer service, values, and the elimination of wasted effort led to the successes recounted in the second story. The author served as the person-centered plan facilitator for both individuals.

Winston

The first situation illustrates extremely poor customer service. "Winston," an African-American male in his late twenties, is described as having dual-diagnosis (mild mental retardation and a psychiatric disability). When the career planning process began, Winston was working daily at a used car dealership, detailing cars for resale, cleaning up the premises, and performing various maintenance tasks. The owner of the dealership took great interest in Winston's welfare and helped him talk through his spells of anger on the job. Winston was also a regular at her home in the country, and he especially enjoyed visiting when her children and their families would come for a Sunday barbeque. The employer went beyond our typical impression of "the boss" by being personally interested, protective, and hopeful. In fact, Winston let it be known clearly that his employer treated him with much greater respect than his assigned residential staff.

Winston made it known to his boss and his vocational staff (the latter provided very limited on-the-job support) that he desired a job with more hours, higher pay, and less physical work. The vocational coordinator approached Winston with the idea of developing a career plan. He agreed, and a team consisting of Winston, his employer, a paid advocate, a residential counselor, and the author met one snowy Rocky Mountain afternoon at the car dealer's home.

The vocational coordinator explained that Winston might wish to keep some personal issues to himself. Winston explained that if the details were important to developing a new job, he would share these facts of his life at the meeting. A person-centered career planning process was used to form the foundation of the career advancement plan (Griffin & Hammis, 1996). Winston's boss was dedicated to keeping him employed while he sought out other opportunities and would use her influence in the community to help develop job leads and interviews.

Our first task was to develop a relationships map. Here we discovered the important people in Winston's life and a little about their relationship with him. We discovered that Winston was somewhat well connected in his local neighborhood, although a good number of his friends were also devalued individuals and several were in trouble with the law. We found, as the residential provider already knew, that the influence of these folks was often harmful to Winston. Meeting up with these friends sometimes resulted in fighting, being late to work, or being cheated out of his money. The residential staff, with good intentions, wished to restrict Winston's access to these people. However, no social replacements were found, except for Winston's roommate, who Winston found "annoying."

On the positive side, Winston had a good relationship with another person at work and especially with his boss, who invited him to her home. Still, Winston's access to the community was quite limited. He "hung out" with his friends who took advantage of him, or he walked from his apartment to a local bar where he went dancing on the weekends.

Winston's mother lived about 50 miles away in another town, and he occasionally visited her when he could get a ride. His mother was dying of cancer, which naturally upset Winston a great deal. His only other close relative was his brother who was serving a jail term in a federal correctional facility in the state. Winston's support system lacked friendship and intimacy. He did date a couple of women on a regular basis, but, because these women were considered a bad influence by the residential provider, access was limited. Further, Winston's access to privacy for his relationships was severely inhibited because he lived with a roommate.

Winston and the team decided to seek out other opportunities to make friends. Past experience illustrates that this best occurs in environments where meeting other people is possible. Lists of places Winston wanted to visit, and his preferred activities, were developed. Further, a community member would be sought as a connector and role model for Winston.

The team next explored Winston's preferences and dreams. He explained that he would like to explore several new jobs. He thought he might enjoy selling cars and that a few classes in sales might be worthwhile. Someone commented that Winston's inability to read and comprehend well would make the job "impossible." It was explained that "impossible" is not the focus of a career plan, but that creative approaches are. If being a salesman was Winston's dream, it was our obligation to help create that reality.

Winston also offered a number of other job possibilities that were discussed. One career possibility that he strongly wished to explore was carpet cleaning. A plan was made to contact a number of carpet cleaning businesses to find out if they were hiring and if they would hire Winston if he brought his own equipment to the job (in the same way that a mechanic brings her tools to a car dealership, or a computer programmer brings his education to a software firm) (Griffin, 1999a). Other factors such as transportation to the job would need to be determined. The team decided to investigate funding under a Plan for Achieving Self-Support (PASS) and through Vocational Rehabilitation as methods of increasing support and Winston's ownership and control.

Because a job is only one facet of a person's life, other preferences were explored to bring balance and help improve Winston's quality of life. Winston reported that he liked women, dancing, gambling, motorcycles, and that he really wanted to live on his own. A job could go a long way towards securing many of these life enhancements. However, it became apparent that the advocacy organization and the residential provider had different views of Winston's abilities and desires.

The provider and advocacy organization representative volunteered little input during the employment discussion, and it became obvious now that they did not fully endorse the plan of action. Together they recounted Winston's many negative behaviors: others often influenced him negatively; he got into fights; he was moody; his current boss was "one in a million" so employment was a pipe dream; his hygiene was too bad to allow him to work as a carpet shampooer; he fought with his roommate—the list seemed endless. When questioned about a functional analysis of these behaviors, they ascribed Winston's behavior to his psychiatric diagnosis and his general personality. A positive behavioral approach had never been employed. The behaviors were considered "maladaptive" and control was to be maintained, otherwise Winston risked being returned to a state institution.

The team was stunned to learn that Winston had to take a week's vacation because he had acquired too much in savings ($5,000) and faced benefits loss from Social Security. Half the group saw this as an opportunity. After all, Winston needed money for sales classes, social events and dating, and needed money for carpet shampooing training and equipment; and/or he could put a down payment on a home of his own, using a local bank's discounted mortgage rate for buyers with disabilities. Instead, we were informed enthusiastically by the residential provider and the paid advocate that Winston was going to Disneyland.

Winston could be incredibly compliant, especially when those who controlled his money insisted he do something. In this case, the residential provider had mismanaged Winston's funds, and Winston was now going to pay for this malfeasance by personally paying the travel expenses of two residential staff assigned to accompany him to Disneyland. He was not allowed to take a friend or relative. The people who failed to control his finances were now claiming that Winston's behaviors dictated strict controls on his freedom. Winston had some challenging behaviors, reinforced by the dread of his mother's impending death and the role-modeling of his brother, but the residential staff themselves, through control and manipulation, had taught Winston exactly how to behave.

Winston made his trip, despite efforts to cancel by the vocational service provider. When he returned, Winston found that his belongings had been moved to another floor of his apartment complex and that he now had a new roommate. He was very upset that Sunday evening and did not sleep. He went to work the next morning, was teased by co-workers for visiting Disneyland, got into a fight, and struck a fellow worker. The boss had little recourse: fire Winston or face a liability lawsuit. She fired him and pledged to help him find a new job and to remain his friend. Throughout this process, the employer was Winston's strongest advocate.

Little has changed for Winston. He lives with a roommate he did not choose and does not like. He has a part time job sweeping the parking lot at a fast food restaurant. Placement on an enclave has been discussed. He has limited social engagement and sees a community role model only occasionally. His mother passed away and when he attended the funeral he re-established a few family links. His PASS plan is still under development, but moving forward under his direction. Many of his support staff feel his behavior is deteriorating to the point that he probably cannot work and that he should be placed in a specialized behavioral group home.

Winston is living a self-fulfilling prophecy. He has been set up to fail by a system concerned with "slots," "case loads," and "programs." He is surrounded by staff who work in bad management systems, without clear values-based leadership, where inventiveness is simply an inconvenience, and are stuck in the daily grind of human services. Winston has little to say about the quality of the service he receives and he is surrounded by many people with no sense of immediacy. There is no incentive for positive, consumer-directed outcomes. Instead, the desired outcome seems to be maintaining stability. The management system seems troubled by the ideas of Winston having his own home and having access to a career, and by a full accounting of his finances. The support agencies are managed for numbers, not individuals.

Winston is stuck with his history. The staff no longer trust his ability to self-direct his life. They have created a no-win situation where his assertiveness is seen as non-compliance and with formal evaluations that justify their basic pessimism regarding Winston's dreams to be free. His file contains statements to the effect that: "Winston has maladaptive behaviors;" "he has low self-esteem and creates fantasies to fulfill his goals;" "he seems to think the world revolves around him;" "he prefers to be left alone." This evaluation doesn't contain any statements as to why Winston may behave the way he does. One might think that this evaluation could be used to drive a new life for Winston. Instead it is used to justify organizational malfeasance. Winston's behavior clearly indicates what he wants and needs. Instead, the provider agency is spending thousands of dollars ensuring that he gets exactly what he is rebelling against. This control model of program management wastes resources and is disrespectful of human beings.