Characteristics, Services, and Outcomes of Rehabilitation Consumers
who are Blind or Visually Impaired
Served in Separate and General Agencies
Brenda S. Cavenaugh, Principal Investigator
Mississippi State University
Steven J. Pierce, Graduate Research Assistant
Mississippi State University
May 1998
Copyright 1998
All Rights Reserved
Mississippi State University
Rehabilitation Research and Training Center
on Blindness and Low Vision
P.O. Box 6189, Mississippi State, MS 39762
Development of this document was supported in part by the Rehabilitation
Research and Training Center on Blindness and Low Vision Grant H133B10003
from the National Institute on Disability and Rehabilitation Research, U.S.
Department of Education, Washington, DC. Opinions expressed in this document
are not necessarily those of the granting agency.
Mississippi State University does not discriminate on the basis of race, color,
religion, age, sex, national origin, veteran status, or disability.
TABLE OF CONTENTS
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Statement of Problem . . . . . . . . . . . . . . . . . . . . . . 2
Research Questions . . . . . . . . . . . . . . . . . . . . . . . 2
Definition of Terms. . . . . . . . . . . . . . . . . . . . . . . 3
LITERATURE REVIEW. . . . . . . . . . . . . . . . . . . . . . . . 5
History of Specialized Rehabilitation Services . . . . . . . . . 5
The Beginning of Separate Employment Programs . . . . . . . 5
The Emergence of State Commissions or Agencies. . . . . . . 5
Early Federal Rehabilitation Legislation. . . . . . . . . . 6
Current Status of Separate Agencies . . . . . . . . . . . . 7
Position of Consumer and Professional Groups . . . . . . . . . . 8
Previous Research on Efficacy of Specialized Agencies. . . . . . 8
The Mallas Study. . . . . . . . . . . . . . . . . . . . . . 8
The J. W. K. Study. . . . . . . . . . . . . . . . . . . . . 9
Kirchner and Peterson Findings. . . . . . . . . . . . . . .10
NAC Study . . . . . . . . . . . . . . . . . . . . . . . . .10
RRTC Agency Classification Study. . . . . . . . . . . . . .11
Summary of the Literature Review . . . . . . . . . . . . . . . .11
METHOD . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
Subjects . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
The 1989 RSA-911 Database. . . . . . . . . . . . . . . . . . . .13
Converting the Data into an SPSS Data File. . . . . . . . .13
Database Cleaning and Variable Recoding . . . . . . . . . .14
Vision Classification . . . . . . . . . . . . . . . . . . .14
Status Codes. . . . . . . . . . . . . . . . . . . . . . . .14
Focus of Analysis . . . . . . . . . . . . . . . . . . . . .15
Agency Classification . . . . . . . . . . . . . . . . . . .15
Data Analysis. . . . . . . . . . . . . . . . . . . . . . . . . .16
RESULTS. . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Sample Characteristics. . . . . . . . . . . . . . . . . . .19
Research Question 1 . . . . . . . . . . . . . . . . . . . .19
Levels of visual impairment. . . . . . . . . . . . . .19
Race and ethnicity . . . . . . . . . . . . . . . . . .20
Sex. . . . . . . . . . . . . . . . . . . . . . . . . .21
Age. . . . . . . . . . . . . . . . . . . . . . . . . .21
Education. . . . . . . . . . . . . . . . . . . . . . .23
Transfer payments. . . . . . . . . . . . . . . . . . .23
Secondary disability . . . . . . . . . . . . . . . . .24
Research Question 2 . . . . . . . . . . . . . . . . . . . .24
Acceptance rates . . . . . . . . . . . . . . . . . . .24
Average number of services received. . . . . . . . . .25
Average cost of services . . . . . . . . . . . . . . .25
Duration of services . . . . . . . . . . . . . . . . .26
Research Question 3 . . . . . . . . . . . . . . . . . . . .26
Rehabilitation rate. . . . . . . . . . . . . . . . . .26
Work status at closure . . . . . . . . . . . . . . . .27
Self-support . . . . . . . . . . . . . . . . . . . . .28
DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . .29
Consumer Characteristics. . . . . . . . . . . . . . . . . .29
Overall differences. . . . . . . . . . . . . . . . . .29
Vision groups. . . . . . . . . . . . . . . . . . . . .30
Consumer Services . . . . . . . . . . . . . . . . . . . . .30
Acceptance rates. . . . . . . . . . . . . . . . . . .30
Number of services . . . . . . . . . . . . . . . . . .31
Cost of services . . . . . . . . . . . . . . . . . . .32
Duration of services . . . . . . . . . . . . . . . . .33
Consumer Outcomes . . . . . . . . . . . . . . . . . . . . .33
Rehabilitation rate. . . . . . . . . . . . . . . . . .33
Work status. . . . . . . . . . . . . . . . . . . . . .34
Self-support . . . . . . . . . . . . . . . . . . . . .35
CONCLUSIONS AND IMPLICATIONS . . . . . . . . . . . . . . . . . .37
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . .41
APPENDIX . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
INTRODUCTION
Issues regarding the merits of separate state agencies
providing specialized vocational rehabilitation (VR) services to
consumers who are blind have generated spirited discussions
throughout the history of the state-federal program. With the
flurry of activities associated with the reauthorization of the
Rehabilitation Act of 1973, arguments for and against separate
service delivery structures are again being intensely debated and
are in the forefront of disability issues. Proponents for separate
service delivery agencies have argued that dissolution of separate
rehabilitation agencies will result in a loss of specialized services
(e.g., rehabilitation teaching, orientation and mobility, and low vision
services) critical to the independent living of consumers who are
blind or visually impaired (Augusto, 1997; Jernigan, 1996). Opponents
have argued that the separate service delivery system is duplicative
and possibly inequitable for persons with other disabilities (National
Council on Disability [NCD], 1997a).
The civilian vocational rehabilitation program began with the
passage in 1920 of the Smith-Fess Act (P.L. 66-236). During the
1920s and 1930s, blind persons were considered to have limited
vocational potential and received little benefit from this initial
rehabilitation legislation (Clunk, 1966). However, vocational
opportunities began to expand with the Randolph-Sheppard Act of
1936 (P.L. 74-732) and the Wagner-ODay Act of 1938 (P.L. 75-739).
(The Randolph-Sheppard Act enabled persons who are blind to
operate vending facilities in federal buildings while the Wagner-
ODay Act mandated the federal government to purchase products
made by blind employees of sheltered work facilities.) As more blind
people demonstrated their ability to be successfully employed, public
perceptions slowly began to change. Consequently, federal support
for the vocational rehabilitation needs of blind consumers was
included in the next major rehabilitation legislation, the Barden-
LaFollette Act of 1943 (P.L. 79-113). This Act broadened the
rehabilitation program by allowing existing state agencies or
commissions serving blind persons to administer the state-federal
VR program (Rubin & Roessler, 1995). A review of 1994 RSA-911
federal reporting data indicates that this long tradition of
specialized rehabilitation services continues today with the majority
of consumers who are visually impaired receiving VR services from
one of the 25 separate state agencies.
Although consumers who are blind or visually impaired
historically have supported the separate agency model of service
delivery, other disability groups have tended to favor a general or
cross-disability integrative model. This opposite perspective was
most recently articulated in a March 1997 statement by the
National Council on Disability (1997a). As part of its involvement in
the process of reauthorizing the Rehabilitation Act of 1973, NCD
recommended that the Rehabilitation Services Administration (RSA)
discontinue funding of separate VR programs for clients with visual
impairments. Facing major resistance from blindness-related
consumer and professional groups, NCD later withdrew its
recommendation in favor of another, asking that the General
Accounting Office (GAO) initiate a study to investigate differences in
the performance, benefits, and costs of separate and combined
agencies (1997b). Although NCDs statements were congruent with
its cross-disability philosophy, the Council justified its
recommendations largely by pointing to the absence of conclusive
empirical research to validate the claim that separate agencies are
more effective. The NCD also acknowledged that its position is
directly opposed to that of organizations supporting blind people
and testimony of blind consumers during related public hearings.
Statement of Problem
Rehabilitation professionals and consumers of major agencies
and organizations in the blindness field believe that specialized,
comprehensive services and essential changes in social attitudes
about blindness do not occur when rehabilitation services for the
blind are provided through a single program which serves both
blind and disabled persons (Spungin, 1997, p. 4). Despite this
widespread belief, the paucity of supporting empirical research
substantially threatens the future existence of separate state
agencies. Organizations supporting single or general rehabilitation
programs serving all disability groups have called for a halt to
current Title I state plan authority [29 U.S.C. 721(a)] permitting
separate agencies for blind consumers (NCD, 1997a).
If significant public policy changes regarding the funding of
separate agencies providing specialized blindness services are to be
implemented, it is imperative that these policy changes are grounded
in thorough empirical studies that examine the current
effectiveness of separate and general agencies. Recognizing this
need, this study investigated the consumer characteristics, services,
and outcomes of consumers who are blind or visually impaired
served in separate and general agencies.
Research Questions
To facilitate comparisons with previous research, RSA case
closure data was used in the analysis. This study was originally
designed as a follow-up to a Rehabilitation Research and Training
Center (RRTC) investigation of agency structure classification for
fiscal year (FY) 1989 (Talor, Maxson, Johnson, and Robertson, 1996).
Therefore, the RSA database for FY 1989 was chosen for analysis.
Information from the database was collected on individual case
records (R911" forms) and reported by all of the state-federal
rehabilitation programs to meet annual reporting requirements of
RSA.
In order to investigate the relationships of agency structure to
rehabilitation services for consumers who are blind or visually
impaired, the following research questions were proposed.
1. What are the client demographic and disability characteristics as
measured by age, gender, race, severity of vision loss, presence of secondary
disability, and receipt of transfer payments for rehabilitation consumers with
blindness or visual impairments who are served in separate and in general
rehabilitation agencies?
2. What are the acceptance rates, costs of services, number of services,
and duration of services for rehabilitation consumers with blindness or visual
impairments who are served in separate and in general rehabilitation agencies?
3. What are the outcomes as measured by rehabilitation rate, work status,
and self-support of rehabilitation consumers with blindness or visual impairments
who are served in separate and in general rehabilitation agencies?
Definition of Terms
For purposes of this study, the following terms are defined as
follows:
Business Enterprise Program (BEP) refers to vending facilities and other
small businesses managed by persons with severe visual
impairments under the supervision of a state VR agency.
Client Income includes earnings, interest, dividends, and/or rent as
reported on the RSA-911 to describe the individuals largest single
source of support at application and at closure.
Competitive labor refers to work for wages, salary, commissions, tips,
or piece-rates, but does not include work in sheltered workshops.
General Agencies refer to the 25 state VR agencies providing services
to all disabilities plus the 25 state VR agencies co-existing in states
with separate blindness agencies and reporting RSA-911 data for FY
1989.
Homemaker refers to men and women whose principal activity is
keeping house for their families or themselves, if they live alone.
Legally Blind Group refers to VR consumers who are blind in both eyes,
with a correction of not more than 20/200 in the better eye or
have a field limitation of less than 20 degrees (RSA major disability
codes 100-119).
Separate Agencies refer to the 24 state VR blindness agencies reporting
RSA-911 case service data for FY 1989 which had separate
administrators, separate budget authorities, and separate state
plans for provision of services to blind or visually impaired persons.
Although Nebraska does have a separate agency, no data for that
agency were available in the FY 1989 database.
Self-employed refers to work for profit or fees in ones own business,
farm, shop, or office (excludes BEP).
Some Visual Loss Group refers to VR consumers who are legally blind in
one eye, other eye good, or have any other visual impairments (RSA
major disability codes 130-149).
Status 08 Closures refer to those clients not accepted for VR services
from the applicant status (08 from 02) or from extended
evaluation services (08 from 06).
Status 26 Closures refer to those clients accepted for services and
closed rehabilitated.
Status 28 Closures refer to those clients accepted for services and
closed not rehabilitated after individualized written rehabilitation
program (IWRP) initiated.
Status 30 Closures refer to those clients accepted for services and
closed not rehabilitated before IWRP initiated.
Transfer Payments are types of public support received during the VR
process including SSDI, SSI-aged, SSI-blind, SSI-disabled, AFDC, and
General assistance.
Unpaid family worker refers to unpaid family work that cannot be
classified according to any of the DOT occupations.
Visually Impaired Group refers to VR consumers who are visually
impaired in both eyes, better eye with correction less than 20/60,
but better than 20/200, or a corresponding loss in visual field (RSA
major disability codes 120-129).
LITERATURE REVIEW
History of Specialized Rehabilitation Services
The Beginning of Separate Employment Programs
Early employment programs for adults with blindness or
severe visual impairment were established on the campuses of
residential schools serving blind students. The countrys first
employment program opened in 1840 at the Perkins Institution for
the Blind (Obermann, 1965). Given the virtual nonexistence of
employment opportunities for persons who were blind or visually
impaired, the program was developed to assist the schools
graduates in finding jobs. Building upon its early successes, the
Perkins employment program soon became available to all blind
persons in the New England area. Quickly, the number of persons
seeking employment exceeded available jobs, and in an effort to
expand placement options, Perkins established the nations first
sheltered workshop in 1850. Although educational institutes and
private rehabilitation organizations in other states also established
sheltered employment facilities, these programs were few in
number and, for the most part, limited vocational training to piano
tuning and to broom and mop making (Magers, 1969).
The Emergence of State Commissions or Agencies
Despite the beginnings of a national network of service
delivery, employment opportunities for most blind Americans were
isolated or nonexistent for the remainder of the 19th century.
Moreover, employment opportunities remained stagnant until the
creation of a number of state agencies serving blind adults resulted
in an expanded blindness service delivery system. The first of these
state agencies was located in Connecticut (Magers, 1969).
Established by the state legislature in 1893, the Connecticut Agency
for the Blind was responsible for providing teaching in the homes of
adults who were blind. After the turn of the century, other
commissions or agencies serving only consumers with blindness or
visual impairment appeared in several states (Obermann, 1965).
These commissions were established to administer the separate
social, economic, and medical state programs and to create or
expand employment opportunities. The Massachusetts Commission
for the Blind was established in 1906 and was successful in placing
a blind client in private industry that same year. Early commissions
were also established in New Jersey and Ohio in 1908 (Magers).
Before 1925, most of the industrial placements were made by
separate commissions and private agencies in Chicago, Cleveland,
Milwaukee, Minneapolis, Detroit, and Boston (Clunk, 1966). With the
establishment and growth of these public and private agencies, the
blindness service delivery system, as we know it today, began to
emerge (Magers, 1978).
Early Federal Rehabilitation Legislation
On June 2, 1920, President Woodrow Wilson signed the Smith-
Fess Act (P.L. 66-236), the nations first civilian vocational
rehabilitation legislation. The Act provided federal funding to states
on a 50-50 matching basis for the provision of vocational guidance,
education, adjustment, and placement services to individuals with
physical disabilities (Rives, 1966). The Federal Board of Vocational
Education was given the responsibility for administering the new
program. Because the Board already regarded home economics as
a legitimate training area, it is not surprising that the homemaker
placement was also considered a valid occupation for clients with
disabilities (Rubin & Roessler, 1995).
During the next two decades, the state vocational
rehabilitation programs provided few, if any, services to
consumers who were blind (Clunk, 1966; Koestler, 1976; Rives, 1966;
Rubin & Roessler, 1995). Clunk reported that during 1936 the
general rehabilitation agencies for the sighted of the country
reported two blind persons as being rehabilitated (p.145). For the
most part, blind applicants were not considered feasible for
rehabilitation and were referred to the separate state commissions
and agencies serving blind persons. These commissions and agencies
operated with limited budgets and with no federal funding.
Consequently, consumers who were blind continued to receive
minimal vocational services (Magers, 1969).
Although providing no direct federal funding, the passage of
the Randolph-Sheppard Vending Stand Act of 1936 (P.L. 74-732)
appreciably expanded the employment opportunities of blind adults.
The Act permitted the establishment of vending facilities in federal
buildings to be operated by blind persons and empowered the
Commissioner of Education to designate the The State Commission
for the Blind in each State, or in any State in which there is no such
commission some other public agency to issue licenses to blind
persons (Randolph, 1965). Clunk (1966) credited the successful
outcomes of the Randolph-Sheppard program with opening the
doors to the promotion and employment of blind persons in the
United States and throughout the world.
Employment opportunities continued to expand with the
passage in 1938 of the Wagner-ODay Act (P.L. 75-739). The Act
provided for government purchase of products made by sheltered
shops and led to the creation of the National Industries for the Blind
to coordinate government purchases between the workshops and
federal agencies. The Wagner-ODay Act began to stabilize and
substantially expand sheltered work opportunities at a time when
economic conditions had previously resulted in a loss of
employment for many blind workers (Clunk, 1966).
The return of veterans disabled during World War II gave rise
to the next major civilian rehabilitation legislation, the Barden-
LaFollette Act of 1943 (P.L. 79-113) (Rives, 1966). Signed by President
Franklin Roosevelt, the Barden-LaFollette Act provided the first
federal-state support for blind consumers and extended physical
restoration services to consumers with physical disabilities.
Koestler (1976) addressed the pronounced impact of the Act on the
stabilization and growth of specialized agencies and services in the
following statement.
Because little of this progress would have taken place without
the specialized skills of the organizations working with and for
blind people, one of the most important contributions of the
Barden-LaFollette Act was the way it legislated these
organizations into partnership with the federal government.
The Act specifically provided that any state with a legally
constituted commission or agency for the blind could assign to
it the administration of the federal-state vocational
rehabilitation program for visually disabled persons. For the
first time, state agencies for the blind, some of which had
been in existence for more than thirty years, were no longer
solely dependent on the capricious ups and downs of annual
legislative appropriations. For the first time, they had
sufficiently firm financial backing to plan, staff, and organize
their work on a systematic, comprehensive basis. It was no
wonder that some called the Barden-LaFollette Act the Magna
Charta of the blind. (p. 232)
Current Status of Separate Agencies
Currently, 25 states have a separate VR agency or commission
which provides rehabilitation services exclusively for consumers
who are blind or visually impaired. Each of these agencies has a
separate state budget, spending authority, and plan for the
provision of services to consumers who are blind. In addition, in
each of the 25 states a general VR agency is responsible for the
administration and provision of services to the remainder of
consumers with disabilities. Because some of the separate agencies
restrict services to those consumers with the most severe visual
impairments, those with less severe visual impairments (e.g., legally
blind one eye, other eye good) may be served by a general agency
coexisting with a separate agency in the same state.
In each of the remaining 25 states, territories, and in
Washington, DC, consumers who are blind or visually impaired are
served in a single (also referred to as general or combined) VR
agency which provides rehabilitation services to consumers with all
disabilities. In states with a single (combined) agency, the types of
service delivery systems may range on a continuum from those
having an identifiable subunit responsible for the separate
administration and service delivery of all specialized blindness
services to those having no separate administration and/or no
specialized service delivery staff for blindness services.
Position of Consumer and Professional Groups
Whether considering blindness a mere physical nuisance
(Jernigan, 1986, p. 371) or a serious psychological, physiological, and
cognitive blow (Gallagher, 1988, p. 276), leaders within the blindness
community have consistently been staunch advocates for
specialized services and the preservation of separate agencies. In
testimony delivered to the National Council on Disability on March
24, 1997, Edwards reconfirmed this united position when he
reported that Every organization of and for blind people believes
in the efficacy of separate state agencies for the blind. Given the
paucity and ambiguity of empirical research on the strength of
separate agencies and the lack of evidence that general or
combined agencies are equally effective, this strong support
appears to be largely based upon logical or commonsense
observations, case studies, and the genuine fear that specialized
services will not survive in general disability agencies.
Previous Research on Efficacy of Specialized Agencies
For the most part, case service data reported annually to RSA
by the state-federal programs are used in studies on the effects of
agency structure on services to blind or visually impaired
consumers. Often, researchers analyzing the annual case service
reports have reported missing data (National Accreditation Council
for Agencies Serving the Blind and Visually Handicapped [NAC], 1997)
and, in some cases, data inconsistent with that actually recorded in
individual case records (Giesen, Graves, Schmitt, Lamb, Cook, Capps,
& Boyet, 1985). In addition, researchers have encountered
difficulties in categorizing VR agencies by their organizational
structure for comparative purposes. Because each state has great
latitude for structuring state rehabilitation agencies and because
each state has its own history and tradition, considerable
variability in agency structure is found among rehabilitation
agencies. Differences are further compounded by individual state
mandates (e.g., services to both children and adults), state financial
commitments, opportunities for outsourcing, and composition of
professional staff. Thus, broad based differences among state VR
agencies have confounded efforts to create a single, accepted
agency structure classification system. Issues regarding RSA data
and agency structure classification have added complexity in the
comparisons studies presented below.
The Mallas Study
In a report to the National Council of State Agencies for the
Blind, Management Services Associates (1975) concluded that the
strongest, most effective and most dynamic (in respect to impact
of services on clients and the breadth of spectrum of services
offered to clients) systems are those in separate agency status (p.
22). In the same report, organizational structure was reported to
be less important than the presence of strong agency leadership
having direct access to the governor and legislature. Referred to as
the Mallas study, this investigation was the first major attempt of
the blindness field to respond to the growing trend in state
government to create large umbrella-type human services
organizations for the provision of generic social and rehabilitative
services (Hopkins, 1991). Unfortunately, the absence of sufficient
documentation of research methodology and supporting data has
caused many to question the validity of Mallass findings (viz., JWK,
1981; Kirchner, 1982).
The J. W. K. Study
In a 1981 study funded by the Rehabilitation Services
Administration (RSA) and conducted by JWK International
Corporation, the effects of administrative structure on service
delivery to rehabilitation clients reporting blindness or visual
impairment were again examined. Rehabilitation agencies were
categorized into three administrative types according to a decision-
tree procedure based on answers to questions on organizational
structure. Of the three types, administrative type C was the
smallest and most homogeneous group. Of the 14 type C agencies,
13 had separate state plans for services to blind or visually
impaired consumers. Administrative type B was the largest group.
Although almost half of the type B agencies had a separate state
plan, the majority of the directors did not have the authority to
initiate formal contacts with the governor or state legislature.
Administrative type A included 18 agencies and was the least
homogeneous group. While three of these agencies had a separate
state plan, most of the agencies did not have a separate legislative
appropriation for VR services to blind consumers nor did the
majority of directors have authority to initiate formal contact
with the governor or state legislature. Comparisons were made
among the three structure groupings on selected rehabilitation
process and outcome variables. Overall research results indicated
that (a) regardless of agency structure, blind consumers were
served better by counselors with specialized caseloads; (b) the type
of administrative structure had only a slight relationship to
outcome; and (c) there was no evidence to indicate that one
administrative structure grouping was more cost-effective than
another administrative structure.
Of particular concern in investigating comparisons of agency
types were the substantial differences between state rehabilitation
programs within structure groupings and the resulting lack of a
consensus within the field regarding a valid classification method.
JWKs classification system was essentially based on the results of
12 administrative structure questions completed by each state
agency. Given the diversity of organizational structures, it is not
surprising that six administrative types were originally identified,
although these were ultimately collapsed into three types.
Kirchner and Peterson Findings
In a later study, researchers from the American Foundation
for the Blind (Kirchner & Peterson, 1982) responded to the
classification problem by using the official RSA designation of state
agencies as their basis for categorizing agencies. In this
classification system, each state agency is designated as either a
General or Blind agency. Comparisons of the two agency types
were based on analysis of the RSA database of all rehabilitation
cases closed in 1971. Although not the most current at that time,
this database was chosen to take advantage of a special study done
by the Social Security Administration which included data on
employment earnings of consumers 1 year after closure. As with
the JWK study, results were mixed with small or no differences
found on selected outcome variables between the two agency types.
Of special note is that although the analysis of employment and
earnings 1 year after closure showed no difference between
agency types, visually impaired clients of separate (Blind) agencies
tended to be members of demographic groups that are generally
considered to be more socially disadvantaged. For example,
separate agencies served more older women and more African
American consumers than did general agencies. Kirchner and
Peterson also noted that no data were available on the proportions
of clients with multiple disabilities served in the two types of
agencies.
NAC Study
More recently, the National Accreditation Council for Agencies
Serving the Blind and Visually Handicapped (NAC) (1997) published its
report comparing rehabilitation outcomes for consumers served in
separate and general agencies. As in the Kirchner and Peterson
study, the official RSA Blind (Separate) or General designation
was used in categorizing agencies. In developing the NAC report,
selected descriptive data from the 1994 database were requested
from RSA. Results showed that separate agencies reported a higher
rate of competitive closures, a lower rate of homemaker closures,
and higher average weekly earnings for closures than were
reported by general agencies. Although the amount of time spent in
the VR program was essentially the same for both agency types, the
average cost of services was found to be $600 more for clients
closed from separate agencies.
RRTC Agency Classification Study
In a 1996 study, Talor, Maxson, Johnson, and Robertson
developed questions to classify state agencies serving consumers
with blindness or visual impairment. Four administrative structure
types were identified on the basis of state agency responses to eight
questions regarding line of authority, funding, operating
procedures, and presence of a separate state plan for the 1989
fiscal year. As expected, agencies classified as Separate were the
most similar with all but one state reporting affirmatively to
questions on agency administrator status, presence of a separate
state plan, budget authority, and administrator reports to a
governor or cabinet-level secretary. Agencies classified as
Combined reported 100% agreement for the question on
reporting to the head of another agency and 80% agreement for
another three key questions indicating some form of specialized
administration of services. Agencies classified as Partially-
Combined were in 100% agreement on the key question regarding
direct line authority over all services except vocational
rehabilitation case management. Talor et al. described this group as
a variation of the Combined type in which the agency
administrator has full line authority over some agency personnel
(e.g., vending facility, rehabilitation teaching) but not those
performing VR case management. As in the JWK study, agencies
classified as General were the most diverse with agencies
reporting only 50% to 80% agreement in response to those
questions assessing general agencies. The overall purpose of the
Talor et al. study was to develop a classification system that
potentially could be used in subsequent investigations of
relationships of agency structure to rehabilitation process and
outcome variables.
Summary of the Literature Review
Rehabilitation consumers and practitioners in the blindness
rehabilitation field accept, without equivocation, the premise that
the separate agency delivery system is critical to ensuring quality
services and outcomes. Further, they believe that the opportunities
for specialized blindness services by qualified staff would not long
survive in a generic service delivery environment. Although
opposing disability groups have called for the end of federal VR
funding of separate agencies serving only those consumers who
are blind or visually impaired, there have been few empirical studies
investigating the effects of agency structure on rehabilitation
services and outcomes. This review confirmed that (a) the
heterogeneity of administrative structures has complicated the
process of making valid comparisons of rehabilitation programs, (b)
the mixed findings from studies have not provided conclusive
evidence that separate agencies are more effective nor have they
provided evidence that general agencies are equally effective, and (c)
additional research is needed. In response, this present study
investigated and reported characteristics, services, and outcomes
for blind or visually impaired consumers served in different agency
structure types.
METHOD
Subjects
The data for the present study were selected from the 1989
RSA-911 database. This database includes slightly more than
613,000 records from state-federal VR clients whose cases were
closed in fiscal year 1989. Of those, we were interested in cases
with major disabling conditions of blindness or visual impairments.
Thus, in the first round of case selection, the 38,387 cases with RSA
codes 100-149 for the primary disabling condition were retained,
and all other cases were dropped. In the second round of case
selection, cases served in Washington, DC and the US Territories
(1,890 cases) were dropped, leaving a total population size of 36,497
cases. This is the number of cases used in most analyses, though
deviations from this population size occurred with some variables
where there were data-entry errors and/or missing data.
The 1989 RSA-911 Database
The 1989 RSA-911 database was obtained from the RSA Data
Management Unit and transferred from tape to CD-ROM as an
ASCII text file. The corresponding Data Processing Documentation
issued on April 9, 1990 was also obtained and used to identify the
structure of the database for further processing.
Converting the Data into an SPSS Data File
The documentation for the 1989 RSA-911 database was used
to define the beginning and ending columns for each variable in an
SPSS 7.5.1 for Windows 95/NT command syntax file. The data were
read as a fixed width ASCII text file. Most variables were defined as
numeric variables and the remaining variables were defined as
string variables to accommodate alphabetic character entries.
Descriptive variable labels were assigned to each variable with
SPSS commands, and labels for each possible value of a variable
were assigned where appropriate. In order to facilitate future
comparisons with the 1994 data set, the Reporting Manual for the
Case Service Report (for the 1994 RSA-911 database) was obtained
and variables that were common between the two databases were
labeled in accordance with the 1994 documentation; otherwise,
labels were assigned according to the 1989 documentation.
Database Cleaning and Variable Recoding
The data were inspected for missing, impossible or invalid
codes, and inconsistencies between selected variables. Some
variables were recoded so as to exclude invalid values or to extract
specific categories from existing variables. User-defined missing
values were used to prevent invalid codes from being confused
with valid data and to allow them to be treated separately from
cases where data were explicitly coded as having been Not
Reported.
Some variables not explicitly stored in the database were
computed from existing variables (e.g., age at application was
computed from date of birth and date of application). In computing
age, some cases were found to have two-digit birth year codes that
were unlikely (for example, 97) unless they represented people born
in the 1890s, so all birth year codes were converted to four-digit
codes to accurately handle these cases. Other new variables were
simply recoded forms of existing variables with new labels selected
by the authors for the purposes of the present study. For example,
the level of vision of a client was a recoded form of the major
disabling condition recorded in the RSA-911 database, as described
below.
Vision Classification
For the present study, each client was classified into one of
three levels of vision. The major disabling condition variable in the
database was recoded to represent cases with RSA codes 100-119
as Legally Blind (20/200 in better eye or limitation in field with less
than 20 degrees), codes 120-129 as Visually Impaired (better eye
with correction less than 20/60, but better than 20/200, or
corresponding loss in visual field), and codes 130-149 as Some
Visual Loss (blindness one eye or visually impaired, other eye better
than 20/60). Analyses were also performed using four levels of
vision by dividing the Legally Blind group into clients with no light
perception and clients with severe visual impairments (legally blind),
but the results were similar enough to the analyses based on three
categories that the analyses based on four vision categories were
not reported here.
Status Codes
In tracking the vocational rehabilitation process, RSA has
developed a standard coding system for use by VR agencies. The
process is categorized into statuses represented by two-digit codes.
One of several status codes is assigned to a case at the time of
closure. A case may be closed as not accepted for services from
applicant status (08 from 02); as not accepted for services after
extended evaluation status (08 from 06); as rehabilitated (26); as
not rehabilitated after an Individualized Written Rehabilitation
Program (IWRP) was initiated (28); or as not rehabilitated before an
IWRP was initiated (30). Thus, clients not accepted for services were
status 08 closures, while those accepted for services were status
26, 28, or 30 closures. Statuses 28 and 30 are both unsuccessfully
rehabilitated cases, differing only in whether services had been
initiated by the time of closure. Status 28 clients had received at
least some services before the case was closed, while status 30
clients had not yet received services.
It is noteworthy that the RSA and the Council of State
Administrators of Vocational Rehabilitation (CSAVR) are
collaborating in an ongoing streamlining initiative to increase the
effectiveness and efficiency of the state-federal VR program. As a
result of this initiative, Schroeder (1998) has reported actions
undertaken by many state VR agencies to implement innovative
management information systems with expectations these changes
will result in more responsive service delivery systems. Clearly,
major improvements in the data reporting process will also entail a
revision of the current status coding system described in this study.
Focus of Analysis
Pursuant to the above description of status codes, it should be
noted that an important focus of the present analysis is on
consumers who were accepted for VR services and services were
initiated as planned in their Individualized Written Rehabilitation
Programs. It was reasoned that the impact of different agency
structure types will be manifest most meaningfully for clients who
actually receive a planned series of services within the given agency
structure type. At the same time, it is recognized that there also
may be some processing differences between agency structure
types that may influence whether and how clients reach the stage
of delivery of services. Therefore, in the reporting of results,
findings may be based on all applicants for services on some
measures (such as acceptance rates, demographics). At other
times, when most meaningful, results may be based on applicants
and/or consumers accepted for services and actually receiving
services and closed in statuses 26 or 28 (such as for number of
services received, cost of services).
Agency Classification
In order to facilitate comparisons with previous studies, the
current study uses the official RSA designation of state agencies
for categorizing agencies. In this classification system, each state
agency is designated as either a General or Blind agency.
Rehabilitation consumers reporting visual impairment as their
major disabling condition were categorized for analysis purposes
as either receiving services from Blind (hereafter referred to as
Separate) agencies or from General agencies for the 1989 fiscal
year. (A small number of consumers reporting visual impairments
in states with Separate blindness agencies were served in General
agencies. These were included with the General agency analysis.)
Separate agencies were those reporting a separate administrator,
separate budget authority, and separate state plan for provision
of services to blind or visually impaired persons. All other agencies
were designated as General agencies. These agencies provided
rehabilitation services to all disability groups including persons with
visual impairments.
Case service data from 74 state VR agencies were included on
the FY 1989 database obtained from RSA. (Data from the Nebraska
agency for the blind were not available.) Of these 74 VR agencies, 24
were identified as Separate agencies and the remaining 50 were
identified as General agencies. The latter included 25 General
(sometimes referred to as Combined or Single) agencies providing VR
services to all consumers with disabilities in their states plus 25
General agencies coexisting in states with Separate agencies for the
provision of services to persons who are blind (see Appendix). In
other words, in about half the states, a Separate agency served
consumers who are blind and coexisted with a General agency
serving other disability groups which may also have served a limited
number of consumers with visual impairments. In the other half
of the states, a General or Combined agency served all consumers
with disabilities, including those with a primary disability of
blindness or visual impairment.
Data Analysis
Analysis was directed toward providing comparisons of
demographic and disability characteristics, services, and outcomes
of consumers with blindness or visual impairment served in
Separate and General agencies. SPSS version 7.5.1 for Windows
95/NT was used for all analyses. Because the data set is a census of
blindness VR cases closed in 1989 and can be considered population data,
descriptive indices were used to report collective characteristics of this population.
Thus, these data provide reliable population parameters for VR cases closed in FY
1989. Statistical tests--for example between agency type groups or levels of
vision--were not employed since such techniques are designed to test hypotheses
and estimate population parameters from samples. Because population data are
available, such tests are not necessary or appropriate. Even if statistical tests were
applied, the increased power from the extremely large number of cases would find
small differences to be statistically significant thus attaching misleading
importance to trivial differences. It is recommended that interpretations
be guided by the apparent practical significance of differences as
judged by readers who are accustomed to dealing with the
measures and indices in the context of program administration.
Therefore, this monograph presents tables of means, proportions,
and percentages and highlights those differences and similarities
that are of practical interest to readers. It is hoped that these
data will serve to provide rehabilitation professionals with critical
information pertaining to the debate over the efficacy of Separate
agencies for consumers who are blind or visually impaired.
RESULTS
The RSA-911 report of VR consumers closed in fiscal year 1989
was the source for these results. From this database, records of
the 36,497 consumers having a primary disability of visual
impairment (RSA codes 100-149) from the 50 states were selected
for analysis. Unless otherwise noted, deviations from this sample
size occurred only in cases where there were data-entry errors
and/or missing data.
Sample Characteristics
Although many cases had incomplete records, basic
demographic data were available for nearly all cases. Of the
36,497 cases, 53.3% were female (n = 19,450), 46.7% were male (n =
17,036), and 0.03% were missing data on client sex (n = 11).
Approximately 77.9% of the clients in the sample were White (n =
28,447), 18.7% were African Americans (n = 6,820), 1.3% were Asian
or Pacific Islanders (n = 480), 0.8% were American Indians/Alaskans
(n = 278), and data on race were not reported for 1.3% of the
sample (n = 472). Hispanic origin is recorded separately from race
in the RSA-911, and 8.8% of the clients were of Hispanic origin (n =
3,215), while 90.4% were not (n = 32,977), and 0.8% were missing
data (n = 305) on this variable. The mean age of the clients was 44.6
years (SD = 18.79), based on the 35,213 cases for which an age could
be determined.
Separate agencies served 51.0% of the consumers (n = 18,621),
while the remaining 49.0% of the consumers (n = 17,876) were
served by General agencies. A breakdown of the cases by closure
status revealed that 29.0% (n = 10,572) of the cases were not
accepted for services (status 08 from 02), 1.6% (n = 597) of the
cases were not accepted for services after extended evaluation
(status 08 from 06), 51.7% (n = 18,881) were successfully
rehabilitated, 13.7% (n = 5,013) were closed not rehabilitated after
services were initiated (status 28), and 3.9% (n = 1,434) were closed
not rehabilitated before services were initiated (status 30).
Research Question 1: What are the demographic and disability characteristics of
blind or visually impaired consumers served in the federal-state VR program?
Levels of visual impairment. Of the total number of VR consumers
with a primary disability of visual impairment, almost half (47.4%)
were Legally Blind (20/200 in the better eye or less than 20 degrees
field). Of the remainder, 11.7% were Visually Impaired (better eye,
with correction, less than 20/60, but better than 20/200; or
corresponding loss in visual field) and 40.9% had Some Visual Loss
(blindness one eye or other visual impairment, but more than 20/60
in the better eye). While more than half (52.2%) of the consumers
served in Separate agencies were Legally Blind, only 42.4% of the
consumers served in General agencies were Legally Blind.
Race and ethnicity. Overall, a slightly smaller percentage of White
consumers were found in Separate agencies (77.9%) than in General
agencies (80.0%). Percentages of consumers by race, level of vision,
and agency structure type are reported in Table 1. Race is
subgrouped into three levels of vision loss from most severe to
least severe (Legally Blind, Visually Impaired, and Some Visual Loss).
For consumers in the Legally Blind group, Separate agencies served
1.8% fewer Whites, 3.5% more African Americans, 0.4% fewer
American Indians/Alaskans, and 1.4% fewer Asians/Pacific Islanders
than did General agencies. For consumers in the Visually Impaired
group, Separate agencies served 2.5% fewer Whites, 3.9% fewer
African Americans, 0.6% fewer American Indians/Alaskans, and
0.9% fewer Asians/Pacific Islanders. For consumers in the Some
Visual Loss group, Separate agencies served 2.7% fewer Whites,
4.3% more African Americans, 0.5% fewer American
Indians/Alaskans, and 1.1% fewer Asian/Pacific Islanders.
Overall, Separate agencies served considerably more
consumers of Hispanic origin (12.2%) than did General agencies
(5.4%). Separate agencies served 2.8% more Hispanics (7.5% vs. 4.7%)
in the Legally Blind group, 5.7% more Hispanics (10.1% vs.
Table 1: Race of Consumers by Level of Vision and Agency Structure
Race of
Consumer
Legally Blind
Visually
Impaired
Some Loss
Total
Separ
ate
Gene
ral
Separ
ate
Gene
ral
Separ
ate
Gene
ral
Separ
ate
Gene
ral
White
79.3
%
81.1
%
77.6
%
80.1
%
76.2
%
78.9
%
77.9
%
80.0
%
African American
19.3
%
15.8
%
21.0
%
17.1
%
22.6
%
18.3
%
20.7
%
17.1
%
American
Indian/Alaskan
0.4%
0.8%
0.5%
1.1%
0.7%
1.2%
0.5%
1.0%
Asian/Pacific
Islander
0.9%
2.3%
0.8%
1.7%
0.5%
1.6%
0.8%
1.9%
4.4%) in the Visually Impaired group, and 13.2% (19.4% vs. 6.2%) more
Hispanics in the Some Visual Loss group than did General agencies.
Sex. A larger percentage of the total consumers from
Separate agencies were female (56.1%) compared with consumers
of General agencies (50.4%). With respect to levels of vision, the
percentage of female consumers in the Legally Blind group was
similar in Separate and General agencies (54.6% vs. 54.7%). This was
not true in the other vision groups where the percentage of female
consumers was larger for Separate agencies in the Visually
Impaired group (57.4% vs. 51.3%) and Some Visual Loss group (57.9%
vs. 46.0%) than for General agencies.
Age. The mean age was greater for consumers of Separate
agencies (M=46.4) compared with consumers of General agencies
(M=42.8). Comparisons of means by level of vision showed
consumers in Separate agencies were older in the Visually Impaired
group (M = 48.6 vs. 44.7) and older for the Some Visual Loss group
(M = 46.1 vs. 38.4). The mean age of consumers in Separate
agencies and General agencies was approximately the same for the
Legally Blind group (M = 46.3 vs. 46.9).
Education. Overall, consumers of Separate agencies reported
fewer years of education (M=10.4) than consumers in General
agencies (M=11.2). This finding was true for consumers from
Separate agencies for all levels of vision loss.
Transfer payments. Table 2 shows that a higher proportion of
consumers of Separate agencies received some type of public
support during the VR process than consumers of General agencies.
Public support was further grouped into either public assistance
(AFDC, general assistance, and other public assistance) or Social
Security (SSI and SSDI). Overall, Separate agencies served more
consumers who received public assistance (13.8% vs. 12.4%) and
more consumers who received SSI or SSDI (39.3% vs. 29.8%) when
compared with General agencies.
Table 2: Proportion of Clients Receiving Transfer Payments
Type of
Assistance
Legally Blind
Visually
Impaired
Some Visual
Loss
Total
Separ
ate
Gene
ral
Separ
ate
Gene
ral
Separ
ate
Gene
ral
Separ
ate
Gene
ral
Public Assistance
15.0%
11.0
%
12.6%
15.6%
11.8%
12.8
%
13.8%
12.4
%
Social Security
52.5%
48.8
%
29.3%
22.4
%
14.6%
10.8
%
39.3%
29.8
%
Secondary disability. Overall, a substantially larger percentage of
consumers of Separate agencies reported secondary disabilities
(48.6%) than were reported in General agencies (37.3%). Moreover,
these findings were true for all vision levels.
Research Question 2: What are the acceptance rates, average number of services
received, average cost of services, and duration of services for consumers with
blindness or visual impairments served in Separate agencies and General agencies?
Acceptance rates. Overall, Separate agencies accepted 67.7% of
all consumers applying for VR services, while General agencies
accepted 71.2% of all consumers applying for VR services. In terms
of severity of vision loss, Separate agencies accepted 2.3% more
consumers in the Legally Blind group, 1.0% fewer consumers in the
Visually Impaired group, and 14.8% fewer consumers in the Some
Visual Loss group than did General agencies.
Average number of services received. Of the subgroup of consumers
who were accepted for VR and services were initiated (those closed
in status 26 or status 28), Separate agencies provided a greater
number of services (M = 4.2) than General agencies (M = 3.8). From
this subgroup, Legally Blind consumers in Separate agencies received
an average of 4.6 services, while Legally Blind consumers in General
agencies received an average of 3.9 services. Visually Impaired
consumers in Separate agencies and General agencies received an
equal number of services (M = 3.8), while consumers with Some
Visual Loss received slightly fewer services in Separate agencies (M
= 3.5) than those in General agencies (M = 3.6). See Table 3 for a
summary of number of services received.
Average cost of services. For all consumers, Separate agencies
reported expenditures of $2,427 per consumer, while General
agencies reported expenditures of $1,571 per consumer. Moreover,
Separate agencies reported higher average expenditures across all
levels of vison than did General agencies. Of the subgroup of
consumers who were accepted and VR services were initiated
(closed status 26 and 28), the average cost of services was greater
in Separate agencies (M = $3,597) when compared with the average
cost of services provided by General agencies (M = $2,241). See
Table 3 for a summary of costs by level of vision loss and by agency
structure for consumers who received services and were closed
status 26 and 28.
Table 3: Consumers who were Accepted for and Received VR Services
(Closed Statuses 26 & 28)
Legally Blind
Visually Impaired
Some Visual
Loss
Total
Separ
ate
Gene
ral
Separ
ate
Gene
ral
Separ
ate
Gene
ral
Separ
ate
Gene
ral
Average Number of
Services Received
4.6
3.9
3.8
3.8
3.5
3.6
4.2
3.8
Average Cost of
Services
$3,961
$2,46
9
$3,43
2
$2,46
1
$2,93
6
$1,89
9
$3,597
$2,24
1
Duration of
Services in yrs.
2.4
2.1
2.0
2.1
1.9
2.2
2.2
2.1
Duration of services. Of the subgroup of consumers who were
accepted for and received VR services (closed status 26 and status
28), the average length of services for those from Separate
agencies was 2.2 years, while the average length of services for
those from General agencies was 2.1 years (see Table 3).
Consumers reported as Legally Blind were served longer in Separate
agencies (M = 2.4) than in General agencies (M = 2.1). This was not
true for clients in the Visually Impaired and Some Visual Loss groups.
These groups were served for a shorter period in Separate
agencies than in General agencies (see Table 3)
Research Question 3: What are the vocational rehabilitation outcomes, as measured
by (a) type of closure, (b) work status at closure, and (c) self-support for
consumers served in Separate and General agencies?
Rehabilitation rate. Separate agencies rehabilitated (closed status
26) 1.9% fewer consumers (50.8% vs. 52.7%) who applied for VR
services than did General agencies. Of the subgroup of consumers
who were accepted and VR services were initiated, 80.4% were
closed rehabilitated (status 26) in Separate agencies and 77.7%
were closed rehabilitated (status 26) in General agencies. In this
subgroup, Separate agencies closed a higher percentage in the
Legally Blind group (79.6% vs. 78.9%), in the Visually Impaired group
(80.9% vs. 78.4%), and in the Some Visual Loss group (82.0% vs.
76.0%) than did General agencies.
Work status at closure. Of the total number of Legally Blind
consumers applying for services, Separate agencies reported a
higher percentage of Competitive closures (37.7% vs. 32.9%); a
higher percentage of Sheltered Employment closures (7.3% vs. 4.3%);
a higher percentage of Self-employed closures (5.6% vs. 2.1%); a
higher percentage of BEP closures (2.0% vs. 1.7%); a lower
percentage of Homemaker closures (46.9% vs. 58.1%); and a lower
percentage of Unpaid Family Worker closures (0.5% vs. 0.9%). Work
statuses for all consumers by level of vision and agency structure
are reported in Table 4.
A similar pattern was reported for the subgroup of
consumers in the Legally Blind group who were accepted for
services and received services. In this subgroup, Separate agencies
reported a much higher percentage of Competitive closures (37.7%
vs. 32.9%); a higher percentage of Sheltered Employment closures
(7.3% vs. 4.3%), a higher percentage of BEP closures (2.0% vs. 1.7%); a
higher percentage of Self-employed closures (5.6% vs. 2.1%); a
considerably lower percentage of Homemaker closures (46.9% vs.
58.1%); and a lower percentage of Unpaid Family Worker closures
(0.5% vs. 0.9%). In the Visually Impaired group, Separate agencies
closed a lower percentage of consumers in Competitive (45.6% vs
54.5%); a lower percentage in Sheltered Employment (1.4% vs. 2.3%); a
higher percentage in Self-employment (7.6% vs. 2.8%); an almost
equal percentage in BEP (0.6% vs. 0.5%); a higher percentage in
Homemaker (44.2% vs. 39.9%); and a higher percentage in Unpaid
Table 4: Work Status at Closure
Legally Blind
Visually Impaired
Some Loss
Separate
General
Separate
General
Separate
General
Competitive
37.7%
32.9%
45.6%
54.5%
52.2%
78.1%
Sheltered
7.3%
4.3%
1.4%
2.3%
1.0%
0.8%
Self-Employed
5.6%
2.1%
7.6%
2.8%
8.5%
2.9%
BEP
2.0%
1.7%
0.6%
0.5%
0.1%
0.1%
Homemaker
46.9%
58.1%
44.2%
39.9%
37.5%
17.8%
Unpaid Family
Worker
0.5%
0.9%
0.6%
0.1%
0.7%
0.3%
Family Worker (0.6% vs. 0.1%). In the Some Visual Loss group,
Separate agencies closed a lower percentage of Competitive (52.2%
vs. 78.1%); a slightly higher percentage of Sheltered Employment
(1.0% vs. 0.8%); a higher percentage of Self-employed (8.5% vs. 2.9%);
a higher percentage of Homemakers (37.5% vs. 17.8%); and a higher
percentage of Unpaid Family Workers (0.7% vs. 0.3%).
Self-support. For the subgroup of consumers who were
accepted and services were initiated (closed in status 26 and status
28), Table 5 shows the percentages of consumers who reported
Client Income (defined by RSA as earnings, interest, dividends, and
rent) as their primary source of support at acceptance and at
closure by level of vision and agency structure. Of this subgroup of
consumers who received VR services, 20.5% served in Separate
agencies reported Client Income as their main source of support at
acceptance, while 19.2% served in General agencies reported Client
Income as their main source of support at acceptance. Of this
same subgroup, 64.2% served in Separate agencies reported Client
Income as their main source of support at closure, while 46.5%
served in General agencies reported Client Income as their main
source of income at closure.
Table 5: Self-SupportConsumers Closed Status 26 & 28
Legally Blind
Visually Impaired
Some Visual Loss
Total
Separ
ate
Gene
ral
Separ
ate
Gene
ral
Separ
ate
Gene
ral
Separ
ate
Gene
ral
Self-supporting at
Application
14.6%
12.3%
22.8%
19.4%
31.7%
27.2
%
20.5%
19.2
%
Self-supporting at
Closure
51.0%
27.1
%
79.7%
48.2
%
83.8%
70.3
%
64.2%
46.5
%
DISCUSSION
The purpose of this study was to examine the vocational
rehabilitation experiences of consumers who are blind or visually
impaired. More specifically, its purpose was to gain greater insight
into how these experiences may differ for persons with primary
disabilities of visual impairments who are served in Separate
agencies and in General agencies. Consumers were categorized into
three groups, Legally Blind, Visually Impaired, Some Visual Loss, with
the Legally Blind group having the least vision and the Some Visual
Loss group having the most vision. Data from the 1989 RSA-911
national database were used for all analyses. Comparisons of
results from investigations of 1971 RSA data (Kirchner & Peterson,
1982), 1977 RSA data (JWK, 1981) and 1994 RSA data (NAC, 1997) have
yielded mixed results. By investigating characteristics, services, and
outcomes of consumers served in Separate and General agencies,
this current study complements previous research by permitting
comparisons across studies on key variables.
Consumer Characteristics
Overall differences. Based upon the current analyses, it is clear
that consumers of Separate agencies have different demographic
and disability characteristics than do consumers of General
agencies. More specifically, when compared with General agencies,
a higher proportion of applicants of Separate agencies
have more severe vision loss (i.e., 52.2% vs. 42.4% are
Legally Blind);
are female (56.1% vs. 50.4%);
are non-White (22.1% vs. 20.0%);
are of Hispanic origin (12.2% vs. 5.4%);
have secondary disabilities (48.6% vs. 37.3%);
receive AFDC or other public assistance (13.8% vs. 12.4%);
receive SSI or SSDI (39.3% vs. 29.8%);
have less education (M =10.4 vs. 11.2); and
are older (M = 46.4 vs. 42.8).
In commenting on JWK findings that Separate agencies close a
lower percentage of competitive closures and a higher percentage
of homemakers than do General agencies, Kirchner (1982)
questioned whether agency types differ in placement outcomes or
whether consumer demographics differ for agency types
therefore affecting employment outcomes. Results from the current
study indicate that consumers of Separate agencies are more socially and
economically disadvantaged than consumers of General agencies. If consumers
who are older, less educated, more severely disabled, more likely to
be non-White, and more likely to receive transfer payments
experience greater barriers to employment, then any valid
evaluation of the efficacy of Separate agencies must consider
differences in consumer demographic and disability characteristics
across agency types.
Vision groups. Consumers of Separate agencies are more
socially and economically disadvantaged across all levels of vision
loss. While a higher percentage of Legally Blind applicants of
Separate agencies are African American, are Hispanic, have
secondary disabilities, and receive transfer payments than are in
General agencies, differences are more pronounced for the Visually
Impaired and Some Visual Loss groups. For example, when
comparing consumers of Separate agency and General agency in
the Some Visual Loss group, a higher proportion of applicants in
Separate agencies
are female (57.9% vs. 46.0%);
have secondary disabilities (46.4% vs. 32.1%);
are African American (22.6% vs. 18.3%)
receive SSI or SSDI (14.6% vs. 10.8%);
have less education (M = 9.8 vs. 11.0);
are older (M = 46.1 vs. 38.4); and
are of Hispanic origin (19.4% vs. 6.2%).
Current findings are consistent with Kirchner and Peterson
(1982) who also reported that consumers in the other visually
impaired (OVI) group served in Separate agencies were older;
proportionately more of them were Hispanics and fewer were
Whites; and the levels of education were lower than was true for
the OVI clients served by General agencies (p. 75).
Consumer Services
Acceptance rates. While Separate agencies accept a lower
percentage of consumers in the Visually Impaired and Some Visual
Loss groups, it was not surprising to find that they accept a higher
percentage of consumers in the Legally Blind group than do General
agencies (79.5% vs. 72.2%). These results are consistent with
Kirchner and Peterson (1982) who also reported that Separate
agencies accepted more consumers who were legally blind and
fewer consumers with other visual impairments when compared
with consumers accepted by General agencies. Moreover, JWK (
1981) reported that Separate agencies accepted a higher percentage
of legally blind consumers than were accepted by General agencies.
Although Separate agencies accept consumers in the Visually
Impaired group at close to the same percentage (74.1% vs. 75.1%),
they accept a much lower percentage of consumers in the Some
Visual Loss group (49.5% vs. 64.3%) than do General agencies. Given
that this finding is consistent over time with the findings of both
Kirchner and Peterson and JWK, it is important to investigate
reasons for this difference. An analysis of the subgroup of
consumers in the Some Visual Loss group who were not accepted
for services (closed in status 08 from statuses 02 and 06) indicates
that Separate agencies compared with General agencies report the
following reasons for closure:
unable to locate/contact/moved (5.7% vs. 13.4%);
handicap too severe (2.4% vs. 3.8%);
refused services (11.7% vs. 20.1%);
death (0.8% vs. 0.8%);
client institutionalized (0.2% vs. 0.6%);
transferred to another agency (6.6% vs. 3.8%);
failure to cooperate (5.7% vs. 16.3%);
no disabling condition (28.6% vs. 10.6%);
no vocational handicap (32.0% vs. 18.4%);
transportation not feasible/available (0.1% vs. 0.1%); and
all other reasons (5.6% vs. 12.1%).
Because Separate agencies may restrict services to consumers
with more severe visual impairments, we expected and found that
a higher percentage were closed for reasons of no disabling
condition, transferred to another agency, or no vocational
handicap. In addition, we found that consumers in the not legally
blind groups differ considerably in Separate and General agencies
on a number of socio-demographic characteristics which have
been found to be negatively related to labor force participation
(LaPlante, Kennedy, & Trupin, 1996). It is reasonable to expect that
major socio-demographic differences would not only affect
acceptance rates but also services, rehabilitation rates, and types
of work statuses. More simply, consumers in the Some Visual Loss
group in Separate agencies share one overriding disability
characteristic--degree of vision loss with consumers in General
agencies but differ considerably on other socio-economic
characteristics. Therefore, it is not logical or methodologically
adequate to evaluate the efficacy of agency types based on their
acceptance rates without controlling for obvious demographic and
disability differences.
Number of services. Of the subgroup of consumers who were
accepted and services were initiated, Separate agencies provide a
higher number of services to those in the Legally Blind group when
compared with the number of services provided by General
agencies (M = 4.6 vs. 3.9). Again, this finding is expected given that
consumers in the Legally Blind group in Separate agencies also spend
more time in VR than the Legally Blind group in General agencies.
Separate and General agencies provide essentially the same number
of services to the Visually Impaired group and the Some Visual Loss
group. These results are also consistent with findings that duration
of services in Separate agencies is only slightly less for the Visually
Impaired and Some Visual Loss groups when compared to General
agencies. In our review of the literature, comparative data
reporting differences in the number of services provided by
different agency types were unavailable.
Cost of services. It also came as no surprise that the average
cost of services in Separate agencies is higher for all three vision
groups when compared with the average cost of services in
General agencies. This finding is true for all consumers including the
subgroup of consumers who were accepted and services were
initiated. Cost of services can be explained, in part, by differences
in consumer characteristics and therefore, types and number of
services provided. It should be noted that Separate agencies
provide a different blend of services than do General agencies. For
example, the subgroup of Legally Blind consumers closed
rehabilitated (status 26) when compared with the same subgroup in
General agencies, received the following services:
physical restoration services (54.4% vs. 44.7%);
university training (8.5% vs. 7.8%);
adjustment services (51.6% vs. 40.6%);
business and vocational training (3.3% vs. 5.3%);
on-the-job training (14.4% vs. 5.8%);
counseling and guidance (80.2% vs. 64.2%);
job referral (28.1% vs. 22.9%);
transportation (35.6% vs. 28.0%);
maintenance (24.1% vs. 16.3%); and
job placement (24.5% vs. 20.3%).
A considerable difference was found in the blend of services
provided to rehabilitated closures (status 26) for the Some Visual
Loss group. Given the socio-demographic differences between
agency types for the Some Visual Loss group, it is not surprising
that consumers of General agencies were approximately 4 times
more likely to receive university training (12.0% vs. 2.8%) and
business/vocational training (8.4% vs. 1.6%) than consumers of
Separate agencies. (Consumers of General agencies in the Some
Visual Loss group are younger, more educated, more likely to be
male, and less likely to have a secondary disability.)
Because R-911 data include only the total amount of money
spent for purchased services, costs for different categories of
services were unavailable and without additional information,
there was no evidence to suggest that one agency type is more cost-
effective than another. More importantly, most studies have
reported that the cost of services is higher in Separate agencies
than in General agencies. For example, JWK (1981) reported that
Separate agencies spend more for services to legally blind
consumers than do General agencies. They also reported that
Separate agencies spend less, or the same, for services to the
remaining visually impaired consumers. NAC (1997) reported the
average cost of services was approximately $600 more in
Separate agencies than in General agencies.
Understanding the potential effect of these findings on public
policy and, therefore, the survival of specialized programs, a
number of interpretations have been advanced within the
rehabilitation community. Supporters of specialized programs may
equate higher cost with positive outcomes (e.g., quality services),
while opponents may equate higher cost with negative outcomes
(e.g., duplication and waste). Given the probable relationship of
socio-economic demographics to financial need policies, types, and
number of services, etc., it is reasonable to expect a higher average
cost of services in Separate agencies. Certainly, we can expect
diverse responses from the rehabilitation field, given the oftentimes
unique perspectives of blind consumers, administrators, and other stakeholders.
Duration of services. The average time (years) spent in VR is
greater in Separate agencies for consumers in the Legally Blind
group (M = 2.4 vs. 2.1) and less for consumers in the Visually
Impaired (M = 2.0 vs. 2.1) and Some Visual Loss groups (M = 1.9 vs.
2.2) when compared to General agencies. Given the expectation
that time spent in services would positively correlate with the
number of services received, these results are consistent with
those which indicate that Separate agencies provide 0.7 more
services to consumers in the Legally Blind group, an equal number of
services to consumers in the Visually Impaired group, and 0.1 fewer
services in the Some Visual Loss group than do General agencies.
NAC (1997) did not find any difference in the amount of time spent
in services for consumers in Separate and General agencies in its
report of 1994 data.
Consumer Outcomes
Rehabilitation rate. Rehabilitation rate is a valuable outcome
measure used routinely in program evaluation. From the current
study, we found that Separate agencies rehabilitate 50.8% of
consumers applying for services, while General agencies rehabilitate
52.7% of those applying for services. Of the subgroup of
consumers who were accepted and VR services were initiated
(status 26 and 28 closures), Separate agencies rehabilitate 80.4%,
while General agencies rehabilitate 77.7%. For the most part, these
findings are consistent with other studies investigating agency
structure. NAC (1997) reported that the overall rehabilitation rate
was 2% higher for General agencies, but they also reported that
the rehabilitation rate for consumers with secondary disabilities
was 7% higher in Separate agencies. Further, Kirchners (1982)
analysis of the RSA 1977 data indicated that the overall
rehabilitation rate in Separate agencies was slightly higher for
legally blind consumers than in General agencies (77% vs. 74%) but
lower for all other visually impaired consumers (61% vs. 67%).
Additionally, Kirchner and Peterson (1982) reported that Separate
agencies rehabilitated a higher percentage of legally blind and other
visually impaired consumers than General agencies.
Work status. An equally important outcome measure examined
in program evaluation is the consumers work status after
receiving rehabilitation services. Rehabilitated consumers are
assigned to one of six work statuses at closure--competitive labor
market, sheltered workshop, self-employed, BEP, homemaker, and
unpaid family worker. Of special concern are the low numbers of
BEP and self-employment closures. Specifically, Separate and
General agencies combined reported only 208 BEP closures and 863
self-employed closures. Separate agencies closed 1.3% of total
consumers into BEP and 6.7% into self-employment, while General
agencies closed 0.9% into BEP and 2.5% into self-employment. In
contrast, U. S. Census data indicate that people with a work
disability report being self-employed at nearly twice the rate of the
general population (14% vs. 8%) (Seekins, 1992).
Although the homemaker closure has been considered a
successful VR outcome since the first civilian rehabilitation
legislation in 1920, Separate agencies have traditionally been
credited with having a higher rate of homemaker closures than
have General agencies. Despite the fact that current findings
suggest that this may be an outdated assumption, members in the
disability community continue to embrace it as the truth. For
example, in a March 17, 1997 memo to fellow NCD members, Bonnie
ODay reported that the rehabilitation rate for 1993-94 was higher
in Separate agencies than in General agencies (67% vs. 60%), but in
the same paragraph, she appeared to qualify this finding by
reminding Council members that blindness agencies have a higher
rate of closures in homemaker/unpaid family worker status. In
this same memo, ODay cited NACs (1997) finding that General
agencies placed a higher percentage of homemakers and unpaid
family workers, but may have cast doubt on the veracity of these
findings with her follow-up statement that This finding is
contrary to all other research I could identify. The purpose of
ODay memo was to summarize research and arguments for and
against Separate agencies in order to facilitate Council discussion
of its relationship to the current reauthorization of the
Rehabilitation Act of 1973.
In fact, our results are consistent with NACs findings that
Separate agencies place a considerably lower percentage of legally
blind consumers as homemakers (46.9% vs. 58.1%) than do General
agencies. Further, Separate agencies place a higher percentage of
legally blind consumers into competitive closures (37.7% vs. 32.9%),
sheltered employment (7.3% vs. 4.3%), self-employment (5.6% vs.
2.1%), and BEP (2.0% vs. 1.7%). It is noteworthy that analyses of
more current RSA data (i.e., 1989, 1994) show an opposite trend
relative to earlier analyses of 1971 RSA data (Kirchner & Peterson,
1982) and 1977 RSA data (JWK, 1981). Continued analyses of
available RSA-911 data should allow greater insight into the
relationship of type of placement and agency structure.
Self-support. At the time of application for rehabilitation
services, consumers are asked to describe their largest single
source of support. Based on their responses, 1 of 11 possible
categories of support is selected. The categories include (a) client
income (earnings, interest, dividends, rent); (b) family and friends; (c)
private relief agency; (d) public assistance, at least partly with
federal funds (SSI and AFDC); (e) public assistance, without federal
funds; (f) public institutiontax supported; (g) workers
compensation; (h) Social Security Disability Insurance; (i) all other
public sources; (j) private insurance, and (k) all other sources. In
addition, consumers answer an identical question at closure and
again are assigned to 1 of 11 possible categories.
Given the estimated 1994 labor participation rate of only
28.9% for adults blind in both eyes (Trupin, Sebesta, Yelin, & LaPlante,
1997), investigations of agency structure and its effect on
consumer earnings are especially appropriate and timely. For those
persons who were accepted and services were initiated, these
analyses indicate that slightly more consumers in Separate agencies
reported client income (earnings, interest, dividends, and/or rent) as
their largest source of support at application than were reported
by consumers in General agencies. Specifically, in the Legally Blind
group, 14.6% from Separate agencies reported client
income/earnings, while 12.3% from General agencies reported client
income/earnings. Moreover, consumers with the most severe visual
impairments were the least likely to report client income/earnings
as their largest source of support at application--the less vision
involved, the lower the chance of client earnings at application.
From the review of the literature, we did not anticipate, but found,
that a considerably higher percentage of the subgroup of
consumers who were accepted and received services in Separate
agencies reported client income/earnings at closure as their largest
source of support than reported by consumers in General agencies.
Specifically, of the subgroup of consumers who were accepted and
received VR services, our analyses indicate the following:
1. While 51% of the Legally Blind group in Separate agencies
reported income/earnings at closure, 27.1% in General
agencies reported such income.
2. While 79.7% of the Visually Impaired group in Separate
agencies reported income/earnings at closure, 48.2% in
General agencies reported such income.
3. While 83.8% of the Some Vision Loss group in Separate
agencies reported income/earnings at closure, 70.3% in
General agencies reported such income.
These results are especially noteworthy given the expectation that
demographic and disability characteristics more typically
characterizing consumers from Separate agencies would generate
greater barriers to self-support.
CONCLUSIONS AND IMPLICATIONS
This study uses a descriptive approach to investigate
demographic and disability characteristics, services, and outcomes
of consumers who are blind or visually impaired served in state-
federal VR programs. In contrasting key measures reported by
Separate blindness agencies and General agencies, our findings
support the following major conclusions:
Separate blindness agencies serve a higher percentage of consumers
with socio-demographic characteristics associated with lower labor
force participation rates.
Separate blindness agencies serve a higher percentage of consumers
with the most severe visual impairments (i.e., legally blind).
Separate blindness agencies provide a higher number of services to
consumers with the most severe visual impairments (i.e., legally blind).
Separate blindness agencies incur greater service costs (consumers
have more severe vision loss and are more likely to have secondary
disabilities).
Separate blindness agencies serve consumers who are more likely to
report client income/earnings as their primary source of support at
closure.
Separate blindness agencies rehabilitate (close status 26)a slightly
lower percentage of all consumers who apply for VR services but
rehabilitate a slightly higher percentage of the subgroup of consumers
who are accepted and VR services are initiated.
Separate blindness agencies close a lower percentage of legally blind
consumers as homemakers.
Separate blindness agencies close a higher percentage of legally blind
consumers as BEP and self-employed, but both agencies report
considerably lower percentages than the national average for self-
employment.
Separate blindness agencies close a higher percentage of legally blind
consumers into competitive labor and in sheltered employment.
Although the current conclusions are based on analysis of
fiscal year 1989 RSA-911 data, they are compared with findings
from analyses of 1971, 1977, and 1994 RSA data. In doing so, our
conclusions are corroborated with studies which also reported
that Separate blindness agencies serve consumers who are (a)
more socially disadvantaged, (Kirchner & Peterson, 1982, p. 76); (b)
more likely to be legally blind (JWK, 1981; Kirchner, 1982); and (c) more
likely to report a secondary disability (NAC, 1997). Although
analyses of 1971 and 1977 RSA data indicated that Separate
blindness agencies close more homemakers (JWK, 1981; Kirchner &
Peterson, 1982), our finding that Separate blindness agencies close a
lower percentage of homemakers is consistent with more recent
studies (NAC, 1997).
From a statistical perspective, Fisher has advanced the
philosophy that in the absence of conclusive significant results of
differences between treatments, existing programs should continue
until further research shows differences at some predetermined
level (Howell, 1992). In other words, policy makers using a Fisherian
perspective would continue support of Separate agency programs
unless further research demonstrates the superiority of General
agencies in serving all blind consumers and particularly those who
might be considered socially disadvantaged.
With the foregoing conclusions in mind, it is important to note
that Separate blindness agencies continue to exist in a political
climate hostile to categorical service delivery models. Although
empirical research has not shown that Separate agencies are less
effective than General agencies (and, in fact, tends to support the
efficacy of Separate blindness agencies), some may argue that
Separate agencies are anachronistic and their existence threatens
a preferred inclusive or integrative service delivery environment. It
appears that supporters of single or combined agencies would have
blind consumers take a trust me approach that specialized
services would survive in a generic environment and be available to
them as needed. In a widely distributed e-mail message, C. H.
Crawford (personal communication, March 28, 1997) suggests that
when any group of people have needs that are sufficiently unique
to warrant specialized and separate services, that they should
receive those services from an agency dedicated to servicing that
group. Also taking an opposing perspective, Edwards (1977, p. 2)
argues that VR order of selection policies, which require that
individuals with the most severe disabilities are selected for services
before other individuals with disabilities, will not protect effective
service delivery for blind people. Edwards also contends that, most
importantly, blind people have said what they want and have a
right to have the service delivery they choose.
In conclusion, we are struck by the impact of socio-
demographic characteristics on the VR process (i.e., types, duration,
and costs of services received; outcomes, etc.). In spite of serving a
higher proportion of socially disadvantaged consumers, our
findings indicate that Separate agencies respond as well as, or
better than, General agencies on key outcome measures. At the
same time, we recognize that (a) consumer characteristics, (b)
diversity of specialized service delivery within each agency type,
and (c) other environmental forces combine to form complex
interactions influencing VR outcomes. These interactions cannot be
fully understood outside a multivariate research context. Quality
of agency personnel, presence and power of consumer
organizations, economics, public policy, opportunities for specialized
itinerant and center-based services, agency organizational changes,
and employment opportunities are but a few of the variables
which combine to forge a unique VR experience for each consumer.
With a 1994 estimated labor force participation rate of only 28.9%
for persons blind in both eyes and 39.1% for persons with visual
impairments in both eyes (Truppin et al., 1997) rehabilitation
professionals and policy makers must focus on increasing
employment opportunities for consumers who are blind or visually
impaired and be wary of any policy changes that would likely lead
to increased unemployment.
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APPENDIX
Separate Agencies
General Agencies *
Arkansas
Alaska
Montana
Connecticut
Alabama
Nebraska
Delaware
Arizona
Nevada
Florida
Arkansas
New
Hampshire
Idaho
California
New Jersey
Iowa
Colorado
New Mexico
Kentucky
Connecticut
New York
Massachusetts
Delaware
North
Carolina
Michigan
Florida
North
Dakota
Minnesota
Georgia
Ohio
Mississippi
Hawaii
Oklahoma
Missouri
Idaho
Oregon
New Jersey
Illinois
Pennsylvania
New Mexico
Indiana
Rhode Island
New York
Iowa
South
Carolina
North Carolina
Kansas
South
Dakota
Oregon
Kentucky
Tennessee
Pennsylvania
Louisiana
Texas
Rhode Island
Maine
Utah
South Carolina
Maryland
Vermont
Texas
Massachus
etts
Virginia
Vermont
Michigan
Washington
Virginia
Minnesota
West Virginia
Washington
Mississippi
Wisconsin
Missouri
Wyoming
* This category includes general agencies that co-exist in
the same state with a separate blindness agency as well
as single or combined agencies that exist in states that do
not have a separate blindness agency.