EXECUTIVE SUMMARY
This report, prepared by the National Accreditation Council for
Agencies Serving the Blind and Visually Handicapped as a part of its
VISION project, reviews closure and outcomes data on over 16,000
blind consumers closed by two types of public VR programs: (1) those
serving only people with visual disabilities, and, (2) those serving
persons with all disabilities. In this report they are referred to as either
"separate" or "general' agencies, respectively. The data was prepared
by Rehabilitation Services Administration (RSA) for FY 1994, ending
September 30, 1994.
The report has the following findings: (1) the specialized agencies
placed a higher percentage of persons into competitive work settings,
(2) had a lower rate closed as homemakers, and, (3) had closures with
higher average weekly earnings than did the general agencies.
Clients closed by the specialized agencies had a higher average
cost of service than did clients of the general agencies, an average
difference of approximately $600. The amount of time spent in VR was
almost exactly the same for both systems, an average of 26 months.
Average costs of service and time spent in VR were essentially the
same in both systems for those clients with additional disabilities.
V.I.S.I.O.N. by NAC
V.I.S.I.O.N. stands for Visually Impaired Services: Input and
Outcomes Network. It is a project of the National Accreditation
Council designed to begin a more public sharing of outcomes achieved
by education and rehabilitation programs serving people with visual
impairments. It is not enough to just share outcomes, however. We
also have to analyze the outcomes achieved by the inputs and
resources expended. VISION by NAC hopes to eventually establish
benchmarks for what can be accomplished by people with visual
impairments and what it costs service providers to help make that
happen. Such benchmarks are increasingly necessary for a number of
reasons:
(1) Governmental as well as private funding sources are requiring
evidence that the human services they fund are cost-effective.
(2) Consumers are being given the opportunity to select the
providers of the services they receive and they need
understandable data to help them choose.
(3) Newly designed and more limited service delivery systems
are emerging as a result of fiscal restraints. Many of
these are multi-disability or multi-function umbrella
agencies. Benchmarks are needed to keep these new systems
honest and to maintain high expectations for what visually
impaired people can accomplish when properly served.
(4) Similarly, as the health care system changes, more medical
practitioners are moving toward the provision of
rehabilitation services. Benchmarks are needed to assure
that services provided in this way achieve appropriate
outcomes for visually impaired people.
Greater concern for measuring and reporting outcomes represents
a universal trend among accreditation organizations. While the
traditional approach of comparing how organizations operate in
comparison to agreed-upon standards is still necessary and valuable, it
is no longer sufficient. Computerized communication and analytic tools
now permit the review of each organization's success in accomplishing
its mission on behalf of the people it serves.
This publication launches an initiative by the National
Accreditation Council for Agencies Serving the Blind and Visually
Handicapped to encourage the sharing of outcome measures currently
used by schools and agencies serving people who are visually impaired.
A more ambitious part of NAC's goal is to encourage the development
of consistent and agreed-upon methods of collecting and analyzing
outcomes which will permit an easy but valid comparison of program
effectiveness between organizations in different settings. It is
impossible to consider that every organization will agree to approach
this task in the same manner. However, it is reasonable to expect that
a sufficient number of schools and agencies will adopt protocols to
permit the development of a representative and reliable database of
benchmarks of quality outcomes for reasonable expenditures in our
field.
Future steps will include the following:
(1) The sharing of general operational information about the
types of organizations participating in NAC's accreditation
process;
(2) The sharing of the methods being used by NAC accredited
organizations and others to study, analyze and report outcomes
and the results of those studies;
(3) The analysis of basic rehabilitation and education data in
selected states and organizations to highlight the
information that is already available;
(4) The identification and study of efforts to reach agreement
on a basic set of outcome and input elements for each kind
of program accredited by NAC;
(5) The selection and sharing of a data base, its elements and
procedures and the dissemination of the software needed by
organizations who wish to share in the development of
representative benchmarks for this field.
The National Accreditation Council represents the largest and
most broadly representative collection of organizations serving blind
people who have agreed to compare themselves to standards for
quality services established through broad-based participation and
input. As such, NAC members represent an excellent base for the
development of representative benchmarks for quality services in this
field. We will welcome your reaction to this project and your
participation in it.
NAC would like to acknowledge the support and cooperation of
the Rehabilitation Services Administration in making this report
possible.
Richard L. Welsh, Ph.D.
President
National Accreditation Council
INTRODUCTION
For more than a decade, there has been a steady trend of
consolidating public vocational rehabilitation programs serving only
people who are blind with general VR agencies. The number of states
with separate, or specialized, agencies serving this population has
declined. This issue has been a controversial one within the field of
vocational rehabilitation, with little research or data to support either
alternative. However, it is the opinion of many consumers and leaders
in the field of blindness that persons with vision loss are best served by
those agencies which maintain a specialized focus upon their needs.
The primary national source of information on characteristics of
public VR agencies, the populations they serve, and service outcomes
is The Rehabilitation Services Administration (RSA). RSA's Annual
Report to Congress contains a wealth of information and statistics.
However, this report seldom distinguishes outcomes for persons who
are blind, from those of persons with all types of disabilities. Nor does
it report rehabilitation outcomes for persons who are blind served by
two different types of public VR agencies: (1) those serving only people
with visual disabilities, and, (2) those serving persons with all
disabilities.
The National Accreditation Council (NAC) has prepared this report
for several reasons. Questions regarding the future status of agencies
providing specialized services to consumers who are blind or visually
impaired are usually decided by a state's legislature. However, in recent
months, it has become apparent that during FY 1997, and possibly
beyond, this question may be addressed on a national level with debate
centered around reauthorization of the Rehabilitation Act. National
organizations and consumer groups on both sides are beginning to
prepare their arguments.
In the future, emotional pleas to legislative bodies by those within
the field of blindness or consumer groups may not be enough to
override arguments of cost effectiveness presented by others. The
issue of paramount importance is that of quality of service, something
that is difficult to authenticate without objective data. It is hoped this
report will contribute to NAC's VISION Project which hopes to provide
benchmarks of rehabilitation outcomes achieved among different types
of programs for different kinds of clients.
There is also a need for information on what happens when two
are combined into one. For example, what happens to the full-time
equivalency (FTE) assigned to serve VR cases of persons with vision
loss? Do specialized positions such as orientation and mobility
specialists and rehabilitation instructors remain? What changes occur,
pre-and-post consolidation, in terms of annual number of service hours,
average case expenditures, and accessibility of adapted technology for
consumers with vision loss? What outcomes occur in the number and
types of job placements, as well as average starting salaries and
benefits? These are only a few questions which must be explored if
advocates for specialized services are to be successful in their efforts.
PURPOSE
During FY 1994, ending September 30, 1994, state rehabilitation
agencies closed the cases of 16,613 blind and visually impaired clients.
Of the total, 9,062 (55%) were served by separate agencies serving
only clients with visual impairment; the remainder, 7,551, were served
by state VR agencies serving people with visual impairments along with
people with all disabilities. For the purposes of this report, these
agencies, respectively, will be referred to as either "specialized" or
"general" agencies.
The purpose of this report is to compare the outcomes of both
types of agencies in six areas:
(1) the number of persons served and closed with additional
disabilities,
(2) the rehabilitation rate,
(3) types of job settings,
(4) average weekly earnings at closure,
(5) time spent in the VR process, and
(6) cost of services.
CLOSURE DATA
As shown in Chart A, during FY 1994 the specialized agencies for
the blind closed about 1,500 more cases than did the general VR
agencies. They also closed more persons with additional disabilities. Of
the 9,062 persons closed by the specialized agencies for the blind in
FY 1994, a total of 4,845 (53.5%) reported having one or more
additional disabilities. By comparison, of the 7,551 cases closed by the
general agencies, 3,634 (48.1%) reported having one or more
additional disabilities.
Of the total number of cases closed, the separate agencies closed
as "rehabilitated" 6,301 (65.6%) persons. Of these, 3,371 (53%) had
one or more additional disabilities. The general agencies closed as
"rehabilitated" a total of 5,108 persons, or 67.6% of their total
closures. Of these, 2,423 (47%) had one or more additional disabilities.
The overall rehabilitation rate for the general agencies is higher by
a margin of 2% than that of the specialized agencies. However, the
percentage of persons closed as rehabilitated by the specialized
agencies who had one or more additional disabilities is higher by a 7%
margin.
EMPLOYMENT SETTING AND AVERAGE SALARY
As no information is given regarding the number and types of
additional disabilities, it was decided that Charts B and C would
compare work settings and average weekly earnings for clients with
blindness only (N= 5,489).
Among specialized agencies, of the 2,930 persons with blindness
only whose cases were closed, 1,325 (45.2%) were placed into
competitive work settings, compared to 1,045 (38.9%) placed by the
general agencies. The general agencies had a higher percentage of
homemaker closures, 54%, vs. 38%, than did the specialized
agencies.
The RSA data breaks down weekly earnings at closure into
categories ranging from $0 per week (presumably most are homemaker
closures) to those earning $400 or more per week. In all categories, the
average weekly earnings of persons served by the specialized agencies
was higher. When broken down into broader categories, such as
weekly earnings in the range of $200 to $400 or more per week, the
percentage of placements by specialized agencies was higher, 32.5%
compared to 26.5% for placements of the general agencies (see Chart
C).
COST OF SERVICE AND TIME IN VR
Clients served and closed by the specialized agencies had a higher
average cost of service than did clients of the general agencies. The
average cost of service to clients with a single disability was $5,103,
compared to $4,510 within the general agencies in FY 1994, an
average difference of approximately $600. The amount of time spent in
VR was virtually the same for both systems, an average of 26 months.
Both average costs of service and time spent in VR were essentially the
same for those clients with additional disabilities.
SUMMARY
The data reviewed is only for case closures. The specialized
agencies placed a higher percentage of persons into competitive work
settings, had a lower rate closed as homemakers, and had closures
with higher average weekly earnings than did the general agencies.
This analysis is based upon data which has limitations. We know
little of the characteristics of the consumers. For some variables
reported by the state VR agencies, as high as 10% of the data is
missing or not reported. Causes and degree of vision loss were not
specified, but it is assumed, perhaps incorrectly without more data,
that each system has similar eligibility requirements and a broad,
heterogeneous client population.
The data for FY 1994 is the most recent data available from RSA.
Since then, additional states with separate agencies serving people
with vision loss have addressed the issue of whether or not to
consolidate those agencies with others. As the number of states
providing specialized services for people with vision loss grows smaller,
the field of vocational rehabilitation will continue to lose the unique
focus and high level of rehabilitation outcomes for consumers with
vision loss provided by those agencies. However, the real losers will be
consumers with vision loss whose needs demand a specialized array of
services.