Note: The decision making process takes into account the client’s values and characteristics, the availability of resources and alternatives, and general economic conditions (per federal technical assistance RSA-TAC-98-01 issued November 3, 1997).
Example 1: DRS approves community college training but the client decides to attend an out of state or private college. The counselor documents that the counselor explained the DRS policy on college sponsorship so that the client understands the possible personal financial impact of this choice.
Example 2: The client and counselor disagree over the use of a particular service provider. The counselor documents the differing opinions and the information the counselor shared with the client about the providers.
Individuals with cognitive (e.g., intellectual disabilities, learning disabilities, head injury, stroke) or other disabilities (e.g., as a result of organic brain damage or mental illness or medications, or individuals with any type of disability who have not had experience in making decisions for themselves, or individuals with significant impairments in communication skills) may require support and assistance to exercise informed choice. The client, counselor, and others working with the client should determine the level of the client skills and abilities needed to exercise informed choice; identify the tasks the client can do independently; identify the tasks for which the client needs support, accommodations, and skill building; and identify tasks that someone else will need to do. This may be accomplished through checklists and inventories, situational assessments or trial work experiences, interviewing family and others, scheduling a longer time period for meetings, counselor judgment and observation, consumer self-discovery (teaching the individual to develop an awareness of how the disability affects them, how they function on a daily basis, and how they respond to information and make decisions), providing a series of short term vocationally-related activities and experiences which test and increase the individual’s level of planning and decision making skills, or other appropriate methods. Exercising informed choice requires communicating clearly, gathering and understanding information, setting goals, making decisions, and following through with decisions. The counselor and others working with the client can provide structure to help the client determine what information is needed, ways to gather that information, what options are available, and ways to decide among the options. To simplify information, some techniques include, but are not limited to: breaking information down; taking more time for information gathering; using simpler language; using tangible methods (e.g., pictures, checklists, first hand experience such as short term volunteer placements to experience different types of work situations) to convey information; asking the individual to repeat in their own words what has been said; providing tools for organizing and retrieving information, such as calendar or daily organizer; or other appropriate methods. Comprehension and retention of information are enhanced when information is provided in multiple modes of communication (e.g., auditory, visual, and experiential modes) and repeated over time. Both the individual and the counselor have a role in discovering the modes most effective for the individual. The counselor’s role is to provide opportunities for information to be presented in various modes. To the extent that the individual participates in the procurement of services, implementing informed choice might also involve basic consumer skills, such as money management and negotiating in the market place. Support services to assist a client to exercise informed choice include, but are not limited to, the use of a representative, an interpreter, and assistive technology. Using a family member as a representative works best when the family is a neutral party. (per federal technical assistance RSA-TAC-98-01 issued November 3, 1997). During the needs assessment process the counselor and evaluator can include the individual in discussions, provide the individual a copy of the reports, and write reports so the individual can understand the information. Other techniques may be used that enable the individual to be able to explain what the information means, how it affect’s the individual’s life, and what the individual wants to do as a result. To assist the individual to gather information about services and service providers the individual and counselor can develop a list of questions. To increase the participation of individuals who are reluctant to make decisions, the counselor can ask what the individual wants the counselor to do, or can state what the counselor is willing to do and ask the individual what he or she is willing to do. The counselor can follow-up frequently and modify or develop strategies to help the individual improve planning and decision-making skills. For individual with deficits in attention, working in a distraction-free space or using familiar surroundings may enable the individual to better attend to the information being presented. Per federal technical assistance RSA-TAC-98-01 issued November 3, 1997.
Throughout the vocational rehabilitation process the counselor shall use appropriate modes of communication to inform the client of the availability and scope of consumer informed choice and how the individual may exercise informed choice. The counselor also shall inform individuals with cognitive or other disabilities who require assistance in exercising informed choice of the availability of support services to assist in exercising informed choice (per 2001 Federal Regulation 34 CFR § 361.52).
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