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...make choices and decisions regarding his or her life. Choice and control are highly valued prerogatives that reflect the autonomy, identity, and independence of an individual (Condeluci, 1987; Kosciulek, 1999a). The right to make choices, express preferences, and exercise control over life issues are critical ingredients for empowering and enhancing the QOL of persons with disabilities (Kiernan & Hagner, 1995).
Unfortunately, people with disabilities too often are denied the opportunity to exercise control over the most basic aspects of daily life. The opportunity to make choices concerning living arrangements, work, and recreation has been limited or is nonexistent for many individuals who have disabilities. For example, some individuals may never have been provided with more than one choice, adequate information about alternatives may never have been made available, decisions may have been made by professionals who feel they know best, or capabilities and self-assertions may have been ignored or underestimated (Bannerman, Sheldon, Sherman, & Harchik, 1990; Parent, 1993).
Choices made by persons with disabilities are often based on the avoidance of undesirable alternatives, or upon the acceptance of the available, rather than on true preferences. External forces such as agency regulations, lack of accessibility, inadequate supports, or stereotypical attitudes (Hagner & Marrone, 1995) have frequently restricted decisions. In addition, while sometimes individuals with disabilities are involved in disability policy development and rehabilitation service delivery in a minor or token fashion (e.g., membership on an advisory council), these processes continue to occur, to a large extent, without the participation and involvement of people with disabilities (National Council on Disability [NCD], 1996). Parent (1993) concluded unequivocally that "it has become increasingly evident that the powerlessness and lack of self-direction often felt by people with disabilities are more frequently related to the attitudes and practices of caregivers, service providers, funding agencies, social institutions, and society in general, rather than to any limitations or impairments resulting from the disability itself" (p. 21).
Informed Consumer Choice in Vocational Rehabilitation
Given that employment is a key to independence and improved QOL for people with disabilities (Federal Register, 2002), choice in the selection of employment goals and rehabilitation services necessary to meet those goals is a critical element for empowering persons with disabilities (Kosciulek, 1999b). Informed choice is a process during which a person sets goals, gathers information, considers a range of options, and then takes responsibility for selecting the option that best meets his or her criteria. Informed choice refers to a person's ability to understand and use programs successfully, because the programs and services are designed to enable consumers to navigate them competently and without fear of reprisal. More specifically, and in direct relation to vocational rehabilitation (VR), informed choice is the process by which individuals participating in VR programs make meaningful decisions about their vocational goals, the services and service providers needed to reach those goals, and how those services will be procured (Rehabilitation Services Administration [RSA], 2001). It is presumed that an individual's skills and abilities to exercise informed choice can be developed through use of self-assessment techniques, training and experience in goal setting and decision-making, and consumer education. In this manner, skills in exercising informed choice could grow in a parallel fashion along with growth of specific vocational and employment skills, enabling the individual to continue making important life decisions following the completion of VR services.
The concept of informed consumer choice currently is infused within rehabilitation philosophy and mandated as part of the VR service process. Consumer choice policies and practices have begun to be embedded within services provided by state VR agencies and community rehabilitation programs (CRPs). In addition, the Choice Demonstration Projects yielded models useful for the initial development of practices promising for enhancing choice in the VR process (InfoUse, 1999b). Despite these policies and projects, however, little is known about the actual process and outcomes of consumer choice in VR processes. In particular, limited information is available regarding the process, extent, and impact of consumer choice on employment outcomes for individuals with disabilities as a result of services provided by the approximately 8,000 CRPs in the United States. Of import is the statement in the Choice Demonstration Project's evaluation summary report (InfoUse, 1999a) that "Additional research is needed to determine the impact of informed choice on employment outcomes. In future demonstrations, the relationship between vocational rehabilitation process objectives and short and long-term employment outcomes should be clarified" (p. viii).
The Need for Theory in Vocational Rehabilitation
In a socio-behavioral discipline such as VR, it is necessary to have models to organize and evaluate research and practice and to stimulate new ideas and concepts. If the VR field is to progress in addressing important matters such as the status of people with disabilities in our society who wish to be independent, productive, and engaged in their communities (NCD, 2003; Stapleton & Burkhauser, 2003), valid models are needed to guide the development, implementation, and evaluation of disability policy and rehabilitation services. Thus, the need for and importance of theoretical models in rehabilitation is repeatedly emphasized in the literature (e.g., Hershenson, 1996; Kosciulek, 1999a; Livneh, 2001; Parker, Schaller, & Hansmann, 2003; Tate & Pledger, 2003). Unfortunately, the disability policy and rehabilitation literature, except for the Choice Demonstration Project reports developed by InfoUse (1999a, 1999b), has provided little information regarding models or constructs that might be useful in conceptualizing specific ways to examine and enhance informed consumer choice.
One model that is potentially useful in the rehabilitation field is the Theory of Informed Consumer Choice in Vocational Rehabilitation ([ICC-VR Model], Kosciulek, 2004). The major tenet of the ICC-VR Model is that increased informed consumer choice in the VR process will lead to enhanced employment outcomes. The ICC-VR Model was developed to provide a theoretical framework for the examination of informed consumer choice in VR. Further, the model provides a structure for the evaluation of informed choice policy (i.e.,...
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