Reengineering rehabilitation in the Texas Rehabilitation Commission - Streamlining Service Delivery

American Rehabilitation,  Summer, 1997  by Jackie Feinberg

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On June 2, 1997, the 513 counselors of the Texas Rehabilitation Commission (TRC) awoke to find a totally redesigned-from-the-ground-up system for providing services to some 100,000 clients annually. Over 3 years in the making, the new system-dubbed Rehabsys--represents a sweeping breakthrough in computerizing and streamlining the provision of VR services.

The Charge

The TRC initiative was in line with the Aspen Document, issued in 1993 by state VR directors, in cooperation with the Council of State Administrators of Vocational Rehabilitation (CSAVR). The document outlined steps to:

* identify practices and policies impeding rehabilitation outcomes;

* simplify "process" requirements,and focus on quality employment outcomes;

* use existing data for the determination of eligibility;

* document only information essential to achieving outcomes or required by law; and

* reduce statuses to eligibility, services, and outcomes.

On the need to streamline, TRC Commissioner Max Arrell maintains that we must keep the integrity of the VR program intact. The mission of what we do is still valid and the commissioner will continue to fight for it, but the way we do business must change. The process must change.

The Results--An Overview

Outcome driven, Rehabsys does the following:

* It increases client involvement.

* It encourages a team approach by the counselor and direct support staff.

* It broadens communication and consultation so that the client benefits from all of TRC's available resources.

* It encourages a comprehensive approach.

* It allows counselors more time with clients, less time pushing paper.

* It increases information available about employer needs and job demands for specific geographic areas.

* It allows counselors to offer more employment options to clients.

* It provides automated checks and balances that reduce approvals, errors, and handoffs.

* It integrates rehabilitation services and procurement processes,.

* It eliminates need for repeated rekeying of data on forms, etc.

* It offers a pulldown English language list to select just about everything: specifications of services and goods, vocational objectives, disability information, providers, demographics, and more.

The system's goal is "Work smarter, not harder." Once basic client information is in the system, Rehabsys then does the once labor-intensive, repetitive tasks at the click of a mouse. Clerical staff now have more time to assist the counselor with direct service support.

Electronic Case File

Counselors access an electronic case file--application (profile), Individualized Written Rehabilitation Program (IWRP), eligibility statement, and counselor notes--via a Pentium-class computer and local area and statewide networks (LAN's and WAN's). The counselor maintains paper documents only if required by law or received from outside sources such as medical records and invoices.

Instead of re-keying data repetitively in the preparation of separate paper applications for vocational rehabilitation, independent living services, comprehensive rehabilitation services, and extended rehabilitation services, the counselor now uses an electronic "profile," which captures information once only at the beginning and then throughout the life of the case.

Rehabsys has achieved significant savings in counselor time by transforming the 16 client statuses into 4 phases:

1. Intake: initial contact, profile, and eligibility determination.

2. Plan Development: comprehensive assessment, explore outcomes, develop services, and develop IWRP.

3. Service Provision: implement services and monitor and evaluate service/access outcomes.

4. Closure.

The phase of "Plan Development" which was not part of the original Aspen Document evolved due to it's importance to a successful outcome and efficient quality services, it's connection to client involvement, and the amount of effort and time required to complete this phase.

Action List

An automated action list helps the counselor manage time more productively by giving timely reminders for different actions that need to happen in a client's plan. The action list increases the role of the rehabilitation services technician (RST) as a partner in the service delivery system and allows the counselor time to market the employment of persons with disabilities to employers.

The action list "Due Dates" are either system-generated by previous actions or initiated by a counselor or RST setting up a specific reminder. Due Dates say to the counselor: "Your attention is due." Actions are no more than a tug on the sleeve or a whispered reminder (see Figure 2).

Figure 2. Examples of System Generated Actions