VR-IL Literature Review: VR-IL Collaboration

VR-IL Collaborations

by Stuart Hanson

© InfoUse, 1998

Background

The focus of this study is on collaborations between the basic, Section 110 vocational rehabilitation program of state-federal VR agencies and independent living centers (ILCs). The latter refers to consumer-controlled, community-based, cross-disability, nonresidential, private nonprofit agencies providing independent living (IL) core services. These core services include information and referral, IL training, peer counseling, and advocacy. Other IL services may also be provided, such as counseling services, housing services, transportation/mobility services, employment-related services, services for children, and training for youths designed to promote self-awareness, develop advocacy skills, and explore career options.^{Footnote 1} Employment-related services may include direct employment services such as job or career development, job placement, or supported employment services; training or support related to job modification, retention, or mobility; and/or community and employer awareness efforts focusing on the benefits of hiring people with severe disabilities.^{Footnote 2}

Approximately 250 ILCs are recognized by the Rehabilitation Services Administration RSA), and 82 agencies are designated by the States to provide VR services.^{Footnote 3} Although ILCs and VR agencies are funded by the same legislation and administered by the same Federal administration, their purposes, culture, and constituencies are very different. Throughout the short history of ILCs, tension rooted in these differences has existed between coordination and conflict--from an ILC perspective, "getting along" with state VR agencies versus advocating for system change and for the rights of VR clients and those not served by VR.

The government's first programs providing vocational rehabilitation were for veterans with war injuries. Since the passage of the Smith-Fess Act (P.L. 66-236) in 1920, the government has provided civilians with vocational rehabilitation services intended to achieve employment. The program was intended to assist people with on-the-job injuries to recover and return to work. Eligibility depended on the likelihood of obtaining a vocational outcome. People with severe disabilities often were excluded from receiving VR services because they were considered "too severely disabled" for employment. In the 1970s, increasing pressure on VR agencies to expand services to more severely disabled persons led to the Rehabilitation Act of 1973, which recodified and revised 50 years of vocational rehabilitation legislation and amendments.^{Footnote 4} The Act defined and provided services for persons with "severe disabilities."

A definition of "employment outcome" was added to the Act in 1986, to clarify that part-time work is an acceptable employment outcome. Prior to 1986 there was no common definition, and each state determined for itself whether a person was employable and qualified to receive rehabilitation services.^{Footnote 5} Currently, employment outcome means, "entering or retaining full-time or, if appropriate, part-time competitive employment in the integrated labor market (including satisfying the vocational outcome of supported employment)..."^{Footnote 6}

Earlier, in 1978, amendments to the Rehabilitation Act created Title VII, recognizing and funding programs of Independent Living Centers^{Footnote 7} and Independent Living Services, to provide services to people who traditionally had not been regarded as capable of employment outcomes. At their beginning, ILCs^{Footnote 8} were either directly funded by RSA, or funded through State VR agencies. Currently, in states in which federal funding to ILCs exceeds state funding, the RSA Commissioner awards such grants; in states in which state funding exceeds federal funding, the director of the designated State unit makes the awards.^{Footnote 9} Today, ILCs and state VR agencies both serve individuals with disabilities, albeit with similarities and differences of philosophy, services, and approach.

The most recent amendments to the Rehabilitation Act (1993) called for a number of changes which affect ILC/VR relationships, including the formation of Rehabilitation Advisory Councils (RACs) and State Independent Living Councils (SILCs), which specify representation by persons with disabilities and ILC representatives.

Rehabilitation Advisory Councils (RACs) were established by the Act as independent entities to:
review, analyze, and advise the designated State unit regarding the performance of its responsibilities;
advise the designated State agency;
assist, at the discretion of the State agency, in the preparation of the State plan, the strategic plan, reports, needs assessments, and evaluations; and,
conduct a review and analysis of the effectiveness of, and consumer satisfaction with vocational rehabilitation services.^{Footnote 10}

State Independent Living Councils are also independent entities, established by the Act to:

jointly develop and sign the State plan;
monitor, review, and evaluate its implementation; and
coordinate activities with the RACs that address the needs of specific disability populations.^{Footnote 11}

SILCs and RACs include persons with disabilities; additionally, SILCs include at least one representative of the state's independent living centers. For this study, SILCs and RACs are considered significant stakeholders in the success of collaborative efforts between VR and ILCs. The results of this study will be useful to SILCs and RACs desiring model programs demonstrating excellence in service and collaborative practice.

Collaboration Between Vocational Rehabilitation and Independent Living

InfoUse conducted a literature review of articles, policy papers, reports, and conference proceedings published since 1990 pertaining to collaborative program efforts between VR agencies and ILCs, as defined above. We reviewed collaboration descriptions, discussions of the relevance of various aspects of collaboration, comparisons for assessing collaborative efforts, descriptions from either a VR or an IL perspective, and descriptions of funding sources.

Thayer and Rice (1990) conducted a broad study of vocational rehabilitation services in independent living centers finding that a large number of ILCs provide a diversity of vocational rehabilitation services. They identified seven "representative" vocational rehabilitation model programs providing comprehensive VR services. All seven ILC programs in this purposive sample were described as having excellent working relationships with the VR agency (general or blind) in their states. The authors concluded that ILCs can combine supportive services that, along with vocational rehabilitation services, can enhance the consumer's ability to function in employment. They also concluded that effective working relations between state VR agencies and ILCs can enhance the effectiveness of both organizations in meeting the employment and independent living needs of consumers.

For each program, the authors describe specific activities designed to improve employment. Some activities are conducted independently of the VR agency. Other are conducted jointly. As an example of a jointly conducted activity, the Washington Coalitions of Citizens with Disabilities and the Division of Vocational Rehabilitation sponsor an annual "Workfest," bringing together employers, consumers, professionals, and vendors to discuss employment related issues for people with disabilities. As an example of the former, the CCD also assesses the IL needs of DVR clients considering self-employment.

Thayer and Rice's study not only suggests that many VR-IL collaborations exist, but also that some partnerships encompass diverse activities and goals (e.g., employer awareness and self-employment). Future study of VR-IL collaboration could build on the Thayer and Rice approach in order to more precisely understand the factors involved in making collaborations successful.

Means and Bolton (1992), in a national survey of the employment services offered by a representative sample of 104 ILCs, found that 61% provided some type of employment/vocational service, identified as a "major" activity by 26% of the centers. They reported that the frequency of contractual arrangements for employment services between ILCs and public vocational rehabilitation agencies suggests considerable collaboration in supporting and assisting persons with disabilities in some communities.

In a follow-up report, Means and Bolton (1994) looked closely at four ILCs "to identify the major considerations (e.g., attitudes, constraints, resources, etc.) which will be relevant to planning the employment activities of [ILCs] as part of the rehabilitation system." One finding was that "only one of the four [ILCs] had what could be described as ongoing communication with the state rehabilitation program concerning the provision of employment services within the community." Findings like these led to a series of recommendations the authors believe would strengthen the provision of employment services to persons with disabilities.

RSA's Section 704 Annual Performance Report for 1995 contains, by subject area, numerous one paragraph descriptions of activities of independent living services and ILCs. Employment programs at six ILCs are identified. An example is the EmployABIL program of the Arizona Bridge to Independent Living, in Phoenix. The program places qualified persons with disabilities in temporary positions, through all the major temporary employment service agencies in the Phoenix area. Descriptions did not clearly identify any of these as collaborations; one description did refer to coordination with VR and other organizations. The state and independent living center are identified, so more information may be obtained.

Hammett (1983) gives brief sketches of productive collaborations between VR agencies and ILCs, that resulted in successful outcomes for individual consumers. On anecdote described the provision, to a young woman with an amputated limb, of on-the-job training at the ILC, after VR-funded clerical training. The on-the-job training improved the woman's self confidence and eased her transition to a position in a local business. Another described the cooperation between a VR counselor and a staff person at an ILC to provide advocacy for the appeal to an Administrative Law Judge of a decision to deny benefits to an applicant to the Social Security Administration who was without the traditional outward signs of Down's Syndrome.

For a number of years, NIDRR (1988, 1989, 1990, 1992, 1993, 1995 and 1996) and, before it, the National Institute of Handicapped Research (1986), have funded centers that seek to identify and disseminate information about model programs. Broadly speaking, two types of efforts have received financial assistance: (1) those developing a program or programs which can be a model for others, and (2) those evaluating existing programs to identify those which exemplify what is in some way considered the best. In some cases, these programs took the designation as a Regional Information Exchange.

Much like the findings discussed above, the Independent Living Rehabilitation Research and Training Center (IL-RRTC) at the Independent Living Research and Utilization (ILRU) in Houston looked at collaborations in four states based on a sample of ILCs.^{Footnote 12} ILRU found that many successful collaborations were based on personal relationships forged between individual staff in some ILC and local VR agency staff. This pattern of collaboration based on individual professional relationships was particularly visible in those states with traditional VR programs (e.g., Louisiana and North Carolina). In the other states, states, collaborations were more likely to be based on formal organizational agreements. This finding suggests that this study should broadly define collaborations to include informal and personal collaborations as well as more formal inter-organizational agreements.

The Council of State Administrators of Vocational Rehabilitation (CSAVR) is currently surveying state VR agencies on exemplary practices and collaborative relationships that promote employment (Hilton, 1997). CSAVR's survey sample frame is larger than our own, including collaborations between state agency Section 110 programs and state agency Independent Living Rehabilitation Service Programs and/or community Independent Living Rehabilitation Services Programs as well as those with Independent Living Centers. Their questionnaire asks for a brief description of the collaborating partner, a list of the key services provided, identification of the "vehicle" used, e.g., contract, cooperative agreement, grant, referrals, an explanation of what makes the collaborative relationship exemplary in promoting employment, and basic program/financial information for the most recent twelve month reporting period. InfoUse is asking CSAVR to work cooperatively with us to identify the sample frame.

An informal polling of several informants in California helped to identify other VR-IL program collaborations, and has been useful in estimating the sample frame for this study.

In response to a need for an evaluation system for independent living centers that takes into consideration their significant differences from the conventional vocational rehabilitation model, Budde, Petty, Nelson, Couch, and Mathers (1987) developed a management information system that includes evaluation of the impact of services on ILC consumers and the community. A national survey of ILCs and state VR administrators identified the areas considered to be of greatest importance in an ILC evaluation system. Items on which there was 80% or greater reliability of agreement between raters were included; some others were rewritten, then included. The measurement of the impacts of ILC services on the community, in addition to consumer outcomes, is a significant contribution of this program evaluation system.

Kirchner and Litvak (1996) discuss the relationship of independent living centers to vocational rehabilitation agencies. Their paper applies a wide-ranging exposition of the independent living point-of-view--summarized as "away from 'fixing the individual with disabilities' towards 'fixing the environment.'"--to potential research topics of interest to NIDRR, ILCs, and IL activists.

The paper also explores the concept of "environmental access professions," i.e., those in which the "professionals must spend more time doing something to the environment than with/to the 'client,'" asks what rehabilitation professions might fit this approach, and suggests that Rehabilitation Engineering and possibly Job Development may fit this model. These environmental efforts are widely practiced, and recognized by other researchers.^{Footnote 13}

The National Council on Independent Living (NCIL) (1996) has also taken a thorough look at independent living and vocational rehabilitation, grounded in the belief that the steady application of basic independent living principles "ensures a consistent, less expensive, and more effective approach.... to fixing society and the rehabilitation system."^{Footnote 14} These principles--which NCIL labels consumer control, cross disability, equal access, community based, and peer relationships, and which have long been recognized in the philosophy of independent living--continue to demonstrate their vitality and real-world implications as they are applied in addressing, section by section, the perceived deficiencies of the Rehabilitation Act, as amended.

Phillips and his associates propose "a mechanism for increasing the level of IL funding and the degree of cooperation between ILCs, rehabilitation facilities, and state VR agencies." The authors identify five issues, the formalization and resolution of which would make positive and successful ongoing collaborative efforts more possible. These issues are:

(1) the expenditure of VR funds on VR eligible persons;
(2) participation of VR counselors in the facility's decision-making process as it relates to VR clients;
(3) services must plan a discernible role in improving individuals' vocational potential;
(4) the separation of funding and advocacy; and,
(5) the acceptance of the fundamental philosophical implications of the decision to collaborate.

These issues are suggestive of dimensions to be evaluated when looking for promising and exemplary practices (Phillips, Fairfax, and Young, 1985).

The literature on the counselor-client relationship in vocational rehabilitation also has implications for this VR-IL partnership project. An issue of Rehab BRIEF (1990) summarizes, "the emergent client-counselor partnership," which is evolving subsequent to the recognition of clients as full partners in decisions affecting their lives. Basic partnership principles are described, such as equality, shared responsibility, and a goal or task orientation. Personal attributes that enhance partnerships are described in four broad categories: attitudes, communication, contracting and negotiating skills, and the ability to be flexible and present to the moment in perceptions as well as behavior. The paper also considers environmental influences on the client-counselor relationship, strategies that help establish empowering partnerships, the influence of families, and systemic remedies to barriers to vocational rehabilitation success.

Staniszewski (1987) profiled the current state of employment programs for persons with chronic mental illness, and looks at some emerging models that seem promising--transitional employment, supported employment, and supported learning. The article identifies Fountain House, a New York City psychosocial rehabilitation center, and Boston University's Center for Psychiatric Rehabilitation, where some of these ideas were initially developed. As before, this study suggests the need for detailed analysis of promising programs on a systematic basis.

Footnotes

¹ The Rehabilitation Act, § 7 (29) and § 7 (30). Back to main text.

² Regional Rehabilitation Exchange (1992). Back to main text.

³ Number of ILCs is from U.S. Department of Education (1997). States have the option of designating separate agencies to provide VR services to persons who are blind, therefore the number of designated State agencies is greater than the number of states. Back to main text.

⁴ Heumann & Roth (1991). Back to main text.

⁵ Office of Special Education and Rehabilitative Services, (1992). Back to main text.

⁶ The Rehabilitation Act of 1973 as amended through 1994, § 7. Back to main text.

⁷ Although the Rehabilitation Act uses the term Centers for Independent Living, as a convention we are using the terms Independent Living Centers and ILCs throughout this paper. Back to main text.

⁸ One of the distinguishing characteristics of an ILC is a consumer-controlled Board of Directors, that is, a majority of the members of the Board are persons with a disability. ILCs are further defined in the Rehabilitation Act at § 725. Programs providing independent living services which do not have this form of consumer control are referred to as independent living services or independent living programs. Back to main text.

⁹ The Rehabilitation Act, § 722 (c) and § 723 (c). Back to main text.

¹⁰ The Rehabilitation Act, § 104. Back to main text.

¹¹ The Rehabilitation Act, § 705. Back to main text.

¹² Telephone conversation with Pam Dautel, ILRU, [undated]. Back to main text.

¹³ For example, in Thayer and Rice (1990), "Employment services... are... those services which are most commonly and directly associated with work preparation, work finding, and work maintenance as well as the creation of job opportunities in the labor market" (p. 90). "Seventy-three percent of the programs reported conducting these types of services" (p. 95). Back to main text.

¹⁴ NCIL (1996), pp. 4-5. Back to main text.

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