Academic journal article The Journal of Rehabilitation

National Trends in Vocational Rehabilitation: A Comparison of Individuals with Physical Disabilities and Individuals with Psychiatric Disabilities

Academic journal article The Journal of Rehabilitation

National Trends in Vocational Rehabilitation: A Comparison of Individuals with Physical Disabilities and Individuals with Psychiatric Disabilities

Article excerpt

Each year, the state-federal rehabilitation system supports vocational rehabilitation (VR) services for hundreds of thousands of individuals with disabilities. During the years 1977-1982, there was a substantial decrease in the purchasing power of rehabilitation expenditures, after adjustment for inflation; in the 1983 and 1984 there were modest increases, but in the latter year inflation-adjusted expenditures were still 28.3% below 1977 levels (Mars, unpublished tabulations).

Data on individuals with disabilities in the state-federal VR system are maintained by the federal Rehabilitation Services Administration (RSA). A recent analysis of these data indicated that total case closures, an index of volume of applicants and clients in the system, have declined markedly since 1977 (RSA, 1988 information memorandum). This decrease appears to be a function of at least two factors. The first is the effect of the decrease in purchasing power of VR budget allocations. The second factor is the long-term impact of the Rehabilitation Act of 1973 and its amendments, which mandated that VR services be made more available to individuals with severe disabilities. Individuals with severe disabilities require, on average, more costly services than individuals with non-severe disabilities (Kent & McLaughlin, 1984); time spent by rehabilitation counselors in evaluation and counselling is also likely to be greater for clients with severe disabilities. Thus the total number who can be served with a given budget allocation decreases as the percentage of individuals with severe disabilities in the system increases.

While these two factors affected the system as a whole, previous research indicated that groups composed of individuals with specific disabilities or demographic characteristics have had very different experiences in the state-federal system over time. For example, among individuals with multiple sclerosis, there was a 17.3% increase during the period 1977-1984 in the number of applicants for rehabilitation services in the state-federal system, and striking 62.4% increase in the number who achieved employment in the competitive labor market after receiving VR services (Kallos, Genevie, Andrews & Struening, 1989). These increases for individuals with multiple sclerosis were much greater than for individuals with any of the other physical or psychiatric disabilities examined. The authors attributed these finding to a 1978 cooperative agreement between the National Multiple Sclerosis Society, RSA, and the Council of State Administrators of Vocational Rehabilitation, in which a commitment was made to improve availability of VR services to individuals with this particular disability. On the other hand, in a retrospective study of gender equity in vocational rehabilitation (Menz, Hansen, Smith, Brown, Ford & McCrowey, 1989), no improvement in either access to rehabilitation services or in rehabilitation outcomes among women found, despite legislative directives barring discrimination on the basis of sex.

Information on changes over time in the relative success of disability-defined subgroups in achieving vocational rehabilitation is essential for administrators, planners, policy makers and advocacy groups. In the research described in this paper, we examined the record of the state-federal VR system in serving individuals with psychiatric disabilities and individuals with physical disabilities during the period 1977-1984. Within each of these disability categories, we compared subgroups defined on the basis of severity of disability. By deriving indicators at key points in the vocational rehabilitation process, we also sought to identity factors inside and outside the VR system which may have brought about the observed trends.

Methods

Sample Selection

Information is collected by the state agencies on a standard reporting form (R300/911) for each individual who is referred for services in the state-federal system. …

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