A. The
first four items are general principles and factors that have
been driving the Vocational Rehabilitation (VR) program over the
last 20 years. These principles definitely affect the outcomes
of the VR program and help to provide a response to some of the
GAO’s questions. A copy of the GAO report can be found at
http://www.gpoaccess.gov/gaoreports/, then go to quick
search and enter GAO05-865. These principles and factors
include:
1. The Rehabilitation Act provides a general
framework for VR services but provides the VR counselor and
client great flexibility in developing an Individualized Plan
for Employment that takes into account the informed choice and
primary employment factors of the individual. In addition the
state is given a great deal of flexibility in implementing the
program based on state needs and resources. This flexibility has
led the GAO to note unexplained differences in a number of areas
between the states. CSAVR supports this continued flexibility at
both the individual and state level rather than a one size fits
all approach. CSAVR also notes that this individualized approach
and flexibility sets VR apart from other programs in meeting
individual needs. The VR Program should be measured on its
outcomes not its differences.
2. Since 1973, the
Rehabilitation Act has emphasized serving individuals with
significant disabilities. As VR has implemented this mandate,
the percentage of significantly disabled and most significantly
disabled individuals being served has dramatically increased as
a percentage of the overall VR population. As a result,
counselors are working with eligible clients who need multiple
and complex services over an extended period of time which
oftentimes translates into higher costs, increased service
times, and more difficulties in assisting the individual to
prepare for and obtain employment. Many of these individuals
live in poverty without the needed supports and thus, require
significant efforts by the VR counselor to coordinate services
that are critical to the individual’s employment success. CSAVR
believes that VR’s outcomes are outstanding, given the
circumstances under which the program operates, but measures of
success can only be determined on a case by case basis where the
barriers to employment, the services provided and the resultant
outcomes can be evaluated.
3. The principle that
individuals with the most significant disabilities can work,
given the opportunity and appropriate supports have driven the
VR system to give the individual an opportunity to prepare for
and obtain employment, unless it can be shown by clear and
convincing evidence that an individual cannot work. In addition,
by law, if a Social Security Administration (SSA) beneficiary
applies for VR services and indicates a desire to work, they are
presumed to be eligible. CSAVR supports these principles, but
recognizes that implementing such principles essentially throws
open the doors of eligibility and leads to some of the concerns
expressed by GAO in terms of individuals exiting the program
unemployed or employed at wages and hours worked that GAO does
not consider acceptable. In their report the GAO implies that VR
can do a better job of predicting individual success. However,
utilizing such a philosophy or methodology would eliminate an
opportunity for these individuals with disabilities that have
already been rejected for services from other programs. VR is
often their last resort. CSAVR’s response to other items in this
paper provides additional insight to the impact of serving this
population.
4. The lack of resources is a major factor
driving the VR program. According to census and RSA data, VR
only has the resources to serve 1 in 20 of those individuals
that are eligible for the program. In the last 10 years, VR has
only received a yearly Cost of Living Increase (COLA) from
Congress. This COLA, while appreciated, has not addressed the
growth in the number of individuals with disabilities needing VR
services. This growth has not only come from increases in the
population but also from the emergence of medical technology
that has resulted in more individuals with critical diseases and
injuries surviving life altering events, but resulting in
significant disabilities and the need for VR services to enter
or re-enter the workforce. The emergence of assistive technology
has also provided a means by which many consumers with
significant disabilities can now become employed with the
assistance of VR services. Vocational rehabilitation of this
population often requires complex, lengthy, and costly services.
Many times VR is criticized because of the high unemployment
rate among people with disabilities; however, Congress has not
yet provided the resources necessary for VR to serve all
individuals who are eligible for services.
B. The
remaining items of this response deal with specific issues in
the GAO report.
1. Too few individuals exit the state VR
program as employed. Of the 650,540 applicants in fiscal year
(FY) 2003, 217,000 individuals (one third) exited the VR program
employed. The remaining two thirds exited the program without
achieving an employment outcome, for a variety of reasons:
failed to cooperate -- 46%; unable to locate -- 24%; no
disabling condition, no impediment to employment or none needed
VR services -- 6%; and, disability too severe (rebutted
presumption of ability to become employed) -- 3%. CSAVR believes
that the GAO interpreted this data incorrectly. The fact that an
individual may not be eligible for VR services or fails to
participate in the program should not be compared to those
exiting as employed as a measure of success. The GAO made this
comparison. It is important to note that if an individual comes
to VR reporting a disability and requesting services, the VR
agency is obligated under the Rehabilitation Act and
implementing Federal Regulations to conduct those assessments
necessary to make an eligibility determination. A review of case
files would document that counselors make a good faith effort to
engage or find individuals who have applied for services before
closing their case file for any reason. CSAVR believes that the
rehabilitation rate used as a standard and indicator more
accurately reflects the effectiveness of the program than the
data used by the GAO in the statement above.
2. Order of
Selection requirements in the Act are so permissive that there
is a wide diversity in their application among state VR agencies
and we are not sure that is good. CSAVR knows that the
principles and factors listed above (items A1, A2, A3, & A4)
have driven many states to entering an Order of Selection (OOS)
and brought the rest of the states to the brink of implementing
an OOS. CSAVR agrees that the current (OOS) requirements lead to
a great deal of diversity and discrimination in implementing the
statute.
3. State VR Agencies do not appear to be
particularly successful in working with individuals who are SSA
beneficiaries: however there is a wide range of success among
State VR Agencies, but we do not know why. Since the inception
of the SSA disability program there has been a tremendous
disincentive for beneficiaries to go to work, e.g. loss of cash
and medical benefits. To get Supplemental Security Income or
Social Security Disability Insurance benefits, an individual
with a significant disability must prove that they cannot work.
This process often takes 1 to 2 years to complete. SSA has
identified 8 barriers that beneficiaries may face to become
employed:
• Psychological impact of the disability
process
• Lack of access to training and employment services
• Loss of ongoing employment supports
• Job loss and
difficulty of reinstatement
• Work related overpayments
•
DI cash cliff and SSI asset limits
• Premature loss of
benefits
• Physical impact of delayed access to health care
These barriers and the distrust the individual develops of
SSA stopping their benefits still exist when they come to VR for
services and are factors that the VR counselor must address with
the client throughout their VR program as well as when they are
ready to enter the work force.
In recent years SSA has
started to evaluate and implement policies to address each of
the barriers listed above. Many of these policies show promise,
but to date have not removed the fears or provided beneficiaries
the necessary incentives for them to return to work. CSAVR is
proposing the Rehabilitation Early Diversion (RED) Program: A
Coordinated Approach to Early Intervention as a proactive
strategy to addressing these issues (This proposal is available
at http://www.rehabnetwork.org/red/red.htm). This program would
allow individuals to choose immediate VR services, cash and
medical benefits in an effort to prepare for or return to work
as opposed to pursuing the current SSA disability process and
the disincentives that have been described. This proposal
received a positive review when it was discussed with the SSA.
CSAVR believes that the implementation of the RED program would
significantly increase the number of individuals choosing
employment rather than a life of poverty on SSI or SSDI.
4. Those individuals who exit the VR system with jobs are
not making much money; and GAO is not sure why. CSAVR believes
that there is other information available to the GAO that
presents a clearer picture of earnings for those exiting the VR
system with jobs after receiving services. In 2002, the Research
Triangle Institute published a report on a Longitudinal Study of
8,000 consumers served by the VR program. This study showed that
consumers earned an average of $7.33/hour with earnings
increasing to $9.62/hour after three years (minimum wage was
$5.15/hour at the time). The study further showed that at exit
from the VR Program, 32% of consumers in competitive jobs were
earning about $15,990/year (200% above poverty level). Among
individuals who completed VR services, the study showed that 44%
no longer needed public assistance.
In addition, an
analysis of the 911 data for federal fiscal year 2003 by Dr.
John O’Neil and Dr. David Vandergoot shows that the mean weekly
earnings at closures is $310.66 or $9.77 per hour based on the
mean hours worked at closure, which was 31.79 hours. Graphs
developed using federal fiscal year 2003 911 data show that many
individuals receiving Social Security chose to hold their wages
(Figure 1) and hours (Figure 2) worked at closure at a level
below substantial gainful activity (SGA), thus skewing the data
with regards to weekly earnings and hours worked. VR consumers
are often forced to make the decision that they will accept
lower wages or reduced hours in order to retain their Medicare
and Medicaid benefits. These circumstances, created by other
laws and programs, are beyond the control of VR, but negatively
impact individual decisions about work and consequently, the
outcomes of the VR Program.
Figure 1:
Figure 2:
The VR
system, with its emphasis on serving transition students and
individuals with the most significant disabilities is providing
services to people who, in many cases, have not had a workplace
experience or are recipients of public assistance and have
little or no wage earning history. Other consumers working with
the VR system do have a substantial work history but are often
making complete career changes due to a disability that
prohibits a return to their previous area of employment and
maintaining the same salary level. Of the population who exit
the VR system successfully in employment, many do so in first
time, entry level positions. CSAVR believes the VR system
provides meaningful employment outcomes in regards to earnings
and that when considering earnings as a measure of success for
those exiting the VR system in employment, such measures should
be based upon earnings after receipt of VR services as compared
to earning prior to VR services, reduction in dependency on SSDI
and SSI and other public assistance benefits, and employment
retention/ earnings increase following the receipt of VR
services.
RSA currently has a contract with Westat to
complete a 3 year longitudinal study of VR closures from federal
fiscal year 2005. The study will consider (1) the post-program
employment experience of VR consumers whose service records have
been closed, including employment status, earnings, and receipt
of job-related benefits; (2) the extent to which VR consumers
continue to obtain services and resources and how such services
improve employment stability and advancement; (3) non-economic
outcomes, such as community integration; (4) how former
consumers’ receipt of SSA benefits changes over time; (5) how
the characteristics of individuals affect economic and other
outcomes; (6) the extent to which these outcomes vary by
specific subgroups, including transitioning youths under age 22
(youths with IEPs and youths without IEPs), individuals with
long-term mental illness, and individuals with mental
retardation; and (7) the policy implications of study findings
for the VR Services Program and for the long-term employment of
individuals with disabilities served by the program. This study
should provide additional information regarding wages after
rehabilitation, the impact of the program, and the answers to
many other questions raised by the GAO in their report.
Two additional studies, “Evaluation of Massachusetts’ Public
Vocational Rehabilitation Program”, conducted by the
Commonwealth Corporation Center for Research and Evaluation,
October 2004, and “Economic Impact of the New Mexico Division of
Vocational Rehabilitation”, conducted by the University of New
Mexico, Bureau of Business and Economic Research, January 2004,
not only show the economic benefit of VR services to the
individual, but the cost benefit that accrues to the state and
federal government as a result of the provision of VR services.
The Massachusetts’ study concluded that, “The average
projected increase in lifetime earnings for consumers who
received services is about $60,000 per individual. The returns
to society based on these projected increases in lifetime
earnings for consumers who received services range from $14 to
$18 for each $1 invested in the MRC Public Vocational
Rehabilitation Program.”
In the New Mexico study those
consumers rehabilitated increased their weekly earnings by 251
percent when before and after rehabilitation services were
compared. Over their estimated work lives those net gains in
weekly earnings are expected to be maintained for those 1,539
clients. In present value the total increase in future income is
estimated at $185.307 million.”
5. It is very difficult
to determine whether the services provided by the state VR
agencies actually help individuals get their jobs. CSAVR again
references the 2002 Longitudinal Study of the VR Program. In
this study, 66% of persons exiting the program into competitive
jobs said if they had to pay for services, they would purchase
“exactly the same” services they received from the VR Program. A
related finding in the study indicates that the quality of the
relationship between the consumer and the VR counselor was
significantly related to employment and earning levels. This is
consistent with many consumer satisfaction surveys conducted by
State Rehabilitation Councils (SRCs), and other program
evaluation outcomes indicating that the counseling and guidance
received was the most significant services received from the
state VR Agencies. In fact, there is little variation in
consumer satisfaction across all agencies for both successful
(status 26) and unsuccessful (status 28 & 30) closures.
State
consumer satisfaction surveys generally report 75% plus
satisfaction with VR services and the impact such services has
had on their lives. Data utilized by the GAO report does not
include the depth of information needed to appropriately assess
the professional counseling and actual services provided by the
state agencies, or the results of the provision of such services
in showing how they helped each individual in achieving
employment.
CSAVR is of the belief that it is necessary
to go beyond the data utilized by the GAO in order to give a
meaningful answer to this issue. In order to effectively answer
the question of how services impact individuals to the end of
obtaining employment, it is necessary to dig deeper than
reported numbers and categorized data. To more meaningfully
answer this question, CSAVR recommends reviews of actual case
files to see, in detail, how the services provided led to
successful outcomes, as well as utilization of information from
each state’s SRC consumer satisfaction surveys and other
independent studies completed on the VR system.
The 2002
longitudinal study clearly shows that VR services have a major
impact on consumers at the time of employment and over time.
CSAVR believes that the Westat study described in item B4 will
also show the real impact of VR services when completed.
6. Most State VR agencies are not working closely with workforce
centers and they should be. As a mandatory partner in the
Workforce Investment Act (WIA), the VR system recognizes the
need to work closely with workforce centers in each state. While
the GAO report indicates that the Department of Education’s data
shows limited overall interaction between state agencies and
one-stop centers, CSAVR knows from State VR Directors that much
is being done by State VR Agencies on a day-to-day basis to work
with workforce centers but will not be identified in the data.
Information on these types of efforts by the agencies is simply
not reported in the necessary detail within the data utilized by
the GAO for their review. CSAVR feels that examples of the true
measure of the partnerships and collaboration between state
agencies and workforce centers needs further investigation at
the state and local level. See CSAVR’s response to B9 for
additional information relevant to this item.
7. “The
decision to eliminate Regional Offices has made details of the
future monitoring process unclear.” CSAVR agrees with this
statement and has concerns as to whether RSA has the number of
staff needed with the right expertise to conduct monitoring
activities and provide Technical Assistance. Closing the
Regional Offices and reducing RSA staff by 56 positions resulted
in a great loss of VR institutional memory. Even in early 2006
the details of such a new system are not available and it will
be several years before the effectiveness of this new monitoring
and technical system will be known. CSAVR is committed to
working with RSA in the ongoing development and implementation
of this monitoring and technical assistance initiative.
8. “Education does not effectively monitor and mange the
performance of State VR Agencies.” CSAVR would like to point out
that the VR program is a State-Federal partnership with states
contributing significant funds to the program. In addition to
RSA monitoring, state agencies undergo monitoring from state
entities such as state single point audits, performance and
fiscal reviews from the Governor’s Office and the State
Legislature, and regular reviews by Commissions, State Boards,
umbrella agencies, and SRC’s. CSAVR believes that the GAO needs
to recognize that the VR program is a State-Federal partnership
and that the program is monitored and managed in many different
ways.
9. “VR Performance measures are not comprehensive,
do not take into account state variations, and do not allow for
comparison with other workforce programs.” CSAVR has already
initiated contact with RSA to assist in a reworking of the data
system and performance measures. CSAVR also has a two day
meeting planned for the middle of February 2006 that will have
as one area of focus performance measures. The GAO indicated in
several places in their report that they weren’t sure why this
or that was happening or that data wasn’t available. Some of the
needed data or information resides in states but is not
collected by RSA. CSAVR also concurs with GAO that the cost of
getting this information may outweigh its value. CSAVR wants to
emphatically state that the VR system is driven by process
requirements and is already overburdened with paperwork.
The issue of comparing the performance of VR with other
workforce programs raises some serious concerns. Items A1, A2,
A3, and A4 of this response recognizes that VR serves a
different more difficult population to prepare for and place in
employment, than do other workforce programs. In addition, VR
serves consumers that require more extensive, complex, and
costly services than do other workforce programs that limit,
service time, and expenditures. The idea that VR can be measured
against these other workforce programs is driven by the
conceptual philosophy, “one size fits all”, and not the
realities of serving individuals with disabilities or the
differences that exist between the various workforce programs.
CSAVR believes that VR should be evaluated on its own merits
given the realities that drive the program and the population
served.
In February of 2005 the Nelson A. Rockefeller
Institute of Government reported on study of “The Workforce
Investment Act In Eight States”. In this report for the U.S.
Department of Labor, Employment and Training Administration
researchers concluded, “Vocational Rehabilitation, a mandatory
partner under WIA, was most frequently cited as the partner that
did not fit well into the One-Stop Career Center environment.
This program was cited as being problematic in most states in
the sample for a number of reasons. The Vocational
Rehabilitation Programs generally have different goals, culture,
and management systems than the workforce development programs
in most states. In part, these stem from the different types of
problems that Vocational Rehabilitation Agencies encounter.
Vocational Rehabilitation customers often require longer-term
and more supportive services than the typical WIA customer.”
Because of the significant disabilities of VR consumers and the
complexity and length of services required researchers
recognized that VR’s participation in one-stops and evaluation
of outcomes must be different than for other WIA partners.
