Rehabilitation facilities: preparing for the 21st century.

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 experts serving the betterment of persons with disabilities,are designated as SWITZER SCHOLARS by certificate, and this recognition has 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, including recommendations for future programming, research, training, and legislative needs. The format is designed for use by counselors, consumers, employers, researchers, educators, policymakers, or anyone interested in the rehabilitation of persons with disabilities.

Over the years the Switzer Monographs have been widely used by counselor educators at the university level, rehabilitation counselors, consumers, advocates and multi-disciplinary professionals.

These special Seminars are named for the late Mary E. Switzer, America's foremost leader and trailblazer for innovative programs at the national, State and local levels for people with disabilities. For more than thirty years her influence was felt in the area of Vocational Rehabilitation as head of the Rehabilitation Services Administration and the Social and Rehabilitation Services of the then U.S. Department of Health, Education and Welfare.

The Switzer Memorial Committee of NRA was started by colleagues and friends of the late Mary E. Switzer, including key members of the Congress, Secretaries of the U.S. Department of Health, Education and Welfare and the Department of Labor, and private citizens interested in the rehabilitation of people with disabilities.

The Seminar

The 16th Mary E. Switzer Memorial Seminar was held in Washington, D.C. June 10-12, 1992 and was hosted this year by the President's Committee on Employment of People with Disabilities (PCEPD). The topic of the Seminar was: Rehabilitation Facilities: Preparing for the 21st Century."

As the late Mary E. Switzer noted in 1963, "Few aspects of rehabilitation have been as dramatic as those found in centers. There, rehabilitation can be seen step by step in a way that permits no doubt as to the value to the people served, or the dedication and skill of those who serve them. Many of the advances in rehabilitation have found early demonstration in centers with the result that the pace of progress increased and became more pronounced." (Mary E. Switzer, 1963)

Much has happened in the field of Vocational Rehabilitation since those words were spoken by that early pioneer in Rehabilitation. The current Seminar took an in-depth look at facilities as they are currently and where we need change in this dynamic society as preparations are made to meet future demands and challenges in the facilities movement in the nation.

Welcomes were provided to the Switzer Scholars by this year's host, Richard Douglas, Executive Director, President's Committee on Employment of People with Disabilities; Ann W. Tourigny, Executive Director, National Rehabilitation Association, the administrator of the Switzer Memorial Seminars; and Carl E. Hansen, Chairperson of the Switzer Seminars. The Honorable Nell C. Carney, U.S. Commissioner of the Rehabilitation Services Administration (RSA), provided the keynote address to the Scholars. Commissioner Carney stated, "It is appropriate for this sixteenth Switzer Memorial Seminar to focus on the role of rehabilitation facilities in the delivery of rehabilitation services because we know facilities are essential to meet the challenges presented by the ever changing needs of people with physical and mental disabilities. The awesome power of the triumvirate - State vocational rehabilitation agencies, rehabilitation facilities, and RSA - once dominated rehabilitation service delivery, only to drift in separate ways, but with the potential to reawaken as a potent force in a new era with new goals and objectives, to contribute to achieving equality in employment and community participation for every American with a physical or mental disability. This Seminar is historic because it sends a message of hope to people who battle stereotypical attitudes that deny them equal access and equal opportunity to jobs and education. This sends a powerful and timely signal to people with disabilities, their families and their advocates, that all of you who are national experts and participating in the discussions over the next three days genuinely care about improving and expanding rehabilitation services. Through dialogue and the exchange of materials, the people who participate in this Seminar will be equipped to introduce new approaches and strengthen current programs - all toward better services for people with disabilities."

The opening remarks set the direction and tone for an exciting three-day think-tank. Five special papers were written especially for the Seminar and served as the foundation for the three-day program. These papers and their authors/scholars were as follows:

An Overview of the Rehabilitation Facilities Movement by C. Todd Jones and Robert E. Brabham.

Ethical Issues in a Changing Rehabilitation World by Joseph F. Campbell

Rehabilitation's 21st Century Client: Back to the Future, by Yolande K. Bestgen.

Resource Development and Rehabilitation Capacities by Frederick E. Menz.

The Value of Rehabilitation Facilities: Financing and Development Issues for the 21st Century, by Kenneth J. Shaw.

The Seminar brought together in the 21 Switzer Scholars a vast array of expertise in the subject matter at hand. The participants included consumers, directors of facilities, business and industry leaders, rehabilitation educators, rehabilitation facility association executives, and Federal and State rehabilitation officials.

Comments of the Scholars

The following excerpts are a sampling of some of the comments and ideas put forth by the Scholars in addressing the Special Papers for the Seminar:

In his paper, Joseph Campbell raises the question of whether there are people with disabilities who cannot be integrated into the mainstream of the workplace. He does not answer the question; possibly because there is no answer. That decision must rest with each individual, based on the best information available. There are, however, two areas of inquiry which, while not mentioned in Mr. Campbell's paper, are surely implied. These are the ability of people to make informed choices, and the willingness of society to permit them to do so.

I hasten to note that individuals with disabilities, when given the necessary supports and opportunities, are quite capable of making appropriate choices. However, this ability must be developed. Well meaning family, friends, health care and service providers have, far too often, tended to take over the decision making process. Not given the opportunity or responsibility to take charge of their lives, many individuals with disabilities have found it difficult to make career and lifestyle choices when called upon to do so. This perceived climate of paternalism is changing, and everyone must be prepared to meet the new challenges.

Joseph Campbell's paper challenges rehabilitation facilities and their professional leadership to promote the human rights and personal dignity of people with disabilities through consumer empowerment. He advocates that consumers determine their rehabilitation programs, full participants in facility policy formulation, leadership and access to training and employment in the work place. Campbell equates the original rehabilitation paradigm as unsuitable for consumer populations which have been disenfranchised from traditional program models and encourages facility leaders to "reexamine how we do business."

What a thrill to read Yolande Bestgen's paper. What a motivating and inspiring work. I found myself writing, Yes! Good! Absolutely!, in the margins throughout. I kept thinking what an exciting time to be in rehabilitation.

Rehabilitation professionals in general have never given themselves enough credit. There is an extremely broad base of knowledge, skills, and expertise available in the rehabilitation community. Skills of mediation, negotiation, and collaboration are essential in today's world. Rehabilitation professionals employ creative, innovative ideas and services to empower their clients to expand their expectations and push the limits. The rehabilitation professionals today must constantly reach out to other service providers, industry, and all community resources to bring focus to the needs of people with disabilities and to influence and shape the opportunities for full participation and inclusion for people with disabilities in their communities.

Ms. Bestgen emphasizes the "community" as rehabilitation's 21st Century "client." She urges rehabilitation facilities to identify its publics, develop a strategic plan, and collaborate with those publics. The goal is a service system which achieves community membership for service consumers.

She also predicts that the 21st Century will see new populations of persons with complex disabilities, of all ages and particularly identifies the elderly as a probable service population. The statistics she cites to support the growth of the older population are certainly dramatic! With fewer taxpayers supporting the social service system, she forecasts that the demand for services will exceed the supply of financial resources. Thus, she suggests, there is a need for creative approaches, including collaboration within the community, for actualizing community life for people with disabilities. For her, the role of the rehabilitation facility is to provide community leadership on behalf of people with disabilities.

Dr. Menz's paper is very thorough in its coverage of the subject. As a facility administrator, it is most curious that most of the technology that is employed in vocational rehabilitation is intellectual in nature. While there are standardized testing and training devices that can assist persons with disabilities in the vocational arena, there is no comparison to the various devices and "modalities" that are utilized in medical rehabilitation programs.

Given these observations, Dr. Menz is quite correct in his discussions about training, basic and continuing education, and job experience and growth. Our most successful vocational rehabilitation professionals are those who have good educational backgrounds, who take advantage of educational opportunities where the sharing of work experiences is highlighted, and, most importantly, who have a street-sense about vocational opportunities in the communities for their clients.

The premise presented in the paper by Ken Shaw centers around the need for rehabilitation facilities to operate more like "for profit" entities, if rehabilitation facilities are to receive appropriate levels of funding to meet the expectations of their many customers.

It is clear from Mr. Shaw's review of the history of public funding support for rehabilitation facilities that in recent years specific dollars earmarked to develop, maintain and increase facilities have been decreasing to a point where in FY '92, there are no allocations for the programs which directly and indirectly relate to the operation of rehabilitation facilities.

The above fact leads the author to the conclusion that rehabilitation facilities must join with other community agencies to secure adequate funding and better market themselves to the public in general which has limited knowledge and understanding of the role of rehabilitation facilities.

Given the changes that demographic, societal, and technological developments are causing in the rehabilitation field, a collaborative approach will be necessary for survival in the 21st century.

Insofar as possible, those utilizing the services of rehabilitation programs must be provided marketable skills as a prerequisite to competing for employment opportunities. This reviewer believes if United States business is to survive nationally and internationally, we urgently need to qualify people with disabilities, not only for entry level positions in the service and hospitality industries, but also in the technical and soft and hard sciences. Discussions on obtaining more Federal or State revenues by service providers (funding), often neglect to mention that the genesis of all so-called tax dollars is from taxing businesses that have successfully competed in providing goods and/or services. Therefore, viable partnerships, between rehabilitation service providers, those with disabilities, governmental policymakers, and the employer community, are imperatives.

Even though the funds for facilities have been diverted from 1977 to 1992, the current trend in rehabilitation is to be more inclusive of persons with disabilities. First, the author, Ken Shaw, proposed that facilities operate as businesses in every aspect, not as charities. Facilities have to become outcome not process oriented. The search for funding must become non-traditional and may involve collaboration with other organizations to a higher level than before. This assumes a new flexibility of programming and a performance-based model.

In order to insure adequate funding, all persons in rehabilitation need to take on a more active legislative role. The concept of returning $7.00 to the economy for every tax dollar spent in rehabilitation services is still a vital statistic for political purposes. Rehabilitation makes good business and economic sense.

In his paper, Ken Shaw links work to the overall well-being of the individual. He suggests that dependency and social problems are companions. He believes that through vocational rehabilitation facilities programs and services, the individual with a disability is introduced to opportunities and options that can result in productivity, employment, independence, and integration into the workplace and the community. This paradigm embraces a proficient and satisfied worker, a community with fewer social problems, and a healthier national economy.

Shaw also identifies a major problem that has contributed to some strain between facilities and their government partners over the years. Too frequently, fees for service do not cover the actual costs of the services and in effect, the facility through donations, fundraising and other earned income, literally subsidize the rehabilitation of the government sponsored client. This issue is ripe for resolution and the creative genius of the partners must be applied toward a mutually acceptable policy, one that benefits the individual, the provider, and the purchaser of services. The dialogue was begun at the 1992 National Conference on Rehabilitation Facilities sponsored by the Federal Rehabilitation Services Administration. Hopefully, it will continue until a workable solution is found and implemented.

Implications For Action

During the three days of discussion and debate, the Scholars developed a list of recommendations and implications for action. These ideas were categorized in areas such as research, policy and program development, service delivery, training needs, and legislation. A sampling of some of these ideas are noted as follows:

* Service providers must accept the responsibility for actively engaging in research and development activity, promoting partnerships with institutions of higher education and including consumers throughout the process to successfully connect people with severe disabilities to valued employment opportunities. The results and findings of such information should receive wide dissemination among service providers, the business sector, and the academic community.

* Changes are needed in the way our society relates to people with disabilities for enhancing consumer self-determination starting with coordinated public policies and resource allocation and extending through the process of delivering services. the allocation of resources by legislative authority must be more closely linked to identified need through leadership by consumers, with professionals, rather than through political clout.

* Organizations should establish and implement marketing plans to include: needs satisfaction surveys; an internal analysis of strengths, needs, opportunities, and threats; an external analysis of competitors; and an environmental trend analysis. Such a review should contribute to a focused vision which is expressed through the mission statement of an organization.

* There is a need to examine the components of collaboration, including negotiation, marketing, mediation, etc., as a foundation for the development of leadership training.

* It is essential to implement management information systems which report on consumer outcomes rather than those outcomes which only aggrandize organizational accomplishments.

* Techniques should be developed to track consumer and community satisfaction and use the findings to improve service delivery and policy development.

* Research should be directed toward determining optimal forms of organizational design which support the creation of agencies which effectively deliver community level services including and especially supported employment; while making optimum use of the personnel who deliver the services. Such research should include the identification of a core skills set that must be mastered in order to function effectively in such an organization.

* Rehabilitation educators should adopt as the fundamental goal for preservice, continuing education, and human resource development for rehabilitation personnel, the development of "a humane capacity which is renewable, sustainable, and competent to conceive, organize, and deliver the kinds of resources which individuals with disabilities in America's communities require to accomplish their employment, independence, and economic goals."

* It is critical to involve the community in the strategic planning process to vest all in the ownership of the common vision; to orient and educate board members to carry forward the mission of the organization to the community; and

* Through active participation and involvement, enjoin all staff in the ownership of the common vision focused on individuals with disabilities and their independence.

CONCLUSIONS

The Switzer Memorial Committee of the National Rehabilitation Association is appreciative of all of the persons whose involvement and dedication assured the success of the 16th Switzer Memorial Seminar. The Seminar covered much ground and the discussion and papers reflect a rich history pf progress since the Vocationally-oriented facilities (mainly "sheltered" workshops in the early days) began to flourish during the 1960s. Looking to the future of the facility movement, Switzer Scholar, Stanley Irzinski, noted, "Today's rehabilitation facility is faced with a multidue of resource problems.

* As new populations develop, waiting lists grow while fiscal resources shrink.

* Over the past decades, traditional funds for expansion, facility improvement, and construction have virtually disappeared.

* Facilities are often expected to be employers, Job Placement Specialists, and change agents all at the same time.

These factors, and many others, all need to be juggled and resolved at a time when facilities are being criticised as antiquated, self-serving organizations that are out of touch with their community and consumers.

It is clear that the rehabilitation facility that thrives in the 21st century will be one that is diversified, both in its programmatic and funding base. Facilities that solely rely on traditional Vocational Rehabilitation (VR) funding will be ill-equipped to meet the challenges of the future. Successful organizations will design realistic marketing plans that develop other funding resources, such as Special Education, Job Training Partnership Act (JTPA), Mental Health and Mental Retardation, Developmental Disabilities, and Insurance Services. They will also continue to cultivate both the employer and organized labor, whose active participation in the placement process is an invaluable resource.

While most facility directors, this writer included, dream of the day when facilities will not need to subsidize State-federal funding, harsh fical reality suggests that day may never come. Consequently, rehabilitation facilities will need to continue to have their greatest asset: Creativity!"