Module #8

Supporting Effective Decision Making

This module focuses on equipping you in supporting youth and families in making effective decisions.  You will learn how to assess the level of support a youth and their family may need, as well as practical strategies for ensuring informed choice.  

Materials in this module were excerpted with permission from the NYS PROMISE Case Management Field Guide v.3.

The Role of Self-Determination in Supporting Informed Choice

Self-determination is the process by which someone controls their own life—referring to a characteristic of a person that leads them to make choices and decisions based on their own preferences and interests, to monitor and regulate their own actions and to be goal-oriented and self-directing.1 There is a growing body of research about self-determination and its effects on youth with disabilities and their post-educational outcomes. Having more self-determination has been shown to lead to positive outcomes for youth with disabilities.  Self-determination is important for individuals from all cultures and of all ability levels. Even individuals with the most severe disabilities are able to make choices about their own lives, with assistance. 

Self-determination for those with disabilities includes an acknowledgement of their right and capapcity to have control over and direct their own lives.

Self-determination should be integrated at the intersection of vocational rehabilitation counseling and benefits and work incentives planning with youth and their families.  Across these two processes, you should promote individual accountability and continuous engagement of the youth, exploring the youth’s goals, motivations, and values. When using self-determination theory in the field of counseling for young people with disabilities, you should examine how the family, school, service providers, and community context can assist the youth to:

  • Identify what they want to do and assist them in making their own goals 

  • Determine what motivates them to make changes, grow, and try new things 

  • Learn how to solve problems and take responsibility

You should build on opportunities for youth to meet these needs by providing opportunities to:

  • discuss preferences
  • identify options
  • examine potential outcomes (positive and negative)
  • set goals
  • outline intermediary steps
  • identify supports

Your goals should focus on helping youth and their families to understand: 

  • Autonomy – an individual’s freedom to make their own choices 

  • Competence - an individual’s ability to be successful 

  • Relatedness - how an individual’s choices are connected 

These three needs are seen as a natural part of the development of all individuals, and an important part of the human experience.  

1 Deci, E.L. & Ryan, R.M (1985). Intrinsic motivation and self-determination in human behavior. New York, NY;
Plenum.
Deci, E.L. & Ryan, R.M (2000). The “what” and “why” of goal pursuits: Human needs and the self-determination of
behavior. Psychological Inquiry, 11, pp. 227-268.

Cultural Competency and Decision Making

Cultural competency has been identified as a predictor of vocational rehabilitation success.  Cultural competency is a set of skills that help you adapt your approaches to a wide variety of cultural environments.  Culture itself can embrace race, ethnicity, religion, gender and many other personal characteristics.  Individuals may be members of many different cultures simultaneously. Situational context impacts which cultural affiliations are ‘active’ and influencing the perspective of the youth and their family. For example, a youth a school may identify more strongly with a different set of cultures (i.e. student with a disability, athlete, high-school senior, Latino-American) than  those that rise to prominence at home or in their community (i.e. oldest sister, grandchild of immigrants, Puerto Rican, Catholic).   

Cultural competence includes four essential components: awareness, attitude, knowledge and skills.  Effective cultural competence does not mean that you have to become an expert in your client’s cultures. However, it does mean that you are able to be aware that others may have different reactions to the world than oneself and conscious of your own reactions to others differences—this includes being cautious regarding your own attitudes, beliefs and values.

It is critical to be respectful and curious, willing and open to learning more and yet patient, understanding that it may be challenging to understand a culture without time, immersion and personal experience.  Practicing and growing skills in cultural competence is a life-long professional development activity.   

Tips for practicing cultural competence:

  • Focus on building a trusting relationship.
  • Communicate honestly and respectfully.
  • Help bridge communications and language barriers, offer appropriate translation services in advance where appropriate.
  • Be sensitive to youth and family preferences, culture, and religion.
  • Learn more. Ask youth and families the values they embrace, how their family functions, and what their priorities are.
  • Don't assume. Cultures may vary internally, and what you have previously learned may not always be transferrable to other situations.

 

Employment Decision Making and Supporting Choice

Understanding the impact of earnings on disability benefits and public entitlements is critical to supporting youth and their families in advancing toward positive employment outcomes and creating pathways out of poverty.  Wikipedia defines decision making as:

"An outcome of mental processes leading to the selection of a course of action among several alternatives. Every decision- making process produces a final choice. The output can be an action or an opinion of choice." 

Immediately, one can see how an individual can make a decision but still not take action.  Making sure that specific next steps are integrated into the individual plan for employment (IPE) is critical, with each action step being assigned to a responsible person—this individual should most often be the individual returning to work but can also  be other support persons. Finally, a due date should be assigned to each action step so the progress can be made, documented, and measured. 

While information may support individuals in making informed choices about work, making a choice does not always translate into taking action.

Decision making is a complex process. An individual’s decision to try work, return to work or advance in work isn't as simple as just deciding "to work or not to work." Decisions must be made regarding the individual’s quality criterion (level of work, career type, support needed, etc.), approaches to securing and/or advancing in a job, choice of service provider, and other variables around conditions of work.   All these choices facing the individual make the development of IEP a multi-dimensional process—with supports from you needed to move from each level of decision. 

The Types of Decisions People Often Make

 

The youth and families you serve are going to be faced with four main types of decisions.  You need to be ready to support them on all fronts. These include: 

  • Decisions Whether are simply binary choices... "to work or not to work." These types of decisions are made by weighing pros and cons.  You should be well-positioned to support recipients in making these types of decisions and should press for decisions and the reasoning behind a decision. You may discover that the individuals have a void in the information that has been provided that you may need to fill to help support individuals in making informed choices.  
  • Decisions Which are decisions that involve a choice of one or more alternatives from among a set of possibilities and, sometimes, can be based on the "decision whether." For example, "to work part-time or full-time." The choice is often based on how well each alternative measures up to a set of predefined criteria. Presenting scenarios to recipients in reports and during advisement are your best tools for supporting recipients in making these types of decisions. You can assist individuals in laying out options so that they can consider the option from various angles. Showing the youth and their family the financial outcome of each scenario presented will help to give a clear idea of the amounts of money involved in each possibility. 

  • Contingent Decisions are decisions that have been made but are put on hold until some other condition is met. "We would like our child to go to work but we have got to figure out how we will replace the SSI check with other income first". It is critical for you to understand contingencies that a youth and/or their family may have before moving to action. This will help you in identifying subsequent supports, referrals and assistance that an individual may need to have in place to aid in moving to action. 

  • Decisions How. The difficulty at this stage is that questions involve the "doing" step. "How will I get a job?" "Who will help me find a job?" This type of decision-making requires active support from you, not passive observance. Making connections to subsequent support providers is critical and will provide necessary linkages to ensure continuity of supports resulting in positive work outcomes. The best way to help individuals is to know your community resources! 

Creating a Positive Decision Environment

Each type of decision described above will be made within a decision environment, which is defined as the collection of information, alternatives, resources, values and preferences available at the time of the decision. Of course the ideal decision environment would include all possible information, all of it accurate and every possible alternative. Creating an ideal and positive environment is your number one priority, and several steps can be taken to help ensure it is developed:

  • Gather as much accurate and comprehensive information on the individual and their benefits portfolio as possible. 

  • Verify information collected to ensure accuracy and reliability of the alternatives and scenarios generated. 

  • Understand the specific goal(s) the youth and their family are interested in. 

  • Identify the reservations and reluctance the individual may have pertaining to the choice(s) they need to make—this will possibly inform you regarding contingencies that will need to be in place. 

  • Establish the criteria, characteristics or requirements that each alternative must possess to a greater or lesser extent—remember that alternatives will be rated on how well they deal with each criterion. 

  • Understand the individual and their values—this will help you gauge how desirable a particular outcome or alternative might be. 

  • Identify the individual's preferences providing some insight into the philosophy and moral hierarchy of the youth and family making the decision. 

  • Most importantly, create an environment that supports work as a positive outcome and sets expectations regarding its value and worth. 

 

Supporting A Work Outcome

Regardless of the strategy employed by the youth and their family making a choice to work, your role is critical. You possess the ability to create the environment and provide information that will support a youth’s choice to work. you can create the most exquisite and comprehensive advice report, but if that report ignores the youth and family’s reluctance and reservations, values, preferences and stated goals the utility of the document is negated and the chances of individuals making the better decision is minimized.

While a decision to work may not always be in every youth’s best interest, you should approach each case with an eye toward work and what approaches would be most conducive to supporting this particular individual in making a choice to work. Your role in the decision making process is not just to provide information.  Without understanding the youth’s final decision, you cannot begin to prescribe needed services and resources to support further movement toward work.

Another critical role for you is understanding why a youth made a certain decision. If a youth chooses not to opt for any of the scenarios created, it is important for you to process with the individual how they came to that choice. It is equally important when a youth makes a positive choice to work to understand what led them to that decision. This will give you better insights into the decision-making processes of individuals they are serving as well as showing what you can learn about the services provided that might produce more positive outcomes. 

Supporting a youth and their family in moving from "knowing" to "doing" is the critical action step. Even in cases where a youth makes a decision to not work, there should be "next steps" involved. Perhaps, now wasn't the right time. Perhaps, there were extenuating circumstances that led to that particular decision that may change in the future. Regardless of the reason, you should come away from every consultation with a youth and a family having an idea of what they need to do next to support the youth's movement toward work.

Guiding Questions:

  • Was the information provied helpful in assisting you in making a decision?
  • Did you feel you had all the information you needed to make an informed choice?
  • If not, what additional information would be helpful?
  • Is your decision final? If not, is there any additional supported I can provide you?
  • What factors contributed to your decision?
  • Is there something I can do to assist you in putting your choice into action?

 

Gauging The Needs for Support in Decision Making

Another important tool for you to assist you in supporting not only effective decision making, but also moving to “doing” and “action”, is gauging the needs for support a youth and their family may have.  To conduct this assessment you need to understand two critical dimensions—the youth and their families knowledge of benefits and work incentives as well as their ability to independently take action.  The illustrationprovided plots these two dimensions along a vertical and horizontal axis establishing a scale of level of sufficiency of knowledge, as well as level of dependence.  This plotting creates four dimensions that will assist you in gauging the level of support a youth and their family may need.  These dimensions include:

  • Knowing / Doing Gap: Youth and their families who may have sufficient levels of knowledge but low levels of ability to act independent of supports.
  • Youth with insufficient levels of knowledge and low levels of ability to act independent of supports.
  • Youth with sufficient levels of knowledge and ability to act independently.
  • Youth with insufficient levels of knowledge, but high ability to act independent of supports.

 

Motivational Interviewing As A Strategy to Support Effective Decision Making

Motivational Interviewing (MI) is a style of interacting with individuals that sets a tone of empathy and compassion. It is a partnership and a commitment to walk “with” a person on his/her journey towards change. The spirit of MI is based on acceptance, and that acceptance can be broken into four parts:

  1. Valuing the inherent worth and potential of every human being.
  2. Providing accurate empathy by taking an interest in and making an effort to understand life through the other person’s eyes.
  3. Supporting autonomy by honoring the person’s right for self-direction.
  4. Affirming the individual by communicating and acknowledging the person’s strengths and efforts.

In contrast to the common approach in the human service profession of focusing on problem behavior, the spirit of MI involves a focus on strengths. The MI philosophy asserts that individuals hold the wisdom and strengths to come up with their own reasons for change and overcome their ambivalence. Your goal in the MI relationship is to evoke or “bring out” the individual’s own internal motivations for change and then assist the youth in creating a plan of action. Sometimes after individuals work through their feelings of ambivalence, they make changes on their own with very little need for assistance from others.