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DOCUMENT RESUME

ED 385 044 EC 304 077

AUTHOR Perlman, Leonard G., Ed.; Hansen, Carl E., Ed.TITLE Vocational Rehabilitation: Prriparing for the 21st

Century. A Report on the Mary E. Switzer MemorialSeminar (18th, Alexandria, Virginia, September 19-21,1994). Switzer Seminar Series. Switzer Monograph,18th Edition.

INSTITUTION National Rehabilitation Association, Alexandria,Va.

PUB DATE Mar 95NOTE 98p.

PUB TYPE Collected Works Conference Proceedings (021)

EDRS PRICE MFO1 /PCO4 Plus Postage.DESCRIPTORS Change Strategies; *Disabilities; *Education Work

Relationship; Employed Women; EmploymentOpportunities; Employment Projections; *EmploymentServices; Federal Legislation; Federal Programs;Federal State Relationship; *Futures (of Society);Independent Living; Job Training; LegalResponsibility; *Rehabilitation Programs; Standards;State Programs; Technological Advancement; TrendAnalysis; Unions; *Vocational Rehabilitation

ABSTRACTThis monograph on vocational rehabilitation programs

and future directions contains papers from the 1994 Switzer Seminar.Contents are as follows: "State/Federal Program Issues and Trends"(Nell C. Carney); "Consumerism and Choice: Basic Standards forJudging Efforts and Expectations in the Vocational RehabilitationProcess" (Patricia A. Morrissey); "The Information Age: What It :leansfor Business and Vocational Rehabilitation" (Debra A. Perry);"Vocational Rehabilitation: Preparing for the 21st Century--A LaborPerspective" (Angela Traiforos); "Rehabilitation Education in the21st Century" (Daniel C. McAlees); "Providers of RehabilitationServices" (Patrick W. McKenna); "The Role of the RehabilitationFacility in the 21st Century" (Kenneth J. Shaw); "Women andVocational Rehabilitation: An Urgent Need for New Directions"(Margaret A. Nosek); "Rehabilitation as a Knowledge Business" (JonLundin); "Independent Living and Disability Culture Perspective"(Paul Spooner); and "The Voice of the Special Group" (Ruth RoyallHill). Also included are recommendations from the seminar andreflections of current and retired rehabilitation leaders on thepast, present, and future of the field. (Some individual paperscontain references.) (SW)

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Reproductions supplied by EDRS are the best that can be madefrom the original document.

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\ UN. DEPAITTMENT OF EDUCATIONM Educational Research and Improvement

EDUCATIONAL RESOURCES INFORMATIONCENTER (ERIC)

13-This document has been reproduced SI',cowed front the person or organizationoriginating a0 Minor changes nave been made :o improvereproduction Quality

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A Memorial Tribute To James IR. Duress, Jr.

On November 4, 1994 the rehabilita-tion community lost a giant of aperson, a leader, teacher and

philosopher. A humble individual whohelped countless persons both here andabroad, yet one who always kept thingsin perspective. His tribute in this mono-graph is most appropriate because of hissignificant relationship with MarySwitzer that began in 1951. Dr. Burresswho worked at the Washington, D.C.Rehabilitation Service Agency, providedan orientation to Miss Switzer, who wasthen recently appointed as Director ofthe Office of Vocational Rehabilitation.(later to become the RehabilitationServices Administration). Burress stated,"She had only one question for me in ourfirst meeting, 'What does a rehabilitationcounselor do and how do you do it?'Twohours later we were still talking." The... . , P ,1.,1-41;tt;n, 1,;ctn,-,

greatness, even though there were timeswhen success in life might not haveseemed possible. To quote from an articlein the Journal of Rehabilitation (1984),There seems to be little doubt about hissuccess as we look back on the life of adetermined and dedicated person.

We are talking of a man who brokethe color barrier, if in fact therewas one in rehabilitation.

We are talking of one who wasallowed to flex his wings and tryout his ideas of rehabilitation.

We are talking about one who wasselected to be at the heart of theCivil Rights investigations in the1960s. He was the only personfrom the rehabilitation field cho-sen, an impressive testimony to therespect he had earned.

We are talking about a person whoserved the NRA as a goalsctter forwell over three decades asPresident and as a volunteer.

What amazes one if teat Dr. Burresshad every chance to be a failure inlife...but he chose to thumb his nose atadversity from the time he was twoyears old, when polio struck him andleft him with a physical impairment forthe rest of his life. "There's one prob-lem with that theory" Burress stated, "Inever figured I was disabled. I dideverything the other kids did. Sure, Ihad a withered right arm and leg, so Ibecame the best left-handed pitcher inthe sand-lot teams in Akron, Ohio. Iplayed basketball, tennis and golf. I didit that way because I had very wise andcaring parents who encouraged me ateverything there was to do."

Dr. Burress was a trailblazer and inno-vator in vocational rehabilitation andgained both a national and internationalreputation for his leadership qualities as

.1c hip -arrn and human annroach to

Colorado °Ince). He also served as ActingU.S. Commissioner of the RehabilitationServices Administration (RSA) in1973-1974. After retirement from RSA ie1976, he became Executive Director of thePeople-to-People: Committee for theHandicapped where he promoted interna-tional attention to the needs of persons inseveral countries including Europe, Africa,South America, and the Middle Ease Healso served in the capacity as a U.S.Representative in numerous internationalconferences in rehabilitation and socialwelfare issues. He has made t nsive

studies of service programs for personswith disabilities in developing countries.

Dr. Burress received his doctorate inRehabilitation Counseling from theUniversity of Northern Colorado, a mas-ter's degree in Social Work fromColumbia University in New York, abachelor's degree from North CarolinaAgricultural & Technical College. Hewas a member of Omega Psi Phi frater-nity. He has received numerous awardsand honors during his memorable career

including the Distinguished ServiceAward, the highest honor given by theSecretary of Health, Education andWeifare in 1970. NRA's Mary SwitzerAward naming him a Switzer Scholar in1974, and the Special Award of Meritfrom the President's Committee onFrnnInvnient of Pennle With Disabilities

lal Ill the development Ui lliL .'")v.

Memorial Seminars and was on the ini-tial Switzer Memorial Committee andserved on the first ten annual SwitzerSeminar planning committee meetings.He was a person of vision and compas-sion who always gave freely of himselffor the benefit of others. Rehabilitationwas a natural career for him and it fithim so well.

He made friends easily in both theU.S. and overseas with rehabilitationpersonnel and heads of state. He was anambassador of goodwill and a model formany over his long and productive life.

Those that knew him could not helpbut to admire him and his imprint onthe Field of Rehabilitation will alwaysbe with us in the most positive sense ofthe word.

Our sympathy goes to his wifeConstance G. Burress, son Melvin L.Burress, daughters Cynthia BurressTurner, and Peggy J. Burress,Step-daughter Julie R. Gough, and threegrandchildren.

105 Switzer Monogra h 18th c7:71:17

NationalRehabilitationAssociation

633 South Washington StreetAlexandria, Virginia 22314

(703) 836-0850 Voice(703) 836-0848 FAX(703) 836-0849 TDD

EditorsLeonard G. Perlman

Carl E. Hansen

NRA Director of CommunicationsRonald J. Acquavita

The Switzer ScholarsTommy H. Allen

Donald DewJack P. Hackett

Phil KosakJon Lundin

Ruth Royall-HillPaul W. SpoonerDavid R. Ziskind

Judy Norman-NunneryJennie R. Joe

Lawrence GloecklerYvonne Johnson

W. Kenneth Tregenza, Jr.Nell C. Carney

Daniel C. McAleesPatrick W. McKennaPatricia A. Morrissey

Debra A. PerryKenneth J. ShawAngela Traiforos

The Switzer Monograph reflects the writings, discus.sions and recommendations of the Switzer Scholarsat the 18th Annual Mary Sw;tzer Memorial Seminar,held Sept.19-21. 1994, in Alexandria, Virginia.Opinions expressed in the Switzer Monograph arethose of the writers and do not necessarily reflectpolicy of the of the National RehabilitationAssociation or any other organization.

The National Rehabilitation Association is a non-profit organization dedicated to improving the quali-ty of life for people with disabilities.

Published March 1995. To order previous editions ofthe Switzer Monograph. contact the NationalRehabilitation Association at (703) 836-0850.

Vocational Rehabilitation:Preparing for the 21st Century

Welcome 4

From the Commissioner 5The Switzer Scholars 6Introduction 8

ChaptersState/Federal Program Issues and Trends 10Nell C. Carney

Consumerism and Choice: Basic Standardsfor Judging Efforts and Expectations in theVocational Rehabilitation Process 16Patricia A. MorrisseyThe Information Age: What it Means ForBusiness and Vocational Rehabilitation 24Debra A. PerryVocational Rehabilitation: Preparing ForThe 21st Century - a Labor Perspective 37Angela Traiforos

Rehabilitation Education in the 21st Century 43Daniel C. McAlees

Providers of Rehabilitation Services 55Patrick W. McKenna

The Role of the Rehabilitation Facilityin the 21st Century 62Kenneth J. Shaw

Seminar Recommendations 71

Special Invited PapersWomen and Vocational Rehabilitation:An Urgent Need for New Directions 74Margaret A. Nosek

Rehabilitation as a Knowledge Business 77Jon LundinIndependent Living andDisability Culture Perspective 80Paul SpoonerThe Voice of the Special Group 82Ruth Royall Hill

Switzer Through The Years 83The Experiment: A Mini Switzer Seminar 92NRA Board of Directors/Staff Directors 93Mary E. Switzer (Brief Biography) 94

Monograph Order Form 95

[ 1995 Switzer Monograph National Rehabilitation Association 4 3

Welcome

Switzer Committee Chairman,Carl E. Hansen, with NRA ExecutiveDirector, Ann W. Tourigny, and NRAPresident, Tommy H. Allen

"While we now face the

challenge of success in rehabil-

itation, we cannot meet the

challenge of success simply by

doing more of the same, in the

same way. The great question is

how can we develop new, faster

and more effective methods of

delivering services, and yet

retain the principles which

have made our work distinctive

and successful."

Mary E. SwitzerExcerpt from an addressgiven at an NRAconference in 1965

Vocational Rehabilitation: Preparing for the 21st Century is a timelytopic and it comes to us as we begin to celebrate the 75th anniver-sary of Vocational Rehabilitation in America. I am extremely

pleased to write these opening remarks for the monographof the 18th Mary E. Switzer Memorial Seminar for a f..w good rea-sons. First the name Switzer and rehabilitation go hand-in-ha,:d, second-ly her innovations in rehabilitation were legendary The fact is that thedevelopment and growth in programs as we know them today had theirroots in the work that Mary Switzer was able to accomplish. Politiciansof both major parties listened to Mary Switzer and she proved to themthe nonpartisan nature and worth of rehabilitation.

It was 1920 when the Smith-Fess Act (the Vocational RehabilitationAct) first authorized vocational guidance, occupational adjustment, andplacement services for civilians with physical disabilities. How far wehave come since those early days is amazing, and has provided a recordthat all of us who toil in the field of rehabilitation can be proud. We cer-tainly have had our critics over the years, but vocational rehabilitationhas weathered many storms and has evolved into a respected profession-al endeavor. No one can dispute the importance of what we do as weassist people with disabilities in their quest for independence.

Mary Switzer stated, "that while we now face the challenge of successin rehabilitation, we cannot meet the challenge of success simply bydoing more of the same, in the same way. The great question is how canwe develop new, faster and more effective methods of delivering ser-vices, and yet retain the principles which have made our work distinctiveand successful." This was excerpted from an address that Ms. Switzerdelivered at an NRA conference in 1965. Her question is still appropri-ate today as we stand at the threshold of a new century.

Let's continue to work together as we plan for the future.

Tommy H. AllenPresident

The Eighteenth Mary Switzer Memorial Seminar is dedicated toexamining one of the most complex and consequential issues insociety - the future course for vocational rehabilitation. As we pre-

pare for the 21st century, the deliberations conducted within this seminarand presented I.) this monograph will provide guidance for the pathwayschosen by policy-makers, administrators, "front-line" providers, andconsumers of rehabilitation services.

Vocational rehabilitation has a long and rich history and has enhancedthe lives of persons with disabilities for the past 75 years. We are now inthe final decade of the 20th century. The pathway chosen now will havean impact on the lives of persons with disabilities well into the 21st cen-tury. NRA is proud to assume leadership in researching and deliberatingthe intricacies of the issues involved in vocational rehabilitation in the21st century through the forum of the Switzer Memorial Seminar.

Ann W. TourignyExecutive Director

4 National Rehabilitation Association5

1995 Switzer Monograph

Commonts from the RSA Commissioner

66 ocational Rehabilitation: Preparing for the 21st Century" is a most timely topicfor the Mary Switzer Memorial Seminar. Diminishing federal and stateresources are driving current debates on streamlining and consolidating ven-

ous government entitlement and training programs. Programs emerging from thesedebates will undoubtedly change the nature of the federal-state-private partnership. Aswe prepare for the 21st century, our challenge will be to make changes in a manner thatsupports the opportunities promised earlier in this decade by the passage of theAmericans with Disabilities Act and the 1992 Amendments to the Rehabilitation Act.

To meet this challenge, we will need to change our thinking. Instead of developingmore programs, we must develop better programs. We must shift from the concept of ser-vices integration to the concept of systems integration. Programs of "packaged" servicesmust become an array, or continuum, of services. Specific rehabilitation techniques andtechnology that enable individuals with disabilities to prepare for and enter into employ-ment must be incorporated into general training and employment settings. Consumersand service providers need to be equally integrated into the information age.

This monograph is important in helping the field of vocational rehabilitation planfor the future.

Frederic K. Schroeder, Ph.D.CommissionerRehabilitation Services AdministrationU. S. Department of Education

The Seminar Sponsors

.1r.11.01=

The support of the following sponsors is deeply appreciated:

The Dole Foundation forEmployment of People with DisabilitiesWashington, D.C.

E.I. Dupont de Nemours and CompanyWilmington, Delaware

Hester Evaluation Systems, Inc.Topeka, Kansas

National RehabilitationCounseling AssociationManassas, Virginia

Vocational Evaluation &Work Adjustment AssociationAlexandria, Virginia

UNUM Life Insurance Company of AmericaPortland, Maine

6

United Rehabilitation Services, Inc.Wilkes-Barre, Pennsylvania

Anthony Bird & AssociatesSpringfield, Virginia

Elizabeth P. DixonAT&T, Morristown, New Jersey

Dr. Carl E. HansenPast President, National Rehabilitation AssociationAustin, Texas

Jeffrey J. Peterson, CIRSSulphur, Louisiana

Paul W. SpoonerExecutive Director, Metro West Centerfor Independent LivingFramingham, Massachusetts

1995 Switzer Monograph National Rehabilitation Association 5

Mary E. Switzer Memorial Seminar

Tommy H. AllenAssistant Regional Dir.

Vocational Rehab. ServicesState of North Carolina

.10.011111.11.1.14

Dr. Donald DewDirector, RRCEP

George Washington Univ.Washington, D.C.

I

Jack P. HackettNRCA President-ElectWest Des Moines, Iowa

.11.=1,

Phil KosakVice President

Carolina Fine SnacksGreensboro, NC

Jon Lundin Ruth Royall-H111 Paul W. Spooner David R. ZiskindPreside-n, Abilities Ctr. Administrator Executive Director Director, State Grants

GOO..1Wi ll Industries RSA Metro West Ctr. for Ind. Living RSA/OSERSRockford, Illinois Washington, D.C. Framingham, MA Washington, D.C.

1

Judy Norman-Nunnery Jennie R. Joe Lawrence Gloeckler Yvonne JohnsonAdministrator Director State Director State Director

Division of Voc. Rehab. Native Am. R&T Ctr. NYS Ed. Dept. (VESID) Div. of Rehab. Services

Madison, Wisconsin Tucson, Arizona Albany, New York Atlanta, Georgia

6 National Rehabilitation Association 7 1995 Switzer Monograph

Scholars

L.

W. Kenneth Tregenza, Jr.Administrator, Emp. Rel.

General Motors Corp.Detroit, Michigan

eh

Patricia A. MorrisseyStaff Dir., U.S. Senate

Comm. on Disability Pol.Washington, D.C.

Nell C. CarneyExecutive Director

Dept. of Rehab. ServicesJackson, Mississippi

.....m.,=1

Debra A. PerryPerry, Winans & Co.

Washington, D.C.

Daniel C. McAleesDirector, R&T Center

Univ. of Wisconsin-StoutMenomonie, Wisconsin

Patrick W. McKennaDeputy Director

Div. of Rehab. ServicesBaltimore, Maryland

Kenneth J. ShawDivision Director

Goodwill Ind. Int'', Inc.Bethesda, Maryland

Angela TraiforosExecutive Director

IAM CARESUpper Marlboro, Maryland

Mary E. Switzer Memorial Planning CommitteeDonald Dew, Director, RRCEP, George Washington University

Ralph Pacinelli, Commissioner, RSA, Regions III & IVRuth Royall-Hill, Administrator, D.C. RSA, Washington, D.C.

David Sharp, Executive Director, Independence Center of Northern VirginiaKen Shaw, Director, Research & Program, Goodwill International, Inc.

Dick Sheppard, President's Committee on Employment of People with DisabilitiesJ. Paul Thomas, NIDRR, U.S. Department of Education

Angela Traiforos, National Director, IAM CARESCharles Richmond, President, Occupational Center of Northern Virginia

Carl Hansen, Chairperson, Switzer Memorial Seminars, NRALeonard Perlman, Coordinator, Switzer Memorial Seminars, NRA

Ann W. Tourigny, Executive Director, NRA


Introduction

Carl E. HansenChairperson,Mary E. SwitzerMemorial Committee

Leonard G. PerlmanCoordinator,Mary E. Switzer MemorialSeminars and Monographs

"We cannot meet the challenge of success simply by doing more of the same, in the same way.

The great question is how we can develop new, faster, and more effective methods of delivering

services, yet retain the principles which have made our work distinctive and successful.

For one thing, we cannot continue to pick and choose among the large number of disabled

people who need services... The public program of vocational rehabilitation is going to be

`used,' in! the senr 3 that we will be expected to fit ourselves into pro-

grams with larger national, state, and

local objectives. These and many other

evolving changes call for a sharp new

look at how we conduct this phase of the

public's business."

Mary E. Switzer, 1965

8

9

he above words were spoken by the late Mary E.Switzer at the National Rehabilitation Association(NRA) annual convention in 1965. Actually, herentire speech could have been written in 1990s andit is a prophetic declaration of where rehabilitationneeds to be in the national scheme of things. The18th Switzer Memorial Seminar comes at a time

when we are celebrating the 75th anniversary of the VocationalRehabilitation Act in the United States (it was signed into law onJune 2, 1920). As we prepare for the 21st century the focus ofthis year's seminar looked at the vocational rehabilitation pro-gram with an eye to the future. One thing that became clear fromthe seminar was that rehabilitation is not a static entity but adynamic and often fast-paced program that must, at once,accommodate a number of publics, philosophies, interest groupsand weave this into the political landscape, which can change atan instant. To our knowledge, the vocational rehabilitation pro-gram is one of the longest running state-federal programs and

Natiorial Rehabilitation Association 1995 Switzer Monograph

continues to be viable and very important in its mission. To havecontinued for 75 years and been upheld by government adminis-trations, both Republican and Democrat, is a testament to theneed that exists in serving persons with disabilities.

The Switzer Memorial Seminars, while keeping the nameof Mary Switzer alive also provides a vehicle by which newideas and innovations can be discussed by multidisciplinaryexperts from various settings including the business andlabor sectors. The results of the current seminar will bewidely distributed and utilized for its ideas and recommen-dations covering such area as research, program develop-ment, service delivery, policy issues and legislation.

It has been over 18 years since the first Switzer MemorialSeminar and our aim has been not only to keep up with thelatest trends in rehabilitation, but to help set the course anddirection for needed change in this dynamic and human ori-ented field. Preparing for the 21st Century is the topic and inreading the chapters of this monograph you will note, notonly the vast array of accomplishments that we can takepride in, but also the number of innovations that need to bedeveloped in order to meet the demands of the future.

As Dr. Nell C. Carney (Switzer Scholar) noted in chapter oneof this monograph, "For seventy-four years, from one generationto the next, from one reauthorization of the Rehabilitation Act tothe next, public rehabilitation has grown and expanded, becomemore responsive and met the challenges of change. Like educa-tion, adequate and responsive public rehabilitation is a debtowed by present to future generations of Americans with dis-abilities. The torch will continue to be passed from one genera-tion to the next. And each new generation will find its own lead-ership, address new issues, set new trends, meet new challenges.But public rehabilitation will continue because it provides thehelp and hope necessary for the achievement of independenceand dignity for Americans with disabilities."

It is the hope of the Switzer Scholars that the ideas andrecommendations found in this monograph of the 18thSwitzer Memorial Seminar will stimulate discussion, think-ing and action as we prepare for the future and the challengesawaiting us in the provision of meaningful services to peoplewith disabilities in their quest for independence.

Background and Purposes of theSwitzer Memorial Seminars

The Switzer Memorial Seminars, a program of theNational Rehabilitation Association (NRA), is designed tobring together a small number of experts in the area of reha-bilitation that is the focus of each year's seminar. The expertsare designated as Switzer Scholars by certificate, and thisrecognition has become a significant and prestigiousachievement for those involved in vocational rehabilitationboth nationally and internationally.

The end-product of the three-day think tank session is a pub-lished monograph of the proceedings, including recommenda-tions and implications for action in such areas as research, pro-gram and policy development, training, service delivery and leg-islation. Special invited papers are also included by those per-sons who may not have been at the seminar, but who may havevaluable input to the current topic.

The format of the monograph is designed for use by reha-bilitation rounselo:n- policy-makers, employers, consumersor anyone interested in rehabilitation and the independenceof persons with disabilities.

The seminars are a living memorial tribute to the lateMary E. Switzer, one of America's foremost leaders andtrailblazer for innovative programs at the national, state andlocal levels for people with disabilities. The SwitzerMemorial Committee of NRA was started by colleagues andfriends of Mary Switzer, including NRA members, membersof the U.S. Congress, Secretaries of the U.S. Department ofHealth, Education and Welfare, Department of Labor, andDepartment of Education, as well as private citizens whoknew of the work and mission of Mary Switzer.

The Current Switzer SeminarThe 18th Mary Switzer Memorial Seminar was held in

Alexandria, Virginia, on September 19-21, 1994. Welcomeswere provided by Carl E. Hansen, Chairperson, SwitzerMemorial Committee (NRA) and Ann W. Tourigny,Executive Director, NRA.

Planning for the 18th seminar took place in February1994, at the President's Committee on Employment ofPeople with Disabilities where the Planning Committeedeveloped the objectives of the seminar and provided the for-mat and subtopics. The subtopics served as the foundationfor the three days of deliberations that have become the hall-mark of the Switzer Memorial Seminars. The papers espe-cially written for the seminar were sent in advance to theSwitzer Scholars for their review and critique. The com-ments and recommendations made by the Switzer Scholarsare found in the monograph.

Acknowledgements

The 18th Mary E. Switzer Memorial and Monograph ofthe proceedings were made possible by a number of peopleand organizations committed to the independence andemployment of people with disabilities.

Thanks to: The Switzer Memorial Committee, Ann WardTourigny, Ph.D.,CAE, Executive Director of NRA for hersupport throughout this project, Ronald J. Acquavita,Director of Communications (NRA), and the NRA staff whohelped with many of the essential details of the seminar.

Gratitude is expressed to Rick Douglas, ExecutiveDirector of the President's Committee on Employment ofPeople with Disabilities for hosting the planning meetingand Paul Hippolitus, Director of Program for the Committeefor his liaison efforts.

Appreciation is expressed to all of the sponsors who helpedmake the 18th Seminar a reality through their generosity.

Our gratitude must go the Switzer Scholars foi giving sofreely of their time and expertise, and whose ideas and rec-ommendations are presented in this monograph.Congratulations to the Scholars for their dedication, commit-ment and their continued work in their respective areas ofendeavor.

1G1995 Switzer Monograph National Rehabilitation Association 9

Chapter One

State/Federal Program

Issues and Trends

Nell C. Carney

rom the beginning of a national effort in 1920 throughtoday, the state-federal vocational rehabilitation pro-gram has been distinguished by a number of uniquecharacteristics found in no other human services

endeavors known to us. There is no doubt these unique char-acteristics account for the overall, enduring success of thepublic rehabilitation program.

Public vocational rehabilitation has always been orient-ed to one primary goalintegrated competitive employmentfor individuals with disabilities. Remaining keenly focusedon this single goal has maintained program integrity andassured federal and state `financial and political support for aservice delivery system that has consistently demonstratedeconomic and social value to our society.

A unique case management system that is focused on indi-vidual assets and limitations has created unparalleled train-ing programs in adjustment to physical and mental disabili-ties as well as training in a broad spectrum of vocational pur-suits. The end result has been and is involvement of ind id-uals with disabilities in every vocational endeavor known toour society with full participation in the family and full inte-gration into the community.

The legislation authorizing the state-federal vocationalrehabilitation program, The Rehabilitation Act of 1973, asamended through 1993, is unique in the manner ;t allowsflexibility to states for establishing and operating state VRagencies through a variety of systems, approaches, and struc-

Dr. Nell C. Carney, Executive Director, Mississippi Department ofRehabilitation Services, Jackson, Mississippi.

tures. The amount of flexibility permitted has led to somevery innovative and creative service delivery systems, guid-ed by an objective to provide substantial services that resultin achieving a single goalemployment.

Throughout most of the history of the public VR program,the unique characteristics of the program have been empha-sized, supported, and reinforced by accompanying endeavorsall of which have roots in the statutor:, language of theRehabilitation Act: professional prepara.ion (rehabilitationeducation), technology, research, and leadership.

Public Vocational Rehabilitation programs, unlike otherhuman services programs, have never been characteriZed bythe attitude of "we, the noble, fulfilling our responsibility tothe less fortunate." Instead, public VR programs have alwaysbeen characterized by a high degree of professionalism dri-ven by a commitment to ethical standards unparalleled in thefield of human services.

Eased in rehabilitation education programs authorized inTitle III of the Act, the superior degree of professionalismthat dominates the field of rehabilitation counseling andrelated areas has for decades played a major role in theimpact Vocational Rehabilitation services have had on thelives of people with disabilities.

Some of us think of the influence of technology on VR asa recent occurrence. In reality, technology has always held asignificant place in the development of essential rehabilita-tion services. Medical technology has created the ability forexpansions of services for decades. Assistive technology,although not always so labeled, has provided answers to per-plexing issues for many years with the development and

11JO National Rehabilitation Association .'995 Switzer Monograph

refinement of wheelchair technology, driver adaptations,home modifications, prosthetic devices, hearing aids, visionenhancers, etc.

With the creation and advancement of adaptive computersand information systems, even broader horizons for individ-uals with disabilities have been discovered in all areas ofvocational pursuits. The impact of technology developmenton industry has also made the goal of employment moreattainable than ever before as assembly lines are beingreplaced with computer systems.

Comprehensive research has provided the evidence,methodology, and projection data that have given continuousdirection to public VR programs and provided lawmakerswith the information necessary to advance legislation thatkeeps step with changing populations, changing socialtrends, a changing economy, and changing technology.Grounded in the statutory language of the Act, medical,social, educational, and technical research are very much apart of the foundation of the public VR programs.

Generally, people relate to people, not causes. When anindividual takes up a cause and motivates other people tosupport that cause we call it leadership. From the beginning,the public VR program has had and been characterized byleadership with varying degrees of effectiveness and influ-ence. Tracy Copp briefly, and then Mary Elizabeth Switzernurtured the program through its infancy and into adoles-cence. Mary Switzer is, of course, the unquestioned strongleader of the program among its thirteen Commissioners.

Mary Switzer left a legacy of faith - faith that governmentwill always be willing to provide the funding needed to pro-vide rehabilitation services for individuals with physical andmental disabilities that will lead to independence and digni-ty. She also left a lega. of hope not just to dedicated reha-bilitation workers but also to multitudes of individuals withdisabilities who look to public rehabilitation for assistance inachieving first class citizenship.

This seminar is one of many fitting tributes to this great cre-ator of a public rehabilitation program that has become as impor-tant to our society as is public education to our children.

Recognizing the value of leadership that had strong polit-ical alliances, lawmakers wrote into the Act a requirementfor the Commissioner of RSA to be a presidential appointee.Although this requirement has been challenged a number oftimes it still stands. The prestige of being a presidentialappointee has been used with varying degrees of effective-ness by Commissioners.

The value of the Commissioner of RSA being a presiden-tial appointee is in the access this status provides toCongress, to the White House, to Cabinet heads and othergovernment officials, including governors and state lawmak-ers. Generally, the Commissioner of RSA is recognized asthe national, and sometimes international, leader in the fieldof rehabilitation. Such recognition places an extraordinaryamount of value on the quality of leadership provided by theCommissioner.

These observations about the state-federal VocationalRehabilitation program lead to a look at contemporary issuesand the impact of such issues on the fundamental principlesof the program.

Americans with disabilities as an emerging minority withexclusive civil rights legislation, and the Americans withDisabilities Act of 1990, brings an expanded perspective to pub-lic VR programs. The populations of individuals with disabilitiesserved by VR programs today are better informed, more educat-ed, more effective self-advocates, and have more self determina-tion and are more demanding of quality services than any popu-lation served by VR programs before now.

Individuals who were once consumers of services are nowservice providers, policy makers, administrators, and lead-ers. Like representatives of other diverse populations, indi-viduals with disabilities often bring a new or different per-spective to the policy making process. For at least a decadenow, the presence of individuals with disabilities in key rolesin VR programs has demonstrated positive influence on thefundamental principles and practices in public VR programs.For example, the case management system that emphasizesindividualized and comprehensive services has been moresharply defined to mean a process of intervention that movesin, addresses training and adjustme ;eds, and moves awayallowing the individual to integrate into the market place andthe main stream of society. No doubt, the focus on ultimateintegration is advanced by individuals with disabilities func-tioning as chief administrators and policy makers.

Choices and increased participation of consumers in theprocess have been issues of concern throughout the historyof public rehabilitation programs. During the past two yearsthese issues have taken on additional meaning by an enlight-ened generation of individuals with disabilities. In this two-year period, programs have clearly demonstrated the capaci-ty to embrace these issues and take them to a meaningfulimplementation within the service delivery system.

A growing national enthusiasm for inclusion has created arenewed awareness in public VR programs to look beyondrace, gender, severity of disability, age, and culture to theultimate goal of economic independence through employ-ment. To effectively do this requires expansion in trainingprograms and attitudes but it does not require change to thebasic principles on which the program has existed and flour-ished for seventy-four years.

Inclusion of individuals with severe disabilities into VRprograms and subsequently into meaningful gainful employ-ment has been facilitated by legislative changes as well as byassistive technology. Individuals once considered too severe-ly disabled to participate in vocational training are nowincluded in meaningful vocational assessment and subse-quent training with the help of assistive technology.

Providing services to these individuals in the public reha-bilitation programs has presented a challenge which hashelped to validate and strengthen the basic principles andpractices by more careful application of resources and wiseruse of qualified rehabilitation personnel.

Concerns about inclusion are also having a significantimpact on research. In an effort to touch on all populationsand all issues, research programs have in some instancesbeen expanded beyond their capacity to be meaningful. Aclear example of such expansion is the diluting of researchauthorities in Title II of the Rehabilitation Act. These provi-sions were intended to advance, promote, and verify the pin-


1

ciples and practices of Vocational Rehabilitation. Over aperiod of time, the initiatives implementing the provisions ofTitle II, under the administration of NIDRR, have duplicatedefforts in other government agencies such as Office ofSpecial Education Programs and National Institute onHealth. The depth and subsequently the impact of rehabilita-tion research on vocational rehabilitation practice has dimin-ished since this research component was removed from RSA.Urgent change is needed in this area, and time is of theessence here.

The 1992 Amendments to the Rehabilitation Act placed aneven greater emphasis on the role of assistive technology inthn rehabilitation process. Just keeping up in this field hasproven to be one of the greatest challenges ever confrontedby public VR programs. Along with the first priority of pro-viding state-of-the-art assistive technology to individualsserved by the progra; consideration must also be given tothe impact of technology on program management, and onthe industrial community. The role of technology in prepar-ing individuals served by VR programs to participate in aworld class work force must not be overlooked or undersold.

Funding, program integrity, and accountability; three cut-ting edge issues, have the same value today that they havealways had for VR programs.

Providing clear evidence of the social and economic valueof the public VR program to argue for increased federal andstate funding continues to be the most powerful approach tosecuring adequate appropriations for programs. Increasedconcerns about accountability, and program integrity haveweakened this argument in the past few years.

Overall, public programs today are held to a higher levelof accountability than at any previous time in our history.Surprisingly, many program administrators welcome thischange with enthusiasm because increased accountabilityrequirements diminish liability and facilitate open govern-ment that is responsive to the populations it serves.

Maintaining program integrity; focusing on the goal ofVocational Rehabilitation and not making futile attempts tobe all things to all individuals with disabilities, has becomeand will continue to be a challenge in public rehabilitation.Because the funding for the public VR program has becomevery stable, there is constant pressure tc divert programresources to other endeavors Maintaining an image as aresponsive, caring program and withstanding the pressures toexpand the program beyond '`.-; intended parameters ispresently one of the grnatPst challenges faced by the state-federal program.

In summary, it has been traditional throughout the historyof the state-federal program t'lat a variety of contemporaryissues influence the current and future trends in philosophyand practices. It is abundantly clear, however, that the uniquecharacteristics of this program supported by the fundamentaland enduring principles have not been significantly alteredby seventy-four years of issues, trends. and changes.

The program continues to practice a unique case manage-ment system that emphasizes indvidualized and comprehen-sive services. The program continues to be cost effectivewith multiples of returned benefits, and high standards ofprofessionalism and commitment continue to be characteris-

tic of program personnel.Leaders come and go; each brings a different image and

usually a different slant on philosophy. Although almostexcluded once through legislative action, the rehabilitationeducation programs continue to exist with changes in empha-sis with the coming and going of leadership.

Technology keeps moving forward as programs ran alongbehind trying desperately to catch up. Populations continueto change, and individuals with disabilities as a minoritybecome stronger, more politically aware, more informed, andmore self determined.

Future trends in the state-federal program will be forgedby issues that will surface as the months and years go by; butthere is one truth that is very obvious, the state/federal pro-gram will respond to any challenge surfaced by time and cir-cumstance. Fifty years ago, who would have thought therewould ever be supported employment programs integratedinto the state/federal system? Thirty years ago, who wouldhave believed a civil rights bill for individuals could be madeinto law and implemented and that it would work in tandemwith the authorities in the Rehabilitation Act?

For seventy-four years, from one generation to the next,from one reauthorization of the Act to the next, public reha-bilitation has grown and expanded, become more responsiveand met the challenges of change. Like education, adequateand responsive public rehabilitation is a debt owed by pre-sent to future generations of Americans with disabilities. Thetorch will continue to be passed from one generation to thenext. And each new generation will find its own leadership,address new issues, set new trends, meet new challenges. Butpublic rehabilitation will continue because it provides thehelp and hope necessary for the achievement of indepen-dence and dignity for Americans with disabilities.

12 National Rehabilitation Association I 1995 Switzer Monograph

Excerpts of Reviews and Comments Chapter One

In her paper Dr. Nell Carney pre-sents the many strengths of thestate/federal program. She details

the effectiveness and importanc- ofthe case management service model,discusses the uniqueness of the publicrehabilitation programs primary goalof "integrated competitive employ-ment for individuals with disabilities,"and points out that for 74 years thisprogram has provided effective serviceto millions of people with disabilities.She states that the system has madevery positive efforts to respond to theexpressed needs of informed con-sumers for greater participation in thedevelopment of the rehabilitation pro-grams. Dr. Carney discusses the costeffectiveness of the program, the factthat it is research based, and describesthe degree of professionalism and thecommitment to ethical standards ofpractice unique to this program.

There is a trend in rehabilitationthat will effect the future of thestate/federal program. The inclusionof choice is a reaction to that trend.

Choice is a word that well describesone of the future challenges of thestate/federal rehabilitation program.Consumers will have many choices foraccessing rehabilitation services and thestate/federal program will be but one ofthose choices. This change is evidentnow in school to work transition pro-grams, in services for students with dis-abilities provided by institutions ofhigher learning, in programs like theIAM Cares program where a businessand labor partnership worked togetherto provide rehabilitation services and inmany other areas where rehabilitationservices have been mainstreamed andwhere the point of service deliveryexists within the broader communityand within the broader life of the personwith the disability.

I believe that this does propose achallenge to the state/federal program.As consumers develop more choices inservice delivery, the state/federal pro-gram will have to change in order toposition itself in a way that will allowit to continue to respond to the needsof persons with disabilities.


The emphasis on choice and thegreater involvement of people with dis-abilities in the pursuit of their rehabilita-tion programs, the advocacy by profes-sionals working in the state/federal reha-bilitation program for issues of impor-tance to persons with disabilities, and thedevelopment of real standards for "qual-ified rehabilitation counselors" will beimportant to the continued success of thestate/federal program.

In a competitive environment, thestate/federal program will be required tobe more responsive and more effectiveand this will require a greater focus onqualified staff and quality of service. AsDr. Carney accurately points out the statefederal program for the past 74 years hasbeen able to respond to each trend andchange in the rehabilitation movementand has a history of increasing its effeL:-tiveness by its willingness to grow withthose forces that have resulted inimproved service to persons with disabil-ities. Consequently it is with optimismthat I outline my views of those forcesthat will continue to cause change in howservices are delivered to people with dis-abilities. It is with a shared awareness ofhow the state/federal program hasevolved that I see the program being ableto change again to meet these forces.

Dr. Carney also points out theinvolvement of persons with disabilitiesnow in leadership and decision makingpositions in the state/federal programand in the rehabilitation movement ingeneral. This involvement points to oneof the strengths of the state/federal pro-gram. In a real way it recognizes who itscustomers are and understands theimportance of involvement of personswith disabilities at all levels of the reha-bilitation process. I am also optimisticthat the state/federal program can meetthe challenges that diversity has posed toits programs. We are now aware of someof the current inequities in service deliv-ery and outcomes. The state/federal pro-gram has already moved to explore solu-tions to these challenges. Again thestrength of this program is that its solu-tions attempt to be research based andthis is no where more clear than in theattempt to pursue solutions to the chal-

lenges of diversity through theRehabilitation VCunseling DiversityInitiatives which are attempts to developsound data bases from which to launcheffective changes in service delivery andeffective methods of involving peoplefrom diverse backgrounds in all levels ofservice provision.

I am proud to say that I began mycareer in rehabilitation in thestate/federal program. The experienceI gained during my three years servingthe State of West Virginia launched meon a wonderful career in an excitingand changing field. Consequently Ihave a personal debt to the state/feder-al program both for the educationalopportunity that it offered me and theopportunity for service that I wasgiven through my ability to serve as anemployee of that program.

I see great challenges facing thestate/federal program in the future andhope that I am putting these out as afriend and ally of the best that this pro-gram has to offer.

Jack Hackett

Ir. Carney provides a well-war-ranted tribute to national andstate vocational rehabilitation

programs by seizing the opportunity toprovide information on a multifacetedrehabilitation program while offeringclarity on the intended focus of manyelements of the program.

Dr. Carney's focus on the uniquecharacteristics of employment, casemanagement, flexible legislation;accompanying endeavors of rehabilita-tion, technology, research leadership;issues of changing populations, con-sumer participation, inclusion,research; and, "cutting edge" issues offunding program integrity, andaccountability are valid and timely.

The main thesis of Dr. Carney's 'manu-script seems to be that the federal-statepublic vocational rehabilitation programhas always experienced and managedchange, and as such, there is little need forconcern as the program moves toward the21st century. Hopefully. this thesis is ;or-

1 4Vational Rehabilitation Association 13

rect. However, as Nadler and Hibino notein Breakthrough Thinking, the "unique-ness principle" which states that regardlessof the apparent similarities, each problemis unique and requires an approach thatdwells on the problem within its ownunique context" needs to be considered.Essentially, the "uniqueness principle"contends that the manner in which yester-day's problems were addressed may notbe appropriate for addressing today's ortomorrow's problems. This principle maybe uncannily accurate because the issuesconfronting the public rehabilitation pro-gram seem to be of a magnitude that hasnot been previously experienced. Tobriefly illustrate, two major issues are: a)the need for a specialized program for aminority group (i.e., people with disabili-ties) in an ADA era; and, b) the need for anational disability agi :dalstrategy thatimpacts on the unacceptably high unem-ployment percent for people with disabili-ties (i.e. percentage that remains highdespite the undaunting efforts of the voca-tional rehabilitation program).

The importance of several of theissues identified by Dr. Carney demandadditional focus and attention. Forinstance, the progrum integrity issue isinclusive of the need to address the man-ner in which the comprehensiveness ofthe vocational rehabilitation program ischanging. This suggests that there is aneed to understand the vocational reha-bilitation program as a system that inter-sects with other systems (e.g. transporta-tion, education, support, information) inmeeting the ancillary employment needsof people with disabilities. The fundingissue includes impact of cooperativeagreements (i.e., third-party match) onthe integrity of the program.

Further, the unique case manage-ment system has experienced increas-ing complexity over the 70-year histo-ry of the program and is in need ofexploration for its feasibility in afuture environment that will have afocus on streamlining and simplicity.As Osborne and Gaebler note inReinventing Government, the tone ofpublic sector services is and will con-tinue to be on rethinking, refocusing,re-designing or reengineering themanner in which services are providedto customers. The Social SecurityAdministration's redesigning of itsdisability claims process is a classic

illustration of the need to examine ser-vice delivery processes.

Judy R. Norman-Nunnery

6r. Nell C. Carney's paper,"state/federal Program Issues andTrends," captivates the historical

significance of the effective delivery sys-tem for serving people with disabilities.She expertly traces significant develop-ments in the Rehabilitation Act, and cor-relates advances in legislative authoritywith corresponding progress in serving awider range of individuals with varyingdegrees of disabilities. Carney, also, inher paper, points out that vocationalrehabilitation has always been orientedto one primary goal integrated compet-itive employment for individuals withdisabilities. She goes on to cite severalsignificant developments in the evolutionof the V.R. pmgram, marking its earlyuse of technology to assist individualswith disabilities.

Carney also ably captures the philo-sophical framework of the public V.R.program as focused on the individual.In this context she highlights the pro-fessional capabilities of the publicV.R. program to provide highlysophisticated services, tailored to thespecial needs of the targeted popula-tions being served.

Carney makes us well aware in herpaper of the special importance ofenlightened leadership. In this contextshe cites Mary E. Switzer as one of thegreat architects and a supreme vision-ary of the V.R. system.

Carney touches on the importance ofAmericans with disabilities and their riseto becoming a powerful minority with itsown civil rights legislation.

Carney's paper is excellent in itsscope and the significance she bringsto highlight progress in the public V.R.program. With the foundation she pro-vides the reader, the public V.R. pro-gram is healthy as should prosper wellinto the 21st century and beyond.

Angela Traiforos

Carney notes that the primary goalof public vocational rehabilita-tion is to provide integrated coml-

.!.

petitive employment for individualswith disabilities. Carney sees the fed-eral/state partnership as a successfularrangement that has been furtheraided by a variety of technologicaladvances as well as by the unique casemanagement system for assistingclients. Carney also characterizesvocational rehabilitation providers ashaving a high degree of professional-ism and commitment to ethical stan-dards - and according to her - it is anunparalleled commitment in the fieldof human services.

Loud voices of discontent fromconsumers and providers alike, how-ever, have been heard, they greatlydisagree with this positive assess-ment of the public vocational reha-bilitation system. Disenchantmentwith the status quo has also influ-enced the initiation of a number ofnew directives in recent policiesaimed at improving the system forindividuals with disabilities.Unfortunately, the paper gives almostno credit to the role of consumersand/or their advocates in bringingabout some of these changes.

There is no question that as the con-cept of "self determination" becomesmore fully realized, vocational reha-bilitation will continue to undergosome major changes. The initial goalfor vocational rehabilitation may notchange, but new goals will probablybe added, i.e., ones that recognizequality of life as important an outcomeas employment.

Jennie R. Joe

Ms. Carney has taken the posi-tion that, because the voca-tional rehabilitation program

has successfully survived everymovement, demand and trend in dis-ability services over the past 74years, it will continue to flourish for-ever by clinging to traditional pro-gram principles (which she does notspecifically articulate). She believesthat the conventions of rehabilitationwill be able to adapt sufficiently toencompass current and future chaplenges. She believes that programsuccess hinges on the public rehabil-itation professional.

14 National Rehabilitation Association 1995 Switzer Monograph

While we should celebrate themany proud accomplishments of thepast, many of her premises are basedon revisionist history: the focus ofvocational rehabilitation has NOTalways been on competitive jobs inte-grated in the community; the vocation-al rehabilitation profession HAS takena very paternalistic role towards per-sons with disabilities in the past and isnow only slowly changing that atti-tude; the presidential appointment ofthe RSA Commissioner has NOTalways led to access and influence(e.g., Justin Dart).

Ms. Carney ignores the fact that the"unique case management system" isno longer able to meet growing andchanging consumer demands, to suchan extent that 37 or more state agen-cies are on an order of selection. Sheoverlooks national data that indicatesfewer successful outcomes, even withincreased funding support. She disre-gards our other customers, employers,in the rehabilitation equation. She failsto acknowledge the pressure from theprivate rehabilitation sector whichpromises better outcomes, quicker andcheaper. She never mentions the bene-fits of involving our service partners,such as other agencies and schools, tofill gaps in needed services.

Most significantly, Ms. Carneyunderestimates the expectations ofconsumer choice. The ultimate visionheld by many individuals giving con-sumers the authority and the means to

select, arrange, pay for, and accountfor their own services and thereforetheir own success would bypass the"unique case management system"Ms. Carney faithfully defends. Shedoes share the view that the systemshe praises is headed for obsolescenceif it does not change dramatically.

Lawrence C. Gloeckler

111

r. Carney adds a necessary andrefreshing view of the many issues,problems and challenges facing

vocational rehabilitation programs asplanning is undertaken for the 21st cen-tury. She reminds us that those who for-get the past, who fail to reflect on whathas been accomplished, and who assumethat the history of a people or an organi-zation can be ignored are ultimatelydoomed to failure. The reality is that lifeis built on what has gone before; moreoften than not the inspiration for new andexpansive initiatives springs from redis-covering original intentions; and that thehistory and experience of an organiza-tion or movement is the best source fordefining and planning its future.

Dr. Carney clearly identifies boththe strengths, weaknesses and chal-lenges facing the public program ofvocational rehabilitation. She's inti-mately aware of how the pry gram canbe victimized by requiring it to movebeyond its defined and traditionalgoals; how the "needs of the moment"

may compromise the essential purposeof the program; and how fluctuatingfederal and state agendas influence theassessziient of the effectiveness of theprogram. Through it all, some basicand fundamental principles need to bepreserved.

What characterizes the public voca-tional rehabilitation program is anenduring commitment to promoteequal employment opportunities forpersons with disabilities. The progressachieved in our society over the pastseveral years reflected, in part, by thepassage of the Americans withDisabilities Act and the RehabilitationAct Amendments of 1992, cannot beseparated from the constant, enduringand active role played by vocationalrehabilitation programs. Sometimesobstructive, frequently empowering,accommodating and supportive, andmore frequently than not supportive,the public program of vocational reha-bilitation has, in one way or another,brought us all, consumers andproviders, to where we are today. Dr.Carney suggests, I believe, that thefuture rests with taking full advantageof those relationships, forgingrenewed cooperative agendas andbuilding on past experience.

Patrick W. McKenna

16


Chapter Two

Consumerism and Choice: Basic

Standards for Judging Efforts and

Expectations in the Vocational

Rehabilitation Process

Patricia A. Morrissey

Introduction

The purpose of this paper is to: outline some basicstandards that might be used to judge efforts to pro-vide choices to individuals with disabilities whoaccess services supplied by vocational rehabilitation

providers, and to judge whether the expectations of suchindividuals with regard to opportunity to choose, andchoices are met. Before presenting the standards, somecontext information and assumptions are posited.

"Consumerism" and "choice" are two terms that are usedfrequently in a variety of social contexts, including those thatinvolve vocational rehabilitation seeking and providing arange of services that result in employment for individualswith disabilities. Unfortunately, consensus about what theseterms mean in relation to vocational rehabilitation has yet toemerge. The terms used here, as elsewhere, are relative.What they mean depends on what you know, what you do,where you are, and what you expect.

From the standpoint of federal policy the RehabilitationAct Amendments of 1992, in both the state grant and demon-stration programs, attempted to define and set direction forstrategies to promote informed choice for consumers of reha-bilitation services; but, these efforts are still evolving. Otherrecent federal legislative actions may further complicate any

Patricia A. Morrissey, Ph.D.. Staff Director, Senate Subcommittee on Disability Policy,Washington. D.C. (This chapter was written when she was employed by ARA.)

efforts to achieve consensus about the meaning of choice invocational rehabilitation.

The Americans with Disabilities Act (ADA, P.L. 101-336),enacted July 26, 1990 and now in effect, prohibits discriminationagainst individuals with disabilities, on the basis of disability, inemployment, services offered by state and local governments,transportation, public accommodations, and telephone services.Obligations to comply with this law apply to both the public andprivate sectors. Complying with this law is not accompanied byfederal funds. Not complying with it, however, could have neg-ative fiscal consequences in the form of loss of federal funds forpublic agencies and the possibility of a range of costs (i.e., fees,damages, and fines) for private entities found guilty of violatingthe ADA. In the area of employment alone, the EqualEmployment Opportunity Commission, the federal agencycharged with enforcing the employment provisions of the ADA,has received 29,270 charges of employment discriminationbetween July 1992 and August 1994. Because they focus on civilrights, as time passes the ADA's requirements, as much as thoseof any other law, will be the standards by which treatment ofindividuals with disabilities will be judged throughout societyincluding treatment of such individuals by vocational rehabilita-tion providers, especially with regard to the opportunity to makeinformed choices.

Goals 2000: Educate America Act, enacted March 31,1994 (P.L. 103-227), has as its core purpose the reform of


American education. The specific purposes eithe Act are to:promote coherent, nationwide, systematic education reform;improve the quality of learning in the classroom and work-place; define appropriate federal, state, and local roles andresponsibilities for school reform and lifelong learning;establish valid and reliable mechanisms for building a broadconsensus on national education reform; assist in the devel-opment and certification of high quality, internationallycompetitive content and student performance standards,opportunity-to-learn standards, and assessment measures;support new initiatives to provide equal opportunity for allstudents to meet high academic and occupational skill stan-dards and to succeed in the world of employment and civicparticipation; and, stimulate the development and adoptionof a voluntary national system of skill standards and certifi-cation to serve as a cornerstone of the national strategy toenhance work force skills. Eventually, the Act will not onlydirect what is learned in school, determine how student per-formance will be evaluated, and if states and local schooldistricts receive federal funds, but also affect if and underwhat conditions individuals are judged qualified for specificoccupations. It is clear that this law will serve as a catalystfor new levels of accountability within the educational sys-tem, and for increased specificity and uniformity duringinstruction and student assessment.

The School-to-Work Opportunities Act, P.L. 103-239,was enacted on May 4, 1994, authorizing funds to assiststates to develop state-wide school-to-work programs. Theseprograms must assist students to select careers; integrateschool-based learning and work-based learning; offer paidwork experience, job shadowing, mentoring of students byemployers, school-sponsored enterprises, and on-the-jobtraining for credit; and provide instruction in general work-place competencies such as positive work attitudes, employ-ability skills and participatory skills, and broad instruction,to the extent practicable, in all aspects of an industry. Inorder to receive state implementation grants, states mustspecify how eleven state entities, including among them thestate vocational rehabilitation agency, will work together toachieve the goals of the law. Moreover, in creating state andlocal partnerships to implement a state plan, rehabilitationagencies and organizations (both public and private) areidentified as one of the membership categories. Finally, it isspecified that multiple federal programs will be coordinatedwith School-to-Work Opportunities Act-related efforts.Included among these programs are those funded by theRehabilitation Act. This law should heighten .areness ofthe importance of preparation for work and of work itself.The fact that specific references are made to vocational reha-bilitation in the statute, indicates that Congress intended andexpects vocational rehabilitation service providers to helpdesign and implement school-to-work programs.

The Reemployment Act of 1994 (H.R. 4040/S. 1951),now under consideration by both the House ofRepresentatives and the Senate, would replace through con-solidation all federal displaced worker programs and createone comprehensive federal program for such workers; entitle

some individuals participating in federally-sponsored train-ing to income supports; and authorize the creation of"one-stop" centers in communities for individuals interestedin, and eligible for, programs supported by the U.S.Department of Labor. If this experiment in federal programconsolidation works successfully, vocational rehabilitationservice providers may have easier access to assistance forsome clients and easier access to new clients.

Impliclr.:ions of Recent Legislative Actions withRegard to the Element of Personal Choice in SelectingVocational Rehabilitation Services. Each of these statutesindividually and collectively is going to influence prepara-tion for employment, employment opportunities, advance-ment in a career, and the availability of opportunities tochange careers. Three of these laws Goals 2000,School-to-Work, and Reemployment will define directlyhow, when, and where future federal dollars will be spentwith regard to federal support for job preparation and acqui-sition. What these laws mean for any consumer (student,graduate, displaced worker, unemployed individual) isevolving now at a rapid pace. What they mean in terms ofchoices for individuals with disabilities specifically isunclear; however, three observations can be made withregard to the implications for providers of vocational reha-bilitation services.

First, no specific rights are specified and no set asides areguaranteed for serving individuals with disabilities suchindividuals are to be included and treated as other eligiblerecipients. Therefore, they have as much right to participatealong with others in whatever is being offered. To remainviable, this may require an increased willingness on the partof vocational rehabilitation providers to work in collabora-tion with others in a greater number of settings, as well as tooffer intense remedial or preparatory assistance in specificsituations. It also may mean that providers may need to learnhow to market their services in new ways, for example in theform of technical assistance or advice, to both potential indi-vidual and organizational clients, who now may have multi-ple sources to whom to turn for help.

Second, considerable energy is being invested in develop-ing world-class educational and occupational skill standards.These standards will eventually function as guide posts andgate keepers, guide posts for shaping the services an individ-ual will receive and for judging an individual's progress, andgate keepers for defining who is qualified and thus eligiblefor additional opportunities. These standards must notbecome the basis upon which opportunities for individualswith disabilities are lessened or channeled separately fromthose offered to other individuals. Individuals with disabili-ties, organizations that represent their interests, and voca-tional rehabilitation service providers should play a centralrole in ensuring that this does not happen.

Third, more and better quality employment-related oppor-tunities will emerge for individuals with disabilities to theextent that vocational rehabilitation service providers takepart in developing new standards, using them as guide poststo assist individuals with disabilities prepare for employmentand careers, and also contribute to the standards being

1 ,r)1995 Switzer Monograph National Rehathigiation Association 17

applied fairly to such individuals by others. A central com-ponent of success in such efforts will be the ability to con-tribute credible, validated approaches to assessing the readi-ness of an individual with a disability to perform the essen-tial functions of specific jobs that are kt:own to be availablein particular labor markets.

There also are four major implications of these recentlaws for individuals with disabilities. First, the pressurethese statutes place on vocational rehabilitation providers arepervasive and far reaching. It will take time for vocationalrehabilitation providers to sort through and decide how theywill respond to these pressures. Thus, individuals with dis-abilities, especially in the immediate future, may haveopportunities to create choices as much as react to those sug-gested by others.

Second, the ADA is the tool by which the individual witha disability can both guide and judge how others offer oppor-tunities to choose and choices, and judge how others respondto the individual's choices. This will be especially importantfor the individual when weighing the usefulness of: (a) thecontent, timing, and access to information provided by voca-tional rehabilitation providers; (b) the type, timing, andeffect of information solicited from or volunteered by theindividual with a disability; and (c) the provider's attitudetoward and use of formal testing to help the individual devel-op viable career options.

Third, because opportunities and choices may be found inmany places, individuals with disabilities must developinformation gathering skills early and apply them to multiplesources. Moreover, even though the exact obligation mayvary by type of agency, organization, and employer, eachmust comply with ADA requirements to provide informationin an accessible format. Thus, especially for individuals whohave faced communication barriers in the past, the avenuesfor collecting information should be greatly increased.

Fourth, an individual with a disability may or may notneed the direct assistance of a vocational rehabilitationprovider in securing training or employment, but such a part-nership, when used, now may result in benefits that extendwell beyond the single case. The vocational rehabilitationprovider will benefit from the information the individualbrings to the table and learn about new opportunities that canbe shared with others with disabilities. The individual with adisability has the opportunity to share with others with dis-abilities what type of information is most likely to expandchoices when engaging vocational rehabilitation providers.

Assumptions Associated with Coiasumerism andChoice. Neither consumerism, nor choice as an element of it,occurs in a vacuum. Consumer satisfactioi. is affected by ahost of factors. This is no less true if the consumer wantsvocational rehabilitation services. Consider these assump-tions with regard to the rehabilitation consumer.

Making Choices Is a Dynamic Process. Generally, con-sumerism as a term suggests that an individual has choicesand that the individual has the right to choose or not tochoose a particular option. In the context of vocational reha-bilitation during career exploration, ability and interest

assessment, career selection, career preparation, job search,and job acquisition the term also may mean that an indi-vidual will be presented with choices and will be able to sug-gest additional options that will become choices at keyp,"ats in the vocational rehabilitation process.

For Choice to Be Viable the Rehabilitation ProcessShould Allow for the Customization of Information.Individuals with disabilities will enter the process at differ-ent points, with varying degrees of preparation. Vocationalrehabilitation providers should be prepared to meet the indi-vidual at that point of entry and provide appropriate, cus-tomized assistance. The information offered to assist an indi-vidual make choices will differ for individuals who just com-pleted high school from that offered to a college graduate ordislocated worker with a disability. Similarly to facilitate anindividual's ability to make choices, information may needto be delivered, formatted, or structured differently becauseof an individual's disability.

Finally, an individual's native language, cultural back-ground, or ethnicity may require that information be present-ed in a special way so that the individual can benefit from it.

Choice Should Be an. Inherent Factor in the OperatingStandards of Providers. Choice in connection to the selec-tion of a rehabilitation counselor may be viewed as a keycomponent of choice in the rehabilitation process. Providedinformation about counselors may suggest that some coun-selors are better than others or have special skills or experi-ences that better equip them to assist individuals with certaindisabilities. If differentiation based on specialization orexpertise is known or practiced, this may enhance the adviceoffered an individual with a disability and enhance the per-son's ability to make choices. As critical a factor may be theavailability, timing, and nature of the information providedto the individual about the service standards by which theprovider and all associated counselors operate.

Choices Must Be Understood to Be Meaningful.Choices in the rehabilitation process have meaning if theindividual understands them. In some instances rehabilita-tion providers may be called upon to assist individuals devel-op the capacity to understand and make choices. in othercases rehabilitation providers may be called upon to summa-rize or contrast the consequences of choices. Both of theseroles for providers are legitimate if the focus is to enhancethe individual's ability to make personal choices. Both ofthese roes, to be legitimate, mean that the provider gives theindividual full and accurate information at a level and in aform that the individual can understand and use.

Labor Market Information Affects Choices. One of thefactors that should be incorporated into information provid-ed to individuals with disabilities is labor market information

where the jobs are, what qualifications are tied to partic-ular jobs, what type of experience and training are tied to thequalifications for specific jobs, where and how long it takesto develop experience or to get training, and what the wages,benefits, and working conditions associated with specific


Figure 1Basic Standards for Information Sharing in the Vocational Rehabilitation Process

INFORMATION FROM THE PROVIDER INFORMATION FROM THE CONSUMER

PROVIDER STANDARD CONSUMER STANDARD PROVIDER ROLE I CONSUMER STANDARD

I lad information available Information was provided

Information was understandableand of use

Described the information thatwas needed

Indicated when information wasneeded and why

Described how the informationwould be used and what itwould affect

Understood what was needed, 't .1rovided it

Information wasappropriate /customised

Provided information in a timelyManner

Understood how theinformation would be used andsaw the effects of its use

Information was sufficient sothat decisionts) could be made

Was able to make choices andmove to the next point in theprocess

Could explain inforniation itsconnection to other informationand its effects or consequencesin terms of pending decisions

Was able to understand theeffects of some information onother information

Offered to assist in the collectionor generation of information

Received necessary assistance inthe collection or generation ofinformation

Could shared information in atimely manner: it had an effecton the decision making pr Tess

!lad information in time toconsider and use it

All information that wasrequested was considered

Explained why certain providedinformation would not be used

Received .eedback on allinformation that was provided

Understood why someinformation provided would notbe used

Content of the informationaffected decisions that weremade

Made decisions based Oninformation provided

jobs are. Such information provides not only a solid basisupon which an individual can explore and make choices, butalso serves as a reference point for discussing and definingthe type and level of support the vocational rehabilitationprovider is prepared to supply.

Resources Affect Choices. All rehabilitation providershave policies, procedures, and practices that affect their abil-ity to make resource commitments the timing of aresource request, the amount and type of a resource request,constraints on how funds are to be used, and case load ofstaff, among others. Thus, as a practical matter an individualwith a disability may or may not have an optimal level ofchoices depending on when, why, and under what conditions,he or she engages a vocational rehabilitation provider. If an;ndividual can approach a provider in a timely manner, thatis at the very beginning or very end of its fiscal year, theprovider's resources may be more plentiful or predictable. Ifan individual has done some detective work, that is, hasdecided a career path; knows what is required; knows wherehe or she stands in terms of prerequisites: knows what per-sonal resources can be committed to the undertaking; then,the individual's control over choices and the efficiency of aprovider's response may be enhanced.

Choice Is Affected by the Nature of AssistanceAvailable and the Type of Assistance Needed. Choice alsois affected by the type of assistance available frr 'heprovider and the type of assistance needed by the it talwith a disability. Providers may be able to offer mor di-


ble advice and assistance if they have had extensive and suc-cessful experience in helping individuals access jobs of cer-tain kinds, in certain industries, or in certain locations.Similarly, providers may know from past experience underwhat conditions individttals with certain interests, disabili-ties, or abilities have experienced high degrees of job satis-faction and can share that information with individuals con-sidering similar careers. If providers lack such information,then the partnership between provider and the individualmay take more time to develop, because both will need tospend time to explore the availability of careers and the con-sequences of certain career choices with which neither isfamiliar. This latter consequence does not in of itself need tonegatively affect an individual's opportunity to choose, butlack of familiarity with desired career information mightdelay decisions.

Comfort with Opportunities to Choose and ChoicesAre Affected by the Individual's Knowledge of aProvider's Past Performance. It is natural, when in need ofservice, for an individual to talk to friends, relatives, andacquaintances about where to get the best help. Thus, whenin need of vocational rehabilitation services, an individualshould be interested in service providers' "track records" andexplore the record of each provider: what is the range ofassistance and support available; what happens to individualswho have been assisted (e.g., wages and benefits received,access to opportunities for career advancement or change,access to opportunities for training); whether the provider isbetter equipped to assist individuals with certain disabilities,

National RehabilikrtiWn Association BEST COPY AVAILABLE 19

Figure 2Basic Standards for Judging the Effects of Information in the Vocational Rehabilitation Process

CONTENTr

PROVIDER ACTION CONSUMER-RELATED OUTCOME

Information about counselor /advisorex pertise. qualifications, mid experience

Provided information and offered choicesof counsekr

Able to select a counselor based on factsiald_preferences

Information about general procedures

Provided information on gcnerm mocess.:Deluding the roles of counselor andconsumer

Understood xvhat would happensequence -- and the responsihilitic, of theindividual and the counselor

Information about range of assistance,services, and supports available from theprovider Provided

I lnderstood the range of assistance that waspossible directly from the provider

Infrumation about range of assistance,services. and surports that the provider willhelp identify and/or coordinate with externalsources Provided

Understood the range of assistance fromother sources that might be possiblethrou h assistance from the rovider

Initial intornunion r.veded from theindividual

Explained information needed !ruin theindividual and offered to assist in itscollection an/or generation

Pro' ided information and obi:MILLInecessary assistance with regard in itsgeneration and preparation

Additional information the individual mightbe expected to provide or assist ingenerating le.g.. through testing)

Explained that the indo idual would be a'participant in collecting and generating!additional information, reviox inginformation, and making decisions basedon it

lInderstood role and responsibilities withreuaid to the use and effect of information

Assessment of informationinterpreted information hosed on theindividual's interests, abilities, imd uttential

Understood what infoimation meant interms of career o mons

Career information

Described and compared careerspreparation requtienients, ft ork mgconditions, wages. benefits

linderstood the similarities and differencesamong various career options and the levelof effort connected to achieving each one

I abor market information Describe ewer openings in labor market

Described assistance at d support availablefrom the provider with regard to each careeroption

With respect to career options, learnedwhich had openings in areas in which theindividual desired to locate

I Inderstood the level of support availablefor each career option front the provider andits implications

Information about conditions of supportand assistance connected to each career1 ytions

Information :Mont additional resourcesneeded for each career option

Described assistance and support neededfrom sources other than the provider is it lirotor(' to each career option

Understood the level of support neededfrom other sources for each career optionand the role the provider would play inattempting to secure it

Ilnderstood the training requirementsconnected with it career option, theindividual's eligibility for it, and how longthe training would takeTraining information

I )escribed information and the consumer'seligibility to train in connection to eachcareer option

Career choice explorationSuggested personal line of inquiry tofacilitate career selection

Based on the information available theindividual was able to choose a career

Informwion related to career choiceselection

Identify, arrange, and monitor the provisionand effects of assistance connected to anindividual's final career choice

Began the path to chosen career or obtainedemployment in chosen career

career interests or needs, cultural or ethic backgrounds, or atcertain stages of career development; how does the providerview its role and that of the consumer. To the extent thatproviders can provide this information and identify specificindividuals with whom a potential consumer can talk, themore likely the individual will be able to decide if he or sheshould seek services from the provider and the more likelyhe or she will know what to expect.

20 BEST COPY AVAILABLE

Competition Will Affect Choice. Once the federally autho-rized state-wide school-to-work programs and the one-stop cen-ters for employment assistance are in place, individuals withdisabilities will have options for exploring employment-relatedassistance that exceed those that are currently available. Thenew options most likely will be both highly visible and easy toaccess. Their emergence in communities will offer currentproviders chances to collaborate in new ways, expand services,

National Rehabilitation Associatft 21 1995 Switzer Monograph

and perhaps specialize. Such chi- nces may be accompanied bypressures to specify how current providers will address con-sumer satisfaction. Not only will approaches to accountability bescrutinized, but also the providers' attitudes and approaches toconsumer choice. This scrutiny will affect opportunities to dobusiness.

Who the Customer Is, Will Affect Choice. In manyinstances the customer will be clearly known and easy toaccommodate with regard to providing information to makeinformed choices and exert control over rehabilitation out-comes. In other instances, however, the matter may not be sosimple, for example when a provider must serve individualswith disabilities on behalf of, on conditions set by, or withfinancial support controlled by another agency or by an indi-vidual employer. Ideally, in such cases any provider, havinga commitment to provide information to individuals with dis-abilities that enables them to make informed choices, shoulddisclose this commitment to agencies and employers withwhich it does business. And likewise, if doing business withsuch agencies or employers places constraints on opportuni-ties to choose and choices offered to individuals with dis-abilities, this information should be shared with such indi-viduals at a point before it would undermine their opportuni-ties to make choices.

Philosophical Choices and Expectations. On theone-hand, providers may view choice as an event, where at aminimum, an individual will be presented with two choices,such as "we will arrange for you to go to computer training"or "we will place you in a telemarketing position." By offer-ing a minimum of two choices after the provider has sift-ed and weighed all factors is seen as a reflection of a com-mitment to choice, a choice made by the individual. On theother hand, providers may view choice as a series of engage-ments in which both the provider and the individual bringinformation to the table. In such a context the provider mayoffer advice or counsel with regard to the implications ofcertain information, but choices when made, are made by tiltindividual.

Some individuals may be more comfortable with providerscollecting and analyzing information, and offering the individuala limited number of choices from which to decide. Such indi-viduals even may desire confirmation from the provider that thefinal choice the person makes is the better one. Other individu-als may thrive on the process of active engagement where theyare called upon to make multiple decisions throughout theirinvolvement with a rehabilitation provider.

At this point it is risky to characterize any philosophytoward choice in the rehabilitation process as either better orworse than the other; it depends on the people involved. In real-ity, most providers and individuals seeking vocational rehabil-itation service may inhabit middle ground with regard tochoice. As a general rule. however, if a provider is committedto a timely and full disci( sure of information and is willing toexplain its value, use, and implications in a form the individualcan understand, the individual may at least become a partner inthe decision making process and at the end of the relationshipwith the vocational rehabilitation provider may be equippedand willing to make independent choices.

Basic Standards to Promote Informed DecisionMaking by Individuals with Disabilities Engaged with aVocational Rehabilitation Provider. The key to informeddecision making by individuals with disabilities and the keyto judging a provider's approach to offering such individualsopportunities to choose is information its availability, itscomprehensibility, its pertinence, its timeliness, and itseffect. These information standards represent dimensions inwhich any information at any point in the rehabilitationprocess could be judged. Figure 1 is one approach to orga-nizing the six information standards that, depending upon ifthey are observed in the individual case, can enhanceinformed decision making by an individual with a disability.In Figure 1 a distinction is made between standards relatedto information pro7ided by the provider and information pro-vided by the individual with a disability.

A second aspect of information is its content. If certaininformation is received in a certain order, then decision mak-ing by an individual with a disability is facilitated. Figure 2lists suggested information content categories in a particularsequence, and provider actions and consumer-related out-comes for each category. In a particular instance, if one wereto observe provider actions and consumer-related outcomeswith respect to specific information that parallel that pro-posed in Figure 2, then one would be able to infer that at aminimal, acceptable level, informed decision making by anindividual with a disability took place.

ConclusionAs indicated earlier, opportunities for employment-related

assistance for individuals with disabilities are likely toexpand in the near future. Thus, where and how someonewill be assisted will take many forms. This paper offers away of thinking about what affects an individual's opportu-nities to choose vocational rehabilitation services; chartssome basic parameters that will help any provider to reviewits strategies for sharing and using information and to deter-mine if such strategies contribute to informed choices byindividuals with disabilities; and suggests what the individ-ual with a disability should lock for when engaging a voca-tional rehabilitation provider.

Selected References

The Americans with Disabilities Act, P.L. 101-336.Demonstration Projects to Increase Client Choice Program,

NPRM affecting 34 CFR Part 377, August, 1993.Goals 2000: Educate America Act, P.L. 103-227.Proposed amendments to the regulations governing the adminis-

tration of Section 110 of the Rehabilitation Act as amended,sections 361.52 and 361.53, March 1994.

The Reemployment Act of 1994 (H.R. 4040/S. 1951).Rehabilitation Act Amendments of 1992, P.L. 102-569, Title

VIII, section 802(g).The School-to-Work Opportunities Act, P.L. 103-239.


Excerpts o Reviews and Comments Chapter Two

0r. Morrissey provides a masterfuldepiction of the complicities inher-ent in the concept of informed

choice by consumers. The summationsof related legislation that will impact onthe concept of informed choice wasextensive and extremely beneficial.

The area of informed choice is in des-perate need of definition and direction,particularly given the fact that it has I.=a long-standing issue awaiting to bepart of the vocational rehabilitation land-scape. Couple this with the fact of a voidin leadership on this issue from the fed-eral level and it is readily apparent thatDr. Morrissey's manuscript is extremelyrelevant and will command widespreaduse by rehabilitation professionals.

Dr. Morrissey's model for basic stan-dards for sharing and judging informa-tion is comprehensive and thought pro-voking; and yet, practical and realistic.

Judy Norman-Nunnery

onsunierism and Lhoice are newtrademarks of the disability move-ment and are reflected in the lan-

guage of a number of recent legislativeactions. How does one evaluate choice?To answer this question, Morrissey pre-sents examples that might he useful injudging efforts made by serviceproviders to provide choices to individu-als with disabilities. Morrissey alsostates that there is a need for develop-ment of some standards to evaluatechoice as well as evaluate client satisfac-tion with the choice options.

Central to such an evaluation toolwould be areas that evaluate the presen-tation of information, types of informa-tion, and other factors such as a timeframe for disseminating the information.

There are many factors that affectdecision-making, some of which maynot be explicit. A standard developed forjudging efforts, while a good idea, maysay more about the rehabilitation systemthan about the client's choices, and suchforms may quickly become just anotherform to fill out. Wherever possible, suchevaluation of effort should be balancedwith some feedback from the clients and

their familiesthis does not have to be a10-page form, but could be accom-plished through a post card or an acces-sible toll -free 800 number.

The Risearch aad :raining centersunder the National Institute on Disabilityand Rehabilitation Research are an idealposition to develop and field test theseinstruments as well as to test the possibleintegration of such tools in the proposed

:enfiloyment centersi.e., whatworks for individuals with disabilitiesmay also be helpful for other groups.

Jennie R. Joe

patricia A. Morrissey's paper"Consumerism and Choice:Basic Standards for Judging

Efforts and Expectations in theVocational Rehabilitation Process",outlines selected, basic standards ina legal framework for a democraticsociety, to provide choices to indi-viduals with disabilities in vocation-al rehabilitation. More specifically,Morrissey, not only addresses basicstandards to judge efforts to providechoices to individuals with disabili-ties, but significantly to even judgewhether these expectations are met.She effectively adopts the languageof consumerism in the marketplaceto the disability field with sophisti-cation and expertise.

Morrissey's overview of legislativedevelopments - even milestones -

includes statutory language in theRehabilitation Amendments of 1992; theAmericans with Disabilities Act of 1990;Goals 2000: Educate America Act of1994; the School to Work OpportunitiesAct of 1994; legislation in process; pro-vides the reader with insight and anin-depth understanding and appreciationof the "legal muscle" documentingchoice and consumerism for personswith disabilities on the American scene.

Morrissey tells us that opportunitiesfor employment and related services toindividuals with disabilities are likely toexpand in the near future. She also pro-vides a sound rationale for choice in theV.R. process and also explains what

effects an individual's opportunities to"choose" vocational rehabilitation ser-vices will have and % that elements theindividual should consider while "engag-ing" the vocational rehabilitationprovider. Morrissey adeptly shifts thecontrol of the management of vocationalrehabilitation services away from theprovider and to the consumer. This fol-lows the philosophy of consumerism inthe marketplace in a democratic society.It's a significant development and longoverdue. "Hooray for Morrissey."

Angela Traiforos

9r. Morrissey directs a very clearcourse of logical direction VR pro-grams will need to take to best face

the challenges ahead. For lack of a betterterm, the fundamental thought seems tobe "mainstreaming". Under the assump-tion that much of the legislation in placein our national educational and vocation-al agenda will function as intended, theobjectives of VR can become morefocused toward preparing and trainingpersons with disabilities to become partof the mainstream of the work force.

Much of the work toward achievingthese goals are logical in much the sameway all persons must deal with the choic-es available to them in career makingdecisions. Information needed to makeproper determinations of abilities and\ortraining goals necessary to reach adesired level of ability or readiness willbe a mutual responsibility between boththe VR provider and the person with dis-abilities. Clear information must betimely offered to both parties to makecorrect, career choices. This is funda-mental and really the clear focused goalof the VR program and the hope of whatit can help achieve for all persons wanti-ng to be part of the work force.

Philip H. Kosak

This is an important paper for a num-ber of reasons. First, it offers adetailed analysis of recent federal

policy initiatives by an informed

22 National Rehabilitation As?soation 1995 Switzer Mon.7graph

Washington observer. Second, it looks atthese initiatives in terms of "con-sumerism" and client "choice". Third, itmakes some educated guesses about thefuture of vocational rehabilitation in thisnew legHative environment from theperspective of service providers and indi-viduals with disabilities. Finally, it sug-gests some ways that the rehabilitationcommunity as a whole can work to clar-ify the rapidly-evolving job training andemployment standards and to ensure thatthese provide increased opportunities forindividuals with disabilities.

In the headlong rush to "reinvent" gov-ernment and streamline the myriad trainingfunctions of our federal programs, legisla-tors have not yet been able - or inclined - tothink through all the consequences of theiractions, especially as these relate to voca-tional rehabilitation. (The most tellingexample of this was the inclusion of the jobtraining programs of the Rehabilitation Actwith those of JTPA in an earlier version ofthe proposed Reemployment Act of 1994.)Morrissey observes that new laws , such asGoals 2000, School-to-Work, andReemployment provide no set-asides orspecific guarantees for individuals withdisabilities they will evidently be treatedlike everyone else in the use of these pro-grams - and one wonders how people withthe most severe disabilities will be affectedby this kind of mainstreaming. It's almostone of those old verbal paradoxes: if indi-viduals with severe disabilities are going tobe on the same footing as everyone else,how in the world are they going to be onthe same footing as everyone else? Perhapsit will all work out, but one's mind bogglesat the possibilities.

Will our vocational rehabilitation sys-tem retain its identity or be absorbed intoa greater service network? How will suc-cessful outcomes be defined? How willrehabilitation providers - if they exist -take credit for what they do? Will thenew "world-class educational and occu-pational standards" that are supposed tobe driving the development of Goals2000 (but, in fact, don't yet exist) includeprovisions for different learning stylesand different kinds of mastery? What isthe government's political agenda interms of vocational rehabilitation?

The last question, I assume, is theplace to begin.

Jon Lundin

DT. Morrissey has done an exemplaryjob of placing choice in the contextof law and practicality, whereas

recent debate on the philosophy ofchoice has often taken either a defensiveposture against or an adversarial demandfor choice.

She appropriately points out theexpanded opportunities that personswith disabilities should have underemployment and educational reforms.We, as rehabilitation leaders, mustseriously heed her call to help ensurethat these opportunities are realized.

We need to respond at both thenational and state implementation lev-els to meet this challenge. Too manysimilar opportunities have been missedin the past, as evidenced by the inabil-ity of persons with disabilities toaccess services under JOBS and JTPA.

Her assumptions about choice seemclear, logical and supportable. Theycorrectly focus on the individual cir-cumstances of the consumer involvedin the choice, which is the true realiza-tion of the Rehabilitation Act. Dr.Morrissey states that information musthe curtomized to the individual's dis-ability, cultural background, commu-nication abilities, desires, and under-standing and that it must be translatedand explained where necessary to gen-uinely achieve informed choice.

One of the most important aspects ofher paper is that she recognizes that therealistic parameters of the program mayoverlay choice. Since vocational rehabil-itation is still not an entitlement programwith unlimited funding, it is importantthat she acknowledges that labor marketand resource realities may limit choicesthat vocational rehabilitation can sup-port. This may balance the debate withsome advocates who espouse that choicemeans unilateral consumer decisionswhich should not be denied regardless ofcost or potential for success. It would beinteresting to know how Dr. Morrisseywould address the question of how toresolve the dilemma of conflicts betweena consumer's choice and the professionalopinion of a rehabilitation counselor thatthe choice is unrealistic.

The standards for promoting choicewhich Dr. Morrissey outlines are excel-lent targets and appropriately shareresponsibility for information gatheringand processing between the provider and

consumer. However, an additional stan-dard related to the comprehensiveness ofthe information should be added. Toooften, counselors only offer limitedoptions from among those services orproviders that they have found to be con-venient and comfortable in the past. Theymay not think creatively beyond the tra-ditional offerings that they have grownaccustomed to using. Also, consumershave an obligation to locate and investi-gate service alternatives that their coun-selor might not be aware of. Measuringcomprehensiveness of information wouldhelp ensure the best possible choice.


Ir. Morrissey discusses con-sumerism and choice within thecontext of a number of recent leg-

islative initiatives. It is particularlyimportant for rehabilitation practitionersto have a thorough understanding ofthose trends since they will influenceefforts to prepare individuals with dis-abilities for gainful work and dictate, insome respects, the scope and nature ofvocational rehabilitation services.

The integration of the philosophy andpractice of consumer choice into the voca-tional rehabilitation process will be chal-lenging and far reaching for both con-sumers and providers. Dr. Morrisseyclearly points out that current and futuresystem changes will require providers to"market" their services in new ways,assure that quality assurance standards arein place and compete in a totally new way.The essential point is that the consumer-must be provided with informationwhich is comprehensive and valuableso that informed choices can be made.The clear message presented in thispaper is that "choice" cannot be con-sidered just another change in aprocess - it represents a fundamentalchange in the way consumers andproviders interact with each other andwill most likely demand that providersadopt whole new strategies if they areto survive in a "free market" arena.

Patrick W. McKenna

2J1995 Switzer Monograph National Rehabilitation Association 23

Chapter Three

The Information Age:

What it Means for Business

and Vocational Rehabilitation

Debra A. Perry

In the industrial age, the machine was the basis of produc-tivity, the worker manipulated (served) the machine, andmaterial was the product. In the information age, the per-son is the basis of productivity, the machine serves the

worker, and information is the product (Drucker, 1994). Capital,land and labor no longer have the same value. As a result, futur-ist Alvin Toffler equates knowledge with power; economistRobert Reich ident:fies skills and insights as the basis of wealth;and business analyst Peter Drucker describes knowledge as thecompetitive economic resource.

This seemingly simple shift from machine to person andgoods to knowledge is the basis of the current transformationin the economy, the workplace and the social order. How thistransformation might effect vocational rehabilitation is thefocus of this paper.

Vocational rehabilitation does not exist in isolation. Thetrends that are transforming how we live and work in theeconomy, technology, demographics, social values and glob-alization effect the practice of vocational rehabilitation aswell. In many cases their impact is felt through the filter ofbusiness. Business and industry will be a defining force inhow vocational rehabilitation is practiced in the 21st centu-ry. Preparing for the future therefore requires an under-standing of business and industry and its relationship tovocational rehabilitation.

That relationship has been based on meeting mutualneeds. Business and industry, in the role of employer, needsqualified workers to produce goods and services; vocationalrehabilitation seeks productive employment for its con-

Debra A. Perry, Perry, Winans & Co., Washington. DC, is an InternationalConsultant specializing in Rehabilitation, Training & Public/PrivatePartnerships.

24 National Rehabilitation Associatio2 5 1995 Switzer Monograph

sumers. This simple equation has become more complex inrecent years with the development of corporate based dis-ability management programs and passage of the Americanswith Disabilities Act. The lines between vocational rehabil-itation and business and services and employment areblurred. Current realities and future trends will add furthercomplexity to the relationship and it is expected that theseboundaries will become even more obscure.

The purpose of this paper is to examine the implications ofthe information age for vocational rehabilitation within the con-text of the business/rehabilitation relationship. It invites us to doso from the perspective of futurists as we prepare for the 21stcentury. Futurists explore the world of what might happen. Theybelieve that if we know the various opportunities and challengesthat lie ahead we can influence how the future unfolds. Actioncan be taken to increase the chances of making desired +possibil-ities a reality and to prevent the undesired from happening. Inorder to take appropriate action, we must have a vision of adesired future. This paper proposes a future where everyonewho wants to work has the opportunity to do so in a challenging,productive and economically rewarding capacity that contributesto the greater good.

With this as a guiding vision, it has three major sections.First, it c plores the relationship of business and rehabilita-tion with particular emphasis on the current business envi-ronment. This environment has tremendous implications forthe workplace of the 21st century and the employment ofpeople with disabilities. At the heart of the paper is the sec-ond section, six major workplace issues which effect busi-ness and rehabilitation in the information age. Four dealwith generic topics which relate to all workers. They are theskill needs of employers, labor shortages, the changing

workplace, and the influence of technology. The remainingtwo workplace issues deal mainly with rehabilitation andpeople with disabilities. They are reasonable accommoda-tions and disability management programs. In a final section,some broad recommendations about resources and approach-es for preparing for the 21st century are discussed.

Business and VocationalRehabilitation: The Relationship

Business is often equated with corporate America. For thepurpose of this paper, business and industry includes busi-nesses large and small, such as the entrepreneur working outof her living room; the machine shop of 100 employees thatfound a special market niche; the airline that is co-owned bya labor union; the multinational conglomerates; and the mul-titude of small businesses that are the source of most of thenew jobs and who do much of the hiring of people with dis-abilities in the United States.

Vocational rehabilitation refers to a discipline of profes-sional practices that includes all of the public, private non-profit and for-profit rehabilitation programs that provide ser-vices to facilitate the employment of people with disabilities.It also includes the professionals, academics, researchers andpolicy makers who work in these organizations or as consul-tants. For purposes of this paper, the goal of vocational reha-bilitation is the placement of people with disabilities in for-mal, competitive employment.

The relationship of business and industry to vocational reha-bilitation prior to and during the 1970s could be *characterizedas that of producer to buyer. Through various services and train-ing, vocational rehabilitation worked with persons with disabil-ities to "add value" (i.e. skills) to what they had to offer busi-nesses as workers. In the 1970s, the marketing approach to jobplacement emerged and vocational rehabilitation began toaddress the needs of business and industry as a customer. Withthe emergence of programs like Projects With Industry and sup-ported employment, business and industry evolved into a part-ner in the vocational rehabilitation process. Business and indus-try was invited to share in the desi en and development of ser-vices to make sure business needs were met along with those ofconsumers with disabilities.

Certain developments in the last quarter of the 20th cen-tury have further changed the nature of the relationshipbetween business and vocational rehabilitation. Among themare: increasing awareness about the abilities of people withdisabilities; rising costs and changes related to workers'compensation and long term disability insurance programs;changing demographics resulting in labor and skill short-ages; increasing civil rights advocacy for people with dis-abilities; passage of legislation such as Sections 503 and 504of the Rehabilitation Act, and the Americans withDisabilities Act; a rising federal deficit with implications for

health care and entitlement programs; and changing expecta-tions about the role of business and industry as a communitymember. As a result, a complex, mere integrated relationshipis emerging between business and industry and vocationalrehabilitation. Business is no longer just a customer of voca-tional rehabilitation, it is a provider and producer of relatedgoods and services as well.' The integrated nature of thecustomer/producer relationship is characteristic of theemerging business climate of the information age.

Business in the Information Age:Leaner, Meaner and Smarter

It officially happened in 1991: For the first time compa-nies spent more on computing and communications equip-ment, the technology of the information age, than they didfor industrial, mining, farming and construction machines.(Stewart, 1994). The implications of this transition must beunderstood to adequately meet business needs for qualifiedworkers. Three aspects of this transition include: (1)Changing demographics resulting in fewer available work-ers and an older, more diverse workforce; (2) A highlydemanding, global business environment requiring compa-nies to be more productive and, at the same time, morefriendly to workers and families; and (3) Rapidly changingtechnology which will dramatically affect the workplaceand the nature of work. By the end of this century, the busi-ness environment will be "brutal" for those companies thatare not large enough to navigate in the global marketplace,or small enough to maintain a specialized market niche(Powers, 1990).

The information age requires a new business enterprise.Holland (1994) likens it to a sailboat rather than the battle-ship of the 20th Century. It will be more agile, flexible, anddriven by customer values that require total quality, timelyresponses and significant added value. It will be necessary todevelop products more quickly and get them to market soon-er; product cycles may be measured in months rather thanyears (Powers, 1990). Business will become more integrated,both internally and in relation to customers. Decisions willbe based on multi-disciplinary input from specialists andwork tasks will be accomplished by empowered, teamsassembled to achieve targeted goals. Restructuring, a painfulphenomena of the 1980s and 1990s, will be continuous andconstant to meet changing needs and multiple tasks.

The terms leaner (flattened structure, less hierarchal,fewer employees), meaner (more efficient, productive andcompetitive) and smarter (greater use of technology, betteruse of efficient methods and human resources, and constantlearning), have already been used to describe the successfulbusiness enterprise of the 21st century. Its workers will con-tinue to be empowered to solve problems, to respond to cus-tomers and to manage work functions. Communication will

1 Business as a producer demonstrates the complexity of this relationship. Private sector rehabilitation businesses operate in both rehabilitation and business sectors.The 1993 Switzer scholar program dealt in-depth with private sector rehabilitation. In addition, other businesses also produce goods and products for a disaoility mar-ket, and private consultants provide disability specific services. The disability market is growing. By the year 2000, it is projected that one in five individuals will havea disability. In an age of diversity, business understands the importance of having the customer base reflected in staffing patterns. The growing consumer market couldtherefore have some direct implications for the hiring of people with disabilities in both disability specific and general consumer oriented businesses. For an innlepthanalysis of business as a producer of goods and services related to disability, see Albrecht (1992) The Disability Business: Rehabilitation in America.

,--,1995 Switzer Monograph National Rehabilitation Assoc2t4n 25

be more open and direct. Job classifications, roles andresponsibilities will change rapidly to meet new markets,new products and new technology (Powers, 1990).

Most new jobs and innovations are expected to come fromsmall businesses. Its business structure is considered moreappropriate (adaptable, cost-effective) for meeting certainmarket demands. This factor and the projected rise in serviceindustries, will mean a workplace smaller in size and numberof employees (Powers, 1990).

Business and Rehabilitation:Six Key Workplace Issues

The following six issues explore the implications of th.information age for business and vocational rehabilitation.

Issue 1. Skills Needs for a New Economy:Workers "In the Know"

One of the major ironies of the technologically-basedinformation age is the critical importance of "people" skills.Whether you are part of a high powered technical problemsolving team, or are what Robert Reich calls an in-personserver (i.e., personal care attendant, bank teller, aerobicstrainer), interpersonal skills are vital. Technical expertiseand an understanding of technology's applications will simi-larly effect many job categories. By the year 2010, a project-ed 90% of the workforce, including farmers, teachers, orpolice officers, will be effected by information technologiesthat include computer networks, massive data otorage sys-tems, and artificial intelligence (Hines, 1994). Basic skills,such as knowing how to learn and math and language litera-cy, are demanded in a workplace where continuous learningwill be the norm. Employers also will require less tangible,"soft" skills like adaptability, flexibility, creative thinking,proi,lem solving, and se- management skills (Carnvales etal. 1988). These basic skills will cross many, if not most jobcategories. In the words of Batelle's CEO:

All of tomorrow s workers, including the scientists, aregoing to need better reading and comprehension skills, peo-ple skills, and conceptual thinking skills. There are a lot oftechnically trained people in the world who know this fact orthat fact, but they can't integrate the two into somethingreally meaningful. The worker in the 21st century will haveto make those connections. All employees will have to belearners all of the time (Kopp, 1994).

Increasingly, education will be important to earningenough to sustain a viable lifestyle. Between now and 2005,jobs requiring education and training after high school areexpected to have faster than average rates of employmentgrowth. By the year 2000, most new jobs will require someform of post-secondary education. Workers with these jobscurrently earn the highest median income among workersfrom all major occupational groups used by the Departmentof Labor to classify jobs (DOL, 1994). They include execu-tives, administrators, managers, professionals and skilledtechnicians in service occupations. In the next 10 years,close to 6 million of these positions will open up, many inthe health care field (Centron, 1994).

Service jobs, which require less academic credentials, willalso increase at rates faster than the average between now andthe year 2005. Earnings for jobs in this category are about 40%below the average for all occupational groups in 1992, the low-est among all nine occupational categories. Almost one-third ofthe workers in this category had less than a high school educa-tion in 1992 and twice as many worked part-time than the aver-age of all workers (DOL, 1994). While the economy is project-ed to continue to generate jobs into the next century at all levelsof education and training, most of the employment growth willbe in the service-producing sector. By 2005, service workers willbecome the largest employment group, followed by professionalspecialty workers.

The prospect for employment in the production sectorcontinues to look bleak. These jobs have been lost, sent off-shore, or "given" to robots. (For example, in 1977 it took 35hours to assemble an automobile. By 1995, with the help ofrobots, it will take 8 hours (Reich, 1991).) The informationage economy in developed countries only requires a produc-tion workforce of less than 10% of the total. Production jobshave become technology and knowledge based (Drucker,1994), requiring more education and training than they need-ed in the past.

Opportunities and Challenges

Current job projections suggest continued growth, espe-cially in service related jobs into the 21st century. Many ofthese jobs present opportunities for individuals with certaintypes of disabilities, especially those who may have beenclosed out of traditional job markets because of physicalrequirements. New jobs will rely on intellectual and inter-personal skills rather than physical prowess. This trend sug-gests that more opportunities will be available for those withphysical and sensory disabilities who can interact with thenew technology of the workplace.

Preparing people with disabilities to qualify for the jobsof the future is the primary challenge. Without meeting thetraining challenge, the promise of the ADA, based on peoplewith disabilities being qualified for jobs, will never be real-ized. Preparing people involves addressing both academicand literacy requirements of jobs and the basic non-technicalskills employers need. The results of the National LiteracySurvey (1993) found that "without exception, adults with anykind of disability, difficulty, or illness were more likely toperform in the lowest literacy levels than those in the gener-al population." The Harris Poll (1994) found that personswith disabilities are less likely than their non-disabled peersto have a high school diploma (25% as compared to 12%).The good news is the percentage of those with disabilitiesfailing to complete high school decreased from 40% in 1986to the 25% figure.

Notwithstanding the difficulty in finding resources toaddress educational needs in times of federal budgetary cut-backs and private rehabilitation cost containment measures,more must be done. An analysis of state and federal rehabil-itation system's performance in relation to Workforce 2000(1987), found that the number of rehabilitants sent to collegeor university was only 10.9% in 1985, the lowest in a decade.Yet, almost a third of future jobs will require a college

26 National Rehabilitation Association 2 7 1995 Switzer Monograph

degree. Training in trade and vocational schools was up morethan 13% however, the greatest increase ever.

Specialized jobs and increasing training costs will requirethat more employers conduct training in house (Waldrop,1994). While larger companies may be able to assimilatethese costs (half of the costs of formal jobs training is paidby two to three hundred of the largest companies (Cetron,1994), small employers may find training a hardship. But,according to the current labor secretary Robert Reich, busi-ness needs to do more. "Skills learned on the job or in workrelated settings are especially valuable. But with someexceptions, companies do too little training and concentrateon workers who are already skilled. We need a new socialcompact with business" (1994).

Traditionally, the non-profit rehabilitation arena has providedinterpersonal skill (e.g., social adjustment, social skills training)and job readiness that addresses many basic non-technical skills.These programs should be reviewed and revised in light of newworkplace skills requirements for flexibility, adaptability, cre-ativity, team building and critical thinking. Teaching these soft-er skills will be a challenge and may require research anddemonstration projects to develop effective training approaches.On a related matter, all aspects of vocational rehabilitation prac-tice, including those related to vocational testing and careerguidance, will need to be re-examined in light of futuredemands. Many of the jobs that formed the basis of certain voca-tional assessment systems and career interest inventories are notrelevant to the future workplace.

To address training (and other) challenges, more collabo-ration between business and industry, vocational rehabilita-tion, labor and other groups is needed. Existing examplesinclude: (1) Projects With Industry which joins business,industry and labor with rehabilitation to train and placeworkers according to workplace needs; (2) Supportedemployment programs which provide intensive trainingapproaches tailored to the needs of the individual and theworkplace; and (3) The High School/High Tech program(PCEPD, 1993) which encourages high school students withdisabilities to pursue careers in science, engineering andtechnology.

Issue 2. Labor Shortages:Where have all the workers gone?

Future projections suggest that there will be more jobsthan people to fill them. It has been seven years sinceWorkforce 2000 forewarned that a workforce that was grow-ing at its slowest rate since the 1930s would have ,,evereimplications for business by the year 2000. A lack of teenageworkers is a major reason. Between 1985 and 1995, the num-ber of 18 to 24 year olds will have declined by 17.5% (Reich,1991). Although restructuring of the workforce temporarilymasked the impact of shortages, competition for workers isexpected to heat up again at the onset of the 21st century.2

Workforce 2000 also explained how demographic changeswould result in an increasingly diverse and aging workforce.Minorities, women and immigrants were expected to account for

most of the growth in the labor pool. For example, by the year2000, 62% of women will be in the labor force and one in fourworkers will be from a minority group. Many will not speakEnglish and most larger corporations will hove special officesthat deal with minority concerns (Waldrop, 1993). A climbingretirement age, to 70 by the year 2000 (Cetron, 1994), coupledwith the aging of the baby boomers will result in an older work-force. By the year 2000, one fifth of the labor force will bebetween the ages of 45 to 54 (Waldrop, 1993).


A shrinking labor pool has obvious positive implicationsfor the employment of people with disabilities. Both the reha-bilitation and human resource literature regularly cite themutual advantages of meeting labor force demands with work-ers who have disabilities, and futurists predict that shortageswill pave the way for jobs for people with disabiiities. But theactual data about employment among people with disabilitiesraises questions.

According to the 1994 Harris poll of people with disabil-ities (NCOD, 1994), the number working full time declinedfrom 24% in 1986 to 20% today. The number of part timeworkers remained the same. In 1986, only 33% of workingage Americans with disabilities (16 to 64 years old) had jobs.The figure declined to 31% in 1994. Only 7% of those work-ing found their jobs through special programs; half foundtheir jobs through personal contacts. Yet, as previouslynoted, increasingly people with disabilities are completinghigh school and becoming more academically prepared forthe workplace of the 21st century. While survey and researchrepeatedly indicates that business has had positive experi-ences with hiring persons with disabilities, employers iden-tify a failure to find qualified candidates as the reason for nothiring more. Further, many businesses are unaware of voca-tional rehabilitation and special hiring programs. Vocationalrehabilitation needs to develop the opportunity to serve as atalent broker for business in the 21st century. As the nextissue discussion will further illustrate, businesses are open tostrategic alliances and effective vendor relationships to meettheir human resource needs. Vocational rehabilitation couldbecome such a vendor. Computer bulletin boards, network-ing and an integrated business environment of the 21st cen-tury are among the resources and concepts that can beapplied to this challenge.

The attention to diversity issues in the workplace provides aforum for addressing discrimination based on disability aswell. Many businesses fully recognize the need to adopt multi-cultural approaches to maintain a competitive advantage in themarketplace. Workshops are held, books and articles written,and consultants hired but disability as a diversity issue is givenonly cursory mention. The dynamics of unconscious bias andinstitutional prejudice that have effected individuals from cul-turally different groups play a role in attitudes towards personswith disabilities. Diversity awareness activities can be exploit-ed to foster positive awareness and to counteract discriminationagainst those with disabilities.

2 Current trends indicate that there will be a new surge of workers in abut 2010 (Reich, 1991)


To truly optimize the workforce and promote participationof people with disabilities in employment, disincentives toworking need to be minimized. More than a quarter of thosesurveyed by the 1994 Harris poll said they would risk losingbenefits or insurance if they worked. Many people with dis-abilities might be willing to risk cash benefits, but are fear-ful or unwilling to lose entitlement-based health care cover-age if tile), become employed. This is a very real issue. In1993, 76% of college educated employees were covered byemployer-sponsored health plans, whereas the rate was only36% for high school graduates (Reich, 1994). With expectedincreases in part-time employment and other alternativework structures that will have questionable benefit coverage,resolving the health care dilemma will become even morecritical.

Issue 3. New Work Structures:To be or not to be employed

Drucker calls the information age worker, those highlyskilled professionals and technicians who generate newideas, knowledge workers. The employer of tomorrow willdo more to find, keep and develop valued knowledge work-ers. Those individuals who are able to keep up with thechanging business environment will find new opportunitiesfor personal and p:ofessional satisfaction Telecommutingend work-at-home policies, made possible by technology,will become acceptable alternatives to going to the office.Benefit programs should improve and pension plans madeportable for those with full-time, permanent jobs. Companieswill become more family-friendly reflecting the changingvalues of a workforce.3

In the workplace of the 21st century, increasing numbers ofindividuals will work but not have a permanent job. According toone scenario the typical business will have a group of core work-ers who will be responsible for essential functions. This coregroup will have broad skills which allow them to function in avariety of jobs. They will be highly prized and remunerated. Acrew of "just-in-time workers," also called the contingent work-force, will support the core group. Retained through temporaryagencies, consulting firms or under individual contract to meetshifting work levels, they will provide specialized services on atime-limited basis.

As another streamlining and cost containment measure,some functions will be outsourced (contracted out) to busi-nesses who will provide needed services on a regular on-goingbasis. Although these alternatives to hiring full-time workerswill not make permanent, full-time employees extinct, theymay become endangered. By some estimates, one of out fourof today's workers is a "contingency worker" (this group actu-ally includes doctors and professionals as well as consultants).By the year 2000, up to half might be (Fierman, 1994). Thenumber of part-time workers will also rise, especially amongservice workers. One obvious concern will be the status of ben-efits, and especially health care coverage, for these workers.

Due to opportunities created by alternative work struc-tures and other factors, entrepreneurship will be on the rise.Many new starts will be very small. For example, of the twomillion new businesses that Dunn and Bradstreet evaluatedin 1993, 20% were one and two-person operations (O'Reilly,1993). Some of these new businesses may take the form ofthe virtual corporation, an organization that may be just oneor a few individuals effectively networked, to "virtualemployees" who are ready to take on contained projectassignments and are willing to disband when the work task iscomplete. Computer bulletin ards will play an instrumen-tal role in the recruitment of virtual workers.

For those who do have permanent jobs, it will not equatewith job security. In the next ten-year period, those in fulltime permanent jobs can expect to shift careers once andhold jobs with three different employers (Krannich andKrannich, 1993).


Many workplace changes that are designed to enhance theproductivity and flexibility of workers in general will makeit possible for many people with disabilities to work, period.The new attitudes created by flexible work policies andattention to diversity issues should generalize to people withdisabilities and the accommodations they require as well.The costs of tools to support the knowledge workei gobeyond what was typical in a manufacturing economy.

The trend towards home-based employment, flexible workhours and flexiplace will make it possible for many peoplewith certain types of disabilities to work in environmentsconducive to their productivity without the energy drain ofpreparing and getting to work. Over 23 million Americanscurrently work at home. Several long-term projects havedemonstrated the effectiveness of home-based employmentfor people with disabilities (Wilhelm, 1993). With the pastrehabilitation focus on mainstreaming and integrationefforts, these projects were abandoned. But in the informa-tion age, home-based employment is expected to become aregular and acceptable way to work for anyone. Since anincreasingly accessible public environment and expandedtelecommunications will open up non-vocational options forintegration, home-based employment warrants another look.

In the information age, entrepreneurship also deserves moreattention as a viable work option for people with disabilities. Inrural areas, inner city neighborhoods, or communities wherejobs are scarce, job creation in the form of self-employment hasparticular appeal. The international development literature pro-vides models of entrepreneurship training, business support andmentoring, and innovative credit programs, including revolvingloan schemes where repaid loans are recycled to help others.Some systems to support entrepreneurship are already in place inthis country, such as the activities of the Small BusinessAdministration and university and college based business incu-bators. More research of entrepreneurial approaches is needed

3 A recent study shows that workers want more time for self and family and, especially among younger workr.rs (age 18-24 years), arc less likely to sacrifice self,

family or education to advance career (Galinsky, et al. 1993).


and vocational rehabilitation professionals should developexpertise in business development.

Small businesses will not only increase but as noted will cre-ate most of the new jobs. That is good news for people with dis-abilities. Research and anecdotal evidence suggests that smallbusinesses are more open to hire people with disabilities, first-time job seekers, and those with disrupted work patterns (Drury,1990). Activities designed to foster hiring of persons with dis-abilities in small business should be an integral part of vocation-al rehabilitation plans and services.

The changing workplace suggests opportunities for thosewith severe disabilities. In the past contract work was the basisfor work in sheltered workshops; it also was a vehicle for workthat involved work crews, enclaves and other more integratedapproaches to supported employment. In the 1980s, some voca-tional rehabilitation programs began linking with temporaryemployment services, or established their own, to assist personswith disabilities ease back into the workplace. The 21st centuryshould provide opportunities to develop innovative work ser-vices. Ones that might be considered include the development ofemployee-owned cooperatives like those demonstrated interna-tionally or a revisiting of affirmative industry models. Such pro-jects could theoretically achieve the goals of competitiveemployment (e.g., integrated work settings, good wages) andstill provide an alternative for those with disabilities who maynot be ready for permanent, full-time jobs.

fhe flexibility required in the new workplace could createformidable challenges for the integration of workers withcertain types of disabilities who need a consistent and a sta-ble environment to maintain their composure and ability toperform. The very nature of essential functions could requirecertain "soft" skills related to flexibility that might excludesome individuals. Conversely, the alternative structures willmake it possible for people to move in and out of the work-force without the stigma. Innovative, appropriate, acceptableaccommodations may need to he designed to assist personswith disabilities, especially those with psychiatric, attentiondeficit disorders and neurological impairments.

Finally, career development strategies will need to beadapted to accommodate the new workplace. The idea that acareer means one line of work, that a job means permanentemployment, that advancement means moving "up" a careerladder, and that training happens at the beginning of thecareer, are already outdated concepts. Trend analysis, con-tingency planning, and the development of portable (trans-ferable) skills will become important features of career coun-seling and planning in the future (Barner, 1994).

Issue 4. Technology:The Good, the Bad and the Unknown

Use of information and communication technology will

become critical to success in the workplace of the 21st centuryfor the worker and the successful business. Computers willbecome ubiquitous, a regular part of the environment rather than

tools used for specific tasks. By the year 2000, virtually everyurban dweller will have contact with computers at home or atwork (United Way of America, 1989). Computers will be joined

by a massive global network that will link the video, telephone

and cable television lines through the phone system. The impli-

cations for home-based employment have been noted; learning,and training will also be dramatically influenced.

Artificial intelligence and virtual reality will revolutionizelife and work in the 21st century, even more than the micro-processor did in the 20th (Coates, 1994). Artificial intelli-gence has the capacity to mimic the human mind and "smartmachines" may eventually match human speech, vision, lan-guage, communication and thought (Coates, K9 I ). While itwill allow business to solve problems and analyze data inways not currently possible, it will also be resporraible forfurther displacement of certain types of jobs.


Technology makes it possible for some individuals with dis-abilities to compete and have access to high skilled, better pay-ing jobs. For many, it is the great leveler. For example, Vice

President Al Gore had been communicating with the WhiteHouse on-line forum operator for some time before he learnedthat she was both deaf and blind (Baig, 1994). Such interactionwould have been improbable just a few years ago.

Exploiting technology to enhance opportunity continues to bea challenge. For example, many older people with disabilities,and those displaced from manufacturing and non-automatedjobs, for whom the computer is a frightening complex tool, needtechnology training to become part of the new workforce.Funding for assistive technology will continue to be problemat-ic. But an even graver concern is the long range implication of aworkplace based on information technology, not only as itrelates to people with disabilities, but the entire population.

The picture of a revolutionized, highly technical workplace,where workers are prized, jobs are challenging and co-workersare highly communicative colleagues is a positive one. Someargue, however, that only the richest, the smart and the techno-logically inclined will be able to take advantage of this work-place (Baig, 1994). Where does that leave the poor, the not-sosmart and the "technology-arrested". Further, what will be theimpact of robotics, of further automation, and of smart machineson those jobs that are more mundane and routine?

The further we look into the 21st century, the more likelytechnological advances will consume certain types of jobs(Reich, 1991; Lerner, 1994). How will these jobs bereplaced? Where will those workers go? How will they sur-vive, if their skills are not needed by the virtual corporationor the contingent workforce.

Those people with disabilities who have the capacity tothrive and survive among the intellectual, technologicalknowledge workers should prosper. But what of those whocannot? If robots replace fast food and assembly line work-ers, where will the jobs be for those who do not have knowl-edge-based skills and abilities? Will the technologicallyadvanced, know:edge-based workplace of the future createbarriers for the mentally and emotionally impaired as severeas architectural barriers are for those with physical disabili-ties? Will technology liberate some and handicap others?

Business and industry, working with the goverr'nent andother vested groups, needs to further assess the impact If tech-

nology on jobs and the implications for all ,orkers. goes to the

heart of an evolving work structure that contd. ,olarize developed

nations into the high paid, high skill. elite k.nowledge workers

1995 Switzer Monograph National Rehabilitation Associatiola 0 29

and technicians, and the lower paid, less educated service work-ers, whose jobs may lack benefits, security, and dignity(Drucker, 1994; Reich, 1991). Because people with disabilitiesas a group are poorer, less educated and less likely to beemployed now, they are more likely to be forced into the ranksof the latter class of workers. To minimize this outcome, morepeople should be trained for the high skilled technical jobs of thefuture (Reich, 1994). The ADA is one of the safeguards thatguarantees the rights of people with disabilities to education andtraining resources. This paper turns to the topic of the ADA, par-ticularly the issue of reasonable accommodation.

Issue 5. Providing ReasonableAccommodations: The ADA Way

Business as a provider of reasonable accommodation, tradi-tionally a vocational rehabilitation function, is totally consistentwith the demands of the new global business environment. Thereader is reminded of Drucker's distinction between knowledgeworkers who are served by machines as opposed to their prede-cessors who served the machine. In the information age, employ-ers will provide employees with the tools, equipment andresources needed to perform their work at optimal levels. Underthe ADA, they must extend this business practice to persons withdisabilities. The ADA requires that employers provide reason-able accommodation to assist qualified workers perform theessential functions of the job. (Exempted are employers of lessthan 15 employees and those for whom it is an undue hardship.)

in some cases, reasonable accommodations takes the form ofproviding assistive technology (a manifestation of the machineserves people concept), job restructuring, or relaxing a policy. Astechnology advances some of the devices that are required bypeople with disabilities will become more common workplacetools. Similarly, increased flexibility in the workplace related toflexitime, flexiplace, and home-based employment may makethe need for "special" accommodations unnecessary, or at leastmore acceptable.

Since the ADA also requires that business and industry removeall discriminatory practices from hiring and employment process-es, it is fully consistent with the needs of the workplace to opti-mize human resources and accommodate diversity. The findingsof a Gallup survey commissioned by the Electronic IndustryFoundation are therefore not surprising: 86% of businesses sur-veyed favored the ADA (EF, 1992). However, according to ADAexpert Griffin Bell, although employers want to comply, they needhelp in understanding how (Laab, 1994). The ElF poll providesconcrete data, only 14% of employers described themselves asvery familial with the act and 44% as somewhat familiar, leavinga full 31% of business unfamiliar with the law. Most expressed lit-tle knowledge of organizations that serve or represent individualswith disabilities and a full 87% did not know what impact theADA would have on their companies. Larger companies as com-pared to smaller were more likely to have an established policy for

hiring persons with disabilities, but a full 92% of companiesreported that they had no policy or implementation plan at thattime. While it ;s interesting to note that many businesses feel thatthe ADA will have a positive impact on their companies byincreasing the potential pool of workers (Wilhelm, 1993; Ledmanand Brown, 1993), it will probably not be until the 21st centurythat its impact can be adequately evaluated.


Advocacy groups see the ADA as an opportunity to dis-cuss disability and educate business and industry about theissues. For certain groups, like those representing the men-tally ill, a highly stigmatized disability, it is hoped that theADA will provide an opportunity to come forward on the jobwithout fear of discrimination (Woolsey, 1994). Althoughmany supervisors have been accommodating workers infor-mally, this can now be done openly.

The opportunities for the ADA to move people from thecurrent state of gross underrepresentation in the labor marketinto employment have positive implications for disabledworkers, business, and society at large if the law is fullyimplemented. According to a study by the National Councilon Disability (NCOD), it was remarkable that after one yearso much had been achieved. still information gaps and ambi-guities in the law remain.

Employers still seem to have conflict and confusion aboutreasonable accommodation. According to one study of 85large national companies, employers were unwilling to makeaccommodations they felt were too costly, or time-consum-ing, or those that required deviation from the "corporate cul-ture." Supports were more likely to be acceptable duringlearning phases of training rather than on an ongoing basis.Employers expressed concern about treating workers "fairly"which they defined as "equally" (University of Maryland,1993). The concept of fairness may need to be re-evaluated.In the information age, fairness does not equal sameness butan approach that provides all employees with the tools andwork environment they need to be optimally productive.Accommodation in this sense reflects the broader issue ofgeneral diversity in the workplace and how to support indi-viduals in doing their jobs.

Misinformation and unfounded fears are additional obsta-cles to full implementation of the ADA. For example,employers have expressed concern that insurance costs willrise dramatically with increased hiring of persons with dis-abilities. Yet, the U.S. Chamber of Commerce and theNational Association of Manufacturers found that 90% ofcompanies realized no increase in insurance costs related tothe ADA (Wilhelm, 1993). The EIF poll found that employ-ers are also concerned that the ADA would result inincreased training costs, the encouragement of lawsuits, anddifficulty in firing a person with a disability.4

4 Between July 1992 ar.d May 1994, the Equal Employment Opportunity Commission (EEOC), the federal agency cha.gecl with zmfercernent 'i:de 1, tne employ-tne:a nrovHons of the ADA, recei"ed 27,944 charges of violations. Of these half alleged a discriminatory discharge and one quarter failure to accommodate (EqualEmployment Advisory Council, 1994). On July 26, 1994, the ADA's coverage expanded from 264,000 employers with 25 or more employees (protecting 77 millior.employees) to those with 15 or more employees (extending ADA protection to an additional MN million employees). As of July 1, 19?4, ,he EEOC had filed lawsuits in 23 ca.. uncr the A: A. The EE'OC anticipates a tai of Sti,(X10 charges in 1994 (EEAC, 1994). Although some e.r.perIA exnect increases as people becomemore familiar with the ADA (Krantz, 1993), others say that employers should not fear a flurry of lawsuits (Woolsey, 1994).


Additional research and clarification of these issues isneeded and information that is available should be furtherdisseminated. According to the NCOD report, a major obsta-cle in doing so is that the need is beyond what publicresources can handle. The study found that cooperativeefforts between business and government/non-profit groupshad been one of the most effective implementation activities.Clearly, these efforts need to continue. (This is a hearteningfinding since an early poll (Blank, et al., date) showed thatsome employers were skeptical about advocacy groups' pol-icy tc "educate and negotiate first, and litigate as a lastresort" (NCOD, 1993.).

The best way to insure compliance with the ADA is toimplement solid, non-discriminatory, job relevant hiringpractices designed to find and retain the best workers. This isa message which must be clearly delivered to business andindustry, and in particular, to smaller employers who do nothave the resources to support human resource and ADA spe-cialists. The ADA represents a tremendous opportunity toincrease participation of people with disabilities in the work-force by facilitating entry and by reinforcing programs tohelp injured and disabled workers return to work.

Issue 6. Disability Management:Information Age Case Study

All the actions and programs designed to control the humanand dollar costs related to disability in the workplace are referredto collectively as disability management (Owens, 1993). Itincludes disability prevention activities, as well as insurance-financed medical care, return to work services, job accommoda-tion, and compensation for lost wages. Disability managementprograms reflect an employer's overall human resource strategy(Owens, 1993). Assisting people to regain functioning and toreturn to work is the cornerstone of disability management pro-grams (Kirchner, 1994).

Employers who put a premium on human resources and whoseek to attract and retain highly skilled workers are more likelyto have such services; those businesses more willing to tolerateturnover, are less likely to have programs in place.

In the information age, with increased attention in attract-ing and retaining skilled workers, it is not surprising thatawareness about the positive benefits of disability manage-ment as an integral part of business operation is developing(Washington Business Group on Health, 1994). Since workis part of a healthy lifesiy!e, disability management pro-grams are increasingly becoming part of the total health andwellness progranis of larger businesses.

All employers are concerned about the cost of illness anddisability in the workplace. These costs are experiencedthrough health insurance coverage, workers' compensationprograms, disability and health insurance benefits.5 Costsare also derived from the loss of productivity due to therehiring, retraining and readjusting necessary when anemployee is unable to return to the job.

These costs are rising at alarming rates. If current trends con-tinue, worker's compensation costs will increase to $150 billionby the year 2000 (WBGH, 1994). In the past 20 years, they haverisen nearly 1,100%, largely due to the increase in medical carecosts (Schachner, 1989). Presently employers are spending inexcess of $10 billion a year on short and long term disability pay-ments and about $69 billion on workers' compensation programs.

Disability management programs have been reported to bean effective cost containment measure. One source suggeststhat from 25 to 30 percent savings is realized in the first yearafter implementing a disa' 'lit), management program thatincludes both prevention and return-to-work features(Maloney, 1992). Disability management defrays costs relat-ed to disability and injury, and preserves vital humanresources so critical to competitiveness. It also contributes tothe overall wellness of the individual by helping to reducethe onset of secondary disabilities and reducing negativelypsycho-social aspects of disability or illness.

Small employers of under 500 employees may only makelimited services available and the smaller the employer, the moreinformal or low budget the services may be (Owens, 1994).Many are joining local business consortiums on health that wareoriginally formed to address raising health care costs but nowalso address disability, return to work and ADA issues (Owen,1994). The very small companies rely on the worker's compen-sation carrier to manage disability, or will provide very informal,personal support (Lechner, 1994).

Large companies on the other hand, are undergoing a majorrestructuring of in-house disability management programs thatare in line with the corporate restructuring and downsizing dis-cussed under Issue #3 of this paper. According to KathleenKirchner of the Washington Business Group on Health (1994),although interest in disability management programs is at an alltime high, in-house disability management departments becom-ing smaller. The function is being integrated with related activi-ties such as occupational safety and health, wellness and healthpromotion, managed medical care, employee assistance andworkers' compensation programs. The result will be a continu-um of care and one that appears treat disability in a more nor-malized fashion.

As part of downsizing, one or more highly skilled profes-stJaals (knowledge. workers), with a broad knowledge andexperience base remains as manager. Essential functions willremain in-house, but other services are and will continue t3be outsourced to specialized consultants and smaller busi-nesses. (In-house rehabilitation and disability managementprofessionals in large companies are experiencing the sametumultuous shifts that have been experienced by others in theworkforce.) It therefore becomes critical for 1ar3er compa-nies to form ;:tiategic all!ances atith apocopriate vendors andvocational rehabilitation providers to secure the disabilitymanagement services that they need.

What does the future hold for disability management? Bythe year 2000, the incidence of injury is expected to decline

5 Is is not the intent of this pal delve into the comp?ex legal and policy issues related to worker's compensation, health care reform, and disability management inthe workplace. The history, issues, and related concerns of this system were reviewed in the 1993 Switzer Seminar Series, "Private Sector Rehabilitation: insurance,Trends and Issues for the 2lst Century."


by 5% to 7% as the workplace continues to shift from pro-duction to information and service jobs (Schachner, 1989).Robotics are being explored to reduce occupational illnessand injury in more dangerous manufacturing settings(Lambrinos arid Johnson, 1984). In spite of these positivedevelopments, serious concerns related to disability in theworkplace loom on the horizon. Health care costs will con-tinue to rise, AIDS is expected to increase significantly, andthe changing demographics of the workforce will createadditional challenges.


The umbrella of disability management has resulted in voca-tional rehabilitation services moving from the public sector intothe private workplace, reducing costs to the public and to thebusiness. Through disability prevention and wellness programs,overall health and functioning are maintained and, through dis-ability management, the impact of disability on individuals andtheir families should be lessened. The high interest in disabilitymanagement translates into opportunities for small businessesand rehabilitation and disability consultants to further advancethese services in the workplace.

Disability management services will need to become moresophisticated to meet 21st century demands. The workforce isaging for a variety of reasons (i.e., demographics, personal eco-nomics, extension of the retirement age, and the desire to retainexperienced workers). Although aging does not equate with dis-ability, loss of function is associated with advancing years, anddisability incidence increases with age. Disability managementneeds to plan for this trend. Some companies are implementingwellness programs for older workers, but the possibility ofincreased disability related to age - associated illnesses and dis-abilities or more severe injuries due to accidents exists(Schachner, 1989).

As women and minorities enter the workforce in increasingnumbers, it will be necessary to address the disabilities andchronic illness more common to these segments of the popula-tion. For example, depression, lupus, multiple sclerosis anddepression are more common among women. Stress related con-ditions could become more prevalent in an information ageworkplace where job change, flexibility, high productivitydemands, job redesign and role changes, are more prevalent.Business and industry will need to address the possibility ofstress related illnesses and disabilities exacerbated by stress,such as certain psychiatric disabilities. (The EmployersResource Center on the ADA and Workers With PsychiatricDisabilities operated by The Washington Business Group onHealth is a resource for employers in making accommodationsfor psy eh;atric

row to manage chronic illness, including AIDS, cancer,chronic heart disease and other debilitating illnesses is yet anoth-er challenge for disability management in the 21st century(Kirchner, 1994). Tn the case of AIDS, approximately one mil-lion Americans are infected with the HIV virus that causes thedisease. The Ln ljority who are infected now, and who are expect-ed to be infects 1 in the future, are between the ages of 24 and 44.

hey make of f,3% of the current workforce and AIDS is thethird leading cause of death among them (CDC, 1992). TheBusiness Response to AIDS program, sponsored by the Center

for Disease Control, suggests that businesses develop a compre-hensive AIDS program with five essential elements: A writtenworkplace policy, a training component for management andlabor unions, an education program for families and employees.and a plan for community involvement to deal with issue (1992).The workplace policy statement outlining and defining the com-pany response to the illness is a key component that has rele-vance to all chronic illnesses.

Just as many enlightened companies had policies and prac-tices in place that wri-; in alignment with the ADA when iipassed, so are there many companies prepared to deal with thecrisis of AIDS, not only f smn the perspective of economic self-interest (Froiland, 1993), but with sensitivity and compassion.As business and industry assumes an ever wider leadership rolein dealing with many of the social challenges and problems fac-ing the world, the talents and knowledge of enlightened leadersand companies will be in increasing demand.

Business and Rehabilitation:Working Together in Community

Historically, business has been considered primarily as aneconomic institution. In recent decades, Hawkins contends(1992) that business has become an important global culturalinfluence as well. At a time when the credibility and influence ofpolitical, governmental, social, educational and religious institu-tions has declined, business is filling a leadership void. Withgreater resources and flexibility, business will begin "to assumeresponsibility for the whole." According to Avishai (1994),"What is 'best' for companies is also, more and more, 'right' forpeople." Others at the forefront of business philosophy suggestthat a fundamental shift in values is transforming the way busi-ness operates, and part of the shift is a greater concern for com-munity (Renesch, 1992; Hawkins, 1992).

At the same time, Peter Drucker applauds thc impressivework of non-profit community organizations which he calk thethird sector. Their greatest contribution wil: come when theybegin to serve as "new centers of meaningful citizenshin" torknowledge workers who need greater community connection.Robert Reich (1991) says we need to "assert that our mutualobligations as citizens extend beyond our economic usefulnessto one another, and ac, accordingly" to resolve some of theDressing challenges of the information age.

This paper described the information age, its implications forbusiness and industry and the field of vocational rehabilitation.Six issues were examined: Skill needs, labor shortages, flexibleworkplace policies, technology, the Americans with DisabilitiesAct and disability management programs. All pointed to increas-ing possibilities for people with disa7nlities in the workplace.The paper proposed a vision of oppoi nifty, a job for everyonewho wants to work in a challenging oductive, and economi-cally rewarding capacity that contri' e.s to the greater good.This is not a vision based on charity, bin community. People withdisabilities, along with many other roe ps who are economical-ly marginalized, have a right and an lility to work and make acontribution. It will take a commitir t of community to breakthrough the intransigent barriers that ' sseps almost 70% of peo-ple with disabilities out of the labor market or unemployed. Thebarriers are not insignificant: discrimination, lack of health care


reform, deficient education and training systems and the need forgreater job diversification.

If the figure of 70% "ni to decline, busincsq vc national reha-bilitation, and the government, must work in partnership withpeople with disabilities at local, state and federal levels. To beeffective, such efforts, for which there are already many exam-ples, must include all members of the community. Not only mustpeople with disabilities be actively involved, small businesses,the structure for job creation, innovation and active communityservice (Frishkoff and Kcstecka, 1991) must not be overlooked.The energies need to be mobilized to seize opportunities andaddress challenges and obstacles, only some of which have beenidentified in this paper.

Finally, just as business is increasingly expected tobecome more socially responsible, so should vocationalrehabilitation become more businesslike. As knowledgeworkers, vocational rehabilitation professionals need to keepabreast of the fast-paced, constantly changing business andsocial environment in which they practice. They need towork smarter (i.e., use technology to achieve goals andengnge in constant learning). They need to listen to andrespond in a timely manner to the needs of their customers,a diverse group of individuals with disal'.ilities and businessand industry partners. In planning, they need to engage allstakeholders in the process.

As the private sector takes more responsibility to solvesocial problems like AIDS, homelessness, and substanceabuse, the lines between the public and private sectors willfade (United Way of America, 1989). They will also fade asthe private sector becomes more concerned with the needs ofbusiness. The result may be an entity called "community:'

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3534

National Rehabilitation Association 1995 Switzer Monograph

Excerpts of Reviews and Comments Chaigekv Three

gebra A. Perry's paper "TheInformation Age: What it Meansfor Business and Vocational

Rehabilitation", offers an excellent,comprehensive overview of the state ofthe art of vocational rehabilitation and itsrelatively recent emergence as a new,bona fide part of the marketplace. In fact,Perry states emphatically that businessand industry will be a significant, defin-ing force in shaping the character andmethodology of vocational rehabilitationin the 21st century. She also mentions thecritical role the projects with industrypartnerships have played in cementingthis important development.

The bulk of the information agewith its accelerated rapid changes intechnology and the computerization ofthe marketplace, she ;ells us, is creat-ing an exciting scenario in which theindividual with a disability can be"programmed" to compete on an equalbasis. There is a giant step, a mile-stone if you will, which will furtherbring vocational rehabilitation, busi-ness and industry, together as partnerson this exciting new era. The "capaci-ties" of the client, e.g., intelligence,special schools, education and train-ing, interpersonal skills, motivation,all become critical "marketplace prod-ucts" to enhance his/her worth as aproducer of products and services.

The V.R. program and business andindustry, nova are bona fide partners inidentifying potential workers andentrepreneurs for the American mar-ketplace. With this scenario, individu-als with disabilities now could be inthe eve of a new golden age of oppor-tunity and success.

Perry's paper portrays for us a newexciting era for vocational rehabilita-tion. Its alliance with business andindustry in the American marketplacewill broaden as well as create newopportunities for V.R. clients. Theimplications for progress are excitingfor both V.R. and the millions ofpotential workers with disabilities whowill help shape the character of the21st century.

Angela Traiforos

Ms. Perry provides a sterling por-trayal of the business-vocationalrehabilitation nexus and the

impacts that the information age willhave on that nexus in the future. Thecore thesis presented in the manuscript isparticularly relevant given the recent,and probably continued, resurgency ofemployment as an outcome of rehabilita-tion program.

The thesis is that vocational reha-bilitation and business are inextricablyconnected. And, as opportunities inbusiness expand, employment oppor-tunities for people with disabilitieswill expand, provided the rehabilita-tion system is positioned to takeadvantage of the opportunity.

The challenges stemming from thethesis are multifaceted, as noted by Ms.Perry. The challenges include a need to:

Understand, monitor and use labormarket information/trends in a man-ner that advantages current "job-ready" individuals with disabilities aswell as those in the early stages of thevocational rehabilitation process;

Structure the vocational rehabilita-tion system so that it is also "leaner,meaner and smarter" and has thecapacity to be responsive, credible,competent and reliable; ard,

Continually work toward improvingknowledge, structures and interac-tion by establishing effective con-sumer input mechanisms.

Judy Norman-Nunnery

This is a big subject, and Debra Perryhas obviously done her homework,listing nearly 70 entries in her select

bibliography. For anyone wanting anintroduction to the issues associated withknowledge work in the 21st century,especially the new workplace skillrequirements and their impact on peoplewith disabilities, her monograph is agood place to start.

Perry is probably more hopeful thanI am about the possibilities of commu-

13

nit;; action reducing the high rate ofunemployment among people with dis-abilities in the future, but her paper isfull of provocative insights, and oneends up reacting to them in a way thatchallenges some basic assumptionsabout the role of rehabilitation in aninformation age. Labor shortages havenot resulted in increased opportunitiesfor people with disabilities, Perrynotes, since the 1994 Harris Poll showsthat the numbers working are actuallydeclining. Small business will be theprincipal area of job creation in thefuture, she says, but small businesstypically lacks the trainingresources necessary to provide oppor-tunities for hard-to-serve applicants.Even new technology turns out to be amixed blessing, supportingdistance-learning and home-basedenterprises, but also allowing us to use"contingent workers". The better jobsin our society are becoming knowl-edge-based, but fewer and fewer peo-ple with disabilities are pursuingadvanced training and higher educa-tion. Such contradictions abound inany analysis of the future.

Perry's research also raises somedisturbing questions. Will the cogni-tive content of future jobs prove to beas much of an obstacle to ae employ-ment of people with disabilities asemployer prejudice, architectural bar-riers, and lack of job accommodationshave been in the past? Will moresmall-business jobs actually meanmore jobs for people with disabilities?(Will people with disabilities be readyto seize the opportunities inherent inentrepreneurship and in home-basedemployment?) If the best future jobsare solving, teamwork, critical think-ing, etc., where are these things beingtaught today? What organizations haveresponded to this training challenge?And the really big question for thefuture: Will the shift in values that istransforming the international market-place necessarily result, at the localand regional level, in a greater concernfor community? It's no criticism ofPerry and no reflection on her patientresearch to observe that some of the


larE,er issues raised by her monographseem to overwhelm the possible solu-tions.

Jon Lundin

perry notes that by the year 2010,90% of the projected workforce,inducting farmers, teachers, and

police officers, will be affected by infor-mation technologies, i.e., computer net-works, massive data storage systems, andartificial intelligence. Perry predicts thatbecause such development will continueto change at a fast rate, the idea oflife-long learning will be the norm formany professions, including those in thevocational rehabilitation community.

According to the author, technologychanges will not only affect the role andrelationship between vocational rehabili-tation services and business but will also

add greater complexity. Within thechanging complex world of technologyand employment, the employment situa-tion for persons with disabilities willmost likely worsen if efforts are notmade now. These changes can serve asopportunities for persons with disabili-ties, e.g., employee-owned cooperatives.Perry states that despite these changes,technology can make it possible for indi-viduals with disabilities to compete andto have access to rewarding careers.Vocational rehabilitation services need toexploit technology to make these innov-ative opportunities possible. Trainingabout ADA, for example, can help edu-cate business on the benefits of employ-ing persons with disabilities and correctsome of the misinformation that busi-nesses have regarding this legislation.

Technology of the future is here todayand is becoming central for many work-

places in both public and private busi-ness. Rehabilitation service providersalso need to acquire these skills or atleast have a working know lege al' tech-nology in the workplace in order to helptheir clients. Working at home is now apossibility in a number of jobs that didnot exist before; but, it also good toremember that these advar.ces ale slowto come to some parts o: America, par-ticularly the rural areas.

And because business continues to bea major force in the success of vocation-al rehabilitation, students and profes-sionals in vocational rehabilitation needto learn more about business, labor mar-kets, etc.

Jennie R. Joe

36

37


Chapter Four

Vocational Rehabilitation:

Preparing for the 21St Century 61

A Labor Perspective

Akrig,da Traiforos

As one who is active in organized labor and professionallyconcerned with disability and employment issues, I greatlyappreciate the privilege of participating in this 18th Switzer

Memorial Seminar. I also appreciate this opportunity to offer alabor perspective on preparing to meet the rehabilitation chal-lenges of the Twenty First Century. Looking to the century aheadin seeking ways to improve vocational rehabilitation services isa particularly fitting way to commemorate the legacy of MarySwitzer. Miss Switzer shaped her own era while looking to thefuture and building upon the past. The VR services available topeople with disabilities today bear her stamp.

Those who pioneered our field, including especially MissSwitzer, have left much for us to build on. An important part oftheir legacy is the creative partnership between VR and privateindustry, which she greatly expanded through the creation ofPWI and other means. It was also under her leadership that a newbeginning was made to bring organized labor more fully into thispartnership that has done so much to expand career opportunitiesfor people with disabilities.

Now it is the task of those of us who have inherited these respon-sibilities to guide VR along the course so ably charted by our pre-decessors. In staying this course, I believe we are realizing many ofthe hopes of those who pointed the way. Today we are bringing intothe work force people with disabilities so severe that even in thevery recent past they would have been past over as being "unfeasi-ble?' We are opening high technology and professional opportuni-ties to these individuals in unprecedented numbers. And we havemade dramatic advances on the legislative front that build on thepast and open the way to even greater achievement.

Angela Traiforos, Executive Director, IAM CARES. Upper Marlboro,Maryland. 0o

Could we be doing more with the resources now availableto us? I believe we could. And I believe that if Mary Switzerwere here today she would take action to see that we do.Those fortunate enough to share personal memories of MissSwitzer will not forget how her unceasing demands translat-ed into uninterrupted achievement. I believe that she wouldbe gratified and maybe even impressed by the manythousands of people placed in jobs under union auspices dur-ing the last two decades, including 13,000 placed by IAMCARES. I am sure that she would note with approval theimpetus that organized labor contributed to efforts to winenactment of the Americans with Disabilities Act and othermeasures supportive of rehabilitation. But she never was onewho left any business unfinished, such as ensuring that theresources of organized labor are used by the VR communityon behalf of those we serve. It is easy to visualize MarySwitzer moving forthrightly to achieve this goal.

How can one presume to envision how Mary Switzerwould respond to contemporary circumstance so long afterher historic contributions had ended and leadership had beenpassed to others? Cali it educated guessing. Through theforce of her personality and leadership, Mary Switzer thor-oughly imbued her own staff and many contemporaries withher ideas and principals. Three of her disciples who servedon her staff have been my close associates in the IAMCARES family and have been indoctrinating me for years inthe philosophy and approaches that are a part of her legacy.

One major reason behind the high productivity of the VRsystem today in placing people with disabilities in jobs isthat rehabilitation professionals have long made a consciouseffort to understand the needs of employers and to satisfythose needs. I believe that a major reason why the VR corn-


munity is not deriving greater benefits through closer rela-tions with organized labor is that too many people in our pro-fession do not understand unions or how they work. Fouryears ago, as a Switzer Scholar and President of IAMCARES, Charles E. Bradford made a perceptive observationwhich merits quotation in this context "... if we are toreshape future employment opportunities for individualswith disabilities, I believe these people will have to use everyadditional resource available to them in order for them tobecome employed and retain their jobs. In my view, animportant resource that has been overlooked entirely or usedonly minimally is the trade union movement represented byAmerica's labor unions." This observation is intended asconstructive criticism and not as a finding of fault; the aim isto call attention to an area that we believe needs attention.

On the basis of personal experience I can well understandand appreciate an unfamiliarity with labor unions. When Ileft the staff of a VR agency in 1980 to join a pioneeringunion-sponsored PWI project, I knew little about organizedlabor and even less about the International Association ofMachinists and Aerospace Workers (IAMAW), my newemployer. The very first thing I learned is of special signifi-cance: unions, no less in the rehabilitation community, arepeople-oriented. To them, people are individuals rather thanthe collective substance of "manpower" or simply names oncomputerized payrolls. This is what unions are all about: thewell being of men and women at work and the opportunitiesavailable to those who need work. As a rehabilitation profes-sional I found immediate comfort in the labor environmentand quickly became a dedicated trade unionist.

Without the understanding of employers' needs that is soessential to VR services, the critical job placement functionof VR would founder. While VR processes can and do pro-ceed in the absence of an understanding of unions and theirfunctions, my experience over the past 15 years convincesme that our profession and those we serve would benefit sig-nificantly if a wider understanding of unions existed withinour field. Unions have much to offer in our common aim ofhelping those whom we serve.

To better visualize how union resources could be used toadvantage in rehabilitation, it is well to consider first someof the functions and needs of unions. While the legal obliga-tions of labor unions relate specifically to their members,unions traditionally have been a source of help in coopera-tive efforts to improve the working lives of all Americans,including those with disabilities. This is a tradition that is asold as the labor movement itself.

Union locals have deep roots within the communities inwhich they operate and can be valuable allies of VR at thelevel of service delivery. In many instances they have earlyknowledge of job openings in establishments where theirmembers work. They monitor state and local legislative ini-tiatives that could affect workers and they often can influ-ence such legislation for the benefit of workers and job seek-ers. In union shops they can and do assist employers ineffecting appropriate job accommodations for workers withdisabilities. Union shop stewards routinely provide on-sitesupport to new employees which in many cases is of criticalimportance to those with disabilities.

Organized labor can be a resource in helping to secure localfunding for job placement and other programs benefiting peoplewith disabilities through the use of JTPA funds allocated by theDepartment of Labor. This help could be of particular impor-tance in meeting the needs of youths with disabilities in theirefforts to make the transition from school to work. It also couldbe of major importance in assuring that JTPA supported pro-grams that provide employment assistance for displaced workersalso include those who have disabilities. Such programs now arepriorities of the Department of Labor. The legally mandatedpresence of a labor representative on each Private IndustryCouncil (PIC) that plans and approves expenditure of JTPAmoney enhances the value of union support of VR activities.

Business Advisory Councils (BACs) and other advisorybodies assisting VR agencies could benefit by the inclusionof greater representation of organized labor, particularly inlocalities where PWI and other rehabilitative child place-ment programs are seeking to place individuals with disabil-ities in jobs covered by union contracts. Even apart fromemployment concerns, labor representatives can provide bal-ance and valuable perspectives on legislative and other issuesthat are important to the rehabilitation community.

Whereas unions can and do recommend individuals toemployers for jobs, it must be borne in mind that employ-ment decisions are the prerogatives of the employer and notthe union. When an individual with a disability is employedin a union shop, the union immediately assumes the role offriend, mentor, and advocate in the work place of that indi-vidual on the job. It is important to bear in mind that, withinany bargaining unit of an employer with a labor agreement,the law requires the union to represent members and non-members alike, regardless of disability status.

There are, of course, different types of unions, just asthere are different types of employers. Some of the definingcriteria may be related to type of industry or business activi-ty: there are industrial, construction, transportation, and pub-lic service unions. Vocational rehabilitation counselors andothers working with these unions on behalf of people withdisabilities should become acquainted with the characteris-tics of those unions with which they have regular contact.Like other organizations, unions are structured, and it isessential that those who work with unions have some under-standing of their organization in order to make the right con-tacts and deal at appropriate levels.

In establishing and cultivating useful relationships, under-standing of some of the current concerns of organized laborcan be very helpful. Most VR counselors are cognizant oftechnological advances and related factors that are reshapingthe American workplace. Significant changes are affectingprocesses and organizational features within the workplaceas well as the way individual workers are performing theirtasks and relating to supervisors and co-workers. The trendtoday is toward more decentralization, greater latitude forinitiative on the part of the individual worker, and anapproach to managing that no longer is a one way street.What we are seeing today is nothing less than a far reachingdemocratization of the workplace.

In many instances dynamic industrial change is altering ina positive way the manner in which union representatives


and managers bargain collectively and interact with oneanother. My union, among many others, envisions an equalpartnership that combines workers and management in whatwe call "High Performance Work Organizations" orHPWO's. It has been a common practice for workers andtheir union representatives to be kept out of decision makingor matters affecting their work and how it is performed inspite of their potentially valuable hands-on experience. Inorder to survive in today's competitive world, progressivemanagements as well as union leaders recognize the necessi-ty for replacing outmoded exclusive top-down industrialprocesses with HPWO's that utilize the neglected ingenuityof the American worker.

With Executive Order 12871, "Labor-ManagementPartnerships", the federal government is showing the way byoffering federal employee unions a more balanced relation-ship between management and labor. Today, organized laborwants and expects a full partnership between the unions andtheir members on one hand and management on the other.This involves shared decision making within the industrialprocess to design, build, and market high quality products. Itinvolves the integration of leading edge technology withcontinuous learning and skill development that takes advan-tage of knowledge and experience of front line workers.

Built upon the historic beliefs of organized labor, the part-nership envisioned in HPWO's will lead to restructuringworkplaces and jobs. This will come about in such a way asto provide higher levels of worker participation and enhanceopportunities for workers including those with disabili-ties to increase their skills and value. Five important prin-cipals must come into play:

The separation between thinking and doing will end.

Workers will be free to use their skill, training, andingenuity to do the right thing instead of merely theprescribed thing.

The multilayered hierarchy will give way to a flatterand more democratic structure.

Workers will have decision making roles at all levelsof enterprise.

Rewards from the new systems will be shared moreequitably.

While unions have always sought fair wages and optimalworking conditions, these as the new initiatives illustratehave never defined the limits of organized labor's agenda.Since the earliest days, unions have sought to improve thequality of life in the work environment and maximize oppor-tunity for all workers to advance. Note that these aims also arefundamental in the philosophy and processes of VR.

The impact of organized labor's current initiatives and pri-orities by no means will be confined only to enterprises wherelabor agreements are in effect between labor unions andemployers. Just as the hard won gains in wages, hours ofwork, and working conditions that unions have achieved fortheir members have carried over into the non-union segments

40

of industry, historic precedents tell us that the trends underly-ing the new initiatives of organized labor will permeate thegeneral work environment. When we discuss what organizedlabor is seeking for union members, we also are dealing withimprovements that, sooner rather than later, can be expectedto affect the work environment of virtually all Americans onthe job. I believe that the accelerated evolution bringing thesechanges will have significant impact on VR and will producesubstantial benefits to the men and women with disabilitieswho enter the work force with the help of VR services.

Certainly the new initiatives of organized labor will havean early impact on the rehabilitative job placement and relat-ed services that are delivered to people with disabilitiesthrough programs directly operated under the auspices oforganized labor. I refer to the PWI programs and relatedactivities of the Human Resources Development Institute(HRDI) of the AFL-CIO and the Center for AdministeringRehabilitation and Employment Services (IAM CARES) ofthe Machinists Union. Both of these labor-affiliated agenciesoperate extensive PWI and other employment-related pro-grams for people with disabilities and both have close rela-tionships with employers expected to cooperate in the imple-mentation of HPWO's.

HRDI has been providing employment assistance to peo-ple with disabilities along with women and minorities since1968. The rehabilitative job placement programs now oper-ated by IAM CARES began with the establishment of ourfirst PWI project in 1980. Over the intervening years, bothHRDI and IAM CARES have come a long way. Today IAMCARES is one of the largest providers of PWI services in theUnited States and Canada.

Since the characteristics and activities of HRDI and IAMCARES were described in a previous Switzer MemorialSeminar and are widely recognized throughout the rehabili-tation community, I will focus here on updating performancedata pertaining to my agency and discussing some conclu-sions drawn from IAM CARES' experience in applying inno-vative approaches in various settings. In fiscal year 1993,IAM CARES placed approximately 2,000 individuals in jobsin its 19 service areas in the United States and its two serviceareas in Canada. In this country we are now placing individ-uals with disabilities in jobs at a rate of 1,500 a year, and ata rate of 400 a year in Canada. Since our job placementsbegan in 1981, we have placed a total of 13,000 individualsin jobs in both countries. Also since the start of our services,three-quarters of those whom we have placed were classifiedas being severely disabled.

IAM CARES began its first project devoted to supportedemployment in 1980, and we now operate such programs in19 areas. The most unusual of these was established by theBoeing Company in cooperation with the Machinists unionin 1989. This program returns to work Boeing employeeswho developed aisabilities during their employment. Mostsuch employees are able to return to their former jobs orother jobs adapted to their capabilities. However, individualswho cannot work without a high level of support areemployed through the supported work program. Theseinclude individuals with some of the most severe disabilitiesever seen in a private industry work setting.


Perhaps the most unique features of this program are itsorganization and funding. Under a labor agreement negotiat-ed between Boeing and the Machinists union, theIAM/Boeing Health and Safety institute was established in1989 to address occupational health and safety issues andtraining needs of the worker. One of the first initiatives to bedeveloped was the Return-to-Work Program. In keeping withthe joint decision making process, a team was selected rep-resenting both union and company to study the occupationalhealth and safety issue, make recommendations, implement,evaluate, and replicate the program company wide. The mis-sion of the Return-to-Work Program is to provide the oppor-tunity for the occupationally injured/ill-worker to return tosafe and productive employment as soon as possible. Thecompany agreed to spend four cents a year for each bargain-ing unit compensated hour but not less than $4 million a yearin support of the Institute's activities. The first of its kind inthis country, the Institute is administered by a board of direc-tors consisting of fifty percent management and fifty percentunion representatives. We hope that, in other locations, wewill be able to participate in replicating the IAM/BoeingHealth and Safety Institute model, including its creative pro-visions for long-term financing.

IAM CARES, like many other agencies in our field, is plac-ing increased emphasis on bringing into the work force individ-uals with disabilities that are extremely severe and who, in yearspast, would have had job opportunities limited at best to shel-tered workshop employment. After placement, many of theseindividuals require support on the job beyond that normallyavaikble through PWI programs. An innovative way that wehave developed to meet this need is through adaptation of thelong standing practice of our union to assign a "buddy" to helpevery aewly employed member become familiar with his or herjob and meet the requirements of the work place. When neces-sary, we in effect extend the buddy system to non-union work-sites by making special orientation available to co-workers toqualify them to serve as mentors for fair newly employed pro-gram participants with severe disabilities. We also are providingextended follow-up by program personnel when this is neces-sary. In doing this, special attention is given to the needs andconcerns of employers, particularly when problems of adjust-ment can be anticipated.

To assure continuity of IAM CARES services we haveinstituted special training for all professional members ofour field staff to familiarize them with .oethods of identify-ing and taking advantage of opportunities to erlist localfinancial participation in program support. This activity haspaid off for our programs and the individuals they servethrough increased funding for services from local sources,including employers.

One of the greatest advantages that we derive from ouraffiliation with IAMAW is access to the union's comprehen-sive Education and Technology Center made available to usfor in-service training. Located in Hollywood, Maryland, thiscenter features a unique acedemic faculty recruited frommajor universities, modern classrooms with the latest in audiovisual equipment, a computer laboratory with instructor staff,library, conference rooms, individual living quarters, recre-ational facilities, and shuttle service linking the campus to

Washington National Airport. The union makes this facilityavailable to IAM CARES annually without cost. Here ourstaff members are brought up to date in such areas as legisla-tion, new developments in VR, and economic and employ-ment trends that affect our work. Our courses are accreditedby the Certification of Insurance Rehabilitation SpecialistsCommission/Certification of Rehabilitation Commission.

In looking ahead to the next century, I believe that farreaching changes taking place in demographics, industrialtechniques, social attitudes, and legislation indicate a needfor greater emphasis on professional development in ourfield. It is reasonable to anticipate that, at all levels, VR willbe facing new and perhaps unfamiliar challenges. Some ofthese are becoming evident even now. In IAM CARES weare finding a need for greater versatility on the part of ourstaff that increases the importance of continued staff devel-opment and in-service training. As VR agencies becomemore diversified in their activities, as I believe they will, pro-fessional skills must develop accordingly.

To better prepare us for the future, IAM CARES is devel-oping capabilities that reach well beyond our traditionalfunctions of delivering rehabilitative job placement andrelated services to people with disabilities. We were amongthree agencies selected by the Departmem of Education todevelop training materials to be used nationally in facilitat-ing implementation of the ADA by various segments of thepublic. This involved design of an information program fea-turing the use of a motion picture available in video cassetteformat developed by IAM CARES. We also developed mate-rials for publication directed to such audiences as employers,union personnel, public officials, people with disabilities,and others directly affected by this law. These materials arebeing processed for mass distribution.

Further expanding our capabilities, IAM CARES hasdeveloped a program to familiarize union shop stewards andsupervisory personnel in industry with the aspects of ADAwith which they will be concerned. We now are seekingfunding to implement this program.

Organized labor and the VR community share many commonvalues and social objectives related to the well being ofAmerica's workers, including particularly those with disabilities.The individual unions that make up the labor movement are wellestablished in their communities as well as nationally, and can besupportive of programs that serve people with disabilities.Unions can open doors, promote constructive legislative initia-tives that are a common interest, locate job openings, and rendertechnical assistance relating to problems within their areas ofexpertise. A closer relationship between organized labor and VRcan be mutually advantageous and ultimately can be of benefit tomany people with disabilities. It is incumbent upon us in the VRcommunity rather than representatives of organized labor to takethe initiative to make these relationships a reality. An organizedlabor presence on our Business Advisory Councils and otheradvisory bodies can add much of value to our programs.

We in the labor component of the VR community are grat-ified at the progress that is evident in the growing contribu-tions of people with disabilities to this nation's economy andwe are proud to have a part in preparing VR for the TwentyFirst Century.


Excerpts of Reviews and Comments

The central theme of this paper callsfor improved relations between therehabilitation community and

organized labor, a relationship that canbe beneficial to both entities. Traiforoscites a number of labor and rehabilita-tion partnership programs, such asProjects with Industry and IAMCARES, as successful examples ofthese joint endeavors. JAM CARES;for example is the result of a 1989labor agreement between Boeing andthe machinists union that led to anoppor .nity to establish a Return-to-Work program: a program which gavethe occupationally injured/ill-work arsan opportunity to return to safe andproductive employment.

Traiforos notes that this modelcould be used in more workplaces, butone of the major barriers that hamperspartnership between organized laborand the vocational rehabilitation com-munity is the lack of knowledge by VRproviders, especially of organizedlabor and its potential for assistingunion members who have disabilities.

Bridging relationships with unionsis a worthwhile endeavor for the VRproviders, but the VR-union partner-ship has its limitations. One limitationis that these resources are restricted tounion members and the other is thatthe model cannot be replicated every-where. Some communities have moreunion visibility than others. For exam-ple, this model would exclude ruralcommunities that have little industryand few if any organized labor unions

Jennie R. Joe

The potential of union involvement inthe vocational rehabilitation processhas yet to be fully realized by reha-

bilitation professionals. Ms. Traiforosprovided a fundamental perspective onthe role of unions for the vocational reha-bilitation system of tomorrow. Theunion-rehabilitation model described byMs. Traiforos is worthy of serious con-sideration and replication.

In preparation for the 21st century,an excellent opportunity is offered to

examine the role of the union moreintensively. For instance, as morevocational rehabilitation agenciesinstitute total quality managementprograms that stress labor-manage-ment partnerships, policies and pro-grams could be developed more com-prehensively to ensure active and con-tinuous union involvement in thefuture. Further, as rehabilitation agen-cies expand employment services,working with unions will be critical indispelling notions of employee dis-placement. Lastly, from an internaloperations as well as an external per-spective, rehabilitation personnelshould be trained to become moreeffective in working with unions.

Judith Norman-Nunnery

ims. Traiforos' paper indicates clear-ly the potential for positive resultstoward the ultimate goal of gain-

ful employment of persons with disabili-ties when steps are taken by the VRSystem to work with the business andlabor community. There is no doubt thatprograms that incorporate the combinedefforts of both the labor unions and VRwill result in tremendous gains towardemployment. These results demonstratethe need for the VR Program to focusmoae effort toward becoming a partner inthe business and labor community.

Taking the idea a step further, I

believe improved response and resultscan be realized if the VR Programbegins to strive to become a businesspeer as opposed to a service providerfor business and labor. The VRProgram has much to gain by becom-ing a part of the business and laborcommunity. Instead of presenting theassets of the VR Program to the busi-ness community as a service, the VRProgram should begin to integrate intothe business and labor sectors as apeer. As a cooperative partner, successtoward the ultimate goals of the pro-gram should become much easier. Ms.Traiforos demonstrates what is possi-ble when the labor unions and VRwork together as a team. The same is

Chapter Four

possible throughout the business com-munity, and will come about with lesseffort when VR is positioned as a peerwithin the business sector, postured tohelp implement labor solutions.

Philip Kosak

Angela Traiforos reminds us thatlabor unions are "people-oriented"by definition, as well as the natural

allies of rehabilitation in the passage ofnew legislation and the delivery of ser-vices. Certainly they are the forgottenpartners in the training and placement ofdisadvantaged adults, for, as Traiforospoints out, her own union-sponsoredProjects with Industry Program (IAMCARES) alone has been responsible forfinding jobs for 13,000 persons with dis-abilities over the last two decades.Unions are one of the mainstays of theAmerican middle class, whose consum-ing power still drives the economy andsupports our national standard of living.They !-,ave long been advocates ofemployee rights and opportunities foremployee advancement, and many oftheir Return to Work Programs havebecome models of job accommodationfor injured workers. The trouble is thatmost people in rehabilitation don't payenough attention to them and don't makean effort to use them to their advantage.Good job placements - and union jobsare almost always well-compensatedjobs - are tough enough to achieve thesedays; we can hardly afford to overlookany opportunity to improve the odds.

Jon Lundin

This paper calls for ensuring that theresources of organized labor areused by the vocational rehabilitation

community on behalf of individuals withdisabilities. The author believes that thisis not happening at the present time dueto the lack of understanding by profes-sionals in the vocational rehabilitationfield of how unions work.

Unions tend t, rocus on the needsof individuals who currently work, and


on the opportunities available forthose who need work, thus makingthem a natural partner of the vocation-al program in:

identifying job openings andemployment trends in companieswhere their members work;

monitoring and advocating for:egislation effecting the work-place; and

playing a role in brokering rea-sonable accommodation issues aswell as serving as mentors to fol-low workers with disabilities.

A partnership with organized laborcould assist the vocational rehabilita-tion system in obtaining greater use of

JTPA funds and programs such asschool-to-work, displaced homemak-ers, and others, by having the laborrepresentative on the Private IndustryCouncil advocate for a greater percentof these funds to be used on behalf ofindividuals with disabilities.

The paper touches on the impactthat technology is having on the work-place, changing the way workers dotheir job. It also reinforces what wealready know - that quality manage-ment and shared decision making isbecoming a way of life in today's workenvironment.

The goals of organized labor - fairwages and optimal working conditionsalong with the maximizing opportuni-ty for all workers to advance - are fun-damentally the same goals the voca-

iional rehabilitation system has for itsonsumers.

Organized labor has a long historyof influencing workforce trends inboth unionized and nonunionizedenvironments. The involvement oforganized labor with the vocationalrehabilitation program should acceler-ate the rate at which individuals withdisabilities are incorporated into theworkforce.


43


Chapter Five

Rehabilitation Education

in the 21st Century

Daniel C. McAlees

If there is a theme underlying my thoughts while writing thispaper about rehabilitation education in the next century, itwould be that of "inclusion, access, and impact."

Inclusion, through educational designs which permitapplications to individuals respective of and accommo-dating to locale, cultural heritage, or disability need;

Access, for all individuals in forms appropriate to needand which are both available when they are neededand affordable; and

Impact, with training outcomes which are measurable,relevant, and valued by all concerned.

This theme is, in part, a reflection of changes taking placethroughout government and America that will naturally affectwhat we will need to do in rehabilitation education in the nextcentury. It would also reflect the issues of relevance and respon-sibility within rehabilitation education, as viewed through theeyes and expectations of the constituencies of our programs.While we certainly will never gain consensus during our meet-ing here at the Switzer Seminar, I do hope to stimulate our col-lective intellects to increase our inherent commitments to peoplewith disabilities, to return to our individual settings with addedperspective and better ideas about how to effectively embraceand solve some cf the issues rehabilitation education will face inthe 21st century. Rehabilitation education will be at a juxtaposi-tion; it will have before it a tremendous opportunity to providedirection for persons and organizations concerned with theimpacts and resolution of conditions brought about because ofphysical, psychological, and functional impairments.

We must seek partners throughout the consumer and the pro-

Deviel C. MvAlees, Ph.D., Director, Rehabilitation Research and TrainingCenter, Professor, Rehabilitation Education, University of Wisconsin-Stout,Menomonie, Wisconsin


4 4

fes'ional communities with whom to work toward clearer andappropriate expectations for rehabilitation education and foreach of us as educators and trainers. We need to engage in self-examination and explore the conflicting demands made upon uspersonally by the shifts in methodological paradigms.

The theme we find in the paradigm shift is not only aboutsocial change, though it is part of that. Mc theme is abouchanges in demand brought about because of new awareness ofneed, possibilities for a better redity, and challenges brought tothe rehabilitation education enterprise to which many of us haveinvested sigai3cara periods of our professional lives and greaterparts of our personal hopes. The theme is about taking the nextstep into relevance of our rehabilitation education programs.

In the 1070s we confirmed new systems. In the 1980s wewould present methods for assurance. In the 1990s we are pur-suing coalitions as ways to solutions. In the 2000s, we will needto not only devise rehabilitation around individual needs, we willneed to provide services and processes which account for indi-vidual differences and accommodate not a single, cultural norm,but processes incorporating multiple heritages. This maturationinto diversity demands that each of us look seriously to the pos-sibilities and our roles in explaiding or bringing practical mean-ing to inclusion, access, and impact.

The spirit and the enforcement of newer civil rights laws doesnot permit us the option to continue the status quo. These lawsdemand that there be a climate rich for change. Acts and resultingregulations are today widening what can and will be real withinAmerica, among Americans with disabilities from within andacross all segments of a recognizable diverse American culture.

Changes in Rehabilitation and inSociety in the United States

This paper presents my analysis of some of the chal-lenges, trends, opportunities, and realities that I believe willinfluence rehabilitation education in the 21st century. My

National Rehabilitation Association 43

view is based upon the premise that rehabilitation educationis a force for empowerment of persons with disabilities inour society because it provides an environment that encour-ages discovery; respects the possibilities of intellectual andsocial integration, demands of the participants application ofboth principles and discovered possibilities; and is our mech-anism, as professionals, to transmit contemporary knowledgeand values to our succeeding generations.

Rehabilitation Education involvementin Promoting Change

Rehabilitation today is undergoing major and significantchanges as indicated by the following trends and significantevents: (a) an organized disability right, movement; (b) anincreasing emphasis on independent living; (c) expansion ofpossibilities and guarantees through the Americans withDisabilities Act of 1990 (ADA); (d) continuing growth of sup-ported employment; !,e) expansion of consumer control throughthe 1992 Amendments to the Rehabilitation Act; (f) a focus oncareer development instead of only job placement; (g) wide-ly based demand for community-based services; (h) a humanresource development initiative; (i) trend towards life-long ser-vices; and (j) emphasis on serving the most severely disabled.The confluence of these trends, along with others, and thediversity of the nation's population, will continue to affect notonly how we envision rehabilitation education programs intothe 21st century, but how we go about transforming the enter-prise and its basic methodologies.

The issues that will face rehabilitation education in the21st century are filled with potential for controversy. Thefield of rehabilitation will be in the midst of efforts directedat the fundamental restructuring of the roles of professionalsand consumers. This will involve clarifying the central mis-sion of services, and in altering the primary basis of servicedelivery. University rehabilitation education programs willbe responsible for a continuous search for "truth" (i.e., whatdoes in fact affect conditions of disability) during thisrestructuring process. It will play the very important role ofexamining alternatives, even when they challenge acceptedpolitical, economic, and cultural values of significant popu-lations present within our constituencies. Vibrant and vitaleducational programs must, therefore, continue to play a vis-ible role and be clearly heard within many of those contro-versies which will occur in the next decade (century).

As fundamental changes will occur into the next century,it will be necessary for us to revisit our underlying premises,processes, and the evidence about how to best achieve learn-ing, and how we go about teaching. It will be necessary forus to engage for a time in some learning to learn and teach-ing how to teach efforts. Rehabilitation education will needto provide a paradigm both for personnel development andthe tools designed in keeping with the new philosophies andemerging services that will be required.

Expectations and Who Is Involved

Meaningful choice, inclusion, and career development forpeople with disabilities require that rehabilitation education

develop instructional strategies that train service providers,people with disabilities and their families, and service agen-cies how to implement: (a) environments which enhanceindividual choice; (b) a continuous provision of supportseach person may require for their success; and (c) an on-going, intentic .Al re-enforcement of respect for individualdifferences, whether those differences are related to ethnici-ty, culture, religion, gender, or disability.

The active involvement of consumers, families, advocates,peer organizations and institutions in rehabilitation serviceswill increase diversity and add more complexity to the tasksand opportunities for enriching curricula for the rehabilita-tion educator; as will the continuing expansion of scientific,technological and professional knowledge that will becomeavailable at this same time. There will also be many societaltrends which will require the particular attention of rehabili-tation educators in the 21st century; such as:

A culturally enriched and diversified society;

The lengthening life span;

Changing demands for quality of life;

Rapid technological change;

Rapid generation of information;

Significant economic and work place changes; and

Emergence of new nontraditional disabilities.

Societal Trends

We can expect to see general trends across disabilities thatrequire serious investments in creating changes in society'sresponses to disability. The following are conditions whichrehabilitation education, through the preparation we provide torehabilitation service providers and administrators, will be calledupon to assist in ameliorating as primary change agents:

Two-thirds of working age Americans with disabilitiesare not working, 20 percent work full time, and 11 per-cent work part time. (1994 Harris Survey)

Eight out of ten working age adults with disabilitieswho are not employed would prefer to work. (1994Harris Survey)

In 1994, 25 percent of people with disabilities had notcompleted high school. (1994 Harris Survey)

Each year the ranks of the illiterate swell with 1 mil-lion teenage dropouts and about 1.3 million non-English speaking immigrants. (Naisbitt & Aburdene,1985, p. 152)

Currently 15 million individuals receive welfare bene-fits. More than half of those on welfare rolls are long-

t rm recipients.5-


Seventy two million Americans have experienced a seri-ous injury, stroke, or other disabling disease; 35 millionAmericans, or one in seven, have ongoing disabling con-ditions; and more than 9 million are unable to work, studyor live independently. (1994 Harris Survey)

Work disabilities increase with age - at ages 55-64,22.2 percent are work disabled. (1994 Harris Survey)

Between the mid-1980s and the end of the century, abouta quarter of all workers entering the American labor forcewill be immigrants. (Federal Immigration andNaturalization Services, 1987, in Reich, 1991, p. 216)

Many industries are reducing the size of their workforce, while global competition is transferring somejobs to other countries and improved technology iseliminating others. Many of the new jobs being creat-ed are part-time or temporary positions with generallylow wages and offering few or no benefits.(Government Accounting Office, 1993, p.14)

New Ways of Thinking and NewDirections for Rehabilitation

The most important impact these propensities will have onrehabilitation education in the next decade will be a require-ment for a new way of thinking and new directions as to how,where and with whom people with severe disabilities canlive, learn, and work. This new way of thinking and newdirections for services involves a shift from a preoccupationwith preparation, care, and treatment to concentration onsupporting participation, building on capabilities, adaptingenvironments, and building relationships. The old way ofthinkirri, meant offering individuals and families a limitednumbe. options. The new way of thinking will meanassisting individuals and families in identifying what isimportant to them, empowering them with decision-making,and spending authority to act upon those choices.

Service Changes. New directions for providing rehabili-tation services to individuals with severe disabilities willchange our expectations about how services are conceivedand held accountable in the 21st century. For example:

Shift from expanding program capacity to increasingservice quality.

Move from fixed and predetermined expectations forpersons with severe disabilities to higher and moredemanding expectations of the individuals themselves,their families and service providers.

Move from short term developmental planning to life-long functional planning based on individual con-sumer needs.

Move from providing a service continuum withemphasis on special facilities and programs to seek-ing service arrays that access multiple diverse

4 6

resources and providing assistance and support asneeded.

Move from a pragmatic grouping of separate, indepen-dent services to recognition of needs for holistic, interde-pendent and integrated service systems to meet theemployment and life nee- of different disability groups.

Move from a system of crn':.....ring models of service deliv-.ffy to one where it is possi to create individual support.

Move from service pay.r., nt based on community-based program budgets to -eimbursement based onvendor performance on indi idual needs.

Rehabilitation Changes. These new directions in reha-bilitation services will have several dimensions:

Provision of services will be based oh the informed choic-es, strength and needs of individuals with severe disabili-ties and their families, rather than forcing choice among anarrow range of preset options and a vroaches;

Planning for and providing services will be based onwhat people need and their abilities, rather thanrequiring more services than are needed or not provid-ing those services which are needed;

Support for individuals, families, and communities togain access to the resources will be available in thecommunity (i.e., job, living arrangements, relation-ships with family, friends and associates rather thanplaces populated only by professionals and other per-sons with disabilities);

Services and supports will be coordinated around thelife of the individual rather than around the needs ofstaff and services organizations;

Abilities of ordinary citizens (i.e., co-workers, neigh-bors) will be recognized and used to teach peopleskills, to assist them to participate, contribute andserve as models of appropriate behaviors, and to helpdevelop interpersonal relationships; and

Habilitation and rehabilitation will be viewed as nat-ural community processes, rather than as insular expe-riences into which an individual is put and kept fromsociety until the process is complete.

Current Status in AchievingNew Directions

These new directions in vocational rehabilitation services allrequire a closer partnership or relationship between the rehabil-itation educator and consumer in order that rehabilitation per-sonnel will be trained appropriately for quality service provisionin the 21st century. Although the impact of legislation, nationalpolicy, higher expectations, innovative projects, and other activ-ities are beginning to be felt throughout the rehabilitation sys-


tern, much progress still needs to be made to address theunderemployment, inappropriate employment, and unemploy-ment of individuals with severe disabilities. The momentum isbuilding and will be even more strongly felt in rehabilitationeducation in the next decade.

Current policies, funding mechanism and services whichare offered by our rehabilitation programs represent our bestefforts in light of what we have perceived as "truth".Recently though, new policies, innovations and finding:have encouraged us to explore innovative service strategiesAnd obtain experience with these new ways of thinking andacting. The impact of these new developments in policiesand services has not yet been felt in the life experiences ofpeople with severe disabilities. That impact will not be fullyrealized until rehabilitation education has incorporated thesenew dimensions in its programmatic curriculum and instruc-tional processes.

Rehabilitation Education's Partin the New Directions

It will be a major responsibility of rehabilitation educatorsinto the 21st century to play an important role in the develop-ment of capacity to implement these emerging community-based employment and independent living services for theseverely disabled at the local level. It is our collective respon-sibility to bring together the expertise present among ourrespective disciplines to programmatically address the funda-mental issues of importance to persons with disabilities. Wemust assure that rehabilitation education programs provide theimportant knowledge, innovation, and technological underpin-nings necessary to assure a constructive impact upon the livesof Americans with disabilities.

Community-based employment and independent livingservices for persons with severe disabilities have advancedso dramatically in the past decade that an extensive body ofbehavioral research data now supports an array of effectivetechnological programmatic solutions to community-basedemployment related problems and provides a foundationupon which we can effectively base our education and train-ing. However, the vast majority of persons with disabilitiesare still either underemployed or unemployed. Individualswith severe disabilities are virtually excluded from activeparticipation in community living.

In addition, there is a "New Universe of Disability inAmerica. Societal forces, most visible in the inner cities, arecreating groups of children and adults with impairments thathave not been seen before in the concentrations and magni-tudes that are occurring. The causes, including unprecedent-ed youth violence, abuse, drugs, AIDS, and stress, are wellknown to us" (Kate Seelman, letter to NIDRR awardees,July, 1994). It will be essential for rehabilitation educationto prepare service professionals and program leaders whohave the knowledge and background to truly make a differ-ence in serving these individuals.

Rehabilitation educators will have to aggressively respond tothese challenges and new directions and be committed to equity,excellence and diversity. As part of such proactive responsive-ness, involvement and empowerment of individuals with disabil-

ities will need to be emphasized throughout rehabilitation edu-cation policy making, goal setting, program design, programevaluation, and instructional delivery. While we must maintaincore elements of our curriculums we will also need to developnew directions that address the fnnriarnental problems affectingthe lives and economic well being of persons with disabilitiesand th, programs that serve them.

We need to creatively design reha :tation education pro.grams in reccgnition of the impacts on our constituency ofthe extraordinary mainstream trends in population composi-tion, the economy, science and technology, skill require-ments. health, information highways, and social unrest. Aseducators, it is our responsibility to anticipate and explorethe implications of these trends for our constituencies.

Taking Advantage ofNew Learning Technologies

Rehabilitation will continue to experience unprecedentedchanges during the course of the next decade. New rehabilita-tion models will make it possi;Ilte to meet the needs of in-dividuals consistent with contemporary ph:1osophies of rehabil-itation. Information technology has already helped foster manyof the changes. Increased access to knowledge via technologycan assist all rehabilitation service providers to get equal accessand more fully participate in quality rehabilitation education andhuman resource development activities.

For example, interactive ;computer) online training will fea-ture tutorial instruction (rehabilitation personnel counseled andadvised individually by trainers), as well as provide seminarsand symposia featuring professional-to-professional interaction.Training program delivery will include current state-ofthe-artaudio and video presentations that reconstruct or replace the tra-ditional face-to-face training environments.

Instructional technology nf the 21st century will provideopportunities for potential users ze engage in pre-service andin continuing professional education (including certificationmaintenance and degree study) without leaving their homecommunities or affecting their professional work obliga-tions. In addition to instructional t; wining, the technologywill offer opportunities for interactive meetings, confer-ences, workshops, and institutes, in which rehabilitation per-sonnel will be able to participate from their homes or worksites. Training and other formats of interest and tue to per-sons with disabilities will also be developed to deliver reha-bilitation information directly to persons with disabilities,their family members, and advacates.

The instructional strategies of the 21st century will bebased on variants of distant learning: short-term training,continuing education (to meet personal and professionalneeds), personal mentoring, specific skills development, andpersonal networking with similarly interested persons(including consumers, professionals, resource persons) pro-vided through a computer network.

These models will deliver solutions to issues such as ruralisolated settings, and travel cost and time commitment, related totraditional training activities. Until such strategies are devel-oped, the field will continue to experience a decrease in trainingattendance, in part due to increasing costs of travel and loss of


professional service hours and decreasing funds to pay for train-ing and development of staff.

We will also need to have a particular focus on the use ofcost effective learning technologies. The American culturewill continue experiencing rapid and dramatic change.Because of this quickening pace, there will be a demand forrapid acquisition of new knowledge and learning of newskills. Rehabilitation is not exempted from this picture. Oneof the major goals of rehabilitation education will be thedevelopment of rehabilitation personnel capable of self-directed learning. Consequeotly, it is important to provideand value multiple avenues of learning that include formaland informal means of acquiring information and skills.

Rehabilitation education must respond to this need for effec-tive life-long learning if it is to be a player in the future lives ofpeople with disabilities and their families. Time is of theessence, yet our rehabilitation education system is still evolvingat a slow rate of change. Rehabilitation education will not beable to continue emphasizing the formal slower process ofdegree acquisition through six years of on campus instructionwith the assumption that learning is then completed. New formsof rehabilitation education will need to evolve (e.g., distancelearning, self-paced learning modules). The picture emerging isone where learning will be continually required over a profes-sional lifetime and acquired through a variety of processes toupdate rehabilitation practitioners with the new fast-paced cul-tural changes and information society.

With appropriate technology, rehabilitation education caneffectively react to changing needs and, itself, become a changeinstrument. Individual learner needs and learning styles must beeffectively addressed. Some examples of lifelong learning tech-nology which must be given priority consideration in rehabilita-tion education in the near future include: interactive computer-based learning, interactive video, apprenticeship, interactiveteleconferencing, mentoring, coaching, self-paced modules,availability of diverse trainers from multiple disciplines, build-ing success-focused learning, building on-going learning oppor-tunities that provide for sequential and in-depth lifelong learn-ing, and person-to-person learning.

Using these technologies, learning can be individualized,flexible, outcome focused, and customized to specific issuesand information. Through this technology, the instructionalstrategies developed by rehabilitation educators for the 21stcentury will attend to the recurring theme of "product anduse fit": user-compatibility, user-specific information/prod-ucts, user-advantage, user-understanding of the material pre-sented, user-perceived complexity, user-trial of the innova-tion, user-modifying of the innovation, user readiness, userability, and/or user's time and resources.

In order to accomplish goals of its customers in the rehabili-tation education system across the nation, there will need to bedeveloped a systematic comprehensive method for evaluatinglearner needs. Lifelong learning needs should be addressed in anintegrated, clearly articulated fashion through continuous assess-ment of needs, evaluation of learning effectiveness, and a strate-gic planning process built into the rehabilitation education sys-tem. The planning process will need to be structured to includeall important stakeholders so that a cohesive, well articulated butdynamic education system can be developed.


48

Features of this system would include flexibility, dynam-ic processes, accessible learning systems, reality-basedlearning that is driven by major stakeholder needs, suiracingof assumptions and values about disability and the needs ofindividuals with disabilities, affordable learning opportuni-ties, fundable learning systems, individualized instruction,clear delineation of values and assumptio underlyinglearning modules and instruction, and an emp.Avered envi-ronment of learning where there is clarity about what is to belearned and why.

Rehabilitation education will develop and apply state-of-the-art learning technology .3 strategies for the effectiveteaching of artnership models for providing rehabilitationservices; to effective approaches for examining beliefs andassumptions about delivery of quality services to people withdisabilities; and to enhancing knowledge regarding the appli-cation of empowerment and choice-making strategies toindividuals and rehabilitation organizations.

For example, the increasing capacity of the Internet and therapidly evolving computer hardware and software are beginningto mike possible the production and distribution of digital audioand video. In the 21st century computers will be commonlyused for video conferencing where video cameras are mountedon the tops of computer screens for precisely this purpose.Cameras will become as standard a computer accessory asmicrophones and speakers are now. It can be expected that bythe turn of the century rehabilitation educators will be able todigitize and compress a 30-minute video presentation into 300megabytes, or less, of data. This will be good quality video, fullcolor and nearly full motion with screen resolution about equalto NTSC, the American broadcast standard.

When the U.S. "data superhighway" with a oneGigabithecond data rate is operational at the beginning ofthe 21st century, the download time for a 30-minute videoprogram will be only 2.4 seconds. At that point virtuallyunlimited use of the Internet for the exchange of video doc-uments and live video multi-casting will be possible. Onecan anticipate that a number of new training models andopportunities will arise.

It also seems clear that rehabilitation education will need tobuild a communication infrastructure which supports quick andeasy feedback channels between practitioners, educators, andpersons with disability needs. To be innovative and responsiveto its customers, rehabilitation education must have effectivedatabases, multi-media, and information systems that support allfunctions that relate to delivery of quality training. Moderninformation and telecommunications systems must be estab-lished and continual "technical training" instituted on its usagein order for this interconnectedness to take place. A commit-ment to mutual support and constructive exchange of informtion must also underlie this effort.

Embracing Diversity ThroughRehabilitation Education

An increased emphasis on the application of basic reha-bilitation skills in culturally diverse settings will requiteimproved cultural competence of service providers and ofagencies. We are beginning to see an American society that


is not absorbing other cultures, but an American societywhich 1,S 3tarting to irretrievably take on the hues and sub-det;es of the "peoples of the world."

Understanding DiversityA diversity orientation must be fused into rehabilitation edu-

cation program development and program evaluation. Trainingmust address the need for change in three essential dimensionsnecessary to develop cultural competence: attitude, knowledge,ana skills. The approach will be long-term, comprehensive, andsystematic. It must cause real change in the way people in reha-bilitation think and provide services.

In order to achieve the goals of the ADA and the state-feder-al VR program, rehabilitation educators must incorporate intotheir knowledge, values, training delivery practices, and philos-ophy a greater understanding of the characteristics and conceptswhich underlie effective training delivery with multi-culturalpersons. A philosophical shift must be attained throughout reha-bilitation from perceiving minority culture as a "disadvantage"to valuing diversity and cultural pluralism.

There will be a need for a systemic approach to enhancethe professional and cultural competence of students, serviceproviders, managers of service providers, and communityleadess, including the representatives of groups of personswith disabilities. Culturally responsive educational pro-grams can provide leadership in establishing a culturallyresponsive service delivery system. The development of cul-turally-competent rehabilitation professionals cannot beviewed as a short-term training mission, but must be a long-term process. Whatever the educational format, training pro-grams will need to address issues from a multiculturalapproach to prepare rehabilitation personnel to be effectivepractitioners within an increasingly pluralistic society.

Cultural competence is not something that is simplyadded onto personal and professional competence. Culturalcompetence is acquired through a developmental process andis integrated with other aspects of personal development.Contemporary rehabilitation ascribes to a social system'sperspective which integrates activities of rehabilitation in acommunity model to achieve improved independent livingand employment outcomes. The success of such modelsassumes that personal knowledge and values are integratedso that needs of persons with severe disabilities, especiallyof culturally diverse backgrounds, are truly reflected acrossthe service planning.

Training for DiversityAlmost every professional journal in the field of rehabilita-

tion has, during the past few years, published a special edition oncultural diversity. There is widespread agreement that rehabilita-tion educators need to pursue a life-long strategy of learningabout culturestheir own and those of the individuals they train.Issues associated with training diverse populations have, forsome time, been identified and discussed. However, effectivesolutions to those concerns have not been developed and imple-mented. We are only at the threshold of significant change andthis challenge will remain a priority well into the 21st century.Diversity issues do not have a short-term solution as they are too

much involved with the evolving fabric and form of Americaninstitutions. This must be a continuing agenda within the reha-bilitation education community.

The need to increase rehabilitation educations' effective-ness in preparing persons from culturally distinct popula-tions will be driven by two factors: (a) the evidence thatrehabilitation education has historically been less effective inrecruitment outi each and outcomes with African Americans,Asian Americans, Pacific Islanders, Hispanics, NativeAmericans, and other culturally diverse groups; and (b) arecognition that such populations will make up an increas-ingly larger percentage of those in need of rehabilitation ser-vices. The knowledge and skills associated with culturalawareness and cultural competence will be essential in allrehabilitation education formats.

The consideration of values in rehabilitation practice hasalways been essential, since service providers must alwaysattempt to understand his/her own internalized system of valuesand avoid attempting to impose those values on the personwhom they assist in rehabilitation. We also need to concentrateon the societal issues which influence a professional's, oftenunconscious, confusion about valuing of cultural diversity. Theinfluences of oppression, assimilation, poverty, educatioaalopportunities, family structure, language differences, and themajority's cultural values in rehabilitation service delivery needto be topical issues for learning activities.

An additional phase of educational preparation could empha-size knowledge-building regarding values, attitudes, and beliefsof specific ethnic groups. Specific focus would be on culturespecific attitudes toward disability, family roles, work ethics, ori-entation to time, acculturation patterns, religion, the role of the"helper," and attitudes toward government-funded services.Rehabilitation educators will continue to play a very significantrole in eliminating the propagation of cultural oppression in therehabilitation delivery process by appropriately educating quali-fied rehabilitation professionals for employment in a systemwhich values cultural diversity.

Effective Resources and Strategies

Families. Family life is particularly important to manypersons from minority cultures. As rehabilitation educationbecomes more multicultural, it will continue to look forstrategies which allow working through families and work-ing with families. Families have a significant impact onwhether their members take advantage of opportunities forand achieve success in community employment. It willbecome important to include family in vocational rehabilita-tion planning, assessment, and evaluation. Thus, the nextdecade will see an increased emphasis in rehabilitation edu-cation of a family-systems approach to assessment and inter-vention for individuals with disabilities.

Peer Training. We will also see an increased emphasis ontraining of peers by rehabilitation education programs. Peer coun-seling is a mandated service in independent living centers and willbecome much more wide-spread in other sectors of the servicedelivery system in the next decade. Peer support is a serviceapproach that may be particularly appropriate for persons from

41ultures that place high value on affiliation. The training of peers


can assist in overcoming the barriers of cultural (inferences whichexist between rehabilitation programs and some of the personsthey attempt to serve. The training of support persons who areindigenous to the population being served is not a new concept. Ithas been validated by researchers from several disciplines.

Improving services that impact on employment outcomes forpeople with severe disabilities (especially those from culturallydiverse backgrounds) involves more than improving the profes-sional practice of individual service providers. Nothing less thana continuous and pro-active program to develop rehabilitationeducation's structural and strategic capacity to facilitate the inde-pendent living and career development of persons with disabili-ties who are members of minority groups, will be acceptable.

Cultural Identity. We cannot discuss diversity issues inrehabilitation education in the 21st century without mentioningthe fact that faculty and trainers will need to become increasing-ly representative of diverse cultures and this will be reflected inthe recruitment and hiring practices for rehabilitation educators.We have made significant progress in dismantling barriers to theparticipation of minorities and people with disabilities in reha-bilitation education. But we have a long way to go before wecan say that they have achieved full and equal participation.Enhancement of this trend, along with a diversity focus in stu-dent recruitment, will begin to address the need for more culturespecific research in rehabilitation education.

Natural Supports. Passage of the Americans withDisabilities Act of 1990 provided communities with criteria forevaluating their responsiveness to the needs of people with dis-abilities. As traditional rehabilitation agencies have expanded toprovide a comprehensive program of services, family and com-munity support systems have received more attention.Supported and transitional employment, independent living cen-ters, Projects With Industry, innovative technology, and othercommunity-based programs have all emphasized the importantrole the community plays in habilitation and rehabilitation. Thistrend capitalizes on the natural supports in the workplace and inthe community. The use of natural supports in the workplacewill become much more extensive whether the issue is severityof disability, cultural diversity, or both. We should anticipatethat the 21st century will see rehabilitation education programsaddressing the training of rehabilitation community develop-ment consultants.

Self-Help Strategies. Self-help, and self-advocacy optionsshould also become a focus, especially for current populationswith disabilities due to traumatic head injury, psychiatrically dis-abled, HIV infection, and substance abuse. According to futur-ists such as John Naisbitt, the self-help movement in the gener-al population will grow significantly over the next decade.People with disabilities will increasingly contribute to.this grow-ing trend. Consequently, training programs should provide formodels that reflect new roles for rehabilitation organizations act-ing as mentors, case managers, and teachers.

Specific Challengesto Rehabilitation Education

We know that in addition to the population becoming moreculturally diverse in the 21st century, the work force will growolder, more female, and more disadvantaged than at any other

50

time in the history of the United States. These trends raise anumber of important issues for rehabilitation education.

Such continuing population diversification will challengerehabilitation education to be proactive and appropriatelyresponsive. Challenges like these are not strangers to ti:erehabilitation community. In many ways, difference is thestandard in rehabilitation practice.

The strength of rehabilitation education's commitment,however, will be tested as more diverse groups demand train-ing and expect it to be provided in nontraditional formats. Itis important to the future vitality and relevance of rehabilita-tion that educators acquire more knowledge and skills inorder to train these populations more effectively. While thisconclusion and recommendation is not new, rehabilitationeducation will need to dedicate itself to achieving this mis-sion well into the 21st century.

Need to Move toHuman Resource Development

The scope of rehabilitation services will enlarge over the nextdecade to serve new populations and include new technologiesand to offer new services. All levels and types of serviceproviders will require expertise in serving new populations,serving individuals with a greater severity of disability, and pro-viding individualized services based on informed consumerchoice. Unfortunately, even with these needs, there is likely tobe no commensurate expansion in training resources.

Rehabilitation educators will continue to be called uponto develop the human resources for the rehabilitation com-munity. However, HRD is impossible to accomplish withouta unified, comprehensive focus on organizational, careerdevelopment, individual, and training needs of all levels ofstaff. We now have a system that is totally contrary to theHRD approach. It is a hit-or-miss strategy, with small frag-mented efforts directed to different levels of staff. Thereexists a miscellany of training resources in each region, (e.g.,a continuing education program for job coaches conductedby one university, a rehabilitation facility administration pro-gram conducted by another university in another state, and apre-service vocational evaluation program by another univer-sity). There is presently no unified approach to improvingthe quality of rehabilitation services.

Decentralize Resources

To alleviate these problems and open avenues for a com-prehensive human resource development approach by reha-bilitation, the 21st century will likely see decentralized fed-eral resources and control with consolidation of existingtraining programs into fewer identifiable resources for preand post-education of all levels of rehabilitation service per-sonnel. This restructuring of the rehabilitation educationdelivery system will occur so that the human resource devel-opment needs of our constituencies can be met throughplanned, unified, regional systems of training and education.History has demonstrated that spreading limited federalRehabilitation Services Administration dollars for trainingover the more than 20 content areas at various levels of edu-cation (i.e., undergraduate, graduate, continuing education)


has not been effective. A primary reason for this will existregardless of how "the pie is sliced" in that the fundingamounts are totally inadequate.

Explore Alternate FormatsIn the 21st century, new organizational patterns for reha-

bilitation education will be established. Some possible for-mats could include a continuum of training that providesPeer, Associate of Arts, general undergraduate degrees,speciai ?Led undergraduate, and graduate degrees that com-bine e i..ember of specialty areas, all offered at one institu-tion ant: nnected". The issue of interdisciplinary train-ing crit.,cal to future rehabilitation education in that anyrehabilitatkm professional/team member must be schooledin core areas, such as medical aspects of disability, psy-chosocial aspects of disability, and rehabilitation servicescontent acid delivery. Core curriculum would be providedfol all professional rehabilitation training within a univer-sity with branching curriculums into speciality areas. Thiswould reduce duplication of effort, maximize resources,and develop a foundation for interdisciplinary servicedelivery in the field.

Collaborate Among. Resources

Given the aging rehabilitation work force, priority in provid-ing a balance between pre-service and in-service/continuingeducation must be addressed. One possible option wouldinvolve all pre-service programs in providing some in-servicetraining annually within their regions in collaboration withRegional Continuing Education Programs, Research andTraining Centers or other Human Resource Development train-ing programs. This would permit continuing education pro-grams more latitude in addressing new and emerging consumerand service needs in their short-term training.

Incorporate Relevant Content

Regarding the content of pre-service programs, we are sim-ply not keeping up! We have a dual challenge, prepare our reha-bilitation education programs for the 21st century at the sametime we are trying to "catch-up to the 20th century!" A reviewof the curriculum requirements for counselor training and voca-tional evaluation programs, reveals that in numerous cases keyservice components are not addressed adequately, or at all.Many programs have not integrated technology (computer oper-ations/literacy, adaptive devices, job accommodations, indepen-dent living skills) information into course work. It appears thatmany programs do not include new policy developments orsuch service delivery options as transition needs and planning,affirmative industries, or supported employment into coursework. Also, core curricula still appear to focus on the needs ofindividuals with physical or developmental disabilities. Littleattention is given in those curricula to the needs of persons withlong-term mental illness, substance abuse, or traumatic braininjury, for example. Further, in many rehabilitati,fin counselingprograms it is debatable whether the curriculum is preparingcounselors for common demands of their jobs: case manage-ment functions and interdisciplinary case manager roles.

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Challenge to Develop NewRehabilitation Education LeadershipA complexity of issues will face rehabilitation educators

in the 21st century. Increasing complexity will be a productof the decentralized character of services to people withsevere disabilities, changes in program philosophy, and thepresence of a multilayered bureaucratic superstructure thatwill continue to develop around rehabilitation service sys-tems. The rehabilitation field will become even more com-plex as system change continues and as programmatic expec-tations and assumptions become more conceptual and lessschematic. Rehabilitation education programs were origi-nally designed for a homogeneous and less numerous systemof providers. Some of us will find it difficult to keep up withthe pace of changing service developments.

The scenario of the future presented here attests to thenecessity to develop a comprehensive national strategy forproviding intensive leadership training for rehabilitation per-sonnel. Once developed, participation would be recognizedby employers as prestigious and this field would begin tohave an expanded pool of qualified leadership personnel.That national strategy would have:

Long-term and short-term training components;

Identify base-line knowledge and performancecompetencies;

Provide for alternate learning routes;

Provide processes for recognition of achievement(e.g., degrees, certificates);

Present cutting edge curricular content; and

Promote significant change in leadershipbehavior over time.

The training formats need to be intensive and on-going inorder to provide for an examination of beliefs that drive lead-ership and organizational behavior. A variety of formatscould include on-going leadership development institutes,support groups c- emerging leaders, mentor models, andpre-service prr ms emphasizing organizational changeand an examination of organizational behavior, to name afew. Regionally based leadership development instituteswould probably provide such a format. These institutescould provide for long-term sequential training, mentoringand supervised on-site practicum experiences in new types ofleadership behavior and skills and allow for the wide-spread,intensive, continuous long-term educational efforts essentialto instilling the new values, beliefs, and skills necessary tothe functioning of rehabilitation education in the 21st cen-tury. An approach like this could nurture the vision neededto address the 21st century successfully so that rehabilitationorganizations become comfortable with innovation, change,quality outcomes, and providing empowerment options foremployees with and without disabilities.

5National Rehabilitation Association 1995 Switzer Monograph

Summary and Conclusion

This review of selected issues to be confronted by reha-bilitation education in the 21st century takes note of theinherent tension between the immutability of many universi-ty procedures and the fluidity and dynamism of a system thatis constantly moving towards more and more uses of nontra-ditional approaches to service delivery. It is incumbent onrehabilitation educators to respond to these challenges bydiversifying instructional methodologies, retooling curricu-lum foci, and involving a wider spectrum of participants inprogram development and implementation.

The broad goal of rehabilitation education will likely remainunchanged. The scope, methodologies, strategies, and possibil-ities of rehabilitation education are what will continue to expandinto the 21st century. Like other rehabilitation professionals,rehabilitation educators have seen themselves in the role of"helping". What may be most difficult for them to come to gripswith is that in the 21st century the consumer (i.e., the personbeing "helped") will be the one to whom they will be primarilyaccountable. It is also with this consumer that they now havereal opportunities to work in close, meaningful, and productivepartnership to begin building the rehabilitation education pro-grams of the next century.

I have always believed that as rehabilitation educators wewere one synergistic national community. Today, however,there seems to be only the most tenuous sense of "nationalcommunity" in rehabilitation education. I believe this thin-to-nonexistent sense of community in rehabilitation educa-tion may be one root cause of a perception (by agencyadminiserators and consumers) of increasing irrelevance ofmuch of our training efforts as we enter the 21st century. I

do not mean that we are going to have to attain some state ofperfect national and regional harmony before we can getanything substantative accomplished. However, there likelyis not a single change predicted to occur in rehabilitation thatwill not entail some cost or sacrifice or disadvantage or atleast diminished privilege on the part of some in rehabilita-tion education for the sake of meeting the training needs ofthe 21st century.

This will have to be accepted and worked with by rehabil-itation education; this is not likely to occur in an environ-ment so atomized into its separate educational settings, sep-arate educational approaches, separate professional identi-ties, and separate credentialing bodies as currently exsits inrehabilitation education.

Looking back at the efforts on behalf of the Americanswith Disabilities Act (ADA), it might seem that the situationis to the contrary, as an apparent uniformity of philosophyand coalition building did exist then. But, even with all thatcommon commitment, I believe distances between the vari-ous component groups of rehabilitation education havewidened. Professional (discipline) identity, pre-service ver-sus HRD, graduate versus undergraduate, and other specialinterests seem ever more assertive and compelling. Thesecomponents of a "synergistic national rehabilitation educa-tion program" seem to be increasingly losing a fundamentalcommitment to a collective responsibility for the well-beingof a national rehabilitation program.

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This idea of a national responsibility, urged upon rehabilita-tion educators by leaders such as Mary Switzer, implied a sharedconcern wherein counselors, consumers, administrators, educa-tors, facility personnel, and others supported each other in acommon effort to build a national rehabilitation program. Therewas always debate, but the broad assumptions were pretty muchaccepted. Now the prevailing spirit in rehabilitation education ismore nearly every discipline, every association, every deliveryapproach, every professional group, every organization actingonly in its perceived best interest.

There will be a need for significant changes in the nation-al rehabilitation education program as we enter the 21st cen-tury, in everything from delivery approaches to content andfocus of training. Only if a genuine feeling of connection andmutual interest and shared purpose exists will rehabilitationeducators be able to respond collectively and proactively tothe challenges of the 21st century.

I believe this connection of shared purpose and mutual inter-est will be found by rehabilitation educators through the devel-opment of meaningful consumer-professional partnerships.There is little doubt that consumer-educator partnerships mustbe formed if present programs of rehabilitation education andtraining are to succeed. Mutual respect must balance fiscal andprogrammatic realities and goal setting with specific, attainableoutcomes. All these and further elements must come together inpartnership if specific educational program goals are to becomecollective national realities.

With the formation of these partnerships, rehabilitationeducation will continue to play an important role in facilitat-ing the field of rehabilitation to achieve its goals. I viewrehabilitation education as an evolving process. It was neverconceived to be a static set of technologies, but rather con-ceived as a process that evolves as underlying issues of dis-ability and societal capacity change, as the knowledge baseof options achievable by individuals expands, and as changesoccur in society's recognition of the needs, concerns, anddemands made of persons with disabilities.

As we move into the 21st century, we may be arm-in-arm,but will we be step-in-step. I believe that we must look moretoward "partnering". The need to resolve disability and diver-sity problems, and develop and maintain competent humanresources consistent with needs of people with disability inAmerica's population is imperative. We must promoteincreased collaboration between rehabilitation educators, con-sumers and service providers where each partner has comple-mentary capacities. Partnering connotes working directly fromthe strengths and differences which the partners have to offer,an open relationship based upon what their combined capaci-ties might yield, and upon the integrity and commitment of thepartners to achieve valid outcomes. The combined expertiseand experience should yield educational programs and process-es that are much more broadly conceived and more relevant tocultural issues that will continue to be the issues of Americansociety in the 2 1 st century.

Our need to get into step is practical. Our supply of reha-bilitation educators is limited. The resources which anyinstitution might bring together are finite and often governedby institutional rules (e.g., tenure, retention) not always inkeeping with a national need to resolve a particular problem


area. The dollars to engage in quality rehabilitation educa-tion are very limited. As far as the issues of disability anddiversity are concerned, such consortia may provide adynamic-aggressive attack on the problem of providing trulyqualified rehabilitationists from multiple perspectives andmultiple locations across the states.

Synopsis

It is clear that the common mission of RehabilitationEducators in the 21st century will be to collectively fashiona national education and training model for rehabilitation.One that identifies effective programmatic organization andstructure; promotes alternate instructional and training/dis-semination strategies; identifies needed support systems;effectively utilizes available resources; and maximizes soci-ety's potential for efficiently and effectively serving individ-uals with disabilities.

Rehabilitation education will need to define a systematicprogram of long-term pro-active education and training setforth in an integrated, coordinated activity plan. This educa-tion and training plan will need to address issues throughprogrammatic long-term education and human resourcetraining utilizing the most current instructional technology.It must ensure that rehabilitation education maintains itsvitality in supporting choice and empowerment for individu-als with disabilities, and, professionalism and competencyfor rehabilitation personnel.

We must begin now with what we have, because what wewill need has yet to be revealed or fully charted. The firststeps should be to build the infrastructure of communicationwith all members of the rehabilitation community, openlytalk about this new frontier, and define the future as we

encounter it. Visioning is not an eventit is a process.Visioning should not just occur every 10, 15 or 20 years, butregularly at all levels of rehabilitation education through col-laboration. We must "unite our vision" through true collab-oration with all stakeholders at all levels to build a rehabili-tation education "system" that is flexible, responsive, andaccountable to its customers and produces quality employ-ment and independent living outcomes for individuals withdisabilities. With less structure and more shared leadership,less revolution and more resolution, less turfism and moretrue collaboration, rehabilitation education will move withvigor into the 21st century.

The unsettling thing about new paradigms is the processof redefinition, when power structures change and roles arere-defined. For full development of the new paradigm tooccur, we must open to scrutiny the very things which mayhave been held in sacred trust. We must neither obstinatelyhold to the old forms nor thoughtlessly discard them withoutdemonstrated cause. Instead, we must openly explore theirvalidity, relevance and impact to the new directions of reha-bilitation as it enters the 21st century.

Acknowledgements

During the course of the development of this paper, a relatedactivity, in concert with the Rehabilitation ServicesAdministration, was occurring at the Research and TrainingCenter. Some of the thoughts submitted by persons in the fieldfor that project were also incorporated into this paper. The indi-viduals leading that undertaking were Dr. Fred Menz,Wisconsin; Thomas L. Evenson, Texas; Peter Griswold,Michigan; and Richard Verville, Washington, D.C. The value oftheir contributions is fully appreciated by the author.

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Excerpts of Reviews and Comments Chapter Five

6r. McAlees offered a brilliant pre-sentation of issues and trendsimpacting on rehabilitation educa-

tion. The litany of excellent perspectiveson emerging paradigms and the need forrehabilitation educators to examine thereality of existing paradigms was verycompelling. While the intent of Dr.McAlees' manuscript was to focus onrehabilitation education, the comprehen-sive nature of issues presented can beused by any rehabilitation proiessional.Given the multi-faceted consistency baseof rehabilitation education, Dr. McAleesenumerated several approaches thatwould be taken in addressing current andfuture issues.

There is one emerging, yet differ-ent perspective on cultural diversitythat warranted expounding in Dr.McAlees' manuscript, The perspec-tive focuses on the need to understanddiversity not only from the perspec-tive of "achieving the goals of theADA and the state-federal VR pro-gram", as contended by Dr. McAlees,to a broader cone .pt of achieving thegoals of inclusion for targeted groupmembers: women, minorities andpeople with disabilities. Emergingparadigms that focus on developingan understanding of and training fordiversity include:

Moving from knowledge buildingon specific ethnic groups to emphasiz-ing all individuals being treated withdignity, respect and worth; hence,changing the assumption that minori-ties are "add-ons" in need of "special,different" treatment.

Moving from culture specificresearch to research on how environ-ments/corporate cultures can be mademore conducive to meet the needs andincrease productivity of all workers:males, females; minority, majority;people with disabilities, people with-out disabilities.

Moving from an assumption thataffirmative action and cultural diversi-ty enlightenment are ends to conceptu-al framework that goes beyond race,gender and disability to the productivecapabilities of people. An ideal refer-ence for emerging philosophies and

strategies for managing diversity canbe found in Roosevelt Thomas' book,Beyond Race and Gender.

Judy Norman-Nunnery

0an McAlees wants to define"instructional strategies" for a pro-fession that is becoming increas-

ingly consumer-driven, multicultural,and technology-based. It's interestingthat he finds rehabilitation educationslow to respond to these challenges v'idbeset by differences of philosophy.

If we are to have community-inte-grated services, he says, educators willneed to move their programs off-cam-pus and to recruit their students fromthe same ethnic minorities that are con-tributing increasingly to rehabilitation'sservice population. (These are the samepopulations, McAlees points out, thatrehabilitation educators have historical-ly been the least effective in attracting.)McAlees calls attention to the "newuniverse of disability" that is emergingin the inner cities of this country as aresult of near-epidemic levels of sub-stance abuse, youth violence, andchronic illness. He is certainly right inthinking that a national training effort,reflecting an actual working alliance ofconsumers, educators, governmentadministrators, and facility providers,will be necessary to deal with the prob-lems of the 21st century.

Where the monograph really comesalive for me is in McAlees' discussionof new learning technologies and theirapplication to rehabilitation trainingand practice: telecommuting; telecon-ferencing and distance-learning; andself-paced multimedia modules cus-tomized to individual learning styles.McAlees thinks that our new commu-nications infrastructure will providemany of the tools that we need torespond to the challenges of a rapid-ly-changing, multicultural society -

but only if we're able to recognize thepossibilities of this network.

The focus of McAlees' paper isbroad, almost panoramic; and headdresses in passing a number of topics

54

that should be exciting to rehabilitationproviders, such as cooperative learning,self-help strategies, and family-systemsapproaches to assessment and planning.The only thing I wish he had discussedis the impact on rehabilitation educationof the proposed consolidation of federalemployment and training programs (e.g.the recent inclusion of the VocationalRehabilitation Act jobs programs in theReemployment Act), sin, ;he stream-lined services that are rio oeing envi-sioned pay little attention to specialpopulations and special-needs programmodels. If more and more rehabilitationservices are going to be institutional-ized in the future, then the demand forrehabilitation specialists will probablydecline - and with it the demand forrehabilitation education.

Jon Lundin

Ihe author states that rehabilitationeducation in the next century shouldreflect the changes taking place

throughout government and the country.He views rehabilitation education as aforce for empowerment of persons withdisabilities and as a mechanism to trans-mit knowledge. He mentions the trendsand significant events which have influ-enced change, including the diversity ofthe nation's population.

Controversy will continue as para-digm shift. "Rehabilitation will be inthe midst of efforts directed at the fun-damental restructuring of the roles ofprofessionals and consumers. This willinvolve clarifying the central missionof services, and in altering the primarybasis of service delivery." Educationmust play a role. The needs of peoplewith disabilities require the develop-ment of strategies to prepareproviders. Diversity will increase andsocietal trends will require the atten-tion of educators.

All of the above require a new wayof thinking and new directives forrehabilitation. There will be changesin services as well as in the field ofrehabilitation itself. It will require acloser partnership with the consumer.


Education must include technology.New directions must be developed toaddress equity and diversity. Use oftechnologies is important to meetingthe needs, including a system fordetermining and evaluating them. Thesystem must be flexible, dynamic, andaccessible. There should be a commu-nication infrastructure for quick andeasy feedback.

The emphasis on the application ofbasic rehabilitation skills in culturallydiverse settings require cultural com-petence of providers. Divetsity cur-riculum should be included in programdevelopment and evaluation.

The population trends provide chal-lenges to rehabilitation educators interms of changing curricula to meetthe times. The change itself is chal-lenged by the paucity of resources.Too much must be accomplished bytoo little funding. Collaboration ofresources is needed.

In addition, a review of training cur-riculum content should be completed,with course work incluOing technologyand new policy developments. New lead-ership must be develops d, whether frominstitutes, mentoring or education.

What the author has stated is true.Much is happening now and is not wait-ing for the 21st century. It behoovesrehabilitation education to develop andimplement the changes to move rehabil-itation beyond the traditional system tothe partnership system, where the pro-fessional is accountable to the con-sumer. Preparation of professionals toimplement the demands of rehabilita-tion is essential. The curriculum ofpreparation should address that beforethe 21st century.


Organized disability rights move-ment, greater consumer control,more emphasis on independent liv-

ing, laws guaranteeing civil rights forpersons with disabilities, and a growthof supported employment all require are-evaluation of rehabilitation educa-tion, according to McAlees. In thispaper, McAlees calls for developingnew instructional strategies in rehabili-tation that cut across different audi-ences, i.e., service providers, consumers

and their families, etc. This action isnecessary because innovative educationstrategies are needed to incorporateways to address new issues in rehabili-tation, issues such as equity, culturalcompetency, diversity, as well as newtypes of disabilities associated with vio-lence, AIDS, etc.

Although the central goal of rehabil-itation education will remain intact,McAlees does envision the use of newmethodologies and technologies toenhance rehabilitation education strate-gies, e.g., distance learning. He alsonotes that as the demands of VR serviceconsumers increase, accountability willshift more towards the consumer.

Much of what has been presented inthis paper rings true, but in order tobring about some of the changes pro-posed, curriculum and certification oftraining programs have to accept andpromote some of these initiatives. 'ibdate there has been little evidence andlittle funding to support such develop-ment. As new needs are identified,most educational settings simply addon another course without evaluatingthe usefulness of the existingcourse-load. Similar activities alsooccur in continuing education.

Jennie R. Joe

This paper represents a great deal ofthinking and planning for the tradi-tional rehabilitation education pro-

gram as it relates to preparing providersin the 21st century. Several items, how-ever, need to be further explored anddiscussed on rehabilitation education aswe look toward the future. First, wehave to take a hard look as to whether ornot rehabilitation education is truly adistinct and separate profession andentity as differentiated from vocationaland technical education, industrial edu-cation and even some forms of humanresource education.

Traditionally rehabilitation educa-tion parallels requirements as definedin the Rehabilitation Act and support-ing regulations. It assumes that themajor influencer is the state agencycoordinating rehabilitation services.More emphasis is needed in futurethinking on the provider side of therehabilitation industry.

There also needs to be considerablymore effort on soliciting the require-ments of those entering our profession.It appears that the preponderance ofpeople entering the provider side ofrehabilitation service delivery are com-ing from related disciplines nonspecificto rehabilitation. Consequently, someshort -terni training or orientation train-ing should be focused on rehabilitationeducation in the future.

A review of whether we are aunique or distinct industry requiringour own educational programs shouldbe carefully evaluated as we see thechanges occurring in the vocationalemployment and training industryserving people with disabilities andother special needs. It may well be thatthere are enough similarities to gener-ate a more comprehensive educationalprogram with needs only for some spe-cialization by types of populationincorporated in long-range curriculumdevelopment.

Kenneth J. Shaw


Chapter Six

Providers of Rehabilitation Services

Patrick W. McKenna

Ten years ago the Mary Switzer Memorial Seminaraddressed the topic "Social Influences in RehabilitationPlanning: Blueprint for the 21st Century". The opening

remarks at that seminar were delivered by Edward D. Berkowitzand included the observation that "the rise of persons with dis-abilities as a group interested in its civil rights represents a morefundamental change than do the other things I have mentioned.Planning needs to recognize this change".

Whether those involved in the planning and delivery ofrehabilitation services took that advice to heart is open toquestion. The "change" did occur, however, and grew inmomentum during the 1980s culminating in the passage ofthe Americans with Disabilities Act in 1990 and theRehabilitation Act Amendments in 1992. Both pieces of leg-islation have dramatically changed the agendas for both con-sumers and providers of rehabilitation services and for pub-lic policy planners.

The 1994 Switzer Memorial Seminar again looks to the futureby addressing the topic "Vocational Rehabilitation: Preparing forthe 21st Century". The challenges facing the vocational rehabil-itation program in the 1990s and beyond are defined, in part, notonly by the legislation that has been passed but also by current,national debates involving such diverse topics as health care,welfare reform, the unification of job training and developmentservices and enhanced initiatives associated with "school towork" programs to name but a few.

Many factors are influencing those debates including theneed to contain and reduce the federal deficit, the growingdisenchantment with entitlement programs, and the drive to"reinvent" government so that it is more efficient and respon-sive. Public policy associated with the planning and deliveryof human and social services is in a period of transition andit is likely that some substantive reforms will occur withinthe next several years. All of that implies that those involvedin vocational rehabilitation endeavors need to be prepared toadopt new strategies to assure that the achievements reachedin the early 1990s are maintained, enhanced and expanded as

Patrick W. McKenna, Director of Client Services, Maryland Division ofRehabilitation Services, Baltimore, Maryland.

56

planning is undertaken for the 21st century. It would be amistake to assume that the program is safe and secure. Itcould be argued, on the contrary, that it has never been morevulnerable.

It appears clear that a persistent and aggressive effort willbe made to unify programs and services, eliminate duplica-tion and give states and local jurisdictions the discretion touse federal money in creative ways. Such initiatives are notwithout their critics since they involve substantive philo-sophical issues associated with the role and function of gov-ernment in a democratic society. The debate moves forward,however, and the outcome will influence the future of allprograms.

These initiatives represent a fundamental change in theapproach t ken by government to plan and deliver humanservices and it would be a mistake for those involved in theplanning and delivery of vocational rehabilitation services toignore these changes. In one way or another, the tides ofchange will influence federal legislation authorizing voca-tional rehabilitation, independent living and associated pro-grams.

This is not mere speculation since recent legislation intro-duced in the Senate designed to unify all job training pro-grams includes provisions to "sunset" the Rehabilitation Act.

How are planners to address these diverse, confusing andvery challenging trends? Is it possible to set a course for thevocational rehabil:tgif,on program in the 21st century whenso much is unknown alia so many conflicting agendas arebeing proposed b-, legislators, consumer groups and the pub-lic at large? W, need to begin the task and the journey byidentifying a. best we can those central issues which willinfluence the planning and delivery of services for the future.

The challenges which lie ahead, in my view, can best bedescribed by reflecting on the fundamental conflict whichhas emerged in the debate ever reform of the nation's healthcare system. While somewhat simplistic, much of that debateinvolves the differences and the sometimes conflicting val-ues between "managed care" and "consumer choice".

A its best, "ma caged care" creates efficient systems ofcare and does so in a cost effective manner. It delivers care


in response to the needs of each individual. It eliminates mis-use of resources and attempts to deliver services in a timelymanner while maintaining strict quality assurance standards.At its worst, "managed care" ignores the needs of the indi-vidual, fails to provide any continuity of services, rationsservices, rarely addresses "quality of life" issues such as"rehabilitation", and is "managed" to assure a profit ratherthan the achievement of quality outcomes for the individual.

"Consumer choice" at its best reflects the basic need ofeach individual to participate as fully as possible in his or herown destiny; values the need to assess the quality of ser-vices; recognizes that informed consent is essential if anyintervention is going to be successful; and explicitly recog-nizes the need to preserve mutual respect between a con-sumer and a provider of services. At its worst, consumerchoice fails to consider the needs of others, ignores commu-nity norms, promotes and encourages a litigious relationshipbetween consumer and provider and compromises the deliv-ery of effective and responsible services funded through pub-lic resources for all citizens.

While not mutually exclusive, the goals, objectives andunderlying philosophies of "managed care" and "consumerchoice" are driven by different needs, assumptions and val-ues. These differences define not only the debate over anational health care policy but also influence the discussionsabout virtually every other social and human service pro-gram. Managed care may be translated to mean "inclusion",consolidation", "privatization" or even "order of selection".Consumer choice may be translated to mean a "marketingstrategy" focusing on "customers", "vouchers", "contract-ing", or "empowerment".

I would suggest that the challenge facing providers of voca-tional rehabilitation services as planning is undertaken for the21st century involves: 1) the need to create a social consensusregarding the value and purpose of rehabilitation within the com-munity as a whole; 2) the need to create programs and serviceswhich value consumer choice while aggressively managing andutilizing scarce resources; 3) the need to improve and expandaccountability; 4) the need to actively promote and develop link-ages with a broad array of community resources, programs andservices not necessarily "identified" with disability issues; and5) the need to aggressively resist the tendency to eliminate orotherwise ignore the needs of special populations as social agen-das are established and implemented.

We face complex times and conflicting agendas but it ispossible to focus our planning and create strategies whichwill make the best use of our experience, skill and knowl-edge as a social agenda for the 21st century is developed.Despite the sometimes conflicting and confusing issues fac-ing us, a confident and progressive course of action can beachieved by remembering our past, celebrating our success,acknowledging our failures and embracing the future.

Public Policy

We need search no further than the Rehabilitation ActAmendments of 1992 to find the broad parameters and specificgoals which must define our planning strategies for the comingyears. The Act asserts that:

56

"Millions of Americans have one or more le cal ormental disabilities and the number of Americans with suchdisabilities is increasing:

"Individuals with disabilities constitute one of the mostdisadvantaged groups in society;

"Disability is a natural part of human experience and in noway diminishes the right of individuals to-

live independently;

enjoy self-determination;

make choices;

contribute to society;

pursue meaningful careers; and enjoy full inclusion inthe economic, political, social, cultural, and education-al mainstream of American society."

These "findings" of Congress contained in theRehabilitation Act .Amendments not only define the scopeand nature of services to be provided by public and privateproviders of rehabilitation services, but also clearly establishthe standards and expectations to be used in determiningwhether or not those prcwiders add any value to the pursuitof those goals and aspirations on the part of individuals withdisabilities. In addition, they establish the basis for theassessment of the program's effectiveness by Congress andthe public at large. Planning for the future must begin here -identifying in what ways we can substantively keep faithwith the goals and objectives of the program as defined byCongress. That effort involves both assessing our past aswell as designing our future. Both of those tasks will requireenormous energy. objective discussion and a capacity tomove beyond familiar territory and take some risks.

The Arena of Change

Future decisions regarding the role and function, the natureand extent of vocational and independent living services willnot take place solely within familiar environments. That is,while organizations and associations formed to representproviders, planners and consumers will undoubtedly continueto exist and exert substantive influence, the focus of power andinfluence will continue to shift, from such groups to more"diverse" and inclusive groups such as state economic planningcommissions and departments; coalitions of public educationalofficials, business executives and state officials; state healthplanning commissions; and local civic organizations. The 21stcentury will surely see dramatic changes in terms of how ourpublic programs are planned and implemented throughout thevarious states and in local communities. Rehabilitationproviders need to be present in all of those arenas since deci-sions will be made which will influence the nature and extentof services as wen as how they will be funded. We must renewefforts to venture beyond familiar territory so as to assure thatthe consumers we represent are not forgotten, abandoned orotherwise ignored. The stake-holders are not only those served

1.4 the program but also the citizens as a whole. Preserving,


promoting and assuring a continued commitment to vocationalrehabilitation services on the part of all Americans will requireaggressive steps to inform, educate and engage the public."Disability is a natural part of human experience". Respondingto it and preserving and expanding the continued capacity ofpersons with disabilities to remain vitally active in their com-munities are goals which need to be embraced by every citizen.

Process

The systems, procedures and required processes imposedon providers of rehabilitation services are an anachronismwhich somehow prevail despite the knowledge that they are,in many respects, obstacles which limit and compromise theeffective and responsible delivery of services for consumers.The public program of vocational rehabilitation has created,over many decades, a burdensome reliance on "process"which has created an environment where value is placed onform over substance. To be fair, much of it has occurred dueto legislative requirements and some of it is necessary. Anyprogram funded through taxes paid by the citizenry needs tomaintain accountability. Nonetheless, it has to be recognizedthat systems and programs tend to lose a clear focus of whatis really important as time passes and a level of comfort isachieved. Even the recent amendments to the RehabilitationAct, while focusing on consumer choice. and positive goals,nonetheless add new and questionable "process" require-ments on providers. It is an endemic problem with federallegislation. It can never be content with stating the "nation'sgoals"; it must subsequently define precisely how thosegoals are going to be achieved, documented, evaluated,assessed and measured.

The impulse to add additional regulatory burdens is gen-erally associated with a perception that a program is nolonger meeting its intended purpose. Regulations proliferateduring periods of decline or when confidence has been lostin the capacity of programs to meet established goals andexpectations. Its a fatal strategy which rarely if ever renewsthe "health" and vitality of a program. Restoring and pro-moting "vision", "purpose" and "commitment" within anorganization or program is never achieved by addressing thelowest common denominator. It is, rather, achieved by elim-inating the layers of bureaucracy created over many years,providing inspired leadership, placing value on professional,ethical and informed standards of performance, and byempowering employees on the front line. A healthy organi-zation has minimal policies, procedures and rt ;ulations. Adesperate one produces administrative manuals.

There are signs of hope. The national initiative beingundertaken- under the leadership of Vice President Gore isseeking to reduce the burden of unnecessary regulations andfocus government interventions on substantive issues. He hasa monumental task ahead of him but it is one which needs tobe addressed if public programs are going to be successfuland product' :'e in the years aheati. Meanwhile, providersneed to take their own steps to eliminate unnecessary obsta-cles faced by consumers who seek to access services; createinternal control and audit systems which place value on pro-fessional services, designed to achieve quality outcomes in a

timely and cost effective manner; and focus program evalua-tion efforts on assessing the satisfaction of the program'smultiple consumers individuals served, employers, referralsources and the public at large.

AccountabilityRenewed and substantive efforts need to be made to focus

program efforts on providing services which make a real dif-ference in the lives of the individuals with disabilities servedby the program. Those efforts need to be clearly directedtoward promoting and assuring, insofar as possible, theachievement of meaningful and productive employment bythose persons. Anything less will compromise the future ofthe program. Maintaining and promoting that goal will notbe easy in light of the confusing and conflicting mandatescontained in the authorizing legislation.

Employment, as millions of Americans have discovered, isnot an "entitlement" even if an education has been achieved oreven if years of service have been committed to it. The con-tinuing volatile nature of the employment market within theUnited States poses particular challenges for individuals withdisabilities and those who work to assist them in achievinggainful employment. The "success" of the program dependsfor the most part on the general health and vitality of the econ-omy and the job market as a whole. Recognizing those facts,providers need to develop a sophisticated awareness of jobtrends, emerging industries, growth areas and unmet needswithin the labor market. Training for "anything", for instance,isn't better than no training at all. Similarly, placement of anindividual into any job cannot be considered a measure of theprogram's success. There needs to be a focused, deliberativeand aggressive effort to enhance. professional, vocationalcounseling services within rehabilitation agencies and pro-grams which focus on the career goals of persons served andon employment outcomes which are productive.

The challenges are, once again, enormous. Many new jobsbeing created within the economic sector are beyond thereach of those who are seeking employment for the first timeand for those seeking to re-enter the labor market after hav-ing experienced a disability. At the same time legislation andprogram goals within the vocational rehabilitation programare emphasizing "quality" outcomes which support thecareer goals of individuas served. Subtle but neverthelessreal pressures are also being applied to "produce" increasednumbers of successful placements in order to prove theeffectiveness of the vocational rehabilitation program.

I return to the conflicts emerging within the health carearena to emphasize the fundamental issues we face. In arecent bulletin published by the Delmarva Foundation forMedical Care, Inc., reference is made to a recent policy pro-nouncement by the Institute of Medicine. "The paradigmshift calls for health plans to provide medical services to apopulation in the face of stringent resource constraints, andthe incentive will likely be to underserve people. Thesechanges will make monitoring the quality of care imperative,especially for the sickest individuals and other at-risk popu-lations. It is critical that quality and consumer protection bebuilt into the system from the onset."


Translating that into the vocational rehabilitation arenasuggests that there are inherent conflicts involved in man-dates to serve the "most severely disabled", assuring qualityoutcomes for such persons, while also meeting the expecta-tions for increased numbers of outcomes or placements.Resources will not be available to meet all of the needs. Whowill be served and who will go unserved? I don't believe it ispossible to propose a solution to that problem at this time.What can be said is that providers need to focus their effortsand place primary value on the goal of achieving quality out-comes for those served by the program.

One of the great challenges facing those involved in the pro-fession of rehabilitation involves the development of a consen-sus regarding what constitutes a "quality" outcome. For better orworse, gainful and productive employment remains the measureof "success" within our society at least for the majority of citi-zens. It is certainly not the only measure of a productive, reward-ing and fulfilling life. Despite what can only be described as theflirtation with such things as "independent living", the vocation-al rehabilitation program is clearly viewed by legislators andmost consumers as a "work" program. Putting all philosophicalarguments aside, the challenge for the 21st century is to promoteand expand that goal.

Building CommunityProviders of vocational rehabilitation services share in the

responsibility to create a community where diversity is notonly recognized but respected, embraced and seen as an essen-tial component of keeping faith with the fundamental values ofour society. "Cultural diversity" is the politically correct termbut its use too often misses or ignores the more enduring andpersistent imperative to place value on "life together" or, inother words, the enduring challenge to build and preserve com-munities. James Baldwin, in ..1.oquent terms, wrote in one of hisnovels that "the moment we cease to hold each other, themoment we break faith with one another, the sea engulfs us andthe light goes out". That translates our current "system" agen-da into very real and human terms.

The Rehabilitation Act Amendments of 1992 include amandate to assure that individuals with disabilities who aremembers of minority groups have equal access to services,benefit from the opportunity to receive comprehensive ser-vices and receive the same level of treatment afforded others.That mandate should never have been required. What elseshould characterize our programs but a commitment to pro-mote, encourage and help assure the achievement or mainte-nance of productive and meaningful participation in the lifeof our communities by individuals with disabilities regard-less of their race, sex, national origin, sexual orientation orspecific disability?

The challenge facing providers in both the public and pri-vate sectors of vocational rehabilitation is to assure that noreal or perceived obstacles are present which limit the oppor-tunities of individuals with disabilities to fully benefit fromservices and programs. The vocational rehabilitation pro-gram cannot solve all of the problems clearly present withinour society. It cannot be expected, with the resources com-mitted to it, to alleviate the poverty, the inadequate educa-

tion, the sometimes dysfunctional social conditions and thecomplex personal problems presented by persons who toooften seek its services as a "last resort" after so many otherpublic services and programs have failed them.

That population knows no specific race, sex or specificdisability - rather, it represents those largely abandoned associal programs were devastated throughout the 1980s. Withthat said, the vocational rehabilitation program also needs tohonestly and aggressively address its own limitations andfailures. It must expand rehabilitation opportunities formembers of minority populations. It must also implementaggressive affirmative action policies associated with theemployment and access to training and continuing educationopportunities by employees.

The Dynamics of Reform

Robert F. Murphy has written eloquently about the per-sonal and social aspects of disability. In The Body Silent hewrites that "It takes a rare combination of intelligence,courage, and persistence to conquer the mental and physicalquarantine thrown up around the disabled by a society thatsecretly sees in them its own epitaph...The intensity of pur-pose required by the drive for autonomy makes the success-ful people unusual. They have entered the mainstream ofsocial life, and they have done this through great determina-tion and unflagging effort."

Those reflections suggest that the real challenge facingproviders is to constantly keep faith with those individuals whocome to programs seeking some measure of fulfillment, hopeand success. While substantive policy issues must be addressed,the ultimate measure of success or failure of our programs willalways rest on the quality and integrity of staff persons and howwell they respond to the needs of individuals.

Reynolds Price adds further insight into the personal experi-ence of disability in his recent book, A Whole New Life.

"1 likewise recall, and without nostalgic glow, the less tech-nologically sophisticated but generally more humane doctorsof my childhood and youth - doctors with the legendary 'bed-side manner'. Those nonstop doctors were men and womenwho, in their willingness to visit patients' homes, had agreed toexpose themselves to the context of their patients' lives-therooms they lived their precious lives in, the beds in whichthey'd expressed their love and bred their children. In my expe-rience, those doctors never indulged in false consolation (theyhad after all few effective drugs); but the depth of understand-ing that they gained by submitting themselves to the lives oftheir patients as opposed to demanding that their patientscome to them, however painfully gave them a far betterchance of meeting the sick as their equals their human kins-men. ',of as victim-supplicants broiled in institutional light andthe dehumanizing air of all hospitals known to me."

The message is that no policy, goal or imperative is of anyimportance unless it is translated into the capacity of professional"helpers" to make contact with, respect, and understand the needs,feelings, pain and anxiety of those who find themselves in a posi-tion of seeking support and assistance from rehabilitation profes-sionals. Institutions, organizations and programs remain healthy,


responsive and dynamic only insofar as they retain the capacity toaddress individual needs; only when they aggressively assure thatprocesses, systems and procedures serve the needs of individualsrather than the needs of the organization; only when they remainflexible, expansive and innovative in response to the unique sur-prises proposed and presented by those served; and only when itis recognized that we all, in one way or another, will most likelybear the burden and challenge of coping with a life which is some-what compromised, limited or otherwise confronted by unfore-seen obstacles. In other words, the endless challenge is to remainopen, sensitive, caring, ethical and respectful.

The philosopher William Barrett posed the question"What is the difference between a poet and technician"? Hisanswer was that "The poet walking in the woods loses him-self in the rapture of its presence; the technician calculatesthe bulldozers that will be needed to level it".

I would propose that the continued presence of rehabilita-tion as a respected, responsive and productive profession, pro-gram and service delivery system within our society rests withour capacity to somehow maintain, promote and enhance bothits "poetic" and "technical" integrity. In other words, we needto commit energies to the human and personal issues associat-ed with "disability" as well as to such things as process, tech-niques, forms and the structure of programs. The "technical"aspects of our work are exceptionally important but they donot ultimately define the value or worth of what we seek toachieve, offer or promote within society.

The "system" as we know it emerged over many years inresponse to an ideal or value - that each person enjoys theright to participate in the life of the community in all of itsaspects. That "fundamental" right remains an illusive goalfor many due to numerous factors including "disability".Fixing the system and removing obstacles must be viewed asmore than creating regulations or streamlining a process.More importantly, it involve.. .,elping to build communities

which value diversity, that promote full participation, andthat are committed to equal opportunity for all citizens.

Vocational rehabilitation programs need to aggressivelypromote those values. Our programs need to be agents ofchange in more ways than one. The future belongs, in manyrespects, to those who can keep alive the spirit and promiseof rehabilitation at its very best while also recognizing justhow many "bulldozers" are needed to clear away unneces-sary bureaucratic obstacles.

There are some troubling and challenging issues arisingwithin our society - growing gaps between classes of people,efforts to strictly limit certain social services, and, closer tohome, the destructive effort to designate "some" individualswith disabilities as more worthy of services than others.

The resolution of those types of conflicts can only beachieved by recognizing the need for informed and inspiredleadership; through the planning and delivery of substantiveand meaningful services; and by helping to assure the fullintegration into society of individuals with disabilities.

The agenda for the 21st century should not focus on whatcan be done to preserve a "system". That goal will take careof itself if we have the courage to devote our energies andcommit our financial and human resources to a larger one -creating and enhancing opportunities for individuals withdisabilities to create a "whole new life" for themselves andfor us. That, after all, is the enduring promise of rehabilita-tion: the elimination of barriers, the promotion of autonomy,the development of new and ever expanding opportunities.

The future of vocational rehabilitation programs will besignificantly more hopeful if a renewed commitment is madeto that "promise" and if serious and continuing efforts aremade to organize and conduct the practice of rehabilitationconsistent with it. Otherwise, we will be just another bureau-cratic institution which could disappear tomorrow withoutany reaction except, perhaps, a sigh of relief.

GO


Excerpts of Reviews and Comments Chapter Six

This paper is a statement of theauthor's philosophy regarding need-ed changes in the Vocational

Rehabilitation system. Basing his posi-tion on the Americans with DisabilitiesAct and the intent of the 1992Amendments of the Rehabilitation Act,McKenna stresses the vulnerability ofthe current system and the need tochange it to improve both its outcomes(meaningful and productive employ-ment) and its responsiveness to thediverse needs of people with disabilities.

McKenna acknowledges the chal-lenge of planning consumer responsiveprograms in an era of scarce resourcesand often conflicting agenda of legisla-tors, consumer groups, and regulations.He speaks out against unnecessary andburdensome government regulationwhile stressing the need to developaccountability measures for assuringquality outcomes for the most severelydisabled and ethnic minorities whilesimultaneously increasing the number ofplacements, McKenna views the ultimatesuccess or failure of the VocationalRehabilitation system as resting on thequality and integrity of people within thesystem who must remain "flexible","innovative", and "respectful" in focus-ing on the needs of individuals ratherthan the preservation of a "system". Hescores an immensely important point inindicating that more than just fixing thesystem, vocational rehabilitation reformmust promote helping to build communi-ties that support diversity, full participa-tion and equal opportunity. Vocationalrehabilitation programs must be changeagents, not preservers of a system.


patrick W. McKenna's paper"Provider of RehabilitationServices", in looking to the 21st

century, envisions dramatic changes inthe management and quality of serviceswhich will be offered to clients in thevocational rehabilitation program. Heanticipates difficulties, unless activeplanning and preventative action aretaken to preserve the significant legisla-

tion gains and other advancementsearned over the years in the act and sci-ence of vocational rehabilitation. Healso cites the Rehabilitation Act as akind of written bible, marking impor-tant milestones of progress andadvances. Added to this he also believesthat the Americans with Disabilities Act(ADA) brings with it a strongpublic/private mandate that shouldenhance V.R. and involve business andindustry to a heightened degree in therehabilitation movement.

McKenna also sees an invasion ofcontrol in case management and aredirection in choice. These trends, heconfides, must be studied and careful-ly addressed to preserve the integrityof the rehabilitation process as "clientfocused". V.R. must go on the offen-sive and dramatize its success inassisting people with disabilitiesachieve personal, social and economicindependence. These accomplishmentsare not only humane achievements buteconomic successes, for the consumerand the nation as a whole.

Angela Traiforos

pat McKenna's paper is full ofpleasant surprises, not the least ofwhich is his use of humor to make

point: "A healthy organization has min-imal policies, procedures, and regula-tions. A desperate one produces admin-istrative manuals." A wonderful throw-away line, but the real surprise is the fact that the author is the Director ofClient Services for the Maryland VR.(What is this a heretic within thewalls?) McKenna calls for a reductionof regulatory burdens on providers ofrehabilitation services, seeing in vari-ous process requirements a triumph ofform over substance. He also puts hisfinger on the principal inconsistency inrehabilitation's authorizing legislation.It's not erough to place an individual inany job these ,:f4s, since many of thebest new jo!so ac out of reach of peoplewith di:. .a:;: 'ii: :::,. The task of rehabilita-tion should be to identify services thatmake a real difference in the lives of

our consumers, and to attempt toachieve higher-quality placements.What is one of the biggest obstacles?"Subtle but nevertheless real pressuresare ... being applied to 'produce'increased numbers of successful place-ments in order to prove the effective-ness of the vocational rehabilitationprogram. "These are unconventionalremarks from a public administrator.

One finds a lot to admire in this paper.Am I the only person to notice that it isunusually well-written and filled withstriking analogies (when is the last timethat anyone enjoyed a rehabilitationmonograph for the sheer pleasure of thestyle?) McKenna correctly places theissue of cultural diversity in the contextof community development, and heshows how far we still have to go in thiscountry to assure equal opportunity forall our citizens by focusing on one of themandates in the recent Amendments tothe Rehabilitation Act. This mandate pro-vided assurances to people with disabili-ties who were also members of minoritygroups that they would be able to benefitfrom the same level of service as others inour society. "That mandate should neverhave been required," McKenna con-cludes. In seven words he makes hispoint. There's nothing more to say.

McKenna's arguments are aided byan awareness of larger social and eco-nomic realities, such as urban poverty,dysfunctional families, and an educa-tional system in crisis. All our lives arecompromised, limited, and challengedby obstacles to some extent; and inpromoting individual autonomy and intrying to eliminate barriers to fulleropportunity for people with disabili-ties, the ultimate absurdity would be toallow our service network to becomean even more unwieldy mechanism -yet another barrier to be overcome.

Jon Lundin

McKenna argues that vocationalrehabilitation has never been morevulnerable as a result of emerging

public policies that require the system tobe more responsive to the changing

601


needs and diversity of its consumers. Thechallenge also calls for creative ways tomaximize minimal or diminishingresources. In light of these develop-ments, McKenna proposes that rehabili-tation service providers be pro-active andlook for models such as the health carereform agenda as a way to begin plan-ning for change.

According to McKenna, some keyissues that need to be explored in thisplanning process include asking ques-tions such as what is the value ofvocational rehabilitation? Other goalsof planning would be to implementrealistic changes that include con-sume: choice and diversity. Changesalso require maintaining accountabfl;-ty and increasing linkages and net-work to broaden options and resourcesfor consumers. Thus McKenna seesthe need to overhaul the VR process inorder to remove unnecessary obsta-cles, to create a system that is evermindful of the changing labor market,and renew the priority to serve indi-viduals rather than to serve the needsof the organization.

McKenna presents an ambitious chal-lenge to the vocational rehabilitationcommunity and delineates some criticalissues that need to be addressed, preserv-ing and building on the strengths of thesystem and not re-inventing or addingnew bureaucracies with new rulesand regulations. The "people-friendly"systems and agencies should be amajor goal in the restructuring govern-ment, including the federal and statevocational rehabilitation system.

Jennie R. Joe

Several excellent issues are enumer-ated by Mr. Mcle -tin& The manu-script is fairly broad in scope and

comprehensive in its detailing of issuesconfronting vocational rehabilitation ser-vice providers as they move toward the21st century.

Mr. McKenna identified three issueareas that were profound and intrigu-ing. First, he noted the need to createcommunity vide, social consensus onthe value and purpose of rehabilita-tion; secondly, the need for and role ofthe provider in reducing regulatoryburden; and, lastly, establishing pro-

gram accountability in terms of quali-ty outcomes.

Regarding the first point of con-sensus on the purpose of the rehabili-tation program, Mr. McKenna'sassessment is accurate from the per-spective of the Rehabilitation ActAmendments of 1992 which definesthe scope of the program. However,there is a deviation that is worthy ofnoting. The Rehabilitation Act 'of1992 required 18 months to be devel-oped so that consensus among reha-bilitation professionals, advocatesand consumers could be reached. Thechallenge that has not been met infostering and promoting that consen-sus on an on-going basis. Further, theRehabilitation Act Amendments of1992, unlike previous legislation,clearly identifies the purpose of theoverall Act (i.e., Section 2(b)(1) and(2)) as well as for programmaticTitles I Basic Rehabilitation, VI-CSupported Employment, and VII -

Independent Living (i.e., Section 100,631 and 701, respectively). A closereview of the overall purpose revealsthe cumulative nature of the purposesof separate titles. This review shouldalso reveal that there should not be aphilosophical dichotomy on the pur-pose of the program.

On the second and third points,reducing regulatory burden and qualityoutcomes, Mr. McKenna contends thatthere are serious challenges for reha-bilitation service providers. In address-ing the challenge of regulatory burden,a fact that cannot be overlooked is thatproviders are a part of a system that,unfortunately, does not empower themto make improvements in the way ser-vices are provided. As such, they areoften challenged to change things thatare not within their control. Changes tothe system are needed and providersneed to advocate for change to the con-trollers of the system.

Last, gainful employment is oneoutput of the vocational rehabilitationprogram. Other dimensions of quality,according to Parasuraman and Berryauthors of Delivering Quality Service,include reliability, responsiveness,competence, courtesy, credibility,access and communication. The chal-lenge to vocational rehabilitation pro-fessionals in the future will be to work

62

with consumers to define, translateand incorporate all the quality dimen-sions into daily practices.

Judy Norman-Nunnery

r. ?v1cKenna presents a rather

i challenging insight to the dilem-ma facing VR for the next decade.

I agree wholeheartily that trends in legis-lation, public awareness and demand foraccountability leave the VR Programparticularly vulnerable. I think that thetumultuous nature of current directionaltrends and the challenges facing the VRProgram leading into the 21st centurysolidifies the need to make clear thegoals of the VR Program.

I was particularly intrigued by Mr.McKenna's concern over the burden-some "processes" currently required inthe VR Program to function accordingto set standards, and how these"processes" not only steal valuable timeand resourc ,s away from the goals ofthe VR Program, they create a loss offocus. I believe it is imperative that fun-damental, clearly defined goals beestablished within the VR Program,minimizing vagueness. With these inplace, it may be possible to eliminatemuch of the current "processes",designed to monitor, or account foractivity or procedure. Everyone is play-ing on the same field and knows theboundaries. This will also lend to flexi-bility within the boundaries to allowchange to evolve within the VRProgram, as trends mandate.

Philip H. Kosak


Chapter Seven

The Role of the Rehabilitation

Facility in the 21st Century

Kenneth J. Shaw

I. Introduction and History

This paper is an adaptation of a concept paper published byGoodwill Industries International January 10, 1994. Thepurpose was to anticipate changes needed by rehabilitation

facilities to prepare for the 21st century. Rehabilitation facilitieshave a long and rich history in the provision of vocational reha-bilitation and employment services to people with disabilitiesand other special needs. In part, our success has been the resultof maintaining commitment to a mission and purpose. and whilethe recognition that we had to anticipate and be receptive tochange to meet new and emerging demands of the work worldand people receiving services. The foundations for our successfor Goodwill Industries were laid by our founder, Dr. Edgar J.Helms, and codified in his writings The Spiritual, Social, andEconomic Implications of the Goodwill Industries Movement. In

those writings, Dr. Helms recognized that, "The GoodwillIndustries is a business-plus. As a business, it must be carried onaccording to good business practices or it will fail. Failure is allthe more imminent in Goodwill Industries because its businessis so difficult." Dr. Helms went on to say that, "From a businesspoint of view, the chances of failure in Goodwill Industries aregreat. Perhaps there have been so few failures because theGoodwill Industries is a business-plus. It exists for service andnot for profit. Unlike ordinary business, it gives primary atten-tion to the human."

In addition to describing Goodwill Industries as a busi-ness, Dr. Helms recognized that Goodwill Industries "is asocial service enterprise-plus. It endorses most of the teach-ings and practice of scientific social work. It investigates andstudies causes, but generally, it regards a job above an inves-tigation." The recognition that Goodwill Industries is a busi-

Kenneth J. Shaw. Director. Program Development and Research, GoodwillIndustries International, Inc., Bethesda, MD 20814

63

ness and a social service enterprise has facilitated GoodwillIndustries in positioning itself as responsive to the changingsocial needs and requirements of our communities.

In our industry success has been due, in part, to demon-strating itself to be both proactive and reactive to the chang-ing needs and requirements of those we serve. We have mod-ified programs based upon the changes that occurred in soci-ety, places of employment, legislative priorities and bestpractices as developed in the broad field of vocational reha-bilitation and employment programs. More importantly,Goodwill Industries, as well as other rehabilitation organiza-tions, have demonstrated leadership in the development ofnew program models, as well as having pressed for account-ability in the social service industry through commitment toaccreditation and measurement of effectiveness and efficien-cy in programming.

The purpose of this paper is to suggest that our changingenvironment requires a new forMat for programs and ser-vices for the future in our industry. Our emphasis has been tobe expert in the provision of vocational rehabilitation pro-grams. These programs, although responsive to the commu-nities and people served over the last 50 years, have becomelimiting due to the perceptions of our broader and expandingpublics as to whom we serve and the major purposes of ourprograms. The term "vocational rehabilitation" is almostexclusively associated with programs serving people withdisabilities. Goodwill Industries has, on a thoughtful andsystematic basis, transitioned from being an organizationthat has served only people with disabilities to serving abroad range of populations needing vocational and employ-ment programs. In order to be fully recognized by the broad-er communities, it is necessary for our industry to look atretitling its emphasis as well as constructing new servicedelivery models, to be responsive to the needs of the broad-er publics and populations served. This paper will providesome background, as well as projections, on the major influ-


encers impacting the way we do business, and suggest thetype of business and services we should engage in over thenext decade. It is hoped that the paper will stimulate think-ing across the vocation rehabilitation network and generatethoughts and reactions to enhance the development of newdelivery systems and program models for the future.

In order to be positioned to maintain the type of successwe have experienced in the past, it is necessary to recognizethat the major influencers providing funding and referrals toour organizations are changing and are developing newemphases. Over the next several years it will not be appro-priate nor acceptable for organizations to continue to provideprograms and services in the same manner as they have overthe last decade.

In order to be responsive to the issues that will be pre-senting themselves, the rehabilitation community needs toposition itself, not only in terms of the services and programsit provides, but in the way it is perceived in the communityby establishing itself and communicating its philosophy asbeing an "Employment, Education and Training Center." Thebroader implications of this title are obvious. There is a long-term requirement to demonstrate that we are responsive tothe broad range of human service needs for a broader rangeof populations, and to developing requirements of externalinfluencers.

II. Trends of Major Referral, Fundingand Legislative Influencers

In order to look at the future it is important to get a senseof what is happening now and analyze the current thinking ofthose who are responsible for the development, maintenanceand implementation of the legislation that influences orimpacts the types of programs and services offered by reha-bilitation facilities. The following is a short summary ofsome of those trends and projections.

A. Traditional Rehabilitation Legislation

One of the major characteristics of the 1992 amendmentsto the Rehabilitation Act is a focus on the issue of "choice"for those receiving services. The 1992 amendments to theRehabilitation Act state: "The goals of the nation properlyinclude the goal of providing individuals with disabilitieswith the tools necessary to: make informed choices and deci-sions; and achieve equality of opportunity, full inclusion andintegration in society and provide for self-sufficiency forsuch individuals. The purposes of the act are to empowerindividuals with disabilities to maximize employment, eco-nomic self-sufficiency, independence and inclusion and inte-gration in society..."

Essentially, the federal legislation, specifically theRehabilitation Act of 1973 as amended, governing servicesto people with disabilities, has changed from one which waspaternalistic, (e.g., making decisions for and doing to indi-viduals) to one which intends to empower individuals tomake informed choices.

Other major and related disability also includes significantorientation to legislation the rights of the consumer and con-sumer representatives. These legislations include the Individuals

1995 Switzer Monograph64

With Disabilities Education Act, the Americans with DisabilitiesAct, and the Developmentally Disabled Bill of Rights Act.

Another focus becoming critical in the area of rehabilitationservices relates to the development of standards. It is recognizedthat accreditation standards promulgated by accrediting entitiespromote and reflect the current thinking on consumer choice andempowerment issues. In being responsive to these standards,organizations are obligated to demonstrate a commitment tothese issues by the development of "values" statements in theirorganizational philosophy, board mandates and program proce-dures. These procedures have been slow to develop and difficultto implement. As a result, many rehabilitation organizations con-tinue to deliver services much as they have done in the past, in apaternalistic rather than a consumer choice-driven model.

The 1992 amendments to the Rehabilitation Act also call forthe development of specific programs and standards to reflectthe direction and configuration of vocational programs nowoffered by traditional vocational rehabilitation organizations.

The legislative initiatives in this area will have significantramifications for how individuals are regarded in the servicedelivery system and how services will be carried out. It willbecome the responsibility for rehabilitation staff to becomefacilitative rather than directive, and people served will needto be provided with options. Consequently, rehabilitationorganizations need to develop services and programs whichfacilitate the development of options for those served. Thelegislation also clearly implies that people served will beresponsible for making decisions for their own future. This isinappropriate if individuals are not provided with the tools tomake informed choices.

B. Department of Labor

The Department of Labor has received a great deal ofattention as part of the present administration's "reinventinggovernment" emphasis. Material written on this topicdescribes a Department of Labor which would make the fol-lowing changes to improve the already existing employmentand training programs.

First, emphasis would be given to enhancing re-employmentprograms for occupationally disabled federal employees. Thisparticular recommendation calls for expansion of theDepartment of Labor's current return-to-work programs so thatfederal employees with disabilities would be able to return toproductive careers, as opposed to collecting benefits and notfinancially contributing to the economy. This is a philosophywhich is consistent in many workers compensation insurancerehabilitation programs across the country.

Second, the Department of Labor has given particularemphasis to the development of a single, comprehensiveworker adjustment strategy. This calls for improved servicesto individuals who are currently unemployed or those whoare perceived to be at risk of dislocation. The thinking of theadministration is that currently available resources would beredirected to develop a new worker adjustment strategy toreturn individuals to work more quickly, the concept beingthat individuals should not be in a dependency and thereforelearn to become dependent on that system.

Third, the philosophy that is most likely to impact the wayservices arc provided to local communities is the concept of


"one-stop centers" for career management. This recommenda-tion also has been generated as part of the reinventing govern-ment philosophy and calls for the establishment of these centersfor career management thus creating a consumer driven work-force system, providing individuals an opportunity to makeinformed choices, and providing the means to achieve theirgoals. Essentially, this would call for the integration, under a sin-gle management coordinating system, of all employment andtraining programs for people with special needs.

Finally, the Department of Labor is also considering thecreation of a "Human Resource Investment Council." Thisrecommendation calls for the development of a multi-agencywork force development council to coordinate all federalemployment programs and to consolidate funds from all ofthe separate programs. The basic idea is that the reason for aperson being enerriployed (i.e. disability or disadvantagingcondition) is not as irvortant as providing a comprehensionprogram to train and place people into employment.

C. Department of Education

The current thinking in the Department of Education andthe government in general is that many youth ace ill-preparedfor work when they leave high school. It is projected thatabout 30 percent of youth aged sixteen to twenty-four lackthe skills for entry-level employment, and 50 percent ofadults in their late twenties have not found a steady job. Thisreflects poor academic preparation, limited career guidance,inadequate workplace experience and other barriers for ade-quate school-to-work transitions. In response, theDepartment of Education is giving a greater emphasis on"transition from school to work" programs and is developingbroader strategies to prepare students for jobs.

The "school-to-work" transition models are most fre-quently defined as education models designed to serve non-college bound youth. These education models are most fre-quently high school career academics, technical preparationprograms, cooperative education programs, urban vocationalschools and other strategies designed to offer an alternativeto traditional college preparatory academic programs.

The prevailing trend is to move away from general educationand move toward education which is goal driven and specific tothe world of work.

The Department of Education is also looking at othertransition trends which include the need to agree on nation-al standards of basic education; specific standards for per-formance in individual industries and occupations; theneed to establish to design, develop and implement formallinkages and the need between education andbusiness/industry. It is likely that we will see competencyand credentialling standards established by educators andbusiness/industry that are constantly updated; school-to-work models that are characterized by active partnershipsbetween education and business/industry, and which pro-vide incentives for both parties; and the development ofperformance benchmarks to measure program quality. It islikely that programs will be more directly related to thedefinition of skill requirements expressed by employers,with instruction offered in a competency based format, asopposed to traditional educational models.

Generally speaking, school-to-work transition modelswill be characterized by four strategies: processes for devel-oping academic and occupational competencies; career edu-cation and development; extensive links between school sys-tems and employers; and meaningful workplace experiences.

The Department of Education also projects that new jobswill be characterized by heavy reliance on educated workerswith problem-solving and communicating skills who canhelp maintain our lead in technology industries. Very fewjobs will be created or will exist for those who cannot read,follow directions and use mathematics. Skills standards willbe developed which will identify the knowledge and skillsneeded for satisfactory performance in the workplace, and berelated to specific occupational areas.

It is anticipated that future workers will require skills inthe basic areas of academics, vocational education, employ-ability and life coping skills. Academics will involve compe-tency in communicating (reading, writing, speaking, listen-ing and computer literacy); computing (mathematics); prob-lem solving (creative thinking, decision making, reasoning,learning how to learn); group living and economic self-suffi-ciency (history, geography, economics, citizenship); under-standing relationships among groups (ini_rpersonal, intercul-tural, international); understanding the natural world (sci-ence); and maintaining personal wellness (health).

Vocational education will include vocational-technicalcourse work that leads to certification in an occupationalarea, or on-the-job training or simulations. The process willalso incorporate vocational preparation and career explo-ration as a readiness activity.

Emphasis on employability skill training will give specificattention to topics such as job search, job application, interviewpreparation and basic work habits associated with employment.The final emphasis on life coping skills training, will include thedevelopment of a well-defined personal identity. Specific topicsmight include identifying and dealing with personal fears, cop-ing with feelings and emotions, making wise choices, dealingwith values conflicts, developing and maintaining positive per-sonal relationships, and demonstrating effort and perseverancetoward goal attainment. The Department of Education appears tobe moving toward the development of a process by which stu-dents will be certified based on demonstrated competencies rel-ative to skills standards endorsed by employers.

D. Other Federal Departments

There are currently more than 120 separate funding or enti-tlement programs for special needs people in the area of employ-ment and training. Although the departments trends are consis-tent with those defined above, a major concern for the vocation-al rehabilitation community might be the U.S. Department ofHealth and Human Services, which has a primary focus over thenext four years on health care and welfare reform. The emphasisof the U.S. Department of Health and Human Services is tostreamline any public training programs which would includethe programs designed specifically for the welfare recipient.Many studies are presently being conducted to make a determi-nation of which employment training programs work and whichdo not, with intent to focus resources on those that work. TheU.S. Department of Health and Human Services is attempting to


develop a national employment training strategy in conjunctionwith the Department of Labor and the Department of Education,and it will be looking at the "one-stop model" previously refer-enced. The other department to watch is the Department ofDefense which will have a continued emphasis on employmentand training programs as a result of downsizing and overalldecreases in spending. This will result in more people beingincorporated in dislocated worker programs and other serviceprograms serving the unemployed.

E. Summary of Projections

In an attempt to get as many services for the dollar as possi-ble, and in an attempt to make government efficient in the deliv-ery of employment and training programs, the trends in federalfunding and the regulations that influence that funding, willsteadily move away from funding designed specifically for asingle population or a single type of program model.

Of the estimated 125 different programs and fundingstreams for employment and training, the majority of thesenow call for nonduplication of services, and collaboration atthe state and local levels. The only exception is where spe-cialization in population services is so explicit as to makecollaboration ineffective. Even those will be re-examined aspart of the reinventing government philosophy.

There have been several attempts by the federal govern-ment to change regulations to make government more effi-cient. One model attempted was the "super private industrycouncils" but at the present time is titled "human resourcesinvestment council,"and has the emphasis of trying to inte-grate multiple employment training programs into a singlemanagement and coordinating function.

We will see the "one-stop shopping" model of human ser-vices piloted and encouraged by major human service entities.This and other forms of "single point of entry" program modelswill be encouraged in order to effectively manage the myriad ofentitlement programs and services. Federal, State and local gov-ernment entities will attempt to collaborate to provide "seamlessservices;" that is a continuous, uninterrupted delivery model.The danger to rehabilitation facilities will be that the serviceswill be provided by government and no point of entry will beavailable for rehabilitation facilities.

This type of collaboration will require rehabilitation facilitiesto become more familiar with other community and fundingorganizations, as well as gain an understanding of multiple pop-ulations. This will also require us to promote a culture of changewhich says it is in our interest to collaborate with other organi-zations even if we do not have a primary role. We will have tobecome familiar with the regulations governing funding and col-laborative projects, as well as establishing ourselves as partnerswith organizations which are nontraditional partners. Our ser-vice-delivery models will have to be responsive to the changingrequirements and objectives of these various entities.

Ill. Transition to Employment,Education and TrainingService Delivery Model

In order to prepare for the opportunities and challengesthat present themselves, rehabilitation facilities will have to

totally examine their present method of delivery of services.At the front end of this process an examination is required inwhat we call ourselves. As a "vocational rehabilitation" orga-nization there are implications in relationship to the types ofpeople served, as well as a perception of our program. Inorder to position ourselves to become credible to the nondis-abled community, we will have to do something as simple asretitling the programs of our organization. The purpose of thispaper is to suggest that our organizations becomeEmployment, Education and Training Centers. It would beinsufficient to simply deal with retitling since the real pur-pose is to communicate to our various publics that there is achange in the orientation of services, as well as communicat-ing an ability on the organization's part to be responsive tothe unique and specific characteristics of multiple popula-tions and to the requirements of regulatory and legislativeemphases. A major part of our emphasis will need to focuson developing and providing an expanded array of servicesspecific to the individual needs of expanded populations.

Traditionally, vocational rehabilitation organizations havebeen delivering services under a "program model." In thismodel, the organization describes a proscribed set of pro-grams that are available for special needs populations. In alocal organization these programs generally include workevaluation, work adjustment, personal adjustment training,sheltered employment, supported employment, occupationalskills training, job readiness training, job seeking skills train-ing and placement. Each program has a defined set of entrycriteria and a prescribed set of services that are available tothe individual while enrolled in each of the programs. Thiskind of model is restrictive in that it is assumed that all peo-ple have a need for the same general type of services whileenrolled in a program. It may well be time to recognize that"programs" are restrictive and nonresponsive to the individ-ual needs and desires of those served. It is time to examine aprocess that constructs a true individual program plan, build-ing a program for an individual from an array of services.

It is recognized that a transition from a program model toa service model might be disruptive in our general communi-cations with our publics, as well as being in conflict with tra-ditional accreditation/certification requirements. The empha-sis, however, from regulatory and other influencers is thatthere needs to be the flexibility to develop a truly individualservice plan for each individual served, and that service planshould be dependent on the unique and specific needs of eachindividual, and referral and funding organizations.

It is being suggested that our organizations look at the estab-lishment of a true service delivery model where the uniqueneeds and expectations of each individual are determined and aspecific plan is developed to be responsive to those needs,choices and desires. This can be accomplished only by offeringa truly comprehensive "cafeteria model" of services for eachperson requesting services within our organization.

In order to be truly responsive, we will need to look at notonly the types of services that are offered but will also haveto look at the location of the delivery of services. It may wellbe that services and programming will need to be set up inalternative locations such as community centers in urban or

66suburban locations using existing facilities such as school


buildings or government offices. It also is likely that we willhave to consider offering classes at irregular hours, such asevening classes for the working poor or for people not ableto devote regular daytime hours to the services.

A "cafeteria model" of service programs must includecomponents that are responsive to a broad range of needsbeing presented by the person served as well as beingresponsive to the requirements and expectations of referraland funding sources. Essentially, services will have to dealwith the issue of empowering individuals served, but moreimportantly incorporate a broad range of services to respondto the needs or requirements that individuals will bring to theprograms from diverse backgrounds.

Goodwill Industries has already made a commitment toexpand the populations served by recognizing the need foremployment, education and training programs for the disad-vantaged populations such as at-risk youth, welfare recipi-ents, immigrants, teen parents, illiterate, dislocated and dis-placed workers. It is recognized that no single programmodel has the capacity or capability to be responsive to thebroad array of needs requiring attention in an employment,education and training center. In order for the new servicedelivery model to be effective there needs to be a great dealof developmental work on specific curriculum content in thevarious service areas. If, however, we truly are to positionourselves to be the premier provider of services for adultswith special needs, then we will need to invest our intellec-tual resources as well as fiscal resources into the develop-ment of the programming responsive to the long-rangerequirements of populations and other influencers.

IV. Components of the Employment,Education and TrainingService Delivery Model

In order to affect change to a service delivery model fromthe more traditional program delivery model, it is necessaryto make a clear definition of the array of services to beoffered. Essentially, there is a need to provide services basedon a clear and concise philosophy which articulates thebelief in the value of work as a solution to social problems,and the requirement to involve people in the process of mak-ing appropriate decisions and facilitating commitment to theachievement of established goals.

The following components are identified as the major cat-egories of a service delivery model:

A.B.C.D.E.

Appropriate philosophyCareer developmentDecision making/planningCareer preparationPlacement

A. PhilosophyGoodwill Industries was proactive in the development of

a philosophy in relationship to those we serve. As an organi-zation, we believe that we arc a developer of creative ability,a stimulant for self respect, a moral enhancer, and a tempo-rary sustainer and facilitator. We believe that the best out-

comes occur for individuals served when services aredesigned to identify, understand and cope with the major lifeactivities of living, working and playing. Further, we believethat services should be client centered and client driven.

In our published philosophy statement, Goodwill Industriesstates that people served are responsible for and entitled to:

be an active participant in rehabilitation planning

establish personal vocational objectives

commit to therapeutic or ongoing rehabilitation programs

develop skills to adapt to life changes

take responsibility for personal behavior and actions

gain an understanding of the world of work, job struc-ture and the ability to equate personal skills to thatunderstanding

expand awareness of resource seeking

increase awareness of leisure activities

develop decision making skills sufficient to last a lifetime

implement career plans

We believe as stated in our corporate philosophy, there-fore, that each person served should have access to the fol-lowing opportunities as part of their service program atGoodwill Industries. The opportunities we offer are that eachperson served will:

receive services which will enable each to acquireinformation; make career decisions; and negotiate andbalance information, decisions and external factorsthat have an impact on work;

receive skills training which reflects current labor mar-ket demands consistent with the community;

have the option to refuse, accept or modify services,because participation is voluntary. Each individual and theorganization should negotiate the best possible arrange-ment of services, including referral to other agencies;

have a right as well as a responsibility to participate inthe development of program planning. To whateverextent possible, each individual must be encouraged totake responsibility for him/herself in the process andoutcomes of services made available;

maintain his/her constitutional civil rights;

expect and receive services without regard to age, sex,race, color, religion, marital status, disability, voca-tional barrier or national origin;

be treated with dignity and respect, remain free fromphysical or mental abuse, receive a fair wage for allwork performed; and

6 7 make informed choices.


The adoption of this philosophy positions GoodwillIndustries as responsive to the developing emphasis on indi-vidual choice and empowerment. More importantly, it setsthe stage for identifying and developing services responsiveto the changing requirements of those to be served.

B. Career Development

A key and major component of any service driven deliv-ery model needs to have as its foundation the implementationof the concepts of career development. Career developmentis a philosophy that encompasses the various roles an indi-vidual plays as family member, citizen, worker and user ofrecreation time. Career development recognizes that the bestoutcomes should be framed around the components of learn-ing, choosing and negotiating.

Learning is described as self-awareness of the individualas a distinct organism, as well as in relationship to other peo-ple, events and objects. Choosing is the identification ofdecisions to be made, prioritizing decisions, and the accept-ing responsibility for personal actions. Negotiating is thebalancing of personal choices against the external factors ofother people, resources and events.

C. Decision Making/Planning

The decision making process is one which provides suffi-cient information to individuals in order to facilitate theiraccepting the responsibility for their own decisions. Thisincludes providing sufficient information to people to recog-nize and define decisions to be made, balance the importanceof the various influencers on their decisions, to gather andevaluate information, as well as analyze the risks and benc-fits of each alternative. The result of the decision makingprocess is a structured plan leading to the achievement ofspecific and defined objectives.

D. Career Preparation

This area is the one that needs the greatest work in order toprepare a new service model. Entirely new curriculums will needto be obtained or developed. Traditionally, we have used pro-gram models for career preparation, using programs such aswork adjustment, personal adjustment, skills training and struc-tured employment. It is now suggested that we incorporate spe-cific career preparation services. These services would include:1) basic skills, such as literacy, numeracy, English as a secondlanguage, adult education, activities of daily living and indepen-dent living; 2) social or life skills development, such as socialskills development, behavioral skills development, motivationalskills development, use of community resources, problem solv-ing, self presentation, communication and use of leisure time;and 3) employment skills, such as work experience, on-the-jobtraining, apprenticeships, technical skills training, entrepreneur-ial training and job search skills. Career preparation will addressnot just the technical skills of employment but offer servicesresponsive to the diverse barriers faced by diverse populations.

E. Placement

Placement is the result of the employment, education andtraining services offered within the rehabilitation industry

Placement hopefully, would lead into an employment andcareer position consistent with the person's needs, desires,wants, expectations and motivations.

V. Delivery Systems

All delivery systems to implement a new service deliverymodel should be curriculum based and criterium referenced.Essentially, there should be a structured method of instruc-tion, assignment of specific staff skilled in the content areas,and defined methods by which people can have mastery ofthe topic measured at the conclusion or completion of the.astructional process. Specific development of materialsshould be a joint project between national organizations,commercial materials developers and local service providers.Every attempt should be made to identify existing materialsthat can be incorporated into the service delivery model.

VI. Support ProgramsSupport programs are those activities, services or pro-

grams which are necessary and must be available to facilitatethe participation in employment training and education ser-vices. Supportive programs may be offered on a time limit-ed or continuing basis and also may be necessary for a peri-od of time following placement of the individual intoemployment or other positive career outcomes. These pro-grams may be managed by the local provider directly or theymay be arranged for, through cooperative agreements andrelationships with other service providers. Local staff willidentify the need, coordinate the access of these services andfollow-up on the effectiveness of the support programs.

Support programs include the folloWing:

A. Housing

Housing may be of a temporary, permanent or semi-per-manent nature and also may be either dependent or indepen-dent or semi-independent.

B. Transportation

Transportation services may include coordination oftransportation, provision of direct transportation operated bythe organization, teaching driving skills, arranging for car-pooling or any other transportation arrangement required toassure the individual's participation in their employment,education and training services.

C. Child Care

Child care must be arranged for and can be offered bythe provider, be coordinated with an existing communityservice offering child care services, provided for in thehome of the person served, or arranged for throughchurches or other private entities. Again, the purpose ofchild care is to ensure the person's flexibility to partici-pate in the services leading to employment outcomes.

D. Other Support Programs

It will oftentimes be necessary for the organization todevelop specific and unique support services or programs to


assure that the individual has the opportunity to participateon a continuous basis in their employment, education andtraining program. The organization needs to be responsive tothose requirements and initiate remedial action.

M. Implications of Change

In addition to the requirement for the development ofappropriate curriculums and materials to support careerdevelopment, decision making and career preparation ser-vices, there are other factors that will influence our ability toreposition ourselves for the delivery of services in the future.A major emphasis will have to be given to the requirementsof skills of staff who will be responsible for the implementa-tion of the new service delivery models. Staff will need tohave the skills to be adaptive and flexible in the recognitionof the service needs of populations served and have the abil-ity to construct appropriate individualized programs drawingfrom the broad array of services that would be available. It isanticipated that staff will become, essentially, case managersand instructors, rather than work evaluators, work adjust-ment specialists or counselors. An intensive orientation andtraining process will need to occur in order for existing staffto make the transition to a new service delivery model.

Our organizations are also going to have to re-examinelocations of the delivery of services. It may no longer beappropriate for all services to be housed and delivered in ourtraditional locations. It will be to our advantage to explorethe feasibility of distributing programs and services acrossthe community. Utilization of churches, schools, libraries,state and federal office buildings, storefronts, neighborhoodcenters, senior centers, as well as other locations might bemore appropriate locations for services to be offered whichare closer to the individuals who are in need of the services.It is also likely that in our "ocations, we will have to take onthe look of educational facilities, utilizing classrooms asopposed to work space.

Rehabilitation facilities will also need to irritate comprehen-sive communications and education programs in our communi-ties to facilitate the recognition of our organizations as beingcomprehensive in the array of services available for specialneeds populations. Specific marketing strategies will be neededto communicate to referral, funding and regulatory influencersas well as targeted marketing to people needing services. Sincewe have invested a great deal of our energies in communicatingand positioning ourselves in our communities as vocationalrehabilitation centers, we are likely to have a difficult timechanging those perceptions. The need will be to have the exter-nal entities recognize that we are truly employment, educationand training organizations, offering a broad array of servicesresponsive to a broad array of needs of various populations.

An additional long-range implication of moving to a servicemodel is the difficulty that will be experienced in traditionalaccreditation/ceitification systems. Essentially, the existingaccreditation/certification processes accredit program models.Although it is generally assumed in the accreditation systems thatindividual program planning will occur, the standards of accredi-tation generally require organizations to have defined programs.Education and training will have to occur with the accreditation

organizations in order to assist them in making the transition froma program model to a service model. Accreditation is going tohave to move toward outcome measures as opposed to processmeasures in order to be responsive to the long-range changesoccurring in the service delivery system.

A transition to a new service delivery model of program-ming will also require rethinking the way we presently man-age programs. Management from a distance will becomenecessary. Concerns associated with staff development mustbe addressed as well. Managers will need to become morefocussed on the outcomes of the services being offered andencourage the ongoing development of new approaches to beresponsive to the ongoing and diverse needs of those served.

VIII. Next Steps /transitionIn order to implement a transition to a service delivery

model, it is going to become necessary to first validate thecomponents of the service delivery model. Those items, par-ticularly under the basic skills, sociaUlife skills and employ-ment skills, should be analyzed to ensure that the necessarycomponents of the service delivery model are included andare likely to be responsive to the presenting needs of the var-ious populations served.

Essentially, what will need to be done, is to identify thevarious modalities for the delivery of services. After thosemodalities have been identified, there will be a need toresearch the availability of existing material that might beapplied to our programs and services. We must then obtainfor evaluation existing materials and where materials do notexist, work on the development of new materials to beresponsive to the services defined. Materials must then beevaluated and the decision made to accept existing materials,modify the material to be more appropriate for our purposes,or to reject materials as not being applicable.

IX. SUMMARY

In order to remain current and to be responsive to the devel-oping needs of people served and the influencers on our organi-zations it will be necessary to reposition ourselves as anEmployment, Education and Training Center. Name changealone will not be sufficient to reposition ourselves to become anacceptable provider. The development and infusion of appropri-ate materials covering the areas of career development, decisionmaking and career preparation services of life skills, basic skillsand employment skills will also be necessary.

In addition to the identification and development of mate-rials to support the transition to a service model of employ-ment, education and training, significant resources must beinvested in the design of adult learning centers.

It is recognized that rehabilitation facilities may not bethe provider of all services defined in this paper. Agreementsfor the delivery of specialized services, such as literacy, maybe developed with other community service providers.

It is necessary, however, to recognize that we will beresponsible for recognizing, implementing, coordinating andmanaging a broader array of services, individually tailored tomeet the needs of a diverse population.


Excerpts of Reviews and Comments Chapter Seven

The role of rehabilitation facilities ispragmatically delineated by Mr.Shaw. The maruscript is extremely

thorough in defining the national keystakeholders (i.e. Departments of Healthand Human Services, Education andLabor) for rehabilitation facilities.Additionally, Mr. Shaw provides a skill-ful portrayal of past, current and project-ed impacts that the key stakeholders willhave on rehabilitation facilities.

Mr. Shaw's basic contention is thatto remain viable rehabilitation facili-ties we will need to examine a) tradi-tional population bases; b) manners inwhich services are determined; and, c)approaches for effective delivery ofservices. In support of Mr. Shaw'scontention, several state rehabilitationfacility associations and numerouslocal community-based rehabilitationprograms have been conducting suchexaminations and have concluded thatthey have diversified population, ser-vices and service delivery approaches.The end result appears to be an abilityto meet the needs of more individualsneeding services while providing thesame level and quality of services tothe traditional population base.

Judith Norman-Nunnery

Iehabilitation facilities face uniquechallenges as we move toward the21st century. It could be argued that

they have outlived their usefulness andare no longer relevant within a worldwhich values "inclusion", integrationand equal access to community educa-tional, social and recreational facilitiesby persons with disabilities. On theother hand, many offer distinct andindividualized services otherwise notavailable within the larger community.Mr. Shaw provides a quite thoughtfuland comprehensive review of all of theissues facing rehabilitation facilitiesand offers some challenging proposalsfor survival in the 1990s and beyond.

As with a number of other presenters,Mr. Shaw discusses the legislative andadministrative initiatives occurring with-in our society which clearly indicate a

change in the way that government isviewing necessary interventions associ-ated with basic education, career devel-opment and transition from school towork. He subsequently explains howrehabilitation facilities will need tochange in order to remain a viable part-ner in those comprehensive efforts topromote positive outcomes for individu-als with disabilities. He rightly asserts, Ibelieve, that the changes occurring with-in public education and job placementand development programs and agenciespresent unique challenges for rehabilita-tion providers. They need to engagethemselves in efforts and activities whichmight have seemed irrelevant in the past.

Mr. Shaw challenges many of theassumptions used within rehabilitationfacilities to plan and provide services.I believe he is correct in asserting thatcurrent practice tends to offer a "pro-gram" which someone has to "fit"into. He suggests that a transition to a"service" model is essential; an indi-vidual should be able to chose from anarray of services which combine tomeet his or her needs. That representsmore than a change in "systems"; itwill require a fundamental and sub-s'antive change in the thinking andapproach of rehabilitation practition-ers. For the most part, facilities tend todetermine what is best for people.They find it exceptionally hard toaccommodate consumer choice, indi-vidual need and cultural diversityissues. Mr. Shaw offers some positiveand constructive suggestions for help-ing to keep such programs honest,responsive and useful for the peoplewho may choose to make use of them.

Patrick W. McKenna

Federal and state governments havelong looked to the nonprofit rehabil-itation facilities such as Goodwill

Industries to deliver rehabilitation andemployment services for persons withdisabilities. Because federal and stategovernments are key consumers of ser-vices, Shaw reminds us that the rehabili-tation facilities must keep an eye on var-

ious legislative changes and prepare forthe changing milieu as well as for clientswho exert more self reliance, are willingto make choices, and represent increasedcultural and ethnic diversity.

As directives and mandates changeand call for such things as "one-stop"employment centers, rehabilitation facil-ities have to keep up with these changes.One way to address these changes,according to Shaw, is to develop what hecalls a "cafeteria model" of service pro-gramsone that can then be responsiveto a broader range of needs and clientele.He uses Goodwill Industries as an exam-ple to describe how one rehabilitationfacility has dealt with these changes, i.e.,by expanding its services to a number ofother disadvantaged populations such aswelfare recipients.

There is no question that rehabilita-tion facilities are important for clients,but they are also an important resourcefor service providers. As these rehabilita-tion centers expand their list of eligibleclientele, one cannot help but wonder ifin the expansion, individuals with moresevere disabilities will be forgotten.After all, as a business, rehabilitationfacilities can always decline to accept aclient. What are the assurances that indi-viduals with disabilities will continue tobe served by these facilities?

Jennie R. Joe

The major concept that is developedin this paper is how rehabilitationfacilities as providers of services

will have to change in light of the manylegislative and philosophical changesthat have occurred over the past fewyears. Rehabilitation providers in thenew service delivery system:

Must collaborate with other com-munity organizations and projects.

Totally examine present methodof delivery of services.

Retitle prog tams of the organi-zation to reflect change inbroader scope of services specif-ic to individual needs of expand-ed populations.

/995 Switzer Monograph National Rehabilitation Association 69

Change from a traditional pro-gram model to an individual ser-vice model that will require flex-ibility. This "cafeteria model"will allow individuals the flexi-bility of choosing what ser-vice(s) best fit their needs. Theywon't all be tracked into thesame sequences and program.

Establish alternative, nontradi-tional locations such as in com-munity centers, schools, localgovernment buildings, libraries.

Expand populations served toinclude at risk youth, dislocatedand displaced workers, welfarerecipients, etc.

Expand philosophy to ensureconsumer driven choices.

Expand service choices fromusual assessment and trainingtracks to new curriculums thatfocus on career development,basic skills, competitives andemployment skills.

Expand support programs toinclude housing, transportation,child care, etc.

Skills of staff may need tochange to meet the new demandsand services required.

New marketing initiatives withinthe community will have to bedeveloped by rehabilitationproviders to reflect the compre-hensive array of new services.

New accreditation standards willneed to be developed to accom-modate these major changes.

General Comments:The paper is based on mandate and

perceptions largely developed outsidethe world of rehabilitation. It proposesa sound but challenging conceptualmodel for the redesign of rehabilita-tion service providers. It does notemphasize enough the cooperation andlinkages with employers. It also couldhave gone farther to disclose how thecurrent rehabilitation system's designserves as a barrier to implementationof this more vibrant model.


Ken Shaw's concept paper is an elab-oration of a position that he hasbeen enunciating for several years,

and it reflects the blend of future-think-ing and nuts-and -bolts common sensethat has always distinguished his writing.The BIG QUESTION in this mono-graph, the really controversial issue, iswhether or not rehabilitation facilitiescan continue to survive only as providersfor people with disabilities. Shawbelieves he can read the proverbial hand-writing on the wall in the growing move-ment towards insolidation of federaljob-training programs - e.g. the nationaltraining strategy being discussed by theDepts. of Labor, Education, and Healthand Human Services; federal funding, hepredicts, will move away from singlepopulations and single types of programmodels towards the creation of one-stopcenters for persons wishing to benefitfrom entitlements. This means, amongother things, an increase in institutional-ized training. Shaw is probably right inwarning that rehabilitation facilities, as

they are presently organized, will have ahard time finding "points of entry" intothis new training market.

Shaw's solution is the "Education,Training, and Employment Center", a21st Century model for rehabilitationfacilities that offers a wide array ofcustomized services for disabled andnon-disabled communities alike. Theprinciple challenge for rehabilitationfacilities in the future, he argues, willbe to make themselves credible to non-disabled populations; he also recog-nizes (and this shows the balance inhis argument) that such a change willbe difficult precisely because facilitieshave been successful in defining them-selves as unique providers of serviceto people with disabilities.

One wonders if anyone else associat-ed with the facilities movement in thiscountry is raising this concern or propos-ing a solution with the same level ofdetail. In support of Shaw, it's clear thatmost businesses in the future are going toneed to customize their services and tomake themselves responsive to a broadspectrum of consumers. It's also clearthat more and more services to peoplewith disabilities are going to be main-streamed, and that the business of reha-bilitation will experience fundamentalchange. If the road that Shaw is recom-mending is full of risk (most rehabilita-tion facilities, after all, do not have a lotof expertise in curriculum developmentand customized learning services), thedecision to stand pat seems riskier stil;.

Jon Lundin

71


Seminar Recommendations

Consumerism Issues

Aerating group definition of the term "consumerism:" Forthe purposes of our discussions we defined "con-sumerism" in the context of vocational rehabilitation, as a

process which is responsive to the employment-related needs ofan individual with a disability and which includes the individualin decision making. Examples which reflect what we assumesuch consumerism to be, are:

listening to the needs, desires, and perceptions of theindividual;

letting information from the individual drive the directionof decisions about assistance, services, and advice; and

holding no preconceived notions about the individual.

Unless otherwise specified, all recommendations refer toboth public and private vocational rehabilitation serviceproviders. The term "consumer" means an individual with adisability seeking employment-related assistance.

Recommendations

I. Recommendations/Implications That Would EnhanceService Delivery:

A method of mediation should be built into any voca-tional rehabilitation system.

The first function of a vocational rehabilitation system isa full and complete exchange of information between thecounselor and the individual with a disability.

Vocational rehabilitation counselors must be empow-ered to _make decisions to meet the needs of con-sumers quickly.

2. Recommendations/Implications For Policy orProgram Development:

Under-served and unserved consumers must be betterrepresented in advocacy; and advisory efforts, e.g.,given opportunities to serve on boards, councils, pan-els, committees, or task forces.

Consumers, who have been recently served by voca-tional rehabilitation service providers, should haveopportunities to function in an advisory capacity tosuch providers.

Demonstration projects should be funded that con-duct outreach to under-served populations (e.g., plac-ing vocational rehabilitation counselors in storefronts and church basements to reach people in theirneighborhoods).


72

3. Recommendations/Implications For Training ofStaff /The General Public, etc:

Professional development and continuing educationmust include training on consumer friendly strategiesin service delivery and administration.

A state vocational rehabilitation agency must educatethe general public about what it is doing, what it cando, and what it cannot do.

Vocational rehabilitation service providers must become anintegral part of business community culture (e.g., join localbusiness groups) and form partnerships with businesses todevelop consumer friendly approaches to employment-relat-ed assistance for individuals with disabilities.

Each vocational rehabilitation provider should work toestablish itself as a business peer within the local busi-ness community.

4. Recommendations/Implications For Needed Research:

A national effort should be undertaken to define whata consumer-responsive, consumer-friendly vocationalrehabilitation service provider should look like andhow to hold such providers accountable for the ser-vices they deliver.

With regard to vocational rehabilitation services, thereis a need to identify non-traditional and innovativeapproaches to reach and assist the underserved.

5. Recommendations/Implications For Legislation -Federal, State, Local:

In law, regulation, and policies derived from them,there is need to identify and eliminate barriers (i.e.,the status system) to effective service delivery.

Business and Labor Union Issues

1. Establish truly-representative business advisory councils,involving business and labor as "senior partners". Developlinkages with chambers of commerce, service clubs(Rotary, Kiwanis, etc.) and merchant groups as a means ofinvolving small business.

2. Establish internships and formal exchanges between reha-bilitation educators/ providers and business and labor.

3. Establish a nationwide quick-response interactive infor-mation network for employers, matching job-ready candi-dates and job openings. This should include opportunitiesfor providers to obtain information from each otherregarding the status of employer contacts, as well asopportunities for advertising job -ready candidates.


4. Link job service and vocational rehabilitation officesin all states in order to share timely information onjob-availability. (Providers should have direct accessto job listings.)

5. Facilitate expansion of business- and labor-based men-toring programs for consumers (e.g., shop stewards as"buddies").

6. Develop collaborative training programs among busi-ness, labor, education, and rehabilitation to address theneeds of re-training and lifelong learning.

7. Work with business and labor to define and validate gen-eral "work skills" (e.g., problem-solving and work "con-cepts") in order to develop an appropriate life span learn-ing system for training/re-training of qualified workers.

8. Develop more effective marketing strategies for existingbusiness-oriented rehabilitation services (ADA training,disability management, recruitment, job screening, etc.).

9. Conduct research into entrepreneurship models as anoption for the training of people with disabilities(especially severe populations).

10. Instruct select providers in small-business and eco-nomic-development strategies, including the availabil-ity of related community-support services.

11. Provide resources and support-services to enable indi-viduals with disabilities to start their own businesses.

12. Promote greater collaboration among rehabilitationservice-providers by removing existing proceduralbarriers (e.g,. the determination of who receives "cred-it" for final placement)

13. Explore the implications of separating the state vocation-al rehabilitation counseling and placement functions.

14. Train providers in appropriate strategies for workingwith labor unions.

15. Develop disability-management policies for handlingH.I.V. and other chronic illnesses in the workplace.

16. Encourage NIDRR to conduct its own survey regardingthe employment status of working-age adults, and toidentify the factors contributing to the high rates ofemployment among individuals with disabilities.

17. Promote greater collaboration among the Depts. ofEducation, Labor, Human Services, and SocialSecurity to address the issue of 70% unemploymentamong individuals with disabilities.

18. Encourage business and labor to integrate disability- aware-ness training with existing cultural-diversity programs.

Education Issues

1. Convene a National Education Forum of stakeholdersincluding but not limited to consumers, RehabilitationServices Administration (RSA), National

Rehabilitation Association (NRA), Council of StateAdministrators of Vocational Rehabilitation (CSAVR),National Council on Rehabilitation Education (NCRE)and the National Institute on Disability andRehabilitation Research (NIDRR) which will establishan ongoing process for communication at national,state, and local levels. To plan, coordinate and reviewRehabilitation Education strategies for the purpose ofensuring excellence in Rehabilitation Education.

2. Encourage the development of Individual EducationPrograms (IEP) for all rehabilitation personnel, serviceproviders, managers and administrators, and universityfaculty, using as one vehicle a Rehabilitation SummerInstitute. Develop position trade programs, using sys-tems like but not limited to RehabilitationAdministration Management Programs (RAMPs) andRegional Rehabilitation Continuing EducationPrograms (RRCEPs).

3. Research Develop ongoing assessment of education-al needs and training effectiveness. One role of educa-tional research will be to test the assumptions, tradi-tions, as well as policies and practices which impact onthe service delivery practices.

4. NIDRR/RSA/CASVR to submit as a topic"Rehabilitation Education in the Twenty-First Centuryfor Service Providers" as an Institute on RehabilitationIssues (IRI) study topic in 1995.

5. To maximize funding for Human ResourceDevelopment (HRD) in that education and trainingresulting in preparing skilled practitioners is one of thecorner stones to quality service delivery.

Service Provider Issues

I. Recommendations That WouldEnhance Service Delivery

A system of service delivery for people with disabilitiesmust incorporate the values expressed in the reauthorizationof the Rehabilitation Act:

1. Disability is a natural life event.

2. Persons with disabilities are entitled to pursue mean-ingful career opportunities in integrated settings.

To achieve these goals, service systems must move to collab-orative models of assistance. In a cooperative model, organiza-tions provide service for people, and choices are made fromexisting services. The collaborators assist by identifyingresources available to achieve the identifying goals.Collaboration means complete openness about the availability ofresources and is driven by the needs identified by the consumer.

In our current model, services are limited and case man-agers serve in "managed care models", limiting access to ser-vices. We propose moving to a case management model


which is consistent with the collaboration model where goalsare identified and resources identified to meet those goals.

We recommend that the greater devotion of resources begiven to systems change efforts and to efforts to developemployer-based models of service. This would include:

A. Marketing efforts to assess employers' needs for ser-vices related to the employment, training and retentionof persons with disabilities.

B. Application of economic development models to pro-mote employment of persons with disabilities.

There is opportunity for substantive improvement in thedelivery of service through the use of marketing models andemployer based-service models.

More resources must be directed to systems change focusedon advocating for improved access to community services.Access is critical to achieving the goals and promoting thevalues of the Rehabilitation Act

II. Recommendations for Policyor Program Development

Policy must be developed to remove disincentives for par-ticipation in employment. These disincentives exist both inlaw and regulation. The continued severe limits on access tohealth care for persons who are current recipients of SocialSecurity Disability (SSDI & SSI) benefits severely limits theopportunities for employment for people served in that sys-tem. The SSI program and public assistance programs havesimilar disincentives that operate to maintain dependencyrelationships of people with disabilities. We must devoteefforts to remove these disincentives.

In the area of employer services, disincentives exist as aresult of the worker's compensation system, limitations onaccess to health care, and attitudinal limitations. These areasmust be addressed in the employment setting.

III. Recommendations for Training

I. Rehabilitation counselor programs must be broad-based tomeet the needs for professional rehabilitation counselorsin a variety of settings including the state and federal pro-grams, private practice, VA and other federal settings, andemployer-based settings.

2. State programs need staff development programs drivenby employee needs that provide training that is individu-ally focused. Likewise, there is a need for continuing skilldevelopment for people employed in the field of rehabili-tation including certification of skills in areas such as jobplacement, chemical dependency, and head injury rehabil-itation. Training provided at or near the worksite or home-site of the individual requires stronger emphasis on devel-oping distance learning programs.

3. There should be continued access to new ideas andnew technology and often this means reaching beyondour own resources and striving to find the latest, mostcurrent best practices in the broader community.

4. There is a need for continued training in the ability tofunction as an effective team member in the provision ofrehabilitation services. These teams are both interdiscipli-nary, transdisciplinary, and transorganizational in natureand require the development of communication and coop-eration for the effective delivery of service is needed.

5. We recommend a stronger focus in training to meet theneeds of people from diverse backgrounds and cultureswho are working in rehabilitation settings; providingaccess to entry positions and developmental positionsin those settings; as well as providing opportunities forprofessional advancement.

IV. Research

There is a significant need for applied research and thedissemination of research findings. It is recommended that inthe dissemination of research findings, the potential user ofthose findings be considered and that a greater focus beplaced on the practical aspects of how to replicate the find-ings of research. Essentially, counselors in the field, users inthe field want to know "how to do it".

We also believe that there is a need for research that looksat activities such as marketing to employers, employer-basedservices, and economic development models to assess theeffectiveness of those models in assisting people with dis-abilities to have greater access to employment. Finally, werecommend that research be directed to accessing outcomeof services provided in facilities to identify programs andfacilities that produce successful outcomes so that thoseactivities can be duplicated.

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Special Invited Paper

Women and Vocational Rehabilitation:

An Urgent Need for New Directions

Margaret A. Nosek

The problems women with disabilities face in obtainingappropriate and effective vocational rehabilitation serviceshave not received due attention among those who are setting

a new course for the field as it enters the 21st century. Thewomen's rights movement has made substantial gains in raisingrates of employment and advancement in employment forwomen in general; however, women with disabilities have notshared in these achievements. Their disability is the characteris-tic that is most predictive of their employment status, not theirwomanhood, nor their educational attainment, which, for thegeneral population, is the most accurate predictor. For us, all thediscrimination and work disincentives that accompany disabilitymust be added to all the discrimination and work disincentivesthat accompany being a woman, and, for nearly one-third of us,all the disadvantages that accompany minority status, before ouremployment situation can be understood.

Let's look at what we know so far about women with dis-abilities. To get a picture of our work status, we must gobeyond the standard "26 Closure" of the vocational rehabili-tation system to some population-based outcome measures.Statistics compiled by the U.S. Department of Labor (1990),Deegan and Brooks (1984), and Fine and Asch (1988) indi-cate that, compared to !nen with disabilities, women withdisabilities are:

less likely to be employed (24% versus 44%); 11.4%disabled women work full-time year-round,

earn substantially less ($5,865 versus $13,863 per yearin 1981); African-American women with disabilitiesearn $0.22 on the white male dollar,

Margaret A. Nosek, Ph.D., Associate Professor, Department of PhysicalMedicine and Rehabilitation, Director, Center for Research on Women withDisabilities, Baylor College of Medicine, Houston, TX.

less likely to receive training from the vocational reha-bilitation system in wage-earning occupations (68%versus 94%), and

less likely to be college educated (3.8% versus 20% ofwomen without disability).

With such substantial barriers to obtaining an earnedincome, it is not surprising that this population ranks verylow on other socioeconomic indicators as well:

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more likely to live in families below the poverty line;56% of all persons with disability living below thepoverty line are women,

have lower levels of disability coverage, insurance, orretirement benefits (24% versus 42%),

less likely to receive Social Security disability insur-ance benefits (55% versus 67.5%),

receiving less money from Social Security benefits($281 versus $399 per month),

half as likely to receive benefits from early retirement,

more likely 'I be divorced if they have a severe dis-ability (2.. ;rsus 14%),

more likely to have a severe disability (85% versus59%), and

less likely to be married (49% versus 60%),

more likely to live in a nursing home (73% versus27%).


The message of these statistics is that women with dis-abilities are one of the most severely disadvantaged groupsin this country. More current statistics have just becomeavailable from the U.S. Census of 1990 (McNeil, 1990), butthey show very little improvement. The employment situa-tion of women with disabilities does not seem to have risenwith the tide of change wrought by the women's movementor the Americans with Disabilities Act. The call for attentionto these problems is loud and clear.

A research group in Region V of the RehabilitationServices Administration conducted a study of gender equitywithin its eight General and Blind agencies in six states over a13-year period from 1972 to 1984. Following are some of theirfindings (Region V kesearch Study Group, 1987, pages 2-6):

After vocational rehabilitation services, women reha-bilitants in Region V earned less than men and had agreater probability of remaining below the povertylevel. The 13-year data indicated that at closure womenachieved less financial independence and maintainedgreater reliance on public assistance than men. Thiswas true even though the financial resources availableat the initial point of contact with the system were sim-ilar for men and women.

Over the 13-year period the Region V vocational reha-bilitation system perpetuated the limiting effects ofgender-role occupational stereotyping for women.

Vocational rehabilitation programs have not formal-ized systematic approaches to address the vocationalexperiences and characteristics of women.

Younger women are under-represented in the Region Vvocational rehabilitation system. The 13 year dataindicate that the referral process that encourages refer-rals of young men seems to be increasingly ineffectivein fostering referrals of young women.

The joint development of the rehabilitation plan maybe adversely influenced by the stereotypes ar.,_ atti-tudes about women, men, and work that state agencypersonnel and clients bring to this planning process.

Although women enter the system with a higher levelof education and are more likely to be sponsored inpost secondary training their pattern of services doesnot yield earnings outcomes that are comparable to theearnings of men.

The vocational rehabilitation system has been used asa societal change agent to create opportunities and toopen avenues for equity. The data from the study arguefor acceptance of a responsibility for establishing thenecessary outreach and intervention strategies that willassure appropriate and equitable access, services, andoutcomes for women with disabilities.

Their report lists numerous questions for earchand recommendations for action by the , tiorL.

7 6

Services Administration, National Institute for Disability andRehabilitation Research, Congress (through theRehabilitation Act), and The Institute on RehabilitationIssues. They cite the lack of a theoretical basis for the voca-tional guidance, counseling and rehabilitation of womenwith disabilities. They call for research that addresses (a)vocational decision-making of women, (b) assessment prac-tices which focus on the functional capacities of women, (c)counseling practices which optimize career choices forwomen, and (d) occupational development approaches whichyield economic self-sufficiency for women (Region VResearch Study Group, 1987, page 7).

It is unfortunate that the excellent research and recom-mendations of the Region V Research Study Group have hadlittle effect on the field of vocational rehabilitation over thepast seven years. I would like to issue a call to arms forresearchers, educators, counselors and vocational rehabilita-tion agency administrators alike. We will continue to see nochange in gender inequity until we force action in the fol-lowing areas:

First., research. Thanks to efforts of the National Councilon Disability, items on disability have been included in ques-tionnaires for the 1990 census and other general populationsurveys from the early part of this decade. With the avail-ability of these data, we can now generate statistics on theinteraction of gender and disability. We need summaryreports, such as those produced by Frank Bowe on the 1980data (Bowe, 1984), as well as in-depth examinations of cer-tain variables, such as disability type, as they relate toemployment status.

There is also a need for research on the various factorsthat effect the employability of women with disabilities. Aresocioeconomic factors a cause or ay. effect? What are ther-2nder specific barriers that prevent women from having

,..ss to education and training? What factors are commonarhong women with disabilities who are successfullyemployed? How does the disproportionate responsibility forchild care and the more limited access to personal assistanceservices faced by women with disabilities affect their abilityto pursue gainful employment?

Second, we must look more closely on a national level athow vocational rehabilitation agencies treat women. The rec-ommendations from the Region V study must be taken seri-ously and implemented. The Rehabilitation ServicesAdministration must be held accountable for its failure toaddress the documented gender inequity of its services. Thehomemaker closure status in particular must come underserious scrutiny. A study at the Baylor College of MedicineResearch and Training Center on Spinal Cord Injury foundthat women who classified their employment status as home-maker had the highest levels of depression (Rintala, Young,Hart, & Fuhrer, 1994). This status must be converted from adumping ground to a legitimate career goal for women whosincerely seek it.

Third, we must look at the status of women within thevocational rehabilitation system itself. '1 here is a strong"glass ceiling" effect that prevents women from moving intopositions where they could have the power to institutechange in VR policy and practice. The number of women


who attend meetings of the Council of State Administratorsfor Vocational Rehabilitation can be counted on one hand.

Fourth, the National Institute for DiSability andRehabilitation Research (NIDRR) must be encouraged toestablish a priority on women. NIDRR has begun to takesteps in this direction. In July 1994, they convened a taskgroup of consumers and researchers to advise them onwomen's rehabilitation issues. The group strongly recom-mended the establishment of a Rehabilitation Research andTraining Center on women, unaware that the same recom-mendation had been made seven years earlier by the RegionV Research Study Group. In October 1994, NIDRR issued arequest for comments in the Federal Register on a researchand demonstration priority related to pregnancy and child-bearing by women with physical disabilities. There was astrong response from the field that this priority was too nar-row and stereotypic. Congress has mandated that theNational Institutes of Health require that all applicants for itsfunds state how their proposed re- iarch addresses concernsof women and minorities. NIDRR has a similar requirement,but it only addresses concerns of minorities. We in the fieldmust pressure Congress to require the same level of account-ability for both funding agencies.

Fifth, we must institute vocational training programs thataddress some of the special life circumstances faced bywomen with disabilities. These programs must encouragewomen to pursue non-traditional career paths. They mustoffer such auxiliary services as child care and personal assis-tance at the training site. The awareness is slowly growingthat the personal hygiene needs of women with physical dis-abilities constitute a much more serious deterrent to employ-ment than they do for men with physical disabilities. Whenresearch results are forthcoming on gender sensitive methodsof vocational assessment and guidance, programs must bereceptive to putting them into practice.

Finally, we must take steps to change social attitudestoward the employment of women with disabilities. The tra-ditional medical model has helped generate the stereotypethat women with disabil: ies are exempt from fulfilling suchsocial roles as mother, wife, and worker. This attitude, how-ever archaic and inappropriate it may seem, is still verystrong among the general public, employers, educators,counselors, service providers, and women with disabilitiesthemselves. Organizations that have scored outstanding suc-cess in raising awareness of disability rights, such as inde-pendent living centers, Paralyzed Veterans of America,Easter Seals, and the President's Committee on Employmentof People with Disabilities, must now also adopt thewomen's rights agenda before real progress can be made.

If these words sound like an incitement to revolution, theywere so intended. Are we all so busy and comfortable in ourniches that we can continue to let the unconscionable situationof women with disabilities continue to exist? Each of us haswithin our power the ability to institute change that will benefitwomen with disabilitieschange in the places where we work,in the policies that govern our practice, in our attitude toward thewomen we serve, in the attitude of the women we serve towardthemselves, and in our own personal lives. Change will comewhen each of us decides to exercise that power.

References

Bowe, F. (1984). Disabled women in America. Washington D.C.President's Committee on Employment of the Handicapped.

Deegan, M.J. & Brooks, N.A. (eds.) (1984). Women and disabil-ity: The double handicap. New Brunswick, NJ: TransactionBooks.

Fine, M. & Asch, A. (eds.) (1988). Women with disabilities:Essays in psychology, culture, and politics. Philadelphia, PA:Temple University Press.

McNeil, J. M. (1993) Americans with Disabilities 1991-92 U.S.Bureau of the Census: Current Population Reports P70-33.Washington, D.C.: U.S. Government Printing Office.

Region V Research Study Group. (1987). Region V study ofaccess, services and benefits from vocational rehabilitation1972 to 1984: A gender perspective. Menomonie, WI:Research and Training Center, Stout VocationalRehabilitation Institute, University of Wisconsin-Stout.

Rintala, D.H., Young, M.E., Hart, K.A., & Fuhrer, M.J. (1994).The relationship between the extent of reciprocity with socialsupporters and measures of depressive symptomatology,impairment, disability, and handicap in persons with spinalcord injury. Rehabilitation Psychology, 39(1), 15-27.

U.S.Department of Labor. (1990). Fact sheet. Washington, DC:U.S. Department of Labor.

7 7



Rehabilitation as a

Knowledge Business

Jon Lundin

Smart Jobs and Social Priorities

Computer technology is changing the American workplace.It's altering the methods of production, the kinds ofemployment, and even the notions of what jobs are. The

essential work in our offices and factories keeps getting moreand more abstract, as better, timelier data is applied to allaspects of production. Good jobs keep getting smarterincreasingly analytical, and more dependent than ever on a per-son's knowledge and expertise.

The computerized workplace holds out the promise ofendless product and service improvements, a brave newworld of high-performance organizations; but it also poses aserious threat to people who are unskilled and uneducatedtoday, to minority populations, and to others who have beentraditionally excluded from the mainstream of American life,such as people with disabilities.

The possible consequence of this should not be underesti-mated. Economists warn of a growing division in societybetween knowledge and service workers, the former com-posed of well-paid and highly-educated professionals, andthe latter made up of much more marginally-skilled employ-ees who compete for jobs requiring physical labor and cer-tain rote procedures and who end up being forced to work -if they're able to work at all - in a low-bid market. PeterDrucker, probably the most eloquent interpreter of theknowledge society, believes it should be a "social priority" indeveloped countries to increase the productivity of servicework, to provide more access to advanced training and edu-cation for those persons at the bottom of the economic lad-der. Unless w.: meet this priority, Drucker says, "the devel-oped world faces increasing social tensions, increasing.

Ion Lundin, President, Abilities Center. Goodwill Industries. Inc. Rockford.Illinois.

78

polarization, increasing radicalization ... [and even] ulti-mately a new class war" (Managing the Future).

Value-Added

These are strong words, but they're hardly the stuff of sciencefiction. Whether Drucker's view is farfetched or not, virtuallyeveryone agrees that knowledge will be the chief source ofvalue-added in the new society. Our traditional sources of wealth- labor, capital, and natural resources - will eventually provideless of a competitive advantage than the creative and productiv-ity-enhancing assets of information technology.

Anyone interested in the future of rehabilitation ought to bethinking about the issue of knowledge work. Are our existingconsumer services going to be sufficient to take us into the21st century? Will they be relevant to a labor market thatrequires abstract reasoning and critical judgment for its jobs ofvalue? Will our system be able to provide opportunities forpeople with disabilities in significant numbers in this auto-mated workplace? If so, what kinds of jobs will they be?

One way of responding to questions such as these is to saythat many people with severe cognitive impairments simplywon't be suited to knowledge work. They aren't today. Thechanges that Drucker is talking about, however, won't alter theneeds of these people to work in real community settings and toparticipate in real work routines, whatever the level of compen-sation. This is a question of civil rights, a legal and ethical issue.Unless the government alters its order of selection, these indi-viduals will continue to be priority clients. The business of reha-bilitation in the future is still going to be the provision of job-placement and job-accommodation services. The present trendtowards mainstreaming, in other words. is right on track.

Sips and Puffs

Some of our current policy-makers may want to expandthis argument by saying that computer technology should


really be viewed as an asset to people with disabilities, an aidin finding better jobs and in doing them successfully; and it'scertainly true that the rapid commercial development ofadaptive and assistive tools is providing much greater accessto technology today.

Computers can be activated now by simple muscle move-ments: nods, eye blinks, sips and puffs on a straw, tonguemotions on a dental retainer. Computers can convert speechinto text and text into speech as well as into braille and codedsensory vibrations. Intelligent word-prediction software helpsus process thoughts, anticipating the words and phrases beingtyped on the screen. Body suits with three-dimensional sound,data gloves, and head-mounted eye sensors offer excitingtraining options in worlds of virtual reality.

There seems to be no end to the possibilities. The enor-mous product resources in all areas of computer technology,from word processing to desktop publishing and graphic artsdesign and multimedia systems, are finding a multitude ofnew applications as assistive tools. And these devices, inturn, are transforming the way that disability is being expe-rienced in the workplace.

This, certainly, is a cause for optimism. Shouldn't we behopeful about the future of rehabilitation when advancessuch as these are leveling the competitive playing field?

Higher Thinking SkillsThe answer is, I think, both yes and no. On the one hand,

new technology is probably equal in importance to theAmericans with Disabilities Act as agent of change in theworkplace. It has already helped to remove a number of barri-ers to employment that people with disabilities encountered inthe past, and it has helped to create jobs that are entirely freefrom sensory and mobility requirements. If brainwork is goingto be the competitive standard of measure in the 21st century,then a person's physical limitations (with the proper assistivetools in place) are obviously not going to matter very much.

On the other hand, it's possible to agree with all these points,to recognize the exceptional value to rehabilitation of computertechnology, and still to be concerned about the job prospects ofpeople with disabilities in the new society. (Pre I am speakingonly of those individuals who are capabiz. . iowledge work,though in any event the majority of perFori. -vith barriers toemployment.) Smart machines are no beuei and no worse thanthe people using them, but the more powerful and versatile thetechnology becomes, the more its users will need to acquirehigher thinking skills to maintain their competitiveness in the jobmarket. The challenge of the 21st century will be one of people,not machines, and what will matter most is the knowledge con-tent of the jobs that they'll be doing. All discussions of assistivetechnology are thus somewhat beside the point except as theyrelate to the skill-levels that people have been trained for. Issuesof "equal access" eventually resolve themselves into questionsof skill development once the physical and sensory barriers to aperson's employment have been overcome by technology.

A Lifespan Learning NetworkThese questions, of course, are not unique to people with

disabilities, though they're absolutely fundamental to the

possibilities of income growth and upward career mobility inthe new society, to the individual options and choices that therehabilitation business is dedicated to providing for itsclients. Can we develop a learning network that addressesthe needs of all ages and all ability-levels and allows peopleto keep pace with changes in technology? Should this bedone exclusively within our existing public institutions, ourschools and colleges? Or should there also be a role in thisfor our rehabilitation facilities (always accepting the fact thatthese organizations will refashion themselves in the futureinto new kinds of learning centers)?

We can try to answer these questions by asking anotherone: Is it realistic to assume that this transformation - thecreation of a learning network which addresses the develop-ment of thinking skills is going to happen very soon outsideof an advocacy system?

Obviously, someone should also ask: Is such a network verylikely even within an advocacy system? If the probability of thishappening seems slightly higher than it does within our publicinstitutions, it's only because rehabilitation facilities have a vest-ed interest in seeing it occur. (They also have the freedom toundertake these changes, from the political pressures of govern-ment that promote the status quo.) As the mainstreaming ofclients continues, as more and more of its traditional services aretransferred to community settings and more and more program-ming takes place in schools and colleges, facilities will need torefashion themselves as a matter of survival. This will be an evo-lutionary change, not a radical one, and it will not be somethingthat every organization wants to undertake.

The Role of Rehabilitation Facilities

The facilities that go through this transformation, the onesthat successfully redesign their programs to address theissues of knowledge work, will draw upon their expertise inrehabilitation to differentiate themselves from their competi-tors. They will focus on the needs of low-income populationsin general, but they will also try to establish a reputation forknowledge services in relation to certain disability groupsand certain types of entry-level employment that offer thepossibilities of ereer development.

These facilities will create a variety of learning environ-ments and encourage students to discover their interests in aparticular area of work; they will use challenging, real-lifesituations to help students identify and solve problems - aswell as to understand the principles and concepts involved.Instead of phasing out their assessment services (as is thetrend today in many organizations), these facilities may sim-ply choose to refocus them on questions of brain dominanceand multiple intelligence; and then to use the informationthat they get from the assessments to help students under-stand the ways that they like to learn.

This kind of customization will undoubtedly be expensiveand require a good deal of software support, but it will pay foritself many times over in improved student performance. Thefact that this software may be in the public domain and accessedthrough an information network of some kind does not alter theneed for small, personalized learning situations where the soft-

7is being used.


Learning does not operate on an economy of scale, as theresults of mass education make so abundantly clear. Instead, it ismotivated by a sense of personal inquiry, by the need to defineone's identity (and to increase one's self-esteem) in relation tothe discovery and development of a unique set of talents. Likethe patterns of fingerprints, human abilities are infinite in theirvariety. Everyone is different; and differences are good.

Beyond the obvious emphasis on technology-assistedlearning, the use of discovery environments, and the focus onindividual learning profiles, the nature of other facilitychanges will be more difficult to predict. Many organizationswill pursue educational certification as a means of makingthemselves more credible to their students. Many will seek toestablish closer working relationships with the businesscommunity along the lines of the current Projects-with-Industry model. Many will try to expand their formal affilia-

tions with public and private education, as well as to devel-op relationships with local providers of housing, health care,day care, and transportation as a way of providing their stu-dents with a comprehensive referral network. Some facilities- only a few at first, but more and more as the results becomeclear - may choose to integrate the arts into their knowledgeservices, offering students an opportunity to consolidatetheir technical understanding of a subject through the mostbasic, instinctive kind of human enterprise.

Drawing word-processing concepts? Singing and dancingsoftware routines? Acting out the sequences of an informa-tion system? All this may sound foolish and beyond thefringe, but if the future of rehabilitation is all about optionsand choices and making knowledge work a-cessible to thegreatest number of people, then these things are probablymuch more on the money than we are ready to admit.

S 0



Independent Living and

Disability Culture Perspective

Paul Spooner

Introduction

As Public and Private Rehabilitation prepares for the 21stcentury, our direction seems clear. Empowered by the pas-sage of the Americans with Disabilities Act of 1990, and

the Rehabilitation Act Amendments of 1992, people with dis-abilities are now playing an active and informed role in the pro-vision of rehabilitation services. The language of the 1990s andthe 21st century proclaims, "client choice, empowerment,cooperation and collaboration", toward the goal of achievingthe best possible rehabilitation goals an individual with a dis-ability can attai-.. However, from the independent living per-spective, not much has changed. These are merely new wordsto describe the same old ways of providing rehabilitation ser-vices, and the same old bureaucracies providing services. Therehabilitation service delivery model continues to operate onold principles and practices.

The Problem

The mode! of public vocational rehabilitation services isbased on a number of values and practices set forth in therehabilitation paradigm. Through this model, the individualserved has a physical or mental impairment and/or lack of avocational skill necessary to attain employment. With pro-fessional intervention and treatment, the "patient" or "client"receives services to fix or improve functional skills neces-sary for a vocational goal. The desired outcome of this modelis maximum self-care and activities of daily living, and gain-ful employment, usually in entry level jobs. The profession-al controls the process of rehabilitation services provided tothe individual with a disability.

Paul Spooner. Executive Directo-. Metro West Center For Independent Living.

Framingham. MA.

With the model of the independent living paradigm, thedefinition of the problem is depe.idence upon professionals,family members and others, as well as facing the hostile atti-tudes, discrimination and inaccessible nvironment our soci-ety provides. The real problem is not with the individual, butthe environment and the medical and/or rehabilitationprocess itself, which continues to provide services based onthe charity or paternalistic form of interaction. Individualswith disabilities are daily treated as second class citizens, oras clients/patients who are offered limited choices in pursu-ing life goals and dreams. The solution to the problem is bar-rier removal, advocacy, self-help, peer role models and coun-seling, and complete control over a range of options and ser-vices available to a non-disabled individual. The role of theindividual with a disability is a "consumer" or "user" of ser-vice and products. The consumer controls the process ofrehabilitation services, with the desired outcomes beingindependence through control over acceptable options foreveryday living in an integrated community.

Essentially, independent living is a new field, with a histo-ry dating back to the Lae 1950s and early 1960s. This move-ment was started by individuals with disabilities unwilling tocontinue their existence in institutions or hidden away. Manyof the early pioneers of the movement were, in fact, clientsfound too severely disabled for employment by the publicvocational rehabilitation agencies in their respective states.People with disabilities, like other groups in the sixties,demanded social justice, equal rights, and equal access. Theearly independent living centers were founded on collegecampuses, run by the disabled students, providing peer-rolemodeling, assistance with housing, and personal attendant ser-vices. The introduction of the Rehabilitation Act of 1973,which led to the first federal funding of independent livingcenters, and civil rights protection to individuals with disabil-ities in programs funded by the federal government, created awave of support for the independent living philosophy and the


emerging disability culture. However, during the seventies, atrend grew within the rehabilitation community, called inde-pendent living rehabilitation services, which are the supportservices, such as personal assistance services, home modifica-tion, etc., necessary for an individual with a severe disabilityto live independently. The services are provided by indepen-dent living counselors working for the public vocational reha-bilitation agency following the more traditional rehab. para-digm. The current Title VII Part B program funds these ser-vices. Most of us in the independent living community con-sider this a rehabilitation perspective form of independent liv-ing, without a true commitment to consumer control, and theright to make educated choices among a number of options.

Throughout the history of the independent living move-ment, it has been a struggle to teach people with disabilitiesand others how different we really are. Our movement isabout consumer control and the right to expect the samechoices and options that the non-disabled population has.With self-help, peer-role modeling and self-advocacy, theindependent living movement has empowered individualswith disabilities to demand and expect equal access andequal treatment. Independent living centers (ILCs), are not inthe business of providing services, but in the business ofadvocating for the rights of individuals with disabilities toreceive the services they need. In addition, ILCs provide sys-temic advocacy to ensure compliance with forms of legisla-tion protecting the rights of individuals with disabilities. Thepassage of the Rehabilitation Act Amendments of 1992,requires ILCs to meet standards and indicators that define inthe law what an independent living center is. Included in thestandards is the requirement that all centers must providesystemic advocacy. These standards will enable centers toreturn to the job of being primarily advocacy organizationsbuilt on the principles of consumer-controlled, peer-rolemodeling organizations controlled and run by individualswith disabilities. As a result of this model of empowermentand consumer control, the disability culture came into being.As individuals gained control over their lives, pride started togrow, individuals started to believe having a disability wasnot somethir., bad, but good, and can add to the quality oflife for many individuals. With this pride and consumer con-trol comes power. Individuals with disabilities no longerneed professionals telling them what is best for them. Whatwe need is professionals assisting us ir_ attaining the goalsand options we want. Every day, more individuals with dis-abilities are demanding services, speaking out against the oldway of providing services, and confronting the traditionalrehabilitation system at all levels.

The Solution

In order for the public vocational rehabilitation system tochange, a number of issues need to be resolved. Individualswith disabilities must he treated as equal partners in theprocess, rehabilitation professionals must become more advo-cacy focused, and play the role of facilitator. Vocationai reha-bilitation services need to meet the goals of the individual, notthe needs of the bureaucracy. Outcomes should be measuredby the satisfaction of the services received, not by the individ-

ual gaining an entry-level job. For far too long the current sys-tem has counted numbers, not successful outcomes.

The direction for vocational rehabilitation clearly indi-cates a trend of greater control by the individual receivingthe services. Systems and agencies must be flexible to pro-vide a range of services and options to meet the diverseneeds of individuals with disabilities. The rehabilitationcommunity must include independent living centers as equalpartners in the process of providing services to individualswith disabilities, and understand that independent livingencompasses the whole person, not just their vocationalgoals. For the vocational rehabilitation community to betruly prepared for the 21st century, will require an invest-ment in empowering the very individuals they serve, not tolead the way for them, but to facilitate a process of informedchoice and a range of options that is equal to the optionsavailable to the non-disabled community.

Without this change, the public vocational rehabilitationsystem will cease to exist. Many members of Congress, andindividuals with disabilities are asking if this system reallyworks, why does the disability community continue to facean unemployment rate of over 60%? The answer to thesequestions is simple. Allow individuals with disabilities tohave control over the decisions that affect their lives, includ-ing vocational rehabilitation.

Conclusion

Throughout history, disenfranchised members of societyhave developed and created movements to overcome theoppression of society. This is true with the disability com-munity. We are tired of being told what we should be, whatkind of work is right for us, and how to "fix" us, so we fitbetter in society. We do not need to fixed; the system does.We want to be treated as equal members of our society, notas second class citizens. The community of individuals withdisabilities is gaining its strength. We are proud of who weare, and we expect an equal share and place in our society.Join us and work with us, or step aside!

8 2



The Voice of the Special Group

Ruth Royall Hill

Iwill make a conscious assumption that those of us who aretruly knowledgeable of the State-Federal VocationalRehabilitation Program know that the program has over the

years made, and continues to make, a substantial and significantcontribution to the lives of persons with disabilities. Moreover,I again make a conscious assumption that the overwhelmingmajority of recipients of vocational rehabilitation services andtheir families, as well as the overwhelming majority of state-agency vocational rehabilitation counbelors compose a SPE-CIAL GROUP who can best attest to this.

Somewhere, however, the voice of this Special Group hasgotten lost in the scheme of things; whether political, leg-islative, programmatic or otherwise. Somehow, this Voice,in effect, has been the Silent Voice. Yet, the Voice of thisSpecial Group is the one to be heard if we are to truly builda foundation for progress. This Voice should be utilized asthe guiding force for the direction of chnge. Yet, the Voiceis seldom heard; its wisdom seldom utilized.

In many meetings that I have attended that include con-sumers and advocates providing input for policy, legislativeand/or programmatic de visions relevant to the VR program, Ihear "a story" from the consumers and advocates that appearsto form a basis for decision making. I rarely, however, hearthe "rest of the story" known so well by the Special Group, nordoes the "rest of the story" appear to be given equal consider-

Ruth Royall Hill, Administrator, District of Columbia. Rehabilitation ServicesAdministration, Washington, D.C.

82

ation in decision making. Quite candidly, even the consumersand advocates present very rarely reflect the racially diversepopulation served by the State VR Agency, nor most clientsthat typically walk through the doors of the State VR Agency.Also, very r, tely is the "Special Group" VR Counselor presentto tell "the rest of the story". Frequently, no VR Counselor ispresent to tell any story. So I ask myself this question, "Whois speaking for Whom?"

The Voice of the "Special Group" is the one that can pro-vide the best basis for decision making to bring aboutprogress and necessary change. Positive begets positive.

The Voice of the "Special Group" must be encouraged,included and heard. The "Special Group", whoever, mustconsider it a personal professional responsibility to make itsVoice heard. Only then, can we as stakeholders be assuredthat decisions affecting the State VR Program are sound.

As a former VR counselor, one of the greatest joys that Iexperienced always occurred when my client and I discussed theclient's assets as a result of vocational assessment. The joy wasoften entrenched in the fact that this was usually the first time inthat client's life that he had been aware of his capability andpotential for success in the work world. My joy was felt becauseof the joy expressed on the face of the client, and the beginningof that client's display of high self-esteem.

There are thousands of stories that can be told by the Voiceof the "Special Group". They must be included and heard.Then we will not just tell "a story" alone, not just the "rest ofthe story" but, together, we can all tell "the real story".

8,3


Through the Years

Reflections Past, Present and FutureRandom Thoughts of Rehabilitation Leaders and Legends

The Switzer Monographs have served not only as a forwardplanning document, but also have captured some of the reha-bilitation history which has reached its 75th anniversary mark

in 1995, and coincides with the publication date of this mono-graph. It seemed proper to poll some of the people in rehabilita-tion that helped to make it the great profession and human endeav-or that it has become over the years. We owe the following authorsa great debt of gratitude for their early work in the field that helpedto provide the foundations upon which we currently function in afield where people are the priority. All of the authors noted belowworked with Mary Switzer in one way or another and all wereinnovators in their own right. We appreciate what they did in thedevelopment of vocational rehabilitation in the United States andalso for sharing their recollections and ideas with us for thisSwitzer Monograph that focuses on the 21st Century. The authorsof the comments have been listed in alphabetical order.

The qualities that set Mary Switzer apart among the socialleaders of her era cannot be defined in a few short paragraphs.But so impressive and enduring are the effects of her efforts

that even a brief reminiscence can convey some sense of thedynamism with which she shaped America's vocational rehabili-tation services. As a member of her staff beginning with the firstyear of her stewardship of the public program that will alwaysbear her stamp, it was my great privilege to witness a successionof the achievements that ensure Mary Switzer's place in history.

Miss Switzer's staff had a persona that in many waysreflected the enthusiasm of its chief. SuccessfLl administra-tors incline toward pragmatism, and Mary Switzer was noexception. Always focused on results, she was demanding ofher subordinates as she was of herself. But always her prag-matism and her demands were tempered by considerationand compassion. One result was a loyal staff fully committedto the Switzer approach.

Among the many reasons for Switzer's success was herkeen sense of public relations and mastery in breaking down

/995 Switzer Monograph

public relations into manageable componer,:s of personalrelationships. In doing so she was profitably served by thetalents of W. Oliver Kincannon, a well-connected formerpolitical reporter and writer. Early on it was he who encour-aged Mary Switzer to exploit her talents and personality infrequent public appearances and one-on-one meetings withpublic and private sector leaders who could help in advanc-ing the cause of rehabilitation.

Due to my involvement in this phase of Switzer's many-faceted administration, I have frequently been misidentifiedas her "speech writer." The fact is that Miss Switzer neverhad a speech writer and never needed one. I never knew herto present a speech written in advance, or to read from ascript. She always spoke extemporaneously from the heart;much would have been lost had she substituted processedpresentations read from texts.

Of course, subsequent published proceedings usuallyrequired written texts of her remarks, and a major task ofmine was to put on paperusually after the factthe sub-stance of her public addresses. "Be sure to make it sound likeme," she would caution (which meant incorporating some ofher distinctively personal literary whimsies).

Staff members always let Mary Switzer be Mary Switzerthey had no choice, of course and rehabilitation was all

the better for it.

John T CollierRetired Director, Special ProjectsSocial & Rehabilitation ServicesDepartment of Health, Education and Welfare

My recollections of the State-Federal program of VocationalRehabilitation began with a 1958 meeting with Dr.Salvatore DiMichael, Regional Commissioner of the New

York Office (HEW Region II), Joseph Hunt, assistant toCommissioner Mary Switzer and of course, Miss Switzer or

84National Rehabilitation Association 83

"Mary" as she was affectionately called by almost everyone,including members of the U.S. Congress. It was said that whenMary went before the Senate or House AppropriationsCommittees to make a case for the V.R. program, the members ofthe Committees would put aside the usual questions and simplyasked Mary how much did she want? The people mentioned aboveshaped my philosophy of rehabilitation for the next 30 years.

As I look back on the history of the public VR program Ithink of the wonderful relationships and cooperative effortsbetween the National Rehabilitation Association, theCouncil of State Vocational Rehabilitation Administratorsand RSA. At one point Ms. Switzer was President of NRAwhile she was Commissioner of RSA. As President she wentto all NRA meetings and encouraged the membership ofNRA to recruit new members, support State funds for theFederal match and promote new State projects. I recall theclose relationship between Mary Switzer and E.B. Whitten,former Executive Director of NRA. I had the privilege ofhaving been elected to the Board Member-at-large positionduring E.B. Whitten's leadership. "E.B. was always in a stateof political motion, calling upon VR State Directors andmembers of the Congress to support new and innovative leg-islation such as Projects with Industry (PWI). Two of thefirst such projects went to Fountain uniise in New York City,and to Human Resources of Long 1 New York. Both ofthese projects went on to become nE nal models.

In the "olden days" Ms. Switzer would chair the meetings ofregional commissioners. I would hear her speak of the VR StateDirectors as "her boys" and of course, that was before the adventof female State Directors. Above all Mary was the consummatebureaucrat and proud of it. Her philosophy, which I believe is thefoundation of vocational rehabilitation, is found in a statement shewas fond of repeating. "Of the three great virtues, Faith, Hope andCharity; the greatest of these is Hope." To my mind this one word"hope" is the embodiment of the VR program, for without hope,there is only despair, and hope is what VR counselors bring to per-sons with disabilities. I feel privileged to have worked with manypeople who have shaped the history and foundation of the State-Federal program. Adrian Levy, NY State, Charles Eby,Pennsylvania State VR, Henry Visca: di, Human Resources of LongIsland, NY, Howard Rusk, M.D., New York University Research &Training Center and my fellow Regional Commissioners.

Having served as Regional Commissioner in three Federalregions I have found the spirit of hope growing and develop-ing not only among providers of services, but also amongpeople with disabilities, and it is this spirit which will keepthe State-Federal program growing into the 21st century.

Anthony Desimone, Ph.D.Rehabilitation Consultant, Former RegionalCommissioner, RSA(New York, Seattle, and San Francisco)

In 1965 when Mary Switzer needed an experienced and ener-getic professional to take the lead in implementing a majorsection of the expanded VR Act recently signed by the

President, she selected Henry Redkey. It was a wise choice onMs. Switzer's part. Redkey recruited his new staff from various

government and private agencies throughout the U.S. and putthem to work, as-'fined deadlines, supervised their training, andmade certain that the regulations and procedures they draftedwere realistic and of top quality.

I had the pleasure of joining the Washington, D.C. officeheaded by Mary Switzer after 15 years with the National EasterSeal Society in Chicago, Illinois where I had just published mystudy entitled, "Contract Procurement Practices of ShelteredWorkshops." My first responsibility at RSA was the develop-ment of the Facility Improvement Grant Program. On reflectionit was a relatively modest grant program when compared withother innovative elements of the 1965 VR Act Amendments, butnevertheless, it was successful and achieved dramatic results.Through this new program and related grant programs, rehabili-tation centers, treatment centers, sheltered workshops and otherrehabilitation facilities were built, additional staffs hired andneeded equipment purchased. These events clearly resulted inmuch needed services and the growth of the rehabilitation facil-ities movement in the U.S.

Michael Do 'nickFormer Director, Rehabilitation Facilities Section,Rehabilitation Services Administration (RSA)

With any luck, Vocational Rehabilitation in the year 2015will differ little from what it was in 1994. Services willbe directed to special populations. They will be defined

and developed by individualized rehabilitation plans. Placementof clients in the job market will be the central goal. Effectivenesswill be measured not only by outcomes, but by checkpointsalong the rehabilitation continuum.

Changes will be influenced by the increasing importanceof disabled individuals in the labor market, due to a propor-tionate shrinking of the working-age population, and theinfluence of new technologies and accessibility in wideningjob opportunities for persons with disabilities.

In research, there will be less emphasis on rehabilitationsystems and more emphasis on restorative and rehabilitationtechniques. In training, immediate access by counselors toinformation, probably through avenues unknown to us at pre-sent, will be increasingly important and as with clients, con-tinual updating of training plans will be essential.

Circumstances will obviously change, but vocational rehabili-tation will continue to deliver services effectively and efficiently.

George A. EngstromFormer Director of Research UtilizationNational Institute of Disability & RehabilitationResearch (NIDRR)

Vocational Rehabilitation, as a fully acknowledged profes-sional discipline, with Its own specialized body of knowl-edge, and a sound philosophy, is well-positioned to contin-

ue to play a vital role in the human service arena in the 21stcentury. This assumes that it keeps abreast of the rapid pace oftechnolegical innovations and other scientific developmentsemerging in the next century.

8'58,1 National Rehabilitation Association 1995 Switzer Monograph

In this volatile milieu, vocational rehabilitation will needto adapt its body of knowledge to be more compatible withthe precision of the computer literate society. Hard data ofthe vocational rehabilitation discipline will readily lenditself to conversion. However, soft data the art of rehabili-tation will be taxed severely in this process. Nevertheless,the entire transformation process will serve as a purifyingexamination of the field and thus, will further strengthen thesubscience of vocational rehabilitation.

Another trend that could stifle the expected progress of voca-tional rehabilitation is the assignment of "professional adminis-trators to manage and direct rehabilitation programs and services.

With the new emphases on cost-containment, accountabil-ity, marketing, and litigation, the era of the M.B.A. type ofmanager is becoming more prevalent. Rehabilitation, to min-imize or overcome this trend should consider preparing itsown professional managers. That is say the individual whocan combine the skills of rehabilitation and also the manage-rial skills of the M.B.A. specialist.

The locale of vocational rehabilitation will be significant-ly broadened to include a more substantial part of the mar-ketplace as well as society as a whole. For instance, with theAmericans with Disabilities Act (ADA) and other relevantlegislation, business, industry, labor unions, schools and col-leges, and public and private social agencies will all be a partof VR's enlarged target. The very nature and diversity of thislarge audience will significantly change and add to the bodyof knowledge of rehabilitation. These changes will alsoaffect VR's philosophy as its framework must incorporatenew configurations of ideas, concepts and values.

The e are a few of the challenges facing vocational rehabili-tation as it takes its place as a leading profession in the humanservice area of the 21st century. Despite the obstacles, VR willbe strengthened by these new challenges and continue to be anessential part of the human service community.

Thomas J. FlemingFormer National DirectorProjects With Industry (PWI) RSA

The state-federal rehabilitation program put in place thebuilding blocks that will prepare us for the 21st century.These fundamental segments include: the basic VR pro-

gram, the single State agency, exclusion from the block grantprinciple, the facility movement, the training of rehabilitationpersonnel, research and demonstration, the international rehabil-itation program, independent living, Projects With Industry,competitive employment goals, supported employment, assistivetechnology, and corporate disability management enhanced byADA. Over the years the legislative experts had crafted a well-balanced law that authorized not only Title I (of the VR Act), butalso other complimentary Titles that provided "special projects"and a wide range of essential and supplementary services.

During the next several decades these public and privaterehabilitation resources will remove any remaining elementsof dependency or paternalism, and will make available forpersons with a significant disability an array of services thatemphasize independence, inclusion, empowerment and

choice. These are the concepts that permeate new legislation,new amendments, and the new leadership that are preparingvocational rehabilitation for the 21st Century.

Wesley GeigelFormer Associate CommissionerOffice of Program Development, RSA

Ihave been privileged to have had a part in the rehabilitationmovement in the United States for over halt a century. Duringthat time there have been a number of outstanding develop-

ments, three of which I was directly associated with MarySwitzer and under her direction.

The first of these early landmarks was the placing of theVR program on a permanent legislative base. When initiallyenacted, the enabling legislation set the program in motionwith time limits which made long-range planning very diffi-cult. It was not until the 1930s, more than ten years after theestablishment of the VR Act, and its incorporation into theSocial Security Act legislation, that the rehabilitation pro-gram was given permanent legislative authority permittinglong-range planning to go forward.

The second of these landmarks came in 1954 when therehabilitation program was authorized to develop and fundresearch efforts. There were virtually no limits on the kindsof organizations that could undertake research or the fieldsof research that could be explored, provided the researchenhanced the rehabilitation movement. Many organizationsthat had never worked with people with disabilities before,became part of the rehabilitation effort and contributed to itsgrowth and effort. Among other things, the "team approach"to solving rehabilitation problems grew out of the bringingtogether of so many agencies with diverse disciplines. MarySwitzer had a primary role, along with Dr. Howard Rusk insecuring the enactment of the 1954 amendments.

The third of the early landmarks was the authorization ofth, rehabilitation program to conduct research overseas uti-lizit.g funds generated under the Public Law 480 program.the P.L. 480 program provided for the sale of agriculturalproducts to certain foreign countries, the payment for whichwas made in the local currency of the receiving country.Most of these funds were retained by the recipient countriesfor use in improving their food production. However, a por-tion of these funds was given to the U.S. for paying localexpenses of the American embassies for use by certain U.S.agencies in conducting research with agencies in the recipi-ent countries. The rehabilitation agency (VRA) was givenauthority to work with foreign rehabilitation agencies inexploring problems of mutual concern as it affected personswith disabilities. This enabled the RSA, for the first time, totap the various overseas resources with outstanding results.For example, one of the cooperative research projects wasconducted by Dr. Marion Weiss, a Polish orthopedic surgeon,v.'ho explored and developed techniques for applying the fit-ting of a prosthetic device immediately after amputation.This innovation greatly reduced the time and costs of hospi-talization of the amputee. The result of this project done inPoland is now used throughout the world. Many other worth-


while results came from the research projects generated andfunded with the P.L. 480 Local Currency Fund.

The rehabilitation program has shown the way to bring aboutgreater functional capacity to many people with disabilities.With the increasing number of people in the U.S. being disabledeach year, particularly among the older population, it is essentialthat the rehabilitation program be expanded and funded to workwith this ever-growing population.

Joseph M. La RoccaFormer Director, International Rehabilitation ProgramsVocational Rehabilitation Administration(now klown as RSA)

In the 1950s, a relatively modest number of persons with dis-abilities were served in rehabilitation facilities. Today, sever-al thousand facilities serve a wide variety of individuals who

are in need of specialized programs.A brief overview indicates the widespread changes that

have occurred during comparatively recent years. in 1959,the National Association of Sheltered Workshops andHomebound Programs (NASWHP) held a meeting in Bostonin conjunction with the annual meeting of the NationalRehabilitation Association (NRA). Approximately seventypersons attended the evening meeting of the workshop asso-ciation. A short time later NASWHP established a nationaloffice in Washington, D.C., and hired its first full-time exec-utive director. Within a relatively short period of time devel-opments led to the establishment of a wide variety of facili-ties serving numerous individuals. Several State VR agenciesset up vocationally-oriented centers that served predomi-nantly clients of the State rehabilitation agency. Early Staterehabilitation centers included the Geoi Oa RehabilitationCenter in Warm Springs, the Woodrow Wilson Center inFishersvi'le, Virginia, the Pennsylvania RehabilitationCenter in Johnstown, Pennsylvania,the Hot Springs Center inArkansas, and the Evaluation Center in Des Moines, Iowa.

The emphasis on rehabilitation facilities was reflected inthe establishment of a Division of Rehabilitation Facilitieswithin the Federal Office of Vocational Rehabilitation (nowRSA) in Washington, D.C. At one time, each State rehabili-tation agency had one or more rehabilitation facilities spe-cialist to assist in the development of programs to meet theneeds of persons with disabilities.

The Rehabilitation Services Administration (RSA) playeda major role in financially supporting the development ofstandards for rehabilitation facilities, the accreditation orga-nization that implemented the standards, training grants,demonstration grants, and research grants. The accreditationbody is known as the Commission on Accreditation ofRehabilitation Facilities (CARF). As of September 1994,9,451 programs in 4,101 facilities have been accredited.

Without a doubt, rehabilitation facilities ha 'e nade greatstrides during the past 35 years, and numerous persons withdisabilities have been served in facilities where new ideasand practices arc continually being introduced.

1 was happy to have been a part of this facility movementas rehabilitation was in its developmental state. There is still

86

much to be done, and I feel optimistic that the new centurywill bring with it new innovations to assist people with theirindependence.

Willman A. MassieFormer staff, Division of Rehabilitation FacilitiesRSA, and Former Executive Secretary, NationalAdvisory Council on Vocational Rehabilitation (RSA)

As we close this century and reflect on future generationsthat will populate the United States during the 21st cen-tury, we realize that many changes will take place within

our personal, social and working lives. A number of thesechanges will relate to programs and services in the field ofvocational rehabilitation.

We recognize that vocational rehabilitation today is much dif-ferent than what we knew in the early 1900s, resulting mainlyfrom two world wars and those who were injured or became illduring the years of conflict. Much emphasis was placed onreturning the disabled veteran to his employer, if possible, or toprovide training or retraining for future employment.

Having seen some of the benefits provided to disabledveterans, a strong demand was made by parents and rehabil-itation advocates to provide services to non-veterans whowere disabled from such causes as polio, tuberculosis, birthdefects or trauma from the mines, mills or other employmentsettings. With this new thrust on providing better and morecomprehensive services, greater emphasis was placed onmore specialized training, new surgical procedures, andsophisticated engineering to offer functional aids anddevices to persons with multi-handicaps, such as home careand independent living programs.

Legislation was passed that provided for more servicesand research and demonstration programs, both domestic andinternational. The latter was stimulated using special foreigncurrency and dollar support during those years. While leg-islative measures were enacted by Federal and State govern-ments initially to returning combat veterans the emphasisshifted to include men, women and children from the civiliansector. This included younger and older persons with differ-ent handicaps and was supported in large measure by volun-teer groups representing, for example, cerebral palsy, mus-cular dystrophy, and mental retardation, to mention a few.

As the last few years of this century draws to a close we beginto realize some of the social and economic changes taking placeand the potential impact these changes will have on our way oflife in the years to come. The daily headlines and TV special pro-grams repeat constantly our national and world problemsinclude: the population explosion, world hunger, environmentalpollution, ethnic cleansing, increased crime and violence, drugand alcohol addiction as well as disabilities resulting from AIDSand mental illness. We can easily see how these factors will beaffecting our social and economic structure and our own person-al lives, and that we need to seek answers in the areas of pre-vention as well as rehabilitation.

To focus on some of the increasing problems in our countrywe must recognize a few key demographic changes taking place,such as an increasingly older population (a 12% increase n the

8 VNational Rehabilitation Association 1995 Switzer Monograph

65+ population projected between 1990 and 2000, based on1990 census figures), a greater proportion of women over men,an increasing number of Spanish-speaking persons. Other socialand economic changes will include downsizing within industry,business and government, and a greater demand for more skilledand specialty-trained employees.

A greater challenge will confront those in the field of reha-bilitation with the need for more in the way of the "teamapproach," an additional emphasis on specialization in the fieldsof medicine, social and behavioral sciences and engineering. Inaddition, there is expected to be more of a need for specialists inthe legal and environmental professions as well as in health pre-vention areas and communications. We can look for a greateremphasis on institutional care, including prisons and specialfacilities for those with addictions and those incarcerated fol-lowing second convictions. The experts in many disciplines willneed to begin to communicate and plan for the multivariateneeds that await us in the century that is almost here.

Martin E. McCavitt, Ed. D.Special Consultant, World Rehabilitation FundFormerly Special Assistant, International AffairsNational Institute on Handicapped ResearchU.S. Department of Education

In a relatively new discipline such as we have chosen to label"Rehabilitation" it is appropriate that we should accept eachavailable opportunity to reflect on where we have been,

where we are currently, and speculate on where we might begoing. With the publication of Switzer Monograph #18, we haveanother such opportunity. In any facet of a rapidly changing psy-cho-social development where interfacirg with establishedactivities and with many that are also de /eloping, the peoplewho are or have been central to the making of decisions thatdefine us are most important. Crucial legislation has marked theroutes we have travelled, but again, the people, their dreams,their values, their capacities to influence lawmakers, and theirabilities to translate laws into programs of action have been cen-tral to shaping rehabilitation as a discipline. The names of thosemen and women will be featured here.

In the years immediately following World War I when grafi-tL:de to the veterans who came home from that war ran high, nogreat difficulty was experienced in getting Congress to providefor the vocational rehabilitation of disabled veterans (Public Law16). The operations under that law proved to be so popular thateven a conservative Congress could be persuaded to approve ofa program of similar services for non-veterans. The CivilianRehabilitation Act was passed in 1920 and carried an appropria-tion of 51,034.000. That was a modest amount, but during thefirst year's operation, less than one-half of the appropriation wasused as the States were not organized to apply the law. However,such names as John Kratz, Tracey Copp, Mark Walter, R.M.Little, John Lee, Oscar Sullivan, and Mary Baker began showingup on reports and on the lists of persons called by congressionalcommittees where they they lobbied for better financing andplanning for rehabilitation programs nationwide.

In 1935 the vocational rehabilitation appropriation of$1,938,000 was added to the Social Security Act of that year.

88

By 1940 special vocational rehabilitation funds were beingprovided by the Congress. Later, the Office of VocationalRehabilitation (OVR) was established with Mary E. Switzeras Director (1951). Prior to that time E.B. Whitten had beeninstalled as Executive Director of the National RehabilitationAssociation (NRA). He and Switzer made an excellent andeffective team in presenting and defending the vocationalrehabilitation program to the Congress and the public.

Through the 1950s many of the features of the programas we know it today were established, e.g., researchgrants, stipends for students training to become rehabili-tation counselors, funds for cooperation with non-publicagencies, expansion of eligible populations, etc.Appropriations are currently well over a billion dollarsper year. Support was usually close to unanimous in theCongress, and it has long been considered one of ourmost successful social programs.

Rehabilitation as a private practice is found in many juris-dictions. This is likely to expand as the economics of privatepractice are established. If the current right-leaning mood ofthe electorate continues, with the election of more conserva-tive members of Congress, the discipline of rehabilitationmight have to be defended all over ag- If balancing theFederal budget moves to the top of the .genda for more andmore members of Congress, many programs that have beenregarded as untouchable will receive additional scrutiny.Pushing publically supposed activities over into the "privatesector" will look attractive to those who insist that balancingthe budget or reducing the deficit is of major importance.Private practice, having been proven to be feasible couldlook very inviting. The National Rehabilitation Associationshould be ready to defend the gains that were made and suc-cessfully demonstrated since 1940.

It is probable that many of the battles that NRA fought atthe Federal level to establish the rights of disabled peoplewill sit' to the State level; a popular ploy to reduce theFederal deficits can be via moving the program burdensdown to the States and challenging them to greater responsi-bility. Considerable "rehabilitation statesmanship" will prob-ably be necessary to defend the rehabilitation discipline, itssupport and "quality" services in the next two decades. Newnames will have to be found to take the places of those ofSwitzer and Whitten, et al., to ensure a new roster of effec-tive leadership in the field of rehabilitation.

C. Esco Obermann, Ph.D.Professor Emeritus, University of IowaPresident, NRA, 1961-1962

As a member of the Switzer staff one recalls that, at theinception of the current era in vocational rehabilitation,leaders provided enlightenment, professionalism and

accountability. The Switzer team was unique in its understand-ing and commitment to client-centered, comprehensive, individ-ualized, interdisciplinary and systematic rehabilitation.

The single goal was to help individuals with disabilities to obtainand retain suitable employment. Congress consistently favored theprogram with substantial increases in funds; in 1965 alone, the VR

/995 Switzer Monograph National Rehabilitation Association 87

program expanded from $100 million to $300 million.The State-Federal partnership was fostered and nurtured dur-

ing this period. Switzer convened the State VR Directors and lednational meetings of Stan.: and Federal specialists in fiscal/statis-tical operations, public information activities, staff developmentmatters and client services issues. State Directors ultimatelyaffiliated through the National Rehabilitation Association(NRA) and later formed the Council of State Administrators ofVocational Rehabilitation (CSAVR) with a full-time executivedirector. This arrangement was highly effective for the programand people served and rehabilitated.

The Switzer years were pivotal for the State-Federal pro-gram. The concepts and strategies implemented provide flex-ibility in administration at the state level, established solestate agency and organizational unit requirements, and solid-ified the full-time commitment of State VR director and staffto vocational rehabilitation matters. The provision thatnobody outside the agency could interdict the direct linebetween the State director and the rehabilitation counselor inthe determination of eligibility for services sustained theintegrity of the program during some turbulent years.Although terminology has changed in the past 25 years, thebasic program requirements remain intact.

The Switzer team established a multifaceted training programfor rehabilitation professionals; implemented an operationsresearch and demonstration program to improve rehabilitation;and organized an effective international research effort usingagriculture surplus funds in selected foreign countries.

Thoughtful observers agree that Mary Switzer led thegolden years in vocational rehabilitation. Will the glow con-tinue? Will the foundational principles and organizationalbuilding blocks withstand the challenge of change? Timewill tell. Stick around for the excitement!

Dr. Ralph N. PacinelliRegional CommissionerRehabilitation Services AdministrationPhiladelphia, PA

Ibegan in vocational rehabilitation in 1937...there was notraining for rehabilitation counselors then so I qualified asbeing in a "related field," social work administration.

Fortunately I learned from a great state director, ClaudeAndrews, a wise man with infinite patieace and compassion forpeople with disabilities whom we served.

My district was 500 miles long covering 33 Florida coun-ties. Crude aptitude tests were administered on the runningboard of my car (anyone remember when cars had runningboards?). We were limited to vocational training and place-ment and prostheses, the latter often delivered by mail fromAtlanta. Georgia. There were no rehabilitation centers then,nor any training in the use of prostheses. Closure of a caserequired six months success on the job.

If this all sounds too primitive let me say that we did place alot of persons with disabilities into good jobs. I recall in one yearalone I had 1(10 successful cases closed as rehabilitated.

World War II brought many changes and it brought metogether with a remarkable Lt. Colonel in the Air Force, Dr.

Howard Rusk. We would be associated with U.S. Army reha-bilitation, the Veterans Administration (VA), rehabilitationcenters, and finally with Mary Switzer in the greatest revolu-tion rehabilitation has seen before or since.

Switzer, a really great American, took a rather staid VRprogram and opened it to a whole new range of services,research and professional training, not only for rehabilitationcounselors, but other professions soon to be allied in a com-prehensive rehabilitation approach. How did she do it? First,she had a vision; she reached out to new ideas, and not to beoverlooked, she had an uncanny way for getting along withother government officials, particularly, U.S. Presidents andthe Congress.

While on her staff I had the opportunity to advance whatwe had learned earlier in VR, and the war. Rehabilitationfacilities became my landmark as we worked for coordinatedservices in the medical, social, psychological and vocationalareas often best found in rehabilitation centers.

After a stint at the rehabilitation of drug addicts for theNational Institute of Mental Health (NIMH) in Washington,D.C., and teaching at the University of Wisconsin at Stout, Iam now retired high on a bluff in Port Townsend,Washington, and at 87 not well positioned to say what thefuture of rehabilitation should be. It will obviously be moresophisticated, more difficult and involve mote interagencycooperation, but it must never lose its dedication to peoplewith disabilities that it is supposed to serve. Not legislation,not money, not professiona} careers, only people make it allworthwhile. I think Claude Andrews, Howard Rusk and ourbeloved Mary Switzer would agree.

Henry RedkeyFormer ChiefDivision of Rehabilitation FacilitiesRehabilitation Services Administration

IIunc 20, 1995 marks the 75th Anniversary of the Federal-State program of Rehabilitation Services in this country.Through the years there has been continuous growth in the

numbers served and the range of programs made available tothem. Legislation was passed unanimously in both houses ofCongress for over 50 years, and still receives a large majority ofsupport from contemporary legislators.

Much of the social legislation of the past several decades usesthe Rehabilitation Act as a model for their particular programs.Some of the highlights receiving such adoption include:

Individtr 'ized services based on needs and resources,a plan co-signed by counselor and client (IWRP-Individualized Written Rehabilitation Plan).

Authority and resources to provide research into new,medical and technological findings and their inclusioninto appropriate services.

Authority and resources to provide professional train-ing to enable the services to he rendered in qualityperformance.


Authority and resources for consumers to estahlishorganizations to assist individuals to live independent-ly and assume responsibility for participation in fami-ly and community life.

Non-discrimination in employment and services by allFederal departments and agencies.

Job placement based on qualifications, not quotas.

All States required to have grievance procedures in orderto receive formula grants, according to State Plans.

Following my work experience as a rehabilitation coun-selor and supervisor at a major community rehabilitationfacility and hospital I joined the Region II, RSA staff.Through s one 20+ years I was responsible for the review,recommendations and monitoring of all discretionary grantsavailable under the Rehabilitation Act.

Some of the special assignments that I recall include thefollowing:

As President of the Metropolitan Chapter of NRA inNew York City, I was the conference coordinator forthe National NRA Conference at the Waldorf AstoriaHotel. Close to 3000 people attended the 200 work-shops, 20 special events and 100 exhibits. OrinLehman chaired the program, Mary Switzer andSenator Jacob Javits were the keynote speakers.

With Kay Arneson, RSA Legislative Director, initiatedand participated in the Switzer Memorial Seminar on"Women and Rehabilitation".

During the international Year for Disabled (IYDP), I hadthe pleasure of representing all 10 Regional Offices on theNational IYDP Committee, and participated in specialmeetings in Washington, D.C., at the United Nations, bothin New York City and Vienna, Austria.

Represented RSA on the Department of Interior's sub-committee on Access-Ability as they underwent therenovations of the Statue of Liberty and Ellis Island.

As the rehabilitation community moves ahead into the21st Century, a number of questions emerge with referenceto meeting the needs of individuals with disabilities. Some ofthese questions and issues beginning to surface include:

Changing labor market reports predict that many jobswill be performed at home, with sophisticated and spe-cialized equipment. How many of our constituents willthis effect in a positive and constructive way?

With improved and affordable technology, activitiesof daily living will be enhanced to offer home shop-ping, banking, entertainment, etc. Interactive TVwill make it possible to visit friends, families,physicians, clergy, and classrooms. Will theseopportunities lead to social isolation or enrichmentof life styles, or both?

Will the Aging of America call for assistance to life-long and long-term consumers? Retirement activities,estate planning, independent living in senior communi-ties, and accessibility issues will require additionalskills and sensitivities. Newly disabled seniors willneed assistance from peers in their age group.

Will genetic research and counseling lead to any sizablereduction in the number of children born with congenitalanomalies? Will family counseling be an increasedresponsibility for those who wish to enhance their fami-lies, with this type of information made available to them.

While there are of course many other questions thatremain to be asked, this short list serves as a reminder thatthere is much to be done as rehabilitation prepares to enter anew century. See you at the Centennial.

Thelma SchmonesFormer Special Assistant for Constituent RelationsRSA Region II Office, New York City

There are very good and valid bases for the idealizing theatmosphere in which we worked in VocationalRehabilitation in the Fifties and Sixties under Mary

Switzer's leadership. In the Federal office we were invited tothink, to stretch our minds to think up programs or ways to helpindividuals with physical or mental disabilities. It reminded meof a long planting season for the seedlings of new ideas.

The bureaucracy was less encumbered, and less barnacled inthose busy and productive years. Upper echelon officials in theFederal establishment were approachable and often receptive,and it was feasible to sell a good idea for some new effort. Risktaking was implicit and recognized as potentially worthwhile,not something to be feared. The ideal of a three-way partnershipamong the State rehabilitation programs, the growing privatesector and the Federal agency (RSA).

In the seventies, horizons began to close in and certainly at theFederal level, the focus necessarily iurned to concentrating on thepragmatic administrative necessities of putting the ideas into prac-tice in both vocational rehabilitation and independent living.

It was so lucky that Mary Switzer linked up in precisely theyears of the Fifties and Sixties. She had a really impressive arrayof personal skills, technical, bureaucratic, conceptual and ana-lytical, as well as strong personal values, all of which takentogether, were almost surprisingly well-suited to the task.

The task was to find and use ways of energizing the forcesneeded to take Rehabilitation forward, up and out of its rathersleepy backwater existence. True, the times were ripe for this ina number of ways. Nonetheless, Mary Switzer is rightly creditedwith giving the times a hearty assist or push, if you will. Thegrowth spurt in Rehabilitation might well have happened andmost probably would have come, had Mary Switzer not been onthe scene, but it would very likely have taken far longer.

Miriam StubbsFormer Director, Policy & Planning StaffRehabilitation Services Administration


Mary E. Switzer Memorial Seminar

Some distinguished Scholars and NRA Members.(L-R) NRA President and Assistant RegionalDirector, VRS, North Carolina, Tommy Allen; NRAPast President and Director Research & T Center,University of Wisconsin-Stout, Dan McAlees;Switzer Committee Chairman, also NRA PastPresident, Carl Hansen; from RSA, D.C., RuthRoyall-Hill; and NRCA President Elect Jack Hackett.

A

RRCEP Director from George WashingtonUniversity, Donald Dew makes a point whileNell Carney, Executive Director, DRS,Mississippi listens.

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Phil Kosak, V.P. Carolina Fine Snackschatting with Patricia Morrissey, StaffDirector, U. S. Senate Subcommittee onDisability Policy, during a seminar break.

as-

Scholars Dan McAlees, Yvonne Johnson, Director,DVR, Georgia, arm Kenneth Tregenza, Jr., ofGeneral Motors Corporation. listen attentively asone of the "action papers" is presented.


to.

Scholars Jennie Joe, Director Native American R&TCenter, University of Arizona, RRCEP Director,George Washington University, Donald Dew,Director R& T Center, University of Wisconsin-Stout, and Tommy Allen,NRA President andAssistant Regional Director,VRS, North Carolina, taketime to discuss one of the"action papers" in a moreinformal setting.

dissiD.C. RSA Administrator, Ruth Royall-Hill.responds to a question, as Paul Spooner,Executive Director Metro West Center forIndependent Living, Massachusetts looks on.

General Motors' Ken Tregneza, Jr., and JudyNorman-Nunnery, DVR, Wisconsin, payclose attention as papers are discussed.

Patricia Morrissey, delivers her paper, flanked by(L-R) Carl Hansen, Switzer Seminar Chairman, LenPerlman, Switzer Seminar Coordinator, and JackHackett, NRCA President Elect.


End Notes

The Experiment:

A Mini Switzer SeminarBarbara Greenstein

Ior a long time before I became a Switzer Scholar in 1993. Ihad heard that it is the highlight of a professional career. It

is also said that you remain a Scholar "for life". After par-ticipating in the Seminar, I was anxious to find a way to keepalive the mental stimulation that accompanies participation. Thethought came to me that a small group of professionals couldgather together to discuss the Issues Papers, and prepare a shortsummary of our conclusions.

The resulting seminar was held at my home on October 23,1994. There were four participants: Kenneth Berg, M.D.,Valerie El lien, Ph.D., Jackie Wilson, and myself. A total of eightpeople had been invited, but scheduling conflicts prevented theothers from attending. We later agreed that a group of six pan-elists would have been ideal. Each of us read the 1994 IssuesPapers in preparation for our meeting.

Originally, a full day of discussion was planned, modeled onthe regular Switzer Seminar in Washington. The plan was to dis-cuss each paper individually, and then conduct a summary dis-cussion to identify the critical issues that emerged. This quick-ly proved to be an inappropriate format for such a small group;also, we did not have the authors available to expand on theirwritten papers. We therefore spent our time discussing the over-all issues that we perceived.

Following are some of the high points of our discussion:1. Rehabilitation education is not keeping pace with the work

that rehabilitation professionals are doing out in the commu-nity. In addition to working in public and private rehabilita-tion agencies, we are working in business and industry, pri-vate practices that do not necessarily serve only disabledclients, in schools, and with groups of disabled people notpreviously served (examples would be AIDS patients and de-institutionalized chronic psychiatric patients).

2. Involvement of the family of the disabled person is an impor-tant key to success of a rehabilitation effort.

3. Rehabilitation programs need to take into account the indi-vidual's needs, but still remain within the realm of commonsense: just as a college degree is not an appropriate goal forevery high school student, a job in competitive industry maynot be right for every rehabilitation client.

Barbara Greenstein, CRC, CIRS, Social Security Specialist, UNUN1 LaicInsurance Company, Tarrytown. New York. (1993 Switzer Scholar)

4. There is a great deal of politics involved in the structure ofrehabilitation programs, particularly in the funding, and thishas the effect of "freezing" programs in the past, rather thanallowing thent to evolve in response to new market forces.

5. There is a lot of competition for scarce resources, and somecreative individuals and agencies are looking for non-tradi-tional funding for their programs.

6. New needs are developing for the skills of rehabilitation pro-fessionals: working with displaced workers to find newopportunities in today's job market, providing EmployeeAssistance Programs for working disabled people whorequire some supports, and working with young people whoare having difficulty finding a place in the increasingly com-plex work world.

7. There is a re-emergence of the sense of community inemployment-related services, where potential employees andemployers connect through agencies in the community.Some of the above comments emerged in a telephone discus-

sion with Diane Neville, who had prepared for the Seminar, butwas unable to attend. We also noted that the consumer of reha-bilitation service is the individual with a disability, but the con-sumer of rehabilitation education is the rehabilitation profes-sional. The blurring of this distinction has limited the growthopportunities for rehabilitation professionals.

At the end of our discussions, all participants agreed that itwas an excellent experience, and that we would like to do itagain in the future. We also agreed that having the opportunityto have our comments published in the Monograph was a moti-vating factor to give the effort needed for such a discussion.Alternatively, such comments might be considered for publica-tion in the Journal of Rehabilitation. Wonderful ideas are gen-erated in a forum such as the Switzer Seminar, and expanding itsimpact into small local groups seems to be a simple way to net-work the ideas right into our daily practice.

Personally, I would like to continue being a "SwitzerScholar for Life", and to participate in another seminar nextyear. I would recommend the experience to any committedrehabilitation professional. I would recommend that othergroups assemble themselves and plan Mini Seminars of theirown. Our clients will thank us for the new level of enthusiasmthis will help us bring to our jobs.


National Rehabilitation Association

Officers

Tommy AllenPresidentClemmons, North Carolina

Doug SeilerPresident-ElectHolland, Michigan

Spencer MosleyPast PresidentGreen Bay, Wisconsin

Jerry BensmanTreasurerAtlanta, Georgia

Board Members at-Large

Susan G. ShermanAtlanta, Georgia

Yvonne JohnsonAtlanta, Georgia

David PriceLansing, Michigan

Willie HorneJackson, Mississippi

Barbara J. JaegerAustin, Texas

C, Odell TyndallGoldsboro, North Carolina

RegionalRepresentatives

Great LakesBettie McClearyBrookfield, Illinois

PacificFlo CurnuttSan Jose, California

Great PlainsPaula NickensonFulton, Missouri


Mid-AtlanticChuck SmolkinBaltimore, Maryland

NortheastJune Ka!ipolitesConcord, Maine

SoutheastSusan WeeseLouisville, Kentucky

SouthwestCharles TappHot Springs, Arkansas

Division RepresentativesNantional Association ofMulticultural RehabilitationConcerns

Thomas C. BridgesDetroit, Michigan

National Association ofRehabilitation Instructors

Faye FearsAmory, Mississippi

National Association ofRehabilitation Secretaries

Patricia BriggsFt. Washington, Maryland

National RehabilitationCounseling Association

Faith S. KirkRockville, Maryland

Vocational Evaluationand Work AdjustmentAssociation

Jo Ann NunnellyDenton, Texas

National Associationof Job PlacementDevelopment

Frank StrongSioux Falls, South Dakota

94

National Association ofService Providers inPrivate Rehabilitation

John LuiBedford, New Hampshire

National Association forIndependent Living

Paul SpoonerFramingham, Massachusetts

National RehabilitationAdministration Association

Kathy WilliamsFrankfort, Kentucky

Council RepresentativesCouncil of DivisionPresidents

Mary LinnLittle Rock, Arkansas

Council ofChapter Presidents

Brian FitzgibbonsTeneck, New Jersey

National Staff

Ann Ward Tourigny,Ph.D., CAEExecutive Director

Michelle A. High leyDirector of Admin. & Membership

Ronald J. AcquavitaDirector of Communications

Thomas G. StewartDirector of Governmental Affairs


Mary E. Switzer 1900-1971

rew people realize that Mary E.Switzer had a satisfying andfully successful career in feder-

al government employment thatspanned several decades prior to herformal entry into the field of reha-bilitation. She was fifty years oldwhen she became director of theOffice of VocationalRehabilitation in 1950, andshe brought to the positiona superior intellect and abil-ity. Her many talents andexperiences in economics,the legislative process, gov-ernment administration,health, welfare and publiceducation were only a fewof the composite assetsbrought with her. Sheentered the movement at acrucial point in its evolu-tion. It was a time in whichdifficult decisions had to bemade between maintainingthe status quo or moving toa larger and unknownfuture, but with increasedopportunity to serve tens ofthousands of people withdisabilities yet in need.

Following a life patternin support of increased ser-vices to people with a moreresponsive and humanitari-an government to changinghuman needs, she readilycommitted herself to the less certainbut more hopefully expanded futurefor rehabilitation. The rest is histo-ry. The breadth and humanity ofMary Switzer are stamped foreveron the passage of Public Law 565with its research and demonstrationfeatures, its concern for rehabilita-tion education, its mandate to con-struct necessary rehabilitation facil-ities, its totally new characteristic ofinternational efforts and cooperationregarding rehabilitation, and per-

haps, above all, in its expandedfunding base for more personnel andprograms for those in need of reha-bilitation services. In the years thatfollowed, she went on to evengreater legislative and governmentalleadership heights on behalf of bothdisabled and disadvantaged people.

Despite the demands on thenational and federal scene, her pres-ence was almost ubiquitous onbehalf of program development andextended services to needy people.On a regional, state or local level,be it public or voluntary services, ifit were in the interest of rehabilitat-ing those in need, somehow, shewould "arrange to be there."

The Who's Who has chronicled hermany national and internationalawards. Also recorded ar r presi-

94 National Rehabilitation Association

dencies of many organizationsincluding the National RehabilitationAssociation, whose members andtheir efforts she held in high esteem.But she did not reach the heights ofher ability when she was made thefirst Administrator of the SocialRehabilitation Services, nor when

she retired from the position,nor when she became inter-nationally involved in theWorld Rehabilitation Fund.Instead, she found her great-ness when she touched eachof us, bringing our fullhumanitarian efforts andqualities to the fore on behalfof disabled and disadvan-taged people. While readilyrecognized as a truly greatadministrator in the classicalsense, her true capacity andability can only be appreciat-ed when we realize that theseaccomplishments sprangfrom an inner expression ofsensitivity, emotional refine-ment and dedication to serveall less fortunate people. Heregalitarian qualities were notcontrived but spontaneous,stemming from love andrespect for all living things.

All of us in the NationalRehabilitation Associationand in rehabilitation, and allpeople with disabilities, have

had better, more meaningful andmore productive lives because herpresence and her being were suffi-ciently large to embrace and acceptus as we are and help us better under-stand where we should be.

What more can be said than thatwe had the joy and privilege ofknowing her?

E.B. Whitten,Journal of Rehabilitation,November/December, 1971.


Previous Monographs Also Available

since the first annual Mary E. Switzer Memorial Seminar in 1976, the Switzer Monograph has illuminatedthe research and recommendations of prominent scholars within the field of rehabilitation. SwitzerMonographs have proven themselves to be useful tools for administrators, practitioners, policy makers, leg-

islators, researchers, education specialists and consumers. To order a particular issue or issues, simply duplicatethis form and send it to the National Rehabilitation Association, 633 South Washington Street, Alexandria,VA 22314, along with your check or credit card information.

Please send me the following Monographs:

#1 Out of print.#2 Rehabilitation of the Older Blind Person: A Shared Responsibility#3 The Role of Vocational Rehabilitation in the 1980s: Serving Those with Invisible Handicaps#4 Rehabilitation of the Mentally Ill in the 1980s#5 International Aspects of Rehabilitation: Policy Guidelines for the 1980s#6 Women and Rehabilitation of Disabled Persons#7 Rehabilitation in the Public Mind: Strategies of Marketing#8 New Technologies and Rehabilitation in the Information Age#9 Social Influences in Rehabilitation Planning: Blueprint for the 21st Century#10 The Transition to Work and Independence for Youth with Disabilities#11 The Aging Workforce: Implications for Rehabilitation#12 The Rehabilitation of Persons with Long-Term Mental Illness in the 1990s#13 Technology and Employment of Persons with Disabilities#14 Employment and Disability: Trends and Issues for the 1990s#15 Aging, Disability and the Nation's Productivity#16 Rehabilitation Facilities: Preparing For The 21st Century#17 Private Sector Rehabilitation: Insurance, Trends & Issues for the 21st Century

All previous available Monographs are $10.00

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Send & Make checks payable to

National Rehabilitation Association633 South Washington StreetAlexandria, Virginia 22314For information on bulk orders, call (703)836-0850FAX (703) 836-0848, TDD (703) 836-0849.


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National Rehabilitation Assockiion 95

Switzer Memorial SeminarsAs a living tribute to the memory of Mary E. Switzer, each year a special

topic of vital interest to the rehabilitation of persons with disabilities isexplored in depth. One of the outcomes of each seminar is a Swti:erMonograph which clarifies the thinking in a given area of rehabilitation andsets goals and objectives for positive action. Those individuals invited to par-ticipate in the Seminar are designated as Switzer Scholars.

97

Mary E. Switzer MemorialSeminar and Monograph

To perpetuate the memory of a great woman and great leader in the field of rehabilitation byestablishing a memorial that will expand and enrich services to persons with disabilities.

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