Abstract
Now in its fifth edition, the Code of Professional Ethics for Rehabilitation Counselors continues to clarify and expand behavioral guidelines and practice for those in the rehabilitation counseling profession. Specific to certified rehabilitation counselors (CRC) in the private sector, this article details changes in the revised Code specific to Forensic Services (Section F) and Business Services (Section K). It also briefly describes the historical development of these sections of the Code and explores its implications.
Certified rehabilitation counselors (CRCs) and Canadian certified rehabilitation counselors (CCRC) working in forensic and indirect service settings are part of a fast-growing specialty area in rehabilitation counseling. The exact number of CRCs/CCRCs working in forensic practice (and the extent to which it is growing) is difficult to predict as the Commission on Rehabilitation Counselor Certification (CRCC) does not maintain statistics about how many CRCs work in forensics (P. Shlemon, personal communication, September 22, 2022). Conversely, the International Association of Rehabilitation Professionals indicates that they have about 675 members in the Forensic Section (K. Bailey, personal communication, September 22, 2022), but did not know if this was an increase or decline over the last 5 years. Likewise, the American Board of Vocational Expert reported having about 475 members (T. Leslie, personal communication, September 21, 2022), although they also did not have any trend analysis on membership numbers. In addition, with the use of the term “forensic” and the term’s contemporary association with pop culture true crime television shows, and an inferred expertise in corrections and offender services, there may be some confusion about what CRCs/CCRCs in forensic settings do (Barros-Bailey, 2018).
The CRCC (2017) defines forensic work as the: “[Provision of] expertise involving the application of professional knowledge, and the use of scientific, technical, or other specialized knowledge for the resolution of legal or administrative issues, proceedings, or decisions” (p. 37). In addition, a CRC/CCRC in the forensic setting was defined as someone “[working] in a forensic setting conducting evaluations and/or [reviewing] records and [conducting] research for the purpose of providing unbiased and objective expert opinions via case consultation or testimony” (CRCC, 2017, p. 37). Summarily, CRCs/CCRCs in forensic settings are typically tasked with evaluating persons with disabilities to determine work capacities and aspects of social inclusion in myriad legal settings, such as Social Security Disability determinations, civil litigation, and workers’ compensation. The forensic practice setting also represents one of the better-compensated areas of specialization for CRCs/CCRCs (CRCC, 2008).
Given the unique demands and work contributions of CRCs/CCRCs to this venue, forensic and indirect service provision was included as a specific section of the Code of Professional Ethics certified rehabilitation counselors in 2010. The 2010 iteration of the Code noted an important aspect of forensic and indirect service provision related to the CRCs/CCRCs’ interactions with the individuals they serve. Rehabilitation counselors in forensic settings do not have clients, they have evaluees, as there is no intent to provide rehabilitation counseling services directly to clients and there is no ongoing professional relationship (Barros-Bailey et al., 2009).
What follows is a brief history of forensic rehabilitation counseling and appropriate business practices, a demonstration of how forensic rehabilitation counseling and business practices are included within the CRCC Scope of Practice Statement for CRCs/CCRCs, and clarification on updates to Section F—Forensic Services, and Section K—Business Practices, as these two elements are often intertwined. It is important that CRCs/CCRCs understand the evolution of the CRCC Code of Professional Ethics (hereafter referred to as the Code, CRCC, 2023) and implement any changes needed to comply.
Brief History of Rehabilitation Counseling in Forensic Settings
A lot has changed in professional ethics since the original 1987 Code of Professional Ethics for Rehabilitation Counselors (“Code”) was approved by the CRCC. The Code has quadrupled in length to the present edition as new sections were added and original sections expanded. This article illustrates modifications to two sections added after the original Code was approved more than 35 years ago. Specifically, in the fifth edition of the 2023 Code, we examine changes to (a) Section F: Forensic Services, initially introduced in the third revision of the Code (CRCC, 2010) and (b) Section K: Business Practices, which was added in the second edition of the Code (CRCC, 2002). The terms “forensic” and “business” that best describe each section were not found in the original 1987 Code, although “expert witness” was in one of the Rules.
Section F: Forensic Services—History of Forensic Rehabilitation and Ethics
While the addition of forensics to the CRC Code of Ethics is relatively new, forensic rehabilitation counseling itself is traced to the late 1920s to the mid-1930s when vocational experts from public vocational rehabilitation agencies provided opinions in workers’ compensation cases resulting in lump-sum agreements (Barros-Bailey, 2014). It was not until the 2010 revision of the CRCC (1987) Code, however, that forensic rehabilitation ethics earned its own section with 17 standards (Barros-Bailey et al., 2010), as compared with a single reference in Rule 2.4 of the initial 1987 Code expecting expert witnesses to provide informed consent and unbiased, objective opinions.
Blackwell et al. (1994) identified nine core themes in forensics that became guidelines in the discourse and evolution of forensic rehabilitation ethics for a generation of practitioners and was foundational for the development of Section F of the Code. Those nine core themes are (a) professionalism and responsibility, (b) public trust, (c) integrity, (d) objectivity and independence, (e) confidentiality and clarification of role, (f) professional care and competence, (g) scope and nature of services, (h) forensic assessment, and (i) fees and promotion. The initial 2010 Section F had four subdomains specific to clients’ and evaluees’ rights, rehabilitation counselors’ forensic competency and conduct, forensic practices, and forensic business practices (Barros-Bailey et al., 2010). Other sections of the 2010 Code provided monumental changes and expectations to all practice settings, but of particular note were the changes in forensic practice parts of the Code, such as the anticipation that informed consent is performed not only orally, but also in writing (Carlisle & Neulicht, 2010).
The reason for the expansion of forensic rehabilitation standards from a handful of standards nearly a quarter of a century ago to its own, separate section arose out of empirical information collected by CRCC from three independent sources: (a) an international qualitative study of rehabilitation counselor ethical issues (Tarvydas & Barros-Bailey, 2010); (b) complaints and violations adjudicated by the CRCC Ethics Committee; and (c) increased request for Advisory Opinions by the CRC Ethics Committee on forensic matters.
Surveys of CRC/CCR ethical issues
The CRCC’s first survey collecting data on current and emerging ethical dilemmas faced by CRCs/CCRCs used to inform the revision of the Code was performed in 2010 (Tarvydas & Barros-Bailey, 2010). As a result of that study, the authors concluded, “Because rehabilitation counselors provide a substantial service in the forensic and indirect service arenas, specific and elaborate guidance in this area may be wise” (p. 210). The study was repeated by the Ethics Committee for the 2017 revision, where it was found that about 9% of ethical dilemmas faced by CRCs/CCRCs had to do with forensic topics (Hartley & Cartwright, 2016). The authors concluded, “Because Section F . . . is relatively new . . ., future revisions will likely continue to address forensic and indirect services” (p. 41). For the 2023 update of the Code, Hill and colleagues (found in this special issue) performed a mixed methods survey of current and ethical dilemmas reported by CRCs/CCRCs. They found that about 4% of those dilemmas fell into forensic services, mostly associated with concerns about an opposing expert’s opinions, serving in clinical and forensic roles in the same case (dual roles), competency for psychometric testing, incongruence between assessment results and opinions, and advocacy. New in the 2022 survey, and perhaps because of the recent experience of remote work due to the worldwide pandemic, some ethical dilemmas were associated with forensic online assessment, known as teleassessment.
Adjudicated complaints and violations
In 2007, the first comprehensive review of ethical complaints and violations of the Code was published, covering the years 1993 to 2006 (Saunders et al., 2007). The largest percentage of certificants (46%) found to be in violation of the Code were employed in the private/proprietary sector, middle-age, and mid-career (Saunders et al., 2007), although the study was silent on the number of complaints and violations that fell into forensic, indirect services, or related areas that are now part of Section F. Following the 2007 analysis of ethical complaints and violations, Hartley and Cartwright (2015) reported that 10.4% of Code violations were from Section F, as follows: not producing unbiased, objective opinions; appropriate assessment instruments and resulting opinions; fair and unbiased critique of a colleague’s work product; conflicts of interest; and failure to disclosure role and its limits.
Advisory opinions issued
In 2008, Shaw and Lane published a content analysis on the first decade (1996–2006) of Advisory Opinions. Advisory Opinions are requests for guidance made to CRCC when interpreting or seeking to understand the Code of Ethics. The CRCC has maintained a repository of all these requests for guidance since 1996. This analysis of the first decade of opinions issued found forensic services to be the fifth most requested out of 13 opinions. Topic areas included undue influence by referral sources, heavily biased opinions, competency, credentialing, and critique versus disparaging comments of opposing experts (Shaw & Lane, 2008). The next content analysis of CRCC Advisory Opinions found in the literature was analyzed through 2013. The research concluded that besides The Counseling Relationship and Resolving Ethical Issues sections of the Code, requests for Advisory Opinions on ethical forensic matters were the most requested guidance sought by rehabilitation counselors (Cartwright & Hartley, 2016). As in the 2008 study, CRCs/CCRCs continued to seek guidance on the issues of bias and competency. There was also a theme showing requests for advice on the topic of informed consent. Analysis of Advisory Opinions from 2013 to the first quarter of 2022 found six additional requests (Advisory Opinions 130, 132, 133, 140, 142, and 144) on forensic topics. Again, opinions continue to be issued in some topical areas from the past: objective/unbiased opinions, informed consent, competencies, and disparaging remarks. New areas of guidance were: changing roles with the same client/evaluee, accepting fees for case referrals to other experts, and contractual relationships with forensic colleagues (CRCC, 2022a).
Section K: Business Practices—History of Business Practice Ethics
An older section of the Code than forensics—Section K: Business Practices—has a smaller but consistent presence in the rehabilitation counseling literature. Some topics tend to overlap with Section F.
Surveys of CRC/CCRC ethical issues
Less than 1% of ethical dilemmas identified by CRCs/CCRCCs before the 2010 Code revision pertained to business practices (Tarvydas & Barros-Bailey, 2010). However, by 2017, business practices were identified in 9.3% of ethical dilemmas, particularly related to “practices that put financial interests above service expectations” (Hartley & Cartwright, 2016). Discrepancies in content analysis between the 2010 and 2017 versions of the Code do not necessarily imply growth in this factor but could be explained by other measurement factors, such as different coding approaches by researchers. Hill et al.’s (2023) survey performed for the 2023 revision found that Section K accounted for only 1.5% of the frequency of concerns by CRCs/CCRCs, second to last before Section I: Research and Publication. Both Sections I: Research and Publication and Section K: Business Practices were tied for last (each at .8%) in rank order of the Code sections as important when handling ethical issues. Specific examples of concerns by CRCs/CCRCs associated with Business Practices were not available.
Adjudicated complaints and violations
Involving ethical complaints and violations, the first published content analysis determined that one of the main clusters involved “business practices (e.g., billing, reports, documentation)” (Saunders et al., 2007, p. 12). More recently, Hartley and Cartwright (2015) found that only 3% of ethical violations were associated with Section K.
Advisory opinions issued
Regarding Advisory Opinions, Shaw and Lane (2008) found that only 2% of requests from 1996 to 2006 revolved around business issues. The updated content analysis of Advisory Opinions by Cartwright and Hartley (2016) concluded similarly that 2.6% of opinions pertained to Section K or a total of 12 requests for opinions. In less than a decade, however, five additional requests have been made (Advisory Opinions 131, 132, 135, 142, and 146) through early 2022, two of which overlapped with forensic services. The main topic areas of requested guidance were commissions, kickbacks, rebates, or other forms of monetary compensation for business referrals, explanation of fees and nonpayment of fees, timely documentation, and recruitment through self-referral.
While there are a few requests for interpretation of the Code in issues surrounding financial relationships, policies, behaviors, and transactions, overall, Section K tends to receive less ethical focus by CRCs/CCRCs.
Forensic and Business Practice Ethics and the CRC/CCRC Scope of Practice
The CRCC (2022b) Scope of Practice overview states: Rehabilitation counselors provide services within the Scope of Practice for Rehabilitation Counseling. They demonstrate beliefs, attitudes, knowledge, and skills to provide competent rehabilitation counseling services and to work collaboratively with diverse groups of individuals, including clients, as well as with programs, institutions, employers, and service delivery systems and provide both direct (e.g., counseling) and indirect (e.g., case review, feasibility evaluation) services. Regardless of the specific tasks, work settings, or technology used, rehabilitation counselors demonstrate adherence to ethical standards and make reasonable efforts to ensure the standards are vigorously enforced. (para. 12)
The CRCC Scope of Practice statement further outlines that when practice involves consultation, as in business and forensic practice, the CRC/CCRC should apply the same scientific principles and procedures used in counseling and human development to provide assistance in understanding and solving current or potential problems that the consultee may have in relation to a third party, be it an individual, group, or organization.
A Scope of Practice statement for a profession outlines the range of roles, functions, responsibilities, and activities for a professional based on their education, training, and experience, and can be within the guidelines of certification or state licensure. Scope of Practice is a general description of the services practitioners are qualified to provide as well as the limitations. The CRCC Scope of Practice identifies knowledge and skills required for the provision of effective rehabilitation counseling services to persons with physical, mental, developmental, cognitive, and emotional disabilities as embodied in the standards of the profession’s credentialing organizations.
Difference Between Scope of Practice and Ethical Guidelines
Scope of Practice is specific to the CRCs/CCRC’s knowledge, skills, experience, competence, and the techniques and modalities used within the rehabilitation counseling process, and ethical guidelines are a professional moral code for practice adopted by a certifying or licensing body that provides a framework and guidance for professionals to practice within. The Code provides ethical guidelines for the CRCs/CCRC’s use within their Scope of Practice. The basic objectives of the CRCC (2017) ethical code are to:
promote the public welfare by specifying ethical behavior expected of rehabilitation counselors;
establish principles that guide the ethical behavior of rehabilitation counselors;
serve as an ethical guide designed to assist rehabilitation counselors in constructing a professional course of action that best serves those utilizing rehabilitation counseling services; and
serve as the basis for the processing of alleged Code violations by CRCs.
Forensic and Business Ethics: Part of the Professional Identity
The updates to the Forensic and Business sections of the Code provide CRC’s/CCRC’s guidance on providing Scope of Practice services within an ethical framework. In further clarifying and expanding the Code, the foundational core values of Rehabilitation Counselors are clarified and reinforced. The core values of rehabilitation counseling—inclusion, independence, social justice, advocacy, and empowerment—underlie all of the changes. In Section F: Forensic Services, the proposed updates further challenge the forensic CRC/CCRC to evaluate any role change when providing forensic evaluations, reinforce the requirement that opinions be unbiased and objective, and ensure that resources utilized are valid and current.
In Section K: Business Practices, the expanded Code specifies that CRCs/CCRCs consider the impact on the client when using their testimonials, disclose any conflicts when referring clients for other services, develop a succession plan for their agency or practice, disclose billing details, and respect the intellectual rights of colleagues. The clarification and expanded language on these issues in both Forensic Services and Business Practices were made through the lens of the previously mentioned core values of the Scope of Practice and the Framework for Ethical Decision-Making.
Section F: Forensic Ethics—Changes and Additions
As outlined above, forensic practice is a dynamic and growing practice area and the inclusion of specific guidelines for CRCs/CCRCs practicing forensic rehabilitation is relatively recent. Changes to the Forensic Services section of the Code largely focused on adding wording to emphasize the “certified” aspect of being a rehabilitation counselor. The term “certified” denotes a level of expertise inherent to the CRC/CCRC designation and the regulatory rights of CRCC in enforcing the ethical code of conduct for professionals holding the CRC/CCRC credential. Another key focus of this update centers on the interaction between the CRC/CCRC and their role with the person they are serving (the evaluee). The CRC/CCRC practicing in forensic venues does not typically engage in the provision of direct rehabilitation counseling services; instead, the services provided are usually limited to assessment, evaluation, report writing, and participation in legal or court proceedings. However, given that rural areas may have few providers, the wording was added to the introduction to Role Changes section (G and G.1.c.) to clarify the procedures to transition from one professional role to another with an evaluee. The primary emphasis is on the need to clarify the new role and its limitations, ensure a new professional disclosure form is completed, and written consent of the evaluee (and legal representative, if necessary) is obtained. This change recognizes the need for continuity of service provision and allows for some flexibility in the event there are limited providers.
The third change of note is specific to the Validity of Resources Consulted standard (G.2. e.). Prior wording focused on the credibility and validity of resources used to draft supporting opinions and reports. The new Code provides additional wording to emphasize the need for using current resources. Other changes to this section were largely cosmetic.
Section K: Business Ethics—Changes and Additions
Changes to the 2023 CRCC Code specific to Business Practices, Section K, take into consideration the practical aspects of private rehabilitation that facilitate rehabilitation service provision while maintaining a profit. The 2017 Code stated that CRCs/CCRCs that use testimonials do not solicit them from current or former clients/evaluees who may be vulnerable to undue influence. The 2023 Code changes and clarifies this Rule (Standard K.1.b.), specifically stating that it is not acceptable to solicit testimonials from current clients/evaluees due to the imbalance of the counselor/client relationship, while it is acceptable to solicit testimonials from former clients/evaluees. In other words, an individual currently being evaluated may feel obligated, or “unable to say no,” to a CRC/CCRC request for a testimonial. A client/evaluee who has completed the evaluation process is more likely to feel empowered to refuse to provide a testimonial because the outcome of the evaluation will not hinge on their willingness (or not) to provide the testimonial. The Code then clarifies that all solicited testimonials give consideration to anyone vulnerable to undue influence or potentially harmful outcomes from the testimonial. For example, an evaluee who experiences diminished cognitive capacity or severe mental illness may not fully understand or may misunderstand the purpose of a testimonial. Other evaluees may not understand the impact of providing a testimonial on future employability. This means that CRCs/CCRCs when soliciting testimonials should always consider those who are vulnerable to undue influence. For example, if a client has difficulty in making decisions, feels overwhelmed by events or information, or is tearful or emotional when talking about providing a testimonial, then, special care must be taken by the CRC/CCRC to determine whether is appropriate to take/use their testimonial. As a general rule, if the CRC/CCRC perceives the client/evaluee as vulnerable, they should not request/utilize their testimonial.
Another area clarified is Recruitment Through Self-Referral (Standard K.1.c). The 2017 Code stated CRCs/CCRCs would not make self-referrals unless there was an agency-specific policy allowing this. This was expanded to include situations in which there are limited or no other agencies available to meet the evaluee’s/client’s needs. This allowance was added because in some areas there are limited CRCs/CCRCs available within reasonable traveling distance. In the event a CRC/CCRC recommends rehabilitation services from their own organization, the CRC/CCRC is to complete a professional disclosure form with the client/evaluee, explaining the CRC’s/CCRC’s role in the private practice, the nature and implications of the referral, and other available rehabilitation options outside of the CRC’s/CCRC’s agency.
There were three additions to this section—succession planning, charging interest on delinquent accounts, and respect for intellectual rights. The Code Revision Task Force discussed the implications of a lack of succession planning on service provision to rehabilitation clients/evaluees and business operations. Given delays and interruptions of services can significantly impact the well-being of clients/evaluees, succession planning was added (K.2.e.). The Code states that CRCs/CCRCs should have a written plan to ensure a smooth, transparent, and fair transition of services for unplanned events, such as death, illness, or business closure. The plan’s aim is to continue client/evaluee rehabilitation services with minimal or no disruption. This means if the unexpected happens, the CRC/CCRC and the agency “know what to do.” For example, leadership and supervisory roles may be taken over by whoever is indicated in the succession plan. Redistribution of caseloads may be automatic if the agency unexpectedly loses a CRC/CCRC. It is important that all CRCs/CCRCs in the agency be aware of and prepared to implement the succession plan at a moment’s notice. Certified rehabilitation counselors/CCRCs are to inform all clients/evaluees, referral sources, and payers that a succession plan is in place. One possible way to do this is to add a statement to service/fee agreements that a succession plan exists. Of course, it is possible one of the parties involved may disagree with the CRC’s/CCRC’s policies. For example, a client/evaluee might not want to be transferred to the CRC/CCRC designated in the succession plan. In this instance, the client/evaluee’s preference must be considered and balanced given the timeline and resources that exist. There are many options for developing and implementing a succession plan and the CRC/CCRC is encouraged to explore the options to determine what best suits their clients/evaluees and company.
Next, Withholding Records for Nonpayment (Section K.f.3) was expanded to allow CRCs/CCRCs to charge an interest rate, as allowed by law, on delinquent accounts. Any and all interest rates must be stated on bills and invoices. The Task Force felt this was reasonable as there are business costs associated with handling delinquent accounts, such as bookkeeping needs or recovery fees.
Finally, the Task Force added Respect for Intellectual Rights (K.f.5.). This rule states that CRCs/CCRCs who attend workshops, conferences, or training events obtain written permission from originating authors and give appropriate credit to the developers of materials before disseminating the materials to a secondary audience. Examples include original PowerPoint presentations, handouts, illustrations, and writing. The CRC/CCRC should respect these intellectual property rights even if the materials are not copyrighted. Although there are some instances where copying and distributing someone else’s work is not an infringement of anything, using copyrighted material without proper credit to the author is typically an infringement of copyright laws.
Discussion and Future Research
Beginning with the third version of the Code (CRCC, 2010), which includes a section specific to Forensic Services, revisions have continued to be honed and clarified to provide guidance to those engaged in the forensic practice setting. From the very beginning of the inclusion of any reference to forensics in the first Code (CRCC, 1987), the focus of this part of the Code has been on a CRC’s responsibility for objectivity. Merriam-Webster (2023) defines objectivity as, “lack of favoritism toward one side or another: freedom from bias” (para. 1). Despite this emphasis since 1987, evidence indicates that examining confirmation bias by CRCs/CCRCs in forensic practice is warranted. Wright-McDougal and Toriello (2013) found that in counseling practice, all ethical principles (beneficence, nonmaleficence, autonomy, fidelity, and veracity) were impacted by confirmation bias, as CRCs in clinical practice frequently searched for evidence to support a preconception instead of deductively arriving at conclusions based on the evidence presented. In forensics, a primarily adversarial setting, and where a fundamental tenet of the process necessitates using a sound methodology to collect primary data and examine secondary data to determine objective and unbiased findings, conclusions, and opinions, the threat of confirmation bias may be strong and merits further research and study to determine whether further ethical guidance is needed.
Another recommended area to be examined from an ethical viewpoint stems from the global public health crisis in 2020—the COVID-19 pandemic—which brought the ethics of telerehabilitation and teleassessment into the spotlight.
These issues had already begun to emerge in clinical practice in 2018, when Holmes and Reid examined the ethical areas of consideration in telerehabilitation, including security, informed consent, and client identity verification. They offered safeguards and resources like the acquisition of compliant software, training, social networking intentionality, boundary setting, integration of technology into sessions, and awareness of cost and access that may have an application to the forensic setting and in business practices.
Hill and colleagues (2023) investigated the ethical dilemmas faced by CRCs in a 2019 mixed-methods study, in which several current telerehabilitation themes emerged, including confidentiality in digital platforms, boundaries in distance counseling, and limitations of agencies working as mobile providers.
When asked to project future ethical issues for rehabilitation counseling professionals, the most cited issues from the responses involved telerehabilitation were
Appropriate use of technology in practice and privacy issues related to technology, including the security of online communications and electronic signatures
How to ethically conduct distance counseling/telehealth, ensuring privacy, security, and confidentiality
Forensic testimony via telephone or video conference
Appropriate evaluation with online assessments
Lack of training in telehealth
Since 2020, many professional organizations have provided specific guidance to their members on the use of technology for providing services at a distance. However, the events of 2020 and 2021 have significantly impacted how rehabilitation counseling services are delivered, and as practitioners and the public adjust to permanent changes to the remote delivery of some services, particular attention should be placed on ethical issues and guidelines for CRCs in forensic practice as well as ethical business practices.
Conclusion
The authors have explained and clarified two aspects of the CRCC Code of Professional Ethics for Rehabilitation Counselors that are especially relevant to CRCs/CCRCs who practice in forensics and/or private practice—Forensic Services (Section F) and Business Services (Section K). The wording was changed to emphasize that CRCs/CCRCs who practice in forensic settings exhibit an appropriate level of expertise and are subject to the regulatory rights of the CRCC. Clarification was provided on the need for role changes and self-referrals, for when circumstances indicate a CRC/CCRC may be in the best position to provide rehabilitation counseling services to an evaluee. Further explanation was added on the use of testimonials, making it clear that testimonials should not be sought or utilized from any evaluee or client who is vulnerable to undue influence. There are several new additions to these two sections of the 2023 Code. One addition is the right of a CRC/CCRC in private practice to charge an interest rate on delinquent accounts. A second addition is an emphasis on the need for a written succession plan, in preparation for the unthinkable. Finally, there is an addition regarding respect for intellectual rights.
It is incumbent upon all CRCs/CCRCs to familiarize themselves with the evolution of the CRCC code and the changes in the 2023 Code, as there may be implications from the Forensic and Business sections that result in agency or policy changes. These changes were made with the interest of those we ultimately serve, the person with a disability, in mind.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
