Bringing the rehabilitation family together: an IL-VR partnership.

As a newly hired independent having program specialist, I was invited to attend the National Training Conference on Independent Living held in Washington, DC, August 26-28,1992. Entitled "Developing New Service Options for Working and Living Independently," one of its primary stated goals was to explore and demonstrate the interdependence of state vocational rehabilitation agencies and independent having centers and programs. In light of my 13 years experience as a vocational rehabilitation counselor, I felt it would be helpful to understand this interdependence so that could use these concepts in my new position.

During those 3 days in Washington, I attended interesting workshops and listened to well-informed and passionate speakers from both rehabilitation programs. I learned about service delivery and services to culturally diverse and underserved populations, but learned little about interdependence. On the contrary, the perception at remains most vivid from the conference is the generally accepted personifications of independent living (IL) as the mistreated stepchild and vocational rehabilitation (VR) as the wicked stepmother. Although this relationship was presented humorously, it seemed hold truth for many attendees, especially those on the IL side of the aisle.

Upon returning to New Jersey it became clear that many of our IL providers and consumers shared this perception. It also became apparent that a key job for the IL program manager would be to work toward strengthening the relationship between these "family members." While both programs shared a general goal of improving the quality of life for people with disabilities, it seemed that little effort was being made to work collaboratively. If anything, the centers for independent having (CIL) staffs seemed skeptical and mistrusting of VR; and VR counseling staffs were, for the most part, uninformed and confused as to the role of IL.

The reasons for this awkward and sometime antagonistic relationship are varied and will not be reviewed here. However, if this relationship is to improve, there needs to be truly collaborative commitment on the part of both programs toward filling their shared purpose - improving the quality of life for people with disabilities. Furthermore, there needs to be better understanding of the philosophical and programmatic differences of these agencies. Once this appreciation has been developed, joint strategies can be prepared and implemented. In addition, a worthy by-product of this process will be eventual assumptions of goodwill. The following suggestions are intended to facilitate these goals.

The operative concept for this partnership between IL and VR is introduction of seamless service delivery that will allow people with disabilities (i.e., consumers) to move freely between programs as their lives change. Since the collective mandate of these programs is to address all ages, roles, and needs of people with disabilities, the means are currently available for developing this comprehensive system. Furthermore, there exists trained and experienced staff persons to deal with all of these issues.

A primary example of how this system might work is in the case of the consumer who traditionally has been determined "too severely disabled" to benefit from vocational services. Although the 1992 reauthorization of the Rehabilitation Act, by requiring clear and convincing evidence," now places the burden for such a decision squarely on VR, the fact remains that many individuals with severe disabilities will have difficulty developing and meeting vocational goals. Their cases may linger in extended evaluation or some other status, but the reality is that outcomes will be unsatisfactory for all.

Based on my experience as a VR counselor, believe that these unsatisfactory outcomes are due to consumer needs that go beyond counseling and guidance, restorative services, vocational training, and job placement. These problems, in almost all cases, can be classified as independent living issues. VR counseling staffs have little training or experience to assist consumers in resolving these difficulties. Also, attempts at resolving them are often time consuming. The six IL problems that most frequently sabotage vocational plan development are:

*Specific disability-related health and activities for daily having needs;

* personal care assistance;

* housing;

* transportation;

* family issues (dependency, parental roles, income, sexuality); and

* adjustment to disability.

As previously mentioned, basic support staffs are generally ill-equipped to address these matters. However, these are staples of the core services for IL, i.e., information and referral, peer support, independent living skills training, and advocacy. IL staffs work with these problems daily. In addition, centers for independent living (CIL!s) have developed networks with other state, county and local agencies, as well as with physicians, therapists, and other professionals who can assist in resolving the items listed above.

This expertise m addressing other than vocational needs of people with disabilities combined with VR's expertise and resources in addressing vocational needs would form the basis for true collaboration in developing seamless service delivery. By working together, IL and VR could develop an holistic approach to rehabilitation. Also, consumers would receive more comprehensive services and the VR program would be applied more accurately as it fits within the total context of the individual's. Such an effort would impact not only specific cases, but also the entire system. By necessity, there would be more frequent interaction between IL and VR staffs and offices. This increased interaction would serve to meet four essential goals of the collaboration: It would foster mutual respect and familiarity between IL and VR, it would add professionalism and sophistication to IL; it would increase sensitivity and awareness regarding people with disabilities by VR; and it would promote a customer service model.

An action plan for achieving a seamless service delivery system could include the following steps:

1. Arrange an orientation program to introduce the concept. This workshop should be attended by staff persons from each CIL, as well as all local office managers and selected supervisors and counselors from VR. From this group, each CIL should select someone responsible for learning VR practice, policy, and philosophy and each VR local office should assign a staff person to learn the same concerning IL. A specific agenda can be determined locally. However, the program should:

* be presented collaboratively by IL and VR staff;

* include breakout session to allow interaction and problem solving;

* as its primary goal, insure that all people with disabilities, parents, guardians, friends, and advocates of people with disabilities receive some measure of assistance whenever they contact any IL or VR office; and

* foster the idea that all services to all people with disabilities can be accessed through this system.

2. Promote as a resource to VR counselors. IL can provide significant assistance to counselors in working with people with disabilities. As previously suggested, core IL services can be provided to help resolve those IL issues that sabotage vocational planning. In addition, VR consumers can be referred to CIL's as volunteers or for doing practice jobs. When appropriate, they right be referred for direct placement or on-the-job training as directors, IL specialists, or clerical workers. Since CLI's are required by federal law to provide equal access to all people with disabilities, the work environments should be accommodating to all consumer-related functional limitations. Finally, IL can be a resource for social or recreational activities or cost services that support IL, but are not provided by VR.

3. Invite CIL staff persons to conduct work orientation sessions. All CIL's have staff members with severe disabilities, representing individuals with a wide range of conditions and functional Imitations. Their firsthand experiences can be very valuable to VR job-ready candidates in many areas. Sessions could be held on the following and other topics:

* Participating in job Interviews

* Resolving Transportation Problems

* Using Personal Care Assistance (before, during, and after work);

* Addressing Disability and Accessibility Problems That Interfere with Being Interviewed and Hired; and

* Demonstrating Assistive Technology Devices that Enable or Enhance Competitive Employment.

4. Acquire additional funds for IL. Additional federal, state, local, and private funds should be aggressively pursued to assist IL in meeting its increased responsibilities as encouraged by the Americans with Disabilities Act and mandated by the 1992 reauthorization of the Rehabilitation Act. Formal strategies for acquiring these funds should be jointly developed by VR, IL, and the Statewide Independent Living Council.

Historically, a major point of contention for IL has been that VR only gives lip service to IL because their usually small staffs have been asked to do much more with little or no increases in state funding. By providing IL with supplemental funding, VR will not only improve service delivery by easing the burden of understanding, but it would concretely acknowledge the importance of IL to its program. In addition, supplemental funds could be used to test out a pilot plan for the IL-VR Partnership.

In summary, IL is an underpublicized, underutilized component of rehabilitation services. Efficient use of this resource could bridge the service gap as presently perceived by the disability community. A stronger alliance between IL and VR would send the message to all people with disabilities that successful vocational outcomes are, at least in part, a manifestation of success in independent living. By embracing and better supporting IL, VR can adopt a more realistic, holistic approach to achieving its mandate and extend valuable services to its counseling staff. Most importantly, by viewing vocational rehabilitation within the context of a person's total life experience, it will improve its chances to assist people with disabilities in acquiring gainful, meaningful employment.