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American Indian vocational rehabilitation services: a unique approach.



An extensive investigation of the prevalence of disabilities among American Indians American Indians: see Americas, antiquity and prehistory of the; Natives, Middle American; Natives, North American; Natives, South American.  resulted in the following data (O'Connell, 1987):

* American Indians had a disproportionately dis·pro·por·tion·ate  
adj.
Out of proportion, as in size, shape, or amount.



dispro·por
 high incidence of disability.

* American Indians had a disproportionately high rate of unemployment.

* The percentage of American Indians employed in low scale jobs was disproportionately high.

* Among American Indians who were employed, a disproportionately high incidence of disability occurred on the job.

These results were corroborated cor·rob·o·rate  
tr.v. cor·rob·o·rat·ed, cor·rob·o·rat·ing, cor·rob·o·rates
To strengthen or support with other evidence; make more certain. See Synonyms at confirm.
 by data reviewed by Kuehn and Imm-Thomas (1993). Their investigation was a response to an observed correlation between the rate of infants born with low birth weights in a population and the percentage of individuals who subsequently exhibited developmental disabilities developmental disabilities (DD),
n.pl the pathologic conditions that have their origin in the embryology and growth and development of an individual. DDs usually appear clinically before 18 years of age.
 within that population. Though the percentage of American Indian American Indian
 or Native American or Amerindian or indigenous American

Any member of the various aboriginal peoples of the Western Hemisphere, with the exception of the Eskimos (Inuit) and the Aleuts.
 infants with low birth weights was comparable to that in the general population, there were significantly higher mortality rates for both neonates and adults among American Indians. The combined effects of these statistics was interpreted as an indication of a greater proportion of developmental disabilities among American Indians.

Other examples of disabling dis·a·ble  
tr.v. dis·a·bled, dis·a·bling, dis·a·bles
1. To deprive of capability or effectiveness, especially to impair the physical abilities of.

2. Law To render legally disqualified.
 conditions that have been reported as occurring with unusual frequency among American Indians included alcoholism alcoholism, disease characterized by impaired control over the consumption of alcoholic beverages. Alcoholism is a serious problem worldwide; in the United States the wide availability of alcoholic beverages makes alcohol the most accessible drug, and alcoholism is  (Kivlahan, Walker, Donovan, & Mischke, 1985; May, 1986; 1988), mental health problems (May, 1987; 1988), communication disorders communication disorder
n.
Any of various disorders, such as stuttering or perseveration, characterized by impaired written or verbal expression.
 (Thielke & Shriberg, 1990), drug and substance abuse (May, 1986), depression (May, 1987), fetal alcohol syndrome fetal alcohol syndrome (FAS), pattern of physical, developmental, and psychological abnormalities seen in babies born to mothers who consumed alcohol during pregnancy.  (McShane, 1988), and the early display of symptoms associated with aging (Martin, White, Saravanabhavan, & Carlise, 1993). Although the incidence of such disabling conditions has been reported as higher among American Indians as a group than among the general population, there can be significant variability in rates of occurrence between tribes (Justice, 1987) and among members of the same tribe. Variability in rates of incidence for disabilities among American Indians has been linked to age as well as social and economic factors (Logue, 1990).

Some critics (Morgan, Guy, Lee, & Cellini, 1986; Morgan & O'Connell, 1985; Toubbeh, 1987; 1989), observing the prevalence of severe disability among American Indians, have argued that American Indians should receive priority as clients for effective rehabilitation programs Noun 1. rehabilitation program - a program for restoring someone to good health
program, programme - a system of projects or services intended to meet a public need; "he proposed an elaborate program of public works"; "working mothers rely on the day care
. However, traditionally organized and delivered rehabilitation programs have been largely unsuccessful with American Indians. Because of the incongruity in·con·gru·i·ty  
n. pl. in·con·gru·i·ties
1. Lack of congruence.

2. The state or quality of being incongruous.

3. Something incongruous.

Noun 1.
 between the assumptions on which these programs are based and the assumptions on which the beliefs of American Indians are founded, critics of traditionally organized programs have even questioned whether such programs constitute a barrier rather than a pathway to rehabilitation rehabilitation: see physical therapy. .

Cultural Diversity

Recounting case studies of American Indians, Joe and Malach (1992) highlighted the distinctive linguistic patterns and cultural values that can prevent the simple extrapolation (mathematics, algorithm) extrapolation - A mathematical procedure which estimates values of a function for certain desired inputs given values for known inputs.

If the desired input is outside the range of the known values this is called extrapolation, if it is inside then
 of intervention models of rehabilitation. On the basis of distinctive features of American Indians, they emphasized the need for family centered assessment and intervention. They advised that service models be implemented by professionals who are sensitive to the social, psychological, philosophical, and spiritual values of American Indians. After reviewing case studies of several American Indians with disabilities, O'Connor (1993) noted that, "... to better understand the meaning of services to Indians, it is important to look not only at programs, but also at the cultural background of the people using the services ..." (p. 315). Locust locust, in botany
locust, in botany, any species of the genus Robinia, deciduous trees or shrubs of the family Leguminosae (pulse family) native to the United States and Mexico.
 (1988) recommended that practitioners develop a rapport The former name of device management software from Wyse Technology, San Jose, CA (www.wyse.com) that is designed to centrally control up to 100,000+ devices, including Wyse thin clients (see Winterm), Palm, PocketPC and other mobile devices.  with their clients, attempting to view their clients' disabilities from a perspective within the culture of American Indians. The National Indian Council Indian Council may refer to:

In India:
  • Indian Council of Agricultural Research, the apex body in agriculture and related allied fields in New Delhi, India
 on Aging (1981) stressed the need for culturally sensitive services as well as the inclusion of American Indians themselves in both planning and implementation. Recognition of clients' legal right to participate in the planning of services that affect them can be extended beyond American Indians to all individuals with disabilities, irrespective of irrespective of
prep.
Without consideration of; regardless of.

irrespective of
preposition despite 
 their ethnic origin or the severity of their disabilities (Gerry & Mirsky, 1992).

Levy (1987) stressed that beliefs between tribes can be sufficiently distinct to influence responses to medical services. As an example, distinct assumptions about the cause of epileptic seizures Noun 1. epileptic seizure - convulsions accompanied by impaired consciousness
convulsion - violent uncontrollable contractions of muscles

generalized seizure, grand mal, epilepsia major - a seizure during which the patient becomes unconscious and has
 by Pueblo and Navajo Indians may have been responsible for the greater number of social and emotional problems exhibited by Navajo Indians with epilepsy epilepsy, a chronic disorder of cerebral function characterized by periodic convulsive seizures. There are many conditions that have epileptic seizures. Sudden discharge of excess electrical activity, which can be either generalized (involving many areas of cells in . Other investigators have examined the possibility that shared group values of American Indians have influenced their perceptions of visual impairment Visual Impairment Definition

Total blindness is the inability to tell light from dark, or the total inability to see. Visual impairment or low vision is a severe reduction in vision that cannot be corrected with standard glasses or contact lenses and
 (Lowrey, 1987) and emotional disturbances Noun 1. emotional disturbance - any mental disorder not caused by detectable organic abnormalities of the brain and in which a major disturbance of emotions is predominant
affective disorder, emotional disorder, major affective disorder
 (Scruggs & Mastropieri, 1985; Thomason 1991; Trimble & Fleming, 1989).

A survey of vocational rehabilitation counselors vocational rehabilitation counselor,
n term coined in the 1960s and 1970s for a professional who incorporates the best of psychology, social work, and nursing in an attempt to integrate psychology with traditional rehabilitation protocols.
 who worked with American Indians (Martin, Frank, Minkler, & Johnson, 1988) indicated that the counselors viewed sensitivity to their clients' cultures and communities as essential components of effective intervention. Although this sensitivity was noted by counselors who worked with clients on the reservation as well as counselors who worked with clients off of the reservation, cultural sensitivity was evaluated as more important by the counselors who worked with clients on the reservation. A culturally adapted network of community support was judged to be critical for all American Indians during the phase of rehabilitation that followed counseling.

Geographical isolation Geographic isolation, or allopatry, is a term used in the study of evolution. When part of a population of a species becomes geographically isolated from the remainder, it may over time evolve characteristics different from the parent population (due to natural selection).

Hodge and Edmonds (1988) described vocational rehabilitation Noun 1. vocational rehabilitation - providing training in a specific trade with the aim of gaining employment
rehabilitation - the restoration of someone to a useful place in society
 projects for American Indians on three reservations. Recipients of services, for whom the average age was the early thirties, were unemployed, living in poverty, and receiving medical care. In addition to lack of adequate finances, inadequate transportation resulting from geographic isolation was identified as a major obstacle to counseling and rehabilitation. Joe (1988) argued that many rehabilitation services were inaccessible inaccessible Surgery adjective Unreachable; referring to a lesion that unmanageable by standard surgical techniques–eg, lesions deep in the brain or adjacent to vital structures–ie, not accessible. See Accessible.  to American Indians because of bureaucratic bu·reau·crat  
n.
1. An official of a bureaucracy.

2. An official who is rigidly devoted to the details of administrative procedure.



bu
 confusion among agency personnel about their responsibilities and because of the geographical remoteness of many American Indians.

There have been several rehabilitation models that have been based on cultural sensitivity and limited geographical accessibility. Family based systems of care (Cottone, Handelsman, & Walters, 1986; Emener, 1991; Joe & Malach, 1992; O'Connell, 1985) involved family and agency collaboration to ensure that services would be available in rural communities when professionals were not accessible. Other models have developed progressive empowerment em·pow·er  
tr.v. em·pow·ered, em·pow·er·ing, em·pow·ers
1. To invest with power, especially legal power or official authority. See Synonyms at authorize.

2.
, with American Indians being trained as paraprofessionals or professionals (Runion & Gregory, 1984; Stuecher, Grossman, Hakala, & Kizlowski, 1985). There were still other models that have been built on collaboration between paraprofessionals or professionals, who may or may not have been tribe members, and who had been trained about the distinctive needs of American Indians receiving rehabilitation (Martin, White, Saravanabhavan, & Carlise, 1993; Yukl, 1986). After reviewing a survey of 17 American Indian vocational rehabilitation projects, Lonetree (1990) called attention to a conclusion formed by proponents of all of these models: effective models require cooperation between state, federal, and tribal agencies.

Models for delivering services to American Indians are somewhat comparable to rehabilitation models for persons representing a broad multicultural mul·ti·cul·tur·al  
adj.
1. Of, relating to, or including several cultures.

2. Of or relating to a social or educational theory that encourages interest in many cultures within a society rather than in only a mainstream culture.
 background (Christensen, 1989; Dodd, Nelson, Ostwald, & Fischer, 1991; Levine, 1987; Lynch & Hanson, 1992). For example, though the culture, values, attitudes, and language of minority groups can be distinct, sensitive and flexible responses to these factors are conditions for effective rehabilitation. Consequently, vocational rehabilitation counselors who are trained with models for American Indians should be able to adapt those models for persons from other minority groups. Nonetheless, there is still a distinct and critical characteristic that distinguishes service models designed for American Indians. This distinct feature is responsiveness to clients who are usually in geographically inaccessible locations.

Kuehn and Imm-Thomas (1993) identified five critical issues that needed to be examined before service delivery models developed with non-minority populations could be extrapolated to American Indians and other minority groups. These issues comprised availability, access, cost effectiveness, accommodation, and cultural appropriateness. Two of these factors, accommodation -- which refers to the interpersonal in·ter·per·son·al  
adj.
1. Of or relating to the interactions between individuals: interpersonal skills.

2.
 attitudes of professionals within service agencies -- and cultural appropriateness, are linked directly to the backgrounds, values, and attitudes of agencies' clients. In the case of American Indians, availability and access are linked inextricably in·ex·tri·ca·ble  
adj.
1.
a. So intricate or entangled as to make escape impossible: an inextricable maze; an inextricable web of deceit.

b.
 to problems of geographical remoteness. And if one considers pervasive poverty as a factor that intertwines with the backgrounds, values, and attitudes of adults with disabilities, cost effectiveness could have an influence as significant as culture (Traustadottir, Lutfiyya, & Shoultz, 1994).

A Unique Vocational

Rehabilitation Services Project

The American Indian Vocational Rehabilitation Services Project followed a pilot study developed through an agreement with the All Indian Pueblo Council. It involved collaboration between the New Mexico New Mexico, state in the SW United States. At its northwestern corner are the so-called Four Corners, where Colorado, New Mexico, Arizona, and Utah meet at right angles; New Mexico is also bordered by Oklahoma (NE), Texas (E, S), and Mexico (S).  Division of Vocational Rehabilitation and American Indian tribes in New Mexico. Its goal was to provide individual vocational rehabilitation services to American Indians at 19 pueblos and on two Apache Apache (əpăch`ē), Native North Americans of the Southwest composed of six culturally related groups. They speak a language that has various dialects and belongs to the Athabascan branch of the Nadene linguistic stock (see Native American  reservations. The American Indians at each of the 19 pueblos are members of sovereign, federally recognized tribes Federally recognized tribes are those Indian tribes recognized by the United States Bureau of Indian Affairs for certain federal government purposes. Description
In the United States, the Indian tribe is a fundamental unit, and the constitution grants to the U.S.
. The constituents of these tribes are extremely heterogeneous, exhibiting diverse cultures and speaking diverse languages. In addition to Spanish and English, residents of the various tribes communicate in seven indigenous American Indian languages American Indian languages: see Native American languages.
American Indian languages

Languages spoken by the original inhabitants of the Americas and the West Indies and by their modern descendants.
 (Apache, Keresan, Tewa, Tiwa, Towa, Navajo, and Zunian).

Preproject Survey

Originally funded in 1987, the project followed an exhaustive investigation of the rehabilitation needs of American Indians of Pueblo descent or other American Indians residing within the Pueblo communities. The subjects of this investigation were 117 residents who were interested in being referred for rehabilitative re·ha·bil·i·tate  
tr.v. re·ha·bil·i·tat·ed, re·ha·bil·i·tat·ing, re·ha·bil·i·tates
1. To restore to good health or useful life, as through therapy and education.

2.
 services. As an example of the linguistic diversity of this group, 34 percent of the respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy.  requested that the interviewers use their native language during the interview; and 74 percent of the interviewed persons indicated that they actively used their native language.

Nearly three-fourths of the interviewed persons were in financial crises and the majority did not have medical insurance. Most of the respondents were not employed; and those who had been employed recently reported mean salaries of $8,000 a year. More than half of the respondents were unemployed and not actively seeking jobs. Among persons actively searching for jobs, one-third had been searching for over a year. The disabilities they reported during the interviews included physical problems, nervous system disorders Nervous system disorders

A satisfactory classification of diseases of the nervous system should include not only the type of reaction (congenital malformation, infection, trauma, neoplasm, vascular diseases, and degenerative, metabolic, toxic, or deficiency
, mental disorders mental disorders: see bipolar disorder; paranoia; psychiatry; psychosis; schizophrenia. , emotional problems, and alcoholism. Some of the reported problems were the result of accidents and others resulted from developmental disabilities.

Based on the interviews, the project personnel identified barriers that hindered the implementation of rehabilitative services to American Indians. The obstacles included language, geographic isolation, transportation, inadequate rehabilitative services, and lack of available jobs.

Project Overview

Following the survey, a unique project was implemented. The project was intended to provide concerted services in vocational rehabilitation that would be delivered in an alternative fashion. This specific model was linked to the survey's results as well as a conviction that American Indians had been underserved in the past. Adaptations to traditional models of service delivery were designated as a means of reducing or eliminating the barriers identified by the respondents to the preproject survey.

Culture was not identified as a barrier so much as an inevitable aspect of the diversity that characterized char·ac·ter·ize  
tr.v. character·ized, character·iz·ing, character·iz·es
1. To describe the qualities or peculiarities of: characterized the warden as ruthless.

2.
 the populations of New Mexico. For example, there are 22 federally recognized Indian tribes INDIAN TRIBE. A separate and distinct community or body of the aboriginal Indian race of men found in the United States.
     2. Such a tribe, situated within the boundaries of a state, and exercising the powers of government and, sovereignty, under the national
 within the state, including 19 Pueblo Indian Pueblo Indian

Any of the historic descendants of the prehistoric Anasazi peoples who have for centuries lived in settled pueblos in what is now northeastern Arizona and northwestern New Mexico, U.S. The contemporary pueblos are divided into eastern and western.
 tribes, 2 Apache tribes, and a large segment of the Navajo Nation. Rehabilitation agency personnel made the distinction that culture was not a barrier, hoping to characterize a positive philosophy of multiculturalism multiculturalism or cultural pluralism, a term describing the coexistence of many cultures in a locality, without any one culture dominating the region.  on the part of the agency. Clearly, agency personnel understood that a monolithic Single object. Self contained. One unit.  approach to providing services to multicultural populations would represent a genuine threat to any service system model.

To ensure that cultural diversity strengthened rather than challenged the project, rehabilitation technicians were employed. The rehabilitation technicians were paraprofessionals drawn from the Indian tribes. The technicians spoke the languages used in the pueblos and were committed to providing services in clients' own communities. This model was viewed as an avenue to culturally sensitive services that would circumvent cir·cum·vent  
tr.v. cir·cum·vent·ed, cir·cum·vent·ing, cir·cum·vents
1. To surround (an enemy, for example); enclose or entrap.

2. To go around; bypass: circumvented the city.
 problems associated with geographical isolation, transportation, communication, and the accessibility of services. Since an explicit goal of the project was to prepare individuals for employment opportunities in their own communities, the problems posed by inadequate jobs could be reduced as well. Additionally, members of the tribes would participate in the design and delivery of services through the feedback they had provided on the pre-project survey They would also participate through opportunities to serve as rehabilitation technicians and through opportunities for ongoing dialogue with the rehabilitation technicians.

An additional problem identified by agency personnel was a history of reluctance within many American Indian families to refer persons with disabilities for services. The ongoing presence of paraprofessionals who themselves were residents of the pueblos was intended to raise the likelihood that referrals would be made.

The training and service of American Indian paraprofessionals was intended to have an impact on the clients with whom they would interact. However, another explicit goal of this project was that the rehabilitation technicians would in turn expand the cultural awareness of agency personnel. The project therefore became a two way conduit conduit /con·du·it/ (kon´doo-it) channel.

ileal conduit  the surgical anastomosis of the ureters to one end of a detached segment of ileum, the other end being used to form a stoma on the
, with opportunities for agency personnel as well as clients to benefit.

Training of the Technicians

Nine persons served as rehabilitation technicians in this project, and each was guided by a vocational rehabilitation counselor. They met with counselors individually and in groups to discuss the clients assigned to them. Additionally, the rehabilitation technicians attended monthly meetings for inservice training. These activities were supervised su·per·vise  
tr.v. su·per·vised, su·per·vis·ing, su·per·vis·es
To have the charge and direction of; superintend.



[Middle English *supervisen, from Medieval Latin
 by a project coordinator -- an American Indian who had been designated from within the project plan area.

The responsibilities of the rehabilitation technicians were to provide culturally sensitive services in: (1) client referral, (2) vocational goal setting, (3) implementation of Individualized in·di·vid·u·al·ize  
tr.v. in·di·vid·u·al·ized, in·di·vid·u·al·iz·ing, in·di·vid·u·al·iz·es
1. To give individuality to.

2. To consider or treat individually; particularize.

3.
 Written Rehabilitation Plans (IWRP's), and (4) job placement. Support training for the technicians focused on topics that were prioritized as needs by project staff at other American Indian vocational rehabilitation service projects as well (Lonetree, 1990). Some of the topics included in this training were:

* vocational evaluation * sheltered employment * rehabilitation terminology * medical terminology Medical terminology is a vocabulary for accurately describing the human body and associated components, conditions, processes and procedures in a science-based manner. This systematic approach to word building and term comprehension is based on the concept of: (1) Word roots, (2)  * establishing resource contacts * job analysis * job placement * foundations of vocational rehabilitation * medical aspects of disabilities * vocational rehabilitation legislation * development of Individualized Written Rehabilitation Plans * confidentiality

The writing of reports was another key topic for inservice training identified by the project coordinators. But this topic was scheduled for later implementation.

Characteristic of the training as well as the overall project are listed in Table 1.

Table 1 Characteristics of the Model Used in the American Indian Vocational Rehabilitation Services Project
1.  the project required collaboration between a vocational
    rehabilitation
    agency and American Indian tribes.
2.  American Indians were empowered to make decisions about the
    project.
3.  Services were provided in native languages.
4.  Services were provided in communities.
5.  The project director was an American Indian.
6.  Paraprofessionals were drawn from the American Indian
    communities.
7.  Paraprofessionals received systematic training.
8.  Paraprofessionals received sustained technical support.
9.  Rehabilitation was linked to community employment.
10. The project's American Indian personnel had opportunities to
    influence the attitudes and values of other agency personnel.
11. the continued presence of paraprofessionals encouraged the
    perception that services were sustained and available despite
    changes
    in governance personnel within the Indian communities.
12. The presence of American Indian paraprofessionals in their own
    community encouraged referrals from families who might otherwise
    have been reluctant to make referrals.




Impact of the Project

As an indication of this project's impact, one can examine data from American Indians applying for vocational rehabilitation services in New Mexico. Table 2 identifies the 415 American Indians who applied for services during a 13-month period ending in January 1994 (New Mexico Division of Vocational Rehabilitation, 1994). The applicants are characterized by disabling conditions.

Table 2 Total Number of American Indians Who Applied for Vocational Rehabilitation Services in New Mexico During a 13-Month Period(1)
                                                           Number of
Type of Impairment                                         Persons

Blindness and Visual Impairments                               9
Deafness and Hearing Impairments                              28
Limb Impairments                                             102
Loss of Extremities                                            7
Psychological and Mental Problems (including alcoholism
and drug addiction)                                          212
Miscellaneous Disorders                                       57

Total                                                        415


(1) Beginning of January 1993 through the end of January 1994.

Table 3 indicates the rehabilitation status of the 415 American Indian applicants at the end of the 13-month period. The categories in Table 3 represent a rough chronology chronology,
n the arrangement of events in a time sequence, usually from the beginning to the end of an event.
 of the rehabilitation process. That process can end in cases being closed successfully by the agency as a result of services, training, and job placement. The table can be viewed as a snapshot (1) A saved copy of memory including the contents of all memory bytes, hardware registers and status indicators. It is periodically taken in order to restore the system in the event of failure.

(2) A saved copy of a file before it is updated.
 of an ongoing process. Because rehabilitation is a dynamic process, the applicants were in varying stages of review and rehabilitation when these data were assembled. For example, at the end of the period, 41 referrals had been initiated that had still not resulted in formal applications, 31 cases were being reviewed, 8 cases were receiving extended evaluations, and 75 applications had been closed because applicants did not qualify for services. An examination of one of the final entries in this table -- the number of applicants who were successfully employed at the end of the period -- indicates that 39 of the 415 total applicants were employed successfully. These figures are limited to progress made by clients during a 13-month period, and additional cases of successful employment certainly emerged during subsequent periods.

Table 3 Rehabilitation Status of American Indians Who Applied for Vocational Rehabilitation Services in New Mexico During a 13-Month Period(1)
                                                           Number of
Rehabilitation Status                                        Persons

In Process of Being Referred to VR Agency                      41
Applying for VR Services                                       31
Receiving Extended Evaluation                                   8
Application or Referral Closed Prior to VR Services            75
Development of IWRP                                            56
Unsuccessfully Closed Cases After IWRP                         15
Receiving Counseling                                           26
Receiving Training                                             54
Ready for Employment                                           12
Supported Employment                                           18
Services Interrupted                                            8
Unsuccessfully Closed Cases After VR Services had
  Been Initiated                                               32
Successful Employment after VR Services had been initiated     39

Total Applicants                                              415




Table 4 contains information about those American Indians who applied for vocational rehabilitation services through the American Indian Vocational Rehabilitation Services Project during the 13-month period ending in January 1994. As such, the persons described in Table 4 are a subset A group of commands or functions that do not include all the capabilities of the original specification. Software or hardware components designed for the subset will also work with the original.  of those in Table 3. The table indicates that all 39 clients who were employed at the end of the period had been associated with the American Indian Vocational Rehabilitation Services Project. Equally impressive, 32 of these 39 successful clients had been involved with the American Indian paraprofessional paraprofessional

1. a person who is specially trained in a particular field or occupation to assist a veterinarian.

2. allied animal health professional.

3. pertaining to a paraprofessional.
 teams.

Table 4 Status of Persons Who Applied for Services Through the American Indian Vocational Rehabilitation Services Project During a 13-Month Period(1)
                                                           Number of
Rehabilitation Status                                      Persons

In Process of Being Referred to VR Agency                       3
Applying for VR Services                                       15
Receiving Extended Evaluation                                   0
Application or Referral Closed Prior to VR Services            31
Development of IWRP                                            24
Unsuccessfully Closed Cases After IWRP                          0
Receiving Counseling                                            3
Receiving Training                                             14
Ready for Employment                                            0
Supported Employment                                            1
Services Interrupted                                            1
Unsuccessfully Closed Cases After VR Services Had
  Been Initiated                                                0
Successful Employment After VR Services Had Been Initiated  (2)39

Total Applicants                                              131


(1) The 131 applicants described in this table were a subset of the 415 applicants identified in Table 3. (2) All of the 39 successfully closed cases during the 13-month period, identified in Table 3, were associated with the American Indian Vocational Rehabilitation Services Project; 32 of the successful cases were associated with the American Indian paraprofessional teams.

The preceding data indicate clearly the project's positive impact. The 39 persons who had successful jobs worked an average of 29 hours per week. The mean hourly wage had been $4.52 an hour; and the mean weekly wage had been $130.16.

Summary

A review of the literature concerning rehabilitation of American Indians indicated that the extension of vocational rehabilitation services to American Indians with disabilities is complicated by cultural, geographical, social, linguistic, and financial problems. A unique project was described that was built on collaboration between the New Mexico Division of Vocational Rehabilitation and American Indian tribes in New Mexico. The project employed American Indians who communicated to persons in their native languages while providing services in the communities of those American Indians. The American Indians who received rehabilitation services were empowered to make decisions about the project and the project's American Indian personnel had opportunities to influence the attitudes and values of other agency personnel. Data were reviewed indicating that all American Indian rehabilitation clients in the state who were successfully employed at the end of the review period were associated with this project.

Bibliography bibliography. The listing of books is of ancient origin. Lists of clay tablets have been found at Nineveh and elsewhere; the library at Alexandria had subject lists of its books.

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[9.] Justice, J. (1987). Contrasting cancer patterns in two American Indian tribes. Tucson, AZ: Native American Research and Training Center.

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Detoxification is one of the more widely used treatments and concepts in alternative medicine. It is based on the principle that illnesses can be caused by the accumulation of toxic substances (toxins) in the body.
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[13.] Levy, J.E. (1987). Psychological and social problems of epileptic epileptic /ep·i·lep·tic/ (ep?i-lep´tik)
1. pertaining to or affected with epilepsy.

2. a person affected with epilepsy.


ep·i·lep·tic
n.
One who has epilepsy.
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[14.] Locust, C. (1988). Wounding the spirit: Discrimination and traditional American Indian belief systems. Harvard Educational Review The Harvard Educational Review is an interdisciplinary scholarly journal of opinion and research dealing with education, published by the Harvard Education Publishing Group. The journal was founded in 1930 with circulation to policymakers, researchers, administrators, and teachers. , 58, 315-330.

[15.] Logue, B.J. (1990). Race differences in long-term disability: Middle-aged and older American Indians, blacks, and whites in Oklahoma. The Social Science Journal, 27, 253-272.

[16.] Lonetree, G.L. (1990). Service, resource and training needs of American Indian vocational rehabilitation projects. American Rehabilitation, 16 (1), 11-29.

[17.] Lowrey, L. (1987). Rehabilitation relevant to culture and disability. Journal of Visual Impairment and Blindness, 81, 162-164.

[18.] Lynch, E.W., & Hanson, J.J. (Eds.) (1992), Developing cross-cultural competence: A guide for working with young children and their families. Baltimore, MD: Brookes.

[19.] Martin, W.E., Frank, L.W., Minkler, S., & Johnson, M. (1988). A survey of vocational rehabilitation counselors who work with American Indians. Journal of Applied Rehabilitation Counseling, 19 (4), 29-34.

[20.] Martin, W.E., White, K., Saravanabhavan, R.C., & Carlise, K. (1993). Training programs for working with older American Indians who are visually impaired. American Rehabilitation, 19 (1), 2-6, 37.

[21.] May, P.A. (1986). Alcohol and drug misuse prevention programs for American Indians: Needs and opportunities. Journal of Studies on Alcohol, 47, 187-195.

[22.] May, P.A. (1987). Suicide and self-destruction among American Indian youths. American Indian and Alaska Native Mental Health Research, 1 (1), 52-69.

[23.] May, P.A. (1988). Mental health and alcohol abuse indicators in the Albuquerque area of Indian Health Service The Indian Health Service (IHS) is an Operating Division (OPDIV) within the U.S. Department of Health and Human Services responsible for providing federal health services to American Indians and Alaska Natives. : An exploratory chart review. American Indian and Alaska Native Mental Health Research, 2 (1), 33-46.

[24.] McShane, D. (1988). An analysis of mental health research with American Indian youth. Journal of Adolescence adolescence, time of life from onset of puberty to full adulthood. The exact period of adolescence, which varies from person to person, falls approximately between the ages 12 and 20 and encompasses both physiological and psychological changes. , 11, 87-116.

[25.] Morgan, C.O., Guy, E., Lee. B., & Cellini, H.R. (1986). Rehabilitation services for American Indians: The Navajo experience. Journal of Rehabilitation, 52, 2), 25-31.

[26.] Morgan, J., & O'Connell, J.C. (1987). The rehabilitation of disabled Native Americans This is a list of Native Americans (first nations and descendents) Cherokee
  • Jeanette Littledove - actress in pornographic films
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. International Journal of Rehabilitation Research, 10, 139-149.

[27.] National Indian Council on Aging. (1981). American Indian elderly: A national profile. Albuquerque: Author.

[28.] New Mexico Division of Vocational Rehabilitation. (1994, January). Indian monthly caseload case·load  
n.
The number of cases handled in a given period, as by an attorney or by a clinic or social services agency.


caseload
Noun
 profile. Santa Fe Santa Fe, city, Argentina
Santa Fe, city (1991 pop. 341,000), capital of Santa Fe prov., NE Argentina, a river port near the Paraná, with which it is connected by canal.
, NM: Author.

[29.] O'Connell, J.C. (1985). A family systems approach for serving rural, reservation Native American communities. Journal of American Indian Education, 24 (2), 1-6.

[30.] O'Connell, J.C. (Ed.) (1987). A study of the special problems and needs of American Indians with handicaps both on and off the reservation: Vol. 1. Executive summary. Flagstaff Flagstaff, city (1990 pop. 45,857), seat of Coconino co., N Ariz., near the San Francisco Peaks; inc. 1894. Lumbering, ranching, and a lively tourist trade thrive in the region, where many ruined pueblos, numerous state parks, several lakes, and large pine forests , AZ: Native American Research and Training Center.

[31.] O'Connor, S. (1993). "I'm not Indian anymore": The challenge of providing culturally sensitive services to American Indians. In J.A. Racino, P. Walker, S. O'Connor, & S.J. Taylor (Eds.), Housing, Support, and Community: Choices and strategies for adults with disabilities (Vol. 2, pp. 313-331). Baltimore, MD: Brookes.

[32.] Runion, K., & Gregory, H. (1984). Special populations: Training Native Americans to deliver mental health services health services Managed care The benefits covered under a health contract  to their own people. Counselor Education and Supervision, 23, 225-233.

[33.] Scruggs, T.E., & Mastropieri, M.A. (1985). Cultural ambivalence ambivalence (ămbĭv`ələns), coexistence of two opposing drives, desires, feelings, or emotions toward the same person, object, or goal. The ambivalent person may be unaware of either of the opposing wishes.  in an Indian community: Perceptions of behaviorally disordered adolescents. Journal of Instructional Psychology, 12 (2), 66-71.

[34.] Stuecher, U., Grossman, E., Hakala, N., & Kizlowski, G. (1985). Training project for Indian school liaison and support personnel in special education. Journal of American Indian Education, 24 (2), 9-19.

[35.] Thielke, H.M., & Shriberg, L.D., (1990). Effects of recurrent Otitis Media Otitis Media Definition

Otitis media is an infection of the middle ear space, behind the eardrum (tympanic membrane). It is characterized by pain, dizziness, and partial loss of hearing.
 on language, speech, and educational achievement in Menominee Indian children. Journal of American Indian Education, 29 (2), 25-35.

[36.] Thomason, T.C. (1991). Counseling Native Americans: An introduction for the non-Native American counselor. Journal of Counseling and Development, 69, 321-327.

[37.] Toubbeh, J.I. (1989). Disability and its prevention in Indian populations: Is it someone else's responsibility? American Rehabilitation, 15, 7-23.

[38.] Toubbeh, J.1. (1987). Larks and wounded eagles: A commentary on services to Native Americans with disabilities. American Rehabilitation, 13 (1), 2-28.

[39.] Traustadottir, R., Lutfiyya, Z.M., & Shoultz, B. (1994). Community living: A multicultural perspective. In M.F. Hayden & B.H. Abery (Eds.), Challenges for a service system in transition: Ensuring quality community experiences for persons with developmental disabilities (pp. 405-426). Baltimore, MD: Brookes.

[40.] Trimble, J.E., & Fleming, C.M. (1989). Providing counseling services for Native American Indians. In P.B. Pedersen, J.G. Draguns, W.J. Lonner, & J.E. Trimble (Eds.), Counseling across cultures (3rd ed., pp. 177-204). Honolulu: University of Hawaii Press The University of Hawaiʻi Press is a university press that is part of the University of Hawaiʻi. .

[41.] Yukl, T. (1986). Cultural responsiveness and social work practice: An Indian clinic's success. Health and Social Work, 11, 223-229.

The authors gratefully acknowledge the contributions of all of the personnel associated with the American Indian Vocational Rehabilitation Project. Without their support and commitment, this project could never have been developed.
COPYRIGHT 1996 U.S. Rehabilitation Services Administration
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1996, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Author:Oyenque, Wayne
Publication:American Rehabilitation
Date:Mar 22, 1996
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