The Population Potentially Eligible for What Are the Women were about as likely as men to report that a health condition or impairment limited their ability to work. Women constituted 53 percent of the work-disabled population versus 51 percent of the working-age population. Black Americans also had a slightly greater representation in the Despite differences in the surveys' methods, they showed considerable How Severe Are These Conditions? SIPP conditions asked of respondents 18 to 64 years old. Percentages are based on all respondents who named a specific condition as a cause of their work limitation. About 7 percent named no specific condition. Cancers and tumors. Includes such conditions as diabetes, end-stage renal disease, genito-urinary disorders, eSIPP total does not add to 100 percent due to rounding. Sources: Assistant Secretary for Planning and Evaluation, Task 1: Population Profile of Disability, report prepared by Mathematica Policy Research, Inc. (Washington, D.C.: U.S. Department of Health and Human Services, October 1989); and M.P. LaPlante, Data on Disability from the National Health Interview Survey, 1983-1985. (Washington, D.C.: U.S. Department of Education, 1988). Mental illness, emotional problems, mental retardation, and substance abuse together accounted for 6 to 8 percent of all conditions. Respiratory conditions, including asthma and emphysema, accounted for 6 to 7 percent of all conditions. And visual and hearing impairments accounted for 4 to 5 percent of all conditions. Both the Rehabilitation Act and the regulations implementing it direct The Population Potentially Eligible for Estimates derived from SIPP were closest to those used by RSA to categorize Based on the sample surveyed by SIPP, an estimated 18 million persons have some work limitation. Around 69 percent of these (12.4 million) could be considered severely disabled based on reported limitations in functioning (8.4 million) or receipt of disability benefits (4.0 million). This is slightly higher than the 65 percent categorized as severely disabled in the VR clientele in 1988. Conclusions The population of persons with work disabilities who are potentially However, this self-reported population that is potentially eligible for VR services might not be the same as the population that would have met the VR criteria for eligibility (in use during the period of our review, but now changed), which are based on medical evidence, counselor judgment, and 3RSA directs state VR agencies to categorize an applicant as "severely disabled" if he or she (1) has a major disabling condition such as blindness or deafness, which is automatically included, or other disabilities as qualified, such as respiratory disorder with sufficient loss of breathing capacity; (2) is a recipient of Social Security Disability Insurance or Supplemental Security Income for reason of blindness or disability, at any time during the rehabilitation process; or (3) has documented evidence of substantial loss of function in conducting certain specified activities. 'Assistant Secretary for Planning and Evaluation, Task I: Population Profile of Disability, report prepared by Mathematica Policy Research, Inc. (Washington, D.C.: U.S. Department of Health and Human Services, October 1989). The Population Potentially Eligible for employability. The exact size of the latter population is difficult to estimate. However, with respect to those who are potentially eligible by virtue of their self-reported degree of disability, the data show that only about 5 to 7 percent of the population with work disabilities is currently being served in a year by the state-federal VR program. Chapter 3 Characteristics of Vocational Rehabilitation Clients The second evaluation question asked us to describe who gets vocational rehabilitation (VR) services. This question is of great importance to many disability advocates, who have charged that VR counselors tend to follow decision rules denoted by the shorthand term "creaming" during the eligibility review process. That is, according to this analysis, counselors accept the easiest cases-those individuals with greater amounts of work experience or education, or with less severe disabilities-because of pressures to achieve quicker and less costly rehabilitations. More sympathetic observers have pointed to the difficulties counselors face in predicting the rehabilitation "potential" (the eventual employability) of any individual applicant. To address the issue of whether applicants who are accepted differ in systematic ways from those who are not, we compared the two groups on a variety of demographic and disability-related characteristics, using data from the 1988 RSA Case Service Reports. In addition, we explored the possibility that applicants differ from the general work-disabled population. Observed differences could result from differences in motivation, but could also suggest that some persons with disabilities who want services and could benefit from them are not even reaching the first step of the process. We investigated this possibility by comparing the VR client group in the 1988 RSA Case Service Reports with the general work-disabled population described in the previous chapter. We found generally that applicants who were accepted were similar to applicants who were not, on many demographic characteristics. There were some small differences between the groups in terms of the type of disabling conditions that were the main causes of work limitations. And, contrary to the creaming argument, applicants who were accepted were more likely to have a severe disability or a secondary disabling condition than applicants who were not accepted.1 We found larger differences between the pool of applicants and the general work-disabled population. Some groups that could face greater difficulties in the labor market, and thus be considered more "difficult" to rehabilitate-including women, older people, and persons with orthopedic disabilities and chronic health conditions-were less likely to apply to the VR program than their numbers in the general work-disabled population would suggest. On the other hand, other groups that also encounter difficulties in the labor market-blacks, persons with no formal education beyond high school, and persons with sensory impairments and mental or 'This generalization concerns aggregate national data. In another study, however, we found significant variation among the states in the extent of persons with severe disabilities in the VR case load. See the more detailed discussion in note 4 in this chapter. |