Rehabilitation in Vermont.

Vermont is a special place. Rollingg hills, lakes, dairy farms, picturesque villages. Hiking, skiingg, boating. Six hundred thousand people who have enough space to breathe, yet are close enough to care. Uncluttered, no billboards, little trash. The Green Mountain State.

Vermonters are special people, with a strong work ethic. They are proud of their heritage, proud of their independence, and unpretentious, conservative, generous. They have strong family ties and guard their privacy and quality of life.

Many are also disabled and many are poor. Dairy farming means long hours for minimal returns and machines that cause injuries. Many elderly have come here, or have stayed here, and have experienced the impairments that come with age. Throughout these green mountains are people who need rehabilitation.

Rehabilitation in Vermont. Is it also special? Does the mystique of Vermont influence the rehabilitation process? Are things different here than in the larger, more populous states?

To answer these questions we need to describe Vermont's rehabilitation programs and how they work together.

The Consumer Movement

Rehabilitation properly begins with the consumers of rehabilitation services. Consumers in Vermont have long played a central part in the rehabilitation process. Since the early 1960's, the state rehabilitation agency has supported their involvement in the rehabilitation process--not only in the development of the individualized written rehabilitation program but also in agency policy issues. People with disabilities were recruited for administrative and staff positions, consumer advisory boards were formed and advocacy groups encouraged.

Among the advocacy groups, the Vermont Center for Independent Living (VCIL) is foremost, representing a wide cross-section of disabilities. Managed and staffed by people with disabilities, this group provides peer counselling, advocacy programs, consultation regarding architectural barrier removal, assistive technology information, and help for people to live more independently. Peer counselors are located strategically throughout the state.

Other consumer oriented groups actively support the needs of people with specific impairments: traumatic brain injury, cerebral palsy, multiple sclerosis, heart disease, and visual, hearing, and psychologic impairments. Each serves its specific constituents and in our small state actually work together for the common good of all people with disabilities.

Another group, "The Physically Challenged Families of Rural Vermont," consisting of farmers with disabilities and their families, provides support for farm families coping with the special problems of farming with a physical impairment.

Each consumer group has made its mark by working closely and meaningfully with governmental and private rehabilitation programs and with people with disabilities to improve services in Vermont.

Vocational Rehabilitation in Vermont has had, through the years, a consistent commitment to first severe people with substantial disabilities. It is strongly committed to being responsive to the consumers of its services. In its deaf program, for instance, three of five counselors are themselves deaf, as is the State Coordinator of Serivices for the Deaf and Hard of Hearing. It contracts with VCIL to manage its independent living programs.

Innovation and linkage has been the hallmark of Vermont's VR program. In 1956, long before other states were considering this, Vermont established halfway houses to allow people from the state hospital to reenter their communities. This first, which ha snow been duplicated in many states, resulted over time in the reduction in population of the state hospital from 1,300 to about 100 people today.

The VR agency established and administered the state's first medical rehabilitation facility in the 1960's. It also supported an innovative program to educate local health care workers and counsellors to provide rehabilitation for people with spinal cord injuries in their homes. In addition, it developed a statewide industrial home work program where isolated Vermonters with disabilities were brought work to do in their homes. This program, started in the 1950's, is still operational today.

For the past 10 years, vocational rehabilitation has routinely utilized supported employment and onsite trainers. It sponsors a program for Vietnam veterans in cooperation with the Department of Employment and Training. It has close working relationships with Medicaid, Social Security, Handicapped Children, Mental Health, the Head Injury Association, and the University's Rehabilitation Medicine program. In 1989, it merged with the State Office on Aging, allowing for a continuity of rehabilitation services throughout one's lifespan.

Working out of four regional offices, VR counsellors are truly "on the road." It is not unusual for a counsellor to spend 2-3 days per week visiting clients in remote corners of Vermont's "Northeast Kingdom" or at the end of dirt roads in southern Vermont. Rehabilitation plans are individually developed for everyone--there are no tailor-made programs or facilities to which clients may be referred.

Two other innovations stand out: the Rural and Farm Family VR Program and "VABIR," the Vermont Association of Business, Industry and Rehabilitation. "Farm Family," established in 1969, unites VR with the University of Vermont Extension Service. Rehabilitation counsellors work along side their Extension Service colleagues to keep disabled farmers and their families on the farm. Approximately 50 percent of referrals come from extension workers and in about 75 percent of these the rehabilitation plan is developed conjointly between the VR counsellor, the extension agent, and the client and his or her family.

VABIR works with business and industry leaders to help them rehabilitate and accommodate to the needs of their injured workers. Located in each VR regional office, VABIR representatives assist counsellors with their rehabilitation plans and also contract directly with private insurers and industries to expedite return-to-work as soon as possible after a worker is injured.

Medical Rehabilitation

Three inpatient rehabilitation centers serve the people of Vermont: a 40-bed center at the Medical Center Hospital of Vermont (MCHV) at the University of Vermont in Burlington, a 10-bed program at Mount Ascutney Hospital in Windsor, and a 12-bed program at the Rutland Regional Medical Center in Rutland.

The Rehabilitation Center at MCHV offers well-developed sub-specialtty rehabilitation programs for people with spinal cord and brain injury, stroke, amputation, and neurologic, orthopaedic, cardiac, and respiratory impairments. The center was established in the early 1960's by the Vermont Division of Vocational Rehabilitation and has been active in training medical, nursing, physical therapy, occupational therapy, and medical psychology students in the practice of rehabilitation. It attracts patients not only from all of Vermont, but also from the northeast section of New York as far as West Lake Ontario. Its medical director also serves as chief medical consultant for the state VR program.

The Mount Ascutney Hospital Rehabilitation Unit serves the Connecticut River Valley and is affiliated with Dartmouth Medical Center in Hanover, New Hampshire. It is a dynamic program in a truly rural setting. The Rutland Regional Medical Center's Rehabilitation Unit--newest of the three centers--provides state-of-the-art rehabilitation for people in the southwest and central portions of the state.

The directors of the three centers meet regularly to coordinate efforts and assure the best service for all Vermonters.

Children's Rehabilitation

The Vermont Achievement Center in Rutland has long been the state's leader in children's rehabilitation. It combines special education for children who have multiple physical handicaps with outpatient and inpatient therapy programs and has outreach programs into all of Vermont. It works closely with the Program for Children with Special Health Needs of the State of Vermont which coordinates outpatient rehabilitation services for Vermon't children.

The University of Vermon't Special Education Department, which is also active in children's rehabilitation, provides interdisciplinary consultation to schools throughout Vermont for children with disabilities.

Two Vermont projects funded by the National Institute on Disability and Rehabilitation Research (NIDRR) should be mentioned.

The Rehabilitation Engineering Center at the University of Vermont, funded by NIDDR since 1983, focuses on research into the prevention, treatment, and rehabilitation of people with "the silent disability," low back pain. Its clinical affiliate (not federally funded), the Spine Institute of New England (SPINE), provides comprehensive diagnostic, treatment, and rehabilitation services for people suffering from low back pain.

Vermont's Assistive Technology Program, also funded by NIDDR, integrates the efforts of a number of state, voluntary, and private rehabilitation providers to bring advances in technology to Vermonters with disabilities.

Summary

So, is rehabilitation in Vermont any different from elsewhere? Most states have strong vocational rehabilitation programs, medical rehabilitation centers, and consumer advocacy. What is different about working in a small rural state?

First, there is easy communication. It is still possible in Vermont for any citizen to call people at all echelons of state government, including the governor, and get results. People in rehabilitation know one another on a first name basis. Communication among VR, Social Security Disability, Medicaid, and other state agencies occurs daily. People in various rehabilitation programs trust each other, and they know that progress is best made when all components of the rehabilitation process cooperate.

A second fact that makes Vermont different is the rural mindset that work is important and that families are important. People with disabilities want to stay in their communities and with their families. Jobs may be scarce; but if one can work, one should.

In addition, there is an attitude that supports innovation. The smallness, the ruralness, easy communication, our unpoliticized environment, and even our poverty makes creativity easier. There is a willingness to make things work in spite of the problems.

People with disabilties face significant problems living here: lack of public transportation, architectural barriers, ice and snow, lack of industry, and isolation.

But Vermonters with disabilties retain the same qualities which make us all gald to be here--a perseverance and belief that things do work out in the end.