Introduction

The Potentially Eligible
Population

congressional staff, and reviewed testimony by witnesses who discussed the VR program in detail. From these sources, we gained a better understanding of the views of critics and supporters of the program, which helped us define questions that we could address with data.

We used analyses and tables from two published reports to answer the first question about the size and nature of the population of people with disabilities who potentially were eligible for VR services. One report used data from a special supplement on disability done as part of the 1984 Survey of Income and Program Participation (SIPP).5 The second report used aggregated data from three years (1983-85) of the National Health Interview Survey (NHIS). Both SIPP and NHIS are surveys of representative household samples of the nation's noninstitutionalized civilian population. SIPP is administered by the Census Bureau.7 NHIS is administered by the National Center for Health Statistics (NCHS).8

We examined estimates derived from these two national surveys from the 1980's for two reasons. First, of several recent national surveys with some information on disability, only NHIS and SIPP have information on the types of disabling conditions prevalent in the population. Second, they contain sufficient information and large enough sample sizes to describe the population of persons with disabilities in terms of other demographic

*The March supplement to the Current Population Survey (CPS) has since 1981 contained questions that provide information on work disability status. CPS estimates of the prevalence of work disability are lower (8.6 percent of the working age population in 1988, for example) than those from the sources we selected and report on in chapter 2. The Bureau of the Census cautions, however, that the difference is a result of technical differences in survey methods and that "CPS data are not the best source for prevalence estimates." J. Bennefield and J. McNeil, Labor Force Status and Other Characteristics of Persons With a Work Disability: 1981-1988, Current Population Reports, Special Studies, Series P-23, No. 160 (Washington, D.C.: U.S. Department of Commerce, Bureau of the Census, 1989).

"Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, Task 1: Population Profiles of Disability, report prepared by Mathematica Policy Research, Inc. (Washington, D.C.: October 1989).

"M.P. LaPlante, Data on Disability from the National Health Interview Survey, 1983-1985, an Info Use Report (Washington, D.C.: National Institute on Disability and Rehabilitation Research, 1988).

'SIPP is a longitudinal survey. The same households are interviewed every 4 months for 2-1/2 years. Core questions are asked in every interview, with questions on specific areas of interest in any one wave. The supplement on disability was the third of four waves and was administered between May and August 1984. The 1984 panel contains information on persons residing in approximately 20,000 dwelling units. Each person 15 years of age and older in the household was interviewed individually. The NHIS is a multistage probability design permitting continuous sampling of the population. Samples are drawn weekly; each is representative of the target population and is additive with other weekly samples. The report we used was based on interviews with 105,620 people in 1983, 105,290 in 1984, and 91,531 in 1985.

Introduction

characteristics. Thus, information from the surveys allowed us to answer the question about the nature of the potentially eligible population, in addition to its size.

NHIS and SIPP contain items developed for the purpose of monitoring the health and economic well-being of the nation's citizens, and the items on disability and employment limitations were not specifically designed to measure whether respondents would meet the criteria for eligibility used by VR program personnel. However, the reports we examined provide the best estimates of the number of persons who potentially meet two of the three criteria for eligibility for VR services—that is, persons (1) who have a disabling condition, and (2) whose ability to work is substantially limited by this condition.

In both SIPP and NHIS, respondents were asked whether an impairment or a health problem limited their ability to work, or kept them from working altogether. Those who reported being limited in working (or prevented altogether) were then asked the names of the conditions that caused their limitation, and what condition was the main cause. The SIPP respondents were shown a flashcard with a list of conditions; the NHIS respondents simply volunteered the condition. In responding to SIPP, a condition that was either acute or chronic could be named as a cause of work limitation. In the NHIS data, however, only chronic conditions were recorded. A condition was classified as chronic if it had been noticed 3 months or more before the date of the interview or was on the NCHS list of conditions that were defined as chronic regardless of time of onset. The exact item wordings from the two surveys are presented in table 1.1.9

The questions were posed only to adults between the ages of 16 and 72 in SIPP, and 18 and 69 in NHIS.

Client Characteristics

The reports we examined presented tabulations of the percentage of the population that was limited in or prevented from working, for the entire working age population (aged 18 to 64), as well as breakdowns of the former population by various demographic characteristics. In addition, individuals were categorized according to the major condition causing the limitation. We relied on the coding of conditions that had been done by the authors since we did not conduct our own analyses of the surveys.

To answer the second question about the characteristics of those served by the VR program, we conducted our own analyses of a major set of data called the Case Service Reports. The Rehabilitation Services

Administration (RSA) routinely collects information from the state agencies at the end of each fiscal year on the characteristics of each client whose case was closed that year in each state's program, as well as on the general types of services that each client received and his or her employment

Introduction

Services Received by VR
Clients

status in both the week of application and the week of case closure. At any particular time, RSA may be waiting for original or corrected data from one or more states for one or more years; thus, at the time we began our study, the most recent full year for which largely complete data were available was fiscal year 1988.

The set of VR clients whose cases were closed during a single fiscal year includes two distinct groups. The first consists of those who applied to the program but were not accepted for services for one of several possible reasons.10 The second and larger group is made up of persons accepted into the program and includes those who during the fiscal year (1) were rehabilitated (as defined later in this chapter), (2) dropped out of the program before a written plan for rehabilitation had been developed or before services had been initiated, or (3) were not rehabilitated after receiving at least one (and perhaps several) of the services agreed upon in the rehabilitation plan.11

We analyzed these RSA records to describe those accepted into the VR
program (in terms of age, gender, ethnicity, education, type of disabling
condition, and severity of disability) and to make comparisons with
persons who applied but were not accepted. Of the 605,872 cases closed in
1988, we found that 58 percent were accepted by the state agencies and 42
percent applied but were not accepted. Where possible, we also compared
the characteristics of VR clients with the characteristics of those
potentially eligible that we derived from SIPP and NHIS data.

To answer the third question about VR services, we used the same Case Service Reports for 1988. The state agency is required to list, for each client, whether or not a service has been received, using a checklist of 13 general categories of services. Using this information, we present the percentage of clients who received each category of service, as well as the average number of service categories they received.

10Some applicants are not accepted because they fail to meet the criteria for eligibility. Other applicants' cases are closed before acceptance because they refuse services, move to another state or cannot be located, fail to cooperate with agency personnel, become institutionalized, or die. An additional subset of applicants may not be accepted after being placed into "extended evaluation." Applicants are placed into this status for up to 18 months when agency staff cannot readily certify eligibility for VR services and must gather further information before a decision can be made.

The Case Service Reports cover clients whose cases were closed any time during the fiscal year. The year of application will vary across individuals and may have been much earlier (because of variations in the length of time required to determine eligibility and to complete the program). For example, two clients may be rehabilitated in 1988, but one may have applied for services in 1983 and the other in 1987.

Introduction

The agency also reports the total dollar amount spent while a client is in
the program to purchase services from other providers. This figure is not
the total dollar cost of all services a client receives, since it excludes those
provided by the VR agency (such as counseling) or those provided by
others but not purchased by the agency (such as community college
tuition covered by student aid, or medical expenses covered by health
insurance). We present the average cost of purchased services and
determine whether the overall cost varies by type and severity of
disability, and by various demographic characteristics. We were
particularly interested in determining if the amount spent on purchased
services varied according to whether clients were severely disabled or
from traditionally underserved or disadvantaged groups, such as women,
blacks, Hispanics, American Indians, and Asian Americans.

Vocational Rehabilitation
Results

In answering the fourth and final evaluation question about the program's results, we limited our examination of program results to economic outcomes-that is, clients' employment and earnings in the years following their participation. The Rehabilitation Act does allow state agencies to provide services to clients who are not presently able to achieve full-time employment in the competitive labor market. Certain clients may be placed in some type of unpaid employment; others may achieve greater independence even if they are unable to find or maintain employment. Nevertheless, paid work in the competitive labor market is still a primary objective for most clients, and a job that pays good wages is a central means of their achieving independence and emotional well-being.

The state VR agencies only collect information and report to RSA on their clients' earnings and employment during the week before referral.12 The agencies also report on rehabilitated clients' earnings and employment in the week of closure. 13 Analyses of these data usually show substantial economic gains between application and case closure for clients who are successfully rehabilitated.14 However, conclusions based on these data suffer from two major limitations: lack of any comparison group and short

12Until the mid-1980's, state agencies reported information on earnings for the week before referral. Since then, state agencies have reported information for the week before application.

13 Clients are considered rehabilitated, and their cases are closed, when they have received the services listed in the individualized written rehabilitation plan and been suitably employed for a minimum of 60 days. Clients can also be considered successfully rehabilitated if they achieve other outcomes than employment.

14RSA, Comparison of Economic Gains Achieved by Persons with Severe and Non-Severe Disabilities Rehabilitated by State Vocational Rehabilitation Agencies in Fiscal Year 1988 (Washington, D.C.: U.S. Department of Education, 1990).