Trends in vocational rehabilitation: 1978, 1988, 1998 - Statistical Data Included

Journal of Rehabilitation, July-Sept, 2002 by Richard T. Walls, Sita Misra, Ranjit K. Majumder

This article examines consistencies and changes across a 20-year period in the public vocational rehabilitation program in the United States. The findings can be instructive, not only to the clients, counselors, and managers in the State-Federal program, but also to the consumers and rehabilitation professionals in a variety of other programs (e.g., mental health, independent living, home health, community rehabilitation, and one-stop centers in the Workforce Investment Act programs). A private rehabilitation program, for example, may find that the demographic composition of clientele has mirrored the State-Federal program, that their costs for services have exceeded those reported herein, or that their profile of occupational placement differs markedly. An organization may consider revision of its data-recording system to include relevant indices of intake, process, and outcome. Rehabilitation personnel in a variety of programs are interested in potential relationships between receipt of public benefits and success in vocational rehabilitation.

The Rehabilitation Services Administration (RSA) within the U.S. Department of Education provides the funding and oversight of the State-Federal Vocational Rehabilitation Program. The program is implemented at the state level through various state departments (Jones, 1995). Program evaluation includes collecting, analyzing, and interpreting client data as a basis for an assessment of service needs, patterns of use, program outcomes, and efficiency of services offered (benefit-cost ratios) (Bua-Iam, Majumder, Walls, Kunjara, 1997). A good rehabilitation database serves to (a) help maintain program accountability and integrity and (b) help identify facilitators as well as barriers to successful rehabilitation of persons with disabilities. Systematic reporting of all vocational rehabilitation cases (Case Service Report System, for SRS-RSA-300) was implemented in accordance with the Vocational Rehabilitation Act Amendments of 1954 and Regulations issued in 1966. The Rehabilitation Act of 1973 mandated development of program evaluation standards for the State-Federal Vocational Rehabilitation Program nationwide, and the state Vocational Rehabilitation programs were required to provide RSA with statistical data on a regular basis (Posavec & Carey, 1985).

The Rehabilitation Act and the Regulations implementing the Act strengthened the recording and reporting requirements. Form SRS-RSA-300 was revised July 1, 1974 for purposes of providing "... a comprehensive, standardized system of statistical reporting on the complete rehabilitation process for every individual coming in contact with that process, from first referral to final closure" (Rehabilitation Services Administration, 1974, p. 13). Form SRSRSA-300 had three parts. Part 1 was "to be recorded at the time of first referral." This part included name, address, referral date, referral source, age, and sex. Part 2 was "to be recorded at completion of the referral process." This part required data on SSDI status, SSI status, race, outcome of referral process, primary and secondary disabling conditions, previous case closures, marital status, dependents, number in the family, highest grade completed, work status, income from earnings and public assistance, and primary source of support. Part 3 was "to be recorded at time of closure." This part included date of closure, federal programs and Social Security statuses, severity of disability, cost of case services, work status, weekly earnings, occupation, time in case statuses, services provided (e.g., diagnostic, restoration, maintenance, college training, business or vocational training, on-the-job training),, and outcome of the rehabilitation process. The possible outcomes of a case could be (a) closed as not accepted for services, determined during the referral-application process or after extended evaluation (Closure Status 08), (b) closed after acceptance for services but before initiation of services under an individualized written rehabilitation plan or individualized plan for employment (Closure Status 30), (c) closed after acceptance for services and after initiation of services under an individualized written rehabilitation plan but not rehabilitated (Closure Status 28), and (d) closed rehabilitated (Closure Status 26).

Although some modifications to the case service report have been implemented since 1974, most of the original data elements have been maintained as the core of the statistical reporting system. Minor revisions to Form SRS-RSA-300 were proposed in the new Case Service Report System (Form RSA-911) in 1984 and subsequently were approved in 1986. For example, although the Office of Management and Budget (OBM) rejected three proposed data elements, "job referral" was approved as an additional type of service to be recorded as "yes" or "no" for each vocational rehabilitation case. Data elements for supported employment were added to Form RSA-911 in 1988, and reporting of monthly public assistance dollars, availability of medical insurance, and primary source of support at closure became part of the case service report system in 1991. In 1995, "year last employed," "rehabilitation technology services," "date of eligibility," "personal assistance services," and "previous employment status" were added to the case service report system. The system continues to evolve in the interests of data quality, measurement of program impact, and enhanced understanding of optimal service complements for the vocational rehabilitation of individuals with disabilities.