Private sector rehabilitation: insurance, trends & issues for the 21st century, a summary of the 17th Mary E. Switzer Memorial Seminar.

As we approach the 21st Century, one thing is sure, private rehabilitation as a field has matured. It has gone from a totally unregulated industry two decades ago to become a fully regulated one. Its practitioners have diversified to include professionals in many disciplines to address the entire process of rehabilitation and client care. Licensing will be in place to insure the necessary qualifications and skills to practice thus establishing a level of professional esteem. The organization of a professional association nationwide (National Association of Service Providers in Private Rehabilitation "NASPPR" a division of NRA) further indicates the stability and staying power of this field of endeavor. Private rehabilitation cannot be in a better position to meet the challenges in the year 2000 and beyond John W. Lui

The Switzer Memorial Seminar, an NRA program, is designed to bring together a small number of experts in the area of rehabilitation that is the focus of each year's Seminar. The invited participants are designated as Switzer Scholars by certificate, and this recognition has over the years become a significant and prestigious achievement for those in vocational rehabilitation, both nationally and internationally. The end-product of the three-day program is a published monograph of the proceedings which includes recommendations for future programming, research, training and legislative needs. The format is designed for ease of use by all members of the field of rehabilitation and allied professions, consumers, business, industry, labor and anyone interested in the rehabilitation and independence of persons with disabilities.

These special Seminars are named for the late Mary E. Switzer as a living tribute to one of America's foremost leaders and trailblazers for innovative programs at the national, state and local levels for people with disabilities. Her insight and commitment was felt on the international scene as well. For more than thirty years her influence and enthusiasm was felt in the area of Vocational Rehabilitation and habilitation as head of the Rehabilitation Services Administration (RSA) and the Social & Rehabilitation Services of the then U.S. Department of Health, Education and Welfare.

The Switzer memorial of NRA was initiated by colleagues and friends of Mary Switzer, including key members of the U.S. Congress, Presidential cabinet members from at least five administrations, rehabilitation counselors and allied professions and private citizens.

The 17th Switzer Memorial Seminar was held in Washington, D.C. June 2-4, 1993, and was hosted this year by the President's Committee on Employment of People with Disabilities (PCEPD). The topic of the seminar was, "Private Sector Rehabilitation for the 21st Century: Insurance, Trends & Issues."

Welcomes were provided by Ann W. Tourigny, NRA Executive Director, Justin W. Dart, Jr., Chairman, PCEPD, Mark Shoob, Acting Deputy Commissioner, Rehabilitation Services Administration (RSA), and Carl E. Hansen, Chairperson, Mary Switzer Memorial Committee who set the tone and direction of the Seminar.

Five "Action Papers" were written specifically for the Seminar and served as the foundation for the three-day think-tank as the Switzer Scholars debated and discussed critical issues facing private sector rehabilitation as we prepare for the 21 st Century which is quickly approaching. The Papers and their authors were as follows:

Rehabilitation in Business & Industry: Implications for Rehabilitation Counselor Training By Ralph M. Crystal

Educating Practitioners for Work in the Private Sector By Dennis D. Gilbride

Insurance Issues and Trends: A Focus on Disability Management Including Rehabilitation By Patricia M. Owens

Ethical Issues in the Private Sector By Edward P. Steffan

Trends & Innovations in Private Sector Rehabilitation for the 21st Century By John W. Lui

In addition to the deliberations concerning the above papers, the Switzer Scholars provided a number of comments and recommendations which are shown in part in order to provide some of the thinking at the Seminar.

Comments by the Scholars

Dr. Crystal (in his paper noted above) discusses the similarities and differences in rehabilitation education needs for the rehabilitation counselor practicing in the private sector versus the public sector. He stresses the need for certain fundamental training on basic knowledge needed by counselors in both settings and he noted some additional training that would be of benefit specifically for professionals working in the private sector. Dr. Crystal's underlying premise is that rehabilitation counseling in either the public or private setting utilizes the same basic skills and approaches. However, he acknowledges that there is a much greater emphasis on prompt placement as a successful outcome for rehabilitation in the private sector. Because of this factor the rehabilitation counselor who aspires to work in the private sector needs to be well-prepared to deal with the most current job placement issues. The rehabilitation education curriculum for the year 2000 and beyond needs to be sure to incorporate the following to keep up with rapid change and advancements: 1. Labor market information-changing occupational patterns

and job requirements. 2. Workplace technology/assistive technology advancements

as related to job accommodation. 3. Ergonomics. 4. Placement techniques, issues and trends.

While these topics are extremely important to the rehabilitation counselor in the private sector, it appears that public sector counselors would benefit from more training in these areas as well.

-- Catherine C. Bennett

Dr. Gilbride in his paper entitled, Educating Practitioners for Work in the Private Sector, presents a thorough exploration of various training-related issues as they impact on the private rehabilitation arena. Certification, accreditation and forensic issues are also discussed in his paper. From the information he presents it is clear that rehabilitation counselor education programs need to work towards expanding their focus of training in order to include the wide range of settings where rehabilitation counseling is employed. With Rehabilitation Services Administration (RSA) funding having been a major funder of rehabilitation counselor training programs it is understandable that the focus of graduate programs has been on the public sector. However, with the growth and demand for qualified personnel coming from the private sector, it is time for educational institutions to recognize the demand, and offer training to students that will result in profitable, challenging careers in the private sector.

-- Patricia Nunez

The potential for employment of rehabilitations in workplace disability management has yet to be fully realized by the professional rehabilitation community. The disability management model described by Ms. Patricia M. Owens in her paper expands the traditional private sector rehabilitation professional's role to include prevention programs which focus on employee well-being, health and safety. All too often, the focus is on rehabilitation following disability. In addition, workplace disability management has tended to center on workers' compensation rehabilitation. Ms. Owens notes that rehabilitation provisions are common in short-term, long-term and individual disability plans, and the Social Security disability program. One point made in regard to workers' compensation programs related to other insurance rehabilitation systems. It focuses on the weakening of formal mandated rehabilitation programs as part of workers' compensation legislation. Without documentation of rehabilitation effectiveness and efficiency in terms of human and dollar costs, workplace disability management will never realize its full potential. The public rehabilitation system has been able to document this type of data for years through specific program evaluation methods.

-- Juliet H. Fried

Mr. Steffan in his paper on ethics has addressed probably M the most difficult area and collection of issues in all of rehabilitation. Every association or group that comes along tends to develop, and usually does, an ethics statement for their organization and its members. At this time there are approximately twenty different ethics statements by various rehabilitation counseling associations and allied groups that would have some direct or indirect bearing on the practice of rehabilitation consultants. As Mr. Steffan has correctly observed, the central issue for private sector rehabilitation is and always has been, "who is the client.?"

The client is not always the person with a disability or a handicapping condition. In a review of almost any of the ethics statements you will find that the client is indeed identified as the person with the disabling condition, but in practice within the area of private sector rehabilitation, that is not always true. A case in point is the typical rehabilitation consultant who is hired by insurance to most expeditiously and cost-effectively return a person with a disability to work. Other interested parties include, of course, the worker who is injured, the employer, the attorneys (if any), and the rehabilitation consultant. All parties have a vested interest in the alleged rehabilitation process and furthermore, all parties have a legitimate role to play. In my view, the "client" should be perhaps identified as the process that involves all of the parties for the most equitable resolution of issues involving injuries in the workplace.

-- Tim Field 

I believe Mr. Lui in his paper on trends and innovations has touched on some of the major issues of relevance to our field in the years to come, such as the Americans with Disabilities Act, a Federal law that may be revised but likely will never go away. He also draws our attention to the more instantly important issue of many other professions calling themselves rehabilitation practitioners, many of whom have no training or experience of consequence in our field. Mr. Lui brings us to the most important question of all, will we survive as a profession in the 21st Century? The Federal government is in a phase of cutting back spending by passing along federally mandated programs to be provided solely or mostly by state funding. In Maryland, for example, we can already see its impact in the provision of community-based mental health services, which are being phased out as the state in turn passes the obligation along to individual counties which cannot afford to provide them. Public sector rehabilitation cannot help but be affected by a trend of this type. Private sector rehabilitation is no less vulnerable in its own way. Our first task in planning for the 21st Century should be to find out if we are at risk for even surviving, and if so, to what degree? Our planning, education, service delivery and all the other elements that comprise what we presently think of as rehabilitation counseling as a profession will have to take these findings into consideration, but hopefully in a proactive and coordinated fashion.

We are the beneficiaries of the work of the giants of our field, like Mary Switzer, persons who did not wait for events to overtake them. Rather, they worked to shape the events for the benefit of rehabilitation. That is our challenge, and one which I believe we must meet to assure our survival in the years to come.

-- Phillip Bussey

Recommendations For Action

During the Switzer Seminar the Scholars developed a list of recommendations/implications for action. These were categorized in areas such as needed policy and program development, service delivery, training, research and legislation. A sampling of some of these highlights were noted as follows: * Funding strategies for university programs

should be broadened to include training needs

for independent contracting and client choice

service delivery programs. * The Council of Rehabilitation Education

(CORE) should expand curriculum to include

private sector issues, related to all service

delivery systems. * Curriculum changes are needed in areas of business

and industry, job analysis and labor market

information, compensation programs, legal and

forensic issues, insurance and disability management. * More needs to be done to stimulate communication

and an exchange of information between

the insurance industry and private rehabilitation

professionals. We need to develop a

better understanding of the respective issues

which affect both groups. This concept also

has implications for joint research and education/training. * Certification bodies should require a specified amount of

continuing education units regarding insurance industry education

such as outcome measures, performance expectations,

and the disability management spectrum. * Develop additional training and education for customers (the

insurance industry and employers) regarding private rehabilitation

services. This would include:

>> more information regarding the services we provide;

>> when & how to utilize private rehabilitation services to

effect outcome of cases;

>> benefits of early intervention/timely referral; and

>> referral information we need from the customer in order

to provide the most effective services. * As we address the healthcare reform issue, assure that rehabilitation

professionals are included as reimbursed service

providers as a part of the healthcare reform plan. * Broaden the outcome measures used to assess the efficiency

and success of rehabilitation services. * Individuals (consumers) should be able to choose their service

provider. * Rehabilitation providers, their professional associations and

certification bodies need to develop a uniform code of ethics. * Curriculum changes should be required to include the techniques

of professional consultation in order to improve professional

interactions needed in the private sector. * Additional research is needed on how to effectively educate

the front line adjuster within the Workers' Compensation

industry (and other product lines).

Conclusion

The three days of deliberations at the 17th Switzer Memorial Seminar was inspiring to say the least. It was fast-paced, exciting and the discussions were at times, heated. The sense of camaraderie and teamwork was clearly evident as 21 individuals took time from their busy schedules to help discuss, plan and perhaps shape the course of private sector rehabilitation during the latter part of the '90s and the next decade. Switzer Scholar John W. Lui and author of the paper Trends and Innovations summed it up well when he noted: "As we approach the 21st Century, one thing is sure, private rehabilitation as a field has matured. It has gone from a totally unregulated industry two decades ago to become a fully regulated one. Its practitioners have diversified to include professionals in many disciplines to address the entire process of rehabilitation and client care. Licensing will be in place to insure the necessary qualifications and skills to practice thus establishing a level of professional esteem. The organization of a professional association nationwide (National Association of Service Providers in Private Rehabilitation "NASPPR", a division of NRA) further indicates the stability and staying power of this field of endeavor. Private rehabilitation cannot be in a better position to meet the challenges in the year 2000 and beyond."

Acknowledgements

Appreciation is expressed to the many people and organizations that made the 17th Switzer Memorial Seminar a reality. The Switzer Scholars are to be commended for their excellent efforts and commitment to better serving persons with disabilities. Special thanks are also due to the following persons for the significant roles they played in this team effort:

Spencer Mosley, President, NRA; Justin Dart, Jr., Chairman, President's Committee on Employment of Persons with Disabilities (PCEPD); Rick Douglas, Executive Director, PCEPD and Ann W. Tourigny, Executive Director, NRA, for her support in keeping the memory of Mary E. Switzer alive.

The Switzer monograph of the proceedings of the 17th Switzer Memorial Seminar will be published by NRA and ready for distribution at the Annual Training Conference in Atlanta, Georgia, in October 1993.

Carl E. Hansen, Chairperson, Mary E. Switzer Memorial Committee of NRA. Leonard G. Perlman, Coordinator, Switzer Memorial Seminars (NRA).