Services Received by Persons Accepted Into a greater percentage of clients with mental retardation received placement services, adjustment services, and on-the-job training, and a lesser percentage received restoration services and college/university training; and finally, ⚫ a greater percentage of clients with substance abuse problems received counseling and guidance, transportation, income maintenance, and other types of service. The differences in services received, by disability and severity, are shown in table 4.1. Table 4.1: Percent of Clients Who Received Categories of Service, by Type and Severity of Disability Services Received by Persons Accepted Into Number of Services The average client received 3 to 4 services out of the 13 services RSA lists in the service record, and there were few major differences between groups of clients. Two groups stood out from the rest. First, persons of Hispanic origin received somewhat more-an average of 4.4 services. (Although as we report in table 4.3, the average amount spent on purchased services for this group was somewhat lower than the average for all clients.) Second, persons over the age of 65 received somewhat fewer-an average of 3.1 services. These averages are presented in tables 4.2 and 4.3. It should be noted that the number of types of services received, however, provides indication neither of the number of specific services received nor of their intensity or duration. Cost of Purchased On average, the state VR agencies spent $1,573 in purchased services per As might be expected, more money (about 1-1/2 times more) was spent on purchased services for the average client with a severe disability than for the average client with a non-severe disability. As table 4.2 shows, more Services Received by Persons Accepted Into Conclusions was spent on purchased services for the average client with a physical In table 4.3, we present the differences in average service costs by client demographic variables. We found that the largest differences between groups in the average costs of purchased services were as follows: • $379 more was spent for non-Hispanic whites than for American Indians; $293 more was spent for non-Hispanic whites than for blacks; $170 more was spent for non-Hispanic whites than for whites of Hispanic origin; • at least $300 more was spent for clients between 18 and 24 years old than for clients who were age 25 or older, and about $200 more was spent for these clients than for clients who were age 17 or younger; more was spent for clients who already had some higher education than for clients who had no higher education. The findings suggest that after VR agencies provide clients the two common initial services, patterns vary widely, since no other service is provided to more than a third of the group. In terms of quantity of service, at least as measured by the cost of purchased service, states spend more, on the average, when clients have severe rather than non-severe disabilities, when clients have physical rather than mental disabilities, and when clients are white rather than black, Hispanic, or American Indian. We are limited in our conclusions by the data at hand. Thus, based on the data states are required to submit to RSA, we were unable to determine the intensity or cost of any specific category of service that was received. And the total cost figure understates the total dollar value of all a client's services because the states report neither the cost of counselor time and administrative overhead in the VR agency nor the cost of services arranged Services Received by Persons Accepted Into Recommendations for by the agency but paid for by other sources.1 Thus, we could not determine whether disparities in the costs of purchased services may be made up elsewhere, perhaps through more intensive services provided by the agency or services paid for by other sources. And data on services alone, no matter how extensive and detailed, do not yield conclusions on the key question of the appropriateness of the services to the client's needs. The data we have presented in this chapter are descriptive and provide no We recommend that the broad issue of the adequacy of an average purchased-service amount of $1,573 per client (and of less than $500 for half the clients) be an early agenda item for the National Commission on Rehabilitation Services authorized in the Rehabilitation Act Amendments of 1992 (if it is established). The issue is especially important in view of the expansion of eligibility, enacted in the same law, that has the potential to stretch the VR budget over an even larger group of clients. The limitations in the RSA data and the descriptive evidence of racial disparities in purchased service costs prompt us to make two types of recommendations to the Rehabilitation Services Administration (RSA). First, as part of the data review that we have already (in chapter 1A study of one year's cases in one state suggests the magnitude of these omitted costs. In 1982, in Virginia, the average VR client not only received over $1,600 in purchased services (similar to the figure we report), but also over $1,500 in externally funded services and over $300 in counselor services. D. Dean and R.C. Dolan, “Using A Better Measure for Services," in M. Berkowitz (ed.), Measuring the Efficiency of Public Programs (Philadelphia: Temple University Press, 1988), 186-98. A study of all types of services for VR clients in three states later in the 1980's found that the total dollar cost was two to three times greater than the cost of purchased services alone. See M. Berkowitz et al., Enhanced Understanding of the Economics of Disability, final report submitted to the National Institute of Disability and Rehabilitation Research (Richmond, Va.: Virginia Department of Rehabilitative Services, 1988), chapter 5. 2See appendix III for further analysis of differences among clients of different racial groups, using other variables measured in the RSA Case Service Reports as well as measures of state economic context. |