Rehabilitation Cultural Diversity Initiative: a regional survey of cultural diversity within CILs.

The rapidly changing demographics in this country have been well documented (Feist-Price, 1995; Fobbs, 1994; Leung, 1993; Thomas, 1991; Whitfield, 1994; Wright, 1993). Based on the 1990 National Census data, it is projected that by the year 2010, ethnic and racial minorities (Asian Americans, African-Americans and Hispanics) as a group will constitute a 51% population majority in the United States, with Caucasians becoming a minority (Wheaton, 1995; Walton, 1994). Along with this demographic shift, it has also been projected that a higher percentage of racial and ethnic minorities will enter the workforce in service and other labor intensive jobs. A number of contributing factors, including living conditions and employment situations, will result in many of those entrants sustaining injuries requiring rehabilitation (Walker, 1987).

The ability of the nation's rehabilitation system to meet the needs of racial and ethnic minorities with disabilities (i.e., equitable provision of services) has been questioned (Dziekan & Okocha, 1993; GAO, 1993; Giles, 1993; Atkins & Wright, 1980). Giles (1993) observed that concerns about the system have a historical basis as research from the 1970s found that Hispanic Americans were more likely than their white counterparts to be found ineligible for vocational rehabilitation services. Data from the General Accounting Office (GAO) report, Vocational Rehabilitation: Evidence of Federal Programs Effectiveness is Mixed (1993), based on 1988 case service reports, suggests that African-Americans and other ethnic minorities (a) do not receive services at the same rate and (b) are closed out of vocational rehabilitation services at a disproportionately higher rate than their non-minority counterparts. More recently, findings of Section 21 of the 1992 Amendments to the 1973 Rehabilitation Act address continued problems in the vocational rehabilitation system:

Patterns of inequitable treatment of minorities have been documented in all major junctures of the vocational process. As compared to White-Americans, a larger percentage of African-American applicants to the vocational rehabilitation system are denied acceptance, Of the applicants accepted for service, a larger percentage of African-American cases are closed without being rehabilitated. Minorities are provided less training than their white counterparts. Consistently, less money is spent on minorities than on their white counterparts.

Section 21 findings from the 1992 Rehabilitation Act Amendments (hereafter referred to as 'the Act') identifies issues and problems associated with the provision of services to minorities within the public vocational rehabilitation system. However, a paucity of information exists on services available and/or being extended to minorities under other titles of the Act, including independent living services and centers for independent living. Section 704(1) - Outreach, for example, specifically requires centers funded under Title VII of the Act to "set forth steps to be taken regarding outreach to populations that are unserved or underserved...including minority groups, urban and rural populations" (pg. 101).

The Rehabilitation Cultural Diversity Initiative (RCDI) emanated, in part, from the above referenced findings of Section 21 and targeted all programs within public rehabilitation. Funded by Rehabilitation Services Administration's (RSA) as a five year initiative, the RCDI identified two goals: Goal 1 - Provide and enhance equal access, quality services and outcomes within the public rehabilitation programs for individuals with disabilities representing cultural diversity; and Goal 1 - Expand career development in rehabilitation for individual representing cultural diversity employed in the public rehabilitation program. Fobbs (1994) observed that the RDCI goals were "broad and comprehensive" (p. 54).

Purpose Statement

This article focuses on three areas: (1) a brief review of independent living centers and the movement which preceded their establishment; (2) results of a survey describing diversity within independent living centers in a federal Rehabilitation Services Administration (RSA) region; and (3) considerations and strategies for outreach to traditionally unserved and underserved populations referenced in Title VII of the Act.

Independent Living

The independent living movement was launched as part of the social legislation (e.g., civil rights for minorities, equal rights for women and emphasis on consumerism) which swept the country during the late 1960s and early '70s. Shapiro (1993) observed that in addition to serving as a catalyst for the independence of persons with disabilities, the IL movement, more importantly, also served as an integral component in reshaping the way rehabilitation professionals generally viewed persons with disabilities. Individuals with disabilities began to seriously question widely held assumptions that 'disability' was solely caused by a medical problem located in a person's body (Hahn, 1985). In addition, the IL movement focused on political, social and environmental barriers which contributed to the perceptions of individuals with disabilities. These barriers included minority status of individuals with disabilities, cultural attitudes, expectations assumptions, practices, and even such areas as the design of buildings, housing and transportation systems (Shapiro, 1993). A major outcome of this movement was the establishment of community based independent living centers designed to provide advocacy and independent living services for people with disabilities.

More than 300 independent living centers, a majority of which are staffed and governed by persons with disabilities, operate in the United States (Pelka, 1994). According to Smith, Richard, Nosek, & Gerken (1990), the typical independent living center (a) has been in operation less than 10 years; (b) has a staff less than 10 people, more than half of whom are persons with disabilities (PWD); (c) has an executive director and at least two to three other staff involved in center management and (d) is governed by boards of directors, more than half of whom are persons with disabilities.

Independent Living Center Survey

In RSA Region V (Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin), 53 centers of independent living were in operation when the RCDI project was initiated in 1993. All 53 centers were contacted requesting participation in a survey of the demographics of administrative, management, and service delivery staff. The survey also requested information on boards of directors and consumers demographics, in addition to the disability types of persons receiving services. Statements designed to assess (a) whether the center's management perceived their staff demographics to be reflective of the communities in which they were located, and (b) whether centers had assessed and/or implemented strategic plans related to increasing cultural diversity among staff, boards of directors and consumers served were also included in the survey. Representatives from the region's Independent Living Council, comprised of the chairperson of each state's independent living centers, were consulted on key areas and wording of statements on the survey. More than 60% (n=32) of the centers returned the survey instrument over a period of three months and two mailings. The number of centers in each state varied, ranging from a low of three to a high of 18. As shown in Figure #1, the rate of returns among centers in the states ranged from 100% to less than 30%.

Staff demographics were categorized on the following basis: administrative staff - persons who had minimal contact with clients/consumers; management staff - persons who had contact with administrative staff, and clients/consumers; and services delivery staff - persons who had direct contact with clients, and minimal contact with administrative staff. As shown in Table 1, less than 20% of individuals reported in administrative positions from the responding centers were identified as members of culturally diverse groups (n=23/141, 16.3%). Position titles in the administrative staff classification included the traditional management-upper management positions (i.e., executive director, program manager, assistant director, finance director, and bookkeeper). Several other position titles related to various administrative duties and roles were reported, including secretary, typist, bookkeeper, accounting assistant and office manager. One center listed maintenance director among its administrative positions.

[TABULAR DATA FOR TABLE #1 OMITTED]

The reported demographics of the top administrative staff CILs revealed that racial and ethnic diversity among executive directors was present in the region. For example, six of 32 (18.75%) centers reported having executive directors from culturally diverse groups, including four African-Americans and one Hispanic.

While racial and ethnic diversity was in evidence among the executive directors, survey results indicated diversity was even more present in the areas of gender and disability. Nearly 55% of the administrative staff was reported as persons with disabilities (PWD) (n=77/141, 54.6%). In addition, a substantial number of the administrators were reported as female (n=108/141, 77%), with 60% (n=19/32) of the executive directors being identified as female. Interestingly, none of the respondents under the Program Manager/Director (n=17) position title were reported as being members of a culturally diverse group, as defined in the survey (African-American, Asian-American, Native American, Hispanic-American). The absence of persons of color in this strategic position, and its possible effects on consumers being served, will be addressed later.

Demographic information for management position titles was also reported. Position titles in this category, as summarized in Table 2, ranged from Accessibility Coordinator to ADA Coordinator to Employment Training Specialist Manager to Youth Services Supervisor. Similar to the reported data for administrative staff, diversity among management staff was more evident in the area of gender and disability than in race and ethnicity. Less than 15% (n=13/106) of management positions were reportedly staffed by ethnic or racial minorities. Respondents reported, however, that females held two-thirds of the management positions while individuals with disabilities comprised nearly 75% of persons in this category (n=78/106, 73.4%).

Reported data on the direct services staff provided other interesting statistical information. For example, reported demographics revealed that 22% (n=24/110) of direct services staff were from diverse cultural backgrounds. Females (68%) as well as persons with disabilities (59%) comprised the diversity among services delivery staff. While the Independent Living Specialist (n=34) comprised the greatest frequency of among the reported position titles in this category, only 5 persons (15%) were reported to be members of culturally diverse groups.

Regarding board members demographics, the 32 responding centers reported 382 members on their boards of directors. Position titles in this category included president, vice-president, treasurer, secretary and other board members Less the 15% (46/382, 12%) of the members on the boards of directors were reported to be ethnic or racial minorities. However, diversity was reportedly more present in the area of gender (male=222, 58%; female=160, 42%), [TABULAR DATA FOR TABLE #2 OMITTED] and disability (PWD=248, 65%). Interestingly, less than 11% (3/28) of responding centers reported having a board president or immediate past president who was an ethnic or racial minority. The complete demographic information of centers reporting on their boards of directors is shown in Table # 3, including information on the number of persons with disabilities among board members.

Regarding demographics of persons served, responding centers reported serving more than 8,000 persons during the year prior to the survey. Although ethnic and racial information was not reported for another 3,400 persons served, an overwhelming majority of those persons on whose ethnicity was reported, were non-minorities (n=4,172, 89.3%). African-Americans (n=328, 7.02%) represented the largest number of persons from diverse cultures reported to have received services.

Given the findings of Section 21 of the 1992 Rehabilitation Act Amendments and resulting increased focus on persons from diverse cultures within public rehabilitation programs, the RCDI survey asked center administrators if processes for developing outreach strategies for targeted underrepresented groups (e.g., staff, consumers and board members) in their catchment area had been implemented. Fifty eight percent (58%) of responding centers (n=19) reported that their centers did not have plans/programs in place focusing on outreach to culturally diverse consumers. Nearly 66% of the respondents (indicating) that their centers had plans in place which focused on outreach to culturally diverse groups responded "unsure" when questioned on their the plans 'effectiveness.' Only 25% (3/12) felt that their plans were effective. While 37% (n=11) of responding centers indicated that minority staff development plans were already in place, 19 (60%) centers reported that they were 'not sure' whether their center had a plan/strategy focusing increasing staff diversity.

The ethnic and racial population in RSA Region V, as the 1990 census data reflects, is diverse and includes 9.05% African-Americans, 0.9% Asian-American, 2.23% Hispanic and 1.43% Native-American. In addition, the population within the region includes large numbers of other ethnic groups (i.e., Arab-Americans in Michigan and Hmong in Minnesota). The demographic information of the responding centers in Region V, in all likelihood, is typical of other independent living centers in other RSA regions. If one assumes that (a) Pelka's (1994) and Smith et al.'s (1990) assertions are accurate on the centers, staffs and board of directors nationwide and (b) that the demographic data from centers in one RSA region is typical of centers in other regions, it would be logical to conclude that strategies which focus on outreach to unserved and underserved populations may be needed in the surveyed region, as well as other RSA regions nationwide.

[TABULAR DATA FOR TABLE #3 OMITTED]

Outreach

As part of the RCDI survey, responding centers were invited to offer examples of their planned and implemented activities which focused on outreach. Examples of strategies suggested by centers included (a) direct mailings to various organizations, followed by personal visits and presentations to groups; (b) participation in programs and events sponsored by minorities; and (c) distribution of agency information at sites where persons from diverse cultures are served.

Cook and Knox (1994) suggest that prior to initiating outreach activities, centers should identify a specific target group, among the underserved populations, in their catchment areas. This process begins with a review of the most recent census data for their county(ies) of operation, in comparison to the demographics of consumers currently being served. Following the identification of the underrepresented group, centers should assess all previous efforts, if any have been undertaken, to outreach and serve persons from underrepresented groups. Often, centers can learn from previous efforts, rather than duplicating previously unsuccessful initiatives.

Additionally, agencies should review current policies and procedures, including review of governance, programming, human resources and community partnerships areas (Cook & Knox, 1994; Herz, Olson, & Reis, 1988). For example, governance policies and procedures should be reviewed to determine if board orientation and training includes cultural diversity and focus on anti-discrimination issues. Existence of written recruitment strategies for reaching people of color to serve on center boards of directors should always be reviewed. Assessments in the programming area may result the identification of programs which aid in establishing linkages between the center and key people in organizations serving people of color. The goals of the such assessments are tri-fold: provide feedback, establish referral systems and build credibility.

Following assessments, numerous outreach strategies could be implemented for improving services to culturally diverse populations. Conferences, cultural sensitivity training for staff, newsletters, establishment of satellite offices, participation in cultural festivals/community celebrations, establishment of relationships with ministerial alliances and establishment of minority outreach director are examples of strategies that could be implemented to better serve traditionally underserved and unserved groups (Cook 8,: Knox, 1994; Sue & Sue, 1990).

Cultural Sensitivity Training for Staff: While no single area should be considered as the "end all" answer to the issues of outreach and improved services delivery, training of staff should be considered one of the most important, and involves a series of interventions. First, awareness training should be implemented which facilitates staff becoming more familiar with various cultural issues as well as their impact on individual attitudes, values, beliefs and behaviors. The second phase of training should move toward issues related to cultural sensitivity (i.e., beyond awareness training). The goal of this training should include increased skills of staff in developing relationships with peers, clients and consumers who may be from cultures different from their own.

Conferences: This approach involves the development of conferences/meetings in the community in which the center is trying to make inroads. By involving key individuals or stakeholders in the community in planning conferences, program organizers are likely to get more support than when the "outside group" tries to put on a program/presentation without support of the community leaders. Efforts such as these, observe Cook and Knox (1994), "encourage networking among individuals already committed to providing services" (p. 54).

Newsletters/Brochures: Newsletters can provide an alternative method to direct outreach and could be used to provide information to persons unable to attend meetings and conferences arranged in the targeted community. In addition to information about events being held in the community and sponsored by the center, basic information about services available at centers, and profiles of staff could be included. This inclusion of newsletters and other related resources designed to increase awareness of the agency in the community are a part of Gottleib and Vandergoot's (1989) definition of marketing, "a process undertaken by individuals or organizations to engage in exchanges of tangibles or intangible resources which result in benefits to all parties conducting the exchange" (p. 5).

When newsletters are utilized, care must be taken to insure that they are printed in the native language of the targeted group. Centers must be cautious to avoid accepting that the use of newsletters and brochures will suffice in their outreach efforts. If preliminary information on the targeted group suggests that a sizable proportion of the targeted population may have problems reading or are illiterate, for example, questions should be raised whether the newsletters will be read.

Minority Affairs Coordinator: The creation, or designation, of a Minority Affairs Coordinator (MAC) lends credibility to the center's efforts to promote equal access and full participation by all persons with disabilities within the community. Where agency budgets will not allow for the creation of a new position, the designation of an individual to serve in that capacity may be beneficial. Among the duties the MAC could be involved include periodic informational workshops at agencies and organizations serving significant minority populations in the areas of housing, transportation, community accessibility, disability awareness, education, employment, and attendant care.

The outreach strategies identified can be easily replicated in communities with differing racial and ethnic populations. Incorporating such outreach strategies provides persons from underserved groups more equitable access to the services and activities provided by CILs.

Conclusions and recommendations

Several issues related to the provision of services to racially and ethnically diverse persons with disabilities were identified in the GAO report, Evidence for federal program's effectiveness is mixed (1993) as well as research by others (Wheaton, 1995; Dziekan & Okocha, 1993). The findings in Section 21 of the 1992 Rehabilitation Act Amendments have placed increased emphasis on state VR agencies, as well as independent living centers, to address issues of equity of services for persons from diverse backgrounds. While it appears that attempts are being made to reach out to ethnic or racial minorities with disabilities for management staff, board members and populations being served by several CILs in one RSA region, the results might best be described as 'inconclusive'. For example, it was noted above the none of the Program Managers of the responding CILs were identified as being members of cultural diverse backgrounds. Whether a correlation exists between the absence of diversity among staff in the programming area, a essential component of CILs and strongly linked to who ultimately participates in center activities, and number of culturally diverse persons served is worthy of further study.

Given that the survey results from the responding centers (32/53) revealed that nearly 19% of the ILC directors were racial or ethnic minorities and nearly 15% of the management staff positions were held by persons of color, one could make a plausible argument that the demographics of independent living centers are reflective of the region's population. However, it should be noted that nearly 40% of the IL centers in the region failed to respond to the survey, for one reason or another. The failure of such a large percentage of the IL centers to respond may also be interpreted as an indication of their unresponsiveness to the concerns and issues raised in the survey. As a result, it is unclear whether the reported demographics of administrative, management and service delivery staff are truly representative of the region's population or are skewed by those centers which chose to respond. Nonetheless, it appears that increased attention must to be directed towards increasing the efficiency and effectiveness of outreach efforts, especially in the area of service provision to persons from diverse backgrounds.

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Carl R. Flowers, Program Manager, Rehabilitation Continuing Education Program, Southern Illinois University, Carbondale, Illinois 62901