Empowerment Issues in Services to Individuals With Disabilities

David Hagner
University of New Hampshire

Joseph Marrone
Childrens Hospital, Boston

Journal of Disability Policy Studies
Volume 6	Number 2	1995

Running Head: EmpowermentABSTRACT

	Empowerment has become a widely used term in discussions of
disability and rehabilitation issues. However, the term has 
been given a confusing variety of meanings and interpretations. 
The meanings and some conflicting views of empowerment are 
reviewed. We argue that there is a great deal more clarity 
regarding how disability services currently limit empowerment 
than about what empowerment is, and we outline five core 
features of disability services which are said to be 
disempowering. Elements of a service system that overcome these 
limitations and promote empowerment are presented. Incorporating 
these elements will require a more radical restructuring of 
current service systems than many have supposed.

_____

	Together, weve begun to shift disability policy in America away
from exclusion, towards inclusion; away from dependence, 
towards independence; away from paternalism, towards 
empowerment.

	President Bill Clinton
	Statement to the National Council on Disability
	April 16, 1993

	Empowerment has become an increasingly popular term in the
disability and rehabilitation field. It has been used in a 
variety of contexts, and it has been given a variety of 
meanings. Empowerment is almost always viewed as something 
positiveto be aspired to, advocated, and attained. We review 
some of the history and meanings of empowerment and argue that 
the literature, while unclear about the definition of 
empowerment, is largely in agreement on what is disempowering. 
In relation to the system of services available to individuals 
with disabilities, a set of specific service characteristics 
that empower recipients of those systems is proposed.
	Empowerment of individuals with disabilities was first raised as
an issue within the independent living movement (DeJong, 1979) 
and the self-help movement in the mental health field 
(Chamberlin, 1978; Mowbray & Tan, 1992; Tanzman, 1993). More 
recently, calls for greater empowerment can be found associated 
with a variety of groups, such as people with cognitive 
impairments (Jenkinson, 1993; Williams & Schoultz, 1984), with 
discussions of disability and disability issues in general 
(Chandler & Czerlinsky, 1993; Emener, 1991; Holmes, 1993) and 
with a variety of specific service issues, such as employment 
and housing (Klein & Black, 1995; Olney & Salomone, 1992; West & 
Parent, 1992). While all use the same term, several different, 
and perhaps even conflicting, perspectives on empowerment are 
evident within this literature.
	At its most basic level, empowerment is defined as a process of
assumption or transfer of legal power and official authority 
(Websters New World Dictionary, 1994). However, wide divergence 
can be found regarding the specific nature of this assumption or 
transfer and regarding the nature of the power at issue. Some 
writers view empowerment primarily as a feeling or state of mind 
(Riger, 1993; Tyne, 1994), akin in some ways to assertiveness. 
Vash (1991), for example, distinguished between external 
poweractual control over resources or eventsand authentic power, 
which she took to be something fundamentally internal and 
psychospiritual. Vash argued that this authentic power is found 
in oneself, not given by another, and its assumption within the 
individual provides the foundation for external power.
	Other authors view external power as fundamental. Harp (1994)
viewed empowerment of individuals with disabilities as 
possession of the same degree of control over ones own life and 
the conditions that affect life as is generally possessed by 
people without disabilities. West and Parent (1992) defined 
empowerment as the transfer of power and control over decisions, 
choices, and values from external entities to the consumer of 
disability services.
	Riger (1993) noted that because some powerless individuals may
not necessarily experience their lack of power, identifying 
empowerment with an internal feeling can be problematic. She 
argued further that external power is a complex construct that 
can be used to refer to at least three different kinds of power: 
power over (dominance of other people), power to (the ability to 
act freely), and power from (the ability to resist unwanted 
control); and noted some of the problems that can arise from 
confusing these different types of power.
	Authors differ not only on the meaning of power but also on the
level at which empowerment is discussed. Some refer to the 
empowerment at the level of individual people, while others 
speak of the empowerment of groups, such as different disability 
groups, or the empowerment of whole communities (e.g., Rousseau, 
1993; Riger, 1993). Emener (1991) has extended this view of 
empowerment to include a series of levels, including 
professional empowerment and service system empowerment.
	Another difference in perspective has arisen between empowerment
of people in their role as consumers of services and 
empowerment of people viewed more generally in their role as 
citizens. Consumer empowerment, that is, empowerment of 
individuals with disabilities in their role as consumers of 
disability services, is often equated with a high service 
quality and a customer service orientation (e.g., Patterson, 
1992), one or more forms of consumer involvement and influence 
over services (Reidy, 1992; Smith & Ford, 1986), and a 
professional/client relationship based on equality and respect 
(Chandler & Czerlinsky, 1993). Harp (1994) viewed empowerment as 
occurring at each of four levels: (a) freedom of choice 
regarding services, (b) influence over the operation and 
structure of service provision, (c) participation in system-wide 
human service planning, and (d) participation in decision-making 
at the community level. This fourth level addresses the role of 
individuals with disabilities as community citizens in general, 
not merely as service consumers. Holmes (1994) and Tyne (1994) 
have cautioned that empowerment viewed merely as something 
conferred on people in their role as consumers by service 
providers or a service system can be illusory or even deceitful. 
These authors argue forcefully that power that is handed out can 
also be taken back and that the granting of power by one person 
or group to another is, by its very nature, an unequal power 
relationship.
	A final divergence in perspective can be found between those who
view empowerment as a win-win or positive sum enterprise, in 
which enhancing the power of one individual or group enhances 
the power of others, and those who adopt a win-lose or zero-sum 
view in which a relatively fixed amount of power and control is 
at issue, and more power for one person or group means less 
power for someone else. Emener (1991) has adopted a win-win 
perspective, arguing that empowerment at all levels rises or 
falls together. For example, as professionals and service 
systems are empowered, they advance the independence and status 
of individuals with disabilities, thus enhancing consumer 
empowerment as well.
	Authors such as Rousseau (1990), Riger (1993), and Tyne (1994)
hold the opposite view. For Riger (1993), viewing the 
empowerment of individuals with disabilities as part of a larger 
movement toward social justice for members of disadvantaged 
groups is an integral part of the ideology of empowerment. 
According to this ideology, there are groups and individuals 
within society which benefit from limiting individuals with 
disabilities to a relatively disadvantaged, disempowered status, 
and these individuals and groups stand to lose power as people 
with disabilities gain power. Along with McKnight (1995), these 
authors view a lessening of the control of professionals and 
service systems over the lives of individuals with disabilities 
as a necessary condition for greater empowerment.

Critiques of Disempowerment

	It is clear that empowerment is far from a uniform concept with
a consistent meaning across authors and contexts.  Harp (1994) 
has argued that the term empowerment has attained the status of 
a buzzword with little meaning. Tyne (1994) went further, noting 
that loose usage poses a real danger that empowerment 
terminology can be used to obscure important issues in the lives 
of people with disabilities and even to legitimize disempowering 
structures and practices. Ferleger (1995) has noted that unless 
it is viewed in a wider context, the concepts of consumer choice 
and empowerment can be used as an excuse to justify social 
isolation and denial of services.
	Interestingly, while there is wide divergence regarding what
empowerment is, there is a surprising consensus in the 
literature concerning what aspects of disability services limit 
consumer power. This consensus is evident across disabilities, 
across interest areas (e.g., housing, employment), and across 
ideological orientations. Thus, at least with respect to receipt 
of disability services, one useful way to give empowerment a 
clearer meaning is to look closely at what is said to disempower 
people. Critiques of inadequate power by individuals with 
disabilities in relation to service systems and service 
provision have been relatively specific, and have consistently 
centered around the same basic issues. Examination of these 
issues can thus provide the basis for a set of relatively 
specific recommendations for achieving greater empowerment. Five 
basic service issues can be identified: service convenience, 
professional caution, professional expertise, consumer 
compliance, and professional relationships.

Service Convenience

	Service decisions which in theory are guided by consumer needs
or good practice are often in fact based largely on the 
convenience and self-interest of service providers. For example, 
the same standard assessment procedure may be used with each 
service referral. A small number of options (sometimes only one) 
may be made available to and thus pre-selected for people with 
disabilities (West & Parent, 1992), and service decisions thus 
consist of selecting from among this small number. Even the 
provision of a larger number of options alone is no guarantee of 
choice, since as Harp (1994) has noted, it matters little how 
many alternatives are available if none are what you want.
	Inconvenient consumer preferences tend to be dismissed as
unrealistic (Murphy & Hagner, 1988; Salomone & McKenna, 1982), 
or individuals may be allowed minor choices within an overall 
fixed context (Jenkinson, 1993; Tyne, 1994). For example, an 
individual may be placed on a job chosen by professionals and be 
allowed to choose which color clothing to wear or what to eat 
for lunch.
	Often options are presented in the form of a bundle which must
be accepted or rejected all together (Rohrer Institute, 1994). 
Acceptance of the entire bundlefor example, housing support tied 
to living in a home with other people one does not knowis termed 
consumer choice even though it contains elements the consumer 
does not want.
	Standard people processing procedures are often justified on the
basis of limited resources or organizational size (Hasenfeld, 
1983). However, it is certainly possible that such factors as 
simple lack of imagination and a legitimate desire to serve 
people quickly also play a role.

Professional Caution

	Professionals tend to be cautious or afraid of taking big risks
in their decisions and recommendations. This phenomenon occurs 
for a variety of reasons, including low expectations of consumer 
ability, safety and liability concerns, fear of alienating 
superiors, limited resources, a need to produce measurable 
outcomes, and a belief that failure experiences would be too 
devastating for consumers (Atwood, 1982; Holmes, 1994; Olney & 
Salomone, 1992; Salomone & McKenna, 1982; West & Parent, 1992).
	Partly as a result of adherence to a modified medical model,
many disability professionals view individuals with 
disabilities primarily in terms of functional limitations (Hahn, 
1991) and diagnostic labels (Holmes, 1994). Interpreting their 
professional standing in scientific/technical terms (Holmes, 
1994), professionals often give more objective information, such 
as assessment findings, priority over more subjective 
information, such as a consumers expressed preference (Murphy, 
1988). Some may even perceive themselves as guardians of the 
public treasury, to ensure that funds are only expended on those 
who will truly benefit (Holmes, 1994). And the general 
stereotype of people with significant disabilities as requiring 
primarily care and safety remains prevalent.
	The result is that often supports are weighted toward relatively
low-risk opportunities for individuals with disabilities. For 
example, employment services emphasize placement in menial, 
low-skilled jobs that require less of an investment in training 
and are less likely to fail (Olney & Salomone, 1992).

Professional Expertise

	Professionals often take upon themselves the role of defining
the situation for the person with a disability (Vash, 1991). 
For example, the experience of social isolation may be viewed as 
a result of some personal deficit of the individual, whereas an 
equally valid interpretation of the situation may focus more on 
lack of resources, support, or opportunity (Hahn, 1991; Holmes, 
1994). Since the professional interpretation is often taken as 
more valid, the result is that services tend to be designed to 
remediate problems as they are defined by professionals 
(Bertsch, 1992).
	A presumed lack of relevant expertise by individuals with
disabilities, especially as compared with the expertise of 
professionals, results in a de facto presumption of consumer 
decision-making incompetence. Thus, important life decisions are 
made for people by professionals, in a spirit of paternalism 
(Jenkinson, 1993; Murphy, 1988; Tyne, 1994). As Tyne (1994) has 
noted, the resulting dependenceTyne (1994) uses the word 
dominationcan be so strong that people with disabilities come 
not only to expect but also to welcome and demand it.

Consumer Compliance

	Compliance with service system demands and policies is often
taken as evidence of good adjustment and is therefore rewarded 
(Patterson, 1992). Consumers who deviate from the prescribed 
path to personal growth can be perceived as unreasonable or 
unmotivated (Atwood, 1982; Harp, 1994). Compliance may be a 
prerequisite for obtaining further or desired services. For 
example, an organization may require that individuals work in a 
sheltered workshop before being considered for assistance in 
obtaining a community job, or be required to demonstrate 
adjustment to a group home before being helped to move into 
their own apartment. Individuals who resist or fail to adjust 
are then viewed as not ready for the assistance they want.
	A corollary to the high value placed on compliance and
professional expertise has been that few resources have been 
devoted to teaching consumers to make decisions and learn from 
their decisions (Bertsch, 1992; West & Parent, 1992). A vicious 
cycle can then develop in which inexperience in decision-making 
is taken as a valid excuse for further professional control 
(Vash, 1991).

Professional Relationships

	Interagency coordination and collaboration are often seen as
the cornerstones of effective community rehabilitation 
(Bachrach, 1981; Bertsch, 1992; Shern, Surles, & Waizer, 1989). 
The maintenance of professional relationships can sometimes take 
priority over meeting the needs of consumers (West & Parent, 
1992). Meeting some needs may cause tension or conflict because 
they pose problems for agencies or require one team member to 
adopt an advocacy role against another.
	Professionals who must work as a team and who identify with one
another as fellow professionals may find it difficult to 
alienate one another for the sake of a consumer. Anyone with 
experience working on interagency committees can readily 
identify situations of this nature. One particuarly striking 
example from the authors experiences casts a bright light on 
this problem. The director of one mental health service, 
questioned about the relationship between her service and the 
vocational rehabilitation agency, stated that the relationship 
was excellent. When further queried about how many of her 
organizations clients had received vocational rehabilitation 
services, she said that not a single individual had been 
referred. The rehabilitation counselor had told her that she had 
no clients who would make good referrals. When asked why she 
didnt try to advocate more strongly for her clients, her 
response was: I dont want to cause any trouble because we have a 
wonderful working relationship.

Consumer Empowerment and Service Design

	What would a system of disability services look like that was
able to avoid these complaints? Using the critiques of 
disempowerment as a guide, we can give some degree of direction 
to the shape of a service system that allows for and promotes 
consumer empowerment. Clearly some complaints, and thus some 
reforms, are structural in nature. That is, they require a 
broader approach than merely recommending improvements in 
attitudes or behavior, and speak to the fundamental structure of 
the current service system. For example, admonishing 
professionals to treat their clients more respectfully or listen 
better cannot by itself resolve these issues. Nor can greater 
assertiveness and self-confidence by individuals with 
disabilities, in itself, be the complete answer. Taken as a way 
of calling for redirection and reconceptualization of the 
relationship between people with disabilities and the system of 
services and supports that they receive, the concept of 
empowerment has far-reaching implications for practice, 
organizational structure, and policy. The remainder of this 
article discusses some of the requirements of such a system of 
services.

Availability of Service Alternatives

	It is clear that some people need paid services to accommodate
for a disability in fulfilling important social roles and 
participating as a valued member of the community. A high degree 
of choice and control over these services is an essential 
ingredient of empowerment. Shevin and Klein (1984) define choice 
as the act of an individuals selection of a preferred 
alternative from among several familiar options. Choice requires 
options. For example, if only one type of residential or other 
service exists in a particular region, consumers in that region 
have no choices because there are none offered. As Ferleger 
(1995) notes, the lack of meaningful community options for 
housing, work, leisure and other pursuits makes the choices of 
many consumers like the choice made from a magicians deck of 
cards, always somehow turning up the one card the magician has 
predetermined.
	Control should include a choice of vendors to provide a service
(Bertsch, 1992) and choice of individual practitioners or 
subcontractors within an organization (West & Parent, 1992). In 
addition, options need to be familiar; that is, some way to 
receive and process information about them must be within reach 
of the individual. For example, a consumer guide, with quality 
ratings of services by consumers, would be one tool for 
assisting people in obtaining information with which to make 
selections.
	Further, the choices from which to select must be legitimately,
not merely theoretically, available. For example, an 
alternative provider of residential supports with a long waiting 
list is not a true option for an individual who needs supports 
to maintain his or her residence.
	Duplication of services is often seen as wasteful and
inefficient. Yet there is little evidence that community-wide 
attempts to counter fragmentation are cost-efficient (Tessler & 
Goldman, 1982; Mechanic, 1991). Empowerment requires 
duplication. Perhaps it is more accurate to say that empowerment 
leaves it up to the consumer to decide whether services 
duplicate one another, as is the case with a consumer-based 
economy in general. There are numerous examples in any community 
where several stores offer similar merchandise at about the same 
prices with about the same physical layout, yet individual 
consumers express a clear preference for one or another store on 
some basis that is meaningful to them.

Support for Alternative Decisions and Plans

	Consumer empowerment requires that the services allow and
expand access to the settings and resources that are available 
in the community at large, not restrict such access or prescribe 
different options. Obviously, there will always be some limits 
on the choices that can be supportedfrom the unethical, such as 
buying drugs, to the impractical, such as a job in the tropics 
for six months a year. The world all of us inhabit has limits 
based on resources, looks, personality, class, race, gender, et 
cetera. As Harp (1992) noted, the role of an empowering service 
system or service provider is to minimize those limits based on 
disability.
	Services follow such an approach by making the same level of
support available to support a variety of individual plans. 
Thus, a rehabilitation program which provides door-to-door 
transportation to its sheltered workshop but not to any other 
work location is disempowering because it weights support toward 
one employment option instead of towards helping consumers gain 
access to the range of employment options available in the 
community. A residential support service which provides full- or 
part-time assistance to an individual in a home or apartment of 
the individuals own choosing empowers its consumers to select 
from the same array of housing options open to anyone. A 
disempowering residential service bundles supports and place of 
residence on an all-or-none basis (Klein & Black, 1995). This 
recommendation also applies in the area of service funding. 
Empowerment is enhanced when a funding organization makes the 
same dollar amount available to support one selection (e.g., 
college tuition) also available to support another selection 
(e.g., apprenticeship with a craftsperson).

Assistance in Making Choices

	Providing assistance related to making choices is neither
simply a passive process of nonintervention nor a matter 
responding only to fully articulated requests. Some individuals 
have little experience in making choices, have little 
information upon which to base an informed choice, or require 
assistance to communicate, process information, and make 
selections. Active guidance through the process of information 
gathering and information processing is required, in such a way 
that the selections made are not determined by the nature of the 
assistance. Team decision-making, often touted as an empowerment 
vehicle (Jenkinson, 1993), is useful for making some service 
provision decisions but cannot be used to substitute for 
individual choice over matters in which others in the community 
make individual choices.
	In addition, changing ones plans ought to be not only tolerated
but also encouraged as a natural, healthy, and expected part of 
the choice process (Jenkinson, 1993). Finally, consumer choice 
has to include major life decisions (such as where to work, 
where to live, with whom to be intimate), not simply small 
choices (such as what color carpet to purchase or what chores to 
perform).
	Several effective methods have been developed to assist
individuals with intellectual disabilities to make decisions 
(Sigelman & Budd, 1985; Tymchuck, Yokota, & Rabar, 1990) and 
solve problems (Hughes & Rusch, 1989). Strategies such as 
attending to behavioral cues that indicate preference (Shevin & 
Klein, 1984) allowing individuals to proceed at their own pace 
(Mount, Ducharme, & Beeman, 1991), using photographs (March, 
1992), and teaching a sequence of cognitive steps (Powers et 
al., 1995) also contribute to the ability of individuals with 
disabilities to make choices.

Separation of Life Planning Assistance From Other Assistance

	Bertsch (1992) has cautioned that many services, and especially
those using what is sometimes called a single-point-of-entry 
approach, combine and confuse assistance in making life plans 
with assistance in implementing those plans. As consumers, we 
tend to be wary of obtaining help with plan development from 
people who stand to benefit from the plans that are developed 
(Butterworth et al., 1993). For example, we suspect that if we 
ask real estate agents whether it is wiser to buy a new home or 
enlarge our present home, we can predict that they will favor a 
new home purchase, whereas if we take our problem to a building 
contractor we will get a different viewpoint. Thus, many 
consumers prefer an independent process for identifying needs 
and making plans, while relying on professionals to provide 
important pieces of technical information.
	When individuals with disabilities need life planning
assistance, this assistance must also be independent. If a 
planning process or meeting is called for, the process ought not 
be dominated by the same service providers who have a direct 
interest in the outcome. The planning participants, timing, 
location, and planning topics should be chosen by the person and 
should involve friends, family, and community members as the 
individual wishes. Examples of this type of planning include 
personal futures planning (Mount, Ducharme, & Beeman, 1991) and 
whole life planning (Butterworth et al., 1993). When someone who 
also could benefit financially from what is planned assists with 
formulating plans, this conflict of interest should be 
identified and discussed.
	Independent case management is sometimes viewed as providing the
required independence and neutrality. However, case management 
in itself does not always adequately address the issue. Case 
managers may not have the depth and quality of relationship 
required to assist with the subtleties of providing assistance 
to a person in working through a decision, and they may have a 
host of interagency allegiances or conflicts that interfere with 
objectivity. Finally, the term as well as the traditional 
practice of case management suggests a highly unequal power 
relationship and a fundamentally bureaucratic approach that 
takes as its starting point the system of services rather than 
the individual.
	In order to be effective, planning strategies must have as their
focal point the personally meaningful goals of the individual, 
not the individuals weaknesses and problems, not the services available, 
not what is realistic to pursue, nor even the individuals 
objectively determined characteristics and needs. Individuals 
with disabilities, like anyone else, formulate personal goals 
based on needs and aspirations as each person perceives and 
defines them. Envisioning an expansive future for oneself 
despite current constraints or seeming implausibility is 
inextricably woven into the fabric of American culture, 
enshrined in terms such as the American Dream and the Land of 
Opportunity. As plans are implemented, reality often intrudes 
and barriers must be confronted or plans modified along the way. 
But this process only makes sense insofar as it reflects each 
persons evolving vision.

Welcoming and Facilitating Community Connections

	People should be encouraged to seek input from many people in
the community in formulating and implementing their plans. This 
might include involving families, inviting friends to meetings, 
or encouraging people to meet with their friends and others in 
the community to help generate plans for discussion. Service 
providers need to welcome and facilitate this process, without 
worrying that some consumers create conflict by stating 
different needs to different people or complaining about one 
professional helper to another, or that some family and friend 
relationships are extraordinarily confusing, or that some 
individuals may choose to spend some time with other individuals 
with disabilities. All of these will be outweighed by the 
benefits of community connections.
	Support groups such as self-advocacy organizations (Williams &
Schoultz, 1984) offer additional opportunities for mutual 
support and collective action to individuals with disabilities. 
Professionals can work effectively with such self-help groups, 
recognizing their unique capabilities as well as their limits, 
and can work to coordinate efforts in meeting consumer goals 
(Lenrow & Burch, 1981).
	One way services facilitate connections to and input from
numerous people in the community is by facilitating a whole life 
planning process (Butterworth et al., 1993) or circles of 
friends (Ducharme & Beeman, 1991). Another strategy is to 
develop collaborative relationships with generic organizations 
(e.g., a joint project for job-search assistance through a local 
community college placement office rather than a specialized 
job-search club for individuals with disabilities offered by a 
disability service organization).

Funding Tied to Individual Plans

	Olney and Salomone (1992) have called for greater
individualization of services as a mechanism for empowerment. 
Funding of services independent of individual consumer plans 
(for example, an annual contract from a state agency for a 
service provider to operate a service for a specified number or 
people) is inherently disempowering because it requires people 
to select what is available, usually as a bundled set of 
services, some wanted and some unwanted.
	Funding tied to individual plans should reward the achievement
of goals, not merely the provision of a service or trying in 
itself. Consumer control is reinforced by funding the 
achievement of goals that the consumer identifies. Voucher 
systems have been proposed as a mechanism for allowing funds to 
follow individuals, not services (Bertsch, 1992). Under this 
approach, an individual authorizes payment to the people or 
organization(s) he or she feels can provide needed services. 
Specialized disability services, generic community services, and 
also informal or nonprofessional services alike can be selected. 
For example, a consumer may offer to pay a neighbor to prepare 
the evening meal. One individual may deal with several different 
providers in this way, while another may prefer to pay one 
vendor for all of them, a concept sometimes called wrap-around 
services (Bolton, 1993). Another form of voucher system 
allocates some or all funds directly to individuals on a cash 
basis, to achieve identified outcomes.
	When funding is tied to the implementation of individual plans,
consumers do not fill slots in a system of prearranged services. 
When something is not available, a request for proposals or 
help-wanted ad is developed, social networks are canvassed, and 
the good or service is made available. There should be minimal 
oversight of funds and flexibility in how closely consumers and 
families are accountable for the broad uses of these funds. A 
working example of such a process is the Social Security 
Administrations Plan for Achieving Self-Support program.
	Although sometimes viewed as the ultimate expression of
empowerment, voucher systems are not without their problems. 
Some degree of accountability and quality control is required 
both to monitor expenditure of public funds and to ensure that 
individuals are not cheated or harmed. Fragmentation of service 
providers may eliminate some economies of scale. Some judgments 
about service competence may require technical expertise which 
is difficult or expensive to obtain. And recruiting a committed, 
high-quality human service work force might be more difficult 
for organizations unable to count on predictable annual funding. 
However, almost all other professions and organizations in our 
society thrive despite having to project consumer demand, 
including lawyers, accountants, contractors, hospitals, 
restaurants, colleges, and so on. And consumers can deal 
successfully with selection, contracting, and monitoring issues 
if provided with the planning and decision-making assistance 
recommended above. Some service systems are experimenting with a 
mechanism known as service brokerage (Roeher Institute, 1994) to 
assist individuals to select and contract with service providers 
and maintain accountability of funds.

Service Responsiveness

	Some aspects of consumer-centered services involve ensuring a
level of responsiveness and administrative design such that 
recipients of services are treated as valued customers. This 
aspect of empowerment is emphasized by Vash (1991) and is 
similar to calls for a customer perspective made by Patterson 
(1992).
	In a responsive service, real control is exercised over 
operations, not just over ones own service plan. Professionals 
fully disclose information and involve consumers in processing 
that information. The details of service utilization are 
customer friendly and convenient. Quality assurance activities 
and standards are built upon consumer-defined outcomes. 
Amenities people generally expect from a professional service 
are evident: Phone calls are returned promptly, waiting areas 
are attractive, consumers are greeted and escorted to an office, 
and so forth.
	Responsive organizations also treat customer input as essential
to the operation of the service. For example, applicants for 
service positions within the organization are required to obtain 
references from consumers, service staff provide a brief 
biography to assist consumers in choosing from whom they would 
like assistance, and a centralized listing of unedited consumer 
evaluations of service providers is available for anyone to 
review. Consumers are contacted regularly for comments, both 
formal and informal, and are encouraged to generate ideas for 
improvement on the part of the staff.
	Attaining this level of responsiveness, where the consumers
wants guide the process, requires that relationships with 
service providers be more personal, trusting, and reciprocal 
(McCrory, 1991; Olney & Salomone, 1992). In order for the 
provider to be attentive to a persons wants, the service 
recipient must be willing to disclose weaknesses or 
vulnerabilities and to bear direct feedback or confrontation. 
People will only share dreams and aspirations with those they 
trust and with whom they feel comfortable.
	Involvement of consumers in the operation and direction of
services is an important facet of empowerment. Procedures that 
foster administrative involvement include consumers having 
significant input into staff hiring, firings, and promotions, 
program rules, and program publicity. Also, in a responsive 
organization, people with disabilities and consumers of services 
are included in significant numbers on boards of directors and 
are actively recruited and hired as staff. Consumers or consumer 
groups are involved in organizational strategic planning and 
serve as evaluators of program effectiveness.
	Perhaps the highest level of administrative involvement might be
said to be a service run for consumers by consumers (DeJong, 
1979; Harp, 1994; Mowbray & Tan, 1993; Vash, 1991). Certainly, 
programs run by consumers are one vehicle to achieve enhanced 
power over the disability service system. However, defining who 
is a consumer can become a major dilemma. For purposes of 
service delivery, the definition may be straightforward. 
However, in an administrative context, it must be decided 
whether anyone with a disability label is considered a consumer 
or only someone with a defined set of experiences, and to what 
extent parents, spouses, and other family members should be 
considered a type of secondary consumer (Marrone, 1994).

Conclusion

	Empowerment has been a major thrust of recent legislative,
funding, and policy initiatives. For example, the 1992 
amendments to the Rehabilitation Act (P.L. 102-569) require that 
rehabilitation plans be jointly developed by the counselor and 
consumer, and that state vocational rehabilitation advisory 
councils have a majority of members with disabilities. The 
rehabilitation demonstration projects in consumer-controlled 
resource allocation known as the Choices grants, the emphasis on 
participatory action research within the National Institute on 
Disability and Rehabilitation Research (National Council on 
Rehabilitation Education, 1992), and other policy shifts 
increasingly reflect the view that people with disabilities must 
have greater control of systems designed to help them.
	Currently, many systems and policies have the effect of
diminishing the recipients social power in ways not otherwise 
tolerated in our society, or confer what might be considered 
special powers and choices that most people would find unusual. 
For example, most individuals without disabilities cannot choose 
whether to live in an institution or in a group home; nor are 
they legally permitted to choose to work in a setting with other 
people who all share some physical or mental attribute, nor 
choose to work for less than the statutory minimum wage. Use of 
the term empowerment raises the issue of the power to do what? 
If Harps (1992) position that empowerment consists in possessing 
the same degree of control over ones life as ones peers without 
disabilities is on the right track, then many current systems 
and policies should be viewed with suspicion.
	We have argued that particularly at the level of service
provision, the extent to which empowerment challenges the 
current system has been vastly underappreciated. Assumption of 
greater power by service recipients necessitates far-reaching 
changes in organizational structures, funding processes, 
individual service planning procedures, and professional roles 
and relationships. Empowerment does not mean unlimited access to 
public funds to implement any whim, nor does it mean control 
over the technical details of professional services. But it does 
mean the power to define ones own life situation and needs, to 
make and control ones own life decisions independent of service 
convenience, to engage in unpaid relationships, develop 
community ties, and participate as a full member of the 
community, to direct disability supports toward meeting 
individually determined needs, and to be treated as a valued 
customer with input into the operation of service organizations. 
Empowerment thus speaks to the complementary concepts of choice 
and control and is linked to civil rights and citizenship.
	There is little doubt that change of this nature would be
difficult to achieve, not only for the same reasons that any 
large-scale change is difficult, but also because redistributing 
power would take power away from some people. For example, 
service providers would face additional uncertainties were each 
consumer to get a transferable voucher, and staff who attend to 
consumer wants run the risk of being ostracized as not being a 
team player. We must assume that not everyone will perceive 
themselves to be gaining from increases in consumer empowerment, 
and that change will be resisted by some who will perceive 
themselves to be losing power (Riger, 1993).
	However, it does a grave disservice to mask these issues by
making empowerment so broad and loose a term that it refers to 
practically anything, including business as usual. As quickly 
and willingly as we embrace the term, we must also embrace the 
vision to implement fundamental changes in attitudes, service 
processes, and service structures.

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David Hagner is the associate director of the Institute on
Disability at the University of New Hampshire and before that 
was director of pre-service training for the Institute for 
Community Inclusion at the University of Massachusetts, Boston. 
Dr. Hagner has numerous publications on employment, natural 
supports, and decision-making related to people with developmental 
disabilities.

Joe Marrone is currently the coordinator of technical assistance
for the Institute for Community Inclusion and director of 
training for the Rehabilitation Research and Training Center on 
Promoting Employment, both affiliated programs of Childrens 
Hospital, Boston, and the University of Massachusetts, Boston. 
Mr. Marrone has authored several articles and book chapters on 
employment, consumer-driven services, marketing, and 
collaboration related to people with psychiatric disabilities.

Reprints of this article may be obtained by contacting David
Hagner, University of New Hampshire, Institute on 
Disability/UAP, The Concord Center, Suite 318, 10 Ferry Street, 
Unit #14, Concord, NH 03301-5019