Rehabilitation feasibility of blind and visually impaired disability beneficiaries.

Rehabilitation Feasibility of Blind and Visually Impaired Disability Beneficiaries

Major changes were made in Title II and Title XVI of the Social Security Act with the passage of the Omnibus Budget Reconciliation Act of 1981 (Public Law 97-35). This legislation changed the cooperative program between the Social Security Administration and state Vocational Rehabilitation (VR) agencies from a "trust fund" arrangement to an "entitlement" program whereby VR agencies are reimbursed on a case by case basis and only in instances when the individual beneficiary or recipient has performed a continuous nine month period of work at a "substantial gainful activity" (SGA) level. Given this reimbursement process, it is essential that VR administrators and counselors who serve blind and severely impaired adults have access to data that help reflect the prognosis for gainful employment for Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) beneficiaries. The SSDI program is a program of public employment -- disability insurance created by Congress to insure workers contributing to the Social Security Trust Fund against the risk of future unemployment caused by the occurrence of a physically or mentally disabling condition. In contrast, the SSI program is a social welfare program intended to provide basic income replacement for poor people unable to achieve sustained, compensated employment because of a physical and/or mental disability.

State VR agencies provide a program of services that will prepare disabled persons to regain the status of productive members of society. However, some disabled persons who are enrolled in a rehabilitation program may be reluctant to take a job for fear of loss of disability benefits. This has resulted in disability benefits functioning as disincentives to rehabilitation, because it is not economically feasible for the disabled person to return to work. This study focused on the rehabilitation feasibility of blind and visually impaired clients who are disability beneficiaries.

Many studies which shed light on rehabilitation feasibility have used rehabilitation outcome as the major criterion (Aiduk & Longmeyer, 1972; Ben-Yishay, Gertsman, Diller, & Hans, 1970; Gilbert & Lester, 1970). In these studies, clients usually were categorized as successful or unsuccessful closures and compared on various biographical variables included on available agency records. Significant differences among the groups served as the basis for the prediction of rehabilitation outcome of client groups selected for validation. Berkowitz (1980), Better, Fine, Simison, Doss, Walls, and McLaughlin (1979), Manus (1981), Schuermann and Hommertzheim (1979), and Walls (1982) conducted studies on rehabilitation outcome of disability beneficiaries. Other studies (Ammons, 1979; Crouse, 1974; McGowan, 1972) examined variables that predicted rehabilitation outcome and adjustment to blindness for blind clients; however, these studies did not focus specifically on blind and visually impaired disability beneficiaries. Studies in these areas differ in methodology. While some are concerned with the "general," "average," or "typical" client and use aggregate data and refined statistical techniques on a cross-sectional or time-series basis, others adopt a clinical approach, seeking to ascertain individual characteristics of clients and the effects of specified disincentives on them (Berkowitz, 1980). In a recent report to the Subcommittee on Social Security in the U.S. House of Representatives, the General Accounting Office (GAO) reported little success is being achieved in rehabilitating disabled beneficiaries (GAO, 1987). In fact, the GAO concluded that only a small minority of disability beneficiaries -- not more than 10 to 15 percent -- are realistic prospects for rehabilitation. This post hoc evaluation study examined blind and visually impaired disability beneficiaries after their cases were closed. The predictive study investigates the relationship of closure status to each of the process variables of cost of case services, number of services rendered, and number of months on agency rolls. Furthermore, this study adds to the literature on the rehabilitation feasibility of blind and visually impaired disability beneficiaries by investigating variables that predict and those that did not predict successful closures. It specifically focused on differences between blind and severely visually impaired clients in various disability beneficiary statuses and closure statuses.

The purpose of this research was to achieve a feasibility study by investigating the relationship between closure status (successfully rehabilitated-status 26 and unsuccessfully rehabilitated-statuses 28 and 30) and disability beneficiary status (Supplemental Security Income-SSI, Social Security Disability Insurance-SSDI, and SSI/SSDI) on each of five intake variables (age, highest grade completed, marital status, major disabling condition, and monthly family income) and separately on each of the three process variables (cost of case services, number of services received, and number of months on agency rolls). A secondary purpose was to determine the most important predictor(s) and the best single predictor of each of the process variables from each of the five intake variables, closure status, and disability beneficiary status. A Status 26 closure represents an individual whose case has been closed as rehabilitated and who has been declared as eligible, has received appropriate diagnostic and related services, has had a program of VR services formulated, has completed the program in so far as possible, has been provided counseling as an essential rehabilitation service, and who has been determined to be suitably employed for a minimum of 60 days. A Status 28 closure represents a case that was closed not rehabilitated after the Individualized Written Rehabilitation Program (IWRP) was initiated. These also include cases which may have been transferred to another state rehabilitation agency. Status 30 represents those cases which did not progress to the point that rehabilitation services were actually initiated under a rehabilitation plan.

Method

Subjects

The subjects (N=116) selected for the study consisted of a sample of blind and visually impaired disability beneficiaries served by Mississippi Vocational Rehabilitation for the Blind whose cases were closed in Status 26, 28, or 30 during fiscal year 1983. The subjects consisted of 55 males and 61 females, ranging in age from 15 to 64 inclusive. The disability beneficiaries focused on were those who were receiving disability benefits (Supplemental Security Income-SSI, Social Security Disability Insurance-SSDI, and both SSI/SSDI) at intake or referral.

Procedure

The subjects were categorized according to disability beneficiary status and closure status in the following configurations: SSI Status 26-closures--40: SSI Status 28 and 30 closures--16: SSDI Status-26 closures - 35: SSDI Status-28 and 30 closures -- 7: SSI/SSDI 26 Status closures -- 11: and SSI/SSDI Status-28 and 30 closures -- 7. The RSA 300 Information Form including Case Service Codes and the Statistical Reporting System Classification of Disabling Conditions were utilized in the investigation (Rehabilitation Services Administration RSA 1974).

Instruments

The RSA 300 Information Form (now referred to as the RSA 911) is completed by the rehabilitation counselor on each client. It provides data on demographic and biographic characteristics of the client at referral and acceptance into the rehabilitation program (intake variables and process variables) and information on the client at case closure.

The Case Service Codes form is used in conjunction with a computer printout in order to classify categories of information on the number and cost of case services provided by Mississippi Vocational Rehabilitation for the Blind. Major disabling condition was determined by obtaining a code from the RSA 300 Information Form on each client and translating the code from the Classification of Disabling Conditions (RSA, 1974).

Results

Comparisons were made between clients in disability beneficiary status (SSI, SSDI, and both SSI/SSDI) and marital status, major disabling condition, and monthly family income on expected and observed frequencies. Results of the chi-square tests showed that disability beneficiary status groups differed significantly on the variables of monthly family income, X2 (2, N = 116 = 7.124, P = .0284; and marital status, X2 (2, N = 116) = 6.992, P = .1730 (See Table 1). Comparisons between clients in closure statuses (26, 28, and 30) and disability beneficiary status, marital status, major disabling condition, and monthly family income on observed and expected frequencies revealed no significant differences at the .05 level.

Individual two way analyses of variance were conducted on disability beneficiary status groups, closure status, intake and process variables. Results of the analysis of variance to test the main effect of disability beneficiary status on the variable of age yielded a statistically significant difference, F (2, 110) = 7.95, p = .0006, with significant differences between SSDI and SSI/SSDI and SSDI and SSI disability beneficiaries with SSDI clients being older than both SSI and SSI/SSDI disability beneficiaries (see Table 2).

Results of the analysis of variance to test the interaction effect for closure status and disability beneficiary status on the variable of highest grade completed yielded an interaction effect, F (2, 109) = 4.29, p = .0161, with statistically significant differences between SSI/SSDI disability beneficiaries closed in status 26 and SSI/SSDI disability beneficiaries closed in status 26 who were better educated. Results of the analysis of variance to test the main effect for closure status on the variable of number of services received yielded only a main effect, F (2, 110) = 5.06, p = .0265.

Results of the multiple regression analysis revealed that the most important predictors of cost of case services were closure status, F (1, 99) = 7.6292, p = .0068, and major disabling condition, F (4, 99) = 3.3802, p < .0123, which caused a statistically significant reduction in R2 as shown in Table 4.

Results of the multiple regression analysis using number of services as the dependent variable revealed that the most important predictor for number of services received was closure status, F (1, 99) 5.620, p = .0194, which caused a statiscally significant reduction in R2. The multiple regression analysis using cost of services as the dependent variable revealed that the best single predictor of cost of case services was marital status (X5) which accounted for the most variance, .2039 or 20%.

Results of the multiple regression analysis using number of services received as the dependent variable revealed that the best single predictor of number of services received was major disabling condition (X6) which accounted for the most variance, .1299 or 13%. The multiple regression analysis using number of months on agency rolls as the dependent variable revealed that the most important predictor of number of months on agency rolls was monthly family income, F (2, 99) = 5.7214, P = .0045, which caused a statistically significant reduction in R2. The multiple regression analysis using number of months on agency rolls as the dependent variable revealed that the best single predictor of number of months on agency rolls was monthly family income (X7) which accounted for the most variance, .1154 or 12%. Because of space limitations, tables not printed will be provided by the authors upon request.

Discussion

The assertion is that benefit programs cause disability beneficiaries to refrain from work. Walls, Masson, and Werner (1977) reported that the vocational rehabilitation counselor finds work with SSI and/or SSDI recipients discouraging because the success rate is generally low. Prior to this study, there had been no studies reported in the literature that were conducted exclusively on the rehabilitation of blind and visually impaired disability beneficiaries. This study attempted to examine variables that predict successful closure and variables that predict process variables of cost of case services, number of services received, and number of months on agency rolls. The results of this study were beneficial in screening potentially successful blind and visually impaired disability beneficiaries and for resource allocation, program planning, and time management.

Some studies (Better et al., 1979; Walls, 1978, 1982) have revealed a low success rate among disability beneficiaries. Despite the results of previous studies, frequencies from this study revealed that there were more blind and visually impaired disability beneficiaries successfully rehabilitated or closed in status 26 (986 or 74.14% of the total) than those unsuccessfully rehabilitated or closed in statuses 28 and 30 (30 or 25.86% of the total).

Age was not significant on the variable of closure status in this study. This supported the study by Crouse (1974) which did not find age or educational level as useful as program service characteristics in predicting rehabilitation success for legally blind clients. However, this study found highest grade completed to be a significant variable associated with successful rehabilitation.

McGowan (1972) found age to be a significant predictor of Rehabilitation Training Score (RTS) for blind clients. Rubin et al. (1973) and Saxon, Spitznagel, and Shellhorn-Schutt (1983) found age to be a significant variable among successful and unsuccessful clients. Marital status and disability type were found to be significant predictors of client success in the literature review by Rubin, et al. (1973). However, these variables were not significant predictors of closure status in this study. This study also supported the findings of Tseng and Zerega (1976) who reported that successful clients seemed to receive significantly more services. The study also revealed that cost of case services was more expensive for successful clients.

Cost of case services and number of months on agency rolls were not statistically significant on the variable of closure status. These findings were consistent with those reported by Saxon, et al. (1983) which found no statistically significant differences between successful and unsuccessful clients in cost of evaluation and length of evaluation. In this study, highest grade completed was significant on the variable of closure status with significant differences between SSI/SSDI Status 26 and 28/30 closures. Disability beneficiaries who were SSI/SSDI Status 26 closures were better educated than those who were SSI/SSDI Status 28/30 closures. Barney (1974), Kennedy (1974), and Rubin et al. (1973) also found educational level significantly related to rehabilitation success.

Therefore, the age and educational level are demographic variables that should be carefully examined for blind and visually impaired disability beneficiaries to determine the likelihood of successful rehabilitation. The older and better educated a blind or visually impaired disability beneficiary is, the more likely he or she is to be successfully rehabilitated. While the literature supports the success of older, more well educated beneficiaries achieving successful employment outcomes, VR staff must exercise caution in screening out applicants who may otherwise be eligible for VR services just because they are young or less well-educated. Each applicant/beneficiary must be carefully evaluated to ensure that they meet the eligibility criteria for the VR program. Many blind or visually impaired applicants may elect to limit their earnings in order to avoid loosing their SSI/SSDI benefits by exceeding the SGA level; VR counselors will get "credit" for the 26 closures but VR agencies will generally not be reimbursed in such cases by the Social Security Administration. The study further suggests that, if a counselor spends more money on case services and provides more services, the probability of successful closure is greater. In addition, the less time a blind or visually impaired disability beneficiary spends on agency rolls, the higher the probability of successful closure. How much money should be spent or how much time on a VR caseload is necessary to rehabilitate a given individual obviously cannot be determined from these data; there is a real need for further research which could compare blind and visually impaired beneficiaries with non-beneficiaries on closure variables. Further research efforts should also employ a comparative study using disability beneficiaries from the general rehabilitation population. The knowledge generated from such studies could contribute significantly to vocational rehabilitation agency success in placing Social Security beneficiaries who are blind at the SGA level and thus assist agencies in securing reimbursement of funds expended.