Characteristics of Vocational Rehabilitation Demographic emotional conditions-were more likely to apply to the program than their numbers in the general work-disabled population would suggest. Further study of the VR referral process is essential to an understanding of whether some persons who could benefit from the VR program are being systematically discouraged from applying. In the first part of this chapter, we present information on the demographic characteristics of applicants (accepted and not accepted) and the general work-disabled population. In the second part of the chapter, we present information for the same groups on type and severity of disability. Those accepted and not accepted into the program differ only slightly in These data provide no evidence that applicants in any of the demographic groupings that we examined were accepted or not accepted in disproportionate numbers. There were some differences between the overall applicant pool and the work-limited population in the United States, however. On the one hand, fewer women and fewer persons over the age of 44 apply to the program than are represented in the general work-disabled population. On the other hand, more blacks and more persons without education beyond high school apply to the program than are represented in the general work-disabled population. Thus, there is mixed evidence that groups that could be considered more "difficult" to rehabilitate are also less likely to apply to the VR program than their numbers in the general work-disabled population might suggest. Characteristics of Vocational Rehabilitation Type of Disabling Table 3.2: Type and Severity of The state VR agencies serve persons who have a wide range of health conditions or impairments that limit their ability to work. Again, we found only a few differences between persons accepted and persons not accepted into the program with regard to the prevalence of specific conditions that were the primary causes of work limitation. In comparison with persons not accepted into the program, those who were accepted had a greater prevalence of mental retardation (13 versus 8 percent) and hearing impairments (7 versus 4 percent), and a lesser prevalence of miscellaneous conditions (19 versus 23 percent). These percentages appear in table 3.2. Although precise comparisons between VR clients in 1988 and the U.S. work-limited population are impossible because of the different data collection and coding procedures employed, there are some differences between the two populations in general categories of disabling conditions. VR clients are much more likely to have mental, emotional, and cognitive Characteristics of Vocational Rehabilitation Severity of Disability conditions than are individuals in the general U.S. work-limited population In contrast, VR clients are less likely to have "other" disabling State VR agencies classified, in total, 65 percent of all those accepted as Although the data sources are not directly comparable, the percentage of 2On one hand, it is possible that this observed difference would not hold up under closer study; such conditions may be underreported in population surveys. On the other hand, the difference may reflect VR referral practices. That is, there may be better referral methods or particular VR program options for this group that could explain a genuinely higher representation in the VR caseload. 3For example, the prevalence of cardiovascular and circulatory conditions rises dramatically with age. In NHIS, 27 percent of those 45 to 69 years old who report a work limitation say that the primary cause is a cardiovascular or circulatory condition. Only 8 percent of work-limited persons aged 18 to 44 attribute their work limitation to these conditions. "In another evaluation, we found that states varied in the percentage of cases classified as persons with severe disabilities, with a range from 29 to 96 percent. Despite the requirement in the Rehabilitation Act to focus services on this group, some state officials perceived conflicting goals. They told us that increasing service to persons with severe disabilities could significantly reduce the overall number of clients they could serve. Because in that study we also found RSA guidance was unclear and the agency was not adequately checking states' decisions in this regard, we recommended both stronger program guidance and increased oversight, which RSA agreed to and has begun to implement. See Vocational Rehabilitation: Clearer Guidance Could Help Focus Services on Those With Severe Disabilities, HRD-92-12 (November 26, 1991). In the present study, we did not examine data below the national level. Considering the importance of the classification, it is of interest whether the reported data rest on valid and reliable measures used by states to categorize clients as severely disabled, and whether the categorization procedure is applied consistently to accepted and rejected clients. However, we had no practical alternative to using the existing data. Characteristics of Vocational Rehabilitation Conclusions 1988 was slightly smaller than the percentage of severely disabled persons in the U.S. work-limited population (65 versus 69 percent). Overall, we found little evidence that certain types of applicants were disproportionately more likely than other types to be accepted for services (based on comparisons between applicants accepted and those not accepted). The major exception was that individuals with severe disabilities were in the aggregate-more likely to be accepted than were individuals with less severe disabilities. (While the program's decisions thus generally tend to meet the legal requirement that services be focused on those with severe disabilities, we found in another study that states vary widely in this regard.) We did find several differences between the pool of accepted clients and Recommendations We recommend that RSA begin the data review authorized by the 1992 |