Employment Rehabilitation Services in Michigan
Perspectives on the Provision of Rehabilitation Services
The Advisory Committee held a public meeting and received testimony on employment rehabilitation services in Michigan. Those offering testimony included: Douglas Burleigh, regional commissioner, Rehabilitation Services Administration, U.S. Department of Education; Robert Davis, State director, Michigan Jobs Commission-Rehabilitation Services; Patrick Cannon, State director, Michigan Commission for the Blind; Harry Smith, Michigan Association of Rehabilitation Services Organizations; Elizabeth Bauer and Amy Mays, Michigan Protection and Advocacy; Robert McConnell, Michigan Association of Multicultural Rehabilitation Concerns; Richard Webster, Michigan Rehabilitation Advisory Council; RoAnne Cheney, Michigan Disability Rights Coalition; Patricia Cudahy, Statewide Independent Living Council; Greta Wu, Peckham Industries; June Cronk, Lansing Center for Independent Living; and Duncan Wyeth, Governor's Developmental Disabilities Council.
U.S. Department of Education, Rehabilitation Services Administration
Douglas Burleigh, regional commissioner, U.S. Department of Education, Rehabilitation Services Administration, testified about the Federal-State partnership of rehabilitation services programs, definitions of disability, successful delivery of service, and outreach to minorities. He reported:
Rehabilitation Services . . . is a State and Federal program [with] the Federal Government providing 80 percent of funding of the State vocational rehabilitation programs and the State agencies providing 20 percent. In 1997, $2.1 billion were appropriated by Congress for vocational rehabilitation programs around the United States. Of that amount $66.9 million was allocated to Michigan Rehabilitation Services and $9.1 million was allocated to Michigan Blind. In fiscal year 1998, Federal appropriations for vocational rehabilitation services was $2.2 billion, with $67.3 million allocated to Michigan General and $9.1 million allocated to Michigan Blind.
The State-Federal VR program is an eligibility-based program. It is not an entitlement program such as medicaid or medicare. To receive vocational rehabilitation services, an individual must meet eligibility criteria. Those criteria are (1) an individual has to be a person with a disability . . . that constitutes an impediment to work, (2) the presumption of employability, and (3) the individual requires vocational rehabilitation services in order to become employed.
The presumption of employability is a major change by Congress in the 1992 amendments to the act. Prior to that, State vocational rehabilitation agencies determined whether a person could benefit from vocational rehabilitation services. Congress determined that particular eligibility criterion was weeding out individuals with severe disabilities on the assumption that, in fact, they were too severe to be employable. So in 1992, Congress said State vocational rehabilitation agencies will assume that everybody who has a disability, i.e., an impediment to work, can work.
The vocational rehabilitation program, unlike any other Federal or State jobs program, is highly individualized. Vocational rehabilitation counselors sit down with individuals who are eligible for services and with those individuals determine vocational objectives of their choice.
The Department of Education monitors the State's performance activities against the requirements of the law and regulations and whatever policy that is promulgated to interpret the regulations and the law. Every fiscal year the Department selects between 10 and 12 State vocational rehabilitation agencies for comprehensive reviews. A comprehensive review was conducted in Michigan 3 years ago. During the Department reviews, case records [are examined] to ensure that the State agency is delivering services in the way their policies and procedures say they deliver services and which are in compliance with Federal law. In addition, there are public hearings where people from around the State may come and relate their concerns about the State agency and its services they feel are being provided inequitably.
Over the years the Rehabilitation Act has been amended by Congress to give individuals with disabilities more authority and responsibility in determining their vocational objectives and the services they want to receive. Hence, the law and the State plan are replete with the requirements to show evidence that the individual with the disability received information in making an informed choice about the goals and objectives and services on his or her IWRP.
With the several amendments to the Rehabilitation Act of 1973, new requirements on the States are focused on having the States work with individuals with severe disabilities and the most severe disabilities rather than individuals with nonsevere disabilities. An individual with a severe disability is an individual with a disability that seriously limits one or more functional capacities, such as mobility, communication, self-care, interpersonal skills. The regulations list what those disabilities are: stroke, spinal cord injury, paraplegic, quadriplegic, learning disabilities, etc.; however, the list is not considered exclusive. As a result, the person's vocational rehabilitation requires multiple vocational rehabilitation services over an extended period of time. That is how the Federal law and regulations define an individual with a severe disability.
In the State of Michigan and nationally, the preponderance of services and the preponderance of placement employment closures is for individuals with severe disabilities. In Michigan it is around 90 percent. Ninety percent of the people rehabilitated by Michigan General have severe disabilities as I have just defined it. . . . The amount of money spent to rehabilitate individuals with disabilities and place them in employment is more but not necessarily significantly more, but it is more for people with severe disabilities than nonsevere disabilities.
Under the rehabilitation program a success is employment, which is a status 26. There are two other, unsuccessful, ways for an individual to exit the program: (1) the individual can choose not to continue in the program, move out of the State, or become institutionalized before the plan of services starts; or (2) an individual can exit the system while receiving services but before placement in a job. An unsuccessful exit is called a status 28. The rehabilitation success rate, i.e., the proportion of successes to unsuccesses plus successes, is status 30 and is determined by status 28 cases plus status 26 cases divided by status 26 cases. A perfect rate is 100 percent, and an awful rate is zero percent.
In asking about services to people from minority groups, there are many ways to evaluate the adequacy of State vocational rehabilitation agencies. One way is by looking at how much is spent [on the different racial and ethnic groups]. There have been reports that nationally less is spent on individuals from minority groups than is spent on whites. A second way to evaluate services is examining rehabilitation rates for different groups.
In fiscal year 1996 in Michigan General, the average cost of services to people placed in employment was $2,803 for whites, $2,677 for African Americans, $2,550 for American Indians, and $3,355 for Asian Americans. For minority groups who have severe disabilities within the Michigan Rehabilitation Services system, the mean cost was $2,901. For whites with severe disabilities the mean cost was $2,885, for African Americans with severe disabilities the mean cost was $2,967, for American Indians with severe disabilities the mean cost was $2.499, and for Asian Americans with severe disabilities the mean cost was $3,027.
When Congress was reviewing the law to amend it for another 5 years, they received testimony that asserted individuals from diverse cultural backgrounds were being served at a lower level, receiving less services, and in fewer numbers. As a result, Congress in the Rehabilitation Act Amendments of 1992, told agencies to reach out more to individuals from diverse backgrounds. The Department as part of its review of State agencies looks at State agency statistics on services to people from diverse backgrounds, how much is spent, and numbers served and rehabilitated.
Michigan Rehabilitation Services
Robert Davis, State director for Michigan Rehabilitation Services, testified about the agency's rehabilitation services to individuals with disabilities. He first addressed three topics of concern to the Committee: (1) the number of individuals served, (2) order of selection, and (3) rehabilitation services to the most severely disabled.
MRS rehabilitates about 7,000 people in Michigan that have disabilities. There are estimates that in Michigan, 1.7 million individuals may have a disability, but that number would include people beyond retirement age with debilitating illnesses. So it is very difficult to know the exact number of employable-age individuals with a disability. MRS has 26,000 people with disabilities on its open caseload, and 530 staff. In a typical year approximately 40,000 people receive MRS services, 90.2 percent of those coded by Federal definition as severe.
Nationwide the VR program will rehabilitate about a quarter of a million. It is estimated, though, that nationally perhaps 30 to 40 million disabled people potentially want and possibly could work. The overall size of the Federal-State program is obviously not adequate to that challenge, so our strategy in Michigan is to try and make accessible to people mainstream systems. By the mainstream systems I'm talking about the employment and training system and the educational system. And we have strategies in place to do both of those.
MRS does maintain statistics on the number of individuals who apply for services and are deemed ineligible. The agency operates according to a numerical annotation called a status, to everything that happens in the rehabilitation process. A zero to eight closure is a negative closure in the sense of the individual leaving the system before an eligibility decision has been made. Moreover, starting in 1992 there is a presumption across the board for anyone with a personal disability to be employable, so that is no longer a valid reason for being made ineligible.
An order of selection is a process that is very clearly stipulated by Federal regulations that a State must enter into if the State director determines that the State has a significant inability to serve all of those eligible people. In other words, there are not enough funds for people that are eligible for the services, and the State agency has to make a distinction among its clients between most severe and severe. MRS is not an order of selection agency. Ninety percent of the MRS clientele are severe and the agency's feasibility studies indicate that it is a very problematic process to determine who is most severe and [a process] subject to a high degree of subjectivity.
Along this line, the coding of an individual as disabled, severely disabled, or most severely disabled is not subjective and loose. A good portion of the coding is categorical. For example, 40 percent of MRS clients get either a supplemental social security income check or a social security disability insurance check. To qualify for those benefits, by almost anyone s opinion, one would have to be severely disabled. So those are automatically coded severe, according to the Federal definition. There are some other portions of the code, which by disability, are also categorical. The remaining portion have to establish eligibility according to limitations in different important life functions. That is not as loose as sometimes characterized, and 90.2 percent of the MRS population are coded as severe. Further, approximately 88.4 percent of our successful rehabilitations, i.e., people who at the end of the rehabilitation process have successfully worked and their work is verified for a 90-day period, are coded severe.
In years past the agency did cream because counselors had to do a certain number of successful rehabilitations a year. That was identified as a problem by the rehabilitation community and by Congress. Today, there are no hard and fast placement goals. We allow counselors to assess the difficulty level and the severity level of their own caseloads and establish their own numerical goals. We do not punish them for not meeting those goals, but the numbers are looked at as they pose questions about problems that may occur in the management of a caseload, extra resources that might be needed. It is understood that these are more difficult assignments, and the expectations are correspondingly geared down.
To ensure that typecasting on the basis of disability does not happen, it is an item specifically defined and examined in case reviews, i.e., looking for stereotyping, identifying it, and taking actions to move away from it. In addition, when employers and workshop groups act in this manner, the agency pulls its business from those employers and workshops until those organizations provide more choices and more job variety for the MRS clientele.
Davis followed those comments with testimony specific to efforts by the MRS to serve the minority community. The Committee asked Davis to comment on the issue of using local money as part of the State's matching funds. The concern about this practice was grounded in the presumption that communities able to provide local funding are in all likelihood wealthier communities and disproportionately nonminority. Davis responded:
It takes about $17 million of [State] matching funds to receive all available Federal funding. Ten million of that 17 million for Michigan Rehabilitation Services comes from general funds that are appropriated by the State legislature. About $5 million of it comes from local cash match agreements, and these are the 147 local agreements predominantly with local school systems, intermediate school districts, and community mental health centers. Those are the two most frequent partners in the local level. There is an additional million to $2 million in what we called loaned staff, loaned assets, and those are, again, community partners that have given us staff, for example, a community mental health center that's given us two or three staff in the Detroit area to do with as we want, to provide services to our mutual clientele.
We use that money to provide services through 34 offices scattered throughout the State. We try to distribute our resources on the basis of where the population density is. We also try to distribute our staff and our case services accordingly.
MRS is extremely aware of the equity problem coincident with the local cash match part of its budget, which is $5 million and $2 million. What the agency has done is take some discretionary funds earned from successfully rehabilitating social security recipients and put those into communities most disadvantaged by having less opportunity for cash match. The agency specifically targeted funds this year for the Detroit area with the idea that Detroit could perhaps over a 3- or 5-year period develop the same level of partnership agreements and develop a cash match to the degree that the rest of the State could.
The other offsetting governor on match inequity is the existence of a limiter on the amount of cash match that can be made by richer communities. [Such communities] may not go over a certain percentage of their percentage of the population, and that limits the amount of local cash match partnership money they can develop. . . . The agency is trying to maintain an equitable balance in the face of a situation, where, if environmental pressures have their way, resources would be skewed [to the wealthier communities].
Finally, with respect to services provided minorities within the system and outreach to the minority community, Davis told the Committee:
In terms of our clientele and minority representation, in the last population census for African Americans, 13.9 percent of the State's population was African American and 2.2 percent were Hispanic. Currently 25.2 percent of the MRS caseload is African American and 2.6 is Hispanic.
In addition, the agency has tried to hire staff that represent the community. Outreach must really be done with an understanding of cultural values. For example, in the Hispanic community, sometimes Hispanic individuals will not self-identify themselves to the government agencies, so agency workers have to go into the community and be a part of the community and be a trusted individual. Obviously, if you don't speak Spanish that makes the task that much more difficult. So we try our best to hire people with those kinds of skills.
Michigan Commission for the Blind
Patrick Cannon, State director for the Michigan Commission for the Blind, testified about the agency's work with individuals who are blind. Cannon told the Committee that (1) everyone served by the Michigan Commission for the Blind is by definition severely disabled; (2) the agency operates under the philosophy that its clients need to set their own rehabilitation and employment direction; (3) the greatest barrier facing people with disabilities is the biases, fears, myths, and stereotypes on the part of the general public and employers; and (4) for cultural reasons, such biases and stereotypes affect more people with disabilities who are minorities. In addition, Cannon emphasized that the provision of accessible and affordable transportation by a community is a critical component of effective rehabilitation services.
The Michigan Commission for the Blind is an agency with nine offices and a staff of 109 employees, and of those staff members 18 are minorities. As to serving people with severe disabilities, all of the clients served by the Michigan Commission for the Blind would fit the definition of severe disabilities. One of the agency's components is the Blind Training Center in Kalamazoo, a residential training facility where clients learn the skills of blindness on orientation, mobility and travel skills, exposure to Braille, adaptation skills, industrial arts, and many other things that will assist those individuals coming to terms with their blindness and acquiring the skills that will enable them to access additional services, technologies, and opportunities that will pave their pathway toward independence and productivity.
The Michigan Commission for the Blind believes very strongly that its clients need to set their own direction. Blind persons, if given the right opportunities and the right training and supports and technologies, can do just about anything that anyone else can do. The commission's VR counseling staff talks about that to clients to help them set their meaningful goals so the individual who is blind can reach out and achieve his or her full potential.
Today, the greatest barrier facing blind people and people with disabilities is the lack of understanding on the part of the general public and employers. Blindness is not the big deal. It is the biases, fears, myths, and stereotypes of those misunderstandings and assumptions of the disability that really create barriers to independent living and productivity. So the efforts on the part of Rehabilitation [Services] and other disability advocacy agencies to try and create a clearer picture of what blindness is and what it is not is a critical component towards effective rehabilitation. Along with that there is a notion of typecasting or stereotyping. There was a time when it was thought that blind persons could only tune pianos and weave baskets. That was, fortunately, a long time ago, but there are still people who will try and draw connections between a specific disability and a particular job function. Many people think that if a person has a disability, he or she cannot work, cannot be independent, and cannot be productive.
I believe that that same kind of thinking, in some instances for cultural reasons, is more prevalent among people with disabilities who are minorities. That is one of the reasons outreach is essential, and the Commission for the Blind does such outreach in different ways. Outreach and awareness are important components of the agency's service.
A specific barrier that is significant to the clients that the commission serves, as with other people with disabilities, is the lack of accessible and affordable transportation. Transportation to people who are blind is, at times, the most significant provided service because the blind are nondrivers, and as nondrivers have to rely on public transportation. In communities where public transportation is not existent or inadequate, that is a significant barrier to employment and independent living.
Finally, reliable data is inadequate on the extent of the population with disabilities who have functional limitations that are barriers to employment. The Commission on Disability and the National Association of Governors Committee have strongly advocated for a more effective way of counting people with disabilities in the 2000 census. In the next national census, we think we will have more accurate data as to the people with disabilities.
Service Delivery to the Most Severely Disabled
Harry Smith, Michigan Association of Rehabilitation Services Organizations, told the Committee that the definitions of disability were imprecise and vague. As a consequence, the implementation of any order of selection would be flawed. Smith also asserted there is an absence of credible data on the number of persons with functional limitations, which thwarts a rational planning process.
As I see it, you have in the Federal [rehabilitation services program] an unworkable definition. The issues that you are discussing today emanate essentially from an inherent flaw in the Rehabilitation Act in that it assigns to the State rehabilitation agency the responsibility to deliver services to a population which is defined in very loose terms.
The definition [of disability] includes not only a set of functional limitation statements, but also a list of diagnostic categories that allow for eligibility for a program. It is within those diagnostic categories that one begins to have [an idea] of what is wrong with the way this program is structured. For example, the term cerebral palsy is an example of an individual who would be eligible for the program. But the term itself masks a great deal of information and assumes that all cerebral palsy is equal in terms of its functional implications for the individual, as does the term blindness, or any other of the diagnostic labels that are included in this list. Congress assigned responsibility to the States as to what most severely disabled means. As a consequence, within this country there are some 80 jurisdictions required by the Federal Government to define the term most severely disabled. That's an abject failure.
A second problem, in my opinion, is the whole issue of the order of selection provision. There are, by any rational look at the numbers, a pool of individuals who are eligible for services who far outstrip the capability of the State rehabilitation agency to deliver services to them on an annual basis. . . . The order of selection, as you can appreciate, gets more complicated if you have a loose definition given to you by the United States Congress. Who gets what? It is really an inequity issue.
Another major problem is the total absence of useful data that would guide the States in terms of what is a disability. If you look at the catalog of the Federal domestic assistance programs, I think you'll find an excess of 100 different programs that are targeted towards disability, and you will find a plethora of definitions about what constitutes a disability and the programs that are financed and/or operated by the Federal Government. In the last census, there was an attempt to provide input to the Census Bureau so that it could provide a national database of persons with functional limitations that made sense and that would provide a more rational planning process. It does not exist today.
Elizabeth Bauer, executive director of Michigan Protection and Advocacy, and Amy Mays, director of the client assistance program at Michigan Protection and Advocacy, spoke to the Committee about rehabilitation service delivery. Michigan Protection and Advocacy is a private, nonprofit organization established for the purpose of advocating for the federally mandated rights of individuals with disabilities. The representatives from Protection and Advocacy stated calls to their office were largely of three types: (1) calls from service providers who are out of funds, (2) calls from clients who do not understand their rights, and (3) calls from clients wanting more and/or different services than those being provided by MRS.
The purpose of Michigan Protection and Advocacy is to provide services to individual folks who are either interested in receiving vocational rehabilitation services, are current applicants or clients of vocational rehabilitation services, or may have had a former client appropriate our services. On any given day our organization will receive 10 to 15 calls.
Most issues play into the rationing effect. People are generally reacting to the funding levels available in each district office, since whether or not they receive services is connected to the funding level available. As the year goes on the funding level goes down, and that prompts calls to our office from [service providers] saying, We don't have any money. What do we do about that now? In those instances we remind them of their Federal mandates, and tell them to remind their staff that they still need to approach each case individually and make decisions based upon informed choice.
Protection and Advocacy also receives numerous calls dealing with communication problems. Rehabilitation counselors . . . have anywhere from 150 to 200 cases. As a result, we get a lot of clients who either have not heard from their counselor in a while or they have not touched base with them themselves. Many people find that they are unable to advocate for themselves as effectively as they would like, and many times people do not understand what their rights are.
The client assistance program with the Michigan Protection Advocacy Service has served about 1,500 people. A large percentage of calls to MPA are from individuals who feel they are not getting the services that they want. I will also add that sometimes individuals want to have a lot more than what can realistically happen. Most complaints about service provision are [general in nature] as people are not calling and saying, I think I need these services. They are not identifying those.
Roanne Chaney, Michigan Disability Rights Coalition, told the Committee that vocational rehabilitation counselors often do not recognize the effectiveness of providing independent living and working services to clients.
Many [VR counselors] do not recognize the interaction between independent living [IL] issues and rehabilitation services. An upcoming study funded through a Developmental Disabilities Council grant has done a cost effectiveness study of [IL services].
The study shows a cost effectiveness for investing in personal assisted services for people who work, i.e., the dollars put in compared to the dollars returned in taxes are the greatest for people provided IL service. There is also the category of cost avoidance, what is not paid out in terms of . . . government subsidies that are avoided by a person staying employed.
In addition, the study reports on the [cost effectiveness] of IL home-based employment [and] secondary education. It is sometimes difficult to get funding through rehabilitation services [for these types of programs].
Greta Wu is the service director at Peckham Vocational Industries, a community rehabilitation organization in the Lansing area. Peckham Industries provides rehabilitation services, including career assessment, job training, supported work experience, job placement, education, and job coaching services. Wu talked about Peckham's relationship with MRS.
The Michigan Rehab Services refer a lot of people to Peckham. They do vocational assessment. Typically they do not make commitments on how many clients will be referred, they just refer clients to us for services. If the referred person does not have a vocational goal, we help them to determine that.
Although Peckham does not have specific performance requirements from MRS, it is required to report outcomes. MRS evaluates each service provided by Peckham to its referrals. MRS also evaluates how successful the placement rates are and evaluates Peckham on its inclusion of consumer input into services.
June Cronk has been affiliated with the Lansing Center for Independent Living for 18 years. She is currently chairperson of the board for the center. Cronk talked about the center's association with Michigan Rehabilitation Services.
The Lansing Center for Independent Living receives a lot of referrals from the Lansing district office of MRS for many reasons: people who need help with housing, people who need help with transportation, people who need help with the Family Independence Agency . . . For just our regular services, they just refer them over there and we do what we can do, and that's not an issue at that point.
To this end, our agency has contracts with the local district office of MRS that have expected outcomes and numbers at the end of the fiscal year. We report all those things to MRS, and I expect if they are not satisfactory, then MRS will not renew the contract.
One major flaw in the current program is that if a person goes to work, he loses his social security after 12 months if he earns over $500 a month. He can also lose medicare after a certain amount of time, and if on medicaid and have subsidized housing, lose that too. . . . There is a whole system of disincentives in place for people with disabilities if they want to go with work.
Duncan Wyeth, a specialist in customer relations with Michigan Rehabilitation Services and a member of the Michigan Developmental Disabilities Council, addressed the issues of severe disability and the number of individuals needing services.
The discussion of severity is amusing in that it is similar to the futile Medieval discussions about the number of angels that can dance on the head of a pin. I have cerebral palsy. It affects my balance, my walking, my fine motor control. In my work environment as an advocate for persons with disabilities, I would suggest to you that my cerebral palsy is a significant advantage. Severity is a very relative term. There are no absolutes in terms of severity. The issue is whether or not the specific social and physical environment that an individual is in causes that characteristic to interact with that environment in such a way as to present a disadvantage.
The number of people needing services and the number of people actually being served by the rehab system is an important issue. Historically in this country . . . people with disabilities were either underserved or unserved. So developed a series of specialized programs to specifically remedy that underservice or nonservice. Those specialized programs have themselves, at times, become a barrier to further progress insofar as when a person with a disability contacts the employment service and identifies himself as having a disability, that employment service automatically says, Oh, you need to go to rehabilitation or vocational rehabilitation. There needs to be a total integration of persons with disabilities so that the State agency, rather than becoming the first service delivery system for persons with disabilities might be just one component of employment services.
Service Delivery to Minorities
Harry Smith, Michigan Association of Rehabilitation Services Organizations, has 30 years of experience in rehabilitation services in Michigan. He told the Committee that over that period there has been a fundamental change in funding. Years ago there was no reliance on local third-party dollars; today there are more than 100 local entities in the State providing part of the State s matching grant money. This development could have a severe impact on the equitable delivery of rehabilitation services to the poorer communities.
In Michigan we have gone from a situation where there was no reliance on dollars originating from the third-party sources, to a situation where there are now 140 plus agreements that are entered into between the State rehabilitation agency and local entities to generate the local dollars that can then be used by the State of Michigan to claim the Federal match that is necessary to drive the program.
What is the consequence of using that local match? [First], in some instances a consequence is that dollars are targeted towards populations that may or may not be consistent with the intent of the Congress. [Second], the targeted dollars may be consistent with [the intent of Congress] in the broad definitional sense provided to the State rehabilitation agency, but nevertheless directs resources to populations when there are equally valid claims from other disability groups that do not have those kind of contacts in local communities where they can have dollars put up and targeted to meet their needs.
[So service provision] becomes a function of where you reside within the State of Michigan. As one would expect, the richer communities of the State of Michigan are in better positions to make contributions to provide for an expansion of rehabilitation service capacity than the poorer communities are within the State of Michigan. So you end up with a dollar skewing. And I recognize that the State rehabilitation agency has taken efforts to minimize the impact of that. The question I have in my mind is, Can they eliminate it? And I would suggest that would be very difficult for them to do. This problem with the local money is not a recent phenomenon that's just occurred with this particular administration.
Robert McConnell, Michigan Association of Multicultural Rehabilitation Concerns, discussed rehabilitation services relevant to minority persons with disabilities.
The Rehabilitation Act Amendments in 1992 had a special section, section 21, that addresses issues that affect minority persons with disabilities and rehabilitation service delivery systems. There is a significant difference in the incidence of disability between the minority and nonminority populations. Depending upon the racial or ethnic [minority] group, minorities are from 1 to 2 times as likely to have a disability.
Employment and rehabilitation programs seem to be less effective for minorities than nonminorities. In general, earning levels, type of employment, ability to acquire employment, and ability to maintain employment are all issues that are more pronounced with minority populations of persons with disabilities than nonminorities.
Data also indicates that persons with disabilities from minority backgrounds have lower income levels than nonminorities with disabilities. Education levels of minorities are behind those of the majority population, and health care and treatment is an issue that is particularly pronounced for minority persons with disabilities.
The effectiveness of the Americans with Disabilities Act (ADA) depends on awareness about the law among those affected, and the adequacy of enforcement. In both areas, minority populations appear to be disadvantaged. . . . Two factors appear to mitigate against timely resolution: (1) inadequate staffing, and (2) cumbersome complaint resolution process . . .
It is recommended that annual followup and monitoring and quarterly reporting occur by the Rehabilitation Services Administration. This monitoring should occur on two levels: (1) performance as described in the State Plan . . . and (2) maintenance of data on equity performance indicators [including] outreach/penetration, outcome indicators, and service equity.
Greta Wu identified cultural barriers that interfere with rehabilitation service delivery to minority communities.
From the experiences at Peckham Industries, we notice that with the refugee population often we encounter a lot of resistance. The [refugee] family does not want to recognize the disability and do not want to seek help. It is almost a kind of issue that they do not want even to discuss, so when we offer to help they say, No, we can take care of that. Particularly with mental health, there is a very big stigma.
Surveys on Rehabilitation Services
Michigan Rehabilitation Advisory Council Report
Richard Webster, director of the Michigan Rehabilitation Advisory Council, submitted the council's most recent annual report on the status and quality of vocational programs operated within the State. The Michigan Rehabilitation Advisory Council is a federally mandated council to advise Michigan Rehabilitation Services (MRS) on all programs and policies related to title I and title VII C of the Rehabilitation Act. Pertaining to the FY 1997 performance of MRS, the council reported:
Total of 9,800 individuals placed into employment, with 6,488 rehabilitated (90 days of suitable work), compared with a goal of 6,700. 41,000 customers served with case service/grants budget exceeding $37M. All goals surpassed with the exception of successful rehabilitations; 3% gap was due to early retirement of 38 counselors and change of federal policy requiring 90 days follow up for successful rehabilitation.
Service delivery redesign pilot project completed; implementation in all offices underway. Three-year comparison shows significant reduction in cycle time for critical stages of rehabilitation model (79 to 36 days for eligibility; 125 to 92 days for rehabilitation plan).
Increases in all categories in number of under served people with disabilities served. Increase of 1,150 school age youth and 1,100 African Americans.
Full funding achieved as result of expanding cash match to $4.5M in 1997 and $5.0M in 1998. 140 agreements show balance between community mental health (40%), schools (37%), and other sources (22%).
Survey of Needs for Rehabilitation Services
An internal study by the Michigan Rehabilitation Services in 1988 found that existing information about needs for rehabilitation services was inadequate. The information was either national in scope or dealt with disability rather than need for services. As a result, MRS engaged in a statewide survey to learn the number of people in Michigan limited in their ability to function in employment and independent living because of physical, mental, or emotional condition and the severity of the limitation.
Surveys of the general population provide notoriously variable estimates of the number of people who have disabilities. Surveys of the general population require that individuals who have disabilities identify themselves, and the results may vary widely when different methods of inquiry are used. Some individuals do not consider themselves disabled or functionally impaired even when they have conditions that might be regarded as a physical or mental impairment that constitutes or results in a substantial impediment to employment by others. The same individuals may view their situation differently when they are success fully working than when they are out of work and seeking employment.
The content of the MRS survey was developed after reviewing other studies by Federal and State agencies and consumer groups. The study's overall design was based on the survey, The ICD Survey of Disabled Americans: Bringing Disabled Americans into the Mainstream, conducted in 1986 by Louis S. Harris and Associates for the International Center for the Disabled in cooperation with the National Council for the Handicapped.
The MRS design employs screening techniques to locate respondents for the study. Screening questions leading to indepth interviews gen erally do not provide the same estimates as studies designed solely to estab lish prevalence rates. Table 4 shows the MRS survey resulted in an estimate that 5.4 percent of the persons in Michigan aged 16 74, or 356,900 indi viduals, have a disability or health condition that limits their ability to work or conduct other major life activities. The estimated prevalence of disability resulting from this survey is lower than the rate obtained by other methods.
The 1990 U.S. census found the number of people in Michigan aged 16 to 64 who were limited in their ability to work at a job to be 9.3 percent, or 550,000. Other estimates based on national studies are also generally higher.
The MRS study provides evidence that the number Michigan residents with a physical or mental impairment causing a substantial impediment to employment is large some 356,900 adults aged 16 74. Moreover, according to the MRS survey, 91 percent of those responding they had a disability had a severe disability by Federal definition. Assuming the rate of disability to be constant and given the increase in population in the last 10 years, the number of individuals aged 16 74 with a disability that is a substantial impediment to employment is 400,000, and 364,000 of those individuals have a disability that by Federal definition is severe. According to the testimony of Robert Davis, State director of Michigan Rehabilitation Services, MRS rehabilitates 7,000 people on an annual basis. In a typical year approximately 40,000 people receive MRS services.
Households in Michigan (1987)
Total population (1987)
Population aged 16 74 (total pop. x .721)
Mean residents in screened households
Number aged 16 74 (37,536 x .721)
Survey identified 16 74 persons w/disability
As percent of households screened
As percent of individuals screened
Percent times total population 16 74 (5.4 x 6,633,200)
Statewide Independent Living Council Survey
Patricia Cudahy from the Statewide Independent Living Council (SILC) testified on its survey of rehabilitation services delivery. SILC, a Governor-appointed council made up of 18 individuals, more than half of whom have disabilities, advises the Governor and the State departments on issues affecting the lives of people with disabilities. In the 3-year period 1995 97 at a series of town hall meetings, SILC undertook to collect input from individuals with disabilities, their families, advocates, and professionals on the concerns and shortcomings in the delivery of rehabilitation services. Cudahy told the Committee:
When we did the town hall meetings, SILC had five different disability issues: employment, transportation, assisted technology, personal and family supports, and independent living services. Out of the 275 people surveyed, [all] 275 thought that people with disabilities in their area needed help in finding available jobs . . . and they needed transportation to get to work.
Several themes emerged regarding employment. One of these is transition programs. While transition services for youth is a major and important emphasis [of MRS], other life transitions should be considered. For people with significant disabilities the aging process poses many challenges. The person with a significant disability is now living longer and is faced with an added stress of a body going through the aging process along with the disability. [Rehabilitation Services delivery programs] also need to consider job longevity expectations. There needs it be an increased awareness of the impact of adding employment to the life of a person with a significant disability.
Transportation continues to be a high concern of people with disabilities. . . . There need to be more people employed in the [rehabilitation] system who have disabilities themselves in order to affect the systems change we need. . . . Independent living is a key component of employment; a person who has a significant disability has to understand in his own mind that he has value and worth and that he can go to work and amount to something. And that is where independent living starts.
 The public hearing was held on June 25, 1998, in Lansing, Michigan. A complete transcript is available from the U.S. Commission on Civil Rights, Midwestern Regional Office, Chicago, Illinois. Douglas Wyeth testified during the public session of the meeting.
 Douglas Burleigh, testimony before the Michigan Advisory Committee to the U.S. Commission on Civil Rights, factfinding meeting, Lansing, MI, June 25, 1998, Lansing, Michigan, transcript, pp. 5 44 (hereafter cited as Michigan Transcript).
 Testimony of Robert Davis, Michigan Transcript, pp. 124 43.
 Testimony of Patrick Cannon, Michigan Transcript, pp. 144 55.
 Testimony of Harry Smith, Michigan Transcript, pp. 45 64.
 Testimony of Amy Mays, Michigan Transcript, pp. 79 83.
 Testimony of RoAnne Chaney, Michigan Transcript, pp. 109 17.
 Testimony of Greta Wu, Michigan Transcript, pp. 197 207.
 Testimony of June Cronk, Michigan Transcript, pp. 207 12. In December 1999 President Clinton signed the Work Incentives Improvement Act, which removes income limits and allows disabled workers to retain health insurance coverage through medicaid or medicare.
 Testimony of Duncan Wyeth, Michigan Transcript, pp. 227 36.
 Testimony of Harry Smith, Michigan Transcript, pp. 45 64.
 Testimony of Robert McConnell, Michigan Transcript, pp. 70 75.
 L. Robert McConnell, letter to Michigan Advisory Committee, U.S. Commission on Civil Rights, July 13, 1998, Midwestern Regional Office files.
 Testimony of Greta Wu, Michigan Transcript, p. 206.
 The Michigan Rehabilitation Advisory Council, MRAC Annual Report 1996 97.
 Michigan Rehabilitation Services, The MRS Survey of Needs for Rehabilitation Services in Michigan, conducted by Project Outreach of the Michigan Board of Education, Robert D. Struthers, Ph.D., project coordinator, July 18 Aug. 3, 1988 (hereafter cited as MRS Survey).
 See L.D. Haber, Trends and Demographic Studies on Programs for Disabled Persons, in Social Influences in Rehabilitation Planning: Blueprint for the 21st Century (Alexandria, VA: National Rehabilitation Association, 1984).
 MRS Survey.
 See chap. 3, testimony of Robert Davis.
 Testimony of Patricia Cudahy, Michigan Transcript, pp. 139 47.