VOLUME II TABLE OF CONTENTS FOREWORD SUMMARY OF BOTH VOLUMES TABLE OF CONTENTS TASK FORCE REPORTS Case finding Evaluation, Treatment and/or Training Occupational Placement and Follow-Up Internal Structure and Organization Interagency Cooperation and Coordination Manpower Needs and Potential STAFF CONDUCTED RESEARCH Community Involvement: A Pilot Project A Pilot Project Determining the Effectiveness of a Film for Orienting New VR Clients Page i iii 1 3 23 99 167 2~ 343 451 487 J J J J J J J J J J J J J J J J J J J J J J J J FOREWORD This, the second volume of the Statewide Vocational Rehabilitation Planning Project's Final Report, reflects the diligence of many individuals and groups as they worked to determine the needs of vocational rehabilitation in Georgia. The reports embodied in this volume are the results of meetings, contracted research, surveying designated segments of the citizenry, field studies and other activities too numerous to specify. Volume One attempts to gather the most important points of each of these activities and place their context into a meaningful light in terms of implementing the recommendations that would contribute to the fruition of our task: ... so that by July 1, 1975, or sooner, vocational rehabilitation services will be available to all handicapped individuals in the State. One can readily see after reading the following summary, as it appears in Volume One, that for full appreciation of the two-year study it is necessary to examine both volumes of this document. This is especially important in connection with the recommendations and means of implementing those recommendations which were a result of this study. i SUMMARY The final report of Statewide Planning is divided into two volumes. Volume One is subdivided into five Chapters as follows: Chapter I, Introduction; Chapter II, The Planning Organization; Chapter III, Method of Operation; Chapter IV, Findings and Recommendations; and Chapter V, The Composite Working Plan. Volume II contains supporting information and data including task force research reports and reports of pilot projects necessary in the development of Volume I. The first Chapter of Volume I contains three major sections: Background, Purpose, and Scope. Under Background, a sketch of the progress of the Georgia Agency over the past decade is given. This includes the tremendous strides in expanding services and facilities for the rehabilitation of disabled people. Highlighted are the significant advances made in the rehabilitation of the mentally ill and the mentally retarded. Note is also made of the fact that Georgia's old agricultural economy is giving way to industry. The Purpose of the Planning Effort is to chart the orderly development of services and resources, both public and non-profit private, so that by July 1, 1975, or sooner, vocational rehabilitation services will be available to all handicapped individuals in the State. The Scope of the Planning Project included a study of not only services provided by the Office of Vocational Rehabilitation, but also the services provided by other governmental agencies at the local, state, and national level, and the services made available through private, non-profit organizations. Chapter II, The Planning Organization, describes the mechanics of the division of labor and specifies who was responsible for which portion of the overall task. An outline of the Chapter follows: iii A. Designated Organization G. Organizational Chart The organization designated by the Governor as responsible for statewide planning was the Office of Vocational Rehabilitation of the State Department of Education. B. Policy Board This section contains a list of names and affiliations of the members as well as the method of appointment, size, and a description of the functions of the Board. This board was established for the purpose of providing leadership, general guidance, and stimulation necessary for this planning effort. C. Statewide Advisory Committee This section contains a list of names and affiliations of the members as well as the method of appointment, size, and a description of the functions of the Committee, The Advisory Committee performed a rather unique role. Not only did they act in an advisory and consulting capacity to the Policy Board and Planning Staff, but individually and collectively played a major part in the actual formulation and implementation of the recommendations resulting from this planning effort. D. Task Forces This section describes the area of responsibility of the seven task forces and a list of the names and affiliations of task force members. E. Subcontractors Certain data and information was necessary which the Staff or the Task Forces could not feasibly produce; therefore, contracts were let to various specialized organizations to furnish this material. This section briefly describes each contract. F. The Staff In this section the influence of staff turnover is discussed in relation to periodic reorganization and redirection of project activities. This Chapter is concluded with a chart specifying the organizational structure of the entire planning effort. Chapter III, Method of Operation, describes the operational procedures in detail. The two-year interval of the Statewide Planning Project was divided into four phases by category of function. A flow chart (Chart , page ) contains an outline of the activities in these four phases and the relationship between them and the various categorical functions. This chart reflects that activities in three categories, organization, research, and pilot projects, were being pursued simultaneously throughout all four phases. This chart reflects the fact that the fruits of the planning effort were to be contained in the task force reports. The major portion of the research and data collection was done for the purpose of providing the task forces with basic information about the problem in terms of the number of handicapped to be served in terms of the quality of services to be provided and effective methods for providing these services. Chapter IV, Findings and Recommendations, is divided into three basic sections: (1) Contracted research, (2) Research conducted by Project Staff, and (3) Task Force reports. There were four areas of research contracted as follows: 1. Population Estimates and Projections. Doctors John Belcher and James D. Tarver, Department of Sociology and Anthropology, University of Georgia, were contracted to provide an estimate of Georgia's population by county, age, sex, and race. They listed two specific objectives of this study: (a) To prepare July 1, 1965 population estimates for Georgia's 159 counties by sex and race for sixteen age classifications, and (b) To prepare 1970 and 1975 population projections for Georgia's 159 counties by sex and race for sixteen age classifications. The results of these statistics were presented as a monograph with one page for each of Georgia's 159 counties. Figure 1, page , and Figure 2, page , show the population changes from 1965 to 1975 for each county and for each district of the Office of Vocational Rehabilitation. iv 2. Estimates of Disability in the State of Georgia. Doctor Thomas Porter, Coordinator, Rehabilitation Counselor Training Program, University of Georgia, accepted the contract to study the incidence of disability in Georgia. The purpose of this study was to compile and assimilate data showing the present number of people with physical and emotional impairments. Due to costs in both time and money it was necessary to rely on data already in existence. Excluding school-age children, the aged, and Welfare and Social Security beneficiaries, this study shows that persons in the designated disability grouping comprise 30.6% of Georgia's total population. Because this data consists mainly of persons who receive assistance and does not include all those who could qualify, these estimates and projections are, in the most instances, considered low. 3. A Follow-up Study of 151 Former OVR Clients Closed in Three Categories. Doctor Fred H. Wright, Georgia State College, was commissioned to conduct a follow-up study of former Vocational Rehabilitation clients closed in three classifications. In addition to contracted studies discussed above, the staff carried out the following research: 1. A Pilot Project Determining the Effectiveness of a Film for Orienting New VR Clients. A film was produced about Vocational Rehabilitation services which might be used in a client orientation program. A basic assumption was that those clients who see an orientation film about Vocational Rehabilitation will have a better understanding of the rehabilitation process. A research design was developed to evaluate the effectiveness of this film. The results of this pilot project in terms of client orientation through a film indicate needs in several areas. These can be summarized in the following observations: a. This study and others prove that clients can learn from such a method of instructions, and, indeed, a better understanding of the rehabilitation process would seem to increase his personal esteem as a member of society. The objectives of this study were to discover from the client's point of view existing practices of Vocational Rehabilitation in terms of characteristics of the population served, services rendered, status of the client at the time of the survey, relative satisfaction with services, client's perceptions and attitudes toward Vocational Rehabilitation, and recommendations for improvement. It was hoped that the study would shed light on practices typical of Vocational Rehabilitation which may militate against successful rehabilitation. The following is a summary of recommendations from this study: a. Re-evaluate the image which VR wishes to portray to the public, both clients and non-clients. b. Based on the re-evaluation, create and initiate a publicity program to inform the public of VR. c. Study in depth the factors which caused the latency in case reporting as shown in this study and initiate within the system controls for preventing its recurrence. b. By standardizing what a client learns about Vocational Rehabilitation at his first contact, there should be less misunderstanding about what services are available, who provides them, and who is eligible for them. c. This tool appears to be the best method for use with clients covering a wide range of educational background. d. Implementation of this method of client orientation would not consume an extreme amount of space nor time. e. The weaknesses in the film are in the process of being corrected. 2. Community Involvement: A Pilot Project. The Planning Project established a Technical Force composed of volunteers with experience in community-wide activities, as well as interest in vocational rehabilitation, to investigate the feasibility and means of attaining an involvement on the grass roots level in the rehabilitation program. v For this project, a community was defined as a county. This decision was made because records of schools, disabilities, hospitals, etc., are kept on a county level. In order to categorically clarify the re:o~endations ~or the purpose of placing pr1or1ty on the 1mplementation presented in Chapter V, the recommendations have been grouped according to logically related functions. The Technical Force decided upon basic steps which would lead to the ultimate goal of involvement. Members of the local vocational rehabilitation offices were to be asked to enlist the support of various leaders in community life to act as an advisory group in establishing an involvement program. Although the Technical Force would create a format that would possibly be used to initiate a program of community involvement, it was agreed that the Advisory group would have to decide: (1) Whether or not it was felt that such a program was, in fact, wanted, and (2) the actual means by which a program could be established and perpetuated if it was decided it would be worthwhile. To be a meaningful program on a community level, the Technical Force felt it was necessary that an organization within the community should be approached to establish, and maintain an involvement program within its boundaries. The Advisory group (after agreeing on the importance of this program) would suggest such a group to be approached with the request that they take the vocational rehabilitation community involvement program as a continuing project. Although the Technical Force realized failures and disillusionment in the Pilot Study of two Georgia counties for Community Involvement, it is emphasized that these shortcomings ~ be observed objectively for actual implementation of a realistic program for the remaining counties. Every community will have its own pitfalls; the preceding narrative was recorded so that further planning in this area can take into account basic errors which can be avoided. The conviction of the Planning Project and the steadfastness of the Technical Force remain unchanged: community involvement is a vital part in the total vocational rehabilitation program. Summaries of the recommendations from the task forces are also contained in this chapter. The combined summaries and recommendations will be discussed in the summary of Chapter V that follows. The fact that the Governor designated the OVR to carry out the Statewide Planning establishes expectations in the high levels of government that this Agency will offer leadership in developing sound rehabilitation programs. Accepting this responsibility, a specialized Task Force was organized to evaluate the effectiveness of the present organizational structure of the OVR. Based on this study, the Planning Staff concludes that reorganization is vital. The reorganizing of the structure of the key agency offering the widest range of rehabilitation services must receive first priority since the implementation of the other recommendations is contingent on such a workable organizational structure. The spirit of the federal planning guidelines requires that there be no duplication of rehabilitation effort in the state. In order to utilize this principle in the provision of quality services, it is imperative that the implementation of Interagency Cooperation recommendations be given subsequent priority to the reorganization of the OVR. Concurrent and in conjunction with the activation of the plan for Interagency Cooperation would be the implementation of the recommendations contained under the category of Rehabilitation Services and Facilities. Initial efforts to effectuate the Interagency recommendations should, in fact, lay a firm foundation for supporting cooperative efforts in the establishment of these facilities and services. In view of the fact that all of the Task Forces either implicitly or explicitly emphasized the importance of public awareness, it was obvious that this category of recommendations should be highlighted, even though the element of public awareness is intertwined among all the recommendations. Not only does this establish priority, it gives an opportunity to exemplify the activity of actual implementation of this study and the OVR specifically. vi STATEWIDE VOCATIONAL REHABILITATION PLANNING PROJECT Vernon L. Vinson Project Coordinator William M. Holbert, Ph.D. Consultant Miss Karen Butler Research Associate Charles Long Information Officer Mrs. Allowee Hatcher Stenographer Mrs. Audrey Powell Typist Miss Theresa Anglin Typist REPORT OF THE TASK FORCE ON CASEFINDING Statewide Vocational Rehabilitation Planning Project CASEFINDING TABLE OF CONTENTS Page Background and Problem .................................... 6 Basic Data ........................................ 7 Discussion ........................................................ 20 Summary and Recommendations ..................... 21 6 The basic problem of the task force on casefinding becomes one of developing procedures that will bring these unknown individuals in need of vocational rehabilitation services in contact with a vocational rehabilitation counselor. BACKGROUND AND PROBLEM Casefinding is an old, recognized responsibility of the rehabilitation counselor. It is only meagerly treated in most orientation and training programs for counselors, and almost totally neglected as an area of research. The prime goal of this planning effort is to provide, by 1975 or before, vocational rehabilitation services to all citizens of the State of Georgia who are in need of and could or would benefit from such services. The Rehabilitation Services Administration (formerly Vocational Rehabilitation) estimated a few years ago that there were 3.7 million impaired individuals in this country who are in need of and could benefit from rehabilitation services. They also estimated that there were approximately 500 thousand additional individuals acquiring impairments each year who could benefit from such services. Assuming that Georgia has its proportionate percentage of these individuals, there are now approximately 66,000 people who are in need of services in this State and an additional 10,000 becoming disabled each year. During the fiscal year ending June 30, 1967, Georgia rehabilitated 8,750 individuals. The present program is losing ground each year with the backlog growing larger. Based upon the above information, we will assume that: 1. There is a problem in casefinding-there are "invisible" people who can benefit from rehabilitation services. 2. There are sufficient procedural gaps to warrant planning. 3. There are basic principles of referral that can be developed and practiced. In order to realistically make recommendations on the development of procedures that will bring these unknown individuals in need of vocational rehabilitation services in contact with a rehabilitation counselor, the committee felt that it needed some basic data regarding the present referral procedures. Dr. Benjamin Wyckoff, Director of the Research Unit, was asked to prepare the following information: 1. Which disability category results in the number of individuals closed "too severe?" 2. Which disability category(ies) yield greatest number rehabilitated? 3. Which referral source(s) produce the greatest number who are accepted for servcies? 4. To what extent are individuals evaluated before closing them as "too severe?" 5. Is there a difference in the percentage of males accepted for services as opposed to females? 6. Is there a relationship between time in referral or applicant status and number accepted for services? 7. What is the relationship of money spent on evaluation between those accepted and closed "too severe?" 8. Is there a relationship between age and those accepted for services and those closed "too severe?" 9. Which referral sources have we saturated; that is, sources that are giving us all the referrals we could expect from them? Which referral sources are not saturated and would indicate they should be saturated further? 10. Is there a tendency for physicians to refer physical restoration cases only? Do educators and welfare workers tend to refer training cases only? 11. When rehabilitation counselors reject referrals, are they in turn, referred to a more appropriate resource? 12. Are clients being served in accordance with geographical distributions of disability categories? For example, if we are fairly sure that tuberculosis is evenly distributed over the State's population, do counselors' caseloads indicate that they are serving most of the clients in this disability category? Dr. Wyckoff was able to give us information on the first eight of the above items from data processing; however, he did not have sufficient records to supply information on items nine through twelve. Among the 10,837 cases closed referred, 1,616 indicated "disability too severe" as a reason for closure. This section is concerned primarily with these 1,616 cases. Data from the 10,248 cases who were accepted for services were obtained essentially as a basis of comparison. These included cases closed rehabilitated as well as cases closed otherwise, but all were accepted for services, and then closed during the year in question. The characteristics summarized in this section include the disability as reported, the referral source, sex, the number of months in referred status and expenditures for diagnosis for these clients. Table I gives the number of clients in each disability category. Disabilities are also grouped into four major groupings. BASIC DATA This portion of the report was prepared by Dr. Wyckoff, based upon the first eight of the above listed items. The data presented in this section were obtained by scanning closure records (R-300) for 10,837 clients closed referred and 10,248 clients who were accepted for services and whose cases were closed during the fiscal year ending June, 1967. Using the number of cases accepted as a basis of comparison, we note that disabilities in the communications group contribute a proportionately small number of cases closed as "too severe." Orthopedic and mental disabilities contribute a relatively high proportion of cases closed as "too severe", while internal and other disabilities, taken as a group, show a slightly lower proportion. An exceptionally high rate of rejection may also be noted for certain specific disabilities. These include impairment of three or more limbs or entire body, one upper and one lower limb (including side), other and ill-defined orthopedic impairments, psychotic disorders, epilepsy, cardiac and circulatory conditions and respiratory diseases. Cardiac and circulatory conditions represent the highest single category of "Cases Closed Too Severe." The proportion of cases considered "too severe" in this category was also high with one case being rejected for each two cases that were accepted. Exceptionally low rates of rejection as "too severe" are seen in the case of blindness in one eye, speech impairments and disorders of the digestive and genitourinary systems. Table I also breaks the 8,750 closed rehabilitated during the fiscal year ending June, 1967 into category percentages. 8 TABLE I FREQUENCY DISTRIBUTIONS OF DIFFERENT DISABILITY GROUPINGS OF CASES CLOSED REFERRED DUE TO SEVERITY OF HANDICAP AND CLOSED REHABILITATED DISABILITY CLOSED "TOO SEVERE" NUMBER ACCEPTED REHABILITATED Connnunications: Blindness, both eyes, no light 6 65 perception Blindness, both eyes (with correction 37 318 not more than 20,200 in better eye, or limitation in field within 20 degrees, but not VR 10) Blindness, one eye, other eye defective 4 92 Blindness, one eye, other eye good 6 220 Other visual impairments 22 260 Deafness, unable to talk 4 32 Deafness, able to talk 8 111 Other hearing impairments 10 194 Speech impairments 2 72 Total Communications: 99 1,364 1,190 Percent of Communications of Total of All Disabilities 6.2% 13.4% 13.6% Orthopedic: Three or more limbs or entire body 47 One upper and one lower limb 44 (incl. side) One or both upper limbs 35 One or both lower limbs 114 Other and ill-defined impairments 132 Amputation involving: One upper and one lower major 1 extremity Both major upper extremities 1 One major upper extremity 6 One or both major lower extremities 21 Other and unspecified parts 1 Total Orthopedic 402 105 50 247 614 509 11 3 88 315 17 1,959 1,460 Percent of Orthopedic of Total of All Disabilities 25 3/o 19 3/o 16.7% 9 TABLE J (CON'T) FREQL:ENCY DISTRIBUTIONS OF DIFFERENT DISABILITY GROUPINGS OF CASES CLOSED REFERRED DUE TO SEVERITY OF HANDICAP AND CLOSED REHABILITATED DISABILITY CLOSED "TOO SEVERE" NUMBER ACCEPTED REHAB'LITATED Mental: Psychotic disorders Psychoneurotic disorders Other mental disorders Mental retardation Total Mental 144 512 86 693 64 414 158 765 452 2,384 1,980 Percent of Mental of Total of All Disabilities 28 o5/o 23,5/o 22.6% Internal and Other Disabilities: Other conditions resulting from 12 neoplasms Allergic, endocrine system, metabolic 47 and nutritional diseases Blood and blood-forming organs 6 Other specified disorders of the 70 nervous system (epilepsy) Cardiac and circulatory conditions 276 Respiratory diseases 76 Digestive system 39 Conditions of genito-urinary system 32 Other diseases 75 Total of Internal and Other Disabilities 633 234 377 11 140 545 241 1,435 954 551 4,488 4,120 Percent of Internal and Other Disabilities of Total of All Disabilities 39 9/o 44o2% 47.1% Grand Total 1,616 10,247 8,750 10 Table II gives distributions of cases accepted and cases closed as "too severe" from different categories of referral sources. As would be expected, the largest number of cases rejected as "too severe" comes from the Social Security Administration, where approximately two cases were rejected for each case accepted. Other referral sources with relatively high rates of rejection were welfare and correctional. The lowest rates of rejection are seen in referrals from artificial appliance companies and from educational institutions. TABLE II FREQUENCY DISTRIBUTION OF REFERRAL SOURCE OF CASES CLOSED REFERRED "TOO SEVERE" AND CASES ACCEPTED REFERRAL SOURCE Educational Institution Hospitals and Sanitariums Health Physicians Social Security Administration Welfare State Employment Service Artificial Appliance Company Individual except client himself Self-referred Persons Other Source Correctional \.Jorkmen' s Compensation Total CLOSED "TOO SEVERE" 41 113 45 171 636 310 17 1 113 71 42 56 0 1,616 ACCEPTED 1 062 1 198 390 3,145 331 1 084 186 145 1 154 916 463 171 2 10,247 ll Table III shows that approximately half of the cases closed as "too severe" were in the referred status and half in the applicant status. Table IV gives a breakdown by sex and shows a substantially higher number and higher proportion of male clients closed as too severe. TABLE III NUMBER OF CLIENTS CLOSED FROM 00 AND 02 STATUS DUE TO SEVERITY OF HANDICAP (Referred) (Applicant) STATUS 00 02 NUMBER 805 811 Total 1,616 TABLE IV BREAKDOWN BY SEX OF NUMBER OF CASES CLOSED REFERRED DUE TO SEVERITY OF HANDICAP Male Female CLOSED "TOO SEVERE" 999 617 ACCEPTED 4,860 5,388 Total 1,616 10,248 12 TABLE V NUMBER OF MONTHS IN 00 AND 02 STATUS FOR CLIENTS CLOSED REFERRED DUE TO SEVERITY OF HANDICAP TABLE VI DOLLARS SPENT ON CASES CLOSED REFERRED DUE TO SEVERITY OF HANDICAP MONTHS IN 00-02 STATUS 00 01-03 04-06 07-09 10-12 13-15 16-18 19-21 22-24 25-27 28-30 31-33 34-36 37-39 40-42 43-45 46-48 49-51 52-54 55-57 58-60 61-63 64-66 67-69 70-72 73-75 76-78 79-81 82-84 85 -87 Mean ''TOO SEVERE" 111 555 291 160 107 71 52 72 47 38 17 19 11 13 15 6 11 6 3 6 1 0 1 1 0 1 0 0 0 0 9.19 4.76 CASES ACCEPTED 2 529 4 897 1 214 504 319 193 124 106 79 58 51 47 29 26 15 14 10 13 4 6 4 1 0 1 0 0 0 1 0 1 4.14 1. 46;'d~ DOLLARS SPENT ON CASES CLOSED "TOO SEVERE" $ 00-09 10-49 50-99 100-149 150-199 200-249 250-299 300-349 350-399 400-449 450-499 500-549 550-599 600-649 650-699 700-749 750-799 800-849 850-899 900-949 950-999 Mean Median "TOO SEVERE" 1,125 298 110 37 15 7 7 0 2 2 5 1 1 1 2 1 0 0 1 0 1 $26.23 0-9 CASES ACCEPT: 3 896 4 631 969 289 152 85 63 43 39 20 12 5 9 8 2 5 1 4 3 1 11 $35.66 10-19 Tables V and VI show the distribution of time in referred status and dollars spent on diagnosis for these cases. * (50% of cases are more than 4.76 months) ** (50% of cases are more than 1.46 months) 13 TABLE VII AGE 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 Total CASES ACCEPTED Percent Number of Total 96 .9% 1,709 16.7 1 121 10.9 972 8.5 1 002 9.8 1 072 10.5 1 137 11.1 1 077 10.5 863 8.4 676 6.6 361 3.5 117 1.1 25 .2 18 .17 2 01 10,248 100.00% CASES REJECTED "TOO SEVERE" Percent Number of Total 6 0 3 7"/o 184 11.4 92 5.7 71 4.4 103 6.4 139 8.6 175 10.8 222 13.7 274 17.0 218 13.5 114 7.1 8 .5 10 .6 0 0 0 0 1,616 100.00% Data on the age of clients are presented in Table VII and Figure I. The percentage of clients in each age group is presented for clients rejected as "too severe" and clients accepted. The graph shows, for example, that 4.4 percent of the clients rejected as "too severe" fall in the 25 to 29 age group, whereas 17 percent of these clients fall in the 50 to 54 age group. A striking increase is seen in going from the 25year to the 54-year ages. By contrast, this trend is not seen in the curve for cases accepted. The pattern indicates that counselors are more and more likely to view the clients' disability as "too severe" as the age of the clients increases in this range. LEGEND: Solid Lines Indicate Cases Accepted Broken Lines Indicate Cases Closed Referred "too severe" 20 - .....::1 ,... ~ H 0 15 H ~ 0 H 10 z w u ~ w 5- . . . .. . I . . . I .. I I .. .. I .... . . I I . .~ I I I .. . I . I I ~ I -------...----- .. ~ -- ..- ~ , , , , ', ' ' ' ' ' ' ." ...... .p- I p.., I I I I I I I t; I I I I I I I I I I I I ~ 0"1 ~ 0"1 ~ 0"1 ~ 0"1 ~ 0"1 ~ 0"1 ~ 0"1 ~ M M N N ("') ("') ~ ~ Ll"\ Ll"\ \0 \0 I' I' 00 I I I I I I I I I I I I I I I 0 Ll"\ 0 Ll"\ 0 Ll"\ 0 Ll"\ 0 Ll"\ 0 Ll"\ 0 Ll"\ 0 M M N N ("') ("') ~ ~ Ll"\ Ll"\ \0 \0 I' I' 00 AGE GR0 Up I NGS FIGURE 1 FREQUENCY DISTRIBUTION BY AGE GROUPS OF CASES CLOSED REFERRED DUE TO THE SEVERITY OF HANDICAP AND CASES ACCEPTED Table VIII reveals that of the 897 clients accepted for services from public elementary or high schools, 493 of them were classified as mental. On scanning a sample of these cases from this referral source there is a good indication that almost 100 percent of these individuals were accepted on the basis of retardation. Counselors should give serious consideration to emphasizing to the public school teachers not only the wide variety of services available from Vocational Rehabilitation, but also the variety of disabilities that are eligible for these services. With the necessary emphasis in the Cooperative Work Study Programs between Special Education Departments and Vocational Rehabilitation, there is a possibility that principals, teachers, and other school staff members have gotten the impression that the Vocational Rehabilitation program is somewhat restricted to the retarded. Table IX indicates that of tne 10,788 cases closed referred in 1966 and 1967, 1,702 were closed because the counselor was unable to locate them. Spot checks of the actual cases indicate that clients included in this category had been in referred status up to three years. Since rehabi~itation clients tend to change addresses fairly often, it would seem that a system should be developed where these individuals who do change addresses would inform the counselor. More than one fourth of the cases closed referred was due to the client's refusal of services. It would be interesting to know if "refused services" means that the client refused vocational rehabilitation services, per se, or refused the categorical services offered by the counselor. Table VIII also reveals that of the 751 individuals referred by the State mental hospital, more than one third were closed referred. This seems to indicate that the screening teams at the hospital should have further information on the guidelines for eligibility requirements of the agency. On the same table, referrals from the Social Security Administration total 2,568, and of this number only 330 were accepted for services or 2,238 were closed referred. These figures indicate that some study should be given to the screening procedures that the Social Security Administration utilizes. TABLE VIII REFERRAL SOURCES FOR CLIENTS IN SIX DISABILITY CATEGORIES Cases Closed Referred or Accepted for Service and Closed in 1966-67 ACCEPTED FOR SERVICE CLOSED REFERRED REFERRAL SOURCE u z H 0 0:: ~ u z H 0 ~ p... 0 H E-<--1 E--1 ~ ~~;I: ZE--1 0::0 :::J (/) H !> 0-<:: ;""I": ;I: E--1 0:: 0 p::.:.J. ~ Ez--1 ";:;"::": E"z""--z10 H 0:: ;J ;I: ;I: E--1 0:: 0 :p::.J.. ~ Ez--1 ";:";:":: E"z""--z10 HOther health agencies or organizations Physicians not elsewhere classifiable TABLE VIII (Continued) REFERRAL SOURCES FOR CLIENTS IN SIX DISABILITY CATEGORIES Cases Closed Referred or Accepted for Service and Closed in 1966-67 ACCEPTED FOR SERVICE CLOSED REFERRED REFERRAL SOURCE u z H 0 0::: zc..? w~ p..., H E--< ~ .....:1 .....:IW ~::::: ZE--< H 0::: ~ w::r:: :0:r:: E--< 0::: 0 E--< ;::J p..., ~ ~ Ez--< ~ w0:::0 z z E--<~ H~ u z H 0 0::: .....:1 zc..? w~ p..., H E--< ~ .....:1 .....:IW ~::::: ZE--< ~ ;::J {/) H > H 0::: i:il Cfl 0 0 Cfl ui:il > H ~ Q z u 0 z 0 ~ z ~ E--< i:il H 0 0 Cfl ....:l H E--< i:il P-< ~ u Q i:il ~ ~ Cfl E--< u ~ ....:l ~ z !:J H Cfl Q !:J ~ I=Lo i:il ~ H Q 0 z > 0 0 z ~ i:::ri:l: E--< 0 OTALS 1702 1616 2620 1021 1339 2490 2 1 2 1 4 2 2 I 2 1 1 I 2 3 2 4 2 304 35 358 121 225 157 1 1 9 3 6 1 1 11 21 1 26 2 5 15 1 42 69 83 5 6 67 7 2 13 3 4 32 6 35 3 13 31 124 24 57 20 23 61 15 9 16 1 2 15 6 3 5 1 1 8 6 8 6 5 11 52 2 3 1 3 7 35 31 57 36 39 53 2 1 2 1 1 3 1 2 1 1 4 2 1 1 2 1 i 2 I I College or university Other college Private vocational school Public vocational school Public elementary or high school Private elementary or high school School for physically or mentally handicapped Other educational institution State mental hospital Other mental hospital State or local T. B. hospital or sanitarium Other T.B. hospital or sanitarium General hospital Hospital or other special facility for chronic con Other hospital or clinic n.e.c. Rehabilitation center State CriQpled Children's Agency ~-state or local oublic health dept. or agency_ Arthritis & rheumatoid organizations (private) Blind organization (private} Cancer organization (private) Cerebral palsy organization (private) Crippled children and adult organization (private' Deaf and hearing organization (private) Epilepsy organization (private) Heart organization (private) Mental retardation organization (private) Mental health organization (private) Multiple sclerosis organization (private) Poliomyelitis organization (private) TABLE IX (Continued) REFERRAL SOURCES FOR CASES CLOSED REFERRED IN 1966-67 BROKEN DOWN BY SIX REASONS FOR CLOSCRE Referral Sources Are Represented by Codes as on Federal R-300 z p... 0 H ~ u ~ E--< H ~ E--< ~ u 0 ....:! 0::: ~ > ~ C/) 0 0 C/) ~ u H > 0::: H @ 0 u Cz l ~ ::r:: ....:! zc..? ~ z E--< ~ H 0 0 E--< p... C/) ....:! P=l H E--< ~ ~ u Cl ~ ~ C/) ~ u ....:! P=l ~ z ;::; H zCl ~ ::r:: C/) ;::; ~ ~ 0::: H Cl 0 z > 0 0 z 0::: ~ ::r:: E--< 0 I ! I 10: 21 21 ! 1 41 1 I 17 162 171 299 193 229 239 I I I 1 1 258 636' 590 132 153 462 1 2 1 ----- Poliomyelitis oraanization (private) Tuberculosis organization lQrivateJ Other health agency or organization (pub. or pvt.) Physicians not elsewhere classifiable Insurance company Social Security Administration State temporary disabilit~ insurance agency State Workmen's Compensation Agen~ u.s. Bureau of Employees' Compensation 137 302 264 186 230 474 1 1 2 1 2 1 1 7 6 7 5 2 4 Public welfare agency lstate and local govt.) Private welfare a_gency United Mine Workers' Welfare and Retirement Fund Other Labor Union Welfare Fund Civic organizations and clubs Community adviso~ center 24 2 98 33 40 279 3 6 8 1 4 8 40 17 65 12 18 42 10 4 16 4 7 6 34 17 53 8 16 32 I 8 1 9 2 4 9 8 7 16 7 3 1 126 114 246 108 143 186 88 72 167 76 129 134 3 2 7 4 4 6 Selective Service System {includin_g local boards) State Vocational Rehabilitation Agency State Employment Service Public official (local state federal, n.e.c.) u.s. Civil Service Commission Government agency (other than listed above) Artificial appliance com_Q_al'!Y_ Em_Q_lover Labor union Individual 1 exce2t client himself Self-referred persons, n.e.c. Other, n.e.c. 2 1 2 1 2 164 56 72 35 11 95 Criminal Court Judges (public offenders) Parole officers JRublic offenders} Other (public offenders~ ~~ Including public health nurses, clinics, etc. DISCUSSION This discussion is based upon several meetings of the members of this task force and the materials prepared by Dr. Wyckoff. 20 The Federal Register was established to implement and explain Public Law 89333 which was passed by Congress in November, 1965. The criteria in this document are: "eligible" or "eligibility" when used in relation to an individual's qualification for vocational rehabilitation services, refers to a certification that 1. the handicapped individual has a physical or mental disability which constitutes a substantial handicap to employment, and Community education and public relations in general cannot be separated from casefinding. There has been emphasis in this agency upon the importance of enhancing the status of the agency and the counselor in the community. One of the difficulties in enhancing this status has been the fact that our educational contact has indicated that services are available for all people with impairments. There are, in fact, many people with impairments that are not eligible for rehabilitation services or who are so severely handicapped that they cannot reasonably be expected to become employed after rehabilitation services. In reported instances, key community people have referred persons with impairments who were not eligible on the basis of feasibility; that is, there was insufficient assurance that rehabilitation services would result in employment. An example might be an individual with a terminal condition which would not allow time for preparation for employment. In other instances, the referral would not be served on the basis of ineligibility. The medical impairment must constitute a vocational disability. The bilateral leg amputee who is already skilled as a watchmaker might not be eligible. In many cases the referral source receives no feedback as to why the referral was refused service; consequently, ill feelings are incurred. The Vocational Rehabilitation Act of 1954 defined a physically handicapped individual as "an individual who is under a physical or mental disability which constitutes a substantial handicap to employment, but which is of such a nature that vocational rehabilitation services may reasonably be expected to render him fit to engage in a remunerative occupation." 2. vocational rehabilitation services may reasonably be expected to render him fit to engage in a gainful occupation. Eligibility no longer is defined in a narrow sense of physical disability or limited to the classical diagnostic concept of mental and emotional diseases or disturbances. It now includes: "Behavioral disorders characterized by deviant social behavior or impaired ability to carry out normal relationships with family and community, which may result from vocational, educational, cultural, social, environmental--or other factors." The lack of a grasp of the concept of eligibility as a meaningful and dynamic force in the counseling relationship makes it even more necessary that we give it much additional discussion and interpretation to referral sources. Extended evaluation provisions of the 1965 Amendments seem to point up eligibility as a process rather than a status. This appears to have eliminated a static element and gives to the process a dynamic proportion which did not exist before--at least not in practice. This means that a counselor cannot merely say a client is or is not eligible. The referral source should also have some knowledge concerning how the client will be received and treated. Only a personal knowledge of institutions and professional workers will provide information as to their respective ways of functioning and availability of services rendered. 21 More thought should be given to informing referral sources on the meaning of eligibility and feasibility so they could do a better job in screening and referring individuals for rehabilitation services. Feedback to referral sources as to the status of the person that they referred is a method of teaching them and keeping them informed as to the criterion for services from Vocational Rehabilitation. Referral sources contributing a high number of persons closed "too severe" should be given special attention. Orthopedic and mental disabilities contribute a relatively high proportion of cases closed "too severe." This could indicate intensified training for counselors who have exclusive or heavy caseloads from these disability categories. The fact that higher numbers and percentages of males are closed as "too severe" could be accounted for by the fact that many of the females are closed as housewives, which would generally have less rigid standards of production. The fact that those clients closed as "too severe" were in referred status substantially longer than those accepted for service indicates that counselors should give speeder evaluation and disposition of cases. This suggests that thought should be given to reducing the counselor's caseloads and territory. There is an indication that increasing age constitutes a handicap to employment. Special emphasis should be given to educating the employer on the merits of hiring the older handicapped worker, especially in jobs requiring great accuracy and less speed. The committee recommends that the Georgia Office of Vocational Rehabilitation consider implementing the following recommendations: SU1'-frlARY AND RECOMMENDATIONS The basic problem of the task force on casefinding becomes one of developing procedures that will bring these unknown individuals in need of vocational rehabilitation services in contact with a rehabilitation counselor. 1. With the new emphasis on total rehabilitation services to all ages (from birth to death) toward adjustment and not just a job, as is indicated in the federal reorganization and change in name to Social and Rehabilitation Service, there should be a counselor in each district office to work with parents and guardians of the impaired child. This person would help them to plan their children's special educational needs and give them help in developing and strengthening every possible potential the child possesses. The person would be identified at the time he became impaired, as early as birth. The rehabilitation (habilitation) program would be a going on process to the time the person reached his optimum adjustment and interdependence. 2. There should be instituted formal and periodic interagency contacts, as well as informal personal relationships, to make the other agencies conscious of Vocational Rehabilitation services. Information should be included in these contacts that would help the referring agency in selecting appropriate cases. Comprehensive guidelines should be developed on the procedures and steps necessary to refer clients to Vocational Rehabilitation. Also included in these comprehensive guidelines should be encouragement to the referral agency to supply the counselor with as much relevant information about the client as possible. 3. University programs including undergraduate, graduate, and postgraduate should include in the curriculum courses that would develop competency in the use of different community resources. 4. Develop a pay scale for counselors that would parallel the supervisor's salary. This would mean a counselor could be rewarded on the basis of his merit as a counselor. It would then not be necessary to be "promoted" to supervisor in order to be rewarded for his ability as a counselor. In a dynamic growing agency there are always higher positions being created which are tempting to the counselor. T'he supervisor is often tempted to transfer effective counselors to these positions. If a counselor is permitted to stay for only a short time in a territory, the people in the community get somewhat discouraged in having to relate to a different individual, and also the new counselor must spend a disproportionate amount of his time in developing relationships with the community. 22 who are in need of such service. This would include spot announcements on radio, television, and in the newspapers, in addition to information on such bulletin boards as the courthouse and housing developments. 6. Transportation should be provided for those who need (particularly in rural areas) it getting in to see the counselor. 7. Increase the number of counselors in territories where there is a backlog of people who have been referred, but not seen. There is evidence that there is a relationship between time spent in referred status and closed "too severe." (See Table V.) 8. The counselor should be encouraged to give prompt feedback on all referred cases. This procedure will not only engender good public relations, but is an excellent opportunity to educate the referral agent in such areas as eligibility and feasibility. 9. The State Plan for Vocational Rehabilitation Services should contain the recommendation that counselors refer those individuals closed "too severe" to an appropriate agency that would have a program which could possibly benefit the person. The committee feels that if the above recommendations can be implemented into the Georgia Office of Vocational Rehabilitation, individuals who are in need of rehabilitation services will be brought in contact with the counselor in a more efficient manner. 5. Educate the general public in the area of potential services that Vocational Rehabilitation can provide those REPORT OF THE TASK FORCE ON EVALUATION, TREATMENT, AND TRAINING Statewide Vocational Rehabilitation Planning Project February, 1968 24 TABLE OF CONTENTS Letter of Submittal 25 List of Diagrams, Tables and Maps 26 List of Task Force Members 27 I. INTRODUCTION 28 II. AN OVERVIEW OF CURRENT PROGRAMS 29 A. The Flow of Clients Through the Rehabilitation 29 Process B. Evaluation Procedures 31 C. Treatment and Training Procedures 45 D. Cost of Evaluation, Treatment and Training 54 E. Summary of Findings and Conclusions 58 III. ASSUMPTIONS AND RECOMMENDATIONS 61 A. Assumptions 61 B. Recommendations 61 Selected Bibliography 65 Appendices 67 A. Minutes of Meetings 67 B. Maps 78 25 COPY: LETTER OF SUBMITTAL February 1, 1968 Mr. Vernon L. Vinson Project Coordinator Statewide Planning Project Office of Vocational Rehabilitation 159 Forrest Avenue, N.E. Atlanta, Georgia 30303 Dear Mr. Vinson: On January 26, 1968, Task Force Two held its last scheduled meeting. At this meeting we reviewed the findings and recommendations related to evaluation, treatment and training. These efforts are summarized in the accompanying report, which has the unanimous approval of those attending this last meeting. The dedication and hard work of the members of the Task Force, especially its chairman, Dr. Floyd Blevin, have been most inspiring and helpful. The work of the Task Force has been greatly facilitated by the efforts of your staff, and especially the help given by the late Mr. F. E. Wynn and his successor, Miss Karen Butler. The special reports by Dr. Cecil Harbin and Mr. Bobby Todd contributed much material for the Task Force's consideration and for inclusion in our report. To all of these people I gratefully acknowledge my appreciation. The final recommendation of this Task Force is the best indication of the interest and dedication of its members. They have, as you will read, recommended the adjournment rather than disbanding of the Task Force, with perhaps annual or semi-annual meetings in the next seven years to review the movements made toward the objective of providing rehabilitation services to all those who need it by 1975. I have learned much and enjoyed my association with the planning project staff and the Task Force members. Thank you for this opportunity to work with you, your staff and the Task Force members toward the betterment of rehabilitation services in Georgia. Sincerely, Sherwood B. Slater, Ph.D. Consultant to Task Force II -~" v1um.L vr OPERATIONAL PROCEDURES PHASE I May--Dec. 1966 PHASE II Jan.--Aug. 1967 PHASE III Aug. --Jan. 1968 PHASE IV Jan. --Apr. 1963 ORGANIZATION RESEARCH PILOT PROJECTS TECHNICAL TASK FORCE Recruitment Coordinator Staff Equipment Assembly of Names Policy Board and Advisory Committee Personnel Data Collection Preparatory to Task Force Needs Planned and Contracted Population Estimates and Projections for Georgia Counties Estimates of Disability in the State of Georgia A Follow-Up Study of 151 Former DVR Clients Closed in Three Categories Plan for Facilities and Workshops Policy Board and Advisory Committee Formally Organized and Functioning Task Forces Defined Appointed First Meeting Held Studies Conducted and Reported Case finding Evaluation, Treatment and/or Training Internal Structure Interagency Cooperation and Coordination Hanpower Needs and Potential Legislation and Finance Occupational Placement and Follow-Up Facilities and Workshops Planning Input Research as required by task forces Referral Source Breakdown Placement Survey, Interagency Cooperation Survey Current Staff Characteristics, etc. Survey of Personnel Who Left Agency Task Force Reports H ::J r't ro {)Q ti ,...!lJ r't 0 ::J ("t 0 "'1 >-' ::J !lJ >-' :;o (D Facilities '"0 0 and Work- ti r't shops Plan- ning Report Staff Survey (Department of Family and Children Services) Agency Survey (Depa.~t ment of Public Health) Client Orientation Project Started 1 Filn_,__D_e_l_i_,,_e_r_e_0------C~o~r-r-J-p-l-c-t-io-n---;o-n-d--A--n--a-ly--s-i-s----------------l Client Tests Run Film Contracted Pi lot Project !Zeports Community Involvement Planning - Equipment Reorganized Initial Test County Program Completion and Analysis 26 LIST OF DIAGRAMS, TABLES AND MAPS DIAGRAM 1. The Flow of Clients Through the Rehabilitation Process 30 2. The Flow of Clients Through the Georgia Office of Vocational Rehabilitation 32 3. Organization and Sources of Medical Personnel Used by OVR 34 TABLE 1. Medical Association of Georgia (MAG) and Office of Vocational Rehabilitation (OVR) Listing of Specialists 35 2. Percent Excess Urban Distribution of Specialists with Cities over 30,000 37 3. Ratios of Acceptance to Rejections at Different Stages of the Client's Career 42 4. OVR Use of Facilities Providing Work Evaluation 44 5. Adequacy of Case Development by Training Completions (Percent Judged Adequate) 47 6. OVR Use of Facilities by Types of Services and Sponsorship 49 7. Use of Facilities by Sponsorship 50 8. Case Services Expenditures for Georgia and the Forty- Nine Other States (1964-66) 55 MAPS (Appendix B) 78 27 TASK FORCE TWO (Evaluation, Treatment and/or Training) Mr. R. V. Bankston Case Worker 415 Pine Avenue Building Albany, Georgia 31702 Dr. Robert L. Bennett Medical Director Warm Springs Foundation Warm Springs, Georgia 31830 Dr. Floyd Edward Bliven Professor of Surgery (Orthopedics) Medical College of Georgia Augusta, teorgia 30902 Dr. Charles K. Bush, Jr. Director, Hospital Services Branch 47 Trinity Avenue, S.W. Atlanta, Georgia 30334 Mr. William A. Craft Disability Determination Unit Vocationai Rehabilitation 805 Peachtree Street Atlanta, Georgia 30308 Dr. Bird Daniel 203 Donehoo Street Statesboro, Georgia 30458 Dr. Cecil Harbin Veterans Administration Hospital 1670 Clairmont Road, N.E. Atlanta, Georgia 30329 Dr. Calvin Jackson 209 Broad Street Manchester, Georgia 31816 Dr. Donald J. McKenzie 818 Gordon Avenue Thomasville, Georgia 31792 Dr. Clifford Montgomery Butler, Georgia 31006 Dr. John Mooney Statesboro, Georgia 30458 Dr. Lamar B. Peacock 478 Peachtree Street, N.E. Atlanta, Georgia 30308 Mr. Oliver G. Prince 433 Waterford Road, N.W. Atlanta, Georgia 30318 Mr. Bob Todd State Department of Education 50 Whitehall Street, S.W. Atlanta, Georgia 30303 Mr. W. A. Tomlin Counselor Georgia Rehabilitation Center Warm Springs, Georgia 31830 Dr. Thomas 0. Vinson 126 Trinity Place Decatur, Georgia 30030 Dr. Vance Watt 900 Gordon Avenue Thomasville, Georgia 31792 CONSULTANT Dr. Sherwood Slater Department of Sociology Emory University 1364 Clifton Road, N.E. Atlanta, Georgia 30322 28 continued success in treating acute illnesses, and the concomitant increased incidence of chronic and degenerative diseases, the high rate of traffic injuries, and the eligibility of persons with primarily non-physical handicaps have placed increased and different kinds of demands on existing services. It is at this point, and with these changes in mind that this task force has sought to answer the following questions related to the current state of evaluation, treatment and training: 1. How are clients' impairments and disabilities being assessed medically, vocationally, and psychologically today? 2. Is the medical diagnosis complete and satisfactory? 3. Is the medical advisory board fulfilling its proper role? 4. Are we using all the doctors we should? I. INTRODUCTION The responsibilities of this task force are 1) the examination of existing evaluation, treatment and training procedures, facilities, and practices, 2) the projection of future needs, 3) the recommendation of changes, expansions and improvements in existing rehabilitation programs, and 4) coordination of medical and vocational programs so that by 1975, for all in need of such services, they will be readily available. Since the first vocational rehabilitation legislation in the 1920s, the State of Georgia has been in the "rehabilitation business" and has maintained itself as one of the leading states in this area of endeavor. Through the years a number of advances, both social and technological, have altered the processes of and the prospects for successful rehabilitation. For the most part, the cases referred to vocational rehabilitation agencies today were previously excluded; clients with certain disabilities offered unique challenges in the past, but today the same clients constitute relatively "routine cases." The 5. Is the geographic distribution of doctors the best that we could have? 6. Are we using all the hospitals we should? 7. How well are the training facilities fulfilling their job? These questions relate to the existing situation, and indicate the areas of concern when assessing current evaluation, treatment and training programs. Additional questions, related to the anticipated needs and practices as they would exist in 1975 are raised, specifically: 1. How can the assessment of clients' medical, vocational and psychological impairments and disabilities be improved? 2. How can we get the excellent doctors who do not now work with Vocational Rehabilitation to do so? 3. What additional types of training facilities should we be using? These two sets of questions served as the basis for our deliberations by providing a focus for discussion and investigation and suggesting further questions that we sought to answer. A. The Flow of Clients through Rehabilitation Program II. AN OVERVIEW OF CURRENT PROGRAMS The express purpose of rehabilitation programs is the provision of services to disabled individuals that 'maximize" the opportunity for the development of his potentials. 1 A wide variety of both public and private agencies provide these services in the State of Georgia. Some agencies concentrate upon particular disability groups (e.g., blindness, congenital defects, deafness), certain age or social categories of impaired individuals, or specialize in the services they provide to various groups (e.g., physical restoration centers, training schools, evaluation agencies, casework and counseling). This review of current programs concentrates on the State of Georgia, Office of Vocational Rehabilitation (OVR). The concentration on a single agency, in this case the OVR, is necessitated by the limitations of available and reliable data. In the State of Georgia, however, the OVR expends more funds and provides services to more of the disabled population than any other single agency treating this population. When possible other agencies and services have been considered in this examination of current programs. For any agency a necessary condition for the provision of rehabilitation services to individuals is the presence of some impairment. Impairment is defined as a condition or state which limits or precludes usual functions or activities. Some rehabilitation agencies focus upon the impairment and seek by treatment, training and/ or by the provision of appliances to remove, compensate or substitute for lost functions. If in addition, the individual has not adapted to the impairment which is so severe as to limit functioning or activity in significant areas of the individual's life situations, the impairment constitutes a disability. Since disability is relative to the life situation of the impaired person, judgments must be made on an individualistic basis as to the extent to which the impairment imposes disability on that person. Thus, inherent in any rehabilitation agency's determination of the eligibility of potential clients for their services, the following questions need to be answered: 1. To what extent does an impairment exist? 2. Is the impairment sufficiently limiting to constitute a disability for this particular individual? 3. Is the individual's impairment treatable, removable, or compensable? 4. Can the individual with a dis- ability be rehabilitated? The stated purpose of the OVR is "to provide or make available by purchase such services for which provisions are made under public law authorizing and supporting public programs of Vocational Rehabilitation to individuals who are physically or mentally impaired and w2o have a substantial employment handicap. This section will examine the current programs of the OVR, particularly as they relate to the provision of services (including evaluation, treatment and training) to clients. An affirmative response to all of these questions, stated in terms of the agency's definition of rehabilitation (e.g., physical restoration, independent living, vocational rehabilitation) implies acceptance for servcies. Thus, the first stages in the flow of clients through a rehabilitation agency involve the steps of establishing impairment, determining disability, and estimation of rehabilitation potential. This initial set of steps in the flow of clients through an agency is shown in Diagram 1. 1. Office of Vocational Rehabilitation, Manual of Policies, Sec. 1.01. 2. Ibid. 30 DIAGRAM I THE FLOW OF CLIENTS THROUGH THE REHABILITATION PROCESS Congenital and Acquired Conditions Is the impairment a disability? Deaths No No No No 31 The increment in Georgia's population is by natural increase (births) and immigration; decrement occurs from mortality and migration. At any point of time the population contains a number of persons who are impaired. When identified, and the determination is made that their condition does constitute impairment (whether physical, mental, emotional, social) the question is raised if this person's impairment is so severe as to constitute a disability. If the person is not found to be impaired, he retains his former status in the population. If he is found to be impaired, but to an extent that is not determined to be disabling, he is not eligible for rehabilitation services, except possibly for those that provide for the correction or alteration of the impairment. The objective of rehabilitation is the return of the individual to a suitable place in society. If completely successful, the individual can be expected to be an independent, productive member of society. If the agency fails to meet its objective fully, the individual, by definition, returns to a less than optimal position. When the OVR is examined the distinction between productive, independent persons and non-productive, dependent persons becomes more salient, particularly in view of the stated objectives of the agency. Specifically, the OVR defines eligibility for services on the basis of employment or productive work potential, although a broad interpretation is practiced. The OVR has formalized the flow of clients through the agency in its "case status classification."3 This formalized flow of clients, with the added distinction of productive/non-productive populations is shown in Diagram 2. The span of time from a client's first contact with the agency until his case is closed and no further services are offered constitutes his career in the agency. While, in terms of overall planning the total client career is of concern, this task force concentrates only on the stages related to evaluation, treatment and training. Other very important questions are more appropriately the concern of other task forces (e.g., How do we find potential clients? Which of these are eligible for the range of services provided by the agency? Which of these are excluded from all or part of the services? Which ones and by whom are they placed in gainful employment?). Therefore, the status of applicant (02) through the status of ready for employment (20) is considered to constitute the portion of the client's career which circumscribes evaluation, treatment and training processes. B. Evaluation Procedures As presently constituted there are three statuses that specifically include as the primary objective evaluation of the client. These are Applicant (02), Six-month Extended Evaluation (04), and Eighteen-Month Extended Evaluation (06). These evaluation periods are provided in order to establish the three conditions of eligibility for vocational rehabilitation services or rehabilitation potential. 1. The presence of ~ physical and/or mental impairment 2. The existence of a substantial handicap to employment 3. The determination of a reasonable expectation that vocational rehabilitation services will render the client fit for gainful employment. The first determination in the evaluation process is the determination of an impairment, the stability of the impairing condition and the prognosis. As presently constituted the impairment may be physical or mental, but in all cases there must be a General Medical Report (Form R-3) filed. This form, completed by the rehabilitation counselor and the physician, gives information about the client's medical history and his present physical condition. This General Medical Report is supplemented by additional medical examination reports by specialists when the medical consultant and/or the counselor have "reason to believe such examination is necessary."4 In each instance the specialist reports to the agency the pres- 3. ~., Sec. 4.03. 4. Ibid., Sec. 6.03. Diagram 2 The Flow of Clients Through the Georgia Office of Vocational Rehabilitation I (oo) Referred reques~ signed for services ' I {022 A2plicant I o{ certification selected::-1 severity disabilities I I (04) (06) 6 mos. evaluation Ills mos. evaluation I I I (10) Ace;epted I I plan written (08) Closed after evaluation .- I I (30) Closed before plan initiated services begun I ' 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ' I (14) Couns c>l ing '(16) Physical '(18) Training I Guidance Placement I Restoration I preparation complete I (20) I II (24) Services Interrupted employment begun (28) Closed after plan initiated (not rehabilitated) I I I I I I I I I I I I I 1 11 11 11 1 1111I I I I I I I I I I I I I I I I I Plan completed so far as possible substantial counseling one or more other services suitable employment 30 days or more I (26) Closed em2loyed I ( ) OVR STATUS ent condition, the nature of any indicated treatment, and the work limitations imposed by the impairing condition. The task force raised a number of specific questions regarding the current medical evaluation procedures. Specifically, we were concerned with the following questions: 1. Is the medical report complete and satisfactory? 2. Is the medical advisory board fulfilling its proper role? 3. Are we (OVR) using all the physicians we should? 4. Is the geographic distribution of physicians the best that we (OVR) could have? 5. Are we using all the hospitals we (OVR) should? We discussed at length, during the first deliberations of the task force, the questions related to medical evaluation (see the minutes of the meeting of September 8, 1967 in Appendix A). Concrete data were not readily available from which a definitive answer to the first of these questions could be obtained. It was quite clear, however, from the testimony of members of the task force and OVR personnel that there was great variation in the quality and utility of the completed General Medical Reports. The conclusion was, as stated in the approved minutes, "that many of our (OVR's) medical reports are worthless and perhaps they could be revised so that pertinent facts could be presented on a form and then a narrative be attached." The discussion related to the second question of the role of the Medical Advisory Board was considered in conjunction with the third question about the extent to which physicians were being used by the program as presently constituted. The arrangement and functions of physicians at various levels are shown in Diagram 3. From among the licensed physicians in the State, in each client's case there will be a "Primary Physician" who completes for that client the General Medical Examination. This 33 is the basic medical evaluation data obtained for all clients. The counselor and/or the OVR Medical Consultant, on the basis of the information from the Primary Physician and other sources, select when deemed necessary, a member of the "Panel of Medical Specialists," or a "Special Medical Facility," to further examine the client, and thereby provide additional information.for the evaluation of the impairment. The approval of medical personnel and facilities is under the control of the Medical Advisory Board. The task force examined in some detail the distribution and use of medical specialists and consultants in the evaluation of clients for OVR services. The attempt has been made by OVR to obtain an adequate number and geographical distribution of specialists for use in the medical evaluation of applicants. The number and distribution of various medical specialists on the Panel of Specialists, which is approved by the Medical Advisory Committee, were examined. It was apparent from the maps and the testimony of members of the task force that in some cases clients had to travel as much as one hundred miles to obtain examinations by approved specialists. This was considered an undue burden on clients, and the task force considered the questions of adequacy of coverage in areas and specialties, and modifications of the process for selecting specialists. Using the Medical Association of Georgia Roster of January, 1967, the distribution of selected specialties in the State were compared to those on the OVR Panel of Specialists. The comparison maps are found in Appendix B. The specialties examined and the number in each listing are shown in Table 1. The coverage by specialty varies considerably from a low of 20 percent of the pathologists to a high of 154 percent of the chest and thoracic surgeons listed by the Medical Association of Georgia who are on the OVR panel with an average of 77 percent for the 16 specialties. When the nine counties with cities of over 30,000 are examined, it is found that the major portions of the difference between specialists on the OVR panel and those listed by the Medical Association of Georgia Roster occur in these urban areas (see Table 2). The only excep- 34 DIAGRAM 3 ORGANIZATION AND SOURCES OF MEDICAL PERSONNEL USED BY OVR MEDICAL ADVISORY BOARD I Appoints I 1r r------------, .,. I L- - -C-O- U-N-S-EL-O-R-.J~---- MEDICAL CONSULTANT 1r EVALUATES MEDICAL ,. INFORMATION I Selects J l ' L A_QJ)_oint s J l Approves PANEL OF SPECIALISTS ~ PROVIDE MEDICAL , INFORMATION ~I" ~r MEDICAL FACILITIES J PRIMARY PHYSICIAN COMPLETES R-3 LICENSED PHYSICIANS IN GEORGIA 35 TABLE I MEDICAL ASSOCIATION OF GEORGIA (MAG) AND OFFICE OF VOCATIONAL REHABILITATION (OVR) LISTING OF SPECIALISTS SPECIALTY Allergy Chest and Thoracic Surgery Dennatology E.E.N.T E.N.T. Gvnecology Internal Medicine and Cardiology Neurology and Neurosurgery Orthopedic Surgery Pathology Physical Medicine Plastic Surgery Proctology Psychiatry and Neuro- psychiatry Radiology Surgery Urology NUMBER MAG 7 13 30 152 250 400 36 77 65 8 10 6 97 103 393 73 NUMBER OVR 8 20 17 65 153 240 28 60 13 6 11 4 72 32 420 76 RATIO OVR/MAG 114 154 57 43 61 60 78 78 20 75 110 67 74 31 107 104 36 tions found are in orthopedic surgery (18 percent of the underdistribution is in urban areas), internal medicine (70 percent) and radiology (45 percent); in all other specialties more than 75 percent of the underdistribution is in urban areas. In the instance of orthopedic surgery the distributions of the OVR and MAG listed physicians are not greatly dissimilar, since 9 out of 17 not on the OVR list are in counties contiguous to Fulton. A better estimate is that 71 percent of the underdistribution of orthopedic surgeons is in urban areas. In the case of internal medicine the underdistribution is not critical because this is the largest number of any specialty group (240) on the OVR panel. The most serious underdistribution occurs among radiologists, although this may not be a frequently used specialty. While for the most part the distribution of specialists may be inadequate in certain geographical areas, it does not seem to be based on inadequacies of the current system but more likely it reflects the general maldistribution of physicians in rural and less urbanized areas. This conclusion is further supported by examination of the distribution of all physicians by counties and the physicians population ratio (see Map 2, Appendix B). There were a number of instances where the evidence suggested that physicians were poorly or incompletely oriented to the services provided by the OVR. This was thought to be a factor in inappropriate referrals and possibly related to the inadequacies reported in some medical reports being supplied to OVR. After lengthy discussion of this problem, it was also concluded that a very strong contributing factor to these problems, and in particular that of appropriate referral, is the fault of the OVR in not providing more extensive follow-up and feedback. The problem seems to emerge from the absence of a simple but routine way of informing referral sources of the disposition of referred clients and the various services provided to them. There are some data which bear on this problem, reflecting the different~al importance of referral from physicians. During the three fiscal years, 1961-63, there were 18,622 rehabilitants, of which 7,586 (41 percent) were referred by physicians. The percent of all referrals for OVR services made by physicians is unavailable. When the 2,010 clients who received training during this period are considered separately, only 161 (8 percent) were referred by physicians. By fiscal year the percent of rehabilitants referred from 1961 to 1966 by physicians is shown below: Another question related to medical evaluation and also to treatment, is the availability and use of hospital facilities. There are 108 hospitals in Georgia and 3 in Chattanooga that are approved by use by the OVR. These are well distributed geographically, with few counties not having a hospital in their own or an adjacent couroty (see Map 4, Appendix B. It was diff~cult to assess the qualitative differences in these facilities, but it was assumed that approval of a facility implied that a minimum acceptable standard of care is being provided. It was concluded, however, that the efforts of OVR to select and approve hospitals is very possibly a duplication of wo~k done by other State agencies. Specifically, the State Department of Health was found to be in a more strategic position to evaluate, license and approve hospital facilities, this being a legally defined responsibility of that agency. Year Percent Cumulative Percent 1961 41 1962 30 1963 41 1964 41 1965 37 1966 36 40.3 40.7 40.8 40.0 39.2 The physicians, as a single source, refer more rehabilitants than any other group making referrals, but in recent years this has been declining. Furthermore, while it is unknown what proportion of all referrals are made by physicians, it is apparent from data available that they are not the principal source of referral for clients who go into training. This would seem to suggest that physicians are more likely to refer candidates who are in need of rehabilitation services other than training, such as physical restoration, prosthetic appliances, etc. 5. Buice and OVR Annual Reports. SPECIALTY GROUP Dermatology E.E.N.T. Gynecology Internal Medicine Neurology Orthopedic Surgery Pathology Psychiatry Radiology All Specialties TABLE 2 PERCENT EXCESS URBAN DISTRIBUTION OF SPECIALISTS BY COUNTIES WITH CITIES OVER 30,000 (City Underscored) r::: I:Q 0 I:Q (.) H ttl I:Q;:F::; ~~ ;g~ UCI) COUNTIES AND CITIES ~J u~ :>-4 ~ ~ E (.!) ttl ::;,..a Or-! Cl~ s 8 ~ (!) ~0:: I z2 0 r::: H ttl ~......, f;:~ ttl C/).j.J !@~ CIJ ~~0 ~~ ~ CIJ ~ ::J s t!>..o u0 ::J Cl) ......, i!3 zCl ttl o.j.J ~ CIJ u S'o H ;:J 0::~ ALL URBAN COUNTIES -46 23 8 0 0 108 0 15 - 8 100 11 3 1 2 2 46 5 3 5 78 -1 0 7 4 4 112 2 4 7 139 -2 4 2 4 -6 56 1 0 11 70 13 0 0 0 0 63 5 3 5 89 18 6 0 0 0 18 0 0 12 18 12 6 4 4 4 35 2 8 12 87 0 0 -4 0 0 48 0 4 28 76 4 1 4 4 0 21 4 6 11 55 1 3 3 3 -0.2 58 2 3 10 83 NUMBER OF PHYSICIANS EXCESS (MAG-OVR) Georgia Urban Co. 13 13 87 69 97 136 160 112 8 7 17 3 52 44 25 19 71 40 530 443 Without a more detailed data analysis it 38 is not possible to determine if this happens because physicians 1) refer clients with better work experience and prior training, 2) for the most part physicians have contact with clients needing physical restoration services alone, or 3) are unaware of the extensive training services provided by the OVR. In conclusion, however, physicians have in the past been a major referral source, and the continued and increased use of this group is necessary to reach as many potential clients as possible. A second area of vital concern in the evaluation process is psychological evaluations of clients when these are indicated. Unlike medical evaluation it is not a universal requirement for all clients in order to determine eligibility for services. It was deemed to occur frequently enough, and to be of critical importance in those cases where it does occur, to warrant examination by the task force. The OVR recognizes that not all clients served by them require psychological testing. The OVR counselors have been provided with the following basic psychological tests: 1. General Clerical Test 2. Kuder Preference Record 3. Mechanical Comprehension Test 4. Otis Intelligence Test 5. Peabody Picture Vocabulary Test 6. Purdue Pegboard Test 7. Wide Range Achievement Test 8. Weschler Adult Intelligence Scale Other aptitude tests are utilized by the counselor on an optional basis. In those cases where it is deemed necessary, a referral for psychological evaluation may be made upon recommendation of a consultant or supervisor who has reviewed the case or another professional person who has evaluated the client. The final determination to obtain more extensive psychological evaluation is made by the counselor. The following describes in detail the prov~s~ons and conditions for psychological evaluation services.* The types of psychological services available are Intellectual Evaluations and Clinical Evaluations. The primary purpose of the Intellectual Evaluation is to provide a measure of the client's current intellectual functioning, to give a description of the pattern of specific strengths and weakresses in intellectual ability, and to furnish an estimate of any intellectual deficit that may be present. This information is used as an aid in reaching a determination as to a client's eligibility for services and/or in developing a vocational rehabilitation plan. The evaluation is based on an interview and on an individually administered Intelligence Scale. In most instances, the Weschler Scale for Children are probably the most appropriate instruments. The Clinical Evaluation includes the Intellectual Evaluation and a Personality Evaluation based primarily on projective techniques. The purpose of the Clinical Personality Evaluation is to provide an assessment of intellectual and personality factors for use in reaching a determination as to a client's eligibility for services and/or in developing a vocational rehabilitation plan, with consideration of personality dynamics and concomitant strengths and liabilities. Paper-andpencil personality tests may be included in the test battery, but they are not _ utilized as a substitute for projective instruments. Unless there is some good reason to the contrary for which an explanation is given, the Rorschach is usually included in the test battery. The Clinical Personality Evaluation is utilized when more information regarding personality factors is required than would be furnished by the Intellectual Evaluation. As indicated, the counselor has been provided with several tests which he uses with his clients, especially on training cases. There are more difficult cases where the counselor finds there is a need for more data than can be obtained from the psychometric examination he is prepared to administer. In these cases, the counselor purchases psychological evaluations. * The Task Force gratefully acknowledges the special assistance given by Dr. Cecil Harbin, of the Atlanta Veterans Administration Hospital. The following guidelines relating to Psychological Evaluations have been developed. They must be obtained when: of long standing, and individuals whose employment record indicates they are "accident-prone." 1. Mental retardation has to be determined; i.e., Psychological Evaluation should be considered when: a. The applicant's eligibility for rehabilitation is based on mental retardation as the primary impairment. b. It is suspected that the applicant has subnormal intelligence as a secondary impairment. 2. Long term or expensive training is involved in a rehabilitation plan, i.e., a. The job objective under consideration involves college or university training; 1. The counselor needs information or confirmation of the client's abilities, aptitudes, achievements, interests, and personality patterns; i.e., a. The counselor or client is undecided about a vocational choice and desires information about the client's aptitudes, interests, achievements, and personality; b. A tentative job choice has been made, which the counselor or client wishes to confirm through psychological evaluation; b. The job objective under consideration involves business or vocational school training; c. The job objective involves more than three months of apprentice on-the-job training; d. The client's vocational background is not in the field of the skilled work for which he is being considered. 3. An individual is shown or suspected to have certain impairments that require specialized evaluations of his capacities, abilities, skills, interests, and personality; i.e., c. The job choice of the client is considered unsuitable by the counselor, who then seeks objective data with which to support or refute the tentative decision. 2. Data on the client's capacities and abilities are lacking, are ambiguous, or are contradictory; i.e., a. There is no educational or work record available for the client. b. The case history shows serious contradictory data in regard to the client's capacities and abilities, and his expressed vocational interests. a. Persons with actual or suspected brain or head injuries, cerebral palsy, epilepsy, or other conditions involving neuro-muscular disorders; b. Persons who have mental retardation or emotional disturbances, or for whom it is desirable to determine whether a psychiatric consultation is indicated; c. Persons with suspected mental deterioration; d. Persons with other severe impairments which require specialized individual testing, such as the blind, the totally deaf and seriously hard of hearing, the aphasic, the paraplegic, those with severe reading disability, chronic cases 3. Important talents, capacities, abilities or impairments are suspected by the counselor or client; i.e., a. A special talent or capacity is suspected, but the case history shows no reliable evidence of its existence; b. The counselor or client suspects that the latter has a specific impairment which will materially affect his successful pursuit of the vocational objective; c. The client or counselor seeks to establish the equivalent of a certain level of education for the client, but he does not have the formal credits necessary to substantiate the claim, and the sub- 40 stituted equivalent credits determined The provLsLon of psychological evalu- through psychological tests are necessary ation services as stated in the above to attain the job objective in the most guidelines is apparently satisfactory. expeditious way. There was no suggestion that there were difficulties inherent in the program as outlined above; however, there is appar- ently some manpower problem in obtaining a sufficient geographical coverage of Psychological diagnosis and evaluation may not necessarily be required when: psychologists in the State (see Map 3, Appendix B). Another pr~blem that is reported is the inordinate amount of time being spent by counselor to admin- 1. The client has very recently been successfully employed and intends to return to his work as soon as physical restoration services have been rendered; ister the basic psychological and aptitude tests. Careful and extensive discussion led to a number of recommendations for utilization of other personnel to release counselors from the need to admin- 2. The person has been successfully ister these tests themselves. employed and is now unable to find similar work because of the prejudice of employers toward the handicapped, and it is necessary for the counselor to convince the employer that the client has the abilities required for the position; The final area of evaluation considered by the task force was vocational evaluation. As presently operating, "in order for a client to be eligible for (OVR) services, the prognosis for vocational purposes must be a reasonable expectation that (OVR) services will render the indi- 3. The client has been successfully employed and only a minor change is contemplated in the type of work that he will do in the future; vidual fit to engage in a gainful occupation within a reasonable length of time."6 "Gainful occupation includes employment in the competitive labor market; practice of a profession; self-employment; homemaking, 4. The counselor has a long and rich background of information on jobs held, the jobs are in related types of work, and the client has changed jobs for reasons beyond his control; farm or family work (including work for which payment is in kind rather than cash); sheltered employment; and home industries or other homebound work of a remunerative nature."7 The vocational evaluation is based on 5. The counselor has a long and rich data collected by the counselor. He uses background of educational information, the such information as the client's personal caliber of the school which the client has history, family situation, social and been attending is well established, the economic status, personality traits, inter- caliber of the teachers in important sub- ests, aptitudes, work history, etc. It jects is well established, and the client is apparent that the vocational evaluation does not plan to study or work in areas is dependent on the counselor and client unrelated to his background; cooperating to develop a mutually agree- able vocational objective for the client. 6. The client is not cooperative and This vocational objective, stated in does not desire to be tested. In such varying degrees of specificity, is req- cases, testing is contraindicated until uisite to the provision of any services the reasons for such uncooperative attitudes are understood and dealt with intel- beyond diagnosis or evaluation. Six important factors influencing the selec- ligently. tion of the vocational objective are identified: 6. Office of Vocational Rehabilitation, Manual of Policies, Sec. 5.05. 7. Cited from Regulations Governing the Vocational Rehabilitation Program, in the Office of Vocational Rehabilitation, Manual of Policies, Sec. 6.06. 41 1. Educational performance 2. Work experience 3. Avocational interests and abilities 4. Aptitudes and attitudes as demonstrated by appropriate tests 5. Availability of work in the selected vocational objective, and 6. Family or community situations that may affect achievement of the vocational objective. Obviously, for some clients, several of these factors may not be relevant; e.g., a youngster without a work history, a person who has spent a long period of time in an institution, housewives. Further complications or delays to the vocational evaluation develop from the nature of severe or multiple impairments, the unstabilized nature of an impairment at the time of vocational evaluation, or the need for physical restoration services prior to the definition of a vocational objective. The difficulty of defining vocational objectives for some clients is recognized, and the provision of six and eighteen months evaluation periods to obtain further information are provided for in the State Plan: When the counselor is unable to determine that there is a reasonable expectation that (OVR) services may render the individual fit to engage in a gainful occupation and there is a physical or mental impairment which constitutes a substantial handicap to employment, the counselor may initiate an extended evaluation not to exceed eighteen months for those individuals whose disability is: (1) mental retardation, (2) deafness, (3) blindness, (4) paraplegia, quadriplegia, and any other spinal cord injuries or diseases, (5) heart disease, (6) cancer, (7) stroke, (8) epilepsy, (9) mental illness, (10) cerebral palsy, or (11) brain damage, and not in excess of six months in the case of any individual with any other impairment.8 It is permissible, therefore, to provide at least six months extended evaluation services to all clients for whom it is deemed necessary. The experience in the last fiscal year indicates that relatively few clients are afforded these services. Of 26,588 clients who entered Applicant Status (02) in 1966-67, 12,657 (48 percent) were accepted without receiving extended evaluations, 110 (0.4 percent) entered six months and 187 (0.7 percent) entered eighteen months evaluations. Any interpretation of these figures must take into account the fact that this is the first fiscal year in which extended evaluations have been a part of the State's rehabilitation program. If the 5,893 applicants (22 percent) in 196667 who were rejected before acceptance or extended evaluation are subtracted from the applicants, then of the 20,695 remaining, 12,657 (61 percent) were accepted for six and eighteen months evaluations, respectively. Since there are a large number of clients who had not had final determination of their eligibility or had not been placed in extended evaluation by the end of the fiscal year, it is appropriate to use as the base the 12,954 who had been accepted or placed in extended evaluation. Using this last base, 97.7 percent were accepted for service without extended evaluation, 0.9 percent were placed in six months extended evaluation and 1.4 percent in eighteen months evaluation. It is apparent, whichever the appropriate base used, that a very small proportion of the clients are being placed in extended evaluation. 9 The policy of OVR provides that termination of the extended evaluation periods may occur prematurely for either of the following reasons: (1) when it is determined that there is a reasonable expectation that the client can be rendered fit to engage in a gainful occupation; or (2) it is determined that there is no reasonable likelihood that the client can be rendered fit to engage in a gainful occupation. The data available do not differentiate between premature termination and 8. Manual of Policies, Sec. 6.05. 9. Health, Education and Welfare, VRA Quarterly Cumulative Caseload Report, July-June, 1967. 42 full tenure in the evaluation period. It is logical to assume that since this is the first year of eighteen months evaluations any terminations that occurred during this year were in less than the full period of eighteen months; the logical distinction is not possible for the clients in the six months extended evaluation~ Of the 187 clients that entered eighteen months evaluations during 1966-67, 53 (28 percent) were accepted for further OVR services and 13 (7 percent) were rejected; an acceptance to rejection ratio of 4:1, with 121 (65 percent) still in evaluation. From the 110 in six months evaluations, 35 (32 percent) were accepted, 11 (10 percent) were rejected, 64 (58 percent) still remain; an acceptance to rejection ratio of about 3:1. When these acceptance to rejection ratios for extended evaluations are compared to other stages of the client's career, as shown in Table 3, the ratios for extended evaluations fall between the extremes of other stages. It would seem that the tentative conclusion that the extended evaluation program has yielded a relatively high proportion of rehabilitation prospects is in order. We do not know, however, what the ratio for the total cohort wi!l be, or the reason for this performance. When it is realized that this group is likely to be the most problematic, it is possible that a selectivity bias is operating to provide extended evaluation to the "best of the worst", or the evaluation process itself has been most effective in evoking from the clients high levels of performance relative to their expected performance. As a new, and apparently critical, program it should be subjected to immediate and continuing assessment, TABLE 3 RATIOS OF ACCEPTANCE TO REJECTIONS AT DIFFERENT STAGES OF THE CLIENT'S CAREER 1966-67 CHANGES IN STAGES APPROXIMATE RATIO Referrals becoming Applicants/Referrals rejected; i.e. 5:1 (Status 00 -+ Status 02)/(Status 00 -+ Status 08) Applicants accepted/Applicants rejected; i.e., 2:1 (Status 02 -+ Status 10)/(Status 02 -+ Status 08) Accepted from 6 mos. evaluation/Rejected from 6 mos. evaluation; 3:1 i.e., (Status 04 -+ Status 10) I (Status 04 .... Status 08) Accepted from 18 mos. evaluation/Rejected from 18 mos. evaluation; 4:1 i.e., (Status 06 .. Status 10)/(Status 06 .. Status 10) Accepted to closed rehabilitated/Accepted to closed not 6:1 rehabilitated; i.e., (Status 10 + Status 26)/(Status 10 -+ Status 28 and 30) 43 Another explanation of the small proportion of clients being placed in extended evaluation is the possible lack of facilities for extended evaluation. Still another explanation is the effectiveness of short-term as opposed to extended evaluation programs. The availability of vocational evaluation facilities was examined using data reported in the Utilization Summary of Facilities and Workshops in Georgia. The relevant findings are reported in Table 4. In relation to discharges, almost 4 out of 5 discharges from private facilities, 1 out of 2 from the OVR facilities, and 1 out of 3 from public facilities are clie~ts discharged to employment. Of all the discharges from the three kinds of facilities with work evaluation programs, over half (52 percent) went into employment. Only 1 out of 20 of all discharged clients went into extended workshop placements, with most of these coming from public facilities and fewest of these from OVR facilities. About 1 out of 8 of the discharged clients went into training, with most of these coming from OVR facilities which discharged 1 out of 4 into training. There are 59 agencies included in the utilization report; 41 (70 percent) of the 59 reported that they provided some form of vocational evaluation services in combination with other evaluation and/or training services. There are no facilities reported to offer vocational evaluation services alone. Of the 41 facilities providing vocational evaluation services 16 (39 percent) are sponsored by the OVR, 14 (34 percent) are other public sponsored facilities, and 11 (27 percent) are private nonprofit facilities. As Table 4 shows, the 39 of 41 facilities reporting served 20,229 clients in the survey period (1966); of which 16 percent were served by 10 private facilities, 42 percent by 13 public facilities, and 42 percent by 16 OVR sponsored facilities. Almost half (47.7 percent) of the clients served in facilities with vocational evaluation were OVR referrals. The relative number of OVR clients to all clients was highest in OVR facilities (3 out of 4) and about 3 out of 10 in the public and private facilities. Of the 39 agencies reporting clients served, 24 also reported discharges. The lowest ratio of discharges to served is in the OVR facilities (1:3.8), followed by the public facilities (1:1.9), and the lowest ratio is in private facilities (1:1.5). Finally, the differences in kind of discharge are examined; discharges to employment (competitive+ homemaking+ homebound), extended workshop placement, and training. These data indicate that the OVR has tended to use their own facilities which provide work evaluation rather than private agencies; 65 percent of the OVR referrals are to their own, 25 percent to public and 10 percent to private facilities.* Yet the agencies least used report the best results in terms of overall discharges and discharges to employment. This, however, may be the result of the multiplicity of services given rather than differences in work evaluation procedures alone. The OVR facilities are discharging fewer clients relative to those served, but more than any other kind of facilities, they are discharging clients into training. A number of very crucial data is not available from this source (e.g., average client stay, discharges by types of service, services provided OVR referrals) which would be helpful in determining the reasons for the few number of clients placed in extended evaluations. *N.B.: This is not to be construed as a discussion of clients receiving work evaluation, but only about agencies providing this service, since there are no data broken down by the clients receiving different kinds of services. 44 TABLE 4 OVR USE OF FACILITIES PROVIDING WORK EVALUATION No. of Facilities No. of Clients Served OVR REFERRALS No. of Facilities No. of OVR Clients % OVR Clients Discharges Facilities Reporting No. of Clients Served No. of Clients Discharged % of Clients Discharged Disposition No. into Employment % into Employment No. into Workshops % into Workshops No. into Training to into Training FACILITIES SPONSORSHIP OVR PUBLIC PRIVATE 16 14 11 8,400 14 6,288 74.9 10 2,435 28.6 10 925 28.0 13 3,589 948 26.4 3 2,501 1,350 54.0 8 1,196 794 66.4 479 50.5 20 2.1 241 25.4 508 37.6 94 7.0 103 7.6 630 79.3 38 4.8 54 6.8 ALL FACILITIES 41 20, 229 34 9,648 47.7 24 7,286 3,092 42.4 1,617 52.3 152 4.9 398 12.9 1No information for one facility. Source: VRA-32 Reports 45 The findings related to the evaluation has reviewed the case or another profes- stage of the client career have provided sional person who has evaluated the client. the basis for several recommendations that The final responsibility for making a re- are reported later. In conclusion, it is ferral for psychotherapy rests with the apparent that for the most part the process counselor who must decide that the client's of evaluation except for possibly psycho- emotional problems are interfering with social areas has been well developed, and the rehabilitative process. judging by the outcomes, evaluation in com- bination with treatment and training produces a respectable ratio of eventual suc- Individual psychotherapy is used to pro- cesses to failures. vide personal guidance and adjustment training with the goal of enabling the handicapped client to engage in a remuner- ative occupation. The service involves the utilization and application of psycho- logical principles and appropriate tech- C. Treatment and Training Procedures niques in providing help to individual clients in cooperation with the efforts Once the client has completed the evaluation process and has been determined to be eligible for rehabilitation services, the further steps in his career are treatment and training. This section considers the current practices and procedures in these areas of client services. As presently constituted, the OVR can provide of the rehabilitation counselor. These principles and techniques, for example, may include individual psychotherapy/ counseling, conditioning ~ethqds, habit training, and learning techniques which provide for improved motivation, communication, learning, adjustment, adaptation and vocational attainment. as part of its services a wide array of treatments; medical, surgical, psycho- logical, vocational adjustment, appli- Group psychotherapy is considered when- ances, etc. Usually such services are ever the client is particularly in need of limited to: (1) treatment of impairments help with problems of socialization which (physical or mental) that handicap the can be acquired through group opportuni- client's occupational performance (2) ties for social reality testing. This relatively stable impairments, and (3) service involves the utilization and appli- impairments amenable to treatment within cation of psychological principles and a reasonable period of time (usually 12 appropriate techniques in group psycho- months). In the case of physical restor- therapy/counseling, group dynamics or con- ation the following specific services are ditioning methods, milieu therapy and currently available: (1) medical treat- learning techniques which provide for ment, (2) specialists' services in the improved socialization, acceptance of fields suitable to the specific med~cal training, supervision, and help, motiva- or surgical problems, (3) nursing serv- tion, communication, adjustment, social ices, (4) hospitalization. (5) dentistry, adaptation and vocational attainment. (6) drugs and supplies, (7) physical and These services are arranged in cooperation occupational therapy, and (8) prosthetic appliances.l3 with the rehabilitation counselor's plan and goals for the clients involved. In the examination of evaluation procedures the availability of medical personnel is discussed, and will not be reexamined. In addition to medical treatment, where the provision of services is within the usual limitations stated above, psychiatric treatment (psychotherapy) is available. A referral for psychotherapy is made upon the recommendation of a consultant who 13. Manual of Policies, Sec. 8.30. Personal and/or social and/or work adjustment may be provided for clients to the extent necessary to achieve the client's placement into a vocation. Comprehensive evaluation needs to be completed prior to writing a plan for adjustment training in order that appropriate, specific methods of training can be outlined in the plan. Personal adjustment training may include training in areas such as personal hygiene, '+0 Having completed the objective assess- He randomly sampled 2,159 OVR clients who ment of evaluation procedures, it is reasonable to raise the question of how they received training in the three years, 1961-63. Of these 2,010 were closed as are working. For the most part the preceding has focused upon the process stated in expected terms (i.e., what the present program should be), however, the other question that needs to be asked is how rehabilitated (93 percent) and 149 were closed not rehabilitated. Of the total 2,159 clients sampled, 1,871 (87 percent) completed training; 94 percent of them completed training and were closed as are these programs being implemented. The rehabilitated. Of the' 288 (13 percent) ratio of closed rehabilitated to closed not rehabilitated is 6:1, which is the highest "success" to "failure" ratio of not completing training, 61 percent were closed rehabilitated. Unfortunately, comparisons of the rehabilitated and not any stage of the program for which data rehabilitated groups for factors relevant is available (see Table 3, supra). The to evaluation are not available. Some most selective stage is the evaluation data do, however, suggest a number of period (applicant to accepted status) in important aspects. which the ratio of acceptance to rejec- tions is 2:1. The question is then raised if within the evaluation process, only First the facilities used to evaluate physical and mental capacities are exam- "sure bets" are being taken to the detri- ined.11 During the five-year period (1961- ment of more problematic clients. Is the 65) almost half (47 percent) of the sample quality of evaluation, and the requisite was evaluated in appraisal clinics or reha- knowledge, of such caliber that there is bilitation centers. Similar proportions a high degree of certainty that those ac- received physical and mental capacities cepted for services would fail to be "reha- evaluations in the two kinds of facilities; bilitated" if denied these OVR services, 21 percent and 26 percent, respectively. and conversely those denied the services Appraisal clinics were used about equally would fail even though given them? The for mental capacities (14 percent) and answer to this critical question is one physical capacities (16 percent) evalu- that requires an experimental approach, ations. Rehabilitation centers were more and is beyond immediate solution. There than twice as frequently the facility used are data available from one study which for evaluation of mental capacities (12 reflects, tangentially on this issue. percent) than physical capacities (5 percent). The author cautions that in inter- In the "Follow-up Study and Evaluation preting these data it must be noted that of Training Provided Clients by the Georgia in many instances the clients received Office of Vocational Rehabilitation," the adequacy of case development was examined. both physical and mental capacities evaluations. Buice states: The principal contribution of this study The data are taken from responses to relevant questions of the counselor interview schedule and from the interviewer's evaluation of those interviews. The questions were related to the aids the counselor used in the evaluation to our concern with evaluation, is the adequacy of evaluation ("case development") which the author examined. Table 5 presents a reanalysis of the data he provides. There is virtually no difference in the counselors' judgments of adequacy of evaluations for those clients completing and of the client in areas of physical those not completing training. The ade- capacity, intellect, emotional sta- quacies of these evaluations as judged by bility, background, motivation and the research interviewer are less than the home situation . Judgment of ade- counselors' in a number of areas; e.g., quacy was based upon the different physical restoration, intellectual and aids used in each case and whether the the aid was adequate considered essential evaluation of the cl t i o e n t. 10 emotional evaluations. It is interesting to note that in the remaining areas of background, motivation and home situation 10. Buice, p. 54. 11. Ibid., Table 19, p. 58. 47 TABLE 5 ADEQUACY OF CASE DEVELOPMENT BY TRAINING COMPLETIONS (Percent Judged Adequate) EVALUATION AREA PhYsical Restoration Intellectual Emotional Background Motivation Home Situation N TRAINING COMPLETED 98 94 99 100 100 100 1,871 TRAINING NOT COMPLETED 98 94 100 100 100 100 288 BOTH COMPLETED BY COUNSELOR 98 94 99 100 100 100 2,159 NOT COMPLETED BY INTERVIEWER'>': 89 74 95 100 99 100 2,159 *Rating based on aids used by counselor Source: Buice (Tables 1, 18, 31) evaluations, objective measures are not readily obtainable, yet both counselors and interviewers rate these at or near 100 percent adequacy. This is more significant when the reasons for not completing training are examined. Half of those failing to complete training were discontinued for reasons similar or related to these more subjective areas of evaluation; namely, lack of motivation (17 percent), emotional instability (12 percent), home situation (11 percent) and failure to adjust (10 percent). These were also the most frequent single reasons given for discontinuing training. 12 Although limited in applicability, the findings of this study suggest a number of directions for concern with the evaluation process as presently constituted. As defined, counselors admit to a less than adequate intellectual evaluation of clients going into training. This may be confirmation of the previous finding that under the present provisions of 12. Ibid., p. 85. services, the administration of psychological tests is an undue burden on counselors. Secondly, and more critical, the areas that account for the most discontinuity between objective and outcome (i.e., failure to complete training) are attributed to areas which are judged by both counselors and interviewers to be most adequate with the evaluation aids available. This finding suggests two possible aspects of the evaluation process that need to be considered in any future developments. First, the aids currently being used do not provide reliable information about the client that contributes to the accurate prediction of outcome, or secondly, the aids provide reliable data, but these are not related to the factors that account for failures to complete training. The area of psychosocial evaluation would appear then, on the basis of the data available, to be the poorest developed or the least reliable. It is singled out above all other areas of evaluation as apparently the most inadequate. 48 grooming, dress, manners and appropriate behavioral reaction patterns. Social adjustment training may include training in areas such as social relationships, table manners, r~lationships with peer group and authority figures, recreation, use of leisure time, and dating. Work adjustment training may include training in such areas as how to conduct an employment interview, how to maintain appropriate relationships with other employees, how to accept supervision and authority, how to establish a proper employeeemployer relationship, punctuality, employee-employer obligations, remedial academic instructions to improve vocational proficiency, and/or any other training to develop adequate worker traits, habits and attitudes leading to a vocation. Training in the above areas may be secured through numerous means and resources such as in the pre-vocational special education classroom, in training stations within the school, in vocational education classes, in training stations in community businesses, through individual and group counseling provided by a psychologist and vocational rehabilitation staff member, and/or through facilities and service~ provided in institutional sett~ngs. 14 As with evaluation the area of treatment can be divided into medical, psychological, personal and vocational therapies. In addition to the distribution of physicians and hospitals (already discussed) there are a number of other services and facilities that are used in treatment and training. In a recent survey of rehabilitation facilities there were 59 offering a wide spectrum of services. 15 To reduce complexities in analysis, the following groupings have been made: 14. Ibid., Sec. 8.22. Sponsorship 1. Office of Vocational Rehabilitation (OVR) 2. Public Supported (PUB), including City County State (other than OVR) Other Public 3. Private, Non-profit (PRIV), including Community non-profit associations Church affiliated Other non-profit Services 1. Medical, Psychological and Social Evaluation and Treatment (Dx/Rx), including Physical and medical evaluation Medical management Physical therapy Occupational therapy Speech and hearing services Medical consultation Psychological services, diagnostic and treatment Social services 2. Vocational Evaluation (VocEv) 3. Vocational Training and Treatment (VocTr) including Pre-vocational and vocational training Vocational counseling/rehabilitation counseling Personal adjustment training, including mobility Job conditioning Job placement Extended employment Transitional employment Others The combination of the three types of service in various arrangements is the basis for the analysis presented in Tables 4, 6 and 7. Of the 59 facilities reported, 35 (60 percent) provide all three types of services, 15 (18 percent) provide two types of services, and 13 (22 percent) provide only one type of service. The sponsorship of the facilities is about evenly divided between OVR (30 percent), Public (34 percent) and Private (36 percent); 18, 20 and 21 facilities respectively. 15. Utilization Summaries of Facilities and Workshops, VRA-32 Reports for Georgia. 49 The comprehensive facilities offering all three types of services had the highest proportion of discharges (42.7 percent), of which over half of the clients were discharged into employment (51.7 percent). The other facilities reporting had a lower rate of discharge (25 percent), but had more clients being discharged into employment (71.4 percent). The same was found with regard to discharges into training, with the comprehensive facilities discharging 12.8 percent and the other- discharging 14.3 percent into training. In absolute numbers, however, the comprehensive facilities account for much greater numbers of client discharges. span of the client's career with which the OVR is concerned. While OVR facilities discharge fewer clients relative to those served, the proportions discharged into training and employment are higher than either the public or private facilities (75.9 percent). Half of the discharges from OVR facilities are into employment, with only a s'lightly larger proportion of discharges from private facilities going into employment; 50.5 percent to 51.~ percent, respectively. Far more clients from OVR facilities are discharged into training, and fewer into extended workshop placement than either public or private facilities. As seen in Table 6, the facilities providing all three types of service are most used (90 percent) by the OVR for treatment and training of this group of 10,438 OVR referrals; the majority (60 percent) being treated and trained in OVR sponsored facilities. The next greatest usage is of facilities offering only diagnostic and treatment services (5 percent), but these are mostly private ones as OVR sponsors only one facility providing this single service. From the 59 facilities, discharge information was provided by 25, with most of these facilities (20) offering all three types of services. Four facilities offered vocational training and treatment only, and one offered vocational evaluation, and vocational treatment and training. There were no facilities that provided vocational evaluation alone; this occurred in some combination with other services (see Table 4, supra). It is concluded that the OVR has used its own facilities, and that these have performed at a level equal to or better than facilities with other kinds of sponsorship. It is not possible to determine, from the available data, if this is the result of more effective services or greater selectivity. For the present it would appear that OVR has developed a group of facilities that in comparison with other facilities are performing effectively. The important question is raised, however, of the adequacy of these services to meet present and anticipated needs. Two special surveys, conducted as part of the Statewide Planning Project, provide information that relates to the perceived adequacy of existing facilities; the "Counselor Questionnaires" (CQ) and the "Agency Survey Report" (ASR). In the first (CQ) survey the respondents were asked: In Table 7 facilities have been grouped by sponsorship without regard to types of services provided. As anticipated the largest proportion of OVR referrals in any group of facilities are in the OVR sponsored ones (75.4 percent), and fewest in private ones (5.6 percent). On the other hand more private facilities received OVR referrals than any other sponsorship. When performance in terms of discharges reported is examined, it is found that the OVR facilities have the lowest ratio of discharges to served (26.4 percent). Possibly this is explained by the more precise conditions required to close cases and the prolonged 1. What facilities, if they were available in suitable locations with adequate capacity, are most needed by you in your work? 2. What are the most important areas toward which this planning effort could be directed? The responses to the two questions were combined from 351 counselors in the OVR with the following needs relatgd to treatment and training identified: 1 16. Counselor Questionnaire, Table III, p. 5. TABU!; 6 DVR USE OF FACILITIES BY TYPES OF SERVICES AND SPONSORSHIP (SOURCE VRA-32 REPORTS FOR GEORGIA) TYPES OF SERVICES PROVIDED No. of Total Dx/Rx Voc.Ev. Voc. Tr. Spon. Fac. Served Yes Yes Yes DVR 16 8,400 PUB. 14 a 8,521 PRIV 5 1 694 TOTAL 35 18,615 DVR Refer. 6,288 2,435 676 9,399 %DVR Clients 74.9 28.6 39.9 50.5 No.Fac. With DVR Dischargir No. NQ. Disch. Sen 14 948 3, 5l 10 1,350 2, 5( 10 715 9~ 34 3,013 7;01 Yes Yes No DVR 0 PUB. 0 PRIV. 2 1 388 134 9.7 1 TOTAL 2 1,388 134 9.7 1 Yes No Yes DVR 1 150 150 PUB. 2 1,750 79 PRIV, 2 319 5 TOTAL 5 2,219 234 No Yes Yes DVR 0 PUB. 0 PRIV. 4 226a 115 TOTAL 4 226 115 No No Yes DVR 0 PUB. 1 113 20 PRIV. 2 52 9 TOTAL 3 165 29 Yes No No DVR 1 40 40 PUB. 3 4,380 40 PRIV. 6 21,222 447 TOTAL 10 25,642 527 TOTAL ALL TYPES 59 48,255 10,438 a - one facility made no report of no. served. 100.0 4.5 1.6 10.5 50.9 50.9 17.7 17.3 17.6 100.0 0.9 2.1 2.1 40.1 1 2 1 4 1 79 22 1 79 22 1 5 1 7 2 12 1 2 6 9 51 3,104 11 2 13: 7,424 ~lit:z: ~ Disch. lor Served 26.4 54.0 73.7 42.7 Disch. to Employment No. % 479 50.5 508 37.6 572 80.0 1,559 51.7 Disc~arge to Workshop No. % 20 2.1 94 7.0 31 4.3 145 4.8 Disch. to Train- ing No. % 241 25.4 103 7.6 43 6.0 387 12.8 35.0 35.0 4.4 28.0 8.7 58 73.4 58 73.4 4 80.0 3 42.9 7 58.3 7 7 8.9 0 0 0 0 0 0 11 11 13.9 1 20.0 1 14.3 2 16.7 41.8 1,624 52.3 152 4.9 400 12.9 TABLE 7 USE OF FACILITIES BY SPONSORSHIP SPONSORSHIP OVR Public Private NO. OF TOTAL FACILITIES SERVED 18 8,590 20 14,764a 21 24,90la OVR REFERRED 6,478 2,574 1,3?6 % OVR CLIENTS 75.4 17.4 5.6 NO. OF FACILITIES WITH OVR 16 15 20 NO. DISCHARGED 948 1,355 801 SERVED BY DISCHARGED FACILITY 3,589 2,614 1,221 % DISCHARGED 26.4 51.8 65.6 :n:> SPONSORSHIP OVR Public Private DISCHARGED TO EMPLOYMENT NO. % 479 50.5 512 37.8 633 51.8 DISCHARGED TO WORKSHOP NO. % 20 2.1 94 6.9 38 3.1 DISCHARGED TO TRAINING NO. % 241 25.4 104 7.7 55 4.5 aOne facility made no report of number served. Source: Table 5 Workshops 143 Work adjustment and 58 training centers Evaluation centers 40 Comprehensive rehabili- 33 tation facilities and residences (33.3%) (13.5%) ( 9.3%) ( 7.7%) jl reflect a need for specific treatment and training programs. The bulk of responses from workers in these two agencies related to services to specific disability groups (e.g., mentally handicapped, alcoholics, children). The need for services to the following groups was reported: Mental illness, retar- 72 dation and illiteracy (11.0%) 274 (62.8%) All responses 429 The counselors by their responses suggest the need for treatment and training centers beyond those presently available. The other survey (ASR) requested similar information from workers in the Departments of Public Health, and Family and Children Services. The 652 responses to the following questions were combined: 1. What services do you feel (OVR) should add, delete, emphasize, or de-emphasize? 2. What gaps in service do you see? 3. In your opinion what are the most important areas toward which this planning effort could be directed? The combined responses from the 173 respondents about areas of needed emphasis related to treatment and training are: 17 Workshop and training programs 53 ( 8.1%) General medical and den- 33 tal programs and services ( 5.1%) Visual (training) services 17 ( 2.6%) 103 (15.8%) All responses 652 A much smaller proportion of these responses from personnel outside of the OVR 17. Agency Survey Report, Tables I and II, pp. 3, 6. Children and families 27 Special handicapped 22 groups; e.g., stroke, TB, diabetes Aged or middle aged 22 ( 4.1%) ( 3.4%) ( 3.4%) 143 (21.9%) If it is assumed that these identify general areas of service needs, it can be argued that they furthermore imply that extension of existing services, facilities and staffs will be necessary. The limited evidence available to us suggests strongly that there are facilities that are available at present, they are being used effectively; but they are not sufficient for current or anticipated demand. Specifically, we refer to the greater demand for treatment and training facilities, and services for current OVR eligible persons, and for other impaired groups which are at present only marginally served or excluded by OVR. In addition to the training facilities included in the previous discussion there is another group of facilities that is used for vocational training by the OVR. The OVR maintains a listing of approved training facilities, with conditions for inclusion on the list based on accreditation, previous experience with the facility or the OVR's own investigations. These facilities are grouped as follows: 1. Colleges and universities (accredited by the Certification Division of the Georgia State Department of Education); 2 State and area vocational schools (public schools under the supervision of the Division of Vocational Education of the Georgia State Department of Education); 52 3. Private vocational schools (approved and enlarged facilities and curriculums, by the OVR Supervisor of Guidance, Training, and raised entrance requirements, in an and Placement) effort to improve the quality of training. 4. Business schools (primarily for shorter-term secretarial and stenographic training, approved by the OVR Supervisor of Guidance, Training, and Placement); 5. Employment training (on-the-job training, work under normal job conditions without pay, in situations approved after thorough investigation by the OVR counselor); and 6. Other training situations (e.g., tutorial arrangements, correspondence schools--used in special situations). There is an order of preference in the use of training facilities; first for public facilities in the State of Georgia, private facilities within the State, and then outof-state facilities. The recent study of training clients by Buice provides useful information for examining the effectiveness of the various training programs. The study included a sample of OVR clients receiving training in the years from 1961-66. The conclusions of the author, relevant to the concerns of this task force are: 1. The degree of success attained in the rehabilitation of clients is indicative of the fact that the Georgia (OVR) has been aware of the changing and expanding occupational structure, and has provided the needed training services to adequately prepare its clients for secure employment in a competitive labor market 3. Successful efforts have been made to assure clients of quality training through the subjective/objective (sic) selection of both the public and private training institutions of Georgia 5. The (OVR) provides training services in most professions, vocations, and trades, in a myriad of public and private institutions as well as training situations and stations with individuals, business, and industry. 6. The public technical and vocational schools of Georgia have been used to train increasing numbers of (OVR) clients. These schools have increased in number, expanded 7. The (OVR) has been providing most of. its training to clients under (the age of) 35. 8. The older clients, having more dependents, family obligations, and less formal training, were provided vocational and trade training. However, there is indication of a trend toward increasing use of the public technical and vocational schools in training clients, especially those who have as much as 11 and 12 years of formal training. 9. Efforts to rehabilitate mentally ill clients resulted in a significant increase in the percentage of mentally ill clients being provided training services. 10. Efforts have been successful in satisfactorily meeting both the economic and social needs in the provision of training services for clients, as the needs arose. The economic status, vocational adjustment and stability of employment of clients have been improved. 11. Employers are well pleased with the training, adjustment, and work output of the trained (OVR) clients. 12. Clients have benefited from the training through improved social adjustment, improved attitudes, self-evaluation, and a greater feeling of security in the family and in the community. 14. Kinds of training and client impairments are not related except in cases in which the impairment may preclude training for and/or employment in a given occupation. 15. Clients, as they are further removed in time from their training experiences, tend to move into better paying occupations in which they no longer use the specific training provided them by the (OVR). This is interpreted to be a healthy tendency since it reflects the vocational adjustment and flexibility of the clients following their receipt of the (OVR's) training services. 53 16. The vocational evaluation process can be improved by a more adequate assessment of the client's intellectual abilities. This, in turn, should reduce the number of drop-outs or failures to complete training programs. 17. The vocational evaluation process can be improved further by a more extensive use of the aids and resources which are available to the counselor. 18. There is a tendency toward an increase in the use of public facilities and institutions to train (OVR) clients, at all training levels 22. The major reasons for the poor achievement in training, failures, and drop-outs are: (1) the client's lack of motivation, (2) the client's emotional instability and failure in adjusting to training situations, (3) the client's problems and difficulties at home. This implies a need for a more continuous counseling relationship in training cases. 23. The percentage of clients who completed their training programs, increased significantly during the five years (from 1961 to 1966) . 25. The college trainees completing training, have a higher percentage of rehabilitation than those trainees of the other groups who complete training, while the public vocational school trainees have the lowest percentage rehabilitated. 26. The percentage rehabilitated from the group not completing training programs is significantly less than that o f t h ose camp 1et1.ng t ra1.n1. ng programs. 18 The acceptance of these conclusions as validly derived from the findings, suggests that for the most part the OVR has utilized the training aspects of their program quite well. There is a high proportion of successful rehabilitants among those provided training (93 percent) than the overall percent of closed rehabilitated (86 percent). Once again, however, the question about selectivity arises: to what extent are clients not provided training, capable of 18. Buice, pp. 108-11. utilizing it?; to what extent would clients presently being given training be "rehabilitated" without the provision of such training services? As before when these questions were raised, the answers, though crucial to any consideration of future services, can be answered only through experimentation and research. The design and implementation of such research, and the obtaining of results upon which to assess the maximum effectiveness of training services requires careful planning, control and financial and temporal resources. It is apparent that OVR has, as Buice states in his conclusions, shown a willingness and commitment to program innovations and evaluative research. The expanded and continued research and innovative programs are requisite to the improvement and growth of the OVR. Another concern of the task force related to the area of training is the projected growth and development of the local and area vocational schools program. As Buice demonstrated, these are second only to colleges and universities in their use as training facilities. The State Department of Education, Division of Vocational Education, is actively engaged in the development of more extensive and higher level vocational training programs for Georgia. Projections of the future needs for vocational education are based on an estimated 55,000 youngsters in 1967 who presumably need additional skills to enter the labor market, and even greater numbers in the future. It is recognized that the characteristics of these students are greatly variable; ranging from disadvantaged to middle class backgrounds, and a variety of class, ethnic, religious and racial backgrounds. It is estimated that 90 percent of the occupations in Georgia do not require a college degree for entrance. It is the training of individuals for entry into these occupations that is the province of vocational education. A recent report states, A brief list of occupations reported in the Occupational Outlook Handbook, which offers rapidly increasing employment, for which vocational education should offer training includes stenographers, secretaries, office machine oper- ators, wholesale salesmen, manufac- turer's salesmen, real estate sales- mopetn~,. can1ur ses aides, h technicians, ospital privat e attenda house- n t s , hold workers, child care center attend- ants, build i cooks, ng trad ch es ecfrsa, ftcsomsemne, tomlaoignitsetns~nce and repair servicemen, horticulture and landscape technologists, farm machinery repairmen, and instrumen- tation technicians. This list is by no means exhaustive, but it does give an idea of the direction which voca- tional education might take.l9 54 training is the cost of While the effectiveness othfestheesseervasicpeecs~s of the OVR program as presently consti- tuted has been examined, the question of. cost efficiency has not. To assess the cost efficiency of the evaluation, treatment and training aspects of the OVR program, Geq!gia's expenditures for case services in the fiscal years 1964-66 are compared to those of the 49 other states. These data are shown in Table 8, and are taken fr~m the Federal V.R.A. Program Reports for those fiscal years. It is realistic to consider further development of vocational education programs as highly probable, and as having important effects on the OVR training programs. Specifically, the Division of Vocational Education is currently engaged in a study for arriving at a detailed plan for the direction of vocational education in Georgia for the next five years. This year-long study is for the purpose of developing detailed plans for secondary and post-secondary vocational programs, and facilities, to serve the State's anticipated needs. Many issues have been raised for examination during this proposed study, one of which has particular interest to the OVR, that of providing a pre-vocational progLam that will offer an exploratory experience for students. The projections and plans of the State Department of Education have far-reaching implications for the provision of services by the OVR. for example, It is reasonable that an enlarged ptorogarsasmumoe f' service occupations that do not require more than high school level for entry may provide a more desirable facility for the training of mildly retarded clients. D. The Cost of Evaluation, Treatment and Training The final consideration in the examination of evaluation, treatment and 19. Division of Vocational Education, p. 2. As Table 8 shows, Georgia spent less per client for every type of service (except rehabilitation and adjustment centers) than the other forty-nine states. While it has been established that the ratio for "closed rehabilitctted" to "closed not rehabili- tated" for Georgia is 6:1, we do not know the comparable ratios fo although on a per capita r the basis other Geor state gia is s' very high in the number rehabilitated. In total case services costs per rehabilitant, Georgia is about 10 percent less than the rest of the U.S.; $610 and $670 per reha- bilitant, respectively. The allocation of these monies to specific types of services are, however, quite different for Georgia and the rest of the United States. From every $100 spent for case services, Georgia spent $9.70 for diagnostic procedures and the rest of the U.S. spent $8.30. From every $100 Georgia spent $35.60 for surgery, treatment, hospitalization and convalescent care (exclusive of rehabilitation and adjustment centers and not part of diagnosis); the rest of the u.s. spent less than half that amount, $17.30. Out of every $100 spent on case service, Georgia spent $21.50 for training and related services (e.g., materials, maintenance, transportation, licenses, tools) compared to the $45.70 spent by the other states. Georgia spent $28.60 of every $100 of case services monies for workshops and rehabilitation and adjustment centers; the rest of the states spent $23.20. For the fiscal years 1964-66 Georgia spent twice as much, relative to its case services monies, for treatment and care, half as much for training and related services, and slightly less for diagnostic procedures, prosthetics, workshops, rehabilitation adjustment centers than the other forty-nine states. TABLE 8 CASE SERVICES EXPENDITURES FOR GEORGIA AND THE FORTY-NINE OTHER STATES (1964-66) TYPE OF CASE SERVICE Diagnostic Procedures GEORGIA DOLLARS CLIENTS _(OOO's) SERVED DOLLARS PER CLIENT to OF ALL DOLLARS SPENT GA. OTHER U.S. GA. OTHER U.S. $ 1,305.6 38,317 $ 34 $ 29 9. n 8 3/o lo OF ALL CLIENTS SERVED GA. OTHER u.s. 45 6/o 47.8% CLIENTS SERVED PER REHABILITANTS GA. OTHER u.s. 1. 74 1. 94 Surgery and Treatment 2,102.3 15,972 131 145 15.6 8.0 19.0 9.2 .72 .37 Prosthetic Appli&nces 620.1 4,968 125 161 4.6 5.5 5.9 5.5 .23 .23 Hospitalization and Convalescent Care 2,694.5 10,581 255 294 20.0 9.3 Training and Training 1,661.2 6,082 273 421 12.4 28.7 Materials Maintenance and Transportation 779.0 4,172 187 234 5.8 14.9 Tools, Equipment Licenses etc. 437.5 1,654 265 204 3.3 2.1 Rehabilitation and Ad1ustment Centers 3,741.4 1,823 2,052 461 27.8 19.0 Wor~~shops 102.9 391 263 326 .8 4.2 12.6 7.3 5.0 2.0 2.0 .5 5.2 11.3 10.4 1.7 6.8 2.1 .48 .21 'Jl VI .28 .47 19 .42 08 06 08 .27 02 .09 All Case Services $13,444.5 22' 033"( $ 610~h'( $ 67~b'( iiOO.OO 100.00 99.90 100.00 -- -- - - - -- -- --------- ~(Number closed rehabilitated, 1964-66 **Dollars spent on all services per rehabilitant Source: VRA Program Data _lV Of all OVR clients given different case services (i.e., the sum of the clients given each separate case service, not the number of individual clients served) slightly less than half of them were those given diagnostic procedures; 45.6 percent in Georgia and 47.8 percent in the rest of the u.s. Surgery, hospitalization, and other care and treatment (except in workshops, rehabilitation and adjustment centers) accounted for 37.5 percent of the Georgia client services, and 19.9 percent for the other states. Training and training related services accounted for 14.3 percent of the Georgia clients served, and 23.4 percent for the rest of the u.s. Services given in workshops and rehabilitation and adjustment centers accounted for 2.5 percent of the Georgia client services and 8.9 percent in the other states. Similar trends are seen when the cases served per 100 rehabilitated are examined. For every 100 rehabilitants in Georgia in 1964-66, there ~ere 174 given diagnostic services and in the rest of the U.S. there were 194 given diagnostic services per 100 rehabilitated. Almost twice as many clients were given surgery, and other treatments per 100 rehabilitated in Georgia than in the rest of the U.S.; 72 and 37 per 100 rehabilitants, respectively. The same differences hold for hospital and convalescent care, where in Georgia 49 per 100 rehabilitants received these services compared to 21 per 100 rehabilitants in the rest of the states. The direction of the differences changes in the provision of training and training related services, workshops and rehabilitation and adjustment center services. Georgia provided training and training materials to 28 clients per 100 rehabilitants compared to the 47 per 100 rehabilitants in the rest of the u.s. Transportation and maintenance were given to 19 clients per 100 rehabilitants in Georgia, and to 42 per 100 rehabilitants in the rest of the states. Services in rehabilitation and adjustment centers were given to 8 Georgia clients per 100 rehabilitants and 2 Georgia clients per 100 rehabilitants received services in workshops; in the rest of the United States there were 27 clients served in rehabilitation and adjustment centers and 9 clients served in workshops per 100 rehabilitants. The clients given prosthetic services, tools, licenses and equipment per 100 rehabilitants were about the same in Georgia and the rest of the states. This analysis clearly points to a differential allocation of resources in Georgia and the rest of the United States. Georgia has provided a bulk of services and allocated relatively more of its rehabilitation dollars to surgery, treatment, hospital and convalescent care, and considerably less to training and training related services. In the other forty-nine states the allocation of resources and the proportion of clients given services are more weighted toward training and training related services and less for surgery, treatment and hospital care. Another discrepancy between Georgia and the rest of the states appears in the proportion of rehabilitation dollars and clients served in rehabilitation and adjustment centers. There are proportionally more dollars spent and fewer clients served by these facilities in Georgia than in the rest of the u.s. It is not known if these expenditures include those made for plant, equipment and other capital improvements which in part may explain the disproportionality of Georgia's expenses. In recent years Georgia has been building such facilities, whereas they have been long established in other states; e.g., the major state rehabilitation facility at Warm Springs opened in June 1964, the Atlanta Employment and Evaluation Center in October 1965. The most disturbing aspect of these findings is the maldistribution of resources and clients between treatment and training services. If we assume that this reflects the needs of Georgia's OVR eligible population rather than selectivity of cases for OVR services, the planning for 1975 takes on one perspective. If on the other hand the explanation of this diSproportional distribution is in the selectivity of cases to obtain those who require only physical restoration in order to enter or re-enter gainful employment, the implications for the development of future services for "all those in need of it" portends a serious inadequacy in need of readjustment. In the course of its deliberations it has become apparent to this task force that the extent and delivery of medical and health services to the less affluent segments of State's population as well as in the rest of the United States is changing markedly by virtue of the provision of health and medical care for aged and the medically indigent under Titles XVIII and XIX. The declared goal of Title XIX by 1975 is to: 'J/ furnish medical assistance in behalf of families with dependent children, and of aged, blind or permanently and totally disabled individuals whose resources are insufficient to meet the costs of necessary medical services and secondly, rehabilitation and other services to help such families and individuals attain or retain capability for independence or selfcare, and finally that states shall progressively broaden the scope, amount and duration of medical care toward a goal of comprehensive service for all medically indigent by 1975. 20 In Georgia such planning is actively being undertaken by the State's Department of Health, and the implementation of such a comprehensive plan has major implications for the future provision of services by OVR and other agencies providing services to the disabled. It is likely that the bulk of surgery, treatment, hospitalization and other physical restoration costs will be borne by other programs and agencies. What then of OVR, given its present penchant for physical restoration services rather than for training services: will there be a 30 to 40 percent decrease in fund allocations to parallel the decline in needs to serve a large portion of its former clientele or can OVR at the same or increased funding levels, provide a broader range of evaluation, treatment and training services to more clients? If the present emphasis on physical restoration is in response to the heretofore unmet needs of the State's disabled population, and where to the extent of available resources, training has been provided and emphasized, then the implementation of Title XIX will relieve the OVR of a costly and imposing part of its programo If this is the condition that exists, then the funding of OVR at increased or the same levels will permit the allocation of its resources to training, diagnosis and treatment of more complex and non-physical impairments. In exam~n~ng the projections for client disabilities it is quite apparent that in 20. Schaefer, p. 56, italics added. 21. Wyckoff, Fig. 5. the years to come, the majority of clients will be those with mental impairments;21 the major challenges even without the provisions of Title XIX would be non-physical impairment. If, and hopefully this is not the case, the high proportion of clients and resources allocated to physical restoration services is the consequences of a deliberate or unintentional selectivity of cases, the implementation of Title XIX has very serious implications for the provision of services by OVR in the future. First, having dealt primarily with the "easy cases" the provision of comprehensive medical care competes for this clientele. Remaining for the OVR is an accumulated clientele of non-physically impaired; those with multiple problems of which physical impairment is but a minor aspect, and those whose physical impairments are great but irreparable. This backlog of "hard cases" will be increased as the problems of medical care for the indigent are attacked, and what remains is an even greater backlog of nonphysical disabilities. Such a snowballing could have disastrous results if selectivity has been the principle factor in the present emphasis on physical restoration. It suggests that the skills needed to deliver to all types of impaired individuals services that will enable them to attain gainful employment are not currently available or being utilized by the OVR today. It is apparent, given the goals established under Title XIX, that rehabilitation services will no longer primarily deal with needs for physical restoration; this will be taken care of by other programs. The increased emphasis will be on determination of disability through comprehensive evaluation, and the provision of training for vocational and personal independence, and for self-care. The signs of the changing focus of vocational rehabilitation programs are apparent today; we no longer have a Vocational Rehabilitation Administration, but a new department of Social and Rehabilitation Services. The development of rehabilitation services for the year 1975 are predicated on the assumption thal over the year the commendable achievements of the Georgia OVR and the skills and competencies developed through the years of experience can be translated into rehabili- 58 tation for individuals for whom vocational objectives may not be feasible, but for whom personal independence and the ability to care for themselves is the desired and attainable goalo Thus, to begin any projections for future services we assume that the major emphases of the OVR programs will in all likelihood be on comprehensive evaluation, adjustment and pre-vocational training, vocational training, and training for personal independence and self-care. These services, in their entire range and extent, may not be the province of the State rehabilitation agency; it may more reasonably be the charge of this agency to coordinate on the client's behalf the delivery of needed services by providing some services themselves and purchasing others for the client. Our examination of the various aspects of evaluation, treatment and training have ranged far and wideo At points we have had an abundance of information, at others a paucity. We have tended to raise more questions than we could answer. Some areas we have discussed and examined long and hard, others most cursorily. Our most obvious conclusion is that the real work is about to begin, for with all our efforts, we have only scratched and picked upon the surface. Recognizing these limitations and inadequacies we have reached a number of conclusions based on our findings, made a number of assumptions and have set forth a number of recommendations for the provision of rehabilitation services in 1975. E. Summary of Findings and Conclusions The important findings of this task force are: EVALUATION 1. There is a great amount of variation in the quality, content and usefulness of the General Medical Reports submitted to OVRo 59 2. For the most part the OVR has achieved a fairly equitable distribution of medical specialists and hospital facilities, to the extent that such services are available in different communities. The inadequacies in the geographical distribution of specialists and facilities are more the reflection of rural-urban differences in the availability of car~ and facilities than in OVR's lack of efforts to obtain maximum coverage. 3. The availability and use of hospitals appear adequate, although there is some apparent duplication of the work of other state agencies in the investigation and approval of these facilities for OVR use. 4. The Medical Advisory Board is ful- filling its role adequately, but there are a number of specialties that are not represented. Some changes in composition and amendment of the rules for inclusion on the Panel of Specialists are desirable. 5. There is evidence of insufficient orientation of physicians (as well as other professional groups) to the total range of services provided by OVR, particularly those other than physical restoration. Another aspect of this same problem is the lack of feedback to referral sources, providing them with information about the services provided and the disposition of referrals. 6. As presently organized there appears to be a sufficient range of psychological tests available for use by the counselor in evaluating the client's intellectual functioning, personality, and motivation. 7. The policy of having counselors administer basic psychological tests may be too costly in terms of valuable counselor time and the willingness to use these tests whenever there is the least possibility that they could be an aid in the evaluative process. The findings of one study indicate that intellectual evaluations have been one of the most inadequately used aids. is reflection of a manpower shortage in some areas or a failure to recruit psychologists. 9. In the first year of operation, a very small proportion of applicants (1.5 percent) has been placed in extended evaluation programs, but the results thus far for the group that has been given these services are encouraging. The ratio of acceptances to rejections for OVR services from these programs is about 3.7:1. 10. There are no vocational evaluation facilities reported that do not operate in combination with other kinds of services. Most facilities reporting vocational evaluation services are sponsored by OVR, hut private agencies which are least used by OVR have the best reported results in discharging clients into employment. OVR facilities with work evaluation services discharge more clients into training than similar private or public facilities. 11. The most selective stage of the client career is the evaluation period which has an acceptance to rejection ratio of 2:1, compared to a "closed rehabilitated" to "closed not rehabilitated" ratio of 6: 1. 12. The most frequent reasons for clients not completing training are lack of motivation, emotional instability, home situation and failure to adjust to the training situation. In one study, however, these areas were judged to be almost 100 percent adequately evaluated given the available case diagnosis aids. This raises a serious question ftbout the current quality of psychosocial evaluation and its reliability for predicting client training or vocational potential. 13. It is apparent that for the most part the process of evaluation, possibly except for psychosocial areas, has been well developed, and judging from the outcomes, evaluation in combination with treatment and training produces a respectable ratio of eventual success to failures. 8. There are probably too few psychologists available for testing, therapy and consultation to give adequate coverage to all parts of the State. It is not known, however, the extent to which this TREATMENT AND TRAINING 14. There is a wide array of treatment services provided by OVR, including medical, psychiatric and hospital care. 60 15. There is a fairly wide array of ties for this group should be comprehensive OVR, public and private sponsored facili- in scope. ties to provide treatment and training for physical, psychological, vocational and personal adjustment needs. The largest number of facilities reported (60 percent) provide comprehensive treatment, evaluation and training services. The sponsorship of these facilities is about evenly divided between OVR, public and private auspices. The comprehensive facilities are most frequently used by the OVR, and for the most part they are their own facilities. The largest number, but not proportion, of discharges into employment 20. The projections and plans of the State Department of Education have farreaching implications for the provision of services by the OVR. It is reasonable to assume that an enlarged program of services will be more available for clients who are not now using state vocational training. The expansion of the State's vocational education programs should relieve some of the existing problems in finding appropriate training facilities within the State. are from the comprehensive facilities. COSTS OF EVALUATION, TREATMENT AND TRAINING 16. The OVR facilities discharge about 3 out of 4 clients into employment or training; higher than facilities under public or private sponsorship. It is concluded that OVR has made good use of its own facilities, and that these yield rehabilitation outcomes equal to or better than facilities under other sponsorship. It is not known if this is due to more effective methods or greater client selectivity. 21. In recent years Georgia has spent twice as much of its case services dollar for treatment and care (i.e., physical restoration services), and half as much for training and training related services than the rest of the U.So Physical restoration services are given to twice the proportion of clients than the rest of the states, and a considerably smaller proportion are given training and services in workshops, rehabilitation and adjustment centers. Georgia 17. OVR counselors have indicated that they now need, and planning should be directed toward more workshops, work adjustment, training, evaluation and comprehensive rehabilitation facilities. To a has provided the bulk of services and the allocation of a major portion of its rehabilitation dollars to physical restoration, in contrast to the rest of the states which have emphasized training. lesser extent workers in the Departments of Public Health, and Family and Children Services identify similar needs. They more frequently than OVR counselors, identified the need for services to disability groups rather than specific service needs. 22. Provisions for the development of comprehensive medical care for the medically indigent under Title XIX will greatly alter the types of services required of the OVR in 1975. OVR will most likely be relieved of the need to provide physical 18. Facilities are presently available; they are probably being used effectively but they are not thought sufficient for current or anticipated demands. Apparently restoration services to many of its clients, but instead will be responsible for the provision of comprehensive rehabilitation services, including evaluation, ad- there is an unmet need for treatment and training facilities and services for those justment and pre-vocational services, vocational training and training for personal currently eligible and for other impaired independence and self-care. groups which at present are only marginally served or excluded. 23. There were many questions raised for which data was not or could not be 19. Vocational training facilities (colleges, universities, private and public vocational schools, employment training) are adequate at present for the qualified. made readily available. They were questions relating to various aspects of the program's operation. For the most part these were questions which required an The training of more poorly educated clients is difficult due primarily to a lack of facilities for training this group. There is a need, statewide, for training facilities for this marginal, unskilled experimental approach or additions to established data collection procedures. It was concluded that the absence of these data did not point to deficits, but gave direction for further development of re- and semi-skilled group. Training facili- search programs. We consider these twenty-three statements as the most significant findings of this task force treatment rel and ated to training c urrent service sevianluGateioorng'ia. ASSUMPTIONS AND RECOMMENDATIONS The importance of evaluation, treatment and training as the core of rehabilitation services is obvious. There are at present a number of trends detectable, as well as areas of impending or needed change for which directions are not clear. To present responsible, concrete recommendations for the year 1975, we have given careful and critical consideration to the services as they exist now, and on the basis of anticipated and preferred directions of change, we have made a number of assumptions upon \vhich to develop our recommendations. 2. Successful rehabilitation: Already the traditional definition of rehabilitation is changing and being expanded and we need to maintain flexibility in the program. Specifically, we consider the desired outcome of rehabilitation or rehabilitation services to be the attainment by the individual of a level of performance commensurate with his fullest potential. 3. Availability of medical care: Beginning with Title XIX which is concerned with total health care for the welfare and medically indigent person and other governmental and private programs, the cost of medical care will be met, releasing the traditional rehabilitation programs from concentration on the medical problems of clients. 4. Development of Vocational Education: Assumptions 1. Eligibility for rehabilitation services: The series of legislations, related to vocational rehabilitation, have continually liberalized eligibility for services. Furthermore, the recent reorganization of several agencies within the Department of Health, Education and Welfare into the Social and Rehabilitation Service portends an expanded role for rehabilitation. With these trends in mind we have assumed that the eligibility requirements existing in 1967 are more restrictive, and will probably be inappropriate for 1975. The current eligibility requirements regarding age, employment potential, diagnostic groups, types of disorders, etc., serve only as guidelines. Therefore, assuming that those eligible for rehabilitation services in 1975 will present problems equal to or greater than the complexities seen with clients in 1967, we have elected to develop our recommendations with respect to a broad concept of impairment and disability; including consideration of homemaker services and provision of services to disabled from a family unit plan, or to provide services to a disabled individual to reduce dependency on another family member, or dependency on society in general. It is assumed that the State of Georgia Department of Education will significantly increase the scope and extent of vocational education programs and facilities by 1975. The availability of public vocational education can then absorb a segment of the population that has been more in need of 'babilitation" services than rehabilitatioq services; i.e., they are absorbed into the normal educational process as education programs change to provide a wider range of relevant services. 5. Jurisdiction irrelevant: We choose to specify what services should be available to the client, when they should be provided, and who shall be responsible for the coordination of such services. We are not concerned with who provides the services, so long as the services to the client are of high quality. Recommendations I. THE REORGANIZATION OF EVALUATION SERVICES A. Development of a program based on a preventive, habilitation and rehabilitation perspective. 62 1. There should be early referral and entry of potential clients into a rehabilitation program when impairment is recognized and consequent disability is prognosticated. Impairment can be due to physical, mental, emotional or sociocultural conditions (alone or in combination) that may reduce the potential of the individual to achieve economic independence and social competence. 2. The full range of services should be widely publicized so that wherever there is an expectancy of disability the earliest possible intervention of rehabilitation services is sought. 3. The closest possible cooperation and communication among agencies to identify potential impairment and provide services as soon as possible to minimize potential disability should be developed. 4. The shift in emphasis from rehabilitation to habilitation and the prevention of disability should include objectives other than vocational independence. (It is probable that with increasing technology the productive proportion of the population will decline; for the young, the old and marginally skilled, gainful employment in the traditional sense may not be feasible.) It is recommended that services be provided to develop personal independence and social competence in those clients for whom vocational objectives are unfeasible. The traditional base of services should be expanded to prevent or minimize dependency on others; any impairment that causes dependency must be considered amenable by rehabilitation services. B. Specific recommendations for the current programs 1. The client's privacy should be protected. At each level of evaluation, treatment and training the clients should be required to sign a release for use of information as it is determined advisable by the agency. 2. The general medical form (R-3) should be revised to obtain the recommendations that assist in medical evaluation of the present condition and other medical factors. 3. The President of the Georgia Academy-of General Practice and a physiatrist should be added to the membership of the Medical Advisory Board. A rotation system should be considered for the Medical Advisory Board membershipo 4. All board certified physicians who have at least one year of residence in Georgia should be placed on the Panel of Specialists. Those physicians who are board eligible can be placed on the Panel of Specialists through action of the Medical Advisory Board. The use of out-ofstate consultants should be governed by the same guidelines and criteria used in the selection of Georgia physicians; i.e., board certification and one year of residency in their state. 5. The fee structure for payment of consultants should be changed as one means of attracting a more representative group of specialists. 6. The approval of hospitals and medical facilities should be based on the licensing and certification procedures of the State Health Department; i.eo, the resources of the latter be used to avoid duplication of effort. 7. With proper training and selection the administration of the basic psychological tests now done by the rehabilitation counselor can be accomplished by other personnel; thus enabling the counselor to devote more of his time to counseling. Personnel can be prepared to administer tests through on-the-job training or through short courses offered by universities' rehabilitation counseling programs. The work of these personnel will be performed under the supervision of the rehabilitation counselors or psychology consultants. 8. There should be increased use of extended evaluation, and evaluations done through formal, organized and objective programs whenever there is some doubt about the client's potential or ability to perform. 9. A copy of the client's record (especially previous consultants' reports) should be provided to consultants evaluating or treating that client, if the client has provided a release. (See Recommendation I., B., 1) 63 10. Recognizing the inadequacy of psychosocial evaluation, social work consultation services should be provided on the same basis as is psychological serv~ ices. Social work consultation services should include the direct referral of clients to social workers in either agencies or private practice, and the availability of a social work consultant to the rehabilitation counselor to define for the latter the areas of the client's family and community situation that are relevant for evaluation and planning. 11. It is recommended that the OVR develop in cooperation with the medical schools and health related training programs an educational program to inform medical and other students in these institutions of the distinction between impairment and disability, the scope and nature of rehabilitation services provided, the means of referral, when referrals should be made, etc. II. THE RECONSTITUTION OF TREATMENT SERVICES 2. There should be further development of work adjustment training to provide unprepared clients with the situations for learning the skills, attitudes and values requisite to vocational achievement where economic independence is a feasible goal. III. REVISIONS IN TRAINING PROGRAMS FOR CLIENTS A. OVR should develop further on-the-job and cooperative training programs with industry and commerce. B. Cooperation and joint efforts with the Department of Education should be promoted to develop suitable training programs for rehabilitation clients. C. Training programs sponsored by the rehabilitation agency for which there is a labor market demand but formal training programs are not available (i.e., those in the service, unskilled and marginal occupations) should be developed. A. The restriction of medical treatment services 1. The bulk of current case services monies is spent on physical restoration. Under Title XIX and other medical payment programs the provision of costly medical, surgical and psychiatric treatment will be covered. These should be excluded as the only services provided a client by the rehabilitation agencies. 2. The treatment services that should be provided are those requisite to the attainment of rehabilitation goals and unavailable through other programs. Given the projected availability of comprehensive medical care to cope with the problems of impairment, the primary concern of rehabilitation services should be the prevention or alleviation of disability. B. The expansion of non-medical treatment services 1. Emphasis should be placed on what have been called adjustment training programs. Rehabilitation agencies should provide a broadly based program of therapies designed to remove or reduce personal dependence, deficits in self-care and social incompetencies. IV. REORGANIZATION FOR THE COORDINATED DELIVERY OF SERVICES A. The development of comprehensive zone facilities 1. There should be developed throughout the State chosen locations and central facilities to provide, on a non-resident and/or resident basis, evaluation, treatment and training services. The model of the work evaluation/work adjustment center developed by rehabilitation agencies is suggested. The counselor having direct access to the facility could observe client performance and could exercise greater control over the evaluation process, and the prescription and administration of treatment and training programs. 2. The comprehensive zone facilities should be representative of the economic base of the area served, so that transitions from treatment and training into employment or independence in the community could be accomplished with a minimum of discontinuity for the clients. 3. There should be continued but selective development of comprehensive rehabilitation centers (to include necessary physical or mental restoration services). These should be in contrast to zonal facilities that provide comprehensive evaluation, work, personal and social adjustment, and on-the-job training. The comprehensive rehabilitation center should be used for clients who require as part of their rehabilitation closer supervision around the clock, more intensive therapy or removal from their usual social environment. The zonal facilities should be daytime operations to which the client comes from his usual residence or a residence maintained by the rehabilitation agency. 64 This task force in submitting its report has fulfilled the initial responsibilities with which it was charged. As this initial phase is concluded we are favorably impressed by what has been done thus far, but this is necessarily tempered by the gaps in existing knowledge and the enormity of the work ahead. It is our opinion that perhaps at this point we are ready to ask the most self-search~ng questions, to experiment with programs, and begin the really hard work toward our goal for 1975 of providing to all those Georgians in need of them, the highest quality of rehabilitation services. B. Reconstituting the role of the counselor 1. The counselor's role should be one of coordinator of services to an individual client. He is responsible for the coordination of services to the client in an orderly and logical fashion to utilize the skills of all professionals in order to accomplish the rehabilitation goals. 2. The counselor should, using the consultative services and expert judgment of others, evolve with them and the client the best prescription for achieving the desired outcomes. Vo DEVELOPMENT OF PROGRAMATIC RESEARCH The existing research department should be expanded in order to evaluate on a continuous basis existing programs and to evaluate scientifically all experimental and innovative additions and services. VI. THE CONTINUANCE OF THE TASK FORCES The final recommendation is that the task forces not be disbanded upon the submission of their reports. They should be continued and called into session annually or semiannually to review the progress made toward the goal of providing rehabilitation services in 1975 to all in need. 65 SELECTED BIBLIOGRAPHY Buice, E. R., Follow-~ Study and Evaluation of Training Provided Clients Qy the Georgia Office of Vocational Rehabilitation, n.d. --------~--~--------~---------' Counselor Questionnaires. (Memorandum from F. E. Wynn, n.d.) Division of Vocational Education, Presentation to the Georgia State Board Qf Education, December 12, 1967. (Memorandum, December 15, 1967) Manual of Policies for Georgia's Rehabilitation Program, February 17, 1967. Office of Vocational Rehabilitation, Georgia State Department of Education, Agency Survey Report, n.d. ---------------------------------' Report to the Vocational Rehabilitation Administration: Quarterly Cumulative Caseload June -July 1967. ---------------------------------' ~eport to the Vocational Rehabilitation Administration: Utilization Summaries of Facilities and Workshops for Georgia (VRA-32). , Vocational Rehabilitation Services Advance ------w-i-t-h--S-c-i-e-n-c-e-,--M--e-d-i-c-in-e--a-n~d Automation, n.d. --------------------~----~-----' Worthy of Their Hire (Annual Report for fiscal year 1964-65). ------~----------------------~' ~ Year of Services to Disabled Georgians (Annual Report for fiscal year 1965-66). Schaefer, Mrs. Bruce, ''Medical Care for the Needy," Journal of the Medical Association of Georgia, Vol. 56 (February 1967), pp. 54-58. Vocational Rehabilitation Administration, Department of Health, Education and Welfare, Program Reports, 1962-66. Wyckoff, L. Benjamin, Caseload and Final Projections Based on Present Trends and Estimates of Future Federal Allocations, n.d. 67 APPENDIX A Minutes of Meeting 68 HINUTES OF MEETING OF TASK FORCE NO. TWO ON EVALUATION, TREATMENT AND/OR TRAINING HELD ON NOVEl'1BER 10, 1967 Those Present: Floyd Bliven, N.D. Cecil Harbin, E.D.D. William Craft William Tomlin Sherwood Slater, Bobby R. Todd Charles K. Bush, Charles Long Ph.D. Jr., M.D. Noted the passing of Mr. Wynn and what the Task Force meant to him. Minutes of the last meeting reviewed and accepted. Reviewed the Interim report by Dr. Slater. Recogni"ed the importance of training and instruction for all disciplines involved in the process of rehabilitation. Note was made by Mr. Todd that twenty-three (23) vocational training facilities are operating in the state today. ~vo (2) are residence schools, Clarksville and Americus, the other twenty-one (21) are classified as "drive in" schools. By 1975 it is anticipated that a total of twenty-five (25) vocational-technical schools will be in full operation. These schools will be serving approximately 40% of the school population in a vocational-technical course. Nr. Tocld listed the types of training offered at present time in the vocational-technical schools. Dr. Harbin gave first part of his report, requested by Task Force from the minutes of October 6, 1967, page five. Considering the number of clients we will be serving by 1975, it may be important to consider providing some psychometric services in a field office or district office. Hention was made of some inter-agency transfer or some system whereby disabled individuals receiving services from one phase can easily anci as fast as possible complete or delete some paper work to insure that the disabled person can move from one phase to another and receive the best services without delays. It was further noted that another task force group was working on this problem. Discussion of the assumptions on pages three and four of Dr. Slater's interim report. l. Eligibility: Consideration of homemaker services and provision of services to disabled from a family vnit plan, or to provide services to a disabled individual to reduce dependency on another family member. It may be best to leave eligibility open at this time and let the need or needs between now and 1975 determine this problem. 2. Distinction between impairment and disability: In the description of the terms impairment and disability. 69 -2- This problem will require further deliberation and clarification, but tentatively we will consider impairment as referring to a unit (mental, physical, social, etc.) limitation. Disability would be effects of units of impairment. It is very important to visualize the counselor's role in the future as one being concerned with coordination of services to the client plus personal counseling. 3. Availability of medical care: Beginning with Title 19 which is concerneG with total health care for the welfare and medically indigent person and other governmental and private programs, the cost of medical care will be met, releasing the tra~itional rehabilitation programs from concentration on the me0ical problems. 3.A. Expanding the present facilities and programs to more adequately meet the needs of these clients. 4. Jurisdiction irrelevant: We choose to specify what services are needed by the client or should be available to the client, when they should be provided, and who shall be responsible for the coordination of such services. We are not concerned with who provides the services, so long as the services are high quality to the client. 5. "Successful Rehabilitation:" Already the traditional definition of rehabilitation is changing and being expanded and we need to maintain flexibility in the program. Specifically, we consider the desired outcome of rehabilitation or habilitation services to be the attainment by the individual of a level of performance commensurate with his fullest potential. Dr. Harbin will continue his findings regarding what psychometric procedures could be utilized. Mr. Todd will give some specific plans and activities on the Department of Education's vocational-technical programs. We will meet in Augusta, Georgia, on Friday, December 15, at Eugene Talmadge Memorial Hospital at 9:00 a.m. Respectfully submitted, William Tomlin, Recorder 70 MINLTES OF MEETING OF TASK FORCE NO. 2 ON EVALl.'ATION, TREATMENT AND /OR TRAINING HELD ON SEPTEMBER 8, 196 7 Those present: Vernon Bankston William Craft 1\Tilliam Tomlin F. E. Hynn Nathan 0:olan Calvin Jackson, M.D. Floyd Bliven, M.D. Charles K. Bush, Jr., M.D. Thomas 0. Vinson, M.D. Robert L. Bennett, M.D. Bird Daniel, M.D. Sherwood Slater, Ph.D. Dr. Floyd Bliven was elected Chairman of this Task Force. The charge of this Task Force was again presented which stated that they would be concerned with how clients are evaluated, treated and/or trained now and how these activities should be improved or changed. Occasionally, the committee strayed fro~ its direct charge. However, this background information and discussion turned out to be very valuable as the meeting proceeded. There was considerable discussion of the rules of eligibility. The committee was informed that: we are planning what should be in 1975 and need not be too concerned with the eligibility as it is defined todav. There was considerable discussion of Title 19 which will go into partial effect in October of this year and which will cover all medically indigent people by 19;5. Medical indigence will properly be defined as an income of 50% more than the present welfare limitations. Even though an individual does not need medical services, there are many other services which rehabilitation can render. The public, the client, and the medical profession should be made aware of these. Evaluation was stated to mean "what a person could do occupationally after thorough study of his potentials, his physical and mental condition, his past training and past experience." The services which a person should receive can be determined first by the physician who determines the disability and impairment and what if anything can be done to improve the function. By physician, the group seemed to feel that psychologists and psychiatrists should be included. Second, VR counselors determine what services are necessary to get a person into employment. He gathers all of the available, ~seful information, pulls it together and after catmseli:'-; with the client determines what is best that can be done for this individual. The discussion was held on certain factors affecting the success of Vocational Rehabilitation. 1. The psychological aspect of the family; 2. The cost of services (Should the counselor handle one case cost- ing $3,000 or six cases costing $500 each?); 3. The kind and type of training definitely is a factor. If the client is given all the needed services and is not then employed, the whole objective of VR has been lost. The question was raised as to whether evaluation of the disabled is being blocked by regulations. It was felt that rehabilitation should come into the case early and start working with him. In any case, this should be only after a treatment is started (see chart entitled "Role of Physicians and VR" prepared by Dr. Robert Bennett). Here again it was pointed out that we needed to better orientate the physician so that he would know when to call on the rehab man. It is felt that 71 this should be done by individual visitation to the doctor, as well as speeches for the county and local medical societies. Closer cooperation with the crippled children's division program was recommended. It was felt that perhaps this could be further improved by change in age requirements and economic eligibility. It was felt that many of our medica~ reports are worthless and perhaps they could be revised so that the pertinent facts could be presented on a form and then a narrative be attached. There was considerable discussion of medical advisors and medical consultants. It was felt that perhaps we were not using them as much as we should. It was recommended that a general practitioner be put on the Advisory Committee. The groups included in the evaluation of the disabled are as follows: (1) Medical Advisory Board; (2) Medical consultants; (3) Medical Panel of Specialists; (4) Special Medical Facilities; (5) Primary examining physician; (6) All physicians. There was considerable discussion regarding the protection of a patient's privacy. It was suggested that in each level of his evaluation and treatment that the client be required to sign a release for the use of this information as it is determined advisable. There was some discussion of the counselors overriding the medical consultant's decision. This is done in only rare incidences and then only after consultation with district and State medical and rehab staff. There apparently is very poor follow-up and feedback to the referral source and to the outside agencies and people who take part in the rehab process. The following statements were made at the conclusion of the meeting: 1. It was felt that we did not have a sufficient number of evaluating facilities; 2. The group was not too concerned over the number or kind of training agencies; 3. More use of on the job training was recommended. The two main values of on the job training is evaluation and probation; 4. There was more discussion on what to do about very costly or expensive cases; 5. Emphasis was placed on the need for self care cases (A.D.L.). It was felt that some of these people, even if they had to go to a nursing home, would be able to care for themselves and would not need so much nursing services. It was agreed that the next meeting will be held at the Mental Health Institute in Atlanta beginning at 9:00A.M. on October 6, 1967. Earlier in the meeting Dr. Sherwood Slater, our consultant, was introduced. Dr. Slater is associated with the Sociology Department at Emory University. 72 MINliTES TASK FORCE ON EVALUATION, TREATMENT AND/OR TRAINING Held on October 6, 1967 At The Georgia Mental Health Institute Atlanta, Georgia Those present: Robert L. Bennett, M. D. Floyd Bliven, M. D. Thomas 0. Vinson, M. D. William Craft William Tomlin Vernon Bankston Cecil Harbin, E.D.D. Sherwood Slater, Ph.D. Charles K. Bush, Jr., M. D. F. E. Wynn E. R. Buice Minutes of September 8, 1967, reviewed and accepted by committee, except following changes. In second paragraph, page 1 changed sentence to read as follows: "The services which a person should receive can be determined first by the medical team which determines the impairment and what if anything can be done to improve the performance." The following sentence was removed from minutes: Page 2, third and fourth line removed from minutes, specific line as follows: "In any case, this should be only after a treatment is started." Page 2, first paragraph, should read as follows: "It was recommended that a general practitioner and psychiatrist be put on the Advisory Committee. On the graph presented by Dr. Floyd Bliven, the Progress through the V.R. Process, should read on the bottom line: Disability & Education Training Vocational Prescription Copy of reorganization of Department of Health, Education and Welfare was distributed and emphasis was placed on Social and Rehabilitation Service. Dr. Sherwood Slater attended the National Rehabilitation Association meeting in Cleveland, Ohio, this week, and he gave his impression and interpretation of the meeting and the impact of reorganization of services and its results and importance to rehabilitation aEencies. Dr. Slater also noted the effects of program from his meetings in Washington, D. C. Dr. Bliven Dr. Vinson Dr. Bliven Dr. Slater Discussion Topics 1. Monetary aspects of client's services 2. General practitioner's role in program 3. Dr. Bennett's Warm Springs approach to total rehabilitation team services 4. Expanded definition of services to sociocultural deprivation clients and the impaired from medical and physical aspects 73 Discussion Topics (Continued) Dr. Bennett 5. Crippled children's agency and Department of Education relationship Mr. Wynn 6. Vocational Rehabilitation involvement in education programs (Alto project) Mr. Tomlin 7. Social aspects and involvement of Rehabilitation counselors work with clients Dr. Bush 8. Total health care for everyone Dr. Harbin 9. Definition of term "Health" and its meaning to rehabilitation process Dr. Slater 10. Alternatives to Vocational Rehabilitation services Dr. Bliven 11. Life adjustment counselors role Dr. Bennett 12. Patients; Socially deprived; prison cases Mr. Craft 13. Social service, example: Atlanta Economic Opportunity program Dr. Bennett 14. Too many government agencies and each department not aware of what other departments are doing Dr. Slater 15. Treatment and training, physician's role, counselor's role Dr. Bennett 16. Services gain to the child, Special Education or Vocational Rehabilitation providing services Mr. Bankston 17. Counselor using the agencies in new reorganization and organization use of Vocational Rehabilitation counselor Dr. Bush 18. Two separate organizations running a program and the difficulties can come from two agencies operating a client's program Dr. Bennett 19. Effort should be made to recommend to someone to organize and better coordinate the programs Dr. Bush 20. Liaison group to coordinate the programs Mr. Wynn 21. Broader conception of new rehabilitation services; new counselors philosophy and aggressive outlook to rehabilitation services are good Dr. Bennett 22. Shotgun medicine approach, counselor doing too many things now Mr. E. R. Buice gave the results of the Georgia Rehabilitation program follow-up study of training services to Vocational Rehabilitation clients for years 1961, 74 1962, 1963. Georgia Agency providing training to clients since 1921. Overall results were favorable. Four (4) instruments were devised to supplement interviews with the four (4) groups involved in the study. 2159 clients used: 60% male - 40% female 45% of cases were provided college training 16% - private vocational schools 15% - business school training 27% - public vocational schools 96% were closed rehabilitated in 1961; 91% in 1962; 92% in 1963 Percentage of failures was affected by: 1. New mental health programs 2. Taking on higher percentage of usually non-feasible cases 3. Old age clients were being accepted for services 4. Alcoholics were being included After training, a major portion of placement was attributed to client, family and friends for jobs. Most of clients referred for training were from educational institutions. Many patients will have to travel 100 miles or more to receive medical specialist services. There should be information regarding the number of each specialist in State and location, regardless of Panel of Specialist listing. Discussion followed on physician fees for services, and reports noted of Georgia Medical Association involvement in this endeavor. Discussion was presented regarding physician's Board registration and distinction was made regarding use of terms. Recommendations should be made for all Board certified physicians who have been in Georgia for one year to be placed on Panel of Specialists. Those physicians who are Board eligible can be placed on Panel of Specialists through action of Medical Advisory Committee. In general, the Committee recommends -- on the use of out-of-state consultants, that the same guidelines and criterion be used in the selection as for the Panel of Specialists in Georgia; i.e., diplomats of Specialty Board and one-year residency in state. Committee suggested Dr. Cecil Harbin to bring before the necessary personnel the problems encountered as to when, where, and how psychological services are to be used. In addition to this, some policy could be made as to what instruments are to be used and who could be utilized for testing services. Ten-point review of analyzing present methods and procedures: 1. Response to this is noted in paragraph above. The medical evaluation was reviewed by Mr. Wynn's morning presentation. 2. How can each be improved? This will be our final recommendation. 3. Medical diagnosis complete and satisfactory. Suggested 2 roles involved in evaluation. One, the present condition - evaluation. Secondly, a determination must be made in terms of medical factors. The general medical or R-3 should be revised to obtain the recommendations that assist in medical evaluation. 75 MINUTES OF MEETING OF TASK FORCE NO. TWO ON EVALUATION, TREATMENT AND/OR TRAINING HELD ON NOVEMBER 10, 1967 Those present: Floyd Bliven, M.D. Cecil Harbin, E.D.D. William Craft William Tomlin Sherwood Slater, Ph.D. Bobby R. Todd Charles K. Bush, Jr., M.D. Charles Long Noted the passing of Mr. Wynn and what the Task Force meant to him. Minutes of the last meeting reviewed and accepted. Reviewed the Interim report by Dr. Slater. Recognized the importance of training and instruction for all disciplines involved in the process of rehabilitation. Note was made by Mr. Todd that twenty-three (23) vocational training facilities are operating in the state today. Two (2) are residence schools, Clarksville and Americus, the other twenty-one (21) are classified as "drive in" schools. By 1975 it is anticipated that a total of twenty-five (25) vocational-technical schools will be in full operation. These schools will be serving approximately 40% of the school population in a vocational-technical course. Mr. Todd listed the types of training offered at present time in the vocational-technical schools. Dr. Harbin gave first part of his report, requested by Task Force from the minutes of October 6, 1967, page five. Considering the number of clients we will be serving by 1975, it may be important to consider providing some psychometric services in a field office or district office. Mention was made of some inter-agency transfer or some system whereby disabled individuals receiving services from one phase can easily and as fast as possible complete or delete some paper work to insure that the disabled person can move from one phase to another and receive the best services without delays. 1t was further noted that another task force group was working on this problem. Discussion of the assumptions on pages three and four of Dr. Slater's interim report. 1. Eligibility: Consideration of homemaker services and provision of services to disabled from a family unit plan, or to provide services to a disabled individual to reduce dependency on another family member. It may be best to leave eligibility open at this time and let the need or needs between now and 1975 determine this problem. 2. Distinction between impairment and disability: In the description of the terms impairment and disability. 76 This problem will require further deliberation and clarification, but tentatively we will consider impairment as referring to a unit (mental, physical, social, etc.) limitation. Disability would be effects of units of impairment. It is very important to visualize the counselor's role in the future as one being concerned with coordination of services to the client plus personal counseling. 3. Availability of medical care: Beginning with Title 19 which is concerned with total health care for the welfare and medically indigent person and other governmental and private programs, the cost of medical care will be met, releasing the traditional rehabilitation programs from concentration on the medical problems. 3a. Expanding the present facilities and programs to more adequately meet the needs of these clients. 4. Jurisdiction irrelevant: We choose to specify what services are inneeded by the client or should be available to the client, when they should be provided, and who shall be responsible for the coordination of such services. We are not concerned with who provides the services, so long as the services are high quality to the client. 5. "Successful Rehabilitation:" Already the traditional definition of rehabilitation is changing and being expanded and we need to maintain flexibility in the program. Specifically, we consider the desired outcome of rehabilitation or habilitation services to be the attainment by the individual of a level of performance commensurate with his fullest potential. Dr. Harbin will continue his findings regarding what psychometric procedures could be utilized. Mr. Todd will give some specific plans and activities on the Department of Education's vocational-technical programs. We will meet in Augusta, Georgia, on Friday, December 15, at Eugene Talmadge Memorial Hospital at 9:00 a.m. Respectfully submitted, Is/ William Tomlin, Recorder 77 PROGRESS THROUGH THE VR PROCESS By: Dr. Floyd Bliven Active Individual + (Potential) Disabled Handicapped Impairment Medical Medical Prescription Vocational Prescription ROLE OF PHYSICIAN + VR COUNSELOR By: Dr. Bob Bennett Acute Impairment M.D. Nurses Therapists Technicians Family Job Information Psychological Testing Adaption to Chronic Impairment Voc. Counselor Education Psychological Medical Social Worker Job Placement T E N N. N. c. ---- STATE MAP 1 VOCATIONAL REHABILITATION OFFICES AND DISTRICTS c,. DISTRICT OFFICES .>- I I f L 0 R I D A -~-J T E N N. N. c. --- STATE MAP 2 Number of physicians in private practice and average numb~r of persons per physician, by County. (June l , l 964) Number of physicians in large numerals. Number of persons in small numerals. <( / <( <( F L 0 R D A I _ __j T E N N. N. c. STATE MAP 3 II APPROVED PSYCHOLOGISTS 89 I I I (Including Tallahassee 2) I I I I I :I :I I! I i T E N ----- STATE MAP 4 APPROVED HOSPITALS 108 (Including Chattanooga 3) / i I . I I I . I 'I I f L 0 R D A c. --- STATE MAP 5 SPECIALTY: ALLERGY M-A-G Members:(!) V-R Panel Members:& F L 0 R /' D A I II i ' I _ _j T E N N. N. c. STATE MAP 6 SPECIALTY: GYNECOLOGY _... M-A-G Members: 2..5..._0., V-R Panel Members:l53 <( <( ..J <( F L 0 R D A T E N N. N. c. STATE I MAP 7 SPECIALTY: INTE RGJ AL ME DICI~ E II :I I AND CARDIOLOGY M-A-G Members: 4oO -.._/ c, V-R Pane 1 Members:240 co / F L 0 R s ~ u 0 I D A I, T E N N. N. i I I I I I <( co <( _J <( c. ---- 0 STATE MAP 8 SPECIALTY: DERMATOLOGY M-A-G Members:@ V_ R pane 1 Members : 11 F L 0 R '~--- D A T E N N. N. c. ----- STATE MAP 9 SPECIALTY: EYE, EAR, NOSE AND THROAT and EAR, NOSE AND THROAT M-A-G Members:@ F L 0 R D A I _____ _j T E N N. N. c. STATE MAP 10 SPECIALTY: ORTHOPEDIC SURGERY 0 M-A-G Members:@ C,..V-R Pane 1 Members :60 -~ / F L 0 R D A T N N. N. c. ---- STATE MAP 11 SPECIALTY: r~ EUR0 L0 Gy- NEUR0 0 SURGERY M-A-G Members:@ ,;.. V-R Pane 1 Members:28 <( / <( <( F L 0 R D A I I I I I,I - - _ _ _ _j~ T E N N. N. c. --- 0 STATE MAP 12 SPECIALTY: PATHOLOGY M-A-G Members:@ V- R Pane 1 Members : 13 cO / : i I< f L 0 R D A T E N N. N. c. ---- STATE MAP 13 SPECIALTY: PHYSICAL MEDICINE M-A-G r,1ernbers: V- R Pane 1 \t1e rn be r s :6 ! I I <( <( I! I ! . i <( T E N N. N. i I I ! ' ! c. STATE :@ .'-A-G '.1.'?n,tcrs 0 \1- R Lmr 0 / <( ..J F L 0 R D A T E N N. N. c. .-~ STATE MAP 15 SPECIALTY: PROCTOLOGY M-A-G Members V- R Pane 1 Me mbe r s: 4 <( <( ...J <( F L 0 R i I , I / i I D A ~ I ~ I I 0('"J' I I (J j;: ~ ;~ : , I ~ I ~ I, .I J I T E N N. N. c. STATE MAP 16 SPECIALTY: NPESUYRCOHPIASYTRCYHIAATNRDY M-A-G Members@ >V_ R pane 1 Members 72 dl _J F L 0 R D A T E N N. N. c. --- STATE MAP 17 SPECIALTY: RADIOLOr.Y lOl M-A-G Members : '"---' V-R Panel Members:32 II ! ! <( <( F L 0 R D A T E N N. I N. c. STATE MAP 18 SPECIALTY: SURGERY JE~ M-A-G Members: 0 v_R pane 1 Members : 420 I I I i I II I I 0 dJ _J F L 0 R D A i ~-------______..j T E N N. N. c. STATE MAP 19 SPECIALTY: CHEST . THORACIC SALN'DR~ERY \.1-A-G r.11embers@ I V-R Pan 2 1 ;Aembers 20 II I 'I I' IiI' ; I 'I I I I F L 0 R D A T E N N. N. c. .----- STATE SPECIALTY: UROLOGY r,~-A-G Members:@ V-R Panel \1embers:76 'I / _J . I' F L 0 R D A REPORT OF THE TASK FORCE ON OCCUPATIONAL PLACEMENT AND FOLLOW-UP Statewide Vocational Rehabilitation Planning Project January, 1968 j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j OCCUPATIONAL PLACEMENT AND FOLLOW-UP TABLE OF CONTENTS Page Preface ......................................................... 102 I. Introduction ................................................. 103 II. Pilot Surveys ............................................. 104 Counselors ................................................. 104 Employers ................................................... 105 A. Limitations .......................................... 105 B. Industry Distribution of Respondents ................. 111 C. Attitudes Toward the Hard-Core Unemployed ............ 111 D. Employer Knowledge, Use, and Prospective Use of Handicapped Workers ............................... 114 Ill. Follow-Up and Evaluation of Placement .................... 124 IV. Summary and Recommendations ............................. 158 Appendix Questionnaire for the Survey of VR Counselors in Georgia ...... lR 102 Preface The Committee was composed of several representatives of various public agencies, including the Georgia Vocational Rehabilitation Office (OVR), and of individuals from the private business community around the State. Participation among the membership ranged from no involvement whatever, to full participation in all meetings and discussions. Several meetings of the active members were held, mostly for orientation and for identification of the objective. The task of selecting and analyzing the data, and of writing the report, was assigned to the consultant, with various VR staff members providing him with whatever information he requested. Upon completion of the report, a meeting was held to review the consultant's findings. While there was a consensus of agreement regarding the general findings, conclusions, and recommendations, some members did object to the harsh criticisms of some prior VR studies reviewed and reported by the consultant. Yet the consultant felt that some such studies were sufficiently disturbing to warrant attention by their sponsors, and was of the opinion that caustically phrased criticism would be an effective method of eliciting such attention. Thus, it is to be understood that the wording of the report was constructed exclupively by the consultant, and that he assumes full responsibility for its content. Is/ Mack Moore 103 PART I: INTRODUCTION Method of Approach In approaching the assignmer.t, attention was focused on the three principles involved in placement: clients, vocational rehabilitation agency personnel (especially counselors) and employers. The author felt that it was logical to assume the existence of a fair number of: (1) clients \vho were being rehabilitated to a state of employability, but who were facing obstacles in bridging the final gap, i.e., being placed on jobs; and/or (2) otherwise eligible potential clients who were not being accepted into case status due to lack of reasonable expectations of suitable employment opportunities. Thus, it was felt that the necessary steps would consist of identifying and classifying the above clients and potential clients, determining the obstacles faced, and attempting to project some method of reducing the obstacles. Since it was assumed that the appointing of a task force on placement ipso facto meant that the problem described above was known to exist, it was assumed that information regarding the magnitude of the problem could be extracted from existing vocational rehabilitation records. the body of information already in existence pertaining to placement and follow-up. But at that point, some discouraging findings emerged, notably that internal records do not produce information in the form necessary to determine the extent of the presumed problem, and in fact the author could not positively determine that a problem of any significance in the area under scrutiny even existed. In other \vords, the "problem" had apparently been established by intuition only. These efforts led to a close examination of some prior research projects which purportedly had documented the existence of a problem. Here, candor compels that the author describe his reaction succinctly: shocking. Not only did the projects evaluated reflect incompetence in research design and implementation, but the interpretations were grossly misleading. To summarize the author's reaction to his evaluation of some specific research projects, when read in context with the other knowledge gained regarding VR operations in general, he was left wondering if the "problem" arose from concern over VR clients, or from concern with VR expansion, ~ se. And he would be less than honest not to admit strong inclination toward the latter. Since such strong indictment warrants extensive documentation, Part III is devoted to very lengthy dissection of research reports. On that basis, the effort was directed toward the VR counselor in his role of providing placement services, and on employers and prospective employers in their attitudes and policies toward handicapped job applicants. Due to the very limited resources, empirical collection of original data sufficiently extensive to yield conclusive results was out of the question. Thus, it was decided to confine the effort in that regard to the identification of areas in need of in-depth research, and to establish methodology in pursuing the questions. Findings based on these efforts are presented in Part II. The major findings, however, are based on some analysis of existing research and records, as described in Part III. Summary of Findings While the above surveys were in progress, attention was turned to the examination of While there is no intention to hedge on these criticisms, it should be pointed out that the author of this report is an economist, whose primary research interest is in the field of employment and manpower; he arrived on the present scene with no knowledge whatever of vocational rehabilitation, with no background in the behavioral sciences, and with no knowledge of rehabilitation as an academic discipline. The time allotted did not allow ex~ensive search of the literature, which an overall orientation would have required. The conclusions, then, are based purely on an analysis of the material from the standpoint of economics, in light of logical and commonly accepted procedures in research methodology --whether applied to behavioral science, economics, or any of the other social sciences. Since the criticisms are admittedly caustic, even cynical at ti~es, a plea to accept them as being offered in good faith \vill no doubt be taken as an ex paste facto addendum. 104 PART II: PILOT SURVEYS Counselors A questionnaire was mailed to all VR counselors in the State in October, 1967. There were no illusions about the lack of precision in the survey, as it was based purely on estimates and attitudes, and the only expectation was that of a general notion regarding counselors' feelings regarding their roles in the placement aspect of rehabilitation. Although coordinating the questionnaire through the district supervisors did result in a 100 percent response, no effort was made to draw any statistical inference from the results, for the preceding reasons. In other words, finding nothing as a point of Jeparture, as was reported in the Introduction, the only hope was a rough "reading" of some tendencies in counselor attitudes--not magnitudes. A copy of the questionnaire is inserted as Appendix I. After tabulating the results, it was found that the responses to some of the questions showed no patterns to which even crude implications could be assigned. These results are not reproduced. For whatever it may be worth, the number of respondents in each District is shown in Table 1. From Table 2, it will be noticed that 78.6 percent of the counselors estimated 30 percent or less of their total worktime was spent in placement activities. In Table 3, 57.3 percent were of the opinion that 30 percent or less of their clients needed placement assistance. Thus, even with a conservative allowance for the limitations noted, it appears that time devoted to placement compared \vith the time the counselor thinks is necessary is at least somewhere within a tolerable range. Yet such observation, no matter how valid, does not necessarily lead to the conclusion that the number of clients receiving placement assistance is proper, for the counselor could be incorrect in his assess~ent of needs. Furthermore, there is a very wide range of error possible in the :latching of assistance and need on an individual basis; that is, for example, the 39 clients shown in Table 3 as estimating that from 16-30 percent of their clients needed placement assistance by no means necessarily includes the 38 counselors shown in Table 2 as devoting 16-30 percent of their worktime to the providing of such assistance. In other words, there is no way to know if the clients who need help are the ones who receive it, whether each one receives the proper amount of assistance, or whether some may be overcounseled. Such information would require intensive and specialized research. TABLE 1 DISTRIBUTION OF SAMPLE BY DISTRICT District Percent Albany 19 Atlanta 51 Decatur 24 Gainesville 23 Macon 27 Savannah 34 10.8 28.6 13.5 12.9 15.1 19.1 Total Sample 173 TABLE 2 DISTRIBUTION OF THE PERCENT OF EMPLOYEE WORKTIME SPENT IN PLACEMENT Cumulative Percent Percent 5/o and Under 31 6 to 15/o 71 16 to 30/o 38 31 to 60/o 10 Over 60% 6 N/A (No Answer) 22 17.4 39.9 21.3 5.6 3.4 12.4 17.4 57.3 78.6 34.2 87.6 100.0 Total 178 105 TABLE 3 DISTRIBUTION OF THE PERCENT OF CLIENTS ACTUALLY IN NEED OF PLACEMENT 5% and Under ll 6 to 15% 52 16 to 30% 39 31 to 60% 22 Over 60% 35 N/A (No Answer) 19 Percent 6.2 29.2 21.9 12.3 19.6 10.8 Cumulative Percent 6.2 35.4 57.3 69.6 89.2 100.0 Total 178 The findings in Table 6 when related to Tables 2 and 3 are somewhat puzzling, in that 70.2 percent of the counselors interpret their role as going beyond counseling the client on how to successfully obtain a job. Ostensibly, one concludes that job placement is a relatively minor aspect of the entire counseling process, both in terms of the percentage of clients in need of placement assistance, and in terms of the amount of time required by each client. These findings do not necessarily present any inconsistency, but are noted for whatever thought those actually involved may wish to devote. The implications of the counselor survey cannot be fully analyzed in isolation, but must be integrated with other data collected. Therefore, more reference to the results will appear at later points. Employers A. Limitations The collection of original data on the labor market was not part of the plan at the outset of the committee's formation. But during the period of our existence, the author had occasion to direct some students in practice interviewing, as part of a course in research methodology. Some questions on hiring practices were included. Each of eleven students (plus the author) was to interview three employers in Atlanta, chosen at his discretion, which meant expediency, rather than representativeness, was the only consideration in choosing the "sample." A total of 35 firms was interviewed. In order to provide experience in different interviewing approaches, some structuredresponse questions, as well as some of the open-end variety, were included. In the latter case, each answer was classified and coded by the author, which meant interpreting each interviewer's interpretation of the original responses--a hazardous approach, at best. But the saving feature is that the project was a pilot study, designed to test the feasibility of, and to construct an approach to, a genuine employer survey. On the other hand, in spite of the imperfections, the results are not completely moot, in that certain comparisons of responses appear to reveal some worthwhile knowledge, especially from the structured-response questions. As for the open-end questions, the results should be relied upon only in considering some appropriate areas for study. But here again, the responses were of value in bringing to light the great diversity of attitudes among employers; this provided the basis for a great deal of reflection regarding vocational rehabilitation placement policy. 106 TABLE 4 DISTRIBUTION OF THE PLACEMENT PROBLEMS IN PRIVATE INDUSTRY 1. Insurance, Workmen's Compensation 62 (financial in general) require- ments 2. Union requirements 5 3. Employment opportunity too low 24 4. Client unqualified by training or 38 to meet entrance requirements 5. Unfavorable employer attitude 41 6. Unfavorable employee attitude 2 7. Unknowledgeable concerning various 15 handicaps 8. Counselor inexperience and lack of 13 time 9. Race, sex, age 10 N/A (No Answer) 29 Percent 25.9 2. 1 10.1 15.9 17.2 .8 6.3 5.4 4. 2 12.1 Total 2 3 9~~ *N = more than 178 since some respondents listed more than one problem. 107 TABLE 5 DISTRIBUTION OF SUGGESTIONS FOR RESOLVING PLACEMENT PROBLEMS 1. Workmen's Compensation, insurance 17 revision 2. Public communication and promotion 74 of program 3. Need for placement specialists 16 4. "Proof of the Pudding" 5 5. Training facilities; client 17 preparation 6. Training of counselors; knowledge 7 of client 7. Federal pressure to force ratio 2 8. Revision of entrance requirements 4 9. More time for counselors 6 N/A (No Answer) 60 Total 208 Percent 8.2 35.6 7.7 2.4 8.2 3.4 9 1.9 2.9 28.8 108 TABLE 6 DISTRIBUTION OF ANSWERS TO QUESTION II. 4 Question II. 4: There is no explicit definition of the counselor's relationship and obligation to the client. From your personal view, check the statement that most closely fits your interpretation of the role of the vocational rehabilitation counselor in placement. The counselor prepares the rehabilitated client to find a job by showing him how to conduct himself on the job; he explains the tech- niques involved in a successful job inter- view, teaches him the importance of good grooming, etc., and provides him with per- tinent data concerning the labor market or 44 The counselor not only briefs the client on the above but in addition he personally arranges job interviews and talks with the prospective employer about the individual client before the job interview. 125 N/A (No Answer) 9 Total 178 24.7 70.2 5.1 109 TABLE 7 DISTRIBUTION OF ANSWERS TO QUESTION III. 4 REASONS FOR NOT HIRING HANDICAPPED YES NO NO ANSWER a. Fear of "expense" which might be involved b. Reluctance to having disfigured or "unsightly" individuals in place of business c. Fear of "normal" employees' disapproval d. Fear of business cormnunity ridicule or criticism e. Genuine skepticism regarding disabled worker's competence in his given field f. General avoidance of "change"-wanting to do things as they have always been done g. Fear of increased workmen's compensation premiums h. Others (60. 7) 108 (52.8) 94 (31.4) 56 (38.3) 68 (42.1) 75 ( 9.0) 16 (71.3) 127 (50.6) 90 (82.6) 147 (23.1) 41 (42. 7) (48.3) 76 86 (78.1) 139 (20.8) 37 (14.0) 25 0 ( 7.9) 14 ( 7.9) 14 ( 7.3) 13 ( 8.4) 15 ( 5.6) 10 ( 9.0) 16 ( 7.9) 14 (79.2) 141 TOTAL 178 178 178 178 178 178 178 178 TABLE 8 COUNSELOR CONCEPTIONS OF EMPLOYER ATTITUDES III. 1. Based on your personal contact with employers in your area in regard to placing your rehabilitated clients, check the block that best describes the employers' general attitudes toward hiring the handicapped. Highly Favorable 13 (7. 3) Moderately Favorable 114 (64. 0) Moderately Unfavorable 37 (20.8) Highly Unfavorable 0 (0) N/A No Answer 14 (7. 9) -1---- -- --- Total 178 - - - - 2. According to the specific handicaps in the table below, rate the attitudes of employers in your area whom you have approached to hire clients with these handicaps. 0 ,...; ,...; TYPE OF HANDICAP ATTITUDES OF EMPLOYERS TOWARD PLACING Highly Favorable Moderately Favorable Moderately Unfavorable Highly Unfavorable N/A No Answer Total a. Physical Handicap (other than blindness or e~ile~sy) 18 (10.1) 102 (57.3) 8 (4.5) 0 50 178 (28.1) I b. Legal Blindness 2 (1.1) 12 (6. 7) 36 _{20. 2)_ 13 {7.3) 115 178 (_64. 6) c. Epilepsy 1 11 70 45 51 178 (. 6) (6. 2) _(39.3)_ (_25.3) (28.6) d. Emotional Handicap 2 _(l.ll 61 _{34. 3) 57 (32. 0) 19 ( 10. 7) 39 178 (21.9) e. Mental Retardation - - - - - - -~-- - - - - - - - - - - 5 (2.8) 96 (53.9) 41 (23.0) 9 (5.1) 27 178 (15.2) 111 In summary, the entire survey appears useful as a sort of first approximation of the general profile of attitudes and policies, but the results must be viewed in their composite nature. Caution in approaching the results of any of the questions in isolation cannot be overprescribed. As for the feasibility of an employer survey regarding the handicapped, it was found that employers are reasonably cordial and willing to cooperate. It must be recognized, however, that the amount of thought devoted to responses varies widely-one of the many limitations inherent in any attitudinal survey, no matter how precisely formulated. The amount of time for each interview varied from twenty minutes to two hours, depending upon a combination of the respondent's time available, his general interest in the subject matter, and the degree of efficiency on the part of the interviewer. (This was part of the testing process, as was the application of each student's resourcefulness in arranging the interviews.) B. Industry Distribution of Respondents The firms in the survey were grouped as follows: Manufacturing 16 Hotels, motels, restaurants 5 Hospitals 3 Financial (insurance and banks) 5 Utilities and transportation 4 Department stores 2 35 Limitations of the survey notwithstanding, Table 9 suggests some observations which would appear reasonably valid, even in the absence of any statistical test of significance. Some of the more prominent observations are: 1. Personnel managers as a group feel that the unemployment problem in Atlanta is more attributable to deficiencies on the labor supply side than to inadequate demand. That is, they feel that unemployment is due to some shortcoming on the part of the unemployed worker in qualifying for, and locating, available jobs, more than to a scarcity of job opportunities. (See Items 1-7.) 2. As logical sequel to the above attitude, there appears some feeling that the widely-publicized barriers facing unemployed workers are overstated, such as in the case of older workers (Item 8). 3. There is considerable agreement that personal appearance is a formidable and widespread employment barrier (Item 9). Such finding, if valid, would confirm a hypothesis the author of this report has advocated for years, and its implications for the handicapped will be discussed in the section on hiring policies, but Table 7 (Item b in the counselors' survey) indicated that a majority (52.8 percent) of the responses expressed belief that personal appearance is an employment barrier facing the handicapped. 4. Personnel managers feel considerable personal compassion--perhaps more than one would suspect--toward alcoholics and public offenders (Items 13 and 14). 5. But as one would assume, compassion toward the above groups is not as extensive as it is toward the physically and mentally handicapped (compare Item 12 with 13 and 14). C. Attitudes toward the Hard-Core Unemployed The first part of the survey is presented in Table 9. The form was completed by the respondent (which required from 5 to 30 minutes). 6. In spite of the suggested susp~c~ons regarding motivation of the unemployed, personnel managers feel that public manpower programs are necessary in a dynamic economy. These attitudes combined would conform to the increasing assumption that social effort is necessary but not sufficient in solving whatever employment problems may exist. TABLE 9 PILOT SURVEY OF EMPLOYER ATTITUDES TOWARD THE HARD-CORE UNEMPLOYED We hear a lot about the so-called prosperity unemployment problem; that is, high unemployment among certain groups, such as youths in slums and rural areas, among older workers, the unskilled, etc. The typical arguments used in explaining the problem are listed below, along with some proposed solutions. Based on your experience and/or observations, please check the column indicating your response. STRONGLY AGREE 1. There are not enough jobs to 0 o around 2. There are enough jobs, but the 13 unemployed lack motivation 3. Workers lack the skills, edu- 10 cation or experience 4. Technology has rendered a 4 larger number of workers obsolete 5. There are enough jobs and even 3 assuming workers are willing and capable, the information flow is inadequate, so that workers and jobs don't get to- ether 6. Employer standards, such as 2 education and experience re- quirements are too high in terms of job requirements 7. With the increased level of 7 education, employers have in- creased their educational re- quirements, not just because they are really necessary, but to a very large extent because people with more education are available 8. The problem of the older worker 1 is overstated, since such work- ers more often have other prob- lems, such as lack of skill, unstable employment records, various derelictions etc. SOMEWHAT AGREE 3 18 14 8 19 6 8 18 NO OPINION (N=37) 2 1 1 3 2 1 2 4 SOMEWHAT DISAGREE 11 4 9 11 9 17 14 11 STRONGLY DISAGREE 21 1 3 11 4 11 6 3 TABLE 9 (CON'T) 9. One of the harshest forms of 8 17 0 9 3 discrimination in employment is based on personal appear- ance, such as unsightly facial features, people with a simple appearance, those of abnormal or subnormal height, weight, etc. Some Proposed Solutions 0. We should establish public 7 programs to train the un- skilled 1. We need to ease the pressure 16 for youngsters to attend col- lege, but rather for more to enter the manual and other blue collar trades 12 2 14 0 5 11 5 2 2. We should rehabilitate those 21 15 1 0 0 people with employment problems through no fault of their own, such as physical handicaps, mental disorders etc. 3. We should do more to rehabili- 8 23 2 4 0 tate ex-prisoners into useful em lo ent f. We should do more to rehabili- 12 19 2 3 1 tate alcoholits into useful em lo ent ' In a prosperous economy such as 0 we now have, no public programs or special efforts by employers are warranted 2 2 20 13 ' Unions should relax their rules, 10 10 12 5 0 such as those on apprenticeship, promotions, seniority, etc., to allow employers more flexibility in accommodating disadvantaged workers Employers should re-evaluate all 9 20 0 6 2 jobs in terms of educational and experience requirements 112 7. Items 6, 7, 11 and 17, when read together are intriguing, at least in terms of methodology. Fewer respondents agreed than disagreed that hiring standards are unrealistic (6). While fewer also agreed than disagreed that education. and experience requirements have been unrealistically increased, the magnitude of difference is not as great (7). On the other hand, there is very strong agreement that the pressure for college attendance is overdone (11). But in (17), the answers again appear inconsistent with those in (6) and (7). It could be that the respondents were thinking in terms of certain jobs at some points, but of jobs ~ &eneral at others. Or the mood could have changed in the transition of thought from causes to soluti~. Or is a respondent in answering this type cjuestion influenced by a _ri~ question on the list, and/or his answer to a prior c;uestion? In any event, if there is an area of labor market analysis starving for research, that of job requirements versus hiring requirements must surely be it, regarding handicapped as well as non-handicapped workers. some later findings) some further words of caution are in order. First, if there is a word of truth in their stated positions, Atlanta employers are experiencing a shortage of qualified applicants rivaled only by the days of World War II. As an introductory question, each firm was asked to state his biggest problem in hiring workers. Even a crude classification of the answers would have ceen r.1eaningless, but all except ~ gave some version of "shortage of applicants." Replies such as shortage of applicants who were "qualified," "trainable," "dependable, "willing," and the like, were almost unanimous. A few mentioned skilled workers, although several specified unskilled help. Others said "shortage of applicants--period, (which seemed to mean anything from an inadequate number of "bodies," to a shortage of acceptable applicants for all levels of jobs). A second reason for caution lies in the structure of the sample. That is: (1) manufacturing accounted for 16 of the 35 firms, and most jobs in that sector require at least some ability above the warm body 11 level; (2) hotels, motels, restaurants, and The qualifying phrase, "assuming you have suitable jobs open," in the instructions with Table 10 does not parallel the concepts used in the counselor survey, where the respondents were to indicate any barriers to placement of the handicapped. (See, for example, Table 4.) At one early point in the deliberations, the committee discussed the possibility of comparing actual employer attitudes with those assumed on the part of counselors. But since the coun- hospitals accounted for an additional 8 of the finms, and such institutions offer a large proportion of menial jobs at low wages, which means high turnover and hence constant recruiting; and (3) financial institutions and department stores (7 of the 35) are always hard hit by labor shortages in a tight labor market, since their volume is strongly pro-cyclical and they must have dependable help at "stable11 wages while alternatives facing prospective applicants become relatively more attractive. selor survey was statewide (for desirable reasons), and the employer survey was (of necessity) limited to Atlanta, an) such comparison would have been wholly meaningless. The purpose of the employer survey was not to measure current job openings, but to gain some notion of employer attitudes when jobs are open. Hence, the above phrase~ for the purpose of confining answers to conditions when jobs were available. As for the results in Table 10, rehabilitation practitioners will no doubt question the open-mindedness the results apparently reflect. And such suspicion may well be in order. But before condemning or commending the respondents (as one is tempted to do in Turning again to the results in Table 10, one at first blush is led to suspect that the compassion noted in the discussion of Table 9 toward alcoholics and public offenders may reflect a double standard, in that actual hiring policies (shown in the last two items of Table 10) do not seem to agree with the attitudes toward the plight of these applicants (as expressed in Items 13 and 14 of Table 9). But such suspicion is not positively sup ported by any means (although it is not necessarily rejected). That is, responses in Table 9 reflect attitudes on the part o: personnel managers as individuals, while the responses in Table 10 were intended to reflect policies of their firms. 113 TABLE 10 HIRING POLICIES TOWARD HANDICAPPED AND DISADVANTAGED APPLICANTS Hiring Policies toward "Problem" Applicants Here is a list of the groups commonly considered suffering from handicaps and other disadvantages in employment. You may not agree that all of them are entitled to such consideration, but all of them are currently receiving varying degrees of public attention. What is your general policy toward each group, assuming you have suitable jobs open? HANDICAP No restrictions; treated same as all applicants Arrm_utee 3 Blind 1 Hearing Defect 12 Mental Disorder 4 Epilepsy 3 Heart 5 Over 45 25 Young, inexperienced 26 HiRh school dro~-outs 13 Armed Forces Rejectees 4 Dishonorable Discharge 1 Prison Record 4 Alcoholics 1 Totals 102 HIRING POLICY No formal restrictions; but screened carefully 18 7 18 16 17 17 7 4 15 18 17 19 11 184 N 35 Do Not Seriously Consider 11 23 3 9 10 8 0 1 4 0 14 9 19 111 No Answer')!. 3 4 2 6 5 5 3 4 3 3 3 3 4 48 *The reason for the "no answer" category is that this part of the interview was read to the respondent, and in cases where his response was too vague to classify, it was classified in that category. The same applies to all of the open-end questions (next). 114 In fact, probing for inconsistencies reflecting standards was not the purpose; the purpose (on this score) was to illustrate the importance of distinguishing between attitudes and policies. A business firm (except in case of the shrinking minority of owner-operated firms), being an inanimate entity, cannot express attitude; it can only express policy through an appointed spokesman. The Use of Handicapped Workers 1. What has been your general experience, if any, with physically handicapped workers? Significant experience 17 Limited experience 9 No experience 8 Did not know 1 But the most important implication arising from a comparison of Tables 9 and 10 is that personnel managers qua personnel managers are not only limited by company policy, but by the nature of the work involved. Thus, while one would be hard-pressed to locate any citizen not sympathetic with the blind, e.g., the vast majority of jobs require vision at a functional level. Any employer surveys on job opportunities, then, must make sure the information collected reflects actual policies rather than personal preferences. 35 Results (from the 26 with some experience): Good; no complaints 21 Fair 1 Poor 3 Did not know 1 26 A very serious limitation in attempting to measure policies and attitudes toward the handicapped lies in the definition of the term. Any survey, to be statisticall meaningful, must classify the questions by type of handicap. D. Employer Knowledge, Use, and Prospective Use of Handicapped Workers Introduction The remainder of the data on employers is derived from the results of the open-end uestions. As explained, the purpose of the entire survey--particularly this portion--was twofold: (1) to serve as a pilot study for future research; and (2) as a point of departure in formulating recommendations regarding current vocational rehabilitation practices. For these purposes, it is felt that reproducing the question (or a group of questions) pertaining to each topic, then presenting results, analysis, and conclusions on that topic, is preferred, since the results do not lend themselves to the more usual tabular arrangement. The reader is again cautioned to read the Limitations (page , A) of the survey before attaching any significance to these results. As an illustration of definitional problems, the reader is asked to refer back to Table 8, under the counselor survey. It will be noticed that not one marked the category "highly unfavorableYon employers' general attitudes toward hiring the handicapped. But when asked to mark the choice of attitudes toward handicaps other than physical, from 9 to 45 out of the 178 marked highly unfavorable. This raises two questions: (1) when the term "handicap" is raised, do counselors, themselves, tend to think of physical handicap? or (2) do the response patterns indicate that coun selors think employers are not highly unfavorable toward the handicapped in general, but ~highly unfavorable if one specifies handicaps other than physical? These points are raised to emphasize that attitudinal surveys without some objective quantifiable data included are of very limited value (and possibly of negative value, i.e., they may be misleading), unless questions are included whereby one can cross-check response patterns. Further examples of this process of raising more questions than one answers will become apparent at other points of the employer survey. 5. What is your reaction toward being solicited by VR, i.e., is it (or would it be) annoying, would it be worthwhile, etc.? Favorable>~ 20 Formal Contact with VR and Parallel Agencies Indifferent 5 Unfavorable>':>'( 4 2. Have you had any contact or dealings No answer 6 with the Vocational Rehabilitation (VR~ peo- ple regarding hiring the handicapped? 35 Yes, of significance 12 Yes, but not of significance 8 6. If you were approached by competent No 13 people from VR or elsewhere, do you think Did not know 2 more workers from any of the above groups could be employed by you (assuming you had openings)? 35 Yes 17 3. If you are contacted by other groups Qualified yes 7 engaged in job placement for people with em- Not likely 5 ployment problems, please list some of them. No 3 No answer 3 Had been contacted by other groups 18 Had not been contacted 15 35 Did not know 2 Note: Total responses include the 20 who had had some contact with VR (noted in No. 35 2), but the 24 affirmative responses here included 11 of the 14 who had had no con- Note: This question was primarily a lead- tact. in question for No. 4. It should be mentioned that all of the The caution urged in the Introduction, 35 firms contacted were very large; thus notably that of the tight labor market in the above responses in no wise reflect an Atlanta, should serve as a restraining force indication of a penetration rate by VR. over any exuberant reaction VR personnel, ~ Yet only two of the 16 firms which had ex- alia, might be tempted to experience in perienced significant contact with VR were viewing the results in Question No. 5 as a in manufacturing, which would suggest the "reception index." And yet, while the re- possibility that more contacts in that sec- sponses, no doubt, do overstate the affec- tor might prove fruitful. (More on this tion employers feel toward solicitors, they later.) also point up the potential for convincing Another point to note is that the sur- employers to adopt a policy of using satis- vey did not determine whether contact was factory performance as the sole criterion initiated by VR, or by the employer. Any in hiring, in hopes that such policy would future survey might do well to determine become routine even under more normal labor and record such distinction, such as to see market conditions. if at some point the sentiment "catches on." Attitudes Toward Solicitation 4. Are you over-solicited in terms of the number of agencies contacting you (or do you have business associates who complain of this)? Yes 2 No 31 No answer 2 >~Ranged from answers such as "Yes, it might be worthwhile," to some degree of enthusiasm, such as ''Would be very glad to see them." **Usually because no suitable jobs were available (or at least that was the comment). 35 116 Employer Knowledge of VR Programs and Procedures: These responses tend simply to verify that many employers have no information, or wrong information, of VR operations. Yet some additional knowledge was revealed, in 7. Are you familiar wit~ the various services offered by VR, and of their method of operation in working with employers in placing handicapped workers? that answers to the above block of questions formed the beginning of a very clear "pattern" \vhich pervaded the entire survey, which is that there is no pattern. For example, in Question 8, several respondents This question was fruitless, in that all respondents had "heard of it. 11 But it was primarily intended as a dummy question to set the stage for Questions 7 through 12. stated that they preferred the counselor not offer his services in choosing a job for the client. And in Question 9, at least one noted his objections even to the counselor's accompanying the client for the in- 8. Does VR (A) work with employers in terview. helping to determine just what jobs workers with handicaps might fit into; or (B) do they simply send the worker out and put him in your hands? Continuing this theme, the responses in Questions 11 and 12 confirm the diversity of preferences and attitudes. In reviewing the remarks, one clearly discerns a pronounced (A) (B) Did not know No answer 12 feeling of resentment toward intrusion into 3 matters which many apparently feel (rightly 17 3 or wrongly) is the responsibility of the firm. Several commented to that effect, and some expressed fear that the continuance of 9. Does a counselor accompany the worker what might be called a quasi-guardianship for the interview? arrangement may lead to over-dependence. One remarked that the handicapped were "too Yes No Did not know No answer 10 pampered already." Now it would be naive 1 19 1 t.o imply the assumption that such attitudes are not well-known to VR behaviorists. But the importance of recognizing the reality of diversity, and the error in attempting 10. Does a counselor follow-up and continue working with the employer and the to mold any practice to be imposed upon all subjects is reiterated. worker in making the adjustment? Wage-Hour Legislation Yes No Did not know No answer 12 1 13. Do you think it would be helpful 19 for the handicapped workers, and for very 1 young workers, if it were more convenient to obtain waivers on minimum wage require- 11. Does fear of possibly having to dis- ments?~<: charge a worker who doesn't work out cause you any apprehension in hiring the handi- Yes, definitely 1 capped? Yes, perhaps 6 No 25 Yes, definitely 5 No answer 3 Yes, somewhat 6 No 19 No answer 5 12. If someone else, such as the VR counselor, assumed that chore, would you be more receptive to hiring the handicapped? Yes, definitely 2 Qualified yes 5 No 21 No answer 7 *Under the 1966 amendment to the Wage-Hour Law, all firms in the survey are covered, but, except for some workers in the hotel, restaurant, hospital and retail industries, it is suspected that virtually all workers are paid at a level above the legal minimum hence, a waiver would probably be of little or no significance in most cases. ll/ Before the 1966 amendments to the Fair Labor Standards Act (Wage-Hour Law), the Regional Director could issue individual permits for handicapped workers to be paid whatever rate the Director deemed warranted With the amendments, however, he cannot issue permits for a wage less than 50 percent of the legal minimum. According to a spoke man in the Atlanta office of the Wage-Hour and Public Contracts Division, a regulation is pending which would allow individual workers under VR direction to be issued permits for a wage of 25 percent. The popularity of wage-hour waivers is declining (probably due to prosperity in general). As of September 30, 1967, there were only 1,134 permits for all types of waivers (i.e., including age as well as handicap) in effect in the four-state region. As the use of waivers declines, it will likely be easier for their opponents to quietly whittle away at the limits. The Congressional committee reporting out the 1966 amendments was critical of the wage levels permitted by regional directors, suggesting a preference for 75 percent as a desirable minimum level. It is very difficult to rationalize restrictions upon workers (whether state or federal) to whom the therapeutic value of useful work is inestimable. Thus, it \vould behoove VR and other rehabilitation groups to continue efforts to restore the legal provision for unlimited waivers for supervised handicapped workers, and torevise the state regulations regarding repairable equipment. (We have been told, although we have not verified, that pieces of small equipment, such as pumps, lmvnmmvers, and the like, are routinely salvaged as being beyond economical repair. If so, it is shameful that such practice should occur when handicapped trainees are starving for productive work.) Workmen's Compensation 14. From your experience, do you think Workmen's Compensation claims have been abused, such as on occupationally-induced deaths, and if so, do you think older workers would benefit if the la\v \vas changed so as to exclude some of the causes of death from the category of occupationally connected? While recognizing the need for vigilance, lest exploitation occur, minimum wage waivers are crucial, according to information reaching this author, to a continued progressive VR operation. Instructors at the Georgia Rehabilitation Center, in Warm Springs, reported that the most serious morale problem among trainees was the paucity of "live work." And while on the question of live work, we understand that the Georgia law is rather restrictive on allowing work from state agencies to be performed in VR workshops, on the grounds that they would be competing with private contractors. But workers whose handicaps are so severe as to require rehabilitation are by definition less productive; furthermore, it is inconceivable that VR administrators would retain workers beyond the rehabilitation period, even if willing to remain at trainee wages. The law still allows, under Sec. 14d (2)(3), permits for handicapped workers in bona fide sheltered workshops. Such permits can be issued on a blanket basis, whereas permits in competitive industries must be on individual, specific basis (except under some very restricted conditions, not here important). Yes, definitely 6 Yes, perhaps 9 No 12 No opinion (yes and no) 4 No answer 4 This report has already confessed to the charge of raising more questions than it has answered; this is particularly true on the question of Workmen's Compensation. In Table 4, it was seen that when the counselors were asked to list the placement problems in private industry, Workmen's Compensation (and financial risk in general) was the most frequently mentioned (25.9 percent). But in Table 5, only 8.2 percent indicated revision of Workmen's Compensation rules as a major step believed to be of help in removing employment barriers. Yet the employer responses to Question 14 suggest the possibility that considerable relief might be forthcoming from changes in the rules. These results are reported, not in an effort to point up inconsistencies, but to illustrate the importance of comparability in surveys. For one thing, the counselor questions asked for completely independent responses, while the one put to the employers asked for agreement or disagreement to the hypothesis posed to the respondent (i.e., was a structured-response question). l.l.O The most serious error in method, however, was ~t Question 14 (employer survey) only asked for opinions regarding the law and older workers. Thus, all of the findings regarding Workmen's Compensation have utility only for pointing up the importance of distinguishing the two separate issues involved: that of occupationally-induced death, and that of injury or death from accidents on the job. On the occupational death question, for some years there has been a controversy over Workmen's Compensation as an alleged barrier to older workers in seeking employment, due to the increasing chances of death from circulatory and respiratory causes as age advances. And there is little question that interpretations of the statute have permitted abuses. In our employer survey, one personnel manager lamented that if an employee died in the process of picking up a pen to sign a letter, a Workmen's Compensation claim would be automatic. In fact, many employers seem to have resigned themselves to the fact that if an employee dies on the premises-from whatever cause--a claim is almost sure to be filed. 3. that the employer's insurance company won't allow the hiring of the handicapped. About the most we can offer on the subject, which is admittedly very little, is that some means should be devised to determine the real attitudes of employers, VR counselors' assessments of those attitudes, and some method of clearing up the misunderstandings, then attempt any changes in the statute which would be most beneficial to prospective job applicants only. In so doing, however, one must weigh the abuses of the law on the part of workers against the fact that some of the cruellest forms of worker exploitation, historically at least, have been in the area of occupational death-injury. Thus, a very real question is that of whether a relaxing of the law might lead to more abuses by employers than now occur among employees (and their survivors). Promotional Activities and Rehabilitation: the 11Image 11 Factor On the other hand, those in close touch with the administration of the statutes indicate that a great deal of the attitudes are based more on emotions than on fact. Regarding Workmen's Compensation and on-the-job injuries, there likewise appears to be considerable misunderstanding. The insurance industry has been waging an extensive campaign to abolish some myths surrounding risks and the handicapped. A recent report stated the three most common myths as: 1 1. that handicapped workers are more likely to have accidents than other workers. 2. that an employer's Workmen's Compensation rates will rise if he hires handicapped workers. There is a feeling in some quarters that the 11merchandising 11 approach should be taken in persuading employers to hire handicapped workers. Some excerpts from a recent journal article entitled, 11 Better Public Relations through Effective Speech, 11 by Carl E. Hansen, are worth quoting:2 I observe that the rehabilitation counselor or administrator tries to keep current with new medical practices, new psychological concepts, new counseling techniques, etc., but in the area of public relations and public communication he seems somewhat backward. On more than one occasion I have seen professional rehabilitation workers encounter extreme difficulty in selling the concept of rehabilitation on a one-to-one basis, let alone on a mass basis. 111Employment of the Handicapped; An Insurance Crusade. 11 (A report presented to the Executive Committee of the President's Committee on Employment of the Handicapped, December 1, 1966, by a representative of the Casualty Insurance Industry). 2Journal of Rehabilitation, September, October 1967, pp. 12-13. 119 Most of us cringe at the word selling, but when it comes to convincing an employer your client has valuable work assets we are really acting as salesmen. The term selling --which many rehabilitation workers 17. If yes in No. 16, would it be worthwhile if such groups as VR would quietly campaign to get a handicapped worker in each establishment, especially those dealing with the public at large, such as retail outlets, restaurants, etc.? equate with high pressure car salesman- Yes 11 ship is held in great disfavor .. No 3 Hansen goes on to urge courses in pub- No answer 1 lic speaking, and joining a group such as the Toastmasters International as a method of improving the counselor's speaking abil- Obviously, there is a fair amount of opinion that promotional campaigns are beneficial to the employment of handicapped ity as well as establishing contacts with businessmen in the community. workers. But the typical employer operates on the "economic man" approach, i.e., his long-run motives are shaped by the quest Certainly, there can be no quarrel with the notion that a counselor must feel relaxed in meeting people; and above all, he must enjoy contacting his clients' pro- for profit; this is especially true in the large firm, where ownership and management are separate. spective employers. And from discussions with various people in touch with VR counseling, the Committee derived some suspicions that counselors as a group are more oriented toward the client's internal situation than toward his employment prospects. (This point will be discussed later, under the counselor's role, ~ ~) We ~ inclined to think, however, that the image factor is a large obstacle facing the handicapped applicant. Several respondents, when asked about their policies toward the handicapped, replied that they were used, or could be used, for other than 11 front 11 jobs. We believe that if some way could be devised to accustom the public The above apprehensions do not, how- to dealing with the handicapped, a great barrier could be diminished. Such belief ever, gainsay the importance of public in- is tentatively encouraged by the responses formation regarding rehabilitation, which in Question 17. On the other hand, none of brings us to the next block of questions. the affirmative replies reflected any strong 15. Do you think promotional campaigns by VR, such as 11Hire the Handicapped," are enthusiasm. In fact, one said that, "Such campaigns are seldom quiet. 11 of any value in getting those workers placed? In addition, there is the danger of Yes (with varying degrees 23 of reservation) No 7 No answer 5 overdoing the sales concept even on an individual basis. In fact, several employers in this survey who reflected a favorable attitude toward VR volunteered such remarks as, 11They are reasonable," or "They are realistic," or "They don't try to pressure us. 11 If the car salesman Hansen mentions 35 oversells a customer, the customer is the loser. But if a counselor oversells an em- 16. There is some feeling that employers ployer, the client is the ultimate loser, are reluctant to hire the handicapped from in addition to later clients who may become fear of breaking the ice, i.e., fear that prospective employees of that employer. In their public image will be damaged. Do you addition, the image of the agency is impair- think this is true? ed. And Hansen seems to assign the image of the agency a rank about equal to that of Yes, definitely 5 clients, in selling employers. But here Yes, somewhat 10 again, while the agency's reputation for No opinion 13 providing qualified applicants is important, No, not noticeably 5 there is the danger that form may become No answer 2 more important than substance. Thus, as is the case with any sound value, the most effective advertising media will likely be found in a satisfied clientele. 120 Who Should Perform the Placement Function? One of the most bothersome questions was that of the role of the counselor and Since there is a task force on inter- of the placement specialist. The two final agency cooperation and coordination, we as- questions were intended to shed some possi- sume it will devote some effort to the com- ble light on the matter. parative roles in placement. But we did give some attention to the question of other 22. On the question of placement in agencies in general, primarily as part of general, it is becoming increasingly appar- the effort to study employer attitudes on ent that in a dynamic and complex society, various matters regarding placement. The most workers--whether handicapped, disad- 1uestions and results follow. vantaged, or normal--will need some help not only in deciding upon a career, but in 18. Would it be better if all groups involved with handicapped workers coordinated their placement activities? finding a job once that decision has been made. Hence, there is some feeling that placement should become a discipline in itself. What is your opinion? 19. What has been your general experience with the Georgia State Employment Service (GSES) and with private employment agencies in recruiting help? If any, evaluate. Fairly strong agreement 12 Some agreement 8 No opinion 3 Some disagreement 5 Fairly strong disagreement 4 20. The Georgia State Employment Serv- No answer 3 ice (GSES) is allowed to use a small amount of its budget for advertising jobs open and for job listing. What do you think of this? 35 No objections-1: 19 Some objectives (varying 6 degrees) No answer 10 23. Should placement personnel know more of the structure, role, etc., of various business firms and of industry in general? 21. Should the GSES be allowed to solicit job openings by calling on employers? No objections (same note 21 as above) Some objections 8 No answer 6 The responses to Questions 18 and 19 were too vague and varied to classify, ranging from complete approval to fairly outspoken protest, such as (in the case of No. 18): "It would lead to more bureaucracy," and "It would lead to complacency." In Question 19, if any thread at all could be detected it was the complaint of poor screening. Yet several reported good success with both public and private agencies. But the essence of most responses was that experiences ranged from real good to real bad, depending on the agency, the type of worker needed, and so on. Yes, definitely 12 Yes, somewhat 7 No 1 It would be presumptuous to offer an absentia evaluation of the counselor's performance of his duty in the placement process, or of what his role should be. Insofar as validity can be assumed, the results in Questions 22 and 23 lend some credence to the notion that employers would like for counselors to know more of the business world. On the other hand, one notes some dissent. And recalling the discussion of Questions 8 through 12, one could conjecture that some employers apparently assume a position which says: "You worry about the client as a handicapped individual, and I'll worry about him as my employee." In viewing all the above questions, the scarcity of qualified applicants of all types in Atlanta must be recalled. And by far the most important conclusion to be drawn from these results is the diversity among employer preferences. >':Ranged from fairly strong endorsement to indifference >'<>':Was only asked of the 20 respondents answering affirmatively in No. 22. 121 But such comparison is not appropriate for the concern at this point is with the counselor in finding the client a job, not in his relationship with the client after he is on the job. We are intuitively, at least, inclined to suspect that counselors as a group are somewhat uncomfortable in soliciting among employers. If so, such attitude is not necessarily a reflection on the counselor, since his educational preparation is usually in the behavioral disciplines rather than in industry or commerce. More significant is the fact that people in general are uncomfortable in soliciting anyone for anything. (Otherwise, we would not offer such premium rewards for salesmen.) It is human nature to feel some anxiety toward rejection, and soliciting inherently involves that risk. In addition to hard-to-place clients, the PS refers to counselors any openings uncovered during his contacts for which he has no suitable client among his active cases. For fiscal 1966, one referred 60 such openings, and from July 1 to November 3, 1967, referred 17. The PS also performs in-service training for counselors in placement work, although we understand that such training has been largely suspended in recent months, for in addition to the above duties, the PS engages in a wide variety of external activities like community relations and professional association work. Whether handicapped workers, or normal prospects for employment are involved, it is one of the paradoxes of our economic system that specialization has assumed so many roles, yet the worker still largely serves as his own agent in finding a job. But there is little question that the specialist will assume that function on an increased scale in the future, i.e., that the hypothesis set forth in Question 22 will be confirmed. On that basis, the ultimate question in analyzing the role of VR personnel in placement is that of the division of the placement between the counselor and the placement specialist. A national survey in early 1964 revealed that thirty-nine out of ninety responding agencies had at least 1 placement specialist (PS); twentythree of them had 1 PS; seven had 2; five had 3, two had 4; one had 6; and one had 12. Of the thirty-nine agencies with one or more placement specialist, twenty-three were agencies for the blind. So again, diversity is the only pattern. Georgia has two placement specialists, one for Atlanta and Northern Georgia, and one for the southern portion of the State. These specialists' duties are limited to the hard-to-place clients, but this does not necessarily mean the severely handicapped only; that is, the clients may be hard to place because of scarce opportunities due to severity of disability, or to location. In short, the specialists get clients with which counselors experience difficulty in placing. As indicated, it is the opinion here that the counselor generally tends to be client-oriented, and it is proper that his primary orientation be in that direction. On the other hand, he should also be more active in employer relations and should orient himself on the ways of the business world and of the particular firm he is to contact. In spite of some of the employers' responses in the pilot survey, it is likely that the counselor will continue to serve a third-party function in a great number of the employment relationships. The point mentioned above regarding orientation of the particular employer the counselor is to contact deserves some discussion. One of the oldest rules of selling is the slogan, "Know your product." But in the case of VR job solicitation, the emphasis should be on uncovering as many jobs as possible, then subtly placing the burden on the employer of showing why a handicapped worker cannot perform a job, rather than peddling handicapped workers to certain job openings with a preconceived set of duties. If the job solicitor could persuade an employer to expose all of his job vacancies, the chances of job fractionalization should be greatly enhanced. Returning to the author's thesis regarding personal appearance as a form of discrimination--which might be called aesthetic discrimination--such approach as outlined may hold considerable promise. Part of the thesis is that some handicapped workers are refused for certain jobs, not because of their physical handicap alone, but because the physical handicap also is an aesthetic handicap. To elaborate, it is common knowledge that employers have a general image in mind in filling job openings. Usually, this means favoring applicants who blend in with other employees, especially in public-contact establishments. In the employer survey, when asked to discuss their policies toward hiring the handicapped, several service establishments reported that they would accept ce'ttain handicaps, but not for "front jobs." In other words, some employers in Table 10 who indicated the treating of handicapped applicants the "same as other applicants" very likely meant the same as other applicants for jobs "in the back." The author recognizes the difficulties faced by VR job solicitors regarding personal image, and no doubt considerable effort has been made to "break the bias." But if solicitors could conceive some way of "passively coercing" the employer into a defensive position, progress might improve. For example, a businessman reflects no compunction in preferring an attractive secretary; but would he be as relaxed in explaining why he will not hire one with ordinary or sub-ordinary aesthetic features? The sum and substance of the preceding discussion is that the solicitor must establish a relationship with his clientele, with regard to the personalities involved, but more importantly with regard to the operation of the prospective firm. In that manner, the VR solicitor will stand a better chance of knowing the entire spectrum of jobs, rather than having to view those on display for the handicapped by tradition. In short, we would expand the sales slogan cited earlier to read: "Know your product and your prospect." F. VR and the Georgia State Employment Service Of the 341 handicapped applicants placed by GSES, 13 were classified as "VR cases," and 3,127 of the 14,102 referrals in November were "handicapped," 53 of which were VR cases. (The term is not further defined, but presumably means cases referred by VR counselors.) While there is no apparent antagonism between VR and GSES, it does appear that VR is not what one would call ecstatic over the results with clients referred to GSES for placement. By the same token, GSES is of the opinion that VR only refers applicants for whom virtually all hope of placement has been abandoned. VR did have a representative assigned to GSES, who teamed with a counterpart from the latter, but the arrangement was discontinued; reasons were not determined, nor was the outcome of the arrangement during its existence learned. The only appropriate point for discussion in this report, then, is from a conceptual (and conjectural) point of view. VR has offices located in 24 cities (excluding special service centers), and GSES has 34; the territories served by the two agencies do not coincide, so that VR does not always have a GSES office available. GSES does have its inter-area recruitment, but it does not appear that a significant percentage of referrals are handled through that system. In any case, it would seem remote that a handicapped worker with an extensive disability would receive much consideration by an employer in a distant location. The basis for such reasoning is that employers generally do not go to any effort to seek out the handicapped, and in fact, are far more likely to assume a condescending attitude, even among the locally handicapped. It is difficult to judge the functional relationship between VR and the GSES. In November 1967, GSES received 796 handicapped applicants, and placed 341. 3 During November, GSES received a total of 14,102 applicants and placed 11,122. But none of the figures can be viewed as a placement ratio, due to the backlog and carry over factors. 3Data on GSES activities are from Georgia Employment Service Activities, Georgia Department of Labor, Employment Security Agency, November 1967, Table 1, as supplemented by figures from the Research and Analysis Division. VR personnel, themselves, are to varying degrees oriented toward volume, and are known to choose cases accordingly. Since the GSES counselor is even more volumeoriented, is it not logical for him to yield to the tendency of allowing the most difficult cases to filter to the bottom, just as the VR counselor quite naturally places clients with the least problems first? Thus, dissatisfaction with GSES may be overstated. With no intention of evaluating the criticism of GSES, per se, a fair amount of the opposition does proceed from an ill-informed basis. There are some out- 123 spoken demands fro'1! certain quarters that In the case of regular clients, there is the employment service in general (at the even less evidence regarding the effective- national level) be "made" to carry out its ness of additional placement personnel. On "mandate." Such sweeping demands appar- the hard-to-place cases, at least one can ently assume that the employment service see that there is a backlog, although one could, except for inertia and/or indiffer- cannot determine whether additional person- ence, create jobs, or force applicants on nel would solve the backlog, as noted above. employers. Critics seem to forget that the But the author could not even learn if there quality of jobs and applicants are mutually is a backlog at all, of regular clients. determined. In an effort to shed its de- The reason is that the VR records are not pression-born image of the "unemployment" kept in such fashion to permit one to deter- service, it attempts to attract higher qual- mine the number of clients whose only ob- ity jobs by offering higher quality appli- stacle to rehabilitation is placement. cants, and vice versa. Whether this ap- Furthermore, assuming there are such cli- proach is idealogically agreeable will not ents, there is no way to tell if the obsta- be appraised here, but the point is, the cles are dJe to demand, or to supply, phe- employment service ~vould logically select nomena. That is, are there insufficient the best applicants for the best jobs, for job opportunities, or are the clients not to do otherwise would not be offering the placeable in the current labor market? employer the best "service" available. In fact, based on the information made In the case of VR, the same dilemma does available, there is no way to tell the num- not exist, in that the handicapped appli- ber of clients who discontinue the program cant is not expected to compete on the same or the number not accepted for rehabilita- basis with normal applicants. In a sense, tion because of inadequate job opportunities. then, all of the handicapped applicants are hard to place, while employers actively re- Returning to the question of adequacy of cruit only for those jobs hard to fill. VR placement services, although the survey of clients are not likely to "match up" with counselors was of very limited validity, it many such jobs, except those at the very surely must be of some significance that bottom of the heap; this would seem to im- out of 208 suggestions (by the 178 counse- ply that the handicapped must be in the lors) for ways of solving problem areas, hands of one who has a primary commitment only 16 of them were for a placement spe- to the handicapped, if their interests are cialist. But without some method of in- to be maximized. depth analysis, who can know the validity of the counselors' replies, i.e., are they If one does assume that placement of the handicapped is a specialized function, the in the best position to project the value of a placement specialist? next"question is whether VR needs placement specialists, or whether counselors can adequately perform that role. Regarding hardto-place clients, one PS received 204 cases in fiscal 1965-66, of which 103 were placed. In fiscal 1966-67, 107 out of 286 were placed. On July 1, 1966 he had 33 cases awaiting placement, compared with 115 on the same date in 1967. Some grounds for suspicion on that count lie in the other items in Table 5. For example, only 3.4 percent of the responses were for "more training of counselors and knowledge of clients," and only 2.9 percent were for "more time for counselors." But, on the other hand, one must take particular note of the fact that 35.6 percent of the responses were for "public communication and promotion of program," and that that The limited survey of employers derived response was the only one accounting for the tentative impression that more jobs more than 8.2 percent of the total! Now could be opened up for the handicapped. if there is ~ useful finding in the en- Yet, as noted, what is one's definition tire survey of counselors, it is that of of handicapped? That is, those employers raising the suspicion that they seem to be responding in the affirmative may have had of the attitude that "We're doing fine, if very minor handicaps in mind, whereas the people only knew of us." If that be the backlog of unplaced cases may contain a case, then it should lend credence to the very high percentage of severe handicaps. expressed view that "selling" must be on a Thus, one cannot say whether more personnel behind-the-scenes, one-to-one basis if the would result in m~re placements, even in massive promotional campaigns have been as the case of the hard-to-place. ineffective as these responses indicate. 124 Needless to say, whatever the real picture, this subject should head the list of "areas for further study." In the first chapter, "Persp~ctive, 11 the report notes that the results were being used (inter alia) to improve pla~ement There is one final but crucial item before leaving this topic: Looking again at Table 5, one is immediately impressed with the fact that 28.8 percent of the counselors did not list anything as a suggestion for resolving problem areas. That void, plus some other points to be mentioned later, compels the author of this report to raise the question of whether there really are any placement problems of note, or whether problems" are being machinated in order to justify an expansion of VR 1 s base of operation. service, and for planning expansion of training opportunities (p. 4). The study purp0rtedly evaluated training in light of client satisfaction and improve~e~t in economic status, as \vell as employer satisfaction with rehabilitated clients, and was in progress for some two and one-half years, and presumably consumed substantial resources. This author was puzzled, then, as to why further study of place~ent and follo';v-up warranted a task force effort. As far as the above report could be assumed to have precluded the need for further study, the answer was not long in co~ing. The first sentence in Chapter III (p. 15) reads: 4 PART III: FOLLOW-UP AND EVALUATION OF PLACEt--lENT The report has thus far been devoted to the question of placement. Regarding follow-up, insight to some questions \vhich should be pursued was gained from the materials discussed in Part II, and will be brought into focus in the concluding section. But the major effort on that count was devoted to a review of some literature pertaining to follow-up, consisting largely of three items; a follow-U? study on VR clients in Georgia; a study of national VR applicants; and the Georgia VR Division 1 s annual report for 1965-66. These will be discussed in turn. 1. T~e Georgia Study Follmv-!I.E_ Study and Evaluation of Training Provide le. Highly Unfavorable I 2. According to the specific handicaps in the table below, rate the attitudes of employers in your area whom you have approached to hire clients with thPse handicaps. Type of Handicap Attitudes of Employers Toward Placing I Highly 11oderately l1o derate ly Highly Favorable Favorable Unfavorable Unfavorable I(_.; ex: a. Physical Handicap (other than blindness or epilepsy) b. Legal Blindness I I I c. Epilepsy d. Emotional Handicap e. Mental Retardation I I I I I I I - 139 -4- III. 3. Where are the four major sources of employment for the handicapped worker in your area? (Numerically rank the sources, with l representing the major source of employ- ment). ______Service Occupations ______semi- ski 11 e d 0 c cup at ions __________Unskilled Occupations ______Skilled Occupations ______Clerical and Sales Occupations ___________Agriculture, Forestry, and Kindred Occupations __________Professional Occupations _________s enli-prof e s s ion a 1 0 c cup at ions Comments, if any: 140 -5- III. 4. Do you feel that any of the following are reasons for employer refusal or reluctance in hiring handicapped YES NO a. Fear of "expense" which might be involved b. Reluctance to having disfigured or "unsightly" individuals in place of business c. Fear of ''normal'i employees' disapproval d. Fear of business community ridicule or criticism e. Genuine skepticism regarding disabled worker's competence in his given field f. General avoidance of "change" -- wanting to do things as they have always been done g. Fear of increased workmen's compensation premiums. h. Others (specify) Comments, if any:------------------------- 141 APPENDIX II DETAILED EVALUATION OF A NATIONAL STUDY OF VOCATIONAL REHABILITATION APPLICANTS, COUNSELORS AND DIRECTORS The third publication is a summary and analysis of selected findings from the two surveys, and will be referred to as Highlights. The final volume is entitled Vital Issues and Recommendations, and is a report on the proceedings of four regional institutes held in 1965 for the purpose of discussing the usefulness of the findings; the institutes were attended by a total of 175 VR administrators, and the publication will be referred to as Vital Issues. (Complete references were cited in footnotes 8 through 11.) This evaluation in the Appendix is largely limited to methodology used in collecting and interpreting the data from the studies. An evaluation of the purpose and usefulness of the study is contained in Part III of this report, and is summarized in Part IV. The following evaluation of the national study involves extensive and often complex referrals to lengthy portions of the volumes. Thus, for lack of a better term, these reproductions are labeled as "Exhibits." The complete background of the national study may best be seen by reading the first page from the introduction to the Director survey, since it includes a description of both phases of the study. It follows as Exhibit A. The national study consists of four publications. One was on the 90 VR state agencies, including certain attitudes and philosophies of each director, and will be referred to as the Director study. The second one was a survey of all applicants at those agencies during January, February, and March, 1964, and included some data regarding counselors' personal characteristics and attitudes; it will be referred to as the Applicant survey. EXHIBIT A (From page vii of the Director Survey) INTRODUCTION This Study The objective of this study was to obtain a comprehensive picture-from the agency director's point of view--of those program aspects which most affect each agency's rehabilitation services. A detailed questionnaire was completed by the director of each of the 90 state vocational rehabilitation agencies. It covered 31 areas of information about each director's rehabilitation philosophy and the administrative and program practices in his agency. The questionnaire was designed to enable directors to add explanations, comments, and further information for each item. Background of the Project Phase One of the Patterns of Services Project was essentially an information gathering phase during which two national studies were designed and carried out in the 90 state vocational rehabilitation agencies of the United States. The first study, which is the subject of this report, utilized a very intensive and detailed questionnaire which was developed with the aid of nationally recognized leaders in the field of rehabilitation: state VR agency directors, exceptionally experienced casework supervisors, and experts from private rehabilitation agencies, universities, and the Vocational Rehabilitation Administration. 142 The second study obtained basic information about the 84,699 applicants for vocational rehabilitation services who were processed by the 90 state VR agencies during the period from January 1 through March 31, 1964. The second study also obtained personal background information about the 2,448 counselors who processed the applicants. An outline of the contents of that study is included in the Appendix of this report. The complete report on that study is available under separate cover. The two studies thus provide patterns of information from several levels: from the levels of the agency director and his administrative supervision, and from the levels of the vocational rehabilitation counselors and the applicants they processed for rehabilitation services. Phase Two of the Patterns of Services Project will be an educational phase to facilitate the fullest national utilization of its information. It will center around a National Institute to be attended by directors and technical representatives from the state VR agencies, Vocational Rehabilitation Administration staff and Regional Representatives, personnel from VRA traineeship universities, and regional research center directors. Other activities will include contingency analyses of the data and the preparation of educational media. This project has been sponsored by the Council of State Directors of Vocational Rehabilitation and the National Rehabilitation Association. It received research grant funds from the Vocational Rehabilitation Administration, U.S. Department of Health, Education, and Welfare (RD-893-65-C2). The reader here is asked to note particularly the second paragraph under "Background of the Project," in the Introduction reproduced above. There is no indication that the questionnaire was tested (although Vital Issues--which was prepared over a year after the study was conducted--does report that the questionnaire was tested in five VR agencies; there is no mention even there of testing the questionnaire used in the Applicant survey). It would have eased the burden of sorting out the material in the study if the usual practice of inserting a copy of the questionnaire had been followed. After having gone to such length in providing assurance of the cultured quality of the questionnaire, it is unfortunate that the study did not go the last mile by sharing that collector's item with the reader. After reading the passage referred to above, one may wonder why an obscure and untested critic would take issue with the study's findings, in the face of such an awesome array of scholars and expert practitioners. Whether his decision to do so reflects courage, naivete, or plain foolhardiness, will be left to the reader. Since this task force is concerned primarily with placement and follow-up, no comments are offered regarding the content of the Applicant survey, although certain portions of it will be introduced in evaluating the Highlights, and the method of the study, in general. Turning to the Director survey, in the chapter on "Placement Services" (pp. 107128), each agency director was asked to describe and rank the placement procedures his agency had found to be the most "productive," and to do the same for those found to be the least productive (by the Director' definition of "productive"). The agencies were then classified as shown in the following matrix: 143 EXHIBIT B Size of Agency Number of Agencies small 30 medium 30 large 30 When further divided by type of client group served: Type of Agency Agencies for the Blind Agencies for the NonBlind Combined Agencies Small 26 Medium 10 17 Large 19 Total 36 36 4 3 ll 18 Total Number of Agencies 30 30 30 90 There were no agencies for the blind which were "large" according to the criterion of applicant activity, and there were no agencies for the non-blind which were "small" according to the criterion of applicant activity. The reader is then forced to suffer through some 20 pages of the most laborious detail, as each of the most and least productive procedures described by each respondent is reproduced. That approach is rationalized at page 107: It was felt that, for this item /i.e., placement/ a presentation of responses exactly as stated by state agency directors provides a richer picture of variations in procedure than would be offered by summarization. In addition, such verbatim presentation retains the flavor of the responses and permits readier comparisons among similar types of agencies. But leaving nothing to chance, the study does include a "sum.rnarization" for each group in the matrix under Exhibit B. The one thread pervading every summarization coincides with this author's findings thus far: diversity. Exhibit C is noteworthy in that regard. 144 EXHIBIT C (From pages 121-22, Director Survey) A SUMMARY OF THE SINGLE MOST PRODUCTIVE AND SINGLE LEAST PRODUCTIVE PLACEMENT PROCEDURES LISTED BY EACH OF THE 17 MEDIUM STATE VR AGENCIES FOR THE NON-BLIND Single Most Productive Placement Procedure No. of Agencies 1. Counselor contact with employers.................... 5 2. Contacting employers personally (not stated by whom)............................. 1 3. Client locates own jobooo 3 4. Client locates own job or returns to former employment . o 1 5. Counselor-client cooperate for client self-placementoooo 1 6. State Employment Service a. Referral to b. Referral to, and cooperation with counselor handicapped placement specialist, training agency and client c. Close liaison with.ooo 3 7. Client placed by or with assistance of training agency ooooo 1 8. Placement of college trained graduates.............. 1 9. No responseo 1 Total 17 Single Least Productive Placement Procedure No. of Agencies 1. Client locates job without counselor participation oo 3 2. State Employment Service............................ 3 3. State Employment Service, without VR agency involved in employer contact..................... 1 4. Counselor takes total responsibility for placement ...... ooo 1 5. Selective placement .... oo 1 6. Placement conference tmong counselors only.......... 1 7. Placement by schools and training institutions...... 1 8. Placement by labor unions........................... 1 9. Radio spot announcements of available clients....... 1 10. No response 4 From Exhibit C, notice that out of 17 agencies in that category, three believed "client locates own job" to be the single most productive placement procedure, while an equal number believed it the least productive procedure (Item 3, top sector, and Item 1 in the bottom); furthermore, that same result is duplicated for "state employment service" (Item 6, top, and 3, bottom). Total 17 145 EXHIBIT D (From pages 123-24, Director Survey) A SUMMARY OF THE SINGLE MOST PRODUCTIVE AND SINGLE LEAST PRODUCTIVE PLACEMENT PROCEDURE LISTED BY EACH OF THE 11 LARGE STATE VR "COMBINED" AGENCIES Single Most Productive Placement Procedure No. of Agencies 1. Client returns to former job........................ 1 2. Client locates new job 1 3. Client receives on-job training followed by placement........................................ 1 4. Employer is contacted (counselor or client, not stated)...................................... 1 5. Employer is contacted face-to-face (counselor or client, not stated)........................... 1 6. Employer is contacted by placement counselor........ 1 7. Employer is contacted by placement specialist with workshops and centers....................... 1 8. Employer is contacted by counselor re specific client; then counseling on applying is done with the client; then the client contacts employer alone................................... 1 9. Same as above, with specialized placement counselor included............................... 1 10. Counselor and client plan placement................. 1 11. Cooperation with State Employment Service........... 1 Total 11 Single Least Productive Placement Procedure No. of Agencies 1. Use of telephone calls by counselor................. 3 1. Use of mails by counselor Letters Descriptive cards of applicants.................. 2 3. State Employment Service Referral to, Placement by........................ 2 4. Private employment services 1 5. Client locates job.................................. 2 6. Client sent to company uninformed on how to apply or facts re company............................... 1 Exhibit D is very enlightening, showing eleven different answers from eleven respondents, as the single~ productive procedure. Although there is some dupli:ation of responses in the single least productive category, no pattern whatever is established, even there, either within itself or when compared with the single ~ productive sector. Total 11 146 EXHIBIT E (From pages 124-25, Director Survey) A SUMMARY OF THE SINGLE MOST PRODUCTIVE AND SINGLE LEAST PRODUCTIVE PLACEMENT PROCEDURES LISTED BY EACH OF THE 3 MEDIUM STATE VR "COMBINED" AGENCIES Single Most Productive Placement Procedure No. of Agencies 1. Formulation of specific placement plan, with employer contact cards...................... 1 2. Personal contact with employer...................... 1 3. Use of specialized placement personnel.............. 1 Total 3 Single Least Productive Placement Procedure No. of Agencies 1. Newspaper ads o 1 2. Client locates job.................................. 1 3. State Employment Service, referral to............... 1 Total 3 EXHIBIT F (From page 125, Applicant Survey) A SUMMARY OF THE SINGLE MOST PROPUCTIVE AND SINGLE LEAST PRODUCTIVE PLACEMENT PROCEDURES LISTED BY EACH OF THE 4 SMALL STATE VR "COMBINED" AGENCIES Single Most Productive Placement Procedure No. of Agencies 1. On-job training secur~d by counselor 2 2. Self-placement 1 3. No response 1 Total 4 Single Least Productive Placement Procedure No. of Agencies 1. State Employment Service Depending on, referral to 2 2. No response 2 Total 4 147 Exhibits E and F are included to illustrate how ludicrous the minutia in the national study becomes. One is tempted to ask why the agencies were not broken down by north, south, east, and west, so that decimal portions of an agency could be shown, achieving real precision. These excerpts regarding placement are not extreme. Although on some questions the responses did show three, four, or five agencies as listing the same procedures as the ~ (or least) productive placement procedures, in no case did as many as half of the agencies in a category list the same procedure as the most or least productive, except when the total number of agencies was insignificant in the inception. An ex- ample is in the "least productive" sector of Exhibit F, where two agencies listed the same procedure, and the other two did not respond. Since some presumably sound reason dictated that the agencies be so thinly stratified, resulting in such small numbers that in some cases even unanimous responses would have been insignificant, one wonders why the obvious futility of the project was not respected ~ priori. That is, the Introduction to the Applicant Survey goes to great pains to convince the reader of the project's objectivity (p. 1). It even apologizes for the unpolished appearance of the data which resulted from reproducing the print-outs exactly as they were hatched off from the computer. (This approach is typical of the practice of injecting the mystique of a computer to certify the arithmetic accuracy of the data, which often (by design or otherwise) disarms the reader who otherwise might question the pedigree of the data.) But the virtue of those objectivity vows is open to serious question by the time one reads the interpretation of the study, in the Highlights. The reader without the opportunity and/or inclination to hack his way through the virtually impassable jungle of numbers and verbiage of the complete study will find his vision considerably blinded by the Highlights. Such harsh an indictment demands substanial and documentary evidence. Yet the above is not to imply that lack of a concensus among respondents was limited to categories where their numbers were small. For example, of the 26 "small state VR agencies for the blind" (which, incidentally, was the largest category, as was seen in the matrix under Exhibit B), there were nineteen different most productive procedures listed, and only two of them were listed by more than~ respondent, i.e., the remaining 17 procedures were distributed among 17 agencies. As for the least productive procedures, one of them was listed by 3 agencies, four procedures ~eceived the vote of four agencies, each of the remaining 10 procedures was listed by~ agency, and the most popular choice among the 26 directors was "No Response," which received the nod from five agency directors. Now in view of the alleged blandness of the Director survey, the reader may wonder why it was subjected to such close scrunity. But a reading of the Highlights causes one to seriously wonder if the national study, when viewed in its composite form, is simply another exercise in mass data collection. EXHIBIT G (From page 3 of the Highlights) INTAKE SERVICES Fifty of the 90 state vocational rehabilitation agencies indicated that they were unable to serve all referred individuals who were eligible for services under federal regulations. Since the factors which screen out eligible individuals will also influence the number and types of individuals accepted, directors of the fifty agencies were asked to rank them. Chart I shows the frequency of factors considered in screening out eligible cases at the fifty agencies. Motivational inadequacies and severity of disability head the list. 148 Severity of disability as a factor is very understandable. But ''motivational inadequacies" is rather startling, especially as a factor at the time of intake. Questions are raised as to what criteria were used, whether the inadequacy might be amenable to counseling if the individual were accepted for services, and if perhaps the individual's attention was upon himself rather than a job because at the time of intake he was unhappy and hurt. Yet Chart X shows that each year about 60,000 applicants are not accepted for case services because they don't respond to communications or appear for appointments, refuse services, or can't be located or contacted! In the first place, the "Chart X" referred to in the above quote shows that for the three reasons mentioned ("did not respond to communication," "refused services," "could not be located"), a total of 15,736 VR referrals were "not accepted for services" during the sample period of January 1-March 31, 1964. Although that figure does represent an annual rate of over 60,000, there could be some seasonal variations; but even if it is a true annual rate, one is hardly justified in stating dramatically and without reservations that "each year about 60,0JO applicants are not accepted," as was done in the quote in Exhibit G. Furthermore, it seems strange that a certain number are shown as not accepted for case services because they "don't respond to communications," "refuse services," etc. Would it not be more accurate to say they declined services? But the bewildering aspect of this portion of the study is yet to come. Notice that in the first sentence under Exhibit G it was noted that 50 of the 90 agencies indicated that they were "unable to serve all referred individuals who were eligible for services under federal regulations." Also, that "Chart I" shows the frequency of factors used in "screening out eligible cases at the fifty agencies." The data from "Chart I" is presented as Exhibit H: 149 EXHIBIT H (From page 5 of the Highlights) CHART I FREQUENCY OF FACTORS CONSIDERED IN SCREENING OUT CASES BECAUSE 0~ INSUFFICIENT STAFF AND FUNDS AT 50 STATE VOCATIONAL REHABILITATION AGENCIES FACTOR Motivational inadequacies Severity_ of disability Age Alcoholism Multiple disabilities Lacking iob availabilities I .Q. Emotional inadequacies Probable cost of services Length of work expectancy Facility limitations Type of disability Educational inadequacies Current employment at a given salary Vocational objective home- makPr Other No. of Agencies Naming This Factor Among Most Frequent _{Total N = 50) 42 38 37 36 35 35 33 33 33 33 32 31 30 27 25 5 No. of Agencies Ranking This Among Three Most Frequent Factors {Total = N 40)~\" 20 20 8 7 8 6 6 6 5 7 4 8 2 5 ? 1 *Does not include 10 agencies which did not rank factors. No. of Agencies Ranking This As The Most Frequent Factor (Total N = 401* 7 10 5 1 2 2 3 1 2 2 1 3 0 0 0 1 150 Before discussing Exhibit H, it is neces- the information in Table 3 of the survey sary to introduce some more evidence. Al- report (and in Chart VI above) was appar- though Chart I (under Exhibit H above) ap- ently derived, is obscurely buried on page pears as Table 3 on page 19 of the Director 100 of the Director Survey report. It is Survey, the original question put to the presented, along with its results, as Ex- agency directors, i.e., the one from which hibit I: EXHIBIT I (From page 100 of the Director Survey) Have Insufficient Funds Been a Major Limitation to Better Case Services by Your Agency During the Past 12 Months? Only one state director didn't answer. The responses of the other 89 are below. Agencies for the Blind Agencies for the NonBlind Combined Agencies NUMBER OF AGENCIES No Yes No Response 10 25 1 22 14 0 Total 36 36 8 10 0 18 Total 40 49 1 90 It must be carefully noted from Exhibit I that only forty (40) directors--not fifty (SO), as the Highlights reported (shown in Exhibit G)--indicated that insufficient funds were a major limitation to better case services. Even more mysterious is the source of the "N=SO" in the first column of Chart I (under Exhibit H). It is also difficult to imagine this as simply an oversight or an error in addition, for such errors would have become self-evident in the two-way addition necessary in Exhibit I. Finally, it is difficult to imagine how 42 directors indicated "motiva- tional inadequacies" (in Exhibit H) as a "most frequent factor" in screening out cases because of insufficient staff and funds, when only 40 directors even said that insufficient funds were a major fac- tor.l9 ---- 19It is possible that the information in Chart I (Exhibit H) did not come from the question posed in Exhibit I; there is some discussion of the returns to a question involving sufficiency of staff and funds at page 20. But the question in Exhibit I is, as noted, at page 100, and the same information shown in Chart I is opposite it, at page 101. Since the material in the entirE study is arrayed almost at random, the confusion is overwhelming. 151 On page 11 of the Highlights, the following statement appears, under the heading, ''What Counselors Said They Need:" Chart XIII lists what the 2,448 counselors said could most help them to provide better case services. ~ is of interest to compare this list with Chart VI which shows what their directors though~ ~ most important to improve services (emphasis supplied). "Chart VI" is a reproduction of Table 24, from page 101 of the Director survey, and is at page 10 of the Highlights. '~hart XIII" is from page 75 of the Applicant ~ vey, and appears at page 19 of the Highlights, as in Exhibit J: EXHIBIT J (From pages 10 and 19 of Highlights) CHART VI FACTORS WHICH AGENCY DIRECTORS CONSIDERED THE MOST IMPORTANT FOR THE IMPROVEMENT OF VOCATIONAL REHABILITATION SERVICES PROVIDED BY THEIR RESPECTIVE STATE VR AGENCIES IMPROVEMENT FACTOR No. of Agencies Naming This Factor More rehabilitation 62 counselors More money in budget 58 Better public or employer 52 attitudes Higher salaries for 51 counselors Better training facili- so ties in state Better rehabilitation 37 counselors More secretarial and 31 clerical help Less importance on "number" 29 of rehabilitations More local field offices 27 More supervisors 22 No. of Agencies Ranking This Factor Among First Three 55 39 16 29 17 22 10 10 9 6 No. of Agencies Ranking This As The Most Important Factor 21 31 4 5 3 10 0 1 0 2 152 EXHIBIT J (Continued) CHART XIII TrliNGS WHICH 2,448 COUNSELORS SAID COULD MOST HELP THEM TO PROVIDE BETTER CASE SERVICES '~hich ONE of the following do you think could most help you to provide better case services?" NUMBER OF COUNSELORS 709 527 410 340 92 92 278 2,448 said said said said said said said THE ONE THING MOST NEEDED llmore rehabilitation facilities" "more counselors in agency" "more money for case services" "more clerical-secretarial help" "more consultative services" "none" or "don't know" "other" things (mostly combinations of the above) Now the following discussion on that passage is rather lengthy, but this author firmly believes that the reward will be commensurate with the reading effort required, for some of the "comparisons" will indeed be "interesting." The information in Chart VI (Exhibit J) was derived from the questionnaire sent to the directors, and appears on page 100 of the director survey as follows: EXHIBIT K (From page 100 of the Director Survey) ITEM 24 - IMPROVING THE PROGRAM OF SERVICES Factors Considered Most Important for Improvement of VR Services Each state director was asked to select from a list or to specify the seven factors which he considered most important for the possible improvement of VR services provided by his agency, and to rank them in order of importance. The list was as follows: 153 1. More rehabilitation counselors. 2. Better rehabilitation counselors. 3. Greater leeway to get rid of counselors who are not doing a good enough job. 4. Higher salaries for counselors. 5. More supervisors. 6. More consultant services (general). 7. More medical consultants. 8. More medical facilities. 9. A new state agency operated rehabilita- tion center. 10. Other new rehabilitation center. 11. An independent State Commission for rehabilitation. 12. More local field offices. 13. More centralized facilities. 14. Better training facilities in state. 15. Less importance on "number" of rehabili- tations. 16. Less restrictions or red tape (specify). 17. Better cooperation from other agencies. 18. Better public or employer attitudes. 19. State operated workshops. 20. More clerical and secretarial help. 21. More money in budget. 22. Other (specify). Table 24 lists the factors named most frequently by state VR agency directors as considered most important for the possible improvement of VR services. 3. Both lists, but especially the one provided the directors, would seem to hold very limited promise, if any at all, due to the intermingled overlap. For example, would a respondent not logically experience considerable difficulty in finding a line of demarcation between "more money in budget," and such factors as ''more rehabi 1itation counselors," "more supervisors," etc.? Is it any surprise, then, that virtually all of the responses are simply disguised versions of "more money in budget?" There could have been some really interesting comparisons had the counselors been given the same instructions as the directors. For example, how many counselors would have ranked '~igher salaries for counselors" as the first item? And how would counselors have ranked such choices as those indicated by Items 15 and 16 (Exhibit K)? It is of some interest to compare the charge issued to the counselors for providing the information in Chart XIII. On page xi of the Applicant survey, the questionnaire sent to the counselors is reproduced; it also appears at page 84, along with very exacting instructions for recording the data and for mailing the questionnaire. In both places, the instructions shown in Chart XIII is exactly as it ap- pears under Exhibit J: The most obvious "interesting" comparison between Charts VI and XIII is that the directors' questionnaire bears virtually no resemblance to the counselors' questionnaire. (Compare the statemen~ to the OUn- selors, shown in Chart XIII LExhibit II with the instructions issued to the directors, as shown in Exhibit K.) As if the discrepancies need delineating: 1. The director questionnaire contained 21 choices (excluding "other"), while the counselor questionnaire contained five choices (excluding "'none' or 'don't know,'" and "other"); and even at that, the latter list only partially coincides with the former. 2. The directors were instructed to rank seven choices (in descending order), vlhi le the counselors were to indicate 2 choice only. Which ONE of the following do you think could most help you to provide better case services? But on page 75 of the Applicant survey report, under Findings, the statement appears exactly as follows: For this item each counselor was asked to indicate what he thought would most help him to provide better case services, i.e., not what he thought might be best for his agency or the u.s. Except to further illustrate the general level of incompetence pervading the entire study, the above lack of agreement between the two versions of the statement may not be terribly important. Yet is it not conceivable that the respondent may well not have understood that he was to emphasi;;what would help him to do a better job, and not to be influenced by what he thought might help his agency or his country? 1'14 The intrigue revealed by protracted study of the Highlights in context with the full reports struck this author as increasingly intensifying. In Chart VI (under Exhibit J), it will be noticed that the first column of figures is labeled "No. of Agencies Naming this Factor." And on page 3 of the Highlights, in summarizing the findings in Chart VI, it is observed: verse of only 90 observations, except for the familiar refrain throughout this entire study--that of diversity. Chart VI shows the factors which state directors considered the most important for the possible improvement of VR services provided by their respective agencies. More rehabilitation counselors, more money, better public or employer attitudes, and higher counselor salaries headed the list. Below are the three most frequent factors named by each type of agency (emphasis supplied). Now the fact of the maLter is, of course, that the directors did not "name" any of the factors; they were forced to select them from a structured list. (Although they were given the opportunity of writing in choices, it will be noted that "other" did not even receive honorable mention in Chart VI, i.e., all of the directors were able to select seven factors from the list of 21 provided; this is quite understandable, since some 14 or 15 of them may be subsumed under the category of "more money.") The climax to this harrowing experience is finally approaching. Recall again from Exhibit K that the directors were instructed to rank the seven most important factors in improving VR services, from the list of 21 provided (or to specify their own). Then notice that 31 ranked "more money in budget" as the most important factor, 39 ranked it among the first three, and 58 "named" it. But, in Exhibit I, notice again that when asked if "insufficient funds" was a major limitation to providing better case services, only 40 of the 90 answered in the affirmative (as discussed under Exhibits H and I). Why, then, would 58 name "more money in budget" as one of the most important factors in improving VR services, when only 40 answered that insufficient funds was a major limitation in providing services? This author can deduce only one logical answer: in Exhibit J, Chart VI, the respondents had to indicate seven factors, in order to comply with the instructions, even though this meant choosing some factors which were really not "most important.' One might defend against the above criticism on the grounds that the questionnaire was tested and those 21 choices were found to be the most popular. But such defense would be unconvincing on several counts: 1. The description of the study makes no reference, or even a suggestion, that either the counselor or the director questionnaire was tested. 20 2. If the questionnaire had been properly tested, and the answers were so diverse that they could not be condensed into fewer than 21 items, then that finding should, itself, have been sufficient evidence that no answers would be meaningful with a uni- 20In Vital Issues, however, it is reported that the director questionnaire was tested at five agencies. These results, in addition to pointing up perhaps the most misleading--and c~r tainly the most subtle--aspect of the entire study, produces an excellent lesson in methodology: forcing respondents to make a: choice from a predetermined list produces results which differ from those obtained from independent responses, and ~ importantly, the difference is one in kind, rather than simply of degree. In order to expose the real significance of the above conclusion, with regard to the study under review, it is necessary to further prolong this already voluminous section of the report. Each director was instructed to indicate his preferences for educational backgrounds of counselors. The instructions begin on page 79 of the director survey, and the results of that phase appear as Table 18A on page 85: 155 The instructions under Item 18, shown in Exhibit 1, are truncated at the bottom of page 79. Then, after inserting four pages of profound triteness relating to Item 16, which was discussed at page 75, the instructions are abruptly renewed at page 84.* That phase of the instructions, along with the results, which appear as Table 18B, on page 86, appear below. ~'<"This was typical of the sheer frustration experienced in attempting to decipher the incredible confusion ingeniously blended in with the report; some three hours was devoted by this author in detecting the implications of the material in Exhibits 1 and M (next). EXHIBIT 1 (From pages 79, 85, Director Survey) ITEM 18 - COUNSELOR EDUCATIONAL BACKGROUNDS Preferences for Educational Backgrounds for New Counselors State agency directors were asked to rank their first five preferences for educational backgrounds in the selection of new rehabilitation counselors. Choices offered were: Education major (B.A.) Psychology major (B.A.) Social Work major (B.A.) Industrial Arts major (B.A.) Agricultural major (B.A.) Business Administration major (B.A.) Master's degree regardless of major Other (specify) 156 EXHIBIT L (Cont'd.) TABLE 18A DIRECTORS' FIRST PREFERENCES FOR EDUCATIONAL BACKGROUNDS IN THE SELECTION OF NEW REHABILITATION COUNSELORS FOR STATE VR AGENCIES EDUCATIONAL BACKGROUND M.A. in Rehabilitation Counseling B.A., Psychology major B.A., Social Work major B.A., Education major M.A. regardless of the major M.A. in Social Work B.A., Industrial Arts major M.A. in field related to Rehabilitation Counseling M.A. in field related to fields listed in item M.A. in Liberal Arts B.A., Humanities major Educational background preference not given NO. OF AGENCIES 27 23 13 10 5 4 2 1 1 1 1 5 93* ~~Three directors gave two choices as their "first" preference. EXHIBIT M (From pages 84, 86, Director Survey) State agency directors were also asked to rank their first five preferences for educational backgrounds for their rehabilitation counselors. Choices offered were: M.A. in rehabilitation, education, psychology, social case work, and other field (specify). The first preferences of directors for educational backgrounds for new counselors may be seen in Table 18A. The most frequently named choice (27 agencies) was for an M.A. in rehabilitation counseling or rehabilitation. A B.A. with a psychology major was the next most frequently named first preference, named by 23 agencies. 157 TABLE 18B DIRECTORS' FIRST PREFERENCES FOR EDUCATIONAL BACKGROUNDS FOR REHABILITATION COUNSELORS IN STATE VR AGENCIES EDUCATIONAL BACKGROUND M.A. in Rehabilitation M.A. in Psychology M.A. in Social Case Work M.A. in Natural Sciences M.A. in Liberal Arts Educational background preference not given NO. OF AGENCIES 75 6 5 1 1 2 90 It is crucial to apply very careful comparative verbiage between the first sentence of the instructions shown under Exhibit L, with the first sentence of the instructions shown under Exhibit M. After several readings, one finds that the difference is between the "selection of new rehabilitation counselors," and the directors preference "for their rebabilitation counselors." Presumably, this must mean a distinguishing of new recruits from continuing counselors. But for the present purposes at hand, that question is irrelevant. The important point is that since ''M.A. in Rehabilitation Counseling" does not appear in the list under '~ew counselors" (Exhibit L), why did the results (Table 18A) .Produce that as the leading response? The only logical explanation is that the 27 represents write-in votes under the "other" category. Now the reader must look back at Exhibit M, raising this question: Why would 1l out of 90 directors indicate a master's degree in rehabilitation as their preference over all other master's degrees listed as choices while only IL out of the ~ 90 prefer a master's degree in rehabilitation over all the bachelor's degrees listed as choices? It is perhaps conceivable that some directors would prefer a bachelor's degree for new counselors, but would prefer a master's degree for "their rehabilitation counselors" (which, as noted above, presumably means counselors already on the staff). 21 But such explanation is extremely obtuse; a much more likely reason for the differences in the preferences as indicated by Tables 18A and 18B was that the directors chose the most favorable choices from those listed. Thus, the lesson in methodology emerging from this episode is: If the social science researcher wants certain answers, he only has to make them available to the respondents. 21It is herein assumed that an ''M.A. in Rehabilitation," as used in Table 18B, means the same as an ''M.A. in Rehabilitation Counseling," as used in Table 18A. If these are two different degrees, then one is led to wonder why the latter was not included in the choices provided in the list under Exhibit M, since it proved to be such a popular write-in candidate in response to the instructions shown under Exhibit L. SUMMARY AND RECOMMENDATIONS 158 I. PILOT SURVEYS Efforts to extract existing records in such form to establish the existence of problems involving the placement aspect of VR were unsuccessful. In addition to some changes in methods of keeping records, information regarding placement activities must be collected from the labor market, if it is to become available at all. Thus, a major part of this report was devoted to the testing and discussion of methodology in conducting such research, should it be desired. On the other hand, even though the surveys conducted for this study are most tentative, and aimed primarily toward methodology, some functional knowledge was also derived. Counselors A survey was conducted of all VR counselors in Georgia, to obtain some notion of the light in which they see themselves regarding placement. Since the survey was not expected to produce statistically significant results, the findings are subject to considerable discretion. But in general, it was found that counselors see their primary role as that of counseling the client on his personal problems, so to speak, with placement playing a secondary role. Based somewhat on evidence, but mostly on intuition and logic, it appears that counselors generally are not as comfortable in dealing with employers as in dealing with clients. But it was pointed out that some dread of soliciting in general, and of job soliciting in particular, is human nature, due to the apprehension toward rejection. While it is proper that the counselor be primarily oriented toward the client, and toward getting him ready for employment, it would probably improve the client's employment opportunities if counselors would learn more of the operation of the business and industrial world, especially employers in the community; it is felt that by establishing rapport with as many employers as possible, including a continuing interest in the operation of the firms, counselors and other placement personnel could gain insight to a wider range of jobs; this should hopefully lead toward the more positive concept of assuming that the worker can do the job, rather than exposing him only to jobs traditionally allocated to the handicapped, Employers Although it could not be conclusively established that barriers to successful rehabilitation of clients actually exist at the placement stage, analysis of job opportunities was predicated on that assumption. (Some doubts were aroused later, and will be reported accordingly.) A pilot survey was conducted of 35 business firms in Atlanta, but there was no attempt to select a representative sample, since the purpose was to establish methodology for any future surveys, including the identifying and testing of some pertinent questions in need of study. Attitudes toward the hard-core unemployed: In spite of the lack of statistical reliability of the sample, there can be little question that employers are of the opinion that the much-publicized unemployment in the area is a statistical concoction. At the same time, they do feel that public programs are necessary to rehabilitate the unemployables. There is a concensus of opinion that the public insistence that every youth ~ttend college is overdone, but there is divided opinion as to whether hiring requirements have been unrealistically increased in terms of education and experience. Some in-depth research should be conducted on the question of hiring standards versus job requirements to determine if hiring standards are a function of real need, or of the availability of workers with certain education and training. Policy toward problem applicants: Employers were asked to indicate their hiring policies (rather than personal attitudes, as in the previous section) toward the various hard-core groups. The result was that employers express a policy of treating applicants on the basis of ability only. One must be aware of the extremely critical labor shortage in Atlanta, which is known to have caused a relaxing of hiring standards toward all groups of applicants. But notwithstanding the tight labor market, one is suspicious of the extent to which employer policies are based on ability alone. Some evidence was detected, for example, that handicapped workers were more acceptable for jobs out of sight of the public. It was suggested that a determined but quiet campaign might reduce this aes- 159 thetic barrier facing the handicapped; but the suggestion was accompanied by a caution against VR's acquiring any semblance of a pressure group. Employer knowledge, use, and prospective use, of handicapped workers: This part of the survey was very loosely-structured, and thus the specific results are in no wise represented as being reliable. There was one "pattern," however, the spectre of which was encountered at every turn in the entire study, and that was that there was B pattern among employer practices and preferences regarding the procedure in soliciting jobs, in the counselor's providing assistance in selecting a suitable job, or in his participation in carrying out a decision that the client was not an acceptable employee. Most employers seem to guard matters involving the employeeemployer relationship as a sort of management prerogative. Thus, it is strongly urged that procedures in dealing with employers be constructed on an ad hoc basis, and that no effort be made to construct any standard format to be imposed uniformly. Some tentative evidence emerged indicating that a fair number of employers were not intimately aware of VR services or procedures, and that more soliciting, if done properly, may uncover a significant number of opportunities for the handicapped. It was pointed out that the present conditions of high employment would be a propitious time to make a serious attempt toward instilling the wisdom of hiring on the basis of ability, in hope that this might carry over to more normal economic condi~ tions. While it is admitted that counselors and other VR personnel involved in placement should cultivate a relaxed attitude toward contacting employers, and that the public image of VR was important, it is also urged that the "hard sell" not be applied; furthermore, that the basic promotion of hirethe-handicapped can be best performed on a one-to-one basis, and that ultimately the most effective public relations will be carried on by a satisfied clientele. Placement Specialist There appears to be noticeable agreement among employers that placement is becoming a necessary specialty in our complex labor market. In the case of VR, there was no way to determine if the lack of placement services was a bottleneck to rehabilitation, because the records are not available showing the number of clients who discontinue at various stages, by reason for discontinuing. The Georgia VR agency does have two placement specialists, but they are concerned only with the hard-to-place clients. While a backlog of unplaced clients is present, there is still no way to determine if the backlog is due to lack of placement personnel, or to some other reason. (Since those classified in the hard-to-place category are generally, although not always, severely handicapped, it could be that an untold number are unplaceable in terms of labor market conditions.) Although there is some opinion reflected among various VR personnel that placement does present a barrier in the path of completing the rehabilitation process, the point of the discussion herein is that there is no way from the existing records to determine this question conclusively, and certainly no way of making even a rough estimate of the extent to which placement is a barrier. Thus, it is recommended that the statistical methods be arranged so as to maintain continuing records of placement activities, including number of placements by the various methods, number of clients who must wait varying lengths of time before becoming employed, and those who are not placed at all. Most importantly, some figures should be accumulated on applicants who do not become VR cases because of the absence of a reasonable expectation of suitable employment; this should by all means include a differentiation between those rejected because of severity of handicap and those rejected because of unfavorable conditions in the particular labor market (i.e., whether the negative outlook toward employment is a supply, or a demand, factor). Legislation: Although there is a task force on legislation, the one here gave some consideration to legislation as it affected placement; notably wage-hour, and workmen's compensation. On wage-hour legislation, most of the employers surveyed were not strongly affected by minimum wages (although several~ engaged in the hotel, motel, and restaurant industries). It was noted in the report that there is a decline in the use of wage-hour waivers, and that if 160 vigilance was not maintained, the opposi- ment agencies (although, again, the tight tion to their use may find it increasingly labor market must be recalled). When easy to have them more severely restricted asked if all agencies should combine their or abolished. Thus, since waivers for min- placement efforts, however, there was some imum wages reportedly are crucial for some opposition expressed, some of which was VR operations (particularly sheltered work- rather outspoken. Here again, the thread shops), it would behoove VR spokesmen to of diversity weaves its way throughout keep in close touch with legislation poten- all the findings. tially jeopardizing waivers. As for VR and the Georgia Employment Ser- On workmen's compensation, there is a fair amount of sentiment among the employers surveyed that abuses involving occupational death were a deterrent to the employment of older workers. Yet those in touch with the administration of the act seem to assign emotion as the basis for much of the concern. Although workmen's compensation perennially is one of the more controversial legislative strategy issues, this does not alter the fact that the above question still should be examined, with a view toward any desired changes which would benefit the workers. vice (GSES), there is some feeling that VR does not feel satisfied with the experience in placing clients through GSES, accompanied by a feeling on the part of GSES that it only gets the residual of hard-to-place clients. (This is not to suggest evidence of antagonism between the two agencies.) It was pointed out in this report that handicapped applicants will likely receive more attention from personnel with a primary commitment to the handicapped; if so, then VR should continue as the major source of placement services for its clients. It does seem, however, that more coordination between the two agencies could be profitable. There is one other legislative issue, which is not in the political news - that of re- strictions on soliciting sub-contract work from private business firms by non-profit organizations and on the sending of state equipment to non-profit organizations for II. FOLLOW-UP AND EVALUATION STUDIES repair. The question is another one of those areas only peripherially related to this task force, and hence was not pursued ip depth. But the Committee on a visit to the Georgia Rehabilitation Center, in Warm Springs, was most impressed by the discouragement among evaluation students and evaluators over the lack of "live" work. According to rehabilitation personnel, meaningful work is extremely important as a training device, in order to instill confidence and a sense of accomplishment in the minds of the handicapped trainees. In addition, the Committee's int -"it ion suggest that many small items, such,as pumps, small engines and the like, are not economically repairable at competitive rates but would be very appropriate for ,VR trainees. As explained earlier, no information could be discovered to shed light on the experiences of VR clients after becoming employed. One study did, howeve_r, give the impression of having collected and analyzed data in that regard; this author's evaluation of the study was that it was worth nothing, at best, in that it did not conform even to the most elementary rules of research, in spite of its endorsement by responsible members of the academic community. Not only did the approach, i.e., the sampling technique, etc., render the project sterile in its inception, but the interpretations assigned to the findings were irresponsible, invalid, and misleadJ..ng. 1 The making of these items available for evaluation and/or training purposes should not entail any drastic overhaul of state policy. Another study was conducted at the national level (1964), and after reading the introduction, one is convinced that it is the definitive work in the entire field of rehabilitation. However, an exhaustive VR and other agencies involved in placement activities: Among the Atlanta employers surveyed, there was surprisingly little resentment toward being solicited by place- 1Refer to Preface for clarification of the author's opinions. Ed. 161 and deliberative reading of the entire Human Capital," the practice of applying study reveals that it was not concerned cost-benefit analysis to every conceivable with the quality of services rendered to social problem has taken society by storm.l VR clients, or even with the extent of un- Legislation to formally apply the "systems met needs; rather, it was apparently de- approach" to social problems has received voted exclusively to the question of favorable attention in Congress, and would acceptance ratios; that is, it was concerned establish a national social science foun- with applicants who refuse VR services,' and, dation as a counterpart to the National to some extent, with applicants who are re- Science Foundation in the physical sciences. fused ~ VR; but on balance, the study re- This report has argued that social and phy- flects more concern with escapees than with sical science research do not lend them- rejectees. selves to the same techniques, and has offered some basis for the argument. In addition to the above studies, some internal VR records and literature was examined, and this author again detected what he though was a clear pattern of emphasizing volume. The annual report for the Georgia VR agency covering fiscal 1965-66 reflects more concern over the amount of Federal money "lost" as a result of the State's failure to provide adequate funding to support maximum Federal matching, than over the clients in need of service. The study herein pointed out, however, that the emphasis on obtaining more funds is not completely due to an expansionist philosophy, but has, in part, arisen from the national obsession with the concept of "investment in human capital" from the standpoint of society; as a The application of the social investment approach is particularly tragic in the case of rehabilitation of the handicapped, for the very simple reason that the ~ rewarding expenditure from the standpoint of the individual is the least rewarding from the standpoint of society; that is, if one wishes to invest funds in such manner to yield the highest total return, then the funds should be devoted to those with the least severe handicaps, because they will: (1) be the least expensive to rehabilitate; and (2) become the ~ productive workers upon rehabilitation. However, this becomes a two-edged sword, in that the ~~ severely handicapped is in the least favorable position to become self-rehabilitate(. As result, legislative bodies view all pro- pressure builds up for VR administrators posals in terms of the economic return. to show a better profit, in order to com- Elected representatives are thus provided pete with other public agencies for the with ammunition for encyclopedic recitation available funds, the individual, originally of pseudo-statisti~3, to convince their constituents the rete of return is much greater than even the most speculative private investment. (In this study, two spokesmen for VR were cited, one quoting intended as the sole beneficiary, becomes merely a means to an end, or a political factor of production. The end result is that those who need help the most will be the least likely to receive it. a return rate of $10 for each $1 invested (in Georgia), while the other reported $35 for each $1 invested (nationally).) Since both figures were no doubt computed Thus, it is urged that the philosophy of VR be one of service, rather than one of profit to society. by experts in the academic world, any doubt expressed would probably be discounted as heresy. Still, one does wonder if such variation is entirely attributable to "rounding." In reviewing the research reports encountered in collecting materials for this report, the author is distressed over the tendency in social science research, whereby public agencies and academicians form a sort of implicit conspiracy. A "problem" is created by proclamation, then one or a A great part of the excessive attention to the investment approach is attributable to academicians in devising the scheme of cost-benefit analysis, which assumes that all phenomena can be quantified. Since group of "experts" is called in to "study" the problem. The only precaution is the requirement that the expert's title contain the term "doctor", which is taken as being synonymous not only with infallibility but Professor Theodore Schultz' presidential address to the American Economic Associa- 1Published in the American Economic Review, tion in 1960, entitled "The Investment in March 1961, pp.l-18. 162 1vith omuiscience as well. Since expert (In addition, any follow-up evaluation consultants do not establish a reputation of clients should extend over some reason- for recommending that something not be done, able period of time; as it is now, the methodology is designed to generate data time elapsing before a client is pronounced which will lend itself to whatever inter- rehabilitated is largley discretionary with pretation is necessary to provide "docu- the counselor, with thirty days as a rule- mentation" to the desired and preconceived of-thumb minimum. While there is no ob- solution to the problem; , massive data jection to that arrangement, follow-up is discreetly selected which will provide evaluation should equate the time period the raw material from which any desired to a common denominator, to avoid dis- solution can be forged. tortions.) These expert studies are embellished with an impressive group of imminent scholars listed as advisers or consultants, and usually bear the endorsement of prominent citizens. Any doubt regarding validity of the study is put to rest by the display of data sheets exactly as that great oracle, the computer, produced them; further insurance is provided by showing the mathematical formula through which the answer was derived. The problem, and the solution, are both then deified and popularized by journalists, and anyone questioning the gospel according to the prophets is denounced as an infidel. A summary recommendation, then, is that evaluations of VR activities be conducted by someone not committed to the subject matter, i.e., to rehabilitation as an institution, and that every precaution be taken to see that consultants' total effort (including quality) be commensurate with the compensation. If and when it is established that placement is a barrier to successful rehabilitation of a substantial number of individuals, it is recommended that follow-up evaluation of rehabilitated clients be conducted, but based on factual knowledge, rather than on attitudes alone. (Some of the latter is inevitable, of cours,, and some precautions in taking that ~pproach were discussed at length in this report). The follow up should be based on performance by the client placed on a job, as measured by such items as punctuality, safety, production, and turnover, compared with other employees of the same firm. By the same token, if it is felt that client evaluation of VR services would be useful, information collected should be based on actual figures, such as earnings before and after rehabilitation - not simply on inquiries as to whether the client is "satisfied" with VR services, or whether his economic situation has "improved". Reiterating an earlier caution, any followup studies should be for the purpose of improving the service provided to the principals involved: handicapped individuals, and employers. The results should not be weighec in light of the return to society on its investment. On that basis, the author has contended that VR should continue to dwell on those suffering individual handicaps, rather than branching out to reach those suffering group handicaps; the contention is not to imply that those suffering group handicaps do not deserve assistance; it is based on fear that the intermingling of both types of clients under one agency would tend to obscure the special needs of traditionally handicapped individuals, leading to undue attention to the benefits accruing to society as a whole, and henc~ to the assigning of priority to the welfare of the agency, over that of the individuals to be serve0. The report raises suspicion that such philosophy is already aborning within VR, in an effort to fill the void caused by the decline in the number of traditional clients, e.g., physically handicapped. An example of the possible ramifications of that trend were observed at page 25 of Vital Issues: By definition, approximately 2.2% of the total population are mentally retarded or deficient and would score 69 or below on the Wechsler Adult Intelligence Scale. That would be over 4,000,000 people! Where are they? Administrators felt that many of these people were adjusted within the community, even though marginally, and not recognized as people with IQ's of 69 or below. While the "out-reach" approach for cases in genuine need is not inherently objectionable, the increase in the number of VR clients classified as mentally handicapped, relative to the number of physically handicapped, is staggering; and the projections 163 of further domination by the mental group are frightening. Since that is one group where the "need" is not only quantifiable, but also subject to easy manipulation (simply by adjusting the tests), it is easy to foresee. a sort of "leap-frogging" increase, not unlike the wage-price spiral; that is, as the "need'' increases, more funds are demanded, and as the additional funds are made available, the need is increased (by redefining the standards) to meet the funds available. Few academicians deny, internally, that the process is already at work in higher education; as enrollment increases, funds are increased, and as more youngsters enroll, others are influenced to follow the group, which means more funds are needed, and the cycle increases in momentum. But, just as college attendance can become contagious, the layman's empirical observation suggests that mental illness can also be contagious as an escape from reality. And, while it may (or may not) be beneficial to society and its members for college ~ dance to become a function of facilities available, would it not be tragic if ~ tal illness should become a function of facilities available for its treatment?! There is no intention herein to impugn the motives of any public agency or individual. The above process is simply the way that all-American, pernicious institution known as bureaucracy evolves. lR APPENDIX PLACDiENT SURVEY I. We are enlisting your aid as professional field personnel in identifying the problems in the placement of handicapped persons. The next few minutes that you spend on this survey can be of immeasurable va~.Je to the future of Georgia's program to aid the handicapped. Allow yourself full freedom in answering the questions. When a question is not applicable to your particular situation, indicate by ll/A. Of particular importance are your "comments." Please do not leave .2..!!.Y questions unanswered. 1. Name 2. Age 3. District 4. Job Title 5. Length of time employed by Vocational Rehabilitation_____ 6. Estimate the percentage of clients in each disability category in your 1966 caseload. _____Visual Impairment _____Rearing Impairment _______Nental RE: tarda t ion -----Other:Etiology not Known ______Orthopedic deformity or functional impairment, except amputations _____Absence or amputation of major and minor members ________Psychoneurotic, and personality disorder II. 1. ~stimate the percentage of your work time last year which was spent in placement of your clients in renumerative employment----------- 2. Now, estimate the percentage of your clients who were actually in need of renumerative employment placement services. --------------- Of the clients needing these placement services, estimate the percentage (a) placed through the employment service. _______________ ------------ (b) placed by direct referral to employer. (c) placed by your counseling the client on finding the right job. ________________ 2R -2- II. 3. As a professional re~abilitation counselor, you have become acutely aware of the problems in placing handicapped people in employment. List your placement problems in your area in~ (a) Private Industry (b) Federal Government (c) Local Government ~ow, give any suggestions for solving these problems: 4. There is no explicit definition of the counselor's relationship and obligation to tne client. From your personal view, cneck the statement that most closely fits your interpretation of the role of tt1e Vocational Rehabilitation counselor in placement. A. The counselor prepares the rehabilitated client to ~-.,--- find a job by showing ~im how to conduct himself on the job; he explains the techniques involved in a successful job interview, teaches him the invortance of good grooming, etc., and provides him Jith pertinent data concerning the labor market or . ____B. lhe counselor not only briefs the client on the above but iu addition he personally arranges job interviews and talks with the prospective employer about the individual client before the job interview. -3- III. 1. Based on your personal contact with employers in your area in regard to placing your rehabilitated clients. check the block that best describes the employers' general attitudes toward hiring the handicapped. Highly Favorable Moderately Favorable Moderately Unfavorable Highly I Unfavorable - - - -; 2. According to the specific handicaps in the table below, rate the attitudes of employers in your area whom you have approached to hire clients with t~ose handicaps. Type of Handicap Attitudes of Employers Toward Placing I Highly Moderately Hoderately Highly Favorable Favorable Unfavorable Unfavorable w ::0 I a. Physical Handicap (other than blindness or epilepsy) b. Legal Blindness c. Epilepsy d . Emotional Handicap e. Nental Retardation I I I i I ' - i 4R -4- II I. 3. Where are the four major sources of employment for the handicapped worker in your area? (Numerically rank the sources, with 1 representing the major source of employ- ment). ______Service Occupations ______Semi-skilled Occupations ______Unskilled Occupations ______ski 11 e d 0 c cup at ions _______Clerical and Sales Occupations _________Agriculture, Forestry, and Kindred Occupations _______Pro f e s s ion a 1 0 c cup at ions _______Semi-professional Occupations Comments, if any: JL\. -5- III. 4. Do you feel that any of the following are reasons for employer refusal or reluctance in hiring hanaicapped YES NO a. Fear of "expense" which might be involved b. Reluctance to having disfigured or "unsightly" individuals in place of business c. Fear of ''normal'' employees' disapproval d. Fear of business community ridicule or criticism e. Genuine skepticism regarding disabled worker's competence in his given field f. General avoidance of "change" -- wanting to do things as they have always been done g. Fear of increased workmen's compensation premiums. h. Others (specify) Comments, if any:------------------------ O~GANIZATION AND STRUCTURE OF THE OFFICE OF REHABILITATION SERVICES GEORGIA STATE DEPARTMENT OF EDUCATION Task Force on Internal Structure Statewide Planning Project Georgia Office of Rehabilitation Services INSTITUTE OF GOVERNMENT UNIVERSITY OF GEORGIA March 1968 INTERNAL STRUCTURE AND ORGANIZATION TABLE OF CONTENTS Page Introduction .................................................... 168 I. Aims of Vocational Rehabilitation ........................... 169 II. Organization of Georgia Office of Rehabilitation Services .................................... 172 A. Administrative Units .................................. 172 B. Division of General Services .......................... 175 c. Division of Special Services .......................... 177 D. Division of Workshops and Facilities . ................ 190 E. Division of Special Disabilities . .................... 194 III. Administrative Services ...................................... 201 A. Personnel ............................................ 201 B. Budgeting ......................................... 206 IV. Relationships with Other Agencies ........................ 214 V. Findings and Conclusions ..................................... 214 VI. Recommendations ......................................... 215 Appendix A, State Vocational Rehabilitation Agencies ....... 231 168 Introduction This report is submitted to the State- wide Planning Project directed by the Office of Rehabilitation Services of the Georgia State Department of Education by the Task Force on Internal Structure. It is based on research into the programs and operations of the Georgia Office of Rehabilitation Services and its relations with other agencies. The organization and procedures of like agencies in other states were surveyed. This research was conducted by staff members of the Institute of Government of the University of Georgia acting as consultants to the Task Force. The principal author is Mrs. Virginia M. Vobach, Research Assistant in the Institute of Government. She was assisted in several phases of the study by Dr. Augustus B. Turnbull, III, Assistant Professor in the Institute. Other assistance was given by graduate research assistants Alfred K. Barr and George A. Taylor. Staff of the Statewide Planning Project provided invaluable assistance to the consultants during the entire period of the study. Recommendations contained in the report are the result of the careful appraisal of and study given by members of the Task Force: Gordon C. Bynum Manager, Employment Services Personnel Relations Department The Coca-Cola Company P. 0. Drawer 1734 Atlanta, Georgia 30301 Robert T. Morgan, M.D. 207 E. Willingham Street Sylvester, Georgia 31791 Alton R. Salter, Director Student Personnel Service Thomas Technical Schools Thomasville, Georgia 31792 Paul G. Sewell Director Thomas Technical Schools Thomasville, Georgia 31792 Julian C. Sipple Lawton, Sipple and Chamlee Attorneys at Law 26 East Bryan Street P. 0. Box 527 Savannah, Georgia 31402 Edward Craig Personnel Director Southern Territory Sears, Roebuck and Company 675 Ponce de Leon Avenue, N.E. Atlanta, Georgia 30308 G. E. Freer Regional Manager Public Relations Staff General Motors Corporation Rhodes-Haverty Building Atlanta, Georgia 30303 Leon Meenach Director, Special Disabilities Vocational Rehabilitation State Office Building Atlanta, Georgia 30334 Miss Karen Butler (Staff Liaison) Statewide Planning Project Vocational Rehabilitation 159 Forrest Avenue, N.E. Atlanta, Georgia 30303 Mrs. Virginia Vobach (Consultant) Institute of Government University of Georgia Athens, Georgia 30602 169 Part I of the study gives a short summary of the aims of the state federal rehabilitation program together with a short history of the program. Part II is devoted to a description of all the present programs of the Georgia Office of Rehabilitation Services while Part III is concerned with the handling of staff services. Part IV describes in brief the Office's relationships with other agencies, both public and private. Part V outlines the general findings of the Task Force and Part VI gives the recommendations for improvements formulated by the Task Force and the reasons for such recommendations. The Vocational Rehabilitation Agency offers to the individual a number of services to bring about this end. It provides diagnosis and evaluation of the degree of impairment. It offers evaluation of work skills already possessed by the client. It provides counseling on work goals. It provides for treatment of the disability, whether physical or mental, through the purchase of medical services (for this service the client is asked to pay as much of the cost of treatment as he can afford). It will purchase any special training required for the job goal, either in schools or in workshops. It will in some cases pay for tools or equipment needed to establish a small business. It will offer maintenance during training if needed. Finally, it will place the individual in a job and maintain contact with him for a short time after employment to ensure that the employment is satisfactory. Under federal regulation, an applicant, to be eligible for any or all of these services, need (1) have a physical, mental or emotional impairment, (2) sufficient to constitute a substantial impediment to employment and (3) there must be a reasonable assurance that the individual can become employable through the provision of rehabilitation services. I. AIMS OF VOCATIONAL REHABILITATION In practice then, the individual must be of age to become employed and there must be some method or combination of methods of treatment which can enable him to work again. For example, under these criteria the vocational rehabilitation agency could not undertake to provide treatment for a terminal cancer case, although it is conceivable that with improvements in methods of medical treatment they might in the future undertake cases which they are prohibited from accepting at the present time. The primary aim of the state federal program of vocational rehabilitation is the return of disabled individuals to productive employment. The impairment of the disabled individual may have been present at birth or acquired in later life. It may be a physical, mental or behavioral disability. It must be significant enough to prevent the individual's obtaining a job or a job equal to that he held before he acquired the disability. The task of the vocational rehabilitation counselor is to restore the individual to the highest degree of usefulness, productivity, and selfsufficiency of which he is capable. The Vocational Rehabilitation Program was started by this nation as an 'outgrowth of its experience in treating veterans disabled during World War I. In 1920, Congress enacted a grant-in-aid program for vocational training and rehabilitation of "persons injured in industry and otherwise." Until 1943 the program remained small. Through the 1920's and 1930's annual federal authorizations for the entire statefederal program remained at $1 million. Until 1943, no physical restoration was allowed -- emphasis was on training around 170 1966 1965 1960 1955 1950 1945 1940 1935 1930 1925 1921 Table l Total U. S. Expenditures for Vocational Rehabilitation and Total Cases Rehabilitated 1921 - 1966 Total N.A. 161,700,000 80,548,000 39,254,000 29, 347, 000 9,856,000 4,108,000 2,248,000 1,700,000 l' 187,000 285,000 Federal -G-ra-nt-s 142,962,889 100, 100,000 50,059,000 24,463,000 20,340,000 7,130,000 1,472,000 1,032,000 740,000 519,000 93,000 Research & Demonstration 20,600,000 15,406,000 5,513,000 299,000 Training Program 24,800,000 22,968,000 6,117,000 {>37,000 Total Cases Rehabilitated 1966 196 5 1960 1955 1950 1945 1940 1935 1)30 1925 1921 154,279 134,854 88,275 57, 981 59, 597 41, 925 11,890 9,422 4,605 5,825 523 Source: U. S. Department of Health, Education and Welfare, Trends, 1965. 171 Table 2 Georgia Office of Rehabilitation Services Operating Costs 1964-1967a Expenses 1967 1966 1965 1964 Personal Serv. Salaries, Wages, Fees $5, 275, 682 Retirement 379,450 Soc. Sec. 225, 537 Health Ins. 1 03, 321 Travel Exp. 398, 006 Supplies 293, 940 Cornml.lnica tion 1 78, 414 Heat, Lt. , Power, Water 69, 351 Books, Public 4, 264 Printing, Public 24, ll 9 Repairs 57, 782 Rents 291,650 [nsur. Bonding 4, 51 7 :ndemnities 1 53 .::ase Service 7,889, 206 :ontracts Other St. Agencies 589, 700 Other 39' 7 3 l ~quipment 330, 737 v1isc. 32,149 Total $16,545,294 $3, 606, 803 194;745 86,867 74,718 308,472 2.00,-638 122, 592 45,094 9, l 01 17,615 56,478 207,474 4, 860 1, 922. 5,508,710 316,302 (-) 2., 0 1 5 403,016 2 l, 8 86 $ ll, 1 85, 339 $2,634,834 1 61 . 01 8 60, 364 50, 942 255, 340 1 54, 377 98, 061 38,950 1 3, 833 1 7, 006 148, 81 0 3, 883 133 4,441,743 45,381 2.06, 256 l 0, 397 $8, 341,3"30 $l,Y22,867 1 05, V85 45, 771 204, 31 4 82, 072 8l,334 8, 700 l 5, 149 ll 2, 258 834 485 4,37l,St6 225,959 7, 539 :::apital Outlay rotal 409,919 $16,955,212 278, 237 $11, 463, 575 405, 9 14 $8,747,244 1,072, 996 $s, 327, 579 ..J"umber Employees ,f 30 936 735 499 aExcludes Academy for Blind and School for Deaf Source: Report of the State Auditor of Georgia 1966, 1967 172 the handicap. Amendments passed in 1943 expanded the program considerably by grant- ing permission to provide (l) surgical and medical benefits to correct or reduce the disability, (2) cost of hospitalization for up to 90 days and (3) a maintenance allow- ance, and books and training materials while in training. The 1943 amendments II. ORGANIZATION OF THE GEORGIA OFFICE OF also broadened the definition of dis- REHABILITATION SERVICES abilities which could be treated including the mentally as well as the physically A. Administrative Units handicapped. At present, vocational rehabilitation Further amendments in 1954, 1965, and services in Georgia are offered by the 1967 liberalized the matching fund ratio Office of Rehabilitation Services, a major to the present 75 per cent federal-25 per division of the State Department of Educa- cent state for the basic program. Addition- tion. The Office is headed by an Assistant al funds were granted for construction and State Superintendent of Schools for Rehabil- expansion of workshops and facilities, and itation Services (JohnS. Prickett, Jr.) for state-wide planning projects. In ad- who reports directly to the State Superin- dition, the level of support for vocational tendent of Schools (Jack P. Nix). The rehabilitation was increased drastically. Assistant Superintendent is appointed by Present authorizations are: for 1968, $400 the State School Superintendent with the miliion; 1969, $500 million; and 1970, $600 approval of the State Board of Education million (see Table 1 below). and is responsible for overall direction of the State's vocational rehabilitation program. Georgia was one of the first states to participate in the vocational rehabilitation program. A 1920 act passed scarcely after the federal law (it was approved August 16, 1920) accepted the federal program and designated the State Board for Vocational Education as the state agency to administer the program in Georgia. With the emphasis on training in the original program, this move was logical. The 1931 reorganization act (Georgia Laws, 1931 p. 7) abolished this Board and transferred its functions to the Board of Education. In 1951, the General hJsembly recognized the existing program of vocational rehabilitation and provided a statutory basis for it (Georgia Laws, 1951 p. 15 16). It created a Division of Vocational Rehabilitation, within the Department of Education, headed by a Director appointed by the State School Superintendent with the approval of the Board of Education. Thus, in Georgia, vocational rehabilitation has never existed as an independent program but rather has been allied with the state's total educational program. The Georgia program has followed the growth rate of the national program -- expanding rapidly over the past three years (see Table 2). The following officers of the agency report directly to the Assistant State Superintendent: (1) Director of Research (2) Supervisor of Supplies and Property (3) Public Information Officer (4) Director, General Services Division (5) Director, Special Services Division (6) Director, Special Disabilities Division (7) Director, Workshops and Facilities Division (8) Coordinator, Statewide Planning Study (See Chart 1) The Agency also has established two advisory committees, a Medical Advisory Committee and a Psychological Advisory Committee, which report to the Assitant State Superintendent. The Supervisor of Physica~ Restoration serves as the Secretary of the first named committee, and the Supervisor of Guidance, Training, and Placement servef as Secretary to the second. CHART I ORGANIIATION of GA. V.R. STATE SUPERINTENDENT OF SCHOOLS I DIRtCTOR OF Rt:s::ARCH _l SUPf~VISOR OF SUPPLlES AND PR0PER7Y r DIRECTOR OF GENERAL SERV:Cr:S Research Associate ASS I STANT STATE SCHOOL SUPERINTENDENT FOR V .?. SERVICES .___ I T ' PU9'_1 c ' 'i~FORMAT! ON L ll_;g~~~~;il OFFICER _j_ "1!:01 .:AL ___ ___ , ""'--"-- ..._::: '-~~~ --~-- 1 DIRECTOR OF SPECIAL SERV:CE'S J DIRECTOR OF SPECIAL D!SAB1LITIES _l PSYCHOLOG! <:A:... ~ row.. I AD~'ISOI{i L--._~-'~I -~r-.r'-:.'"-~ 1 I i COORu! NATO!\ ,._. l 0~ ~STATEWIDE LI pLA~''"''."..~.. )~ TUDY ..... w -r1e~orary) l DIRECTOR OF WORKSHOPS AND ~ACILITIES Rehabi 1i'tatfonl lli_a_i, S()n Person l Associate Coordinator Research 174 1. Research Unit. The Research Unit of (2) Develop the annual report of the the Agency consists of a Director, a Re- Agency and all reports to Washington, search Associate and one clerical employee. including compiling all statistics The Unit, established about eighteen months that must be reported to the Federal ago, performs the following tasks: Office of Social Rehabilitation Ser- vices. (1) Surveys and evaluates the agency's record-keeping systems to enable ~he The Unit is completely separate from the agency to retrieve more information Public Information Office in the Department from its files and to cut down on of Education, although its Director serves special studies. on a Public Information Committee which coordinates all procedures on public infor- (2) Provides technical advice to members mation in the Department. of the agency on special studies and reports. The head of the Unit also serves on the Funding and Allocation Committee, a spe- (3) Works with the EDP center of the De- cial internal committee established to re- partment to make data accessible to view data for effective funding of the the agency. Agency's operations, and on Task Force Seven of the Statewide Planning Project (4) Does research into the operations of charged with reviewing the recommendations the agency. of the other Task Forces and developing any changes in the laws needed to carry (5) Works with those outside the agency out the recommendations. doing research on vocational rehabil- itation grants to design the most economical methods of obtaining needed data from the records. 3. Office of Supplies and Property. This Unit consists of the Supervisor of Supplies and Property and six clerical employees. The major functions of this Unit are to: The Unit also has worked closely with the Statewide Planning Unit in providing infor- (1) Compile and maintain a yearly inven- mation needed by the task forces and with tory of all property of the Agency the Agency's special committees on internal throughout the state organization, allocation and funding, and methods of services. ~ ' ~ (2) Process all requisitions of property and supplies for the Agency The Director of the Unit works closely with the Public Information Officer in (3) Negotiate leases for office space for charge of preparing the Agency's annual re- the Agency port. He has served on the Agency's Re- search Committee whose function is to ad- (4) Maintain a stock of and issue all vise the Assistant Superintendent on forms and stationery used by the research projects to be undertaken by the Agency, and order new supplies from Agency. The Unit is not a part of the the Printing Department of the School Research and Statistical Services Divi- for the Deaf when the stock runs low sion of the Department's Office of Staff Services. (5) Execute and maintain maintenance agreements on Agency equipment 2. Information Unit. This Unit consists of a Public Relations Representative as (6) Provide mail distribution for the head of the office, two Information Officers Agency and seven clerical employees. The major duties of the Unit are to: (7) Maintain client folders on all active cases and inactive cases for one (l) Project the public image of the year Agency in the state - to develop fea- ture articles, magazine and TV spot (8) Maintain status cards on all active announcements, and bulletins and cases and for seven years on closed pamphlets informing the State's citi- cases (the latter at the warehouse zens of the services that are avail- maintained at the old farmers market able from the Agency. by the State Department of Education) 175 The Unit works very closely with the Office of the State Supervisor of Purchases and the General Services Section of the Department of Education as all requisitions must go through the Education office. The head of the unit serves on the internal committee established to review and modernize or eliminate the forms the department uses. He also serves on a records management committee which is to review Agency policies on the disposition of records and formulate new guidelines on (1) which records may be destroyed, and (2) which kept, and (3) where the records are to be stored and in what state. The Supervisor of Guidance, Training, and Placement is in charge of the in-service training program for all Agency personnel, not j~st those within the General Services Division. He plans, coordinates, and supervises this training and maintains the individual training records of all personnel. He also administers the program of certifying all institutional training facilities throughout the state and disseminating this information to the counselors in the field. He maintains the roster of these facilities for use by other state, federal and private agencies. B. Division of General Services The Division of Genral Services is the Unit which handles the main program of the Agency - the provision of rehabilitation services to those clients with almost any type of physical disability. The Division is headed by a Director who reports directly to the Assistant State Superintendent (at present this post is vacant as the previous incumbent was promoted to the position of Assistant State Superintendent for Rehabilitation Services.) The major function of Director of .the Division of General Services is to give general management and overall direction to the entire program. He also plans studies, draws up the budget for the program, and develops program policy. Another major function of this office is the provision of placement advice to the co~nselors. The Supervisor is assisted by two Placement Specialists, one of whom serves North Georgia and the other South Georgia. This office also maintainr the State Vocational Rehabilitation Library and approves all orders for books and publications. The Supervisor serves on the library committee of the State Department of Education. This office has also been assigned the task of maintaining the Agency Manual of Policy in a current state and distributing any revisions to each user. The Supervisor also serves as Secretary of the Psychological Advisory Committee. The general program of vocational rehabilitation is operated through six district offices and 26 local offices. Each district office covers a geographic area At the state level, the Director has two assistants who report directly to him: (1) the Supervisor of Case Standards and (2) the Supervisor of Guidance, Training, and Placement. The Case Standards program is primarily one of "quality control''' to ensure that each case is handled well and to increase counselor competence. The Case Standards Supervisor works through Casework Supervisors in each division and in installations maintained by the Agency throughout the State. Each of these Casework Supervisors works with a number of local counselors reviewing case folders for quality, identifying weak spots, and helping the counselor to work out problems. Although the Case Standards program is in this General Services Division, the program works with counselors in all four divisions to maintain consistency. of the state and supervises the local offices within that area. Each district is headed by a district supervisor who is responsible for direction of all general rehabilitation activities within that district. Each district also has at least one Casework Supervisor working with eight or ten Counselors in the district. The Casework Supervisor does not report to the District Supervisor but to the Supervisor of Case Standards. Following Charts II through VIII detail the present district organizations. The District Supervisors are responsible for hiring personnel within their district through the Personnel Office of the Department of Education and the State Merit L System Office, for preparing the budget for the district, and for planning office CHART II OFFICE OF GENERAL SERVICES DIRECTOR OF GENERAL SERVICES I lCasework Standards Supervisor II I Guidance, Training and Placement Supervisor II __l I --L District Supervisor I l . I -. I Casework Specialists District . I . I . I I Casework !Specialists District . Supervisor I I . I . I District Supervisor I . . . I District . Supervisor I . . I I District Supervisor I J . Client Training t-' -....) I . Supervisor I "' I Casework I Specialists ICasew::--, ISpecialistsl lcasework JspecialistsJ Casework 'Specialists ;- ---- ----- I I -I ~ I I . . counselor II ,'s(- - - - .L.. - - - - J Placement , Specialists I I_.--.-.---.----- founselor I 's ~.- - . - - - -. - - ---.---~Counselor ,., Casework supervision provided by the Case Standards Unit / '/ ,.~ 177 space, supplies, and equipment. They are The Division is headed by a Director also responsible for the work of counselors (J. L. Rise) who reports directly to the in the district and for coordinating re- Assistant State Superintendent. Each of habilitation services in the district with the Units in the Division reports directly those of related agencies. They must make to the Division Director. Charts IX frequent visits to each of the local of- through XI showing the organization of the fices they supervise. Division and of the larger units within , the Division follow. It is the Counselor who actually provides the services to the--client. He may receive 1. The Disability Determination Unit. a referral from any source - doctor, The major function of this unit is to make another agency, friends or relatives of the a determination of eligibility for Social client himself. He is responsible for de- Security disability payments. The unit, termining the eligibility of the client for which is located in Atlanta, receives Vocational Rehabilitation services guided claims applications from all Social Secu- by federal and state regulations. He must rity offices throughout the state. These provide vocational counseling and arrange are then assigned to one of the 22 Coun- for the tests necessary to evaluate the selors in the office who must determine extent of the handicap. If the client is if the applicant is eligible for Social eligible, he must draw up a vocational plan Security disability benefits. The Counse- outlining the steps to be taken. The Coun- , lor has available to him the services of selor then may authorize the purchase of ten medical consultants retained by the services for the client to either remove unit to help him in his evaluation. He the disability or to provide the training may also request any examination or tests needed. Finally, he must arrange for em- necessary to assist him in determining ployment of the client and follow up to eligibility. make sure that the employment is satis- factory. At the same time, the applicant is (1) The Disability Determination Unit for OASI (2) The Social Security Trust Fund Program (3) The Program for the Blind (4) The Atlanta Referral and Placement Project (5) The Selective Service Project (6) The Atlanta Alcoholism Project ( 7) Progr~for Alcoholics at the Georgian Clinic (8) Medical College Prog~ams at Grady Hospital and Talmadge Hospital (9) The General Hospital programs in Albany, Columbus and Savannah screened to see if he is eligible or could make use of Vocational Rehabilitation services. Once the determination is made, Social Security headquarters in Baltimore is notified and in turn notifies the applicant. At the same time, notification of an approved claim goes to the Supervisor of the Social Security Trust Fund Project and notification of those claims denied for Social Security but eligible for Vocational Rehabilitation are sent to the appropriate local office. The applicant whose claim is denied is entitled to a hearing, in which case the claim will go to a reconsideration specialist on the staff. (10) The Physical Restoration Program This program receives no state money - all expenses of the program are paid for Thus, the Counselor must be skilled in by the Social Security Administration which counseling and guidance. He must have a deposits a letter of credit each quarter thorough knowledge of the sources of medi- pursuant to an agreement between the Admin- cal treatment he may have to turn to for istration and the Department of Education. diagnosis and tr~atment. He must know The program was initiated as a result of what training facilities are available for federal legislation in 1956. the client and what job opportunities there are in the communities he serves. The unit is headed by a Supervisor whose main duties are staffing the unit, includ- C. Division of Special Services ing engaging the consultants, staff train- ing, office management, coordinating the The Division of Special Services consists work of Social Security district offices of ten different and essentially unrelated and the Disability Determination Unit for programs: case development, and preparing the budget Chart III Atlanta District Director Special Services Director General Services Case Standards District Supervisor ,-- - -- ___ ..... _.... ............ - - - - - - - - - - - - ~ - - - - - - - - - Casework Supervisor t-' -...J 00 2 - ' !---=--~---f~ -~- ~------- Grady !... -1 Hospital Georgian - Clinic --- Alcoholic Rehabilitation --- Atlanta Local 1 coordinator 1 counselor 1 coordinator Office 6 counselors 4 counselors 13 1 aide counselors l Rderral Placement Project 4 counselors L...-.- - - - - - - ] Ecorwmic ' I Concentrated Opportunity - Employment 1 coordinator Program 2 counselors Chart IV Decatur District Director General Service Case Standards I ------------------- Casework Supervisors District Supervisor ------ ----- ---- Director World Public Offender Programs ~- Altu Rehab. 1Jrr.t I j Public Ofiender i Field /_ Progran1 1 l IFedecal Offender Project .--,. ----,- I Gr;,ccuood Rehab, Unit ----~ Sp,,c:al 1E-d~uc~at;io]r./ iP~e Voc. I Cer:tcrs, Work Lab I I I Work Labs: Athens Macon Marietta L. Savannah - Yarboraug~ 1 'i I' G. M. H , I . Rehab, Rehab, I Urtr U:--tt I M ll e cl gc vi ll P --"'-"--"-'"-----1. IAftec Cm, omm. ental ; .... alth Prog.l \0 l.n S. W. State! Hospital Unit I Pre Voc. Atlanta Macon Ctrs: 196 1. Programs for Public Offenders a. Alto The installation at Alto is the result of an agreement between the Georgia Department of Corrections and the OVR to provide rehabilitation services to inmates at Alto who meet vocational rehabilitation eligibility requirements. The unit provides vocational counseling, work evaluation, vocational training, and supervises the work program at the Institute. Staff at the unit totals 29 and includes the Superintendent who reports to the Assistant Director for Public Offenders Program of the Division, a Clinical Psychologist, a Clinical Chaplain, three Counselors II, eight Counselors I, four Evaluators II, and two Evaluators I. b. Youthful Offender Field Unit This unit grew out of the work done by Vocational Rehabilitation at Alto. It was found that field Counselors were not following up and contacting inmates referred to them upon release from Alto. It was found that if the work done at Alto was to have any effect on the client, it was most important to contact the released inmate immediately and that this group of clients required a great deal of counseling time which the General Counselor was unable to give. Thus, special counselors were positioned in the local offices to deal solely with public offenders released from Alto. There presently are six field Counselors in the program located at Vocational Rehabilitation field offices throughout the State, in addition to the Program Supervisor in Atlanta. c. Federal Offender Project This is a special research and demonstration project in which Georgia is participating along with seven other states. The program is financed 90 percent by federal funds and 10 percent by state funds. It was initiated in November, 1965, and will terminate February 28, 1969. The aim of the project is to assess and demonstrate the effectiveness of providing Vocational Rehabilitation services to federal offenders at specified stages in the correctional process, i.e., (1) at the time of release or at assignment to probation, (Plan A), (2) 60 days after release or assignment to probation, (Plan B), and (3) 30 to 60 days after admission to prison (Plan C). The Atlanta project encompasses stage 1 and stage 3. The project is a joint program involving the State rehabilitation agencies, the Bureau of Prisons, the U. S. Probation System and the U. S. Board of Paroles. Clients are assigned to a stage in the project by the headquarters of the project in Seattle. In each plan a control group is established which does not receive Vocational Rehabilitation services. To be eligible for the Atlanta project, clients must be between age 15 and 55, U. S. citizens, and their release destination must be Metropolitan Atlanta. Innovations in services offered as cornpared with traditional Vocational Rehabilitation services include treating the whole family, an expanded emergency service, and increasing maintenance allowance to clients pending receipt of their first paycheck. The Atlanta FOR project is staffed by two Counselors II, one for Plan A and one for Plan C, who report to the Assistant Director of the Division for Public Offender programs, and five consultants: two psychiatrists, one psychologist, one project consultant in research and sociology and one project observer in sociology. 2. Programs for the Mentally Retarded a. The Cooperative Education Program By far the largest Vocational Rehabilitation program for the mentally retarded is the Cooperative School Program operated jointly with the Division of Exceptional Children of the State Department of Education and 41 local school systems. The program reaches some 4500 students. In addition to administrative and clerical personnel at the State Office, the program involves 141 Vocational Rehabilitation staff coordinators, evaluators, counselors and clerical personnel and 196 special education teachers. The program deals with those mentally retarded students in special education classes in high school--students age 14 through 20 who are nearing working age. The counselor provides these students with job training, job experience, and development of good work habits, closely related to the academic training the students are receiving from their special education teacher. The counselor develops the rehabilitation plan with the teacher after determining the child's aptitudes and weaknesses. Each counselor works with four classes for a caseload of 100. b. Special Facilities Another of the services offered by Vocational Rehabilitation to the mentally retarded is the development of special facilities for work training--pre-vocational centers and work laboratories. At present, there are four work laboratories in existence--in Athens, Macon, Marietta and Savannah--two pre-vocational centers--in Atlanta and Macon. Present planning calls for the completion of 54 work laboratories and 10 pre-vocational centers throughout the State by 1975. The main purpose of these facilities is to prepare the retarded student for useful work. The centers teach basic work habits and social skills needed to maintain a job and identify broad areas where the client shows aptitude and interest. 197 3. Programs for the Mentally Ill a. Aftercare and Community Mental Health Program The responsibilities of this program are twofold: (1) supervision of the Rehabilitation Residences for the mentally ill operated by the Office of Vocational Rehabilitation and (2) development of more rehabilitation services to the mentally ill in the community. The office maintains five Rehabilitation Residences, or Halfway Houses, two in Atlanta and one each in Augusta, Columbus and Albany--and is in the process of establishing two more--in Macon and Savannah. These residences provide a sheltered home for those discharged from the mental hospital who are unable as yet to meet the demands of independent living. The staff of each residence consists of a Vocational Rehabilitation Counselor, house parents, a cook, secretaries, a psychiatric consultant and a psychiatric social worker consultant. The counselor provides job adjustment, counseling and placement services to clients at the residence. State Office staff of the program and local counselors also work closely with Health Department staff and community leaders in the development of aftercare facilities at the community level. The facilities work closely with the program in public schools, through which clients are referred. The centers will also assist in placement of the client in a job--arranging interviews and developing job openings for the retarded. c. Vocational Rehabilitation Installation at Gracewood The Office of Vocational Rehabilitation also maintains by agreement with the State Department of Public Health a rehabilitation facility at Gracewood State School and Hospital, the state institution for the mentally retarded. Vocational Rehabilitation staff at the school consists of 10 professional and 11 nonprofessional employees including the Supervisor, six Counselors and three Evaluators. b. Vocational Rehabilitation Installations at State Mental Hospitals The Office of Vocational Rehabilitation maintains rehabilitation facilities at Central State Hospital in Milledgeville, at the Georgia Mental Health Institute in Atlanta and at Southwestern State Hospital in Thomasville. The units at Milledgeville and the GMHI are independent and report directly to the Assistant Director in charge of programs for the mentally ill. The unit at Thomasville is, for the time, under the unit at Milledgeville as all cases at Southwestern State Hospital are transfers from Milledgeville. Also subordinate to the Central State Hospital Unit is a counselor in the Atlanta local office who works with patients in the Atlanta area discharged from Milledgeville. Chart XV Public Offender Field Program Director Special Disabilities Assistant Director Public Offender Programs Supervisor Public Offender Field Program =--1 t-' \0 (1:) Columbus Local Office 1 counselor Gainesville Local Office 1 counselor Atlanta Local Office 2 counselors Chart XVI SPECIAL EDUCATION PROGRAM Assistant Director Programs for Mentally Retarded ~uprvisor ~ducation Program I I ____L- -- D" 1 coordin. 9 counselors Albany District I ~ Valdo,la Local Office I Albany Local Office 1 coun,;clo r 1 coo rdin. 2 counselors I I ~ W LoacavlmO'f'fice l coordin. l counselor Savannah District Macon District I I Augusta I Local Office I 1 counselor l L !savannah I ~olumbus I ~:I Local Offij fWOcal Offic<' 11 1 coo rdin. l coordin. al Off. coordin. l2__counselors ! l counselor 2 couns. Chart XVII Aftercare and Community Mental Health Program Director Special Disabilities Assistant Director Programs for Mentally Ill Albany 1 Rehab. Resid. 2 counselors l Psych. Soc. Worker cons. l Psych. cons. - - -- - - - - - - - - Supervisor Aftercare and Community Mental Health Program Atlanta 2 Rehab. Re sid. 2 counselors 2 Psych. Soc. Workers l Psych. cons. I Savannah l counselor I Augusta l Rehab. Resid. l counselor l Psych. Soc. Worker cons. l Psych ccns. I Cclumbus l Rehab. Resid. l ccounselc,r l Psych. Soc. Worker cons. l Fsyc h cons. Macon l counselc r I 201 Vocational Rehabilitation staff at the three institutions include: CSH GMHI SSH Supervisors 1 1 Counselors 20 4 1 III. ADMINISTRATIVE SERVICES Evaluators 8 Instructors 16 2 1 A reorganization of the Department of Education initiated in 1964 created an Office of Departmental Staff Services. Heading the Office is an Assistant State School Superintendent, directly assisted by the Departmental Budget Officer, the Departmental Internal Auditor and a Coordinator of Technical Services. The six major service divisions of the Office are: Clerical 12 5 1 57 12 3 In addition to regular Vocational Rehabilitation Instructors, the units make use of volunteers for certain instructional classes. Personnel Services Accounting Services Systems and Data Processing Research and Statistical Services General Services (Mail, Print Shop, Cen- tral Clerical) Publications and Information Services The Office provides these services to all units of the Department of Education, including the Office of Rehabilitation Services. Vocational Rehabilitation, prior to the reorganization, maintained its own fiscal and accounting unit, information unit, and a unit for records, mailing and supplies -- and personnel transactions were not necessarily channeled through the Department's personnel office. While Vocational Rehabilitation was by its own request the last unit merged, centralization of its staff services is yet to be completed. The office still maintains its own information office and a unit for mail, records and supply services, and has established its own Research Unit. Accounting, budgeting and personnel services have been combined to some extent, although moves in this direction were not initiated until January, 1967. These units offer vocational evaluation, counseling, instruction, and work experience within the hospitals. Counselors work as part of the psychiatric treatment team. A. Personnel All personnel of the Office of Rehabilitation Services are covered by the State Merit System of Personnel Administration, and all personnel transactions must be conducted according to Merit System Rules. All hiring and firing, and changes in job classification and compensation, must have the approval of the Department of Education Personnel Services Division before being sent to the central office of the Merit System. The Vocational Rehabilitation Office no longer deals directly with the Merit System Office. The Merit System assigns each position in state government to a job class according to a specification describing the work involved and the qualifications required or desired. The present classification plan lists over 900 classes covering some 19,000 state and local employees under the Merit System. Each of these classes is assigned to a compensation grade on the state pay schedule, the present plan consisting of 28 grades of seven pay steps each. The first pay grade ranges from a low of $149 per month to a high of $200 per month, while pay grade 28 ranges from $2,082 per month to $2,779 per month (see attached). TABLE 3 PERSONNEL OF THE GEORGlA OF '~CE OF REHABILITATION SERVICES BY JOB TITLE & UNIT June, 196 7 Position Professional: Asst. State Supt. Division Director V R Supervisor II V R Supervisor I V R Counselor II V R Counselor I Dis, Det. Couns, Review Specialist V R Instructor II V R Instructor I Bus Ertt Counselor PRychologist V R Evaluator II V R Evaluator I Other Nonprof~ssional: Clerical Other State Ge~- ral Program Office Atl;- nta Dec at ~1 r G;:, 1 r. ,. s vi.ll e ------ Mac or. Alb;:my Savanna.h Special Disabilities Pub off ~..-1. R. M. I. Other 2 l 1 J. 1 1 , J. l l 8 4 5 I I) 6 4 21 20 lY 25 18 25 l 1 l ") <... 1 1 1 1 l , J. . 1 ? <... 2 1 -9 -1 - - - -- 13 35 26 28 36 27 34 11 -) ~ 24 21 zg 25 22 -l 8 - (l - -2 29 - 2-J. 21 -3 32 - :s 28 -- l 7") :::-) ../~ - ~' 4 50 r - - 49 -68 -s c, --- 57 -~-+ -~ 1 1 l 2 3 :'I 6 5 , ? 11- B 2 10 N 1 , 0 ' l N -~ 2 3 5 10 2 5 l .., -1 - - .., - 24 21 53 1 14 l"? 1 8 , ' 1 - -J. 8 -- ., 1 l -- l ::, zo ;.: ~1 -- 'l t) .I. -4-: -s:-!. ,_) lf>4 TABLE 3 CONTINUED Position Special Services Blind DDU Other Special Facilities GRC AEEC Other Total Professional: As st. State Supt. 1 Division Director 1 1 3 V R Supervisor II 1 1 1 1 8 V R Supervisor I 2 1 4 4 3 1 30 V R Counselor II 1 8 16 1 4 3 89 V R Counselor I 1 11 5 21 2 188 Dis Det. Couns. 12 1 13 Review Specialist 2 9 V R Instructor II 7 4 2 24 N V R Instructor I l 4 w 0 Bus Ent Counselor 3 7 Psychologist l 3 V R Evaluator II 4 16 42 V R Evaluator I 3 1 15 Other - 7 -25 -30 3 26 16 - 32 69 10 468 Nonprofessional: Clerical Other 5 31 31 14 - - -3 -36 5 31 34 50 25 6 316 -17 42 -1 94 7 410 - - -- 12 56 67 76 111 17 878 135 204 878 Table 4 Vocational Rehabilitation Professional Classes Vocational Rehabilitation Professional Classes Grade Range Annual Salary Minim urn- Maximurn Qualifications Educ Exp Job Description l. Evaluator I 13 2. Counseling Aide 13 3. Evaluator II 14 4. Dis. Det. Counselor 15 5. Bus. Ent. Evaluator 1 ::. $ 5784 $ 7752 5784 6372 7032 7032 7752 8544 9420 9420 6. \r. R. Counselor I 15 7. Rehab Center Counselor 8. Counselor II 15e3 16 9. Review Specialist 17 10. Supervisor! 18 7032 9420 7752 7752 8544 9420 10, 380 11' 436 9420 12, 612 11. Supervisor II 19 12. Asst Div. Director 20 13. Division Director 22 10,380 11' 436 13,908 13,908 15, 336 18,636 HS 4 yrs Evaulates clients, plans, organizes, conducts train- ing programs BA Sub prof. duties in aiding counselors carry out program BA 1 yr Evaluates clients in r~hab. ctr. or office BA 2 yrs Determine eligibility of individu'<* 4. 5* Supervisor I 30 Supervisor II 7 5~'r-Jc l~'o'( ** ~'(* 4.5* >'n'r ~'(* 4. 7~'( Div. Director 4 1-,':"'k o.J:k ** 4.5 Rev. Specialist 12 Disability Determination 10 3 Counselor Business Enterprise 6 (' "'"" ,,.,, 1 ...,.... Counseling 3 Aide l-1<* ~b'( ** 4.4 7*~'( l-1<* "' <* 4.1 3** ** *"'k 4.2 3 4.3 * Based on incomplete data ** Based on grossly incomplete data 360 TABLE 3 GRADUATE AND UNDERGRADUATE MAJORS FOR 404 PROFESSIONAL PERSONNEL OF GOVR IN JUNE, 1967 Employment Category Evaluator I Evaluator II Counselor I Counselor II Supervisor I Supervisor II Div. Director 1sa 1 1ty Determination Counselor Business Enterprise Counselor Counseling Aide Educational Major NOTE: Scores above diagonal line refer to undergraduate majors while those below line refer to graduate majors. Key: 0 not known or not elsewhere classified 1 physical science, mathematics, engineering 2 biological science 3 behavioral science 4 humanities 5 education 6 law, government, economics 7 = business, administration, marketing TABLE 4 PRIMARY PREVIOUS JOB EXPERIENCE* OF 363 PROFESSIONAL STAFF MEMBERS OF GOVR, JUNE, 1967 Function 1. Professional 2. Management and Administration . .-l N ('") uE-1 ..;t 1.1"\ \0 r--. 00 o- 0 z 0 H W .PP:.o0:..: t/) w Htl) uz oz WH 0E-1 <~ E-1 P:::H :W:r:Eo-o1 E- ::r: E-1 ,...l < ~ ~ :~ :r: z U) ("') 0 H E~ E-1 If) z z 0 H c.!) H HE-I ~Sue.!) 0:::UH ~ZE-1 ,...l ~ ~~j~ ::r:~oo H0Z ~p..,p.., O: uE-1 < ~ ~ ~ U) 00 ~~ HE-I U)U) :::>:::> ~ O:::H ~ O< 0"1 ~ H ~ ~ H u E-1~ zOofl.o.t 0 U) 0::: ~ 0 Employ- Proba- Loan Elec- 1. Professional Ph a r m - ment tion Teacher acist Ministe Coun. Officer Inter- tri:j:i viewer ca t~C?r Ad v i S H.S. Hos. Church Rehab. Assist. Rich's Hotel 2. Management and Princi Admin- Educ. Coordi- Fld.Dir Floor Sales Office Administration oal istrat Admin. nator Red Cro~ s Mgr. Mgr. Mgr. 3. Accounting, Data University Rehab. Statis. Comm. Insur. Sec. Tr. Bank Claims ~hirt Teller Handling Bk.kee1= Tech. Surve_y Adjus. Factor_y w 0"1 Clerica IRS Real Clerk N (V .R.) Numbers Estate Typist Salesn 4 .. Clerical & Sales Clerk Salesm. Ga.Powe Copywr. Assis. Public 5. Public Communications Adver. Dir. Pro~ Rel. Press library, news etc. A_gency_ (T.V.) Shi_g_ Re_g_res. Jet Eng Air- 6. Specialized skill Specia craft Dairy Draft Musi- or trade Civil Se r. Mech. Farmer ing cian 7. Owner and/or Owner Service Auto operator private Hd.Mas. lsta. Own. Bus. business School IQerator Owner 8. 9. Not specified 0. Miscellaneou!'l High V.A. School Hosp. Dept. Labor Dept. Emp.Ser. Rev. Sears Calla- way Milil'l Florist Eastern Self Air Em- Lines lployec U.S.A.F Constr. u.s. Never Work A.F. Polic e Emp loved TABLE 6 YEAR OF EMPLOYMENT WITH GOVR FOR PROFESSIONAL PERSONNEL EMPLOYED THROUGH JUNE, 1967 CATEGORY OF PERSONNEL 1942 1944 1946 1948 1950 1952 1954 1956 1958 1960 1962 1964 1966 1943 1945 1947 1949 1951 1953 1955 1957 1959 1961 1963 1965 1967 TOTAI MEAN NO. YEAR EVALUATOR I 3 12 15 1966.1 EVALUATOR II 1 1 5 31 38 1966.2 COUNSELOR I 1 1 3 3 1 5 12 48 112 186 1964.4 w COUNSELOR II 2 1 2 2 1 6 2 5 12 18 26 13 90 1962.2 0\ w SUPERVISOR I 2 2 2 3 3 4 2 5 4 3 30 1957.9 SUPERVISOR I 1 2 1 1 1 1 7 1956.2 DIV. DIRECTOR 1 2 1 4 1950.5 REV. SPEC. 1 2 DIS. DET. COUNSELOR BUS, ENTER- PRISE COUN. COUNSELING AIDE 1 1 1 4 1 1 2 12 1956.7 1 6 6 13 1965.5 1 1 4 6 1963.1 1 3 1952.3 '---------- - - - GRAND TOTAL 404 364 From the preceding tables the following portrait emerges. The average professional GOVR employee is a 37.7 year old, married male with a four year bachelor's degree* in education whose previous work experience was primarily as a teacher and who was employed by GOVR in 1962. (''NOTE: Computation of educational level was based on grossly incomplete data.) Table 2, relating to professional personnel, clearly indicates that males employed by GOVR outnumber females by a ratio of ten to one; male counselors outnumber female counselors by twenty to one and male evaluators outnumber female evaluators by two to one. The wisdom of this employment practice is questionable. GOVR is an increasingly multi-faceted agency serving many categories of clients in various settings. This fact would suggest the possibility that a larger number of qualified female employees could be absorbed by the Agency. Regrettably, data provided the consultants in regard to the educational level of professional employees was woefully inadequate. Consequently, analyses drawn from this data should be viewed as suspect. Table 3 suggests that the average counselor has approximately four-tenths of one year of graduate training. Such graduate training was obtained largely within three majors: behavioral science, humanities, and education. The writers are aware that a Master's Degree in Rehabilitation Counseling is no guarantee of success as a rehabilitation counselor and that persons trained in other fields may be very effective as counselors. Bowever, the odds should lie with the person having demonstrated his commitment to the fiQlJ through appropriate graduate work. A cursory examination of Table 6 will reveal the greatly expanded number of personnel employed in recent years. One notes that -125 counselors were employed within the years 1966-67. This represents 45% of the total number of counselors with the Agency in 1966-67. Such growth suggests the crucial importance of correct selection procedures. The table, furthermore suggests that the average professional employee has between four and five years tenure with the Agency. In view of the heavy investment of the Agency's resources in training, a more adequate data system appears highly desirable. Considerable time and effort are currently necessary to obtain data upon which to base appropriate training plans. A more adequate utilization of the IBM data bank should allow for a continuous flow of useful information recounting past training experiences of each member of the Agency. Decisions regarding the need for a particular training experience would then be made upon the basis of hard data. A time sampling study of the GOVR counselor's work (see Appendix F) was conducted during November, 1967, by three graduate assistants in the rehabilitation counseling program at the University of Georgia under the direction of Thomas L. Porter. The study was divided into two major parts: a study of the general counselor's time commitments followed by a study of the facility counselor's use of his work day. The sample for the first part of the study consisted of forty general counselors drawn randomly from the new edition of the GOVR Directory of Professional Personnel. The sample for the second part consisted of twenty facility counselors stratified in order to insure that each type of facility would be represented. The general counselors' sample was broken down into rural and urban counselors. Counselors were called at 11:15 A.M. and 4:15 P.M. and asked to account for the past three hours of work time. The telephone sample of the general counselors extended over ten working days and the sample of the facility counselors over five days. While many aspects of this study will interest the reader, the amount of time devoted to client contact was most interesting to the writers. Facility counselors spent far ~ time with clients than did general counselors. While 43% of the facility counselor's time was reportedly spent in contacting clients, only 19% (less than half that of facility counselors) of the general counselor's time was spent in direct contact with clients. It is evident that the greatest portion of the general counselor's time is being spent on the technical aspects of the job while a minor poreion of their time is spent in direct contact with clients. This fact seems regrettable to the writers. Perhaps greater support personnel (secretaries and other clerical workers) could assume a larger number of routine clerical and recording.activities to help free the counselor for client contact. Furthermore, smaller territories for the rural counselor would reduce time in travel and free the counselor for more client contact. The rural counselor spends thirteen percent of his time in travel while the urban counselor spends only five percent. This way, the counselor could gain a great deal more knowledge about resources available in his territory, and considerable time would be saved in traveling. The expanding categories of clients - children, aged, welfare, behavioral disorders, mentally retarded, etc. would seem to make smaller territories feasible. PART V Projected Need for Rehabilitation Counselors and Counselor-Trainees The task of arriving at a meaningful ratio of counselors to impaired individuals was made considerably more difficult by the following factors: 1. The evolving role for counselors in terms of the population of clients to be served. As stated previously, the "hard core" cases and the clients without an occupational goal are going to require more time, and rehabilitation counselors are going to have to work with them in depth. 2. The wide variety of settings and caseloads in and for which GOVR counselors are employed (i.e., rural, urban, mental hospitals, mental retardation, prisons, blind, alcoholic, welfare, social security recipients, general hospitals, etc.). 3. Differences between the counselors in terms of skill, training, and capacity to work with varying numbers of clients. To assume that all counselors are, or even should be, equal in their ability to work with the same number of clients is erroneous. 4. The agencies' goals and perceptions of the role of the rehabilitation counselor are probably the most significant variant in determining a meaningful ratio. 5. Within the structure of the newly organized SRS is the implication and possibility that the GOVR rehabilitation counselor will not, in the future, expend as much time as he has in the past arranging for physical restoration and for maintenance payments. That is, the counselor may not be working with the "routine medical cases" since services will be available 'to these individuals through the Medical Services Administration. 6. As alluded to previously, it is impossible to ascertain the difficulty of a case by the medical diagnosis. The most salient variable is the pre-morbid and post-morbid personality of the client. After studying numerous statistical re- ports and essays regarding an ideal ratio of counselors to clients, we found that a report published by VRA entitled State Vocational Rehabilitation Agency Program ---- ---- Data: Fiscal ingful guide Ytoeaar r-r1i-9v-6i6-n was g at the a most ratio meanwhich could be projected to the population of prospective clients on hand in 1975. This is assuming that the present staffing pattern will prevail. In the following section of this report we present and rec- ommend alternate directions for meeting manpower needs which will modify this ratio. In Appendix G appear the tables from the Program Data report which we felt were pertinent to this problem. The first tables present a breakdown of case service expenditures by category (by state for FY 1966), the second set of tables presents (1) total cases served per counselor by state in FY 1966, and (2) number rehabilitated per counselor by state in FY 1966. A review of the case service expenditure data reveals a wide range of program emphasis. By adding the percentage of case service monies spent for surgery and treatment, prosthetic appliances, and hospital care, we can get a picture of the physical restoration emphasis. In cases where training is provided, frequently more counseling and client contact is required than in a "straight physical re~toration" case. A state's training emphasis logically should be ascertainable by observing the 366 percentage of case service funds expended for training and training materials. The table below pictures the extremes in terms of the relationship of case service expenditures and clients served. The figures for GOVR and the national averages are also presented. RELATIONSHIP OF CASE SERVICE EXPENDITURES TO CASES SERVED PER COUNSELOR ~ State ! ' I North Carolina I i Virginia Percent of Case Service Money Expended for: (a) Physical (b) Training Restoration 45.1%~': 15.4% 44% 10.0% Cases Per Counselor: (a) Served (b) Rehabilitated 253 186 108~': 72 Iowa 2. 9%~'d: 36.5% 105 28 California 11.2% 31.2% 117 2o~:~: Georgia 36.7% 11.3% 124 49 National Average 23.1% 25.9% 135 42 ! I * Highest in the Nation **Among the very lowest in the Nation It is quite obvious that the "high producing" states (North Carolina and Virginia) emphasize physical restoration (at the expense of training) much more than the "low producing" states (Iowa and California). This point is not intended as criticizing either extreme; however, it does appear to us that within the context of our discussion in Part I of this report that the rehabilitation client of the future will require much more basic and vocational training and that a large portion of the physical restoration will be provided by other agencies. Yet, we feel that frequently physical restoration is essential in a client's rehabilitation and that the availability of medical services for the indigent in Georgia will not be comparable to those in Iowa for severnl years to come. We further feel that a balanced program is much more likely to serve the needs of the largest majority of potential rehabilitation clients. Therefore, we are strongly recommending that if the current staffing pattern is continued, GOVR establish as a basis for determining the ratio of counselors to clients the FY 1966 national average, i.e., employ one counselor for each 135 clients to be served with the expectation that an average of 42 rehabilitants per counselor will result. We believe that this ratio should apply across the board to counselors in all settings. Our reasoning for this recommendation is that if comprehensive services are provided all clients, the specific disability is not a determining variable. This recommendation does not imply that we feel that this ratio should be treated as a per counselor quota. As stated previously we recognize differences in counselors and in settings. 367 Dr. L. Benjamin Wyckoff, Director of 2. Counselor-Aide: These individuals Research, GOVR, estimates that in 1975 could be employed on a full or part-time there will be approximately 72,000 impaired basis. They might be recruited from (a) individuals referred for services. Based housewives with appropriate training and on this projection and on our recommended experiences, (b) retired businessmen, some ratio, the .agency will need to have approx- of whom have excellent community contacts, imately 535 counselors employed if the and (c) junior college graduates. There present staffing pattern is continued. In should be no "minimum" educational require- the following sections we have developed ments for the aide; however, each should an alternative staffing pattern which we complete the Orientation Training Program. feel will prove to be more economical and In this plan there is no differentiation to be more proficient. of function between the counselor-trainee and counselor-aide. The difference between the two is that the trainee is employed Classification of Counseling Personnel with the assumption he will progress to a Counselor classification; the aide is not In order to meet the needs of all disabled Georgians there is going to have to be a more efficient use of counseling man- expected to progress but in unique situations should not be prohibited from doing so. power. We feel that there are many tasks 3. Hinimum Qualifications for Counselor I (see Time Study in Appendix F) and clients Education: The orientation training which do not require the services of a described above, a bachelor's degree in a trained counselor and that counselor-train- counseling related area, i.e., psychology, ees (or rehabilitation aides) can be used sociology, education business management, to a distinct advantage. philosophy, etc., plus six courses (30 quarter hours or 18 semester hours for Presented below are five levels of coun- either graduate or undergraduate credit) seling personnel and a description of the one from each of the following areas: Casework Supervisor which we fee 1 should a. Counseling Theory be adopted. All levels of counselors would b. Tests and Heasurements operate under the supervision of the Case- c. Vocational Development, Occupation- work Supervisor. al Information, etc. d. Human Development or Personality 1. Counselor-Trainee: These would be Theory individuals who have a bachelor's degree e. Abnormal Psychology, Psychopath- in a rehabilitation counseling related ology, Hental Hygiene, etc. area, i.e., psychology, sociology, educa- f. Practicum in Counseling. tion, management, etc. and little or no Experience: Two years of related ex- work experience. They should possess the perience with at least one of these years qualities which might qualify them for in a rehabilitation setting. Graduates of progression to a counselor classification Rehabilitation Counselor Training Programs which is an implied goal for each counsel- who have completed the required internship or-trainee. would be employed at this level. Each trainee should be required to successfully complete the present Orientation Training Program at the University of Georgia within their first year of employment. Also, for each counselor-trainee who demonstrates skill and commitment to rehabilitation as a career, the Agency should encourage and make it possible for him to complete the educational requirements for the Counselor I classification. The duties of the Counselor-Trainee and Counselor Aide are presented in the follow~ng section of this report. 4. Hinimum Requirements for Counselor II Education: Haster's degree in counsel- ing, or the equivalent, e.g., six courses above those required for Counselor I plus three years of successful experience as a Counselor I. Experience: One year as a Counselor I. 5. Minimum Requirements for Master Counselor Education: Master's degree in counseling plus three advanced graduate level counseling related courses, or meet the minimum educational requirements for a Counselor II plus four years of successful experience as a Counselor II. 368 In addition to the above, the Master Counselor should possess the professional and personality characteristics which will make it possible for him to offer informal assistance to Counselors I and II. Minimum Requirements for Casework Supervisor Education: Meet the requirements for a Master Counselor plus three additional courses. Experience: One year as a Master Counselor. The Casework Supervisor is responsible for all levels of counseling personnel. However, the Counselor-Trainee will receive direct supervision from the counselor to whom he is assigned. Therefore, the Casework Supervisor's responsibility for the trainee is indirect. Discussion The above classification plan is so designed that the individual who cannot or does not want to obtain the master's degreel but has the necessary skills can progress through all classifications. Also, encouragement for continuing professional stimulation via academic training is built into the plan. Of course, the salary increases must be commensurate with the train~ng and experience and the pay scale should be so designed that a counselor may choose to remain a counselor without loss of financial reward, i.e., it should be possible for a Master Counselor with several years experience to earn as much or more than his less experienced Casework Supervisor or District Supervisor. A Model of the Use of Counselor-Trainees Some states are using counselor-trainees or aides to perform a specific task in the rehabilitation process, i.eo, placement specialists, physical restoration specialists, in-take specialists, etc. Dr. T. H. Stubbs, a member of the Manpower Task Force, pointed out that some specialists are such because they have time to concentrate on one area, others are regarded as specialists by virtue of special training and talent. The specialists mentioned above are such because of their job description and narrow function. We feel that there are inherent dangers in fragmenting a client's services. There should be no competition for his loyalty nor should there be built- in oppor.tunities for him to manipulate the rehabilitation workers. He should be afforded the security and opportunity to relate to one individual. Also, we do not feel that the professional counselor should detach himself from the placement and physical restoration aspects of the process. These are real problems and if he becomes too therapeutically ambitious and perceives his function solely as a clinical counselor, he will become ineffective as a rehabilitation team member and unable to provide the needed supervision to his counselor-trainees. 369 Therefore, we are recommending that a system be adopted that will allow the professional counselor to assign to counselor-trainees those clients whose problems do not require the services of a professional counselor. In order to accomplish this we are proposing the implementation of a two-dimensional diagnostic classification plan developed by Callis and Clyde (see Appendix H). This plan with some modification for use in rehabilitation settings is presented below in brief. This system would require that the professional counselor work with each client until he has established the problem-goal and tentative causative factors involved. In some instances, this may be accomplished in a single interview; in others it may require several interviews, medical reports and psychological testing. After the classification the counselor would decide (perhaps with the assistance of his Casework Supervisor and counselor-trainee) whether to work with the client himself or assign him to his counselor-trainee. For example, if a client needs physical restoration This is a scheme in which both (1) problem-goal and (2) cause are indicated. Problem-goal: This specifies not only the type of problem dealt with but also the practical rehabilitation goal. The three categories are: (1) vocational-educational, (2) emotional-social, (3) physical restoration. For example, if the problem is judged to be a vocational one, say, choice of a career by a college freshman, it also specifies the goal to be achieved through counseling, i.e., the choice of an appropriate career. which he cannot purchase himself in order to continue a line of work compatible with his skill and education, the problem-goal would be physical restoration and the causative factor would be Lack of Financial Resources. This client could be assigned to a counselor-trainee to arrange the necessary services since there are no apparent problems which require the services of a professional counselor. However, if problems did develop, the trainee would refer the client back to the counselor. Generally, the counselor-trainee would be assigned cases where the coordination of services is the primary service provided. Cause: The other dimension of the diagnosis is causal. The six categories are: (1) lack of information about or understanding of self, (2) lack of information about or understanding of environment, (3) motivational conflict within self, (4) conflict with significant others, (5) lack of skill (the preceding five categories are defined in Appendix H), and (6) lack of financial resources. It should be pointed out here that this plan presupposes that the client has an impairment which makes him eligible for services. The plan is not designed to incorporate medical problems but is intended to classify the practical rehabilitation problem and objective along with the causative factors, e.g., a client who needs a hernia repaired would have a Physical Restoration problem but the cause is not the hernia per se but the barrier which prohibits him from securing the necessary remedial services. Also, a client who is eligible for rehabilitation services by virtue of a schizophrenic disorder in remission has an emotional problem but the practical rehabilitation problemgoal might be vocational, based on his lack of information regarding employment opportunities and inability to relate adequately to fellow workers. The professional counselor would work with those clients who need counseling and a more comprehensive program of services. The diagnostic scheme should be considered as tentative, and, as a client's problems change, the rehabilitation diagnosis should reflect these changes. For example, a client may initially present an emotional problem based on conflict with significant others. After the client and his counselor have worked through this problem, the client may have a vocational-educational problem (wants to attend a trade school but cannot pay his own tuition) based on Lack of Financial Resources. This client could then be assigned to a counselor-trainee, providing that supportive counseling is not needed, to arrange the training. Trainees should be assigned to all levels of professional counselors. We would expect, of course, that the more seasoned counselors would be able to use the trainee more effectively and would require less supervision from the Casework Supervisor. It is impossible at this point, without supporting research, to project the full implication of this model for staffing needs. However, we would hypothesize that, instead of needing 533 professional counselors in 1975 fo the 72,000 referrals, 370 it might be entirely possible to provide comprehensive services with 300 professional counselors and 233 counselor-trainees. This scheme would provide the trainee with an opportunity to work with a wide range of clients and gain experience with all facets of the rehabilitation process. Such experience would be valuable basic training for trainees who desire to progress to a professional counselor position. Obviously, the above discussion of the two-dimensional classification scheme is not comprehensive. Prior to adoption, there would need to be extensive training. We will be very willing to discuss the details of this plan with GOVR administrators upon their request. Employment of Counselor-Trainees 2. Client satisfaction: satisfaction derived from working conditions, from supervision, from compensation, and from co-workers.* 3. Client satisfactoriness to employer: quality of work promotability, recommendation for pay raises, and conformance to rules.* 4. Client evaluation of services: how does the client evaluate counselor services rendered him? *NOTE: (cf. Minnesota Studies in Vocational Rehabilitation, Bulletin 35, May, 1962, and Bulletin 37, December, 1963 for further information in regard to measuring these variables.) If the agency chooses to employ counselor trainees to be supervised by professional counselors, attention should be directed to (1) the in-service training of counselors (2) the allocation of sufficient time for counselors to supervise aides, and (3) a carefully designed research study to evaluate this alternative to manpower staffing. The success of the professional counselor, counselor-trainee model will depend in a large measure upon the adequacy of the diagnosis as to the type and cause of the client's problem. Upon this diagnosis, the assignment of clients to counselors and counselor-trainees will be made. The counselor will need diagnostic skill in order to make this alternate work. The counselor may need extensive in-service training in order to perform this aspect of his work expertly. The quality of the rehabilitation counseling service could deteriorate markedly if the counselor is not allocated sufficient supervisory time. The ratio of counselors to trainees should be low, and their case loads should be reduced appropriately. The plan, if elected, should be begun on a pilot study basis to furnish the administration with hard data upon which to judge the wisdom of the plan. A carefully designed research study to evaluate the effects of the system is called for. Representative of crucial outcomes to be evaluated are: 1. Production level: a measure of size of case load, case closures, and/or other measures of productive efficiency. PART VI Recruitment, Selection, and Rete~tion There is convincing evidence that recruitment will continue to be a problem of the greatest magnitude through 1975 and thereafter. Consequently, careful consideration should be given the task by rehabilitation administrators. Recruitment of rehabilitation counselors is currently at two levels: recruitment for the graduate training programs in rehabilitation counseling and recruitment of individuals with loosely related training for immediate employment. Regrettably it will continue to be necessary to recruit persons for immediate employment to fill needs occasioned by turnover and the opening of new positions. 371 The size of the staffing problem is not which the trainee is well equipped to great enough to make economical recruit- offer. Opening recruitment programs to ment programs directed to the general this large, relatively untapped reservoir public. On the contrary, recruitment pro- of manpower would allow the Agency to be grams should be directed to target popula- more selective of persons having the tions - groups believed to possess in ability to relate genuinely, empathically, greater depth than the general population and warmly to other human beings. interests and aptitudes correlated with successful performance as rehabilitation Selection is another important function counselors. Typically persons with train- of manpower staffing. Adequate selection ing or experience in dealing with people procedures rest upon the identification and who possess characteristics which of worker traits associated with success- suggest that they w~ll be successful in ful performance as a counselor. It is relating to clients and team members have precisely at this point that the counsel- been considered prime prospects. Coun- ing profession's armour proves most selor educators will continue to recruit vulnerable. The question "What kind of undergraduate majors in disciplines be- person makes the best counselor?" has not lieved to attract persons with the above been convincingly answered for most inter- mentioned characteristics. Such majors ested professionals. The quandry is include psychology, sociology, social work, deepened by the various work settings with- and education. Employed persons with the in which counselors are required to func- above mentioned characteristics are likely tion and the variegated roles which coun- to be found in the schools, community selors are called upon to perform. Never- agencies, industry, and various civil ser- theless, an increasing body of research is vice positions. The recruitment program suggesting that bright, genuine, nurturant, is likely to prove more profitable if empathic, warm persons possessing a com- directed to such target populations rather than in shotgun fashion to a more hetero- mitment to working with people make superior candidates. geneous population. Common selection procedures within the State Agency call for an interview and the A recruitment specialist for the Agency successful completion of the State Merit is recommended. The recruitment specialist System's Vocational Rehabilitation Coun- would visit universities and colleges, ju- selor (General) Examination. Two changes nior colleges, and high schools in an in the current selection process seem attempt to interest students in a career in called for: (1) the addition of a situa- rehabilitation. He would supervise the tional test (work sample) and (2) the use construction of recruitment literature, of the Professional Examination Service would review selection procedures, would to supplement the Merit System Examination. analyze retention rates, and interview all (See Appendix I for a description of this prospective professional personnel. In- service which is available without cost dustry has long realized the importance to the Georgia Agency as a member of the of such a position. Annual Service Plan of the Professional Examination Service.) A potential source of manpower infre- quently tapped in our society is the grow- The addition of a situational test (work ing pool of competent, college graduated sample) to present selection procedures housewives and retired business men, career could be made with little difficulty. military men, and teachers. Such persons After a brief explanation of the Agency's could be employed on a part-time basis. mission, the candidate could be called Frequently part-time employees, if care- upon to interview a client, to visit with fully selected, out-produce for the amount an employer, and/or to perform other tasks of time on the job the full-time, regular calling for interpersonal skill all under employee (see studies from the Arkansas the supervision of a master counselor (see Rehabilitation Research Center by Truax, Porter, T. L. ~ ~ "Rehabilitation Mitchell, and others). This option becomes Counselor, Salaries and Benefits," NRCA especially promising if the Agency decides Professional Bulletin. Vol. VII., No. 5, to adopt the master counselor model for September 1967, for a hierarchy of cri- manpower staffing. In this event the part- teria by which to evaluate counselor per- time employee (counselor-trainee) would be formance). Industry has found this pro- assigned clients requiring services for cedure to be highly effective in screening 372 employees. There is little reason to believe that it would prove less useful in If recruitment and selection present two legs of the staffing triangle, retention selecting rehabilitation counselors. represents the third. At present, the turnover rate among counselors of the State A second suggestion for improving se- Agencies is an appalling ten percent (Smits, lection procedures is the use of other in- 1964). struments for assessing personality and interests. Requiring each prospective professional employee to take the Minnesota Multiphasic Personality Inventory and the Strong Vocational Inventory Blank would appear to be a reasonable extension of the current selection process. Such instruments should help screen out the gross deviate and will perhaps serve as a self screening device for those who know themselves to be significantly maladjusted. The figure for the State of Georgia appears to be comparable. A survey of resignees from GOVR during the period January, 1964 through September, 1967 was recently conducted to determine the reasons for terminating employment with the Agency. This survey, in tabular form, is presented on J>lages 37 3 and 374 . Three hundr:ed and seventy-one (371) questionnaires were originally mailed out to terminated employees. Eighty-seven (87) were returned by the Post Office; one hundred and sixty-three (163) were returned to the investigator (57.39%). The third suggestion for improving selection procedures concerns the Merit System Examination. A study of the written portion of the Vocational Rehabilitation Counselor (General) Examination by Caldwell, Fifty (50) of the questionnaires were incomplete and could not be included in the tabulation. One hundred and thirteen (113) questionnaires were usable (39.8% of those delivered by Post Office to former employees) Gettle, and Balkcom (1966) under the aus- pices of the State Agency discovered an inverse correlation between successful performance on this examination and successful performance as a GOVR counselor. This study rendered the use of this examination as a selection instrument highly suspect. However, the examination has subsequently been revised as a result of the study. The writers would like to strongly recommend that the Agency contract with Professional Examination Services for a suitable supplement for the Merit System Examination. Professional Examination Ser- The table suggests that counselors left the Agency primarily for the following reasons: disagreement with administrative philosophy (16.1%); to continue their education (12.9%); low pay (9.7%); and, in order to change jobs (9.7%). Low pay (22.2%) and disagreement with administrative policy (22.2%) were the more frequent reasons given by evaluators; and pregnancy (19.7%), moving (15.8%), advancement (13.2%), and low pay (13.2%) were reasons given most frequently by secretaries. vices is a corporation specializing in the construction of examinations to meet the specific needs of agencies. The corporation will make a complete analysis of the roles and functions of an agency and tailormake an examination to serve as a useful selection instrument. A survey was made of four district offices to determine the counselors' perception of " ... barriers which interfered with their providing the degree of interpersonal contact with their clients necessary for optimal reliable results." Such problems are then broken down into those perceived as time barriers and those perceived as morale factors. Among the A fourth suggestion concerns the contin- time barriers seven categories of responses uation of a six month probation period for emerged: (1) administrative policy and/or all new employees. During this time the procedure; (2) clerical details; (3) in- new counselor or counselor-trainee has sufficient and/or inferior support per- offered the Agency an extensive sample of sonnel; (4) travel time; (5) telephone his work. A mandatory evaluation confer- interference; (6) incomplete information ence with the new employee after this from facilities and other agencies; and period should be held, at which time there (7) time in training. Almost eighty per- should be a discussion of the new employee's cent of complaints having to do with strength and weakness and the employee's barriers to the proper use of their time future with the Agency. had to do with what they saw to be in- Reasons for Leaving Georgia Division of Vocational Rehabilitation Given by Employees Terminated from 1-1964 through 9-1967 Major Reasons for Leaving Agency S:.. 0 r-l (!) r-l CIJ 0J ~ ;::l II u0 z :>, Sm:.. +' .:t (!) c.D S:.. () II (!) (/) z 1. 2. 3. 4. 5. 6. 7. C"') r--- 8. C"') 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. Low pay 3 ( 9. 7%) 10 (13.2) Philosophy of administration 5 (16.1%) 2 (2.6) Continue education 4 (12.9%) 3 (3.9) Change jobs 3 (9.7%) 1 (1.3) No opportunity for advancement 2 (6.4%) 4 (5.3) Lack of professional atmosphere 2 (6.4) 2 (2.6) Advancement (better job) 2 (6.4) 10 (13. 2) Pregnancy 2 (6.4) 15 (19.7) Lack of leadership 2 (6.4) Moved 1 (3.2) 12 (15.8) Small children - needed at home 5 (6.6) Environmental (closer home, transportation) 6 (7.9) Lack of supervision Personality conflict Lack of time Personal problems 1 (3.2) 1 (1.3) Lack of time off Illness 3 (3.9) Lack of necessary ability i S:.. 0 +m' ;::l (") rr-ul II :> ~ z 2 (22.2) 2 (22.2) 1 (11.1) 1 (11.1) 1 (11.1) 1 (11.1) 1 (11.1) S:.. 0 +' () ;::l S:.. r-l +' CIJ II z ~ H 1 (50%) 1 (50%) m ~ rl () rl ..~.c: li) () II z (!) E-< 1 (16. 6) 2 (33.3) (!) (!) ~ 0J rrul II S:.. E-< z 2 (100%) (!) :> rl +m' S:.. +' CIJ rl ~ li) rl ~ II '"'d == ;:l II u0 z :>, H r1l +-' .:j" (j) (!) H C) II z (j) en H 0 +-' r1l ;:l (") rl r1l II :> f.Ll z H 0 -!J C) ;:l H rl +-' Ul II z >== H r>1==l rl C) rl ..c>== l.() C) II z (j) E--< (j) (j) >r=l= N r1l II H E--< z (j) :> rl -!J r1l H +-' Ul rl >r=l= l.() E II 'CJ .::c: z rl r1l >0== rl Ul Ul (j) LH 0 N H rl 0., ..0 II ;:l en z 20. Military obligation 21. Reenter government service 22. Too much paper work 23. Not given permanent appointment 24. Confusion of procedures 25. Unfair work load 26. Temporary - no longer needed 1 (3.2) 1 (3.2) 1 (3.2) 1 (3.2) 1 (1.3) 1 (1.3) Total Reasons ...j" Given by Category r--- ("") Total Percentage -- 31 99.6% 76 99.9% 9 99.9% 2 100% 6 99.9% 2 100% Total Reasons for Termination - All Categories N = 156 I I 9 99.9% 21 100.1% Method: Three hundred and seventy-one (371) questionnaires were originally mailed out to terminated employees. Eighty-seven (87) were returned by the Post Office. One hundred and sixty-three (163) were returned to the investigator (57.39%). Fifty (50) of the questionnaires were incomplete and could not be included in the tabulation. One hundred and thirteen (ll3) questionnaires were usable (39.8% of those delivered by Post Office to former employees). 375 appropriate administrative policy and/or to better perform the more serious aspects procedure and too many clerical details with too little support personnel to help of his work. shoulder the load. Complaints centering around administrative policy and/or procedures called attention to such matters as the heavy pressure for closures and the addition of extra and inappropriate responsibilities such as securing National Rehabilitation Association memberships. Such changes in the relationship of supervisors to counselors should result in a heightened sense of the importance of their work by counselors. This outcome should improve the retention rate of Agency Counselors. Factors considered to be detracting from counselor morale were: (1) dissatisfaction with administrative policy, procedure and/ or supervLsLon; (2) slow payment of salary, travel expenses and vendor bills; (3) inadequate salary and/or opportunity for advancement; (4) inadequate office space; (5) training opportunities; and (6) public image and public relations. 2. Salaries for both beginning and continuing employees should be increased. Financial renumeration remains one of the most powerful incentives for recruitment and retention. While Georgia ranks above the national mean in beginning and highest salaries paid to counselors, significant improvement could yet be made. Texas, paying almost $1600 more in beginning salaries, could well serve as a social Based upon the results of these surveys certain suggestions for improving the retention rate appear justified: model for Georgia. Thirty eight percent of state agencies give salary increases for the attainment of a higher degree (see Appendix J). This policy should serve as 1. Supervisory efforts should be directed toward the enhancement of the professional a carrot to present employees to improve their professional skills. vs. the clerical aspects of the counselor's role. The supervisor should see himself as an "expediter" rather than as a task master. This is the basic difference between a supervisor and a snoopervisor. The supervisor should constantly ask himself "What can I do to help my counselors perform their work more efficiently?" Counselors in the field tend to see the role of the casework supervisor as comprised of three functions: (1) to check case notes, (2) to help determine eligibility on cliffcult cases; and (3) to rate counselor effectiveness. The district supervisor is viewed as primarily concerned with administrative matters such as production, completing forms, administering funds, etc. 3. The system should make it possible for lateral advancement as counselors rather than making it necessary for the counselor to become an administrator in order to advance financially. At present the Georgia Agency makes provision for two levels of counselors: Counselor I and Counselor II. Certain states -Michigan, Utah, Ohio, Washington, etc. - have four levels. Perhaps a schedule calling for Counselor-Trainee, Counselor I, Counselor II, and Master Counselor with commensurate salary increases accompanying advancement would provide sufficient upward mobility while allowing the counselor to remain as a counselor. It would be highly desirable if the counselor would come to view superviaors as expediters-those who attempt to make it possible for the counselor to better perform his work. Perhaps a concluding remark in regard to recruitment, selection, and retention practices is in order. Of the three functions, selection appears to be by far the most important. Superior recruitment pro- The supervisor should protect the counselor's time. Too frequently the counselor sees the supervisor as adding to his encumbrances rather than reducing them. The supervisor should carefully analyze the work of his counselors in an attempt to locate those functions which could be performed equally well by clerical personnel. It is altogether possible that a number of such functions could be performed by clerical workers and greatly free the counselor grams may allow a larger reservoir from which to select, and outstanding retention practices may allow the Agency to keep its workers longer, but it all breaks down if the "wrong" workers are selected in the first place. The writers firmly believe that the job of salvaging poor prospects through inservice training programs is an unpromising one. This statement is not meant to depreciate the importance of inservice training; quite to the contrary, 376 appropriate inservice training programs annual graduates consequently tenuous, it are absolutely essential to the continued appears that within five years combined success of well functioning agencies. How- graduates will approach fifty per year. A ever, there is a world of difference be- substantial percent of these graduates are tween offering such training to persons by expected to seek employment as rehabilita- nature ill-equipped for performance as tion counselors within the State of Georgia. counselors and offering this training to The combined contribution of these two persons well equipped by virtue of the graduate programs should contribute sub- possession of key personality variables. stantially to the supply of trained reha- bilitation manpower within Georgia. The Agency is well advised to devote considerable time and energy to the identification of procedures efficient in the selection of workers known to possess traits associated with success as counselors. The first order of business is the identification of 11 traits associated with success as counselors, 11 (see Truax 1967, Carkhuff 1967, Rogers 1961, ~ ~.), to be followed up by the adoption or construction of instruments for measuring such traits. The writers would like to reiterate previous suggestions that situational tests (work samples) be adopted as one of the selection procedures employed. The American Rehabilitation Counseling Association 1 s Committee on Professional Preparation and Standards has issued a preliminary statement on the professional preparation of rehabilitation counselors (1967). Briefly the Committee recommends course work in the foundations of human behavior and dynamics of behavior change, social-cultural-economic factors influencing individuals and groups, professional studies in counseling, and the characteristics of the client population. Furthermore the Committee recommends a practicum and internship, and personal and profes- sional growth opportunities somewhere built into the program (see Appendix K). Are- view of curricular requirements for reha- bilitation counselor education programs at the University of Georgia and at Georgia State College suggests that the Committee 1s recommendations are incorporated at present in both programs. PART VII Training Programs Preservice Training Programs: As institutions of higher education in other geographical locations throughout the State become adequately staffed, a third graduate program could profitably be added to the existing programs. At present within the State of Georgia two graduate programs in rehabilitation counselor education are offered: one at the University of Georgia under the direction of Thomas L. Porter and a second at Georgia State College under the direction of Kenneth B. Matheny. The program at the University of Georgia began in the fall of 1964 and the program at Georgia State College in the fall of 1966. The programs are highly similar in content requiring six quarters of training, one to two quarters of which is spent in internship. The University program has thirty-eight full-time and 200 part-time students, including GOVR employees enrolled in orientation training and extended work, and the College program has ten full-time and twenty-five part-time students. While both programs are quite young and prediction of Inservice Training Programs The GOVR has an outstanding record of inservice training activities for its counselors. The Georgia Office is a promising contender for national leadership in this regard. This factor figures prominently in the excellent image which the Agency currently enjoys. Inservice training experiences of GOVR professional personnel for fiscal years 1964-65, 1965-66, and 1966-67 are summarized in the table presented on the following pages. A summary of the following table suggests that on the average each professional employee of the Georgia Office of Vocational Rehabilitation attended five and one-tenth (5.1) inservice training experiences ex- 377 GEORGIA OFFICE OF VOCATIONAL REHABILITATION INSERVICE TRAINING 1964 - 1967 INFERENCE 1964-1965 NO. OF NO. OF CONFERENCES PARTICIPANTS Lpervisors' mferences 9 66 mferences on .coholism 8 28 .acement aining Prog. 6 22 mference on oup Leadership 3 50 >Op. Rehab. ogram Between ~ & Spec. Ed. 1 26 as the tic and thotics mrses 3 6 .strict mferences:GRC 5 137 .strict mferences: .acement 5 135 .strict mferences: :aff Training 9 285 agrams for >rkers for .ind 6 61 agrams for .indness and 1rd of Hearing 3 3 ograms on ,e Deaf mferences I MR. 7 17 1dus trial Tours: >b Observation 6 33 1965-1966 NO. OF NO. OF CONFERENCES PARTICIPANTS 6 7 18 32 2 32 4 33 15 620 4 72 5 11 8 33 1966-1967 NO. OF NO. OF CONFERENCES PARTICIPANTS 5 22 12 20 2 39 12 558 4 95 9 53 378 CONFERENCE 1964-1965 NO. OF NO. OF CONFERENCES PARTICIPANTS Conferences and Programs on Handicapped/ Disabled 5 32 NRA Conferences 2 58 Conferences for Evaluators Orientation Programs VR Graduate Training Programs Psychological Testing Courses 3 84 Counseling Seminars: Practicum in Counseling Speech and Hearing Courses Course in Adm. GATB Other Conferences and Programs 19 147 1965-1966 NO. OF NO. OF CONFERENCES PARTICIPANTS 3 32 2 351 2 47 4 72 4 16 2 43 2 26 2 57 2 16 7 360 1966-1967 NO. OF NO. o CONFERENCES PARTICIPA 1 29 3 54 3 51 3 18 1 22 6 67 13 603 379 tending anywhere from one day to eleven cal and psychological aspects of disabil- weeks in the fiscal year 1964-1965, five ity, history and philosophy of rehabilita- and eight-tenths (5.8) similar inservice tion, and Agency procedures and resources). training experiences in the fiscal year Certain specialized assignments require 1965-1966, and three and seven-tenths (3.7) specialized training. An assignment to such experiences in the fiscal year 1966- the Yarbrough Center would presuppose that 1967. This is indeed an enviable record the counselor would have had course work for a state agency. acquainting the counselor with abnormal However, the Agency's policy requ~r~ng counselors to have served three years before becoming eligible for an educational leave seems unfortunate. The beginning counselor is likely in greater need of additional training than the seasoned coun- populations. An assignment to the Alto Prison for Youthful Offenders would presuppose course work in social control and sociopathy. selor. Consequently, such a policy ap- pears to militate against the best inter- ests of the Agency. It is assumed that the basis for the three year service re- quirement is to test the commitment of the employee to the Agency. The rule seems unduly inflexible although excep- tions can be made with the administra- tion's approval. An indenture policy re- quiring the employee to return to the Agency for a specified number of months or years would seem to offer sufficient evidence of the employee's commitment to continued employment with the Agency. A long range training plan based upon an evaluation of the employee's strengths and weaknesses at the time of employment should be worked out by the training officer. Such a master plan should consider the employee's knowledges and competencies in relationship to the functions and roles which he will be called upon to perform. This assumes, of course, that each job has been carefully analyzed to identify functions to be performed and competencie's and knowledges necessary to perform them. The suggestion of a master training plan becomes the most desirable as one reviews the marked discrepancies between past work and educational experiences of beginning counselors. Furthermore, appropriate training should precede change of assignment within the Agency. Minimum training requirements for each position within each work setting should be established, and workers being transferred to a new position should meet these minimum requirements before the transfer is affected. For example, counselor-trainees should complete, as soon as possible, fifteen quarter hours of orientation training (introduction to interviewing techniques, human dynamics, medi- 380 emotionally ill, the mentally retarded, and other difficult-to-rehabilitate clients. As suggested above, counselor services must reflect this change in clientele. PART VIII SUMMARY AND RECOMMENDATIONS This report represents the work of the Task Force on Manpower Needs and Potential. While the various agencies, settings, and personnel involved in meeting the needs of impaired individuals are acknowledged, major treatment is devoted to the Georgia Office of Vocational Rehabilitation. This Agency more than any other accounts for the main thrust of rehabilitative efforts within the State. This summary is not meant to substitute for a careful reading of the body of this report. Rather it purports to furnish the reader with an overview of the contents of the report while focusing the reader's attention upon key concerns of the committee. Part I of this report carefully stated assumptions regarding clients, counselors, and the Federal-State Agency held by this Task Force. Attention was focused on the client's reaction to his impairment as well as the limiting aspects of the impairment itself. The psychological consequences were seen as frequently being more handicapping than the limitations imposed by nature of the physical impairment. Legislative amendments and recent reorganization at the Federal level suggest a broadening of client categories to be served. Services geared to clients with educational, social, and cultural handicaps must of necessity become more intensive. The counselor's role and functions must change to meet the needs of a different clientele. In the near future it is altogether likely that the counselor's case load will primarily consist of hard-core unemployables, behavioral disorders, the Part II reviewed the various professions and support personnel involved in the total rehabilitation effort within the State. Recommendations for role emphasis and change were made in regard to administrative staff, case work supervisors, clerical workers, and psychologists. Administrative personnel should be selected upon an evaluation of their administrative skills rather than upon counseling skills. Counselors should ~ be prohibited from becoming administrators, but, on the other hand, the selection of district supervisors and State level administrators should not be limited to counseling personnel. The case work supervisor is the conscience of the Agency and as such is responsible for quality control. The ratio of case work supervisors to counselors should not exceed one-to-ten. Secretaries should be well trained and capable of demonstrating initiative in assuming responsibilities for aspects of the counselor's job which detract from meaningful client contacts. The Agency should investigate the feasibility of employing masters degree psychologists in order to expedite client services. The counselor and the counselor-trainee were treated in Part V. Part III alluded to three reports regarding rehabilitation manpower, and Part IV reviewed the current status and utilization of rehabilitation manpower in Georgia. Vital statistics in regard to sex, age, educational level and majors, former job experience, and tenure were presented in tabular form. In addition, a study of the GOVR counselor's use of his time was reviewed. Clearly seen was the inappropriate amount of counselor time devoted to job aspects other than client contact. Thereupon followed a recommendation that smaller territories and more efficient use of support personnel be adopted in order to redress the balance between counselor time devoted to client contact and time devoted to other counselor functions. 381 Par.t V predicted future needs for counselors and counselor-trainees. Problems encountered in accurately forecasting future manpower needs were discussed. A review of counselor case loads in 90 state agencies resulted in a recommendation that GOVR ernploy one counselor for each 135 clients to be served with the expectation that the average counselor will produce forty-two rehabilitants per year. Dr. Benjamin Wyckoff, Research Director for GOVR, estimated that there would be between 71,000 and 72,000 GOVR referrals in 1975. Upon the basis of the above mentioned ratio of counselors to clients, approximately 533 counselors would be needed if the current staffing pattern is continued. This figure represents well over twice the number of counselors currently employed by the Agency. Minimum qualifications for five levels of counseling personnel were presented. These included Counselor-Trainee, Counselor I, Counselor II, Master Counselor, and Case Work Supervisor. A scheme for the proper utilization of Counselor-Trainees based upon a two-way classification system involving Problem-Goals and Causative Factors was developed. It was recommended that this scheme be subjected to carefully designed research prior to wide spread implementation. Part VI offered suggestions in regard to recruitment, selection, and retention policies of the Agency. Recruitment should be directed to target populations - groups believed to possess aptitudes and interests related to success as a counselor rather than to the general population. Furthermore, attention was drawn to the potential use of college graduated housewives and retired businessmen, career military men, and teachers as counselortrainees. Two recommendations for improving selection procedures were offered: (1) the use of a situational test (work sample) and (2) the use of the Professional Examination Service to supplement the Merit System Examination. be directed toward the enhancement of the professional versus the clerical aspects of the counselor's role; (2) that adequate support personnel be secured to relieve the counselor of certain clerical duties; (3) that more extensive "lateral" promotions as counselors be allowed; and (4) that salaries for beginning and continuing employees be increased. Part VII reviewed both preservice and inservice training programs. Training standards recommended by the American Rehabilitation Counselors Association were reviewed and comparisons with the University of Georgia and Georgia State College training programs were drawn. The Agency's inservice training efforts appeared in tabular form with acknowledgment of the excellence of such training when compared with the inservice training records of other state agencies. In concluding this Part it was recommended that an individual program of training experiences be planned for each new employee. This study has consumed many thoughtful but tedious hours of work on the part of the Task Force Committee and an even greater amount of time on the part of the consultants (not to mention the research services rendered by professional employees of the Statewide Planning Project). A herculean effort has been made to better understand the current status of rehabilitation manpower within the State and the projected need for su~h workers through 1975. It is sincerely hoped that the Report will be given thoughtful consideration by those in positions to implement recommendations herein offered. It is further hoped that rehabilitation services rendered impaired Georgians will be improved in some small way as a result of this study. A survey of recent resignees' reasons for terminating employment with GOVR yielded interesting information. A study of factors perceived by counselors to interfere with the most professional use of their time also proved interesting. Resulting from these studies were recommendations that (1) supervisory efforts 382 REFERENCES Caldwell, Gettle, and Balkcom. Statistical studies of the written portion of the Vocational Rehabilitation Counselor (general) Examination. State of Georgia Merit System unpublished memorandum, April 1966. Carkhuff, R. R. and Berenson, B. G. P.eyond counselinf; and psychothera.EY_ New York: Holt, Rinehart and Winston~ Inc., 1960. Dishart, Martin. Vital issues and recommendations from the 1965 national institute for rehabilitation research. ',.Jashington, D. C.: National Rehabilitation Association:-octob-erl965. Geor~ia Division of Vocational Rehabilitation Manual of policies. Atlanta: 1967. Halpin, A. \!. f'._ foggy view from Olvmnus. An address to the Southern Rerrional Council on Educational Administrati;-n~-A-tlanta, November 13, lOf-7. McAlees, D. C. and Warren. S. L. Increasing the sunplv of aualified rehabilitation counseling nersonnei" in state vocn.tional rehabif{t-at-fon ay,encies: Guidelines for a_c_!_i_?_!1_ \!ashinr.:ton, n-:-c-:-;- Vocationa_f____ _ Rehabilitation Administration, 1966. McGowan, John F. (Ed.) Counselor develonment in american society. A report to the Office of-~annower, Automation and Training (u.s:-benartment of Labor) and the Office of Education (U. S. Denartment of Health, Education, and Welfare), Washington, D. C., 1965. Smits, Stanley J. Rehabilitation counselor recruitment study final repay~. Hashington, D. C.: N-ational Rehabilitation Association, 1964. McGowan, John F. (Ed.) An introduction to the vocational rehabilitation p~_?c~_s_s. 1-lashington, D. C.: U.S. Government Printinp: Office, 1960. - Rehabilitation service series, No. 416. Vocational Rehabilitation Administration, U. S. Department of Pealth, Education, and Helfare, 1957. R.ogers, Carl R. On becominp- a ner_s_?_n_. Easton: Houghton Mi ffin, 1961. Thoreson, R.ichard W. Disa~ilitv viewed in it's cultural context. Journal of Rehabilitation, 1964, 30 (1), 12-13. Truax, Charles and Carkhuff, ~obert. Toward ef~ective counselinr and nsvchotheranv: Training and practice,--Chicar.:o: Aldine, 1967. 383 APPENDIX A A Study of Attitudes of Vocational Rehabilitation Counselors as Determinants in Accepting Or Rejecting Welfare Referrals For Services 384 INTRODUCTION In the past several years much attention has been focused on the deprived of our nation. We, as a nation, are becoming increasingly aware ~f their needs, and continuous efforts are being made toward providing for their needs, including their rehabilitation into employment. In 1966, on a national level, State Vocational Rehabilitation Agencies rehabilitated 17,000 impaired perso~s who had been dependent on public assistance. After their rehabilitation, 10,000 were no longer dependent on public support. But the rate of rehabilitants per 10,000 recipients of public assistance is only 88.6. It ranges from a low of 19.8 to a high of 217.4.1 The expressed goals of the Georgia Department of Family and Children's Services and the Georgia Office of Vocational Rehabilitation Services are the same in regard to meeting the needs of the impaired individual. Both agencies state in their policies the idea of rehabilitating or restoring a person to a productive self-sustaining life. They profess to make him a contributing member of society rather than a tax burden. Friedlander states, "Often some hundreds of dollar~ spent on rehabilitation save, in the long run, thousands on relief, and transforms the former relief clients into happy, proud, self-supporting citizens."2 In Georgia, only a small percent of the Welfare Recipients are receiving services by Vocational Rehabilitation and this study is being undertaken in an effort to determine if the attitudes of the Vocational Rehabilitation Counselors toward the Welfare Recipients have an effect on the accepting or rejecting these individuals for services and the Rehabilitation program. ILamborn, Emily M. "How Rehabilitation Is Changing", Rehabilitation Record, Vol. 7, No. 4, July-August, 1966, p.3. 2Friedlander, Walter A., Introduction To Social Welfare, Englewood Cliffs, New Jersey, Prentice-Hall, Inc., 1961, p. 289. 385 PURPOSE OF STUDY The purpose of this study was to determine if the various factors, such as age, education, years of work experience, and type of caseload affects the attitudes of the Counselors toward welfare referrals and has an effect on the Counselors accepting or rejecting them for Vocational Rehabilitation services. REVIEW OF RELATED LITERATURE Several studies have been made relating to the attitudes of Counselors causing acceptance or rejection of welfare referrals for rehabilitation services. Yuker suggests that attitudes of an individual toward himself are more important than the severity of the handicap itself. He suggests that attitudes should be a goal of rehabilitation.3 Haas and Goldstein point out that there must be an understanding between the Counselor and client if the rehabilitation process is to be successful. 4 Neisser states, "That in the initial interview, the worker's nonjudgemental attitude enhances the client's sense of worth enough for him to disclose himself with a minimum of defensiveness. In addition, worker and client jointly judge the client's actions so as to teach the client to judge for himself and to acquire a sense of his own worth.5 3Yuker, Harold E., "Attitudes as Determinants of Behavior", Journal of Rehabilitation, June, 1965, pp. 16-17. 4Haas, Kirt and Goldstein, Milton, "Rehabilitation Worker and Client: Understanding Cultural Differences", Rehabilitation Literature, Vol. 26, (2), 1965, pp. 39-40. 5Neisser, Marianne, "Judgements and the Non-Judgement Attitude in Therapeutic Relationships", Social Casework, Vol. XLVI, May, 1965, pp. 278-282. ..)00 Goldin showed that Counselors liked to work with the mentally ill and the mentally retarded least because of the difficulty in counseling and in job placement. Also, the speed and ease of success entered into the reasons why Counselors preferred to work with certain kinds of disabilities.6 Krause, in his study to differentiate the variables influencing types of services and their priorities in Vocational Centers and Workshops, showed the physical type disability constituted 53.5% of all cases served, 80.6% were single, 86.1% were male, 75% depended on the family and relations for support, 91% were referred by public and private agencies, and 51% came from low income areas. He also states the problems of dependency and motivation were of basic importance.7 Harrington lists the followi_ng as characteristics of the culturally deprived: rigidity, suspicious and lacks trust in others, fatalistic, pessimistic, and prone to act out. 8 Reissman, in his study of the culturally deprived, found the culturally deprived individual was not attracted to middle class values or styles of life, high achievements, motivation, delayed gratification, and getting ahead. He is pragmatic and anti-social and anti-intellectual, feels alienated from society, inadequately educated and has low self-esteem.9 6Goldin, George, Jr., "Some Rehabilitation Counselor Attitudes Toward Their Professional Role", Rehabilitation Literature, Vol. 27, December, 1966, pp. 362-365. 7Krause, Elliott A., "The Sponsored and the Socially Isolated: Two Disabled Populations", American Journal of Public Health, Vol. 54, 1964, pp. 1711-1725. 8Harrington, Michael, The Other America, New York, The McMillian Company, 1963, pp. 133-135. 9Reissman, Frank, The Culturally Deprived Child, New York, Harper and Row, 1962, pp. 26-30. 387 In a cooperative project between the Florida State Department of Public Welfare and Florida Vocational Rehabilitation Services families, factors involving rejection by Vocational Rehabilitation included disability, advanced age, certain socio-economic conditions, religious objections by clients, refusal to cooperate, not interested in services, refusal of services, moved from area, and died before accepting services.lO In a national study of the state agencies and services rendered, which was directed by Dishart, showed that, of 13,275 welfare referrals to Vocational Rehabilitation for possible services, 44% were accepted and 56% were rejected.ll These related studies show there are many characteristics and attitudes that are of possible significance in rejecting these referrals from the welfare agency to Vocational Rehabilitation for services. DEFINITION OF TERMS 1. Vocational Rehabilitation - The restoration of disabled persons to the maximum vocational, physical, social and economic usefulness of which they are capable. 2. Welfare Referrals - For the purpose of this study, these are official referrals to the Division of Vocational Rehabilitation for possible services and are drawing public assistance from the Department of Family and Children Services because of one or more disabilities. 3. Vocational Rehabilitation Counselors Persons employed by the Division of Vocational Rehabilitation to render comprehensive services to the disabled. They are employed in the Albany District, State of Georgia and carry a general caseload serving all disabilities except blindness. lOoperation Hope, A Cooperative Project Between Florida State Department of Public Welfare and Florida State Department of Education, Division of Vocational Rehabilitation, Jacksonville, Florida. llDishart, Martin, Project Director, "Highlights of National Studies on 90 State Vocational Rehabilitation Agencies by Patterns of Rehabilitation Services Project," National Rehabilitation, Washington, D.C., April, 1965, p. 14. 388 STATEMENT OF HYPOTHESIS It is felt by the writer that various factors may cause an influence on the attitudes of the Vocational Rehabilitation Counselors in accepting or rejecting welfare referrals for Vocational Rehabilitation services. Therefore, it is hypothesized that: 1. The attitudes of the Counselor does not affect the ratio of Welfare referrals accepted for services. 2. The number of years experience of the Counselor does not affect the ratio of Welfare referrals accepted for services. 3. The number of years experience of the Counselor does not affect the attitude of the Counselor in accepting or rejecting Welfare referrals. PROCEDURES USED SELECTION OF SUBJECTS: For the purpose of this study, ten Vocational Rehabilitation Counselors in the Albany District were selected. These Counselors were carrying a general caseload and were selected because of their age, educational background, number of years experience and type caseload carried. The Vocational Rehabilitation Counselors selected for this study are general Counselors, working a general caseload in the Albany District, which is located in the southwest area of the state of Georgia. The years of experience for these Counselors range from one year to twenty-five years. There are four Counselors who have less than two years experience, four Counselors between two and five years experience, and one Counselor with five and onefourth years and one Counselor with twentyfive years of experience. The mean for the ten Counselors was 4.81 years experience. All Counselors have obtained a college degree, two Counselors have Masters Degree of Education, and seven are working toward their Masters Degree in Education. Nine of the Counselors are married and one Counselor is single. Their ages range from 30 to 57 with a mean age of 39.2 years. Seven of the Counselors' caseloads are considered to be rural, and three Counselors have a combination of a rural-urban caseload. 389 The Welfare referrals are ones who have been officially referred by the Georgia State Department of Family and Children Services to the Division of Vocational Rehabilitation for services in the Albany District in southwest Georgia. These subjects are representative of the welfare referrals for the entire state of Georgia. These referrals were made to Vocational Rehabilitation during the period July 1, 1966 to June 24, 1967. There was a total of 112 referrals accepted by these Counselors for services during this period. An op~n~onnaire was mailed to each Counselor (see appendix) for completion. This opinionnaire consisted of three parts, (1) background information concerning the Counselor, (2) an opinionnaire consisting of 40 items rating the Counselor's attitude toward the characteristics of a typical welfare referral and (3) the total number of cases accepted by each Counselor from July 1, 1966 to June 24, 1967 and number of welfare referrals accepted by the Counselor during this same period. The sematic differential scales were used in rating the attitudes of the Counselor toward welfare referrals. After completing the opinionnaire by the Counselors, the writer assigned a numerical value to each of the seven possible ratings of each characteristic of the welfare referral, with one being assigned to the negative characteristic and seven to the positive characteristic. The interim numerical values were varying degrees of attitudes of the Counselor toward the referral. After tabulating the results of the attitudes of the Counselor toward the welfare referral where a numerical value of one was assigned to the most negative attitude and a numerical value of seven to the most positive attitude toward the forty characteristics of a typical welfare referral, it was found the scores ranged from a low score of 106 to a high of 208. Only three Counselors had numerical scores above the mean of 135.3, while seven Counselors had numerical scores below the mean. Only one Counselor had a positive attitude toward welfare referrals while nine Counselors had a negative attitude. The standard deviation was equal to 7.66 and was significant at the .05 level. 390 RESULTS TABLE I ATTITUDES OF COUNSELORS TOWARD WELFARE REFERRALS COUNSELOR A B c D E F G H I J SCORE 208 120 119 127 136 132 123 153 129 106 X = 135.3 S.D.= 7.66 DEVIATION FROM MEAN d2 +62.7 -15.3 -16.3 - 8.3 + .5 - 3.3 -12.3 +17. 7 - 6.3 -29.3 3931.29 234.09 265.69 68.89 .25 10.89 151.29 313.29 39.69 858.49 d2= 5873.86 391 TABLE II PERCENTAGE OF WELFARE REFERRALS ACCEPTED AND REJECTED OF TOTAL NUMBER OF REFERRALS FOR PERIOD OF 7-1-66 TO 6-24-67 COUNSELOR TOTAL NUMBER ACCEPTED REFERRALS FOR 7-1-66 TO 6-24-67 NUMBER OF WELFARE % WELFARE REFERRALS ACCEPTED REFERRALS FOR 7-1-66 TO ACCEPTED 6-24-67 A 129 B 55 c 113 D 98 E 96 F 151 G 112 H 107 I 122 J 150 4 3.1% 22 40% 18 15.9% 9 9.1% 6 6.24% 5 3.3% 4 3.6% 11 10.3% 21 17.21% 12 8. % TOTAL 1,133 112 - X = 11.67 % Results of Table II show the percent of accepted welfare cases ranged from a high of 17.21% to a low of 3.3% with a mean of 11.67% of welfare referrals accepted. 392 TABLE III THE CORRELATION OF ATTITUDES TO PERCENTAGE OF WELFARE REFERRALS ACCEPTED rouNSELOR A RANK ATTITUDE % OF WELFARE REFERRALS ACCEPTED d; df 1 2 -1 1 B 8 7 1 1 c 9 3 6 36 D 6 5 1 1 E 3 8 -5 25 F 4 10 -6 36 G 7 9 -2 4 H 2 4 -2 4 - I 5 1 4 16 J 10 6 4 16 140 ~di 2= 140 -- r_c;:_ = 152 Table III shows a correlation of .152 between the attitude of the Counselor and the percent of accepted welfare referrals. This indicates that the attitudes of the Counselor does not affect the percentage of accepted welfare referrals by the Counselors. 393 TABLE IV THE COP~ELATION OF THE NU}ffiER OF YEARS EXPERIENCE TO THE ATTITUDE OF COUNSELORS OF WELFARE REFERRALS ~ RANK COUNSELOR IN ATTITUDE NUMBER YEARS EXPERIENCE IN NUMBER YEARS TOWARD WELEXPERIENCE FARE REFERRALS di di2 A 4.0 3 1 2 4 B 1.1 9 8 1 1 c 2.75 6 9 -3 9 D 1.0 10 6 4 16 E 1.3 7 3 4 16 F 3.5 4 4 0 0 G 25.0 1 7 -6 36 H 1.2 8 2 6 36 I 3.0 5 5 0 0 J 5.25 2 -x= 4.81 yrs. 10 -8 64 Ldi 2=182 r 8 = -.103 Table IV shows a correlation of -.103 between the number of years of experience and the attitude of Counselors of welfare referrals which indicates the number years of experience of the Counselors does not effect the attitude of Counselors toward welfare referrals. 394 TABLE V CORRELATION OF THE NUMBER OF YEARS OF EXPERIENCE TO PERCENT OF WELFARE REFERRALS ACCEPTED RANK ~OUNSELOR Nill1BER YEARS IN NUMBER YEARS IN % WELFARE EXPERIENCE EXPERIENCE REFERRALS di di 2 ACCEPTED A 4 3 2 1 1 B 1.1 9 c 2.75 6 7 2 4 3 3 9 D 1.0 10 5 5 25 E 1.3 7 8 i-1 1 F 3.5 4 10 -6 36 G 25.0 1 9 -8 64 H 1.2 8 4 4 16 I 3.0 5 1 4 16 J 5.25 2 :x= 4.81 yrs. 6 -4 16 J~i 2=18 8 rs = -.138 Table V shows the correlation of the number years experience of Counselors to the percent of welfare referrals accepted is -.138. This also indicates the years of experience of Counselors does not affect the percent of welfare referrals accepted for services. 395 DISCUSSION From Table I, data revealed that only one Counselor of the ten in the study has a positive attitude toward welfare referrals. This indicates to the writer that, regardless of the educational background, age of the Counselor, or number years of experience of the Counselor, that a negative attitude of the General Counselor prevails. This could be caused by different factors. One is that the general Counselor may feel he is "pressured" for a high number of successful rehabilitated closures and he would only accept the relatively easy cases to rehabilitate. Another factor which may be involved is that, as the Counselors gained experience in Vocational Rehabilitation, they found the typical welfare referral was not an easy person to rehabilitate and many may have poor potential for returning to remunerative employment. The lack of success on the Counselor's part in being able to rehabilitate the welfare recipient could be a very definite factor in this negative attitude toward them. In Table II, which shows the percent of welfare referrals accepted in relation to the total number of accepted cases by the general Counselor, the cases ranged from a high of 17.21% to a low of 3.3% with a mean of 11.67% cases accepted. This shows that there is a wide spread between Counselors as to their accepting welfare cases even though the survey showed that all but one had a negative attitude toward this source of referral. Also, considering there are sixty official referral sources which make referrals to the general Counselor, it would appear that even the low of 3.3% accepted welfare cases by one Counselor would be a normal amount and the high of 17.21% accepted cases by one Counselor would be an excessively high percentage of accepted cases from this one referral source. Therefore, this writer feels that a mean of 11.67% of accepted welfare cases is not a low percentage of the total accepted cases but rather a normal or even perhaps an above normal number considering the total number of referral sources. 396 Table III shows a very low correlation of .152 between the attitude of Counselors toward welfare referrals and the percentage of welfare referrals accepted. This writer feels that the general Counselor does not let the negative attitude he has interfere with the number of welfare referrals he accepts for services. The implication may be that the Counselor uses his professional judgement and other factor8 pertinent to the case in determining whether the case will be accepted for services and not let his personal attitudes affect this decision. Table IV shows the correlation between the number years experience and attitude toward welfare referrals. Here is a low negative correlation of .103 which implies that as the Counselor gains experience his attitude changes little toward welfare referrals. The number years experience ranged from twenty-five years experience to one year with a mean of 4.81 years. Also, Table V shows there is a very low negative correlation between the number years experience of the Counselors and the percentage of welfare referrals accepted for services. This also indicates there are other factors involved regarding the attitudes of the Counselor other than the number of years experience, age, education and type of caseload carried. 397 CONCLUSIONS AND RECOMMENDATIONS The purpose of this study was to determine if the attitudes of D.V.R. Counselors and the years of experience of these Counselors affected the accepting or rejecting of welfare referrals. Data relevant to the educational background was also collected. Statistical analysis of the data clearly supports the three null hypothesis: (1) That the attitudes of DVR Counselors do not affect the percent of welfare referrals accepted. (2) That the number of years of experience of these Counselors does not affect the percent of welfare referrals accepted. (3) That the number of years of experience of Counselors does not affect the attitude of the Counselors. Therefore, the null hypothesis was retained for each variable of the study. It was found that the percent of welfare referrals accepted by Counselors was not affected by the number of years experience or by the attitudes of the Counselors. Also, it was found that the number of years experience does not affect the attitudes of Counselors toward welfare referrals. It is felt by the writer that further study should be done in this area on a much larger scale, since the data utilized in this study was restricted to a small number of Counselors and may not reflect a true picture of the study. Other factors should be considered also; such as, method of screening welfare referrals before placing on the caseload and other criteria considered, such as, age of referral, severity of disability, race, motivation, etc. All of these factors would have a bearing as determinants in accepting or rejecting welfare referrals by Vocational Rehabilitation Counselors. 398 BIBLIOGRAPHY 1. Lamborn, Emily H. "How Rehabilitation is Changing", Rehabilitation Record, Vol. 7, No. 4, July-August 1966, p 3. 2. Friedlander, Walter A., Introduction to Social Welfare, Englewood Cliffs, New Jersey, Prentice-Hall, Inc. 1961, p 289. 3. Yuker, Harold E., "Attitudes as Determinants of Behavior", Journal of Rehabilitation, June 1965, pp 16-17. 4. Haas, Kirt and Goldstein, Milton, "Rehabilitation Worker and Client: Understanding Cultural Differences," Rehabilitation Literature, Vol. 26, (2), 1965, pp 39-40. 5. Neisser, Harianne, "Judgements and the Non-Judgement Attitude in Therapeutic Relationships, "Social Casework, Vol. XLVI, May, 1965, pp 278-282. 6. Goldin, George Jr., "Some Rehabilitation Counselor Attitudes Toward Their Professional Role," Rehabilitation Literature , Vol. 27, December, 1966, pp 362-365. 7. Krause, Elliott A., "The Sponsored and the Socially Isolated: Two Disabled Populations," American Journal Public Health, Vol. 54, 1964, pp 1711 - 1725. 8. Harrington, Hicheal, The Other America , New York, The HcMillian Company, 1963, pp 133 - 135. 9. Riessman, Frank, The Culturally Deprived Child, New York, Harper and Row, 1962, pp 26 - 30. 10. Operation Hope, A Cooperative Project Between Florida State Department of Public Welfare and Florida State Department of Education, Division of Vocational Rehabilitation, Jacksonville, Florida. 11. Dishart, Martin, Project Director, "Highlights of National Studies on 90 State Vocational Rehabilitation Agencies by Patterns of Rehabilitation Services Project, "National Rehabilitation, Washington, D. C., April 1965, p 14. 399 APPENDIX B Graduate Training Program for Work Evaluators University of Georgia College of Education 400 Proposal Graduate Training Program for Work Evaluators University of Georgia College of Education After repeated requests from work evaluators employed by the Georgia Office of Vocational Rehabilitation, the staff of the Rehabilitation Counselor Training Program began to seriously consider the possibility and feasibility of providing the specialized graduate training in the area of work evaluation. It soon became evident that the existing Counselor Training Program was not structured to meet the need of this particular group of professional personnel. In fact, there were no existing formal training activities for work evaluators in Georgia. Apparently, much has been expected of the evaluators in terms of determining residual function and job potential of hard to place and severely impaired clients, but little has been done to provids them with the training which would enable them to fulfill these expectations. The only formal training afforded them has been a short course in the TOWER System of work evaluation at the Institute for the Crippled and Disabled in New York. The need for a formal training program seemed evident, not only from the conspicuous absence of a formal structured training program but also from the frequent and continuous requests for training from the work evaluators themselves. 401 The first step in planning a training program was to identify the nature of the work evaluator's job. What unique functions does he perform in the rehabilitation process and what new knowledge and skills does he require in order that he may function effectively? A meeting with Chiefs of Evaluation, GOVR, was requested and approved. On November 23, 1966, eight evaluators met with the staff of. the Rehabilitation Counselor Training Program, the Chairman of the Industrial Arts Department, and a staff representative from the Department of Educational Psychology to identify some of the unique needs of work evaluators and to ascertain what new courses would be required to establish a graduate training program. The evaluators were very enthusiastic and eager to be meeting to discuss the possibility of a training program. In the initial phase of the meeting the evaluators discussed their reasons for wanting a graduate training program. Some of the reasons were: I. Evaluators do not have a clearly defined role and function in the rehabilitation process and consequently: A. Much time is lost in the trial and error technique of learning how to "evaluate the vocational skills and aptitudes" of rehabilitation clients. B. Evaluators become too Jependent upon existing work samples because they have not been shown how to develop work samples which might be more practical and useful. C. Evaluators feel insecure in their roles and unsure of their functions. II. The nature of the work demands professional competence and the continuing improvement which is inherent within professionalization. III. Work evaluators want the opportunity to acquire the requisite knowledge and skills which would enable them to discharge their responsibility more effectively and thus earn for themselves status and benefits equivalent to those enjoyed by counselors. The second phase of the discussion was an attempt to identify the role of the work evaluator and enumerate the types of knowledge an evaluator would need to function effectively. While it was felt that the role of the evaluator was not the same in all facilities, the general role definition would be "to assess personality and skill variables and interpret them in terms of job function," whereas it is the function of the VR Counselor to "modify behavior." Two types of knowledge which an evaluator would need were identified: (1) knowledge related to personality variables, and (2) knowledge related to technical or skill variables. The followi~g figure enumerates specific areas of knowledge within these two general areas. EVALUATOR KNOWLEDGE Personality Variables 1. Psychological impact of disability 2. Interpersonal relationship techni- ques 3. Motivation and interest 4. Personality dynamics 5. Basic vocational needs 6. Abnormal psychology Technical or Skill Variables 1. Work sampling techniques 2. Knowledge of total job and critical skills 3. Labor market analysis and trends 4. Standardized tests 5. Occupational information 6. Record keeping and report writing 7. Test construction 8. Shop equipment use and management 9. Medical information 10. Employer-employee relations This list was not meant to be all-inclusive, but rather it was a beginning point to be further expanded and refined. Staff members involved in this initial planning felt that many of these needs could be met within the existing framework of existing courses by having the separate sections of these courses offered with emphasis directed toward the explicit and implicit needs of work evaluators. 403 APPENDIX C DOCTORS ENOUGH FOR ALL? By Marjory Rutherford 404 The Atlanta Journal and The Atlanta Constitution Section E, Page 1 Sunday, November 12, 1967 DOCTORS ENOUGH FOR ALL? By Marjory Rutherford Georgia has approximately 4,511,000 citizens right now. It's a safe guess that a lot of 'em are having to wait a little longer than they like to see their doctor or their dentist. There are 6,500 licensed physicians in the state and 1,491 dentists, with another 808 dentists registered for practice in Georgia but known to be practicing elsewhere. Will there ever be enough doctors and dentists to "go around?" The answer may surprise you -- especially if you have recently tried to make a next morning ,appointment with your medical man or the fellow who offers novocain, hypnosis, or soothing music while he drills. The answer: A qualified "yes." There are a lot of "ifs", however. And it is hard to find an expert in the field either of medicine or dentistry who wants to make an unqualified prediction on the situation that keeps medical and dental school deans across the nation tossing in their sleep these nights. 405 A current shortage? Yes, especially in smaller Georgia cities and in rural sections. A crisis? Not really; it only seems that way to the impatient laymen -- or, and it does happen, unfortunately, the one who can't immediately locate a doctor or dentist in a real emergency. Hope for the future? Undoubtedly. Expert observers point out that Georgia is as building up medical and dental schools are adjoining states. More physicians ' and dentists are graduating. More impor- tant, many now are going into small towns and "the country." And just as Georgia attracts industry, doctors and dentists from other sections of the United States are being lured to this many-splendored capitol of the southeast. Each year, licensing board workers estimate, between 15 and 25 dentists from other areas apply to obtain a license to practice in Georgia. Between 1960 and 1967, a total of 841 physicians from other states have been licensed for Georgia practice. Experts such as Dr. Arthur P. Richardson, Dean of the Emory University School of Medicine, think the brightest hope for the future is not an increase in graduates but a new focus on "delivery'' of health care. That means new ways of aiding harried physicians, especially by the training of not only more nurses but many types of aides in the allied health fields. That way, vital know-how, time and service of the doctor can be spread thinner and benefit more patients. Planning and surveys are as important as new buildings in the eyes of Dr. Walter Rice, Dean of the Medical College of Georgia. He and colleagues are trying to pinpoint needs in the various specialties of physicians. Just now, there is no central clearing house where one can determine, for example, whether there is an acute shortage of say, psychiatrists or heart specialists in a certain area. (It is a good bet, however, both are badly needed in most areas of Georgia, even Atlanta. In Atlanta and Augusta, however, training is under way of "medical specialty assistants" in coronary care. The latter, in an Atlanta program at Grady Memorial Hospital, train under famed Dr. Willis Hurst, who stresses that men will emerge from a two-year training program here qualified to augment work of physicians and nurses. They will compete with neither but, by allowing physicians to spend their time with more patients, will aid the shortage. A similar program is underway at Duke University.) Both Emory University and the Medical College of Georgia are turning out more budding physicians. The latter, in the fast-growing medical center of Augusta, now is in a $6~ million building program. Dr. Rice reported enrollment of medical students has accelerated from 80 to 100 per year and will increase by one-third when the building program is completed. Dr. Rice pointed out the number of physicians in Georgia cannot be counted by the crop of medical school graduates, who may go elsewhere, but by the number who come to this state for residencies and other graduate work. The state offers good graduate programs and is attracting doctors, he said. Shortage of physicians is a poser attracting national attention. Dr. Oliver Cope, professor of surgery at Harvard Medical School, in a recent article, was critical of outmoded medical school training. "If we are to have enough--and enough good doctors," he wrote, "the medical schools must stop force-feeding identical training to future research scientists, family physicians, surgeons, and other specialists, all of whom need very different skills." 406 towns have rarely moved. They tend to become leading members of the community and to remain there." This expert noted that the shortage is "most dramatically evident in our hospitals, where more than 12,000 men and women imported from foreign countries are serving as interns and residents because too few American graduates are available." In Georgia, as elsewhere, there are far more applicants to medical schools than can be accepted. A national survey shows that a total of 18,250 persons applied for admission to the 1966-67 first-year class in United States medical schools--a decrease, actually, from a high of 19,168 in 1964-65. The annual report of the John and Mary M. Markle Foundation, released last week, noted the growth of public concern about the delivery of health care in the United States, declaring: "The public interest in health care appears to be a few strides ahead of the medical profession itself." Georgia's "country doctor program," the state program awarding scholarships to future physicians, has helped send doctors where they are most needed--to rural areas of Georgia. Last month, the State Medical Education Board saluted the 15-year-old program. Dr. Stell B. Traylor of Barnesville, Board Chairman, said it had been recognized as "pace-setter ~n t h e nat ~ on. II "The idea was twofold, to help worthy Georgians finance their medical education and to provide doctors for small communities where they were critically needed," he noted. "After they became doctors, the individuals discharged their debt to the state by practicing medicine in communities where doctors were scarce." The Board issued "certificates of appreciation" to 50 doctors who went to school under the "country doctor bill," then began practice in small towns. Under the plan, a doctor must serve one year for each $1,000 scholarship money he receives. Maximum grant is $5,000. Dr. Traylor said, "Experience has shown that doctors who have practiced in small Still somewhat controversial is the question of whether there is a substantial shortage of dentists in Georgia. Proposal to establish a dental school at the Medical College several years ago, seconded by then Governor Carl Sanders, led to at least one newspaper editorial questioning whether "the rather heavy outlay and operating expenses of a new dental school are justified." Today, according to Henry Neal of the Board of Regents, most questioners agree that the school -- which will take first students in 1969 -- fills a real need. Now a building, with a dean, two assistants and eight other persons on the job, the school already is training dental hygienists and will graduate its first class in 1969. The school will accept 48 dental students in the beginning, according to Dean Judson C. Hickey. Dr. R. Hunter Rackley of Millen, president of the Georgia Dental Associdtion which boasts 1,156 members, thinks "progress is being made" to combat the shortage of dentists. Fluoridation benefits, Dr. Rackley noted will show up in the next generation, so that dentists will have to spend less time in work on cavities, with more time for peridental care and the teaching of good oral care to patients. "The new school at Augusta and new building at Emory's School of Dentistry," he declared, "is virtually equivalent to two new dental schools for Georgia." In addition, South Carolina has just started a new school of dentistry and Florida has plans for one. Board of Regents' spokesmen noted that state scholarships now are offered to dentists and to candidates in many allied health fields. All, the experts believe, will contribute to the re-focused idea of health care which further will lift the current strain on doctors and dentists in Georgia. 407 APPENDIX D RSA SUPPORTED TRAINING PROGRAMS IN HEW REGION IV TRAINEESHIPS IN REGION IV Sneech Pathologv and Audiolo~v Social Work cont. Universitv of Alabama Universitv o~ Tennessee Speech and Hearing Clinic School of Social Work Universitv, Alabama 35486 Dr. Fdwin w. Martin, Jr. 810 Broadwav Nashville, Tennessee 37?03 Sue H. Soencer The Florida State University SPeech and Hearing Clinic Vande~bilt Universitv Tallahassee, Florida 3230F Department of Psvcholo~y Dr. L. L. Schendel Graduate School Nashville, Tennessee 37203 University of Florida Department of Sneech Mental Retardation Gainesville, Florida 32603 Dr. Roy E. Tew University of Georgia Speech Correction Area University of Florida Athens, Georgia College of Health Related Professions Dr. Stanley Ainsworth Department of Communicative Disorders Gainesville, Florida 32603 Rehabilitation of the Deaf Dr. Kenneth R. Bzoch University of Tennessee Universitv of Southern Mississippi College of Education Sneech and Hearing Center Vlest Cumberland Avenue Box 9?, Southern Station Knoxville, Tennessee 37916 Hattiesburg, MississiPPi 39401 Glenn T. Lloyd, M. S. Dr. Robert W. Peters Physicial Medicine and Rehabilitation University of Tennessee Department of Audiologv and Soeech Pathology Georgia Warm Sprinps Foundation Knoxville, Tennessee 37915 Warm Sprinos, Georgia 31830 Dr. Harold Luper Edward D. Haak, M. D. Vanderbilt University Psycholo~ists in Rehabilitation Division of Audiology and Speech Pathology Nashville, Tennessee 37212 University of Florida Dr. Freemen McConnell College of Health Related Professions Department of Clinical Psycholo~v Social Work Gainesville, Florida 32603 Dr. Louis D. Cohen Florida State University School of Social Welfare Vanderbilt University Tallahassee, Florida 32606 Department of Psychology Coyle E. Moore, Dean Graduate School Nashville, Tennessee 37203 Atlanta University School of Social Work Prosthetics and Orthotics Atlanta, Georgia 31314 William S. Jackson, Dean None *University of Georgia Speech Correction Area Athens, Georgia 3060? Dr. StanlAy Ainsworth Recreation None 408 Page two Traineeshin Region IV ~ccupational Therapy University of Florida College of Health Related Services A-94 Teaching Hosoital Gainesville, Florida Miss Alice C. Jantzen, OTR, Chairman Yhvsical Therap~ Universitv of Florida College of Health Related Services ~ox 6?, Teaching Hosoital and Clinics r,ainesville, Florida Miss Barbara C. White 409 TRAINEESPIPS REGION IV ~ehabilitation Counselor Trainin~ University of Alabama Colle~e of Education University, Alabama 3548f Dr. Doral N. West Auburn University School of Education Auburn, Alabama 36830 Florida State University College of Education 90? H. Park Avenue Tallahassee, Florida 32306 Dr. Frank H. Echols Universitv of Florida Colle~e of Health Related Professions J. Hillis Miller Pealth Center Gainesville, Florida 3?~01 Dr. Rruce Thomason Georgia State CoJle~e School of Education 33 Gilmer Street, S. E. Atlanta, Geor~ia 30303 Dr. Kenneth R. Mathenv University of Geor~ia College of Education Athens, Georr.ia 30601 Dr. Thomas L. Porter Mississipni State Universitv College of Education State Colle~e. Mississipni 3976? Dr. Joe M. McKenzie Universitv of South Carolina School of Education Columbia, South CArolina ?9208 Dr. Hubert M. Clements University of Tennessee College of Education ?109 Terrace Avenue Knoxville, Tennessee 37916 Dr. \Hlliam M. Polbert 410 APPENDIX E Orientation Training Program Comprehensive orieutation training for newly employed GDVR counselors was initiated at the University of Georgia during the Spring quarter 1966. The purpose of the program was (1) to provide ~ comprehensive overview of the work of t;;e rehabilitation counselor, ( 2) to assist wi t"h the rccruitment and retention of counselors in the field, and (3) to provide an initial, early up-gr~~ing for those employed. Each of the two initial orientation classes met on campus fur a full academic quarter. The format, but not the content, has been revised and is presented under 11 Program Revisions". Pa~ticipants: The participants are those individuals who have recently been emplGyed as GDVR counselors. Minimum requirements include an undergraduate degr,~e in a social science related field and two years paid employment in similar work, -- employment, personnel, public health, education, welfare, etc. Graduate training in an appropriate area may substitute for up to one year of the required experience. The participants receive their full salary while in training as well as a VRA stipend to help defray the expense of living avray from home. Contert: All of the participants will take three courses, each of which carries-five quarter hours of credit. These courses are: (1) Introduction to Vocational Rehabilitation: This course is designed to provide a comprehensive introduction t-oth_e_ voc-ational rehabili-cation process. Among the topics ~)resented are the history of vocational rebabili tat ion, legislation, incidence of disability, the client study process, an:.. profr~ssional proble:.:. Special attention is given to the developr;1ent of a professional self-image and attitude. State agency personnel are utilized to present the agency's philosophy and procedures in conjunction with the subject matter. (2) Medical and Psychological Aspects of Disability: Course content includes medical term5.nology, the structure of medicine in the U.S. and the medical and psychological aspects of impairments to the various body systems (heart, respiratory, n1usculoskeletal, brain, spinal cord, endocrine, etc.) The medical aspects of the more common impairments are presented by staff and consulting physicians according to their area of specialization. Psychological aspects are presented by the training staff and other consultants. Emphasis is given to chronic disabling conditions, treatment techniques, functional limitations and prognoses. (3) Special Problems in Rehabilitation Counselin~: This course was specially designed for the participan~s- in this program. It follows an introductory synopsis format with equal time devoted to lecture and laboratory discussion. A limited practicum experience includes client contact and critiquing of this experience. Coverage of the following broad areas is intended as an introduction only and includes: (A) Psychological Aspects of vlork and the h'orker (1) Views on the nature of man (2) Environm8ntal influences on behavior (3) Personality and motivation (4) Occupational choice and vocational Gevelopment 411 (B) Counseling (1) Definitions, theories and techniques (2) Application of theory in rehabilitation counseling (3) Role playing and initial interviewing (4) Critiquing of tapes (C) Appraisal techniques (1) Measurement statistics (2) Review of selected tests (3) Use of test data in counseling (4) Pre-vocational and work evaluation ~fuile this outline appears very ambitious, each of the topics is presented with the idea that it represents minimum introductory knowledge only and will serve as a background for subsequent in-service and professional academic Trnining. Field Experiences: During the program salient field experiences are arranged. Initially Wednesdays were reserved for this purpose, and the facilities visited have included those for the retarded, the juvenile offender, the alcoholic, the emotionally ill, and the Georgia Rehabilitation Center. The revision of the field experiences are presented later. Group Counseling: A group counseling experience is provided the participants through arrangement with two experienced group counselors on the counselor education staff. Evidence in the literature supports such experience as enhancing the person's ability to function as a counselor (Carkhuff and Truax, VRA R ar,d D Grant #906-PM). Dr. Blakeman will assume responsibility for the group counseling experience June 1, 1967. follow-up Visits: Follow-up visits were initiated following the completion of each class in order to assess participant performance and to provide a basis for program modification or adjustment. Background The first two orientation training classes of seven and eight participants respectively were enrolled in March and June 1966 and completed their programs during the resp~citve quarters. The third class expected for the fall quarter could not be assembled. Extensive contact with the participants and agency personnel revealed the essential nature of the lack of basic support of the program. The lack of support may be attributed in part to a significant personnel change within the Georgia Agency at the time. Most, however, was attributed to a number of specific factors revealed through follow-up contacts. Criticism centered upon the following areas: ( 1) Extended absence of the ne1-rly employ~d counselors from their local offices. Approximately ten weeks was requi~ed for each academic quarter. (2) Some alleged duplication of effort with and information about the introductory course ( Introduction to Vocational Rehabilitation) which utilized agency personnel to a large extent. 412 (3) Question about the utility of the Wednesday field trips. (4) The frequent long days of almost continuous class was a standard complaint of the participants. (~) Inequality of field experience was a minor, but consistent complaint. Under the original format, some participants would have up to two months field work, while others would complete the program without having been assigned a case load. Such criticism seemed sufficient to consider revisions in the J;asic format of the program. Changes were considered which would preserve most of the advantages built into the original program, while at the same time removing the above negative influences. Pl'ogram Revisions The on-campus academic quarter was abandoned in favor of scheduling subsequent classes according to the hiring experience of the state DVR. This precludes regular graduate credit for such course work. However, fifteen hours of extension (in-service, post-graduate) credit may be applied toward an advanced degree. Since only two of the original fifteen participants and none of those subsequently enrolled would be entitled to regular graduate credit at the time of enrollment, this change is not seen as being of consequence. The length of the program was reduced from approximately ten weeks to seven weeks. This was designed to conform to the university's minimum amount of lecture time for the credit offered (40 hours for each five hour course). The amount of "class" time scheduled initially was far in excess of this minimum and appeared to exceed the endurance of most of the students. This change is seen as a strength rather than a weakness under the revised program by enhancing student operating efficiency. An indepenJent study of this influence by the coorJinator lends support to this interpretation. Continuous scheduling was also abandoned in favor of interval scheduling for each class. Following this initialsession, the students are released to return to a1:tend an additional week of class until they have completed the seven-week profram. This has eliminated the student's continuous absence from his office. It allows the ;.:~cquisi tion of relevant field experience. Prior to the second sessicn, all participants will have been assigned a caseload. The Hednesday field trips were removed from the weekly scheduling. This provides five-day class weeks ~'ather than four. In place of such aclivi ties, the fourth and sixth weeks of th'.:.: program a.re held in their entirety at the Georgia Rehabilitation Center, (Warm Springs) and the Yarbrough Rehabilitation Center, (Milledgeville) respectively. Under the original program, travel time and program development was a consistent problem. This arrangement amply allows for correction of these deficiencies. Regular presentations are scheduled by the instructional staff as well as an intensive orientation to the services available at each facility. These facility visits allow a much better opportunity to a~sess the merits of each program, to get acquainted with the staffs involved, and fer a practicum experience with disabled clients. Course content remains essentially unchanged in the three courses offered. 413 Consulting physicians are utilized during each of the facility visits in the medica1 aspects course. fvlore restrictive use is currently being made of az,ency guest lectures in the introductory course. At the same time, current effort is being devoted by the training staff and agency personnel to developing effective teaching materials related to agency rolicies and procedures. This is developing as a study guide for the newly e~ployed counselor to help direct his becoming acqt:-1inted with the various basic documents, forms, and fisc2l procedures of the Geo~c::ia DVR. These program rev~s~ons were implemented and the first class enrolled January 10, lg67 with fourteen participants. This class h&s completed its fourth week at the Georgia Rehabilitation Center and will complete its seven week program in c.TPJ.y. A second class of nineteen participants h3s recently completed its initial two-week session on campus and should complete its program in September. Parti~i pants are currently being scheduled for the next class to start in late June. Contact with these participants and agency personnel su~:ests that the initial criticism has been essentially neut:r'alized by these revisions. While the hiring experieTlce of the agency would suggest the June class wou2_d be a small one, both previous classes have been much larger than predicted by t~is experience. The orientation training program appears to h2ve won favor among many agency personnel. It appears to be seen by some employed counselors as a means of initiating a graduate training prozram. Others have stated that the program was a significant influence in their decision to accept employment in the Georgia DVR. Host of the initial participants have subsequently enrolled in one or more of the in-service courses offered through the University of Georgia. From these influences, and the size of the classes enrolled, it aopears that the orientation training prograr.1 can becone a significant early influence within the GDVR. It serves to stimulate subsequent professional training of the participan::s, and it helps to break the ice for regular graduate studies. It is estimated that sixty participants can be enrolled during the next fisc:1l year. Classes are tentatively scheduled to begin every tvm to three nonths, with four, and possibly five classes to begin during the year. Both standardized and classroom testing data are being regularly administered in order to assist in making inter-class comparisons, and to begin a;; exploratory assessment of the influences of the orientation program and early e~ployment experience of the participants. The training staff was pleased with the perceived growth of the participants during th~ two initial classes, in spite oE the prevailing criticism. Many of these participants developed an appreciation of individual behavior dynamics which was unexpected during a short quarter of training. This perceived result was attributed to (1) the intensive and continuous interaction within these small groups and (2) the nature of the group counselin[ experience provided. This suggests some rr,eri t in limiting class size, and in contim;ous rather than interval scheduling of clc_sses. Scheduling according to the acader;,ic quarter, hov1ever, did not appear to offer the opportunity for integrating academic and field experience allowed under the revised program. 414 It has been suggested that as existing vacancies are filled within the GDVR that the orientation program again return to scheduling by the academic quarter. Counselors could be hired and assigned to the orientation program. Subsequent selective placement could follow the completion of training in anticipation of employee turn-over. Hith approximately two hundred counselors on the agency staff, turn-over due to resignation and promotion may be predicted with some precision. This would compensate for caseload vacancies and the occasional prolonged delays in filling unexpected openings. A projected budget for the academic year for the orientation program follows. The only significant increase over the current year is in the use of consulting physicians for the medical aspects courses. Three courses were anticipated during the past year with one of these being a combined course of regular and orientation students. Four classes were actually started and only partial corr:bining was possible of regular and orientation students. If five classes are started during the year, then eight such classes will have been in some stage of development during the year. (Two finishing from this year, five new classes enrolled, and one regular class). The cost for consulting physicians for each orientation cla~s will approximate $700. Budget for Orientation Training; Teacl1.i.ng Grant Coordinator of Orientation Training (full-time) Visiting Professor (Medical Aspects) Stu~f (Blakeman, 1/6-time) Staff (Jones, 1/6-time) Consulting Physicians for Medical Aspects Orientation Training Assistant (1/2-time) Graduate Assistant (l/4-time) Academic Consultants Secretary Travel for Staff and Consultants Employee Benefits $ 12,800 2,?00 2,217 2,050 3,300 4,600 2,300 300 3,600 1,600 2,890 Consumable Supplies Teachin~ Materials and Tests Comrr,unications Five Tape Recorders Sub-Total 100 500 100 759 Sub-Total $ 1,459 Traj~ing Grant Stip2nds (60 at $600 per student) Tuition (60 at $180 per student) $36,000 10,800 Sub-Total TOTAL COST $4b,800 $8f. _llf 415 APPENDIX F GOVR COUNSELOR TIME STUDY Purpose: The purpose of this study was to determine as best as possible exactly what the Georgia Vocational Rehabilitation Counselor does with his tbne. Methodology: The methodology for the study was proposed by Dr. Thomas 1. Porter and then applied by three graduate assistants in the Vocational Rehabilitation Counselor Training Program at the University of Georgia. A letter was sent to all professional personnel employed by the Georgia Vocational Rehabilitation Department, explaining the purpose and mechanics of the study. The study was divided into two major parts. First, the general counselor would be studied and then the facility counselor. To begin with, a random sample of 40 general counselors was drawn from the new edition of the Directory of Professional Personnel. Then, between November 2, 1967 and November 15, 1967, 38 persons of this sample were contacted. Two that were selected were not contacted; one was on annual leave and the other on sick leave. Each of the 38 counselors were contacted by phone. Nineteen were called at 11:15 A.M. and 19 were called at 4:15P.M. They were then asked to account for the past three hours of work time. The calls were spread evenly over ten working days; two calls were placed in the morning and two calls were placed in the afternoon. The students making the calls had a form listing 25 activities; specific time intervals were recorded for each activity. After all the data was obtained, the 38 counselors were sub-divided into a rural or urban group, depending on their individual case loads. Then sub-totals were obtained for each activity and percentages were calculated. For the purpose of an over-all picture, grand totals and percentages (urban and rural) were drawn. Exactly the same methodology was followed for the facility counselor with the following exceptions. The sample was stratified and consisted of 20 counselors; the purpose of stratification was to insure that each type of facility would be represented in the sample. Due to the smaller sample, the calls took only five days (November 20, 1967 thru November 29, 1967). The data was not subdivided (rural-urban), and the grand totals and percentages were all that is reported. Conclusions: The purpose of the time study was to determine how the Georgia Rehabilitation counselors spend their time and in what proportion. The work of the general and facility counselor differ significantly; therefore, they must be considered separately. Since the sample was randomly selected from a large sample of the personnel involved, it is felt that the results are indicative of what the counselor actually does (see Methodology). The time study results for the general caseload counselor are given in three categories: (1) rural counselors~ (2) urban counselors and (3) rural and urban counselors combined. For a breakdown of detailed activities and percentages, refer to the table "Counselor Time Study." The survey revealed that the rural counselors (N=25) spent 15% of their tbne on home visits (no actual client contact), 13% on travel, 12% reviewing cases (for plans, closures, decision making, etc.), 8% in dictation (case history, correspondence, etc.), and 7% in continuing counseling (not interview) in the field or territory. These account for 55% of his total time, the remainder being spent in numerous and varied activities. (See table). 416 The urban counselor (N=l3) used 20% of his time on home visits (no actual client contact), 9% on interviewing (initial, R-4, etc.), 9% on general telephone calls, 8% on dictation, and 8% on agency contacts (D.P.H., F.A.C.S., etc.). This accounts for 54% of his total time, the remainder being scattered over many activities. The combined totals for rural and urban general caseload counselors indicate 16% of the time spent in home visits, 10% in travel, 10% reviewing cases, 8% in dictation, and 6% each in interviewing and continuing field counseling for a total of 56%. From both the rural and urban percentage times, it is evident that the greatest majority of time is being spent on the technical aspects of the job and the minority of time is being spent in actual contact with the client. The time study for facility counselors (N=20), who, as a general rule, operate within restricted geographical boundaries, indicate 35% of their time is spent in continuing counseling relationships, 13% in dictation, 13% in conferences (training, state and district), 8% in interviewing, and 8% in consultation (medical and psychological). This accounts for 77% of the total time for facility counselors. Other significant areas, time-wise, for the facility counselors is 7% for testing and review of test results and 5% for talking to co-workers. Adding these two accounts for 89% of the facility counselor's time. Fifty-one percent of the facility counselor's time is spent in either direct contact with the client (counseling or interviewing) or directly related areas pertaining to the client (consultation). In comparing facility and general counselors' time utilization, it seems the only area of commonality is in the area of dictation (8%-13%) and interviewing (6%-8%). Perhaps some of the difference would lie in the different nature of the general and facility counselor's work, i.e., geographical area, larger caseloads, time limitations, for client contact, travel, etc. The counselor time study has the following implications of consideration and study: 1. The general counselor, and to a markedly lesser degree, the facility counselor spends a disproportionately large percentage of his time working on technical details that lessens time for client contact. 2. There are certain implications for a comprehensive study of utilizing rehabilitation coordinators or counselor aides to relieve the professional counselor of some of his technical and clerical workload. Validation Study: Since a study of this type has so many inherent limitations in terms of degree of accuracy on confidence limits, we decided to attempt to further validate the above study by way of another approach to the problem. Nine counselors (six general counselors, one counselor for the blind, one counselor for the EMR, and one counselor in a half-way house) volunteered to complete a self-report time study for themselves over a two week period. The summary of this study may be found in Appendix A. Even though the counselors participating in the self-report study were not a homogeneous group in terms of work setting, it will be noticed that the results of this study are remarkedly similar to the total general counselor group in the above study. 417 While it is impossible to precisely state the error variance in a study such as this, we feel, after considerable consideration, the time study completed by the University of Georgia's Rehabilitation Counselor Training Program is an accurate presentation of how GOVR Counselors are currently utilizing their time, and that there is ~ ~ ~ ~ 20% error factor due to sampling procedures, and the report of counselors in the sample. 419 APPENDIX G 1. Case Service Expenditures by Category FY 1966 2. Total Cases Served Per Counselor FY 1966 3. Number Rehabilitated Per Counselor FY 1966 SOURCE: State Vocational Rehabilitation Agency Program Data Fiscal Year 1966 U.S. Department of Health, Education and Welfare Vocational Rehabilitation Administration Washington, D.C. 20201 420 State or Territory Case Service Expenditure~/ By Category (By State) Fiscal Year 1966 Amount and Percent Each is of Total Case Service Exeenditures Total Case Service l/ Expenditures- Diagnostic P[Qes~J.u;;ea Amount Percent Surgery 6c Treatmen_t_ _ Amount Percent Prosthetic AeeUances Amount Percent Hospital and Convalescent Care Amount Percent Total ~11215881325 ~918191914 8, n; 2915371632 8,57. 2516261154 Region I Connecticut Ma.lne Massachusetts New Hampshire Rhode Island Vermont 942,129 510,832 1,836,355 173,625 896,875 406,149 107,275 40,795 90,225 7,450 111,899 35,674 11.4 8.0 4.9 4.3 12.5 8,8 34,111 23,528 74,934 19,617 170,495 35,259 3.6 4.6 4.1 11.3 19.0 8.7 61,918 32,785 82,950 9,634 44,812 10,053 Region II Delaware New Jersey New York Pennsylvania 382,738 2,697,653 8,780,815 11,855,477 36,956 418,487 731,400 820,464 9.7 15.5 8.3 6.9 37,084 9.7 171,455 6.4 189,621 2.2 909,189 7.7 20,053 178,754 404,323 648,246 Region Ill Dist. of Columbia, ......... Kentucky ......... Maryland North Carolina Puerto Rico Virginia Virgin Islands West Virginia Region Alabama . .IV.. . .. . .. Florida ...... Georgia Mlsalsalppi South Carolina Tennessee 307,761 1,600,628 1,452,266 5,100,938 2,206,706 2,781,155 26,032 2,851,187 3,812,610 4,386,574 5,597,169 1,552,455 2,934,732 2,230,056 37,224 46,362 141,317 245,617 158,475 239,418 1,466 211,652 12.1 2.9 9.7 4,8 7.2 8.6 5,6 7.4 287,028 812,661 496,153 82,316 318,3!)6 265,412 7.5 18.5 8,9 5.3 10.8 11.9 27,619 101,125 164,245 75 7,459 196,171 331,196 3, 718 294,250 9.0 6.3 11.3 14.9 8,9 11.9 14.3 10.3 301 ,079 832,902 815,846 104,146 269,746 326,912 7.9 19,0 14.6 6.7 9.2 14.7 19,250 83,332 139,112 264,505 25,136 113,437 1,597 153,658 155,103 199,015 210,495 66,274 208,609 119,522 Region V Illinois Indiana Michigan Ohio Wisconsin 5,041,232 1,305,760 1,445,965 2,111,685 3,640,167 672,629 104,333 270,5:.7 161,646 280,643 13.3 8,0 18.7 7.6 7.7 663,472 39,983 128,057 104,943 156,294 13.2 3.0 8,8 5,0 4.3 320,084 126,790 135,322 161,344 183,907 Region VI Iowa Kansas Minnesota Missouri ...... Nebraska North Dakota South Dakota 1,330,202 744,050 1,473,047 1,863,783 569,308 421,916 510,861 75,638 5.7 51,817 7.0 91,204 6.2 178,125 9,6 36,816 6.5 22,568 5.4 12,586 2.5 8,172 33,790 10,291 205,784 25,456 9,175 27,141 .6 4.5 .7 11.0 4.5 2.2 5,3 30,757 36,822 36,366 218,838 26,525 10,198 13,488 Region VII Arkansas Louisiana New Mexico Oklahoma Texas 4,286,685 2,589,605 470,574 2,062,380 3,257,080 158,675 3. 7 117,524 4.5 36,055 7.7 142,896 6,9 244,215 7.5 411,696 29,998 64,677 198,533 372,471 9,6 1.1 13.8 9.6 11.4 109,524 152,825 23,552 84,755 242,030 Region VIII Colorado Idaho Montana Utah Wyoming 2,114,027 354,587 473,922 356,261 301,790 198,589 9.4 10,124 2.8 19,600 4.2 29,999 8.4 5,814 1.9 84,909 48,812 31,423 34,405 12,717 4,0 13.8 6.6 9.7 4.2 84,192 16,595 38,312 16,024 4,630 Region IX Alaska Arizona California Guam Hawall ....... Nevada Oregon Washin~on 138,284 1 ,441,031 5,867,888 57,292 487,581 182,609 1,129,087 1,236..749 7,437 155,915 656,339 3,943 32,305 16,095 176,929 104,796 5.4 10.8 11.2 6.9 6.6 8.8 15.7 8.5 7,152 111 ,644 342,684 5,898 29,178 14.729 43,883 88~~58 5.2 7.7 5.8 10.3 6.0 8.1 3.9 7.2 ll,841 50,139 148,213 1,450 14,353 8,509 27,384 38_,812 ll Cash expenditures under Section 2. * Lea a than .05 percent. 12 5,07. i 1018301190 ~ 6.6 54,934 5.8 6.4 43,698 8.6 4.5 154,480 8.4 5.5 41,302 23.8 5.0 61,710 6,9 2.5 47,551 11.7 5.2 47,856 12,5 6.6 140,245 5.2 4.6 222,811 2.5 5.5 941,769 8.0 6.2 5,331 1.7 5.2 103,641 6.5 9.6 140,470 9.7 5.2 1,275,598 25.0 1.1 139,157 6.3 4.1 779,523 28.0 6.1 4,914 18.9 5.4 330,717 11.6 4.1 663,368 17.4 4,5 576,444 13.2 3.7 974,036 17.4 4.3 85,816 5.5 7.1 507,204 17.3 5,4 464,824 20.8 6,3 709,029 14.1 9.7 70,089 5,4 9,4 93,034 6.4 7.6 81,880 3,9 5.0 64,145 1.8 2.3 5,0 2,5 ll. 7 4,6 2.4 2.6 566 * 48,186 6.5 10,203 .7 120,009 6.4 15,761 2.8 5,662 1.3 30,302 5.9 2.6 494,482 u.s 5,9 33,854 1.3 s.o 80,998 17.2 4.1 88,724 4.3 7.4 456,764 14.0 4,0 115,873 5.5 4.7 50,636 14.3 8.1 35,899 7.6 4,5 24,963 7.0 1.5 8,527 2.8 8,5 10,189 7.4 3.5 72,991 5.1 2.5 169,600 2.9 2.5 14,154 24.7 2.9 16,476 3.4 4.7 19,474 10,7 2.4 26,959 2.4 3.1 53,362 4,3 421 Caae Service Expenditure.!/ By Category (By State) Fiscal Year 1966 Amount and Percent Each i! of Total Case Service Exeenditures Training and Trainia& Materials Amount Percent Maintenance and Trans2ortation Amount Percent Tools, Equi~t, Licenses1 & Other Amount Percent At Rehabilitation or Adjus~ent Centers Amount Percent At Workshol!s State or Amount Percent Territory $29.186.~40 25,97. 305,475 182,395 1,057,297 62,871 264,691 23,743 32.4 35,7 57,6 36,2 29,5 5,8 $15.671,777 13,97. $2.305.096 1.& $24.296,276 21,6% $~.314.746 4, 7% !! ! Total 114,621 110,980 173,450 14,715 47,936 26,775 12,2 21,7 9,4 8,5 5,3 6,6 12,521 1.3 20,208 4.0 2,172 .1 2,352 1.4 7,013 ,8 4,261 1,0 148,410 50,678 146,524 14,815 79,432 175,917 15,8 9,9 8,0 8,5 8,9 43,3 102,864 5, 765 54,323 869 108,887 46,916 10,9 1,1 3,0 ,5 12,1 11,6 Conn. Me, Mass, N. H, R, I. Vt, 86,128 887,017 3,648,853 2,928,519 22.5 32,9 41.6 24,7 55,955 312,361 1,559,503 1,521,251 14.6 11,6 17,8 12,8 2,194 ,6 34,369 1.3 100,934 1,1 62,256 ,5 48,150 364,679 1,769,581 3,095,242 12,6 13.5 20,2 26,1 48,362 190,286 153,789 928,541 12.6 7.0 1. 7 7,8 Del, N, J, N. Y, Pa, 68,644 392,922 483,814 787,696 557,146 276,716 2,417 256,326 22,3 24,5 33,3 15,4 25,3 10,0 9,3 9,0 301,134 877,863 630,692 163,076 256,836 457,040 7,9 20,0 11.3 10,5 8,7 20,5 72,502 135,613 244,301 390,932 349,211 127,415 4, 713 217,731 23,6 8,5 16,8 7,7 15,8 4,6 18,1 7,6 262,730 499,466 248,824 150,392 229,606 339,861 6,9 11,4 4,4 9,7 7,8 15.2 5,474 1,8 17,538 1.1 27,597 1,9 92,716 1.& 81,548 3,7 22,519 ,8 805 3.1 34,056 1,2 76,978 2.0 242,951 5.5 150,291 2.7 56,688 3,7 36,863 1.3 60,851 2,7 4,432 682,909 55,805 1,018,852 699,862 876,325 5,517 1,352,797 1,4 42,7 3.9 20,0 31,7 31,5 21.2 47,5 1,765,190 171,916 2,030,000 599,666 1,105,488 108,373 46,3 3,9 36,3 38,6 37,7 4,9 6 7,285 37,186 55,605 267,563 14,606 885 21,9 2,3 3,8 5,2 ,5 3,4 173,356 40,832 244,081 1,994 87,261 4.0 .7 15.7 ,1 3,9 De C, Ky, Md, N, C, P, R, Va, v.ra. W,Va, Alab, Fla. Ga. Mlsa, S, C, Tenn. 1,172, 702 834,104 556,404 1,002,240 752,470 23,3 63.9 38,5 47,5 20,7 971,305 87,321 198,994 310,06 7 603,327 19,3 6,7 13.8 14,7 16,6 133,807 2.6 29,695 2,3 40,548 2.8 46,396 2.2 118,683 3,2 72,113 13;445 23,059 237,862 334,470 1,4 1,0 1.6 11,3 9,2 326,091 6,5 5,307 ,2 1,146,228 31,5 Ill. Ind, Mich. Ohio Wise, 484,893 173,662 624,683 534,830 240,382 153,730 240,999 36,5 23.3 42,4 28,7 42,2 36,4 47,2 208,604 125,914 197,035 335,831 77,819 114,135 104,397 15,7 16.9 13,4 18,0 13,7 27.1 20,4 52,733 4.0 11,867 1.6 87,912 6,0 44,382 2.4 39,512 6,9 13,405 3,2 13,322 2,6 468,839 259,126 314,759 79,700 12,755 33,039 47,277 35,2 34,8 21.3 4,3 2,2 7.8 9,3 2,866 100,594 146,284 94,282 60,004 21,349 ,4 6,8 7,9 16,6 14,2 4.2 Iowa Kana. Minn. Mo, Nebr. N,D, S, D, 323,863 553,531 120,5~ 772,957 843,053 7,6 21,4 25,6 37,5 25,9 116,311 592,595 116,834 316,265 722,354 2,7 22,9 24,8 15,3 22,2 27,509 ,6 20,159 ,8 10,465 2.2 9,611 .5 37,071 1,1 2,579,589 1,045,742 17,407 448,639 204,309 60,2 40,4 3,7 21,8 6,3 65,036 1,5 43,377 1. 7 134,813 4,2 Ark, La. N, M, Okla, Tex. 788,052 191,094 223,850 195,502 65.703 37,3 53,9 47,2 54,9 21,8 625,231 31,719 62,966 41,919 54,299 29,6 8,9 13,3 11,8 18,0 88,718 4.2 2, 757 .a 7,213 1,5 6,833 1,9 7,702 2.6 42,993 2,850 54,659 4,994 139,214 2,0 ,8 11,5 1,4 46,1 85,470 4,0 1,622 .4 3,184 1,1 Colo, Ida, Mont, Utah Wyo, 29,458 400,084 1,830,693 1,384 76,567 35,682 478,595 525,476 21,3 27,8 31,2 2,4 15,7 19,5 42,4 42,5 66,335 336,492 1,458. 711 18,808 36,373 72,578 294,141 162,253 48,0 23,3 24,9 32,8 7,5 39,7 26,0 13,1 1,288 ,9 15~556 1.1 198,750 3,4 655 1,2 2,152 ,4 3,154 1.7 38,16 7 3,4 39,919 3,2 3,756 2,7 222,532 15,4 877,669 15,0 129,560 12,388 40,644 202,327 26,6 6,8 3.6 16,4 828 75,678 11!5 ,229 11,000 150,617 2,385 21,246 ,6 5,3 3,1 19,2 30,9 ,2 1,7 Alas. Ariz, Cal, Guam Haw, Nev, Ore, Wash, 13 422 Total Cases Served Per Counselor Fiscal Year 1966 -135------------- Total 0 25 50 75 100 125 150 175 200 225 and Over Region I Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont Region II Delaware New Jersey New York Pennsylvania Region III Dist. of Columbia Kentucky Maryland North Carolina Puerto Rico Virginia Virgin Islands West Virginia Region IV Alabama Florida Georgia Mississippi South carolina Tennessee Region V Illinois Indiana Michigan Ohio Wisconsin Region VI Iowa Kansas Minnesota Missouri Nebraska North Dakota South Dakota Region VII Arkansas Louisiana New Mexico Oklahoma Texas Region VIII Colorado Idaho Montana Utah Wyoming Region IX Alaska Arizona California Guam Hawaii Nevada Oregon Washington 20 423 Number Rehabilitated Per Counselor Fiscal Year 1966 0 10 20 30 40 50 60 70 80 90 and Over Total - 42-------- Region! Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont Region II Delaware New Jersey New York Pennsylvania Region III Dist. of Columbia Kentucky Maryland North Carolina Puerto Rico Virginia Virgin Islands West Virginia Region IV Alabama Florida Georgia Mississippi South Carolina Tennessee Region V Illinois Indiana Michigan Ohio Wisconsin Region VI Iowa Kansas Minnesota Missouri Nebraska North Dakota South Dakota Region VII Arkansas Louisiana New Mexico Oklahoma Texas Region VIII Colorado Idaho Montana Utah Wyoming Region IX Alaska Arizona California Guam Hawaii Nevada Oregon Washington - 3 v; 1 : : ; ; ; ; ; ; ; : : : : : : : 41 32 51 --- 22iiiiiiiiiiii 49 43 48 48 -42 -85 -52 -108 -39 -72 -29 -55 41 22 - 49 37 - 58 61 - 63 54 - 30 40 - 66 - 28 37 - 45 30 - 35 30 -- 30 49 38 37 - 40 27 - 51 56 43 - 46 25 - 11. 28 - 20 1'. - 22 19 - 29 - 19 21 APPENDIX H A TWO-DIMENSIONAL DIA~NOSTIC CLASSIFICATION PLAN Robert Callis University of Mi~souri Robin J. Clyde University of Missouri The role of diagnosis in counseling has been the object of sporadic attention for the past quarter of a century. In the early history of ccunseling, diagnosis was accepted as a respectable function in counseling. In the early 1940's doubt was cast on the appropriateness of diagnosis as a part of the counselor's behavior. Now, in the past few years there seems to have been a revival of interest in dia~n~sis in connection with counseling (Apostal and Miller, 1959; Berczin, 1957; Byrne, 1958; Myers, et al, 1960; Sloan and Pierce-Jon2s, 1958; and \ieiner, 1959). -- The fundamental purpose of diagnosis in counselin)?; is to enable the counselor to make predictions about client behavior from which he in turn constructs his plans for handling the client's problem (sec Hunt's co~ment on Sloan and Pierce-Jones, 1958). In commenting on Byrne (1958) Gilbert cites essentially the same function of diagnosis in counseling: "Thus we could move from an era vlhich corresponds to the leeching and bleed-letting area of medicine where every ailment was treated in the sc..me way to an era in which different psychological difficulties are treated by procedures which are especially appropriate to the particular difficulty." Hilliarnson and Darley ( 1937) set forth one of the earliest di.,~p:nos t~c schemes where they offered the following categories for client p~oblems: vocational, educational, personal-social-emotional, finan- ci.al, health and family. Bardin ( 19 46) objected to these because they did not lead to differential choice of treatment. He offered instead a new set of categories which held more promise of leading to differential choice of treatment. Pepinsky (1948) modified Bardin's categorj.es slightly and tested them out on actuel case data. Weiner (1959) discussed three "personal adjustment'' cases to show the need for cc-.re ful diagnosis in counseling and in 9,500 D: < ...I 9,000 < rJ) 8,500 ...I < :zz:::l < 8,000 7,500 APPENDIX K The Professional Preparation of Rehabilitation Counselors A Statement of Policy American Rehabilitation Counseling Association March 1967 446 THE PROFESSIONAL PREPARATION OF REHABILITATION COUNSELORS A Statement of Policy American Rehabilitation Counseling Association March 1967 This statement, by the American Rehabilitation Counseling Association is one of a series of statements prepared to supplement the APGA Statement of Policy on The Counselor: Professional Preparation ~ ]2l. The APGA statement is concerned with the common elements of counseling required for high quality performance in any setting in which counselors function. The present statement enlarges upon the APGA statement to delineate the special preparation required by the rehabilitation counselor. These standards are concerned with the preparation of counselors who are employed in such public and private vocational rehabilitation agencies as State Divisions or Bureaus of Vocational Rehabilitation, rehabilitation centers, sheltered workshops vocational guidance and rehabilitation centers and vocational rehabilitation units of mental health facilities. 4-4-1 Clients of such agencies are usually late adolescents or adults who are handicapped either by physical, mental, social or emotional disabilities which often have major socio-cultural and physchological ramifications and who, thereby, are usually in need of general counseling services as well as counseling activities specific to vocational placement. The role and function of a counselor in such agencies are often quite varied, and may include counseling on personal-socialemotional problems, family problems, educational and vocational problems as well as placement services. Though the focus is, necessarily, upon optimal vocational placement of the client, the concern of the agency and of the counselor is with the individual's total development and functioning as a contributing citizen in our society. An important element in the developmental process is the vocational development and economic aspect of life. The educational institution should have either an explicit or implicit concept of goals and objectives which is consistent with preparation for a profession in a democratic society. Selection, Retention, Endorsement and Placement. The educational institution should have a program of recruitment and selection which will assure the selection of candidates (a) possessing an appropriate undergraduate background, (b) capable of successful academic performance at the graduate level, (c) having the potential for developing an effective counseling relationship, and (d) possessing characteristics indicative of continuous growth. While it may be undesirable to limit the candidates to those with specific undergraduate preparation, the nature of graduate preparation in rehabilitation counseling is primarily psychological and a background of undergraduate work in psychology would appear to be desirable. As the APGA Policy Statement emphasizes, the counselor is a professional person and as such is expected to exercise expert judgment, necessarily involving opinion and reason, in his areas of competence. He accepts and performs his work in consonance with a professional code of ethics. His proper expectation is that his work setting and work atmosphere will enable him to function as a professional person at a professional level. The trained counselor will expect to receive technical supervision but this must come from those professionally qualified through training and experience. The nature of counseling, finally, frequently requires relationships with others in counseling, related disciplines, and community agencies. COUNSELOR PREPARATION The objective of professional education is to prepare the individual for entering upon a lifelong profession, not for a specific job or position. Education for a profession never ends. Therefore, a professional curriculum is concerned with inculcating methods and habits of learning professional attitudes and identification, and a critical, questioning and exploratory attitude. Knowledges and skills are essential, but not sufficient. Students with work in developmental psychology, psychology of personality, social psychology and an introduction to statistics and tests and measurements are in a position to pursue a more advanced or accelerated program of counselor preparation at the graduate level. Since the selection process is not infallible, there should be a process of continuous evaluation and selection throughout the rehabilitation counselor education program to eliminate those candidates not demonstrating the requisite characteristics for becoming effective counselors. Those candidates who complete the program should have assistance with placement in positions appropriate to their special interests and abilities. Counselor training programs are encouraged to continuously evaluate their selection and retention procedures. -- --- adLeqevuealte-an-cd-ur Nature of riculum of the Curriculum. An counselor prepara- tion should meet the following requirements: 1. Counselor preparation is graduate level work. Paramount is the development of an understanding of the philosophy and theory and the psychological, sociological and economic principles, that constitute the foundations of counseling. Techniques and skills are operating means of applying the principles built upon these foundations. 448 2. Two years of study, a substantial part of which is on a full-time basis, is necessary for adequate preparation in counseling. 3. While the program may be adapted to differing backgrounds and individual differences among students, there should be a well-defined and patterned sequence of courses fundamental to preparing a professional counselor. 4. The curriculum should include the following elements which are shared with all counselors. a. The foundations of human behavior and dynamics of behavior change. (1) develop in self understanding, including opportunity for personal counseling (2) Understand, observe or participate in research studies or activities (3) Engage in independent or advanced study in areas of special interest (4) Integrate the various aspects of the curriculum, including theory and practice (5) Identify and affiliate with appropriate professional organizations b. Social-cultural-economic factors influencing individuals and groups particularly in their economic and occupational aspects. c. Professional studies in counseling (1) Philosophy and fundamental assumptions in counseling (2) Counseling theory and practice (3) Group approaches to counseling (4) Psychological appraisal by means of tests and other methods of evaluation and measurement, including the requisite statistics (5) Occupational psychology, the psychology of vocational development and the social environmental information necessary for vocational choices. d. Specific preparation for working with the kinds of clients to be encountered in the rehabilitation setting in which the counselor will work. (1) The nature of the setting, its agencies and their programs, and common problems (2) The nature of the particular client population including any special characteristics, needs, and problems. This should include a study of the medical and psychological aspects of disability. e. While there may be no specific courses dealing with the general personal and professional development of the counselor candidate, there should be opportunity, both formal and informal for the candidate to: 5. Supervised Experience. An adequate program of counselor education should provide a graduated series of experiences for the student. a. In the earlier stages of the program, opportunities for observation (direct or indirect, as through films and tapes) should be provided. Laboratory experience in interviewing and testing should also be an integral aspect of the training prior to the assignment of complete responsibility for a client to a trainee. In addition, rotated, pre-counseling training assignments with rehabilitation agencies may provide trainees with relevant information about the structure and function of agencies and the nature of the client population. b. Practicum experience in counseling should be provided. This experience should meet the following requirements: (1) It should be meaningfully integrated with the didactic training. The experience should be intensive and concentrated and under close supervision. (2) This experience should consist of work with a number and variety of clients. (3) Sixty hours appears to be an acceptable minimum for counseling relationships with clients. It is important that the student carry a number of clients for several contacts over a period of time. 449 (4) Close and direct (at least one hour per week) supervision should be provided including some first hand observation of the student either through monitoring or through taped interviews. University supervisors should be counselors, preferably trained to the doctoral level, with experience in counseling beyond that acquired in practicum. (7) The educational institution maintains contact with the student and provides supervision aimed particularly with assisting the student to integrate his academic training with the agency program and requirements. Educational staff supervisors should be preferably trained counselors with experience related to the agency in which the student is placed. (5) Since growth in counseling requires time, the practicum should extend over a period of at least one quarter or semester program as a minimum. (6) The practicum setting should be conducive to maintenance and progress of the counseling relationship. c. An internship should be provided. Internship, in contrast to the practicum, is a supervised experience in a work setting. It should meet the following requirements; (1) The internship may be in a single rehabilitation agency or in more than one agency. (2) It may be on a block or on a concurrent basis (3) It may be paid or unpaid experience (4) Regardless of the nature of the experience, it should be regarded as much more than observation or orientation. It thus must consist of concentrated periods of time in the agency setting so that the student gets the feel of the agency as a junior staff member and is able to carry cases over a period of time. Two full days a week appears to be the minimum time to achieve these goals. The experience should consist of a minimum of 480 hours of work in an agency setting. (5) The agency must provide adequate facilities, equipment and materials for the student to function at a professional level. (6) The agency must provide day by day supervision by a supervisor, qualified by education and experience. Instructional Conditions and Support for Counselor Education. The educational institution should support the program in the following ways: 1. The program should be accepted as an integral part of a strong graduate program. 2. Faculty members should be well qualified by education, with appropriate preparation at the doctoral level viz., counseling or allied fields, the faculty should have had some direct experience as a rehabilitation counselor. a. Staff members should be adequate in number to provide competent instruction in the various specialized areas. b. Faculty teaching courses in related disciplines should be qualified in their respective fields. c. Staff members should have an understanding of the employment settings in which their students will work. d. Staff members should be involved in at least some of the various facets of professional work. 3. Practicum instructors and internship supervisors should be allowed adequate time for individual instruction. 4. Internship settings should be selected in terms of their adequacy in providing the kind and quality of experience required by the student. (The accreditation of internship agencies, while desirable, is, however, not a function of the individual educational institutions.) 5. An effective program of counselor education requires adequate equipment and facilities for laboratory experiences, practicum training, consultation, library research, and other research activities. 6. Assistantships and other forms of assistance are available to able students. 7. Competent secretarial, clerical and research assistance (through the service of graduate assistants) are provided, as well as research facilities and equipment. 451 COMMUNITY INVOLVEMENT: A PILOT PROJECT CHAPTER I. A Survey Of The Literature CHAPTER II. Methodology And Implementation CHAPTER III. Recommendations APPENDIXES 1. Technical Force Members 2. Questionnaire I 3. Questionnaire II 4. Newspaper Clippings 5. Memo: Re: First Meeting on Community Level Page 452 457 461 463 464 470 478 485 452 COMMUNITY INVOLVEMENT: A PILOT PROJECT CHAPTER I A SURVEY OF THE LITERATURE A community is composed of a body of people having common interests or living under the same laws, organization, and regulations. However, do the interests of the general community as reflected in employment patterns, architecture, leisure activities, advertising, school and hospital location, etc., differ from those of the individual suffering from a handicap? Further, if there is a difference, is the community aware that the disabled are being psychologically, socially and functionally isolated from the mainstream? Are community attitudes toward the disabled and th.eir rehabilitation best defined as positive, negative or neutral? Is the community sufficiently knowledgeable about vocational rehabilitation facilities and services to act as a significant referral source? Has the maximum percentage of the community's handicapped been identified for the rehabilitation process? Are present facilities for rehabilitation in the community adequate to meet the needs of the handicapped now as well as in the future? The "ideal" community has the answers to these questions. The ideal community serves its disabled by acting as a source of consumer identification, a source of psychological support to the disabled while he is in the rehabilitation process, and a source of employment and self-support when the process is completed. Obviously, the "ideal" community does not exist. One prominent rehabilitation expert has written that the rehabilitation process must be reassessed to yeild community involvement from inception to completion. According to Dr. Morton A. Seidenfeld in the January, 1966, issue of the Journal of Rehabilitation, a total rehabilitation process is impossible without the direct and active involvement of the community. A well-informed society should be created which would place emphasis on every member assuming his part of the community responsibilities commensurate with his ability, not his disability. Dr. Seidenfeld recommends that the most effective means of eliciting this community involvement is action, commitment, and firm conviction based on the education of the community as to what each individual can contribute and what he can do to meet his share of the community responsibility.l One common strain found in all material on community involvement is the dictate that the action must emerge from the community structure and that the proposal must be consistent with the community definition of what is needed and what is "good". The three stages of community involvement-initiation, legitimation, and action--all revolve around these two factors: (1) who initiates the proposal and, (2) how compati ble it is with existing conceptions of "com munity welfare." The initiation of communit action occurs when an idea held by one or more individuals is moved to the position oJ being a specific proposal for the community to accept. This legitimation process involves the justification ofthe proposal and the commitment of the community to action.2 453 Several sources (2 and 3) recommend the establishment of an "exploratory" committee or "initiating set" which is composed of persons who hold the confidence of various groups in the community. Out of this group should come a convergence of interest arising from the values, beliefs and relationships of the larger community for the initiation of the specific study. This group is designed to determine if a survey is needed, to participate in the planning and execution of the project, and to suggest leaders for survey committees and voluntary assistants.3 The initiating set, therefore, must select the appropriate means to achieve its goals, must perceive the means as potentially available, and must be able to gain access to the means. 2 The initiating set, the sponsoring set, and the final sub-committees responsible for the "leg-work" of the survey should be highly representative of a cross-section of community life. Although the leadership structure should be neither elaborate nor clumsy and should include only as many jobs as must be done, the survey and information program must touch as many vital areas of community existence as possible. Unless the initial groups are well-informed both in terms of the need for the study and of the vocational rehabilitation process, the community, as a whole, cannot be expected to develop any degree of ego-involvement with the problem. Thus, education should be written into the organization oi the initiation and the sponsoring sets.7 From the legitimation process comes the expansion of the initiation set into a "sponsoring set" by the growing involvement of persons and organizations which functioned as legitimating agencies. The sponsoring group can be composed of interested citizens and businessmen, a committee representing service organizations and citizens-at-large, or by a particular group. However, regardless of the initial structure of the sponsoring group, the final form must enlist the aid and support of civic groups, churches, news media, labor representatives, consumers of agency services, interested and informed individuals who are not active in agency programs, .active board members from agencies in the various fields--voluntary and official, and special interest groups to be determined by the local situation.4 Additional study groups might be indicated which would serve to broaden the process of community education and to secure wide participation in special subareas of the survey work. Four areas of potential mobilization are (1) organizations, (2) long-time neighborhood residents (average citizens) most knmvledgeable about local informal communication networks, (3) (informal) leaders, and (4) local professional experts. The local experts could best serve in a consultative capacity to the sponsoring set or as a liaison between the agency (the Technical Force on Community Involvement in this case) and the sponsoring set. 5 The point has been made earlier that the problem presented for community investigation must challenge far-reaching, commonly perceived areas of community welfare. In the case of vocational rehabilitation, the major historical problem has been the lack of community awareness of the rehabilitation process. Even in health related professions, there exists a general breakdown in communication between agencies such as the Hental Health Department, the Cancer, Tuberculosis and Heart Associations and the Division of Vocational Rehabilitation. Therefore, the fundamental element of all initiators recognizing a common goal cannot be assumed existant in the present proposal for community self-study. It becomes necessary to build the recognition of the common goal from the very outset. Various forms of the initial discussion of the problem with a potential sponsoring group have been recommended. However, the following points seem common to the majority of the literature. (1) Discuss the problem, carefully defining and delineating who is proposing the study, why it is being proposed, what the study will investigate, and how it might be accomplished. (2) Give the historical and factual background to the problem. (3) Do not allow debate over ascertainable facts--be prepared to answer questions and to meet opposition. (4) Focus attention on problems and needs, not on controversy. 454 (5) Use primary sources of information rather than hearsay. (6) Be realistic about proposed alternatives to a problem--be open-minded--don 1 t present the ONLY solution to the group. (2) 11Select the organization or individual responsible for directing the survey. It is important that the director be familiar with community structures and relationships and have demonstrated experience in conducting such surveys. 11 (7) The leader should not lend his weight to particular alternatives or decisions based on his position--he must reflect the attitude of the group as a whole. Although the initiating group should not present the sponsoring body with a completed, packaged program for the self-study, it should offer general guidelines indicating the cost, scope and possible ~~of investigating the problem. Its representative should generally serve in the capacity outlined above and the group should give its complete endorsement to the study. 4 The sponsoring body should not be approached until a general blueprint for action has been agreed upon by the initiators. An integral element of this blueprint should be the survey in a preliminary form. This survey can provide a vital informational source in the area of motive and method legitimation. A comprehensive social survey is a study designed to examine the need for social services in the community, to determine the degree to which these needs are being met and the effectiveness of existing agencies in meeting the needs, to develop a plan for coordinated social services, and to make definite recommendations for the accomplishment of the plan.3 Thus, the problem is presented, and, once accepted by the sponsoring set as a legitimate, community-wide issue, the survey is designed to find the depth of the problem and the solution. Once the decision is reached to use the survey as the major investigation tool, plans for its conduct and follow-up should begin immediately. The following outline gives a suggested procedure by which the sponsoring set with its sub-groups might act: (1) 11Review the problems as defined by the initiating set and the recommendations regarding scope, kind, and cost of survey. Draw up a tentative plan. (3) 11Estimate the cost of the survey, including plans for follow-up. 11 (4) 11In consultation with the director, draw up a survey plan, which should include a clear definition of the purpose; proposed methods of dealing with it; recommendations regarding staff and subcommittee organization if needed; a tentative time schedule, including dates for certain meetings; proposed method of handling the report and survey recommendations; and the budget. 11 (5) 11 Present plan to all groups involved. 11 (6) 11Advise with the director in the selection of the volunteer staff to conduct the survey. 11 (7) 11Consult with appropriate state and local agencies. It is suggested that information about the proposed survey be sent to these organizations which frequently have on file information which would be of value to a survey committee and staff. 11 (8) 11Plan for the interpretation of the survey. 11 (9) ~ake a preliminary plan regarding the form of the final report. Usually, a summary of basic findings and all major recommendations will be desired. This should be prepared for general distribution. In addition, in most instances it will be found desirable to submit more detailed individual agency reports. (10) 11Plan for survey follow-up. The post survey responsibilities usually include: (a) consultation with individual agencies; (b) continued, though limited consultation with members of the survey staff for purposes of clarifying certain recommendations or observations. 113 In specific communities and in specific projects, the foregoing outline will be amended to adequately meet the individual nature of the area and the participants in the study. To the extent that conditions essential for adequate cooperation within 455 the community exist (a history of "getting things done", the ability to communicate and vital and knowledgeable leadership), the task of the initiating set, the sponsoring set and the group carrying out the survey will be relatively smooth. In the past few years, there has been a rapid increase in the various community survey and planning programs. One echoed comment has been that these plans end up "catching dust", a condition which is partly due to the lack of social change concomitant with technical change or recommendations for change. Without social change, the same attitudes, values, beliefs, actions, and relationships which are directly related to the perpetuation of environmental problems will continue to block community action. The technical planner is not usually in a position to organize for and implement the changes which are recommended on the basis of the survey. One way to overcome this problem is for the planner. to thoroughly understand the social structure of the community and to devise recommendations which will be in accord with this structure. However, regardless of how well aligned the plans are with the community organization, without adequate support, involvement, and commitment of the community the project report will still catch dust. "THERE HAS TO BE A WILLINGNESS ON THE PART OF THE LEADERS TO USE THE FINDINGS OF SUCH A STUDY, IF IT IS TO BE EFFECTIVE." 6 In summary of what has been said before, an action group committed to democratic values as well as to successful action on a particular problem should plan a project with the following characteristics: 1. The project should be educational-people reached in carrying out the project should become better informed about the problem upon which they are asked to work on. 2. The project should be approached experimentally--the group cannot know the right answers to the problem before it starts to work on it. This means that planning should be flexible. Each step in the project should be planned in the light of the best information obtained through preceding steps, and should be designed to gather information for planning succeeding steps; and, 3. The project should be collaborative-- it should be based on genuine partic- ipation of the people involved in each step of the project as it moves along. It should provide for con- structive contributions toward prac- tical solutions of community prob- lems. As many as possible of the people who will be affected by the project should be involved in making decisions. Their thinking, as well as their leg work and manpower, should of the find its problem. 5way into the solution Returning to Dr. Seidenfeld's article in the Journal of Rehabilitation, the following quote is offered: "A serious self exploration of community failures in meeting the needs of the disabled might lead to less self-satisfaction on the part of community leadership and a demand that rehaoilitation planning no longer be done in the vacuum of a hospital conference room and only by professional representation from agencies well-intentioned but often with only a very superficial knowledge of actual community plans." The foregoing report is presented as one means of instituting such an exploration. 456 FOOTNOTES 1. "Lip Service Won't Do It", Morton A. Seidenfeld, Journal of Rehabilitation, January-February, 1966. 2. Sower, Christopher, Community Involvement, The Free Press, Glencoe, Illinois, 1957. 3. Shall We Make A Survey?, National Social Welfare Assembly, Inc., 345 East 46th Street, New York, N.Y. 10017. 4. Community Self Assistance, Ernest E. Melvin, Institute of Community and Area Development, The University of Georgia, Athens, Georgia. 5. Taking Action in the Community, Leadership Pamphlet #3, Adult Education Association of the United States. 6. Community Social Analysis: Augusta-Richmond County, Harold L. Nix and Charles J. Dudley, The Institute of Community and Area Development and Department of Sociology and Anthropology, The University of Georgia. 7. Design for Community Action, W. Williard Wirtz, Bulletin 248, U. S. Department of Labor. 457 CHAPTER II METHODOLOGY AND IMPLEMENTATION Since a total rehabilitation process is impossible without the direct and active involvement of the community, a wellinformed society should be created which would place emphasis on every member assuming his part of the community responsibilities commensurate with his ability, not his disability. 458 Besides the observation of Dr. Seidenfeld and others in the rehabilitation field concerning the rehabilitated handicapped person's need for acceptance in the community, another significant gain, from a planning aspect, would be the support of the community in expanding and improving vocational rehabilitation services. The Planning Project has been charged with providing recommendations that would assure that by 1975 all eligible disabled persons in the State would receive VR services. Only by the support of the community is this a possible goal. The Planning Project established a Technical Force composed of volunteers with experience in community-wide activities, as well as interest in vocational rehabilitation, to investigate the feasibility and means of attaining an involvement on a grass roots level in the rehabilitation program. Selection of nominees for membership on the Tech Force was based on the individual's experience with the vocationally handicapped and his work with volunteer civic and related groups. The Tech Force created a program of initiation plus legitimation equals action. For this project, a community was defined as a County. This decision was made because records of schools, disabilities, hospitals, etc. are kept on a County level. Since the final report of the Planning Project must be completed by May 14, 1968, it was impossible to establish such longrange programs in each of the counties. It was decided to concentrate on two counties -- one representative of the rural community and the other representative of the urban/rural community. The Te~h Force examined available information on the two counties selected and compared them with other counties in the state. Factors that influenced the decision to use these two counties included: Population changes as projected to 1975; The economic climate; race ratio; whether or not a majority of the population both work and live within the County; ratio of children to adults; family earnings; presence of local news media. The first county was selected because the above factors indicated that it was basically representative of the urban setting and the second county in contrast represented the typically rural community. The Technical Force decided upon basic steps which would lead to the ultimate goal of involvement. Members of the local vocational rehabilitation offices were to be asked to enlist the support of various leaders in community life to act as an advisory group in establishing an involvement program. Although the Tech Force would create a format that would possibly be used to initiate a program of community involvement, it was agreed that the Advisory group would have to decide: (1) Whether or not it was felt that such a program was, in fact, wanted, and (2) The actual means by which a program could be established and perpetuated if it was decided it would be worthwhile. To be a meaningful program on a community level, the Tech Force felt it was necessary that an organization within the community should be approached to establish, and maintain, an involvement program within its boundaries. The Advisory group (after agreeing on the importance of this program) would suggest such a group to be approached with the request that they take the vocational rehabilitation community involvement program as a continuing project. In hindsight, the Planning Project feels that it would have been advisable to have included one or more highranking OVR Staff personnel as members of the Task Force so that the OVR would have had an integral part in the planning and execution of the Pilot Project. As it was, the initial contact with the local OVR representatives did not produce the enthusiasm which the Tech Force anticipated. The structure of OVR is such that each professional staff member jealously guards, and rightly so, his area of activity both geographically and functionally. Therefore, the first District Supervisor contacted displayed a reluctance to accept the project either on its philosophical or practical application. He was particularly concerned with forcing his local counselor to accept added responsibilities in the field of public relations, and indicated that the project would produce a caseload of great proportions which his district would be unable to serve adequately by staff or funds. All of the misg~v~ngs hinged on the fact that the District Supervisor and the local counselor felt that neither the Planning Project Staff nor the Tech Force representatives were knowledgeable in the field of rehabilitation or in the bureaucratic struc- 459 ture of OVR. The good intent of "outsiders" was taken as a bothersome intrusion into a local organization that was doing "just fine." The opposition to the project was so strongly vented that it was felt that continued effort would be unfruitful. Before contacting the OVR Supervisor in whose district the second county was located, the Tech Force enlisted the support of an OVR Director. His endorsement of the project was vastly instrumental in overcoming the apprehension expressed by the second district supervisor. The field counselor for the county compiled a list of perspective members of an Advisory group, contacted each individually, explained in general the program, and invited those who accepted to a dinner meeting. At the initial meeting the district supervisor acted as host and master of ceremonies and introduced members of the Tech Force and Planning Project who presented a program which explained the history of vocational rehabilitation, Georgia's Office of Vocational Rehabilitation, the purpose of the Planning Project, and the philosophy underlying the community involvement pilot project. For over an hour the group enthusiastically discussed the local implications of vocational rehabilitation and asked numerous questions of the local counselor. The group decided to approach several civic organizations to share the responsibility of maintaining an ongoing program. The Tech Force representatives gave details of questionnaires available for the sponsoring organizations to use if they wished. These questionnaires were designed to survey community knowledge of and attitudes toward vocational rehabilitation and the The enthusiasm of the group not only relieved the district supervisor of his fears and misgivings, but also deluded the Tech Force into believing that a strong organization had evolved from this gathering. Unfortunately, each member of the Advisory group has a dominant personality and is a leader in his own right within the community. Of these leaders, then, no one person was selected or assumed to be responsible for the guidance of this activity. Complacently, the Tech Force members and the Planning Project Staff released the reins assuming that they were taken with full authority by the Advisory group. Even though a program was requested and later presented to one of the spousoring groups, the activity remained in a dormant state while all concerned waited for leadership. Although the sponsoring groups agreed on the need of a community-wide survey, as mentioned above, they did not feel that they had a large enough membership to properly conduct such a survey. They decided to ask the senior high school students in the county to survey their housEholds and requested that the Planning Project instruct the students on methodology. To increase the sample size, the Planning Project decided that each student could interview two neighbors as well as the breadwinner in his own home. Two representatives of the Technical Force instructed the students on the methodology in conducting their surveys and also distributed Questionnaire II to those appropriate persons mentioned before. Another important aspect of the methodology to be used in surveying was the decision of the advisory group to ask the civic organizations to survey their members using Questionnaire II. This was the first concrete activity of the community even though it had been nearly four months since the initial meeting of the Advisory group and the time that the Planning Project received the request for assistance on the survey. (No one individual in the community was responsible for the execution of this survey which, undoubtedly, accounted for the poor response.) handicapped. Questionnaire I was designed to survey the general population and Questionnaire II was to be used in surveying specialized groups of Health and Social Service professionals, employers and civic leaders. After analyzing the situation, the Tech Force realized the necessity for further contact with the local individuals to attempt the establishment of local leadership and to more clearly explain that action must come from within the community 460 as a perpetuating project and must not depend upon outside influence. In reviewing the initial approach, the Tech Force saw that the pilot project could easily have been misleading because it appeared that the county had "been chosen", implying that they would be told what to do to aid the Statewide Vocational Rehabilitation Planning Project. At a subsequent meeting, therefore, it was explained that, although the Office of Vocational Rehabilitation would gladly furnish any asssistance requested, the formulation and execution of a Community Involvement program must be generated within the capabilities and limitations of the individual community. The "Pilot Project" would belong to the Tech Force, which would act as observers and reporters of the community-level activity. To support the premise of need for community involvement, the results of the surveys were presented at that meeting by the Planning Project's Research Associate. At that meeting, structured organization was established in the form of a committee, with an elected chairman. This committee was charged with the responsibility of implementing the activity which was discussed at that meeting, e.g., the compiling and publishing of a social services directory for the County, the development of an extensive public education program concerning VR, and self-education of the committee itself. This meeting, five months since the 'first contact on the community level, produced some of the results which should have taken place at the onset. The Tech Force and the Planning Project learned much from this Pilot Study in human relations, volunteer participation, community dynamics, and professional attitudes toward Community Involvement. Tt1e re-o der is asked to draw many of his own conclusions from this chapter of the Planning Project. One obvious analogy: there are many willing soldiers in the field who need effective field officers for a victorious campaign. The OVR, working with an advisory group, can be strong chiefs of staff, but the artillary officer must direct his men from the field. CHAPTER III RECOMMENDATIONS Although the Tech Force realized failures and disillusionment in the Pilot Study of two Georgia counties for Community Involvement, it is emphasized that these shortcomings ~ be observed objectively for actual implementation of a realistic program for the remaining counties. Every community will have its own pitfalls; the preceding narrative was recorded so that further planning in this area can take into account basic errors which can be avoided. The conviction of the Planning Project and the steadfastness of the Tech Force remain unchanged: community involvement is a vital part in the total vocational rehabilitation program. It is recommended: 1. That the OVR Information Office be charged with the responsibility of promoting an extensive drive for Community Involvement using the general guidelines, as established by the Technical Force. It is recognized that this Office continually performs its duties as presently outlined in an exemplary fashion, and this recommendation in no way reflects dissatisfaction with the execution of those duties. Presently, however, the scope of activity of this office does not include extensive participation on a local level. 2. That the organizations chosen by the initial advisory group use all local chapters of statewide organizations, e.g., Kiwanis, Rotary, Senior Women's Club. It is recommended that the pilot activities of these local organizations be closely observed with the objective of proposing to their state level organization that such activity could be included in all chapters throughout the state. Thi~ould be accomplished only by close cooperation between the OVR Information Office and the local Advisory Group. Members of this group are aware and have expressed a willingness to work toward this end. 3. It is extremely important to realize that this project cannot be limited to the OVR but must include all agencies that perform vocational rehabilitative services; therefore, it is of necessity that a further recommendation be included: that close cooperation be maintained between OVR and all other related agencies, state, private non-profit and profit. There must be an initiator for such a relationship. Realizing that, this will mean an added responsibility and burden to the already overworked OVR staff, the Planning Project and the Tech Force who concur that the rewards of a successful community involvement program will far outweigh the task of initiating such action. ;-'F'.J~(~-;r-.;.-~ o.~v.";~~.-;-".,..~ .. ~~~; ;:.: . I N I T I A T 0 N + L E G I T I MA T I 0 N = A C T I 0 N 0 ~\ill~~~ .() ' fllt:f( ' - {.. 0 '"' I I ~ I I ' I ' .j::-- 0\ N . " ...,......,..,.-.,.~. -~~ ..-~....,;._.._;,.;.c.,:,-.~.__._.-:..__._ ri1'E -.,.,........,-.~ -~ -~-~~-....t.--....._~~~~--- . J~~...,___..............._........,.'-.,~~~ bs , ..,. ., \4 PHASE 1: Statewide Vocational Rehabilitation Planning Project recognizt:':i lhe need for community involvement as a part of the rehabilitation process. PHASE 2: PHASE 3: A Technical Force is appointed to develop general guide] ines a cornrnunity could follow in creating a workable program. Tech Force representatives contact county OVR counselor who recommends local leaders to serve as an advisorv aroun. APPENDIX 1 MEMBERS OF THE TECHNICAL FORCE ON COMMUNITY INVOLVEMENT Miss Carol Ann Blair Institute of Government University of Georgia Athens, Georgia 30602 Mrs. Hal Drake 1306 LaVista Road, N.E. Atlanta, Georgia Jim Hester, Director West End Neighborhood Service Center 725 Lawton Street, S.W. Atlanta, Georgia Mr. Charles Long Rehabilitation Liaison Statewide Planning Project 159 Forrest Avenue, N.E. Atlanta, Georgia 30303 Mr. Norman Shavin Department of Health, Education and Welfare 7th Street Building Atlanta, Georgia Zack Tatum, Coordinator Vocational Rehabilitation Grady Hospital 80 Butler Street, S.E. Atlanta, Georgia Mr. Ernest W. Wright Metropolitan Employment Service 61 Trinity Avenue, S.W. Atlanta, Georgia Miss Karen Butler Research Associate Statewide Planning Project 159 Forrest Avenue, N.E. Atlanta, Georgia J j J J j J J j J J j J J j J J j 464 APPENDIX 2 QUESTIONNAIRE I 1<10RTH COUNTY SURVEY Instructions This survey is a part of Worth County's participation in the statewide vocational rehabilitation program. To be a meaningful community survey, it is necessary that you answer every question. Remember, your answers will be kept confidential and there is no grading of the answers. On several questions you will be asked to rate on a scale your feelings about a particular subject. For example: How would you rate your feelings toward the building of a new hospital in your area? V Highly Favorable I Highly 1___,/_ _1_1_ _/ Unfavorable If you felt highly favorable toward a n~1 hospital, you would have placed a check mark as shown above. If you had felt neutral on this issue, you would have checked the middle space. 465 VOCATIONAL REHABILITATION SURVEY CONHUNITY INVOLVEUENT PROJECT 1. PRELIMINARY INFORNATION N~-----L-A~S~T ------------F~IR~S~T--------1~"-I~ID~DL-E----------- ADDRESS__S~T~RE~ET~~&~NU-M-BE-R ---~T~Ot~~~~O~R-R-FD--------~CO~UN~T-Y ---- OCCUPATION._________________________________________________ PLACE OF EMPLOYMENT.________________________________ ADDRESS MARITAL STATUS : - - - HARRIED SEPARATED - - - DIVORCED - - - SINGLE---- NUMBER OF CHILDREN - - - - AGES OF CHILDREN------------ HIGHEST LEVEL OF EDUCATION COMPLETED BY INTERVIEl~E Less than eighth grade Completed eighth gra~e Less than high school Completed high school Some trade or vocational school work Completed trade or vocational school Some college work Completed college Post-college 'vork NUMBER OF PERSONS IN THE HOUSEHOLD - - - - - - - - - - - - - DATE OF INTERVIEW - - - - - - - - - - - - - - - - - - - - - - - - - - - - INTERVIEWER 466' 2. Knowledge of Vocational Rehabilitation Services and Facilities A. Name any agencies that you know of which train, treat, and/or find jobs for the handicapped. B. Have you ever heard the term "vocational rehabilitation?" Yes No If yes, briefly tell what vocational rehabilitation is. C. Have you ever heard of the Georgia Division of Vocational Rehabilitation? Yes No ---------------- IF YES: (1) What was the source of your information? (2) Name as many services as you can that are offered by the Division. (3) Who can receive Vocational Rehabilitation services? (4) Give the location of any Vocational Rehabilitation facilities that you know of. (5) Where is the office of the Vocational Rehabilitation counselor located in your area? (6) Do you have to be low-income to receive Vocational Rehabilitation services? Yes No ----- 467 3. Community I. ttitt::es Tcn-1ard the Disable: an(. Tm~rd Vocational Rehabilitation A. Do you thin~t tax money should be '-'sed to sup,ort programs 1o1hich train, treat and/or fine. employment or the handicapped? - Yes ---- -Ho ---- B. If you feel these programs should not be tax-supported, should the services be provided at all? Yes No_ _ _ _ __ If yes, by whom should they be provide~? C. What tl'O words best riescribe the way you feel when you see a physically or mentelly handicapped person? (l) (2) D. What type of disability makes you more uncomfortable than others? E. What ty!'e of clis,gbility makes you leest uncomfortable? F. Do you think handicappe~ ::>ersons should be allowed to "'ork "'ith "normal': healthy individuals'! Yes -No ------- G. If you were in a ;_::osition to hire new employees, "t-7oulci you consider a trained handicapped !_)erson? Yes No._ _ __ If no, Hhy 't.Yould you !!.2! hire the handicappec t-7orker? H. If you had chil~ren, ~ould it bother you to have handicappe~ children attend school lJith them'! Yes No_ _ __ :. f ! why wotllcl it bother you'? 468 I. Dn you think that the disabled person's problems concern you? Yes Nn _ _ __ If ~. in what way are ynu concerned by their problems? 4. Knowledge of the handicapped A. How many physically or mentally handicapped persons do you know personally? What types of handicaps dn they have? B. Have you ever worked nn a job with handicapped persons? Yes _ __ No ___ If ~~ what types of handicaps did they have? Have you ever gone to school with a handicapped person? - - - Yes ___ No If yes, what types of handicaps did the person have? C. How many handicapped persons do you know of living in your neighborhood? What are their handicaps? E. Are there any handicapped persons in your hovsehol~~ Yes _____ If Yes: No- - - - - A. H~n~icpry with dcscri~tion of Leneth Lest Grade severity. (Can pe~son care of Age Sex Et1ucetion for self? Is nerson mobile?) Disability Cornpleteci 1. Present Employment Employment Before Disability 0' \.'~) ._j- 2. I ----- - --- - - B. Has person(s) ever been enrolled in any vocational rehabilitation program? - Yes ---- If Yes: _ i~o _ _ _ __ Disability of person(s) as given above:(l) 2 Date services received:(l) 2 What services received:(l) 2 --------- ----- ~-- 470 APPENDIX 3 QUESTIONNAIRE II \Jing scale? Excellent - - - - -Poor Comments, if any: 2. In which of the following areas do you feel the public is least and ~ knowledgeable? Least host a. Eligibility for services b. Available services c. Procedure for making a?plicetion d. Location of services f facilities e. Details of services, such as time involved, cost to individual, procedures or steps in rehabilitation process f. Other (specify)_______________________ Comments, if any: 3. How would you value the following means of informing the general public of vocational rehabilitation services in your area? of high value of questionable value of no value a. Local TV coverage of film and vocational rehabilitation personnel describing services, etc., and radio coverage b. Local coverage in newspaper editorials or short series of articles c. Film and VR personnel presentation depicting VR to civic, professional, church and social groups d. Distribution of pamphlets describing VR to general public through mail or hand delivery e. Visual displays (bulletin boards, etc.) in public places f. Special programs in the schools to describe services available g. Publication of a ~ommunity Social Service Directory" to describe all services available giving addresses, eligibility requirements, etc. h. Ocher (specify) Comments, if any: 4. On the following scale, rate general public attitudes toward VR. Vitally concerned !____ I ____ I ____ I ____ I ____I Totally unconcerned Supportive Approving 1_1 _ I _ I _ I _I Non-supportive 1_1 _ I _ I _ I __I Non-approving Comments, if any: 474 S. Of what value do you feel the foll~1ing would have on public attitudes t~ard VR and the disabled citizens of your community? of high value of questionable value of no value a. Volunteer service welcomed in community agencies b. Extensive public information campaigns (regarding work potential of handic~.n7~ci p?.rsons, problems of hanJicapped, need for community support during rehabilitation process, eff~~tiveness of rehabilitation, etc.) c. "Open houses" in which visits by the public to agencies and facilities are invited and welcomed d. More community interaction on the part of handicapped citizens (join service orgattizations, 't'ork committees, etc.)--generally be more "vis ib le11 e. Other (specify)___________ Comments, if any: 6. On the folJ.~'I'.Jing sec. le, rate the attitudes of employers t~ard hiring c' J ,,~;J le.d '1'.-lo.ckers in your area: Highly favorable Unwilling to to hiring the hire the handi- handicapped worker /____ I I I I / capped worker Comments, if any: '+I:J 7. How important do you feel the foll~1ing reasons are for employer refusal or reluctance to hire handicapped workers? highly of questionable of no important importance importance a. Fear of nexpense" which might be involved b. Reluctance to having disfigured or "unsightly" individuals in place of business c. Fear of "normal" employees' disapproval d. Fear of business community's ridicule or criticism e. Genuine skepticism regarding disabled Barker's competence in his given field f. General avoidance of "change"-~1anting to do things as they have always been done g. Other (specify)_ _ _ __ Comments, if any: 476 8. Haw would you evaluate the following proposals for favorably influencing employer attitudes toward employment of the handicapped? of high of questionable of no value value value a. Mailed brochures depicting the value of handicapped workers b. Personal contacts by VR personnel regarding hiring the handicapped c. Meetings of employers with film presentation and discussion by VR personnel and representatives of handicapped workers d. Community-wide "hire the handicapped'; campaign with requests for endorsement by employers e. Personal contacts by indi vidual rehabilitated workers with individual employers f. Other (specify) Comments, if any: 9. '~ithout community involvement, or at least approval, the total rehabilitation process of identification, evaluation, enrollment, training, counseling and employment cannot be complete. 11 How would you evaluate your reaction to this statement? Totally Agree I__ I ___ I I ___ I Totally I Disagree Please briefly comment on your reaction. 4// 10. List ways your community might support the vocational rehabilitation client in the following areas a. Identification and referral of vocationally handicapped individuals: b. Support while the client undergoes rehabilitation: c. Acceptance of the client into the community after rehabilitation: 478 APPENDIX 4 SAMPLES OF NEWS CLIPPINGS PRINTED IN THE SYLVESTER LOCAL, WEEKLY NEWSPAPER FOR WORTH COUNTY 479 Worth A Pilot County For Vocational Rehabilitation Worth county has been included Charlie Long of At chosen as one of two pilot lanta, information officer; Mrs. counties in Georgia to promote Hal Drake of Atlanta, chair- 1\ vocational rehabilitation pro- man of the technical force on gram that is now being spon- community involvement (Mrs. sored by the Statewide Voca- Drake a volunteer worker, is tional Rehabilitation Project, the former Miss Eula Kate with headquarters in Atlanta. Williams, originally from Cor- Through this plan, many dele); R. Watt, Jr., supervisor people who have been handi- for the Albany District; Louis capped will have the oppor- Browne, counsellor for Worth tunity to train for a type of county, and Miss Karen But work which they are capable ler, Atlanta, research associate. of doing and can become self- It is expected that at least -1 supporting. At the same time, two local civic clubs will span after they are trained they sor this program here and will will become tax-payers and enlist volunteer workers all this will help them to main- over the county to assist in tain the dignity to which all the work. Without volunteers people have a right. the work cannot be carried on. The above information was Through the help of volun- revealed at a planning meeting teers, a survey of the county held here Tuesday evening, will be made and those persons Sept. 12, when state and dis- who might receive this special trict workers met for dinner training, (this can include the with a group of local people physically, emotionally or who will serve as an advisory mentally handicapped) will be 1 committee and enlist volunteer sought out and a plan made workers for promoting the pro- to train them for some type gram here. of work to which they may be Those present at the meeting suited. This can also include were Fred Long, Neil Pierce, treatment where necessary. Dr. Bob Morgan, Dr. Fred Mc- The local committee will Lean, Mrs. McLean, Mrs. A. serve in an advisory capacity K. Booth, Mrs. Cecil Rhodes, and the state and district of- Miss Eula Gwines, H. L. Simp- ficials will also advise and as- son, Mrs. H. L. Simpson, Leon sist when it is necessary, but Houston, Jr., and Marian A. the responsibility of the pro-, l Sumner. gram rests in the hands of local The district and state officers people. Mr. Watts said that Worth county was chosen because of the fact that it is known as a rural county that does worth- I while things and has already shown its ability and its desire to go forward. The success of Worth's program will help to determine a plan of operation for the vocational rehabilita- tion program to be used in the 159 counties of Georgia, he said. Further organizational work. must be done here and more information will be given in a later story. In the meantime, I the program needs the help of all public spirited people, it was said. 480 THE SYLVESTER LOCAL is the official organ of Sylvester and Worth County. THE VOCATIONAL REHABILITATION PROGRAM IN WORTH COUNTY "To be a whole man one must be more than an individual functioning as an individual. He must have the privilege of participation and interaction in his society. One of the most important tokens of being a member of his group is awarded when he can participate and interact, through work." This quote from "A History of Vocational Rehabilitation in America" by C. Esco Oberman sets forth the objectives of the Vocational Rehabilitation program in the state of Georgia. That the County of Worth has been chosen as one of two pilot counties in the state to launch a vocational rehabilitation program that may become a model in other counties, is both an honor and a challenge. At a recent dinner meeting here between the local advisory committee and officials of the VR office, the groundwork was laid for the program to get underway in Worth. This meeting was characterized by enthusiasm and interest on the part of the local citizens who make up the advisory committee and the dedicated men and women who administer the progr'am. The object and goal is to reach as many handicapped persons in this area as possible for restoration to the highest physical, mental, social and moral usefulness of which he or she may be capable, PLUS acceptance of that individual, once he or she has been rehabilitated, into all phases of community life. This will not be confined to just those people who will be dealing direct with these individuals, but will call for total community effort. Certain local civic clubs are now being contacted to take the lead in locating the handicapped and giving them direction and guidance into the program. For a handicapped individual to be eligible for Vocational Rehabilitation services, he must meet only three basic eligibility criteria: 1. There must be present a physical or mental impairment. 2. This impairment must constitute a substantial impediment to employment. 3. There must be a reasonable assurance that the individual can be made employable with the provision of Rehabilitation services. When the individual has been determined to meet the eligibility requirements, he or she is then eligible for whatever rehabilitation services are deemed necessary to make him employable. Knowing the good people here in Worth county it is unthinkable that they will do other than give of their wholehearted response and partici- pation to this important project ... for the very success of it will require meaningful community involvement and it is our strong feeling that every citizen of Sylvester and Worth county will make their contribution that "None Shall Go Unserved" and that the "dignity of man," with a place in society, shall be enjoyed by more and more rehabilitated people. LHH HIRE THE HANDICAPPED Nationally "Employ The Physi- cally Handicapped Week" began October 1st and directs attention to the advisability of seeking to give employment to those able to work but not usually considered readily employable. This special week has been authorized by Congress to call attention to the plight of the physicallyhandicapped, who need the opportunity to be self-supporting. Many individuals, suffering physical disabilities, are well able to earn their living if they can find sympathetic employers ready to give them a chance. This week is of particular importance to us here in Worth county as we have recently been chosen by the State Department of Vocational Rehabilitation as a pilot county to formulate a program that will be used in other counties whereby the handicapped may be trained in certain type work for which they are most suited and become wage earners with a meaningful place in society. 482 THE SYLVESTER (GA.) LOCAL. THURSDAY. MAY 2. 1968 Vocational Rehabililalion Plan iTold To Sylvester Woman's Club ! Guest speaker at the Sylves eligibles know of the services ter Woman's Club recently was available. He said that another Lo.uis A. Brown, counselor far-reaching aspect is in edu- with the Division of Vocational eating the economic and social Rehabilitation, State Depart_ communities so that they will ment of Education. actively accept the rehabilitat- M able r.seBrvri~cwens, t ld ~f the locatiOn of avail-~ serv- ed an person, when he effo.rt to return has made as a s. elf- Ices and fac1l1t1es and the e1I.- supportmg mem. be.r of society. . gibility of services through the The spea~er hsted the handi- state -wide vocational rehabili- cap ~ategones as follows: C~m tation program. mumc_at1ve (speech, . hearm_g and sight); orthopedic handiSince Werth county has been caps (amputees, crippled chil- selected as one of the pilot dren, paraplegics, arthritis); counties in Georgia, this pro- c:-:1ctional disorders (alcohol- gram was very timely, as key ism, public offenders), mental orga!lizations have been asked retardation and miscellaneous I , tv::e: saticg~aetpitonthaendchalilemnpgle~meonf tian-1 ha:1dicaps (disorders such as respiratory, circulatory, card- t:on of a forw~rd movmg .~ro-1 iac, epilepsy, tuberculosis, dia- lgram of _vocatiOnal rehab1hta- bEtes, cancer and aged welfare t1cn w1thm the county. recipients). Mr. Brown emphasized the Mr. Brown is in Sylvester broad scope cif services which each Tuesday and can be includes medical and psycholo- reached for appointment by gical. job training and occupa- calling the Worth County !'tiona! placement. He s_tated Health Department. By consultthat one a_rea of concern, _If ti:e ing with him, a likely handicap program IS to be effective, IS can be evaluated to determine in finding the handicapped. It if eligible for assistance, it was ca!lnct be assumed that the said. Mrs. H. L. Simpson, president. presid ':d over the business session. Prior to the meeting, the I members and guests were invited to a beautifully appointed tea table where refreshments were served. Mrs. H. R. Floyd poured coffee. 483 ;Goodwill Week and community cooperation in j helping all men, regardless of race, color, class or creed." I Being Observed Goodwill Industries helps the handicapped, physically, mentally and socially, to help Now; Seeks Help themselves all year round. During National Goodwill Week this year, the rehabilita- Roy McCraney of Alban~, president of the board of directors of Goodwill Industries of South Georgia, Inc., has annunced that his organization has planned to conduct its annual National Goodwill Industries Week May 5-11, a program endorsed by the President of the United States. tion agency is emphasizing how good will and individual will, give help and hope on a personal basis. "We hope that during this week we can help more, to show all men how learning and training can add meaning to the least of lives," Mr. McCraney said. Mr. McCraney stated that "many U. S. cities (as well as our own) are going through a , critical time of confusion and unrest. There is a need in Sylvester and everywhere for people to help other people help themselves and live as full a ilfe as possible. Goodwill Industries is asking local leaders, groups and individuals to join them in stressing the need for more human concern, compassion c 0py APPENDIX 5 September 13, 1967 MEMORANDUM TO: Mr. Nathan Nolan FROM: Charles Long RE: Community Involvement Project: Worth County Mr. R. Watt, Jr. and Mr. Louis Browne nominated persons to serve on an advisory committee to promote a community involvement pilot project in Worth County. A dinner meeting was scheduled for Tuesday, September 12, in Sylvester, Georgia. The film '~orthy of Their Hire" was the first item on the very flexible agenda. Mrs. Hal Drake chaired the meeting in a most persuasive manner. Mr. Watt made the introductions and spoke informally of the importance of Vocational Rehabilitation, calling on his many years of experience with the program. Mrs. Drake eloquently presented the need for community involvement and called on the group to "tell us what is needed and how it can be accomplished." The response was far beyond our expectations. The reaction of this group was spontaneous, sincere and meaningful in its content. Each of us was impressed as they discussed, without interference or direction from us, for a full hour the best way to "sell" the vocational rehabilitation story to every citizen of Worth. Only one nominee was absent. During the program this member telephoned to explain his absence and affirm his eagerness to participate in the program. Details of the meeting will be sent to you in a couple of days. In the meantime, I wanted you to enjoy with the Planning Project the initial success of this program which we feel is vital to vocational rehabilitation. WCL:mb cc: Jack P. Nix Vernon L. Vinson William Sims 487 A PILOT PROJECT DETERMINING THE EFFECTIVENESS OF A FILM FOR ORIENTING NEW VOCATIONAL REHABILITATION CLIENTS Statewide Vocational Rehabilitation Planning Project Atlanta, Georgia November, 1967 '"TUU TABLE OF CONTENTS Page I. Introduction and Theoretical Considerations ....................489 II. Methodology and Sample ......................................... 490 Ill. Representativeness of Sample ................................... 492 IV. Analysis of Data ............................................... 492 V. Cone lus ions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 498 VI. Appendixes .................................................... 501 A. Pre-test . ... .... .. . . . . . . . . . . . . . . . . . . . . . . . . . . . 501 B. Post-test . ...................................... 504 C. Code Sheet . . .. ......................... 507 D. Definitions of Statuses of Clients Used in the Sample ... 509 E. Population and Sample Comparisons ...................... 511 1. Age ....................................... 512 2. Sex ......................................... 512 3. Race ........................................... 513 4. Educational Level .............................. 513 5. Number of Dependents .......................... ,514 6. Referral Source ................................ 514 F. Percentage Analysis of Responses to Questions .......... 515 G. Computer Print-out ..................................... 519 H. Tables Analyzing Score Differences ...................... 523 489 I. INTRODUCTION AND ~HEORETICAL CONSIDERATIONS One of the recurring problems in the rehabilitation process is the failure of a client to complete the process. This may be related to several factors among which is found the client's lack of understanding or misperception of the Vocational Rehabilitation program. Also, a study of client attitudes made for Vocational Rehabilitat"ion by Dr. Fred Wright, July, 1967, indicates that "there was an amazing lack of awareness" among clients about the Vocational Rehabilitation Program. 1 The Statewide Vocational Rehabilitation Planning Project has sponsored the production of a film about Vocational Rehabilitation services which might be used in a client-orientation program. A basic assumption is that those clients who see an orientation film about Vocational Rehabilitation will have a better understanding of the rehabilitation process. First, however, it must be determined if the tool (the film) actually serves this function. Its limits must be defined and the range of its function determined. What questions is the film supposed to answer? Thus the problem for this pilot project can be stated as follows: what effect will exposure to an orientation film have on a client's understanding or perception of the Vocational Rehabilitation program? Perception is defined for purposes here as the process by which people select, organize, and interpret stimulation into a meanin~ful and coherent picture of the world. For this study, perception is the process by which Vocational Rehabilitation clients organize and interpret the information imparted by the film into a meaningful picture of Vocational Rehabilitation. 1Fred H. Wright, Ph.D., A Follow-Up Study of 151 Former DVR Clients Closed in Three Categories, (Atlanta, Georgia State College: Institute for Psychological Services, July, 1967, unpublished.) 2Bernard Berelson and Gary A. Steiner, Human Behavior: An Inventory of Scientific Findings, (New York: Harcourt, Brace and World, Inc., 1964.), p. 88. 4'::10 Theoretically, the perceptual process of the client involved in this communication can be conceptualized as shown in Chart 1. The model is drawn from the works of Sargent and Williamso~ (1958), Hovland (1953), and Bruner (1951). This model is limited in that it only deals with one stage or level of the communication process. There is no attempt in this project to measure attitudes or change in attitudes; but, instead, the project is designed to measure perceptual changes. It can be assumed that the film, if effective as a part of the communication process, will become a part of the client's perceptual process and later influence his functioning in the Vocational Rehabilitation process. Not only should an orientation film effect understanding, but should also save valuable time by giving the counselor an opening for the interview. This standardization of client orientation will also insure that most clients start the Vocational Rehabilitation process with the same basic information. on each set of questions.4 The clarity and preciseness of the questions were pre-tested by administering the tests and showing the film to a group of clients from Goodwill Industries. It was found that even some of the mentally retarded clients could comprehend the testing method with minimum instruction. Since the purpose of the project is to use these tests to indicate the effectiveness of the film as a part of a client orientation program, the basic assumptions are as listed below: 1. More correct answers on the second test than on the first will indicate that the film is positively influential as an orientation tool. Different levels of effectiveness can be determined by varying numbers of correct answers from test to test. 2. Fewer correct answers on the second test than on the first will indicate that the film is negatively influential as an orientation tool. II. METHODOLOGY AND SAMPLE After content analysis of the film's soundtrack, eight questions were constructed to appear identically on both interview schedules. The order of these questions varies on each schedule with the placement of additional general information questions. (See Appendix A & B). By asking the clients these questions before and immediately after they saw the film, the effect of the film was measured by analyzing changes in scores 3s. Sargent and Robert C. Williamson, Social Psychology, (New York: The Ronald Press Company, 1958.); Carl I. Hovland, Irving L. Janis and Harold H. Kelley, Communication and Persuasion, (New Haven: Yale University Press, 1953.); J.S. Bruner, "Personality Dynamics and the Process of Perceiving," in R.R. Blake and G. V. Ramsey, Perception, and Approach to Personali- !Z (New York: The Ronald Press, 1951.), pp. 124-25. 3. When there is no change in the number correct on both tests, two assumptions can be made: a. If all answers are correct on both tests, there is no measure of the effectiveness of the film. 4Refer to Robert K. Merton and Paul F. Lazersfeld, "Studies in Radio and Film Propaganda," in Robert K. Merton, Social Theory and Social Structure, (The Free Press of Glencoe, 1957.), pp. 509-528; A. A. Lumsdaine and I. L. Janis, "Resistance to Counterpropaganda Produced by a Onesides Versus a Two-sided Propaganda Presentation," Public Opinion Quarterly, 1953, 17, 311-318; I. L. Janis, A. A. Lumsdaine and A. I. Gladstone, "Effects of Preparatory Communications on Reactions to a Subsequent News Event," Public Opinion Quarterly, 1951, 15, 487-518. The latter three in particular used the method of testing subjects before and after a communication to measure change. CHART #1 THE PERCEPTUAL PROCESS Perceptual Set: subjective in nature Composed of information Client has assimilated in forming existing perception toward Vocational Rehabilitation. This is a product of past experiences, interests, personality traits, group memberships, attitudes, values, etc. Hovland defines this as "aduience predispositions." Note that this concept is visualized as being on a continuum with some persons having little or no information about Vocational Rehabilitation. This is measured by Test I administered to Clients. Input: objective in nature This refers to the film about Vocational Rehabilitation shown to Clients which is information from the environment. 1. Confirmation Information imparted by the film is assimilated and strengthens existing perceptual set. This is measured by Test II. 0 R .p i.C t- 2. Conflict Information imparted by the film is not in agreement with the Client's existing perceptual set. Alteration of perception of Vocational Rehabilitation is indicated by answers to Test II. b. If fewer than all are correct with no change from Test I to Test II, then ineffectiveness of the film is indicated. Specific areas of ineffectiveness can be judged by analysis of the questions missed on both tests. By selecting an office classified as serving rural clients and one classified as serving urban clients, the rural-urban variable can be analyzed. Savannah, which is classified by the U.S. Census Bureau as a part of a Standard Metropolitan Statistical Area, was designated as the urban office. Thomasville, Bainbridge and Cairo were selected as rural offices since they are not a part of a SMSA. The offices were selected on the basis of two factors: (1) adequacy of facilities and space for showing this film; and (2) cooperation of personnel in accepting the project as a part of their office routine. To obtain a sample of 50, a trained interviewer administered the interview schedules to the first 25 clients who came to the urban office and the first 25 who came to the rural offices. Those interviewed were the clients classified in status 00 or 02 as defined in Appendix D. None of these clients had had the initial interview with the Counselor. In one rural office, the time to obtain a sample of 25 clients in status 00 or 02 would have been a longer period than the proj~ct wished to expend. By selecting three rural offices, the interviewer utilized the interviewing days of each and obtained the sample in a shorter length of time. The trained interviewer was used in an attempt tomaintain objectivity and to interrupt the office routine as little as possible. III. REPRESENTATIVENESS OF SAMPLE The smallness of the sample size (N=SO) questioned the representativeness of the sample of the total population. For this reason, the study sample was compared with the population of the State of Georgia and with the 8,010 Rehabilitants of the Georgia Office of Vocational Rehabilitation in the year ending 6-30-66. The tables in Appendix E include these comparisons: A. Age B. Sex C. Race D. Educational Level E. Number of Dependents F. Referral Source IV. ANALYSIS OF DATA The problem in this study is concerned with the isolation of major variables which can explain variance in test scores and/or changes in these scores as they measure client understanding of the rehabilitation program. A statistical method to analytically measure the effects of two or more variables upon a factor is multiple regression analysis.S The dependent variable in the first analysis was the individual's score on the pre-test; in the second analysis, the score on the post-test. A complete list of the independent variables with computational results is shown in Appendix G. For purposes here, only the effect of the most significant variables will be summarized. Most of the key independent variables are found in the Vocational Rehabilitation case record of each client. These are basic forms completed on each client which include such information as sex, race, age, disability, occupation prior to disability, marital status, number of dependents, education, income and referral source. The interviewer recorded this on the code sheet as shown in Appendix C. The test scores were derived by g~v~ng each person one point for every correct answer. Since there were eight questions which appeared identically on both pre and post-tests, the highest possible score achieved by a person on either test is 8. To determine a score difference, the score on the pre-test was subtracted from the score on the post-test. Ssystem/360 Scientific Subroutine Pack~ Version II, Programmer's Manual (IBM International Business Machines Corporation 1967.), pp.25-27. 4~j To determine if there is a significant statistical difference between the mean scores of the pre-test and the post-test, the student's t test6 was computed. This test gives a way of determining the probability that the post-test mean score would exceed the pre-test score by 1.48 (the mean score difference), due to chance, if the film had no effect. Table 11=1 Table of t test computations Mean Score Difference 1.480 Standard Deviation of Mean Score Difference .181 t=8.17* *Level of significance: .001 Degrees of freedom = N-1 (49) Table #1 shows that the difference between the mean scores is statistically significant beyond the .001 level. On this basis, the hypothesis is accepted that the film is effective in influencing positive change in client perception of Vocational Rehabilitation. Table #2 shows an overall increase in the percentage of persons answering correctly each question from the pre-test to post test. Note that the film appears to be least effective in answering questions V and VIII. Graph #1 gives another indication of the effectiveness of the film as an orien'tation tool by showing the trend for persons to score lower on the pre-test and higher on the post-test after exposure to the film. A more detailed percentage analysis of all answers to the questions is found in Appendix F. 6Quinn McNemar, Psychological Statistics (New York: John Wiley and Sons, Inc., 1962), pp. 98-108. 0 1234 5 SCORES ON TESTS Total N= 50 PERFECT SCORE = 8 PRE-TEST POST-TEST zU) 0 U) 0: UJ 1. IL 0 0: UJ ID ~ z:J ~ 7 8 Histogram Of Scores On Pre-Test And Post-Test Pilot Project, Film, August, t9&7 495 TABLE ffo 2 COMPARISON OF THE PERCENTAGE INCREASE IN THE CORRECT RESPONSE TO EACH QUESTION Question I. Most important person providing VR services II. Main Purpose of VR III. Upper Age Limit of VR IV. Training a Client Gets v. People who work for VR VI. Clients expected to pay for services VII. Reason VR started VIII. VR is a part of % Correct Responses Pre- Post- 36 68 62 76 74 88 42 62 72 80 70 84 54 88 22 32 % Increase +32 +14 +14 +20 + 8 +14 +34 +10 The key variable which seems to explain variation in scores is educational level defined here as the number of years of formal schooling completed by each client. Testing the statistical significance of the regression between education and scores, the t value is extremely high with the score on the pre-test as the dependent variable, and is also significant with the score on the post-test as the dependent variable. This is shown in Table #3. Table #3 Table of Test of Significance of Regression Independent Variable Dependent Variable Correlation Regression Coefficient Education Education Score on pre-test .69 Score on post-test .65 .369 .286 *Significant at .001 level t Value 5. 72* 3.68* ""'t.7V This illustrates that in this study the client's prior knowledge of Vocational Rehabilitation is associated with the amount of his formal education. Likewise, the effectiveness of the film as an orientation tool is significantly related to the amount of the client's education. Since the amount of education might seem to place limits on the film's imparting of knowledge to less literate clients, a more detailed analysis was made of the sample by score differences. As stated earlier, the score difference was derived by subtracting the score on the pre-test from the score on the post-test. Even though there is a general increase in scores from pre to posttest, are there any identifying characteristics of persons whose score decreased from pre to post-test or whose score did not change? Of those whose score increased, was their pre-test score low or high? For descriptive purposes, the sample distribution of score differences is shown in Table #4. Group I Group II Group III Group IV Group v Group VI TABLE #4 Sample uistribution of Score Differences Score Difference -1 0 +1 +2 +3 +4 TOTAL N 4 8/o 8 16% 10 20% 18 36% 8 16% -502- -1-004-/%o Each of the above groups is presented in the tables in Appendix H in terms of two variables: (1) education and (2) county (rural-urban). Table #5 shows 76% of the sample (Groups III-VI) whose score increased from 1 to 4 points from pre to post-test. Of these 38 persons, 39.5% (15) has 6 or less years of formal education. This would indicate some value of the film to less educated persons. Another factor which appears to affect performance on the test is the rural-urban variable. As stated earlier, "urban" is defined by the U.S. Census Bureau classification: Savannah is part of a Standard Metropolitan Statistical Area and Bainbridge, Cairo and Thomasville are not. Table #6 depicts this difference which could partially be attributed to basic rural-urban characteristics. The rural area might offer less in the way of knowledgeable contact with the client about VR prior to his application. The personnel per square mile is less, public informatiot media less encompassing, especially for those persons living in an extremely farm rural area. Another difference which the data indicates is the difference in amount of education of rural and urban clients. Table #7 shows that 52% of the rural clients have six or fewer years of education as compared with 24% of the urban clients. 497 TABLE 115 CLIENTS WHOSE SCORE FROM PRE TO POST-TEST INCREASED FROM 1 TO 4 POINTS BY SCORE ON PRE-TEST AND EDUCATION :ore on e-test 0-3 0 3 (7. 9%) 1 4-7 (2.6%) :orALS 4 (10. 5%) 1-4 2 (5.3/o) 1 (2.6%) 3 (7. 9%) EDUCATION (Years) 5-6 7-10 11-12 4 (10.5%) 3 (7. 9%) 2 (5.3%) 4 4 (10.5%) (10. 5/o) 11 (29 0/o) 8 7 (21.0/o) (18.4/o) 13 (34.3%) OVER TOTALS 0 14 (36 o9/o) 3 (7. 9%) 24 (63.1%) 3 (7. 9%) 38 (100. 0/o) TABLE #6 CLIENTS WHOSE SCORE FROM PRE TO POST-TEST INCREASED FROM 1 TO 4 POINTS BY SCORE ON PRE-TEST AND THE RURAL-URBAN VARIABLE Score on Pre-test 0-3 RURAL 10 (26.3) URBAN 4 (10.6) TOTALS 14 (36. 9) 4-7 7 (18.4) 17 (44.7) 24 (63.1) TOTALS 17 (44. 7) 21 (55.3) Figures in parentheses represent percentages. 38 (100.0) 498 TABLE #7 Vocational Rehabilitation Clients Participating in Pilot Project by Education and Rural-Urban Variable, August, 1967 N=SO Education 0 1-4 5-6 7-10 11-12 Over TOTALS -Ru-ra-l 4 (16%) 3 (12%) 6 (24%) 3 ( 12/o) 6 (24%) 3 (12%) 25 (100%) Urban 0 2 ( 8%) 4 (16%) 6 (24/o) 11 (44%) 2 ~ 8%2 25 (100%) V. CONCLUSIONS AND RECOMMENDATIONS The results of this pilot project in terms of client orientation through a film indicate needs in several areas. These can be summarized in the following observations. 1. This study and others proved that clients can learn from such a method of instruction and, indeed, a better understanding of the rehabilitation process would seem to increase his personal esteem as a member of society. Even though such a method would increase the responsibility of the Counselor in planning with the client, his job should be more thorough, thereby generally improving services to all clients. 2. The knowledge imparted by the client to others should be of higher quality after exposure to such a film. By standardizing what a client learns about Vocational Rehabilitation at his first contact, there should be less misunderstanding about what services are available, who provides them and who is eligible for them. If he understands, the people he tells about Vocational Rehabilitation should have a better knowledge. Here is a potential source of reaching handicapped persons who comprise the group with unmet vocational rehabilitation need. A logical follow-up to this study would be to analyze the progress of each of these clients through the rehabilitation process as compared with a control group to determine just what effect a better understanding of the VR process would have on successful rehabilitation. 499 3. This tool appears to be the best method for use with clients covering a wide range of educational background. As indicated in a previous section of this paper, a key variable in explaining variation in changes in individual test scores (pre-test --- exposure to film --post-test) is educational level. However, an important note to support this third conclusion is that the persons with six or less years of formal schooling did show some increase of knowledge about Vocational Rehabilitation after seeing the film. 4. Implementation of this method of client orientation would not be as time or space consuming for counselors and local offices as one would think. There is a relatively new filming process (continuous film cartridge) which is operated very similarly to an automatic cartridge tape recorder and requires almost as little space. The receptionist, or even the client himself, could be instructed to operate it. This, in fact, should save time for the counselor and should eliminate his having to fulfill this orientation role verbally. Therefore, an important aspect of implementation would seem to be polling the counselors to gain their suggestions since this tool is for their aid in working with clients. 5. Already, the weaknesses in the film, as shown by this study, are being corrected. A new sound track is being developed and should insure more meaningful answering of such questions as, what Vocational Rehabilitation in Georgia is a part of and who works for Vocational Rehabilitation. It should also give a more realistic view of the length of the time involved in the rehabilitation process and should give a broader look at the range of services. It is recommended that this new film and the continuous film cartridge technique be used in a research and demonstration project to determine the practicality and effectiveness of this tool on a lerger scale in rehabilitation offices throughout the state. 501 APPENDIX A Pre-Test COUNTY NUMBER: CASE NUMBER: We want to show you a film about vocational rehabilitation before you talk with the counselor. First, however, we would like for you to answer a few questions so we can get your thoughts about an agency like the Division of Vocational Rehabilitation. NAME~-------------------------------------------------------------------------------- ADDRESS_____________________________________________________________________ Just put a check mark by the answer that best fits your feelings or what you know about each question. 1. Have you ever received any services from Vocational Rehabilitation? Yes No If yes, when?_____________________________________ 2. Do you know anyone who has been helped by Vocational Rehabilitation? Yes If yes, was it: ------------- No a member of your family a friend a co-worker other (list) 3. How did you first learn about Vocational Rehabilitation? booklets doctors newspapers friends radio another agency -------------- magazines television church other (list) 502 4. The most important person in providing rehabilitation services to the disabled is (check only one) Doctor Vocational Rehabilitation Counselor Training Instructor Employer 5. The main purpose of Vocational Rehabilitation is: (check only one) to provide money to pay for operations to help disabled people become employed to help only people who have lost an arm or leg to help poor people 6. Vocational Rehabilitation works with handicapped people as young as 16 years old. The upper age limit is: (check only one) 45 years old 30 years old no age limit 7. The training a client gets: (check only one) depends on his interests and abilities is decided by the counselor is the same for all clients 8. Do you know of any Vocational Rehabilitation training or treatment centers in Georgia? Yes --------------- No If yes, please give any information you know about each, such as who they serve and where they are. 503 9. The people who work for Vocational Rehabilitation are: (check only one) people given the job by local politicians people with professional training and experience in Vocational Rehabilitation work anybody who likes to work with people 10. Clients are expected to pay for the services they receive from Vocational Rehabilitation. Yes No 11. Vocational Rehabilitation was started to give services to: (check only one) all handicapped people ---------------- handicapped people who want to work the unemployed who are not handicapped 12. Vocational Rehabilitation is a part of: (check only one) Social Security ---------------- The Welfare Department ---------------- Workman's Compensation Public Health Department State Unemployment Service None of these 13. Agencies which help people have a big job. Based on what you feel, list the services an agency like Vocational Rehabilitation should offer. 504 APPENDIX B Post-Test COUNTY NUMBER: CASE NUMBER: Now that you have seen a film about Vocational Rehabilitation, we want you to share with us your thoughts by answering a few more questions. You will notice that some of these were on the first questionnaire. NAME -----------------------------------------------------------------------------Just check the answer that best fits your feelings or what you know about each question. 1. Now that you have seen the film, list the services that you feel Vocational Rehabilitation offers. 2. The people who work for Vocational Rehabilitation are: (check only one) -------------- people given the job by local politicians people with professional training and experience in Vocational Rehabilitation work anybody who likes to work with people 3. Vocational Rehabilitation was started to give services to: (check only one) all handicapped people handicapped people who want to work the unemployed who are not handicapped 4. Vocational Rehabilitation is a part of: (check only one) Social Security The Welfare Department -------------Workman's Compensation Public Health Department State Unemployment Service 505 5. The most important person in providing rehabilitation services to the disabled is: (check only one) Doctor Vocational Rehabilitation Counselor ------- Training Instructor Employer 6. Clients are expected to pay for the services they receive from Vocational Rehabilitation. Yes ------------ No 7. Are there more disabilities (handicaps) for which a person can get vocational rehabilitation services than you thought there were before seeing the movie? Yes ---------- No If yes, please name the ones you just found out about. 8. Vocational Rehabilitation works with handicapped people as young as 16 years old. The upper age limit is: (check only one) 45 years 30 years no real age limit 9. The training a client gets: (check only one) depends on his interests and abilities is decided by the counselor is the same for all clients 506 10. The main purpose of Vocational Rehabilitation is: (check only one) --------------- to provide money to pay for operations to help disabled people become employed to help only people who have lost an arm or leg to help poor people 11. What one question about Vocational Rehabilitation would you most like to have answered? ..JV/ APPENDIX C PILOT PROJECT CODE SHEET 1. County number (record code): 2. Case number: 3. Race/Sex: WM NM WF NF 4. Age (record age): 5. Marital status (record code): 1 2 3 4 5 6. Educational level (record# years completed): 7. Number of dependents: 8. Main source of support before disability (record code): 9. Main source of support now (record code): 10. Monthly income of nuclear family before disability (record amt.): 11. Monthly income of nuclear family now (record amt.): 12. Referral source (record code): 13. Client's occupation before disability (record code): (If birth defect, give last occupation, if any.) 14. Client occupation now (record code): 15. Client disability (record code): 16. Length of disability (record# months): JUj APPENDIX D DEFINITION OF STATUSES OF CLIENTS USED IN THE SAMPLE Status 00 - Referred The 00 status represents entrance into the VR process for any individual who has applied, by personal contact with any VR employee, by telephone or by letter; or who has been referred to any VR employee by letter, by telephone, by direct contact, or by any other means; and for whom the following minimum information has been furnished; (1) name and address, (2) disability, (3) age and sex, (4) date of referral, and (5) source of referral. Status 02 - Applicant Referrals (status 00) should be placed in this status as soon as the counselor has a document signed by the individual requesting vocational rehabilitation services. Generally, the document will be an agency application form, but a letter signed by an individual who provides the minimum basic information and requests service should also be considered as a basis for placing the individual in this status. While the individual is in this status, sufficient information is developed to make a determination of eligibility or ineligibility for vocational rehabilitation service, or a decision to put the individual into one of the extended evaluation statuses prior to making such a determination. APPENDIX E POPULATION AND SAMPLE COMPARISONS The smallness of sample size (N = 50) questioned the representa- tiveness of the sample of the total population. For this reason, the study sample was compared with the population of the State of Georgia and with the 8,010 Rehabilitants of the Georgia Office of Vocational Rehabilitation in the year ending 6-30-66. The following tables include these comparisons: I. Age II. Sex III. Race IV. Educational Level v. Number of Dependents VI. Referral Source Characteristics of Study Sample as Compared with State of Georgia Population and the 8,010 Rehabilitants in year ending 6-30-66. 1. Age Age Group Years 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65 and over Study Sam2le N=50 14.00% 20, 00/o 10.00% 4.00% 8, 00/o 8 o00/o 12.00% 14.00% 2 00/o 8, 00/o 0.00% 100.00% 1 Ga. Po:eulation Ages 15 and over 14.08% 11.13% 9.30% 8, 79/o 8.91% 8.98% 8.36% 7.68% 6 .44/o 5.22% 11.09% 100.00% Rehabilitants N=8010 15.26% 30.03% 22.51% 19.12% 10.83% 2.25% 100.00% II. Sex Males Females Study Sam2le N=50 50.00% 50.00% 100, 00/o Ga. Po:eulation Ages 15 and over 47.82% 52.18% 100 .00/o Rehabilitants N=8010 46.59% 53.41% 100 0 00/o 1. James D. Tarver and John C. Belcher, Po:eulation Estimates for Georgia Counties, 1965, Athens, Georgia, February, 1967. 513 III. Race Study Sample N=50 White NonWhite 60 00/o 40 00/o 100. 00/o White/Males 34.00% NonWhite Males 16. 00/o White/Females 26 00/o NonWhite/Females 24 00/o 100.00% 1 Ga. Population Ages 15 and over 75.79% 24.21% 100 00/o 36.70% 11. 12/o 39.09% 13.09% 100.00% Rehabilitants N=8010 65. 64/o 34. 36/o 100.00% IV. Educational Level Years of School Completed Study Sample N=50 None 8 00/o 1,2 2 00/o 3,4 8.00% 5,6 20.00% 7 2 00/o 8 6.00% 9 8 00/o 10 2.00% 11 8.00% 12 26. 00/o 13 14 15 16 Over 4 00/o 4 00/o 2 00/o 0.00% 0.00% 100. 00/o 2 Ga. Population Ages 14 and over 2 64/o 3 51/o 7.99% 11.49% 9.69% 10.47% 8. 24/o 8. 18/o 6.82% 18. 75/o 2 74/o 2. 96% 1. 39/o 3 64/o 1.49% 100 00/o Rehabili tants N=8010 4.62% 13.43% 14.48/o 22.09% 17 .43/o 23.24% 4 71/o 100.00% 1. James D. Tarver and John C. Belcher, Population Estimates for Georgia Counties, 1965, Athens, Georgia, February, 1967. 2. United States Census of Population, 1960, Georgia, Detailed Characteristics, U. S. Department of Commerce, Bureau of Census. 514 v. Number of Dependents Number None Stud:t SamEle N=SO 42.00% 1 10. OOio 2 20.00% 3 14.00% 4 5 6 7 8 9 Over 2.00% 2.00% 4.00% 2.00% 2.00% 2.00% 0.00% 100.00% Ga. PoEulation VI. Referral Source Source Educational Inst. Study SamEle N=SO 2.00% Hospitals 2.00% Other Health Agencies 0.00% Physicians, nee. 34.00% Bureau, OASI 6.00% Workman's Compensation 0.00% Welfare Agencies 18.00% State Employment Service 2.00% Artificial Appliance Co. 0.00% Individual, except self 26.00% Self-referral, nee. 8.00% Other 2.00% 100.00% Rehabilitants N=8010 45.54% 35.09% 19.37% 100.00% Rehabi litants N=8010 9.14% 7.74% 3.67% 36.04% 2.14% .03% 11.48% 1.34% 2.08% 11.94% 9. 74% 4.66% 100.00% 515 APPENDIX F PERCENTAGE ANALYSIS OF THE ANSWERS TO EACH QUESTION ON PRE-TEST AND POST-TEST QUESTION I Most important person providing VR services Doctor Pre-test Post-test 26 (52%) 13 (26%) Totals 39 VR Counselor 18 ( 36%) 34 ( 68/o) 52 Training Instructor 4 (8%) 2 (4/o) 6 Employer 2 (4/o) 1 (2/o) 3 Totals so (100%) so ( 100/o) 100 QUESTION II Main Purpose of VR Pre-test Post-test Totals Money for Op<:_rat ions 6 (12%) 1 ( 2/o) 7 Employment for the Disabled 31 ( 62/o) 38 (76%) 69 Help for Armless, Legless 1 (2%) 0 (0%) 1 Help for the Poor 12 ( 24/o) 11 (22%) 23 Totals so (100%) so ( 100/o) 100 QUESTION I II Upper Age Limit of VR Pre-test Post-test Totals 45 years 12 (24%) 6 (12%) 18 30 years 1 (2%) 0 1 No age limit 37 (74/o) 44 (88/o) 81 Totals so (100%) so (100%) 100 516 QUESTION IV Training a Client Gets Pre-test Post-test Totals Depends on interests & abilities 21 (42%) 31 (62%) 52 QUESTION V People who Work for VR Pre-test Post-test Totals Politician Appointees 0 0 0 QUESTION VI Clients expected to pay for services Pre-test Post-test Totals Yes 15 (30%) 8 (16%) 23 Decided by Counselor 13 (26%) 8 (16%) 21 Same for all Clients 16 (32%) 11 (22%) 27 Totals so (100%) so (100%) 100 Professional training & VR Experience 36 (72%) 40 (80%) 76 Like to Work with People 14 (28%) 10 (20%) 24 Totals so (100%) so (100%) 100 No 35 (70%) 42 (84%) 77 Totals so (100%) so (100%) 100 J~l QUESTION VII Reason VR Started Pre-test Post-test Totals Serve all Handicapped 18 (36%) 6 (12%) 24 Serve Handcapped who want to Work 27 (54%) 44 (88%) 71 Unemployed who are not Handicapped 5 (10%) 0 5 Totals 50 (100%) 50 (100%) 100 QUESTION VIII VR is a part Social of Security Pre-test 4 (8%) Post-test 3 (6%) Totals 7 Welfare 15 (30%) 10 (20%) 25 Workmen's Comp. 2 (4%) 3 (6%) 5 Public Health State Unemploy. 11 (22%) 7 (14%) 9 (18%) 9 (18%) 20 16 None of these 11 (22%) 16 (321o) 27 519 APPENDIX G This appendix is composed of the computer print-out for the regression analysis. Selection 1 shows the score on the pre-test as the dependent variable, and selection 2 shows the score on the post-test as the dependent variable. MULTIPLE REGRESSION .. SELECTION .... 1 ,ounty 'ex/Race ge arital Status ~due. Level ~o. of Dependents )upport Before )upport Now :ncome Before :ncome Now teferral Source >ccupation Before >ccupation Now >isabili ty .ength of Dis. rR_ Service Before :now Anyone VR Helped .earn About VR core on Test I VARIABLE NO. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 DEPENDENT 19 MEAN 53.92000 2.40000 35.98000 1. 96000 8.34000 1.82000 0.48000 1. 52000 174.35999 123.89999 636.87988 338.97998 99.34000 516.43994 61.67999 9.84000 0.36000 7.32000 4.30000 INTERCEPT MULTIPLE CORRELATION STD. ERROR OF ESTIMATE PILOT PROJECT STANDARD DEVIATION 42.87607 1.19523 14.56787 1. 00934 4.20208 2.25597 0.61412 1. 46022 173.72917 126.23183 315.39746 269.31006 203.31386 142.29994 88.06831 30.82756 0.74942 1.81198 1.76415 CORRELATION 0.18352 -0.11614 -0.48177 -0.23381 0.69072 -0.37074 -0.06028 -0.22816 0.07508 0.08848 0.22850 -0.15084 o. 11419 -0.29824 0. 27766 -0.03287 -0.06792 0.17365 REGRESSION COEFFICIENT 0.01737 0.24895 -0.00961 0.25732 0.36874 -0.13380 o. 08871 -0.22035 -0.00003 -0.00034 -0.00004 0.00273 -0.00044 -0.00171 -0.00148 -0.00377 0.28807 0.21350 STD. ERROR COMPUTED OF REG. COEF. T VALUE 0.00501 3.46469 0.19768 1.25940 0.01853 -0.51878 0.26637 0.96603 0.06444 5. 72224 0.09361 0.41521 -1.42933 o. 21366 0.14628 o. 00131 -1.50636 -0.02304 0.00174 -0.19620 0.00067 -0.06302 0.00091 3.01476 0.00096 -0.46385 0.00144 -1.18749 0.00233 -0.63579 0.00579 -0.65057 0.27483 1.04820 0.11280 1. 89282 ~ 0 -1.39282 0.86676 1.10614 R2= .751 SOURCE OF VARIATION ATTRIBUTABLE TO REGRESSION DEVIATION FROM REGRESSION TOTAL ANALYSIS OF VARIANCE FOR THE REGRESSION DEGREES OF FREEDOM 18 31 49 SUM OF SQUARES 114.56998 37.92976 152.49974 MEAN SQUARES 6.36500 1.22354 F VALUE 5.20212 MULTIPLE REGRESSION SELECTION ..... 2 PILOT PROJECT VARIABLE MEAN STANDARD CORRELATION REGRESSION STD. ERROR COMPUTED NO. DEVIATION X VS Y COEFFICIENT OF REG.COEF. T VALUE 1 53.92000 42.87607 -0.04172 0.00356 0.00606 0.58738 2 2.40000 1.19523 -0.14448 -0.03111 0.23902 -0.13014 3 35.98000 14.56787 -0.28434 0.01602 0.02240 0.71502 4 1.96000 1.00934 -0.26972 -0.06456 0.32208 -0.20044 5 8.34000 4.20208 0.65191 0.28637 0. 07792 3.67536 6 1. 82000 2.25597 -0.34322 -0.07311 0.11319 -0.64591 7 0.48000 0.61412 -0.01489 -0.05247 0.50205 -0.10450 8 1. 52000 1.46022 -0.25461 -0.07068 0.17687 -0.39963 9 174.35999 173.72917 0.06826 -0.00079 0.00158 -0.50165 10 123.89999 126.23183 0.00331 -0.00200 0.00210 -0.95224 11 636.87988 315.39746 0.14162 -0.00074 0.00081 -0.90451 12 338.97998 269.31006 -0.30657 -0.00013 0. 00110 -0.12127 13 99.34000 203.31386 0.06862 0.00031 0. 00116 0.26769 14 516.43994 142.29994 -0.21006 -0.00022 0.00174 -0.12748 15 61.67999 88.06831 0.28987 0.00019 0.00282 0.06772 l. 16 9.84000 30.82756 -0.02461 0.00019 0.00700 0.02682 I,..' 17 0.36000 0.74942 -0.15317 -0.27801 0.33231 -0.83659 18 7.32000 1. 81198 0.25591 0.15010 0.13639 1.10052 DEPENDENT SCORE ON TEST II 20 5.78000 1. 60725 INTERCEPT MULTIPLE CORRELATION 3.06259 0.74960 R2=.562 STD. ERROR OF ESTIMATE 1.33749 ANALYSIS OF VARIANCE FOR THE REGRESSION SOURCE OF VARIATION Attributable to Regression Deviation from Regression Total DEGREES OF FREEDOM 18 31 49 SUM OF SQUARES 71.12433 55.45538 126.57971 MEAN SQUARES 3.95135 1. 78888 F VALUE 2.20884 J.:O.) APPENDIX H TABLES OF CLIE~S USING SCORE DIFFERENCES BY EDUCATION AND THE RURAL-URBAN VARIABLE I. Tables of Clients whose score from Pre-test to Post-test Decreased One Point A. By Education Scores on Tests Pre to Post 0 4-3 5-4 7-6 8-7 Education (Years Completed) 1-4 5-6 7-10 11-12 Over 1 1 1 1 Totals 1 1 1 1 Totals 1 1 2 4 B. By County Scores on Tests Rural Pre to Post (Thomas, Decatur, Grady) 4-3 1 5-4 1 7-6 8-7 1 Totals 3 Urban (Chatham) 1 1 524 II. Tables of Clients whose score did not change from Pre-test to Post-test A. By Education Scores on Tests Pre to Post Education (Years Completed) 0 1-4 5-6 7-10 11-12 Over Totals 2-2 1 1 2 5-5 1 1 2 6-6 1 1 7-7 1 2 3 Totals 1 2 1 2 2 8 B. By County Scores on Tests Pre to Post 2-2 5-S 6-6 7-7 Totals Rural (Thomas, Decatur, Grady) 1 1 3 5 Urban (Chatham) 1 1 1 3 Ill. Tables of Clients whose score from Pre-test to Post-test Increased One Point A. By Education Scores on Tests Pre to Post Education (Years Completed) 0 1-4 5-6 7-10 11-12 Over 2-3 1 1 3-4 1 4-5 1 1 6-7 1 1 7-8 3 Totals 2 1 1 1 4 1 Totals 2 1 2 2 3 10 B. By County Scores on Tests Pre to Post 2-3 3-4 4-5 6-7 7-8 Totals Rural (Thomas, Decatur, Grady) 2 1 1 2 6 Urban (Chatham) 1 1 1 1 4 526 IV. Tables of Clients whose score from Pre-test to Pro-test Increased Two Points A. By Education Scores on Tests Pre to Post Education (Years Completed) 0 1-4 5-6 7-10 11-12 Over Totals 2-4 1 1 1 3 3-5 1 1 1 3 4-6 1 2 2 1 6 5-7 1 3 2 6 Totals 1 1 4 5 5 2 18 B. By County Scores on Tests Pre to Post 2-4 3-5 4-6 5-7 Totals Rural (Thomas, Decatur, Grady) 2 2 1 1 6 Urban (Chatham) 1 1 5 5 12 V. Tables of Clients whose score from Pre-test to Post-test Increased Three Points A. By Education Scores on Tests Pre to Post Education (Years Completed) 0 1-4 5-6 7-10 11-12 Over Totals 2-5 1 1 3-6 2 1 3 4-7 2 2 5-8 1 1 2 Totals 1 3 1 3 8 B. By County Scores on Tests Pre to Post 2-5 3-6 4-7 5-8 Totals Rural (Thomas, Decatur, Grady) 3 1 4 Urban (Chatham) 1 2 1 4 528 VI. Tables of Clients whose scores from Pre-test to Post-test Increased Four Points A. By Education Scores on Tests Pre to Post Education (Years Completed) 0 1-4 5-6 7-10 11-12 Over Totals 0-4 1 4-8 1 1 1 Totals 2 B. By County Scores on Tests Pre to Post 0-4 4-8 Totals Rural (Thomas, Decatur, Grady) 1 1 Urban (Chatham) 1 1 T E N N. N. c. Projected Population P rofile Changes 1965 -1975 Scale of Miles 10 20 30 10 ( / _j F L 0 R D A