Two Lives: A Mandate for Quality Customer Service in Community Rehabilitation (Page 2)

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

There are critical lessons to be learned here.

• First, treat individuals as individuals, not as cases. Winston is a living, thinking, feeling human being who has entrusted his life to us. Professionals owe him action.
• Second, act as though "60 Minutes" is auditing program outcomes. Winston's assigned staff have wasted the better part of a year with almost no tangible outcomes (getting a resume typed up has taken over two months and acquiring a debit bank card to assist with creating a credit history is still in limbo).
• Third, hire and develop staff as if the quality of their work means the difference between life and death.
• Fourth, create management systems that focus on outcomes the individual wants.
• Fifth, create organizations that incubate collaborative relationships within the community. Throughout Winston's life, human service agencies have failed to take advantage of typical and/or professional community supports that would assist Winston and reduce the workload on agency staff.
• Sixth, develop and maintain a sense of urgency. If agencies cannot perform, they should be assisted. Nothing presented in Winston's story is out of the realm of the possible. Indeed, many people with fewer resources are living happy, interdependent lives. Such outcomes can be achieved in any community if the desired outcomes are respected and clear (Lovett, 1996).

Leanne

"Leanne's" story provides a sharp contrast to Winston's. Leanne, a woman in her early twenties, lives in an eight-bed group home duplex, with men on one side and women on the other. Family members live nearby and her parents typically take her home on weekends. When I first met Leanne, as the facilitator for her career plan, I found that she spent most of her day in Work Activities performing basic assembly tasks at piece rate and occasionally got limited computer training on an outdated Apple computer loaded with pre-school number and alphabet recognition software. Her file indicated that she had an I.Q. in the mid-30s, was non-verbal, used a motorized wheel chair, had severe cerebral palsy, and was virtually "unemployable."

The vocational service provider was convinced that Leanne could find meaningful work in the community, and a person-centered career plan was initiated. Leanne and her vocational support staff created an initial invitation list and we met at her group home one afternoon. Attending the gathering was the facilitator, the vocational director, the job developer, two residential staff and their manager, Leanne's mother and father, and her older brother. The meeting, unlike Winston's, was positive and upbeat. Leanne communicated largely through the staff, who knew her well, and through her family.

As maps of her personal history, likes and dislikes, hopes and dreams developed, it became clear that Leanne's family was well established with a broad circle of friends and business associates in this city. Also, it was obvious that Leanne had numerous interests that lent themselves well to job exploration and that staff needed a great deal more information about assistive and universal technology and funding that would help Leanne accomplish some of her possible employment goals. Further, it was clear that staff had not worked collaboratively with other agencies such as Vocational Rehabilitation, Adult Continuing Education, or Social Services. Few of the staff had strong links to the business community. The difference between this group and the team working with Winston was that this group wanted to take action and asked for assistance and training. They were focused on the outcomes Leanne wanted and were willing to experiment in unknown territory to meet her needs. After all, if she was brave enough to trust them, staff certainly should respect that courage and support of goals.

Another key issue arising from Leanne's first meeting dealt with communication. She did not have even a simple pictorial communication system, making her interactions with new acquaintances extremely difficult. Leanne was often in public places with her family on the weekend. Together they went shopping, visited neighbors, and dined out. A sophisticated communication system might help break the silence barrier. The residential provider volunteered to assess Leanne's Medicaid account and within weeks had ordered a new computerized voice synthesizer. Although months later it still had not arrived, the point here was that personnel had acted. By creating a team approach and bringing the desires of the individual and the family to bear, staff took decisive action.

Leanne's work preferences showed that she desired jobs possibly doing clerical work, such as paper shredding and photocopying. She also indicated that she liked clothes, makeup, and fashion in general. During our second meeting, about a month after the first, Leanne made it clear that she might like to pursue a career in modeling. The team rose to the occasion. They thought there were concrete steps to take to prepare for such a career.

First, she would have a make-over at a beauty salon. Next, professional portraits would be taken to create a portfolio. The vocational director assigned a new job developer, who had a background in professional modeling, to work with Leanne. Leanne was thrilled, but it was obvious that several team members doubted the existence of work for Leanne and stated their concerns. The team decided to push forward despite their reservations.

Over the next several months progress was slow. Personnel changes due to high turnover in three involved organizations seriously interrupted plans. At long last another gathering was convened with Leanne, her mother and father, the facilitator, the vocational director, the new job developer with modeling experience, a new job coach, a new case manager, and a new residential support person.

From the start it was clear that a good deal of education was needed. The new case manager was hesitant about recommending that the modeling career be pursued. She was concerned that no one would hire Leanne and that we were setting her up for failure. Looking at it from another point of view, one could say that in almost 30 years Leanne had not been provided one true career attempt, this was what Leanne and her family wanted, and that career failure was all Leanne would ever know if she was not "allowed" to try.

After much discussion it was clear that Leanne, the vocational staff, and the family were quite serious about quickly pursuing the modeling career. It was also clear that modeling jobs were limited for anyone wanting to become a model and that Leanne should consider a "day job" while her fashion career matured. Leanne's parents, who both worked in companies that had clerical openings, were enlisted to help develop a clerical job, which with some minor assistive technology, would allow her to be productive. The job developer would research adaptive equipment funding.

Today, Leanne has a part-time clerical day job. She has a professionally photographed portfolio, which was donated through personal staff connections with a photographer, and a request has been made to Vocational Rehabilitation to open Leanne's case for service and to provide her with what all good models need—an agent. Leanne has filmed her first local television commercial for an automobile dealer. The development of Leanne's career is critical to her, her family, and her team. Unlike Winston's team, these people believe that everyone can work and that behavior is often a reaction to life's circumstances. Leanne is being treated in a respectful manner and is responding by working on her job for today, as a clerical assistant, while trying hard for that break that launches her into the modeling career of tomorrow.