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Characteristics of Vocational Rehabilitation
Clients

planning purposes), and (2) data on VR clients are limited with regard to severity of disability.

RSA need not by itself remedy the first of these. However, based on further review of the existing data and options for improvement, RSA could take action. For example, RSA could encourage new efforts by the agencies in charge of monitoring the nation's health and economic well-being, even though we could not in our review develop specific plans and check their feasibility. Some states may already have methods for describing their populations of persons with disabilities. If these methods are sound, they could be expanded to other states (with RSA providing technical assistance and incentives for data quality and comparability). Establishing a national program of periodic special studies is another possibility.

Remedying the second limitation-by improving RSA's definitions and measures in order to strengthen comparisons of data on VR applicants and clients with data from other sources on persons with disabilities-is a difficult conceptual and technical problem that should also be addressed by RSA and the National Commission. RSA could develop measures of the severity of disability that are more comparable with those collected by the Census Bureau and the National Center for Health Statistics-in particular, by paying greater attention to the functional limitations faced by VR clients. It is possible, however, that there are better and more comparable measures already in place in some states that could be more widely adopted. As in the case of population surveys, the scope of our review did not permit us to review state-level data to find promising practices nor to evaluate the costs and feasibility of new options. Whether to augment regular data-gathering and reporting-in this case, adding better measures of severity and more comparable classifications of disability-to states' existing data routines and reports, or whether to get better data in periodic special studies, is again an issue.

In addition, we recommend that RSA Collect additional data on the referral process itself in order to determine why certain groups are less likely than others to apply for VR services. At this point, few relevant data are reported to RSA by the state agencies, other than their recording from a list of agencies the source of a referral. (States may collect, but not report, more such data.) From the data RSA has, one can learn little about how and why certain types of applicants seek rehabilitation services, the alternatives to VR that are available to them, how they access the VR system, and their treatment by referral sources and VR agencies.

Characteristics of Vocational Rehabilitation
Clients

If properly done, an evaluation now in progress could help answer some of these questions. The 1992 amendments to the Rehabilitation Act transferred evaluation authority from the RSA Commissioner to the Secretary of Education, as well as required the Secretary to continue a longitudinal study of the VR program. We recommend use of a design in that evaluation that will trace potential clients from an early point in order to shed light on questions like those previously mentioned concerning the referral stage.

Chapter 4

Services Received by Persons Accepted Into the Program

The third evaluation question asked us to describe what types of services
are received by vocational rehabilitation (VR) clients. The state VR agency
provides some services, such as guidance, counseling, and job referral; the
state agency also purchases services from other providers, such as
diagnosis, psychotherapy, vocational training, and medical restoration;
and it helps locate certain services that are paid for by other agencies.
Rehabilitation counselors work with clients to develop an individualized
service plan that will combine a variety of activities to help clients achieve
their employment potentials. (Clients can also be considered successfully
rehabilitated if they achieve outcomes other than employment.)

But what kind and quantity of services should be provided? Critics of the federal-state VR system have argued that VR agencies spend too much time and effort on such agency-provided services as guidance and counseling, at the expense of providing or purchasing educational and training services that could enhance skills necessary for long-term success in the labor market. These critics suggest that incentives for counselor performance, historical patterns of service provision, and the professional training of rehabilitation counselors may contribute to a paternalistic relationship between counselor and client, with the result being the provision of low-cost service that often may not fit the individual client's needs and capabilities.

Other critics have expressed concerns about whether these same factors have resulted in inequitable treatment for some traditionally underserved groups. These groups include individuals with more severe disabilities, those with mental and emotional disabilities, and minorities and women.

In this chapter, we address these issues by analyzing data in the 1988 RSA Case Service Reports. For all accepted clients whose cases were closed in 1988 (344,865 individuals), state agencies recorded the general categories of services received (whether provided by the VR agency or another source), as well as the total cost of all purchased services. As discussed in chapter 1, the data have significant limitations and do not fully reveal either the kind, quantity, and quality of all services or their cost.

In brief, we found that services purchased by the state agency were
relatively modest in cost (with an overall average of $1,573). Since every
new client requires initial evaluation, the records not surprisingly show
that most received diagnosis and evaluation, as well as counseling and
guidance. About one half of all clients received some type of
skill-enhancing education and training service. Examining services by type

Services Received by Persons Accepted Into
the Program

Types of Services
Received

of disability, we found that the average amount spent on purchased services for persons with mental and emotional disabilities was less than was spent for persons with physical disabilities. Finally, for the most part, the average spent on purchased services for clients who were members of minority groups was less than that spent for clients who were white.

In the first part of the chapter, we present our findings on the types of services received by VR clients. The number of services received and the cost of all purchased services are then tabulated by disability type, severity of disability, gender, age, education, and race/ethnicity.

RSA data show that clients commonly received the two initial services that would be expected: (1) diagnosis and evaluation, and (2) counseling and guidance. A much smaller percentage of the clients received services in the other major categories, ranging from 33 percent who were receiving restoration services to 8 percent receiving on-the-job training. However, 47 percent of all clients received at least one of the five categories of education and training. These percentages are shown in figure 4.1. A description of the specific types of services that make up each of these more general service categories appears in the glossary.

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Transportation

Placement

בבב

Referral

Income maintenance

Adjustment training

Vocational training

12

training

Miscellaneous

College training

11

On-the-job training

Source: GAO analysis of 1988 RSA Case Service Reports

Other services

22

There is some evidence that patterns of service-provision vary according to whether a client is or is not severely disabled, and also according to the client's major disabling condition. (That is, we found variation in services beyond the two most common ones-diagnosis and evaluation, and counseling and guidance.) Concerning differences by severity, clients with severe disabilities were more likely than those with non-severe disabilities to receive services of all kinds, but especially adjustment training. Concerning service differences by type of disability, we found that

clients with visual impairments received referral and placement services least often;

restoration services most often went to clients with hearing impairments, who conversely least often received transportation services;

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