The following articulates an understanding of values that have currency. It is the expectation that each staff person will make a commitment to implementing these values NOW.
Consumer Preference & Helper Responsibilities
Choice is a very important value to human services helpers these days. The idea is usually expressed as the client becoming a partner in the planning of services and supports. Of course, they are rarely an equal partner and often do not completely understand the jargon of the helper in discussing future services. They are often asked to respond to service initiative of the human service experts, but rarely asked to give prior input. This is justified on the basis of “how would they know what is best?”
The service plan is developed around the client’s needs. This is another major value; but of questionable validity. Client need is difficult to determine from the outside. The helper may make a determination that a client needs a structured environment, but what really is this based upon? Presumably, the helper has identified that the client, when in structured environments perform better. But what is better? Most often better – in the eyes of the helper – is that the client is no longer a problem. But what is a problem? A problem is that which bothers me; a barrier that interferes with my reaching my goals. If something about the environment or the people in it bothers me, that’s a problem. But who’s problem is it?
Clearly such a determination of need through the expertise of the professionals is either a labeling of the helper’s problem or an identification of problem from respected adults [teachers, parents, etc.], who may have their own problems with the client. Thus the identification of need is often an identification of what others think the client should be or have. But what happened to choice? If choice is a major value, perhaps we need to ask the client about his/her problem. We may find that the major problem in the client’s life is the helper and the adults that the helper respects. Of course, we could decide that the client thinks this way because of his/her deviance.
The essence of this discussion is that we cannot give the client the right to decide what is in their best interest; they are already deciding. In fact, a major choice that a client in the human service system makes is whether to willingly go along with what the helpers want or to willfully resist. If they make the first choice, these are good clients, but if they choose the latter, they are obviously resistive, hostile or aggressive. In either case, the client does what s/he determines is in her best interest. The argument that is often espoused – that the client, because of his/her disability is unable to make decisions – is inherently false. Clients, even profoundly disabled people, make these decisions every day. Whether they make informed decisions is another question entirely.
In order for people to have the ability to make informed decisions a great deal more information than professionals are presently used to giving will need to be provided. The client is the agent for change. No change can happen without their sanction, for without sanction, the client will resist change. Thus it is profoundly important, if we are to maximize the person’s strength in the helping process, to understand that person’s preferences. In outlining a client’s needs, we must start by identifying the client’s personal goals [wants, desires, dreams] and to identify what barriers exist to inhibit attainment of those goals. Only in this way can we determine if a) the person’s goals are appropriate and reasonable to their personal capacity, and b) how the barriers can be overcome through increase in personal capacity or otherwise.
The client’s personal goals reflect the person’s formal or informal expectations and hopes for the future. The helper may assist in the consideration of personal goals with help from peers and other close friends or family as appropriate, but all must be very careful about undo influence on the client’s decision making process – client’s often want to please us. If the client personal goals are beyond the individual’s apparent capacity, how does the helper know? It is not true that the goal is beyond the person’s capacity simply because the helper believes that to be so. A helper’s decision as to the quality of the goal is also unlikely to change that person’s perspective – although they may say so just to please. The underlying conflict sets in motion a resistance of the helper to the goal or the of the client to the helper. The personal choice of a goal can only become inappropriate or unreasonable based on a re-decision by the person him/herself. The helper’s responsibility is to discuss with the client the starting point, barriers, effort, time and consequences of actualizing the goal. This should be done in a positive and realistic manner. Discussion of difficulties in overcoming barriers should always be oriented towards the eventual achievement. If the individual decides that the process of overcoming barriers is too hard, demanding too much of their time or effort, or that the desired goal doesn’t hold the reward expected, s/he will probably decide that the goal is inappropriate or unreasonable.
The value of choice [decision making, self determination, etc.] is always the driving force for change. Operating in the clients best interest [or “for their own good’] is likely to simply generate resistance, frustration and anger. On the other hand, providing a process of information gathering and evaluation is likely to help the person hone his/her preferences, making them more realistic and reasonable. People with rational information tend to make rational decisions. In addition, such a process develops a clear understanding of outcome expectations and measurements. If the customer should always determines quality [as Deming tells us], this is the process with which quality is developed. A person may make poor choices, but never wrong choices. There is no right or wrong about a person’s choices, only better and worse. If the individual chooses poorly, the helper must provide more information, helping the client think through the potential consequences of such choices in order to help the client reshape his/her perspective of the choice; but can never question the choice itself. To do so is simply to disrespect the chooser.
Planners of services and supports therefore should not individualize service and supports by identifying needs, but rather by identifying preferences [where do you want to live, who do you want to live with, would you like to work, what do you want to learn, etc. ]. The idea of a needs assessment as a means of making the plan person centered is probably not effective if the helpers interpret this as their decision about what the individual needs. The client as a participant in planning is probably not effective if helpers see themselves as the major planner and the agent for change. If helpers see themselves as enablers and their function as enabling the person to reach his/her goals, then, perhaps the value of choice can becomes a significant and culminate in the empowerment of the client’s will toward achievement.
Helpers must “walk around” these concepts several times if they hope to get it right. It is too easy to fall into the trap of our own experiences and expertise. We are too quick to conclude and project the capability or lack of such for people with obvious disabilities without recognizing that the person’s commitment to fulfilling a preferred goal is a salient force for success, if it can only be supported and sustained. It is probably also not helpful to ask the client to articulate his/her needs as such a question focuses on the negative and it is often difficult for all of us to separate needs from wants.
True helpers must avoid at all costs, diagnosis, for this is simply a projection of our expertise onto the client. Good helpers are concerned with dialogue. They recognize that they have no ability to diagnose, since the person’s behaviors will change based on whatever diagnosis [label] and prognosis we give, thereby making any prior prediction a self-fulfilling one. Through dialogue the helper can discover the strength of purpose and intentionality of the person and use this powerful force to achieve successful aims. In the process, the helper empowers the individual to strive ahead even further. The limits of the person’s capacity are defined by default limits. Those limits are fulfilled by the process of dialogue and personal evaluation, not by prediction. And even the identification of a limit can become a strengthening element, as the client can now take stock about the degree of effort and time s/he might want to expend to overcome that limit.
Personal choice then become an interactive process directed by the client and supported by the helper until either the goal is attained or reoriented. In either case, the client is likely to feel that the outcome of this process was one of quality. Each attainment develops new potential and new goals. The desire of the helper to reach absolute outcomes based on their own knowledge and understanding of people and behavior sets artificial limits on the client that are not individualized, nor even relevant. The helper’s ability to predict the limits of a person is much more contingent on their own ability to behave in a manner that makes the outcomes self-fulfilling, than on their prescient skills.
An unfortunate problem is that the helper’s status is so powerful and vulnerable clients are so trusting, that many have already been well trained to believe the helper actually knows more about them than they do. (In fact the most resistive, most difficult clients are probably the most empowered.) This has enhanced the client’s self-depreciation while elevating the status of the helper, placing the helper in the position of power. This is, perhaps, an attractive position for the helper, but inappropriate. The client is powerful; the helper is there as a servant. The helper is not there to speak for the client, but to help the client speak.
Full Community Membership
Another value that might be in need of some specificity is that of valued settings. Often referred to as serving people in community-based services, this gets interpreted as placing the service in a different setting. A partial hospital program placed in a school becomes a “community-based” program even though the child is just as isolated from the value of the setting as s/he would be if s/he went elsewhere (and perhaps suffers from even more stigma). To serve someone in a valued setting is to go to where the individual would be if they were not in service and to intervene in ways that are normalizing.
Thus home, school and community are the valued settings for children and providing services within these settings requires a very different set of supports than would be provided in a “factory” type setting. If you intend to provide services to the child in school, regular school, in their regular home room, you better be prepared to work with that child in situ, dealing not only with the child, but with the environment and the people who populate it. The helper is not helpful if they merely stigmatize the child in valued settings. The ability to involve the relationships within that setting in the helping process is critical to maintaining the value. Thus a helper who involves bullies and children who ridicule in the process of helping the recipient child gain confidence and competence is operating on this value as a commitment, not an ideal or a goal.
The helper may help the child form relationships so that a “circle of friends” from school, work and neighborhood emerges to provide natural support. The helper becomes a mentor, demonstrating how to deal with teasing and problem solving in the situation. Whether as a job coach, therapeutic support staff person, or as a companion, helpers will need to operate as independent contractors, not factory workers. That this will demand a restructuring of the provider organization goes without saying. The idea is to change the way we do business, not simply change the location of the business.
Competence & Empowerment
The final value that needs to be articulated because of its currency is that of strength. Human service staff are increasingly talking about the strengths of the client as important elements in service planning. However, there is little articulation about what this means. Often what are described as client strengths are identified as being those things that the helper does or would like to do. There is a failure to recognize the strength in some things that the helper would probably never do. Leadership strength is often demonstrated negatively in getting others to commit criminal or negative acts. Defiance is often misunderstood as hostility, since it is expended against the helper, when it might be viewed as strength of character. Hallucinations or delusions might indicate great creativity in responding to crisis that seems impossible. Resistance might be a strength of will.
Human service workers tend to place labels on almost everything and the behaviors just described are labeled good or bad, depending on one’s perspective. Helper’s will need to draw on broader perspectives if they want to truly identify strengths. The focus on strength also has implications on the construct of competency – capacity to expectations. With training, these strengths may provide such capacity. The strength of character to stand up for one’s own rights however misdirected can be improved by helping the individual understand the context of expectations and the specific skills in using this strength. Human beings, including helper’s tend to fear emotions, particularly their own. When the recipient’s behavior draws upon the helper’s emotions it is sometimes difficult to identify the strength of personality, will or character that this might imply.
Increasing the client’s strengths through training is one of the major method of using the ability of the client to learn and implement a series of intrapsychic, interpersonal and utilitarian tactics that will increase their performance in living. The overriding value that underlies these three is the belief that people with severe and persistent problems in living can improve their performance and want to do so.