Rural and urban vocational rehabilitation: counselors perceived strengths and problems.

The goal of the federal-state vocational rehabilitation (VR) program is employment for people with disabilities. However, achieving a successful employment outcome in rural areas may not be as easy as in urban areas due to many factors including: poor economic conditions (Bitter, 1972; Rojewski, 1992), lower educational levels (Swanson, 1990), little or no public transportation (Bearer, McWilliams, & Stommes, 1989; Saltzman & Newlin, 1981; Walden, 1982; Wimberley, 1991), different consumer needs (Omohundro, Schneider, Marr, & Grannemann, 1983), service delivery methods and settings (Bitter, 1972; Blayzek, 1982; Lazarus, Page, & Barcome, 1984; Marr, 1988; Schwab, 1983), geographic barriers such as distance and isolation (Rojewski, 1992), cultural reluctance of individuals to seek or accept help (Leland & Schneider, 1982; Clay 1992; Fitzgerald & Anderson, 1992; Seekins, 1992), the general lack of services (Bitter, 1972; Goodyear, Bitter, & Micek, 1973; Lowrey, 1980; Omohundro, et. al., 1983), and the urban nature of the VR program (Bitter, 1972; Carney, 1992; Lowrey, 1980; Seekins, Ravesloot, & Dingman, 1989).

Since 1969 authors have discussed the difficulties experienced by vocational rehabilitation agencies when serving rural consumers and they have suggested solutions for providing equitable and effective services (Arnold & Seekins, 1996; Bitter, 1972; Bitter & Kunce, 1972; Carney, 1992; Goodyear, Bitter, & Micek, 1973; Hulek, 1969; Leland & Schneider, 1982; Lowrey, 1980; Offner, 1989; Omohundro, et. al., 1983; Rojewski, 1992). Despite these efforts, there appears to be little empirical evidence of differences between rural and urban counselors, consensus about the priorities for research or program development for rural vocational rehabilitation, or even the role vocational rehabilitation should play in rural rehabilitation (Rojewski, 1992; Seekins, 1992).

In the absence of clear consensus on need and direction, the Research and Training Center on Rural Rehabilitation Services conducted a national study of rural and urban vocational rehabilitation counselors to identify major issues and priorities for developing solutions. The following research questions were asked.

1. What are the positive features of VR practice in rural and urban areas?

2. What are the problems experienced by rural and urban VR counselors?

3. Are there differences between rural and urban VR counselors?

Method

Research Participants

The population for this study was all state agency vocational rehabilitation counselors and supervisors in the states listed in Table 1. These states were selected because they are among the most rural states in the country when analyzed according to population density and the percentage of the population residing in urban areas (Jackson & Seekins, 1989). It was not possible to survey the entire population due to budget and VR agency constraints. Therefore, the sample was selected according to the following procedures.

Table 1
Rural Ranking of Participating States

RURAL            RURAL
STATE            RANK

Alaska             1
Montana            2
Wyoming            3
South Dakota       4
North Dakota       5
Idaho              6
Nevada             7
New Mexico         8
Nebraska           9
Utah              10
Maine             11
Oregon            12
Vermont           13
Kansas            14
Arizona           15
Colorado          16
Arkansas          17
West Virginia     19
Oklahoma          20
Iowa              21
Minnesota         22
Texas             23
Washington        24
Alabama           25
Kentucky          26
Missouri          27
Wisconsin         29
South Carolina    30
North Carolina    31
Georgia           32
Louisiana         33
Tennessee         34

In 26 of the participating states, 12 counselors were selected to participate. Counselors were selected based on the population density of the areas they served. Three counselors were selected from each of four areas: (a) a town with a population of less than 20,000 in a non-urban area, (b) a town with a population between 20,000 to 50,000 in a non-urban area, (c) a city with a population between 50,000 to 250,000, and (d) a city of 250,000 or more inside a metropolitan statistical area. In states with more than one population center that met the criteria, one participant might be selected from each of the qualifying areas. In the eight states where there was no city with a population of 250,000 or more, just nine counselors were selected. Participants were selected by either the field services director or the director of programming.

Instrument Development

An instrument was developed specifically for this research. It used the concerns report methodology (Fawcett, Seekins, Whang, Muiu, & Suarez de Balcazar, 1982; Fawcett, Suarez de Balcazar, Whang-Ramos, Seekins, Bradford, & Mathews, 1988; Schriner & Fawcett, 1988; Suarez de Balcazar, Bradford, & Fawcett, 1988) where participants rate the importance of and their satisfaction with a concern (survey item). The instrument was developed using the following procedures: in-depth qualitative interviews were conducted with state agency VR counselors and supervisors, a vocational rehabilitation counselor who had worked in both rural and urban settings assisted with developing survey items, and an extensive literature review was conducted.

The instrument was developed according to the Proposed Policy Statement for the National Institute of Rehabilitation Research (NIDRR) on Constituency-Oriented Research and Dissemination (CORD)(Fenton, Batavia, & Roody, 1993) and in accordance with the concerns for acceptable research of the Council of State Administrators of Vocational Rehabilitation (CSAVR)(David Miller, personal communication, 1993).

NIDRR's CORD policy was developed to ensure "meaningful participation by relevant constituencies in all stages of the NIDRR research" process (Fenton, et. al, 1993, p.2). For this research, the constituency was defined as State Agency Vocational Rehabilitation Counselors and the input of state counselors and administrators was solicited throughout the development of the research tool. The instrument was approved by the Council of State Administrators of Vocational Rehabilitation and the University of Montana's Institutional Review Board. CSAVR approval was received.

Content and face validity were addressed through the process of developing the instrument. According to Schriner and Fawcett (1988) another measure of validity for a concerns report instrument is the importance ratings assigned to the items by respondents. Mean importance was 3.57 of a possible 4.0 (ranging from 3.02 to 3.87). For this instrument Cronbach's coefficient alpha based on all VR counselor responses was .94 (Borg & Gall, 1989).

Instrument Content

The final instrument contained 63 items: 11 demographic items and 52 importance and satisfaction items. The respondents rated the importance of and satisfaction with an item using a Likert-type scale anchored by 0 and 4. For importance, 0 = not important, 4 = very important. For satisfaction, 0 = not satisfied, 4 = very satisfied.

Instrument Administration

In 29 states survey packets were sent to a designated contact person for distribution. Survey packets were mailed to the participants in the other three states. All packets included a stamped addressed return envelope, a letter explaining the project, and the survey. Some states included a letter of endorsement from the state agency. In all but two states surveys were returned to the researchers. In those two states, surveys were returned to the state agency and forwarded to the researchers so the state agency could follow-up with nonrespondents.

Data Analysis

Research Questions 1 & 2. Concerns report data analyses methods were used to identify counselor strengths and problems (Fawcett, Seekins, Whang, Muiu, & Suarez de Balcazar, 1982; Fawcett, Suarez de Balcazar, Whang-Ramos, Seekins, Bradford, & Mathews, 1988; Schriner & Fawcett, 1988; Suarez de Balcazar, Bradford, & Fawcett, 1988). Strength and problem ratings were calculated using the following formulas. These percentages were used to determine an item's standing relative to other items.

An item's average strength percentage was computed by multiplying a respondent's importance score by the respondent's satisfaction score and dividing the product by 16 ((I x S)/16). The result was added to all other respondents' importance percentage ratings for this item, then divided by the number of responses to this item to arrive at an average overall strength percent.

An item's average problem percentage was computed by multiplying a respondent's importance rating by 4 minus the respondent's satisfaction score and dividing the product by 16 ((I x (4 - S)/16). The result was added to all other respondents' problem percentage ratings for this item, then divided by the number of responses to this item to arrive at an average overall problem percent.

Research Question 3. To determine if there were statistically significant differences in the strengths and problems reported by rural and urban counselors, t-tests were conducted. Demographic data were analyzed using both t-tests and chi-square tests. A Levine's test was conducted for each t-test to determine equality of variances between the groups. When variances were not equal, the individual group variances were used in the t-test analysis instead of the pooled-variance. All tests were 2-tailed. Alpha was set at .05.

Results

Demographics

A total of 352 surveys were mailed; 332 were returned for a 94% response rate. For ten respondents it could not be determined if they worked in a rural or urban area. This reduced the number of usable surveys to 322: 215 rural, 107 urban. Cohen (1988) recommends a sample size of 276 subjects using an effect size of .30, power of .70, 2-tailed test, and alpha of .05.

There were no statistically significant differences between rural and urban counselors on caseload size ([M.sub.r] = 116, [M.sub.u] = 112), years as a counselor ([M.sub.r] = 11.6, [M.sub.u] = 10.5), education levels, or access to telephones, FAX machines, text telephones, and speaker phones.

Strengths and Problems

Table 2 contains survey items and their strength and problem percentages for both rural and urban counselors. In the table, items are ranked using rural problem percentages from the greatest to the least perceived problem.

Table 2 Rural and Urban Counselor Strength and Problem Scores According to Rural Problem Percentages

                                               Rural

                                       Strength      Problem
                                       % (Rank)      % (Rank)

Public transportation is accessible     22 (34)      68(**) (1)
and responsive to consumers.

Consumers have transportation.          37 (31)      59(**) (2)

Consumers have adequate financial       33 (33)      56(**) (3)
resources to live on until they
find a job.

There are sufficient employment         41 (28)      53(**) (4)
opportunities to meet VR goals
where you work.

There are adequate job                  38 (30)      53(**) (5)
opportunities in your community so
people don't have to move.

The local economy creates and           40 (29)      51(**) (6)
supports jobs appropriate for your
consumers.

Locally there are a variety of          43 (27)      48(**) (7)
employment options.

Local employers hire people with        47 (23)      47(**) (8)
disabilities.

There are an adequate number of job     35 (32)      47(**) (8)
coaches in your area.

You have a reasonable amount of         48 (22)      46(**) (9)
time to serve consumers.

Work evaluation is available            43 (27)      43(**) (10)
without traveling great distances.

Job service, coaches, and placement     48 (22)      43(**) (10)
specialists are available in your
area.

You can establish and maintain          44 (26)      42(**) (11)
relationships that help you work in
local communities.

You have time to provide counseling     45 (25)      42(**) (11)
that helps consumers adjust to
disability.

Your consumers have access to an        40 (29)      42(**) (11)
independent living center.

Local employers of [is less than]       46 (24)      41(**) (12)
15 people make job accommodations
for people with disabilities.

Counselor performance criteria          46 (24)      41(**) (12)
consider relevant job circumstances.

Consumer on-the job training options    46 (24)      41(**) (12)
are adequate.

Your consumers have access to           54 (18)      38(**) (13)
effective training.

Your office has enough staff and        56 (16)      38(**) (13)
other resources.

You can provide adequate student        52 (19)      37 (14)
transitions services.

You can rely on consumer, family,       50 (21)      37 (14)
and community resources.

You can adequately serve people         57 (15)      36 (15)
with severe disabilities.

Available education/training            52 (19)      35 (16)
prepares consumers for
locally-available jobs.

You can maintain contact with           51 (20)      35 (16)
isolated consumers.

Supported employment is available       52 (19)      35 (16)
for your consumers.

Consumers understand they are           52 (19)      35 (16)
responsible for finding and keeping
their own job.

Available educational training is       56 (16)      34 (17)
adequate.

Assessment options are adequate.        59 (13)      32 (18)

Your consumers have adequate            55 (17)      31 (19)
access to assistive technology.

You have time to develop an initial     61(*) (11)   31 (19)
rapport with your consumers.

Your VR office and local mental         60(*) (12)   30 (20)
health providers cooperate.

Looking for 3rd party funding does      56 (16)      29 (21)
not delay services.

Human service agencies in your area     62(*) (10)   29 (21)
work well together.

You have sufficient access to to        59 (13)      28 (22)
interdisciplinary professionals for
evaluations.

You have adequate training and          60(*) (12)   27 (23)
information about the social
aspects of disabilities.

You have enough opportunities to be     58  (14)     27 (23)
a VR presence within your community.

You have adequate training and          65(*) (7)    27 (23)
information about the medical
aspects of disabilities.

The primary outcome of                  64(*) (8)    27 (23)
rehabilitation services is job
placement.

You have access to health care          63(*) (9)    26 (24)
providers knowledgeable about
disabilities.

You can adequately serve minority       59 (13)      26 (24)
individuals.

The primary goal of rehabilitation      56 (16)      26 (24)
is independence.

You have received adequate training     62(*) (10)   26 (24)
on the ADA.

Your consumers can pursue               52 (19)      26 (24)
self-employment.

You have adequate training and          66(*) (6)    25 (25)
information about the psychological
aspects of disabilities.

You have the same opportunity as        69(*) (4)    24 (26)
others to access professional
development/training.

You have adequate opportunities to      62(*) (10)   23 (27)
develop professional networks and
relationships.

You consider community factors in       64(*) (8)    23 (27)
your practice of VR.

In your job you advocate for people     67(*) (5)    23 (27)
with disabilities.

You must be a generalist.               71(*) (2)    22 (28)

You can access advice on ADA.           70(*) (3)    19 (29)

You can make decisions about            74(*) (1)    18 (30)
consumer services.

                                                Urban

                                        Strength     Problem
                                        % (Rank)     % (Rank)

Public transportation is accessible     42 (25)      55(**) (1)
and responsive to consumers.

Consumers have transportation.          50 (19)      47(**) (3)

Consumers have adequate financial       38 (26)      54(**) (2)
resources to live on until they
find a job.

There are sufficient employment         52 (17)      44(**) (5)
opportunities to meet VR goals
where you work.

There are adequate job                  59 (12)      34 (13)
opportunities in your community so
people don't have to move.

The local economy creates and           47 (22)      47(**) (3)
supports jobs appropriate for your
consumers.

Locally there are a variety of          58 (13)      36 (12
employment options.

Local employers hire people with        54 (16)      43(**) (6)
disabilities.

There are an adequate number of job     49 (20)      39 (9)
coaches in your area.

You have a reasonable amount of         51 (18)      46(**) (4)
time to serve consumers.

Work evaluation is available            64(*) (7)    27 (19)
without traveling great distances.

Job service, coaches, and placement     56 (14)      39 (9)
specialists are available in your
area.

You can establish and maintain          37 (27)      46(**) (4)
relationships that help you work in
local communities.

You have time to provide counseling     46 (23)      42(**) (6)
that helps consumers adjust to
disability.

Your consumers have access to an        56 (13)      26 (20)
independent living center.

Local employers of [is less than]       46 (23)      40(**) (8)
15 people make job accommodations
for people with disabilities.

Counselor performance criteria          47 (3)       42(**) (25)
consider relevant job circumstances.

Consumer on-the job training options    49 (20)      41(**) (7)
are adequate.

Your consumers have access to           66(*) (5)    28 (18)
effective training.

Your office has enough staff and        56 (14)      41(**) (7)
other resources.

You can provide adequate student        55 (15)      30 (16)
transitions services.

You can rely on consumer, family,       54 (16)      38 (10)
and community resources.

You can adequately serve people         63(*) (8)    32 (14)
with severe disabilities.

Available education/training            62(*) (9)    29 (17)
prepares consumers for
locally-available jobs.

You can maintain contact with           45 (24)      37 (11)
isolated consumers.

Supported employment is available       58 (13)      30 (16)
for your consumers.

Consumers understand they are           48 (21)      43(**) (6)
responsible for finding and keeping
their own job.

Available educational training is       68(*) (4)    24 (22)
adequate.

Assessment options are adequate.        72(*) (2)    22 (24)

Your consumers have adequate            62(*) (9)    25 (21)

access to assistive technology.

You have time to develop an initial     65(*) (6)    29 (17)
rapport with your consumers.

Your VR office and local mental         56 (14)      37 (11)
health providers cooperate.

Looking for 3rd party funding does      54 (16)      31 (15)
not delay services.

Human service agencies in your area     52 (17)      40(**) (8)
work well together.

You have sufficient access to to        68(*) (4)    19 (27)
interdisciplinary professionals for
evaluations.

You have adequate training and          62(*) (9)    28 (18)
information about the social
aspects of disabilities.

You have enough opportunities to be     52 (17)      32 (14)
a VR presence within your community.

You have adequate training and          66(*) (5)    25 (21)
information about the medical
aspects of disabilities.

The primary outcome of                  61(*) (10)   32 (14)
rehabilitation services is job
placement.

You have access to health care          68(*) (4)    24 (22)
providers knowledgeable about
disabilities.

You can adequately serve minority       63(*) (8)    28 (18)
individuals.

The primary goal of rehabilitation      60(*) (11)   28 (18)
is independence.

You have received adequate training     59 (12)      29 (17)
on the ADA.

Your consumers can pursue               47 (22)      25 (21)
self-employment.

You have adequate training and          69(*) (3)    23 (23)
information about the psychological
aspects of disabilities.

You have the same opportunity as        73(*) (1)    20 (26)
others to access professional
development/training.

You have adequate opportunities to      58 (13)      28 (18)
develop professional networks and
relationships.

You consider community factors in       63(*) (8)    24 (22)
your practice of VR.

In your job you advocate for people     72(*) (2)    20 (26)
with disabilities.

You must be a generalist.               69(*) (3)    22 (24)

You can access advice on ADA.           65(*) (6)    24 (22)

You can make decisions about            73(*) (1)    21 (25)
consumer services.

(*) Strength (**) Problem

Strengths. An item was considered a strength if it had a strength percentage of 60% or greater. Rural counselors reported 16 items as strengths (31% of all items) while urban counselors reported 22 items as strengths (42% of all items). The two groups reported 12 strengths in common. There were 8 items with significant differences. None of the significant items were common to both groups.

Table 3 lists the strength items with significant differences. Of the 8 items, 1 was a strength for rural counselors, 7 were strengths for urban counselors.

Table 3
Strength Items t-test

Item                            n     M    SD    d(a)      t

Significant Rural Strength

Local human service agencies
work well together
  Rural                        215   62%   .25   .89    3.12(**)
  Urban                        107   52%   .28

Significant Urban Strength

Assessment options are
available and adequate
  Rural                        213   59%   .26   .54    4.43(**)
  Urban                        107   72%   .22

There is sufficient access
to interdisciplinary
professionals
  Rural                        214   59%   .26   .34    3.02(**)
  Urban                        107   68%   .27

Available educational
training options are
adequate
  Rural                        215   56%   .26   .46    4.13(**)
  Urban                        107   68%   .26

Consumers have access to
effective training programs
  Rural                        214   54%   .26   .46    3.92(**)
  Urban                        107   66%   .26

Consumers have access to
work evaluation services
at a reasonable distance
  Rural                        212   43%   .27   .83    6.36(**)
  Urban                        107   64%   .28

Consumers have access to
assistive technology
  Rural                        213   55%   .27   .60     2.08(*)
  Urban                        106   62%   .26

Available education or
training prepares consumers
for locally-available jobs
  Rural                        213   52%   .23   .95    3.72(**)
  Urban                        106   62%   .24

(a)Effect size. (*)p [is less than] .05 (**)p [is less than] .01

Problems. An item was considered a problem if it had a problem percentage of 40% or greater. Rural counselors reported 18 issues as problems (35% of all items) while urban counselors reported 14 items as problems (27% of all items). The two groups reported 12 problems in common. There were 10 items with significant differences. Three of the significant items were common to both groups.

Table 4 lists the problem items with significant differences. Of the 10 items, 8 were problems for rural counselors, 2 were problems for urban counselors.

Table 4
Problem Items t-tests

Item                         n     M     SD    d(a)   t

Significant Rural Problems

Public transportation is not accessible or responsive
Rural                        214   68%   .27   .49    4.26(**)
Urban                        107   55%   .27

Consumers do not have transportation to get to work or training
Rural                        215   68%   .27   .49    4.26(**)
Urban                        106   55%   .27

There are insufficient local employment
opportunities to meet VR goals
Rural                        213   53%   .23   .38    3.32(**)
Urban                        107   44%   .25

Consumers have to move because of
inadequate local job opportunities
Rural                        214   52%   .25   .71    6.3(**)
Urban                        107   34%   .26

Local area lacks a variety of employment options
Rural                        213   48%   .27   .50    3.76(**)
Urban                        106   37%   .27

There are an inadequate number of job coaches in the local area
Rural                        214   47%   .29   .29    2.47(*)
Urban                        106   39%   .27

Consumers do not have access to work
evaluation at a reasonable distance
Rural                        212   43%   .27   1.0    5.08(**)
Urban                        107   27%   .24

Consumers do not have access to an
independent living center's services
Rural                        213   42%   .29   1.0    4.76(**)
Urban                        106   26%   .25

Significant Urban Problems

Consumers understand they are responsible
for finding and keeping their job
Rural                        215   35%   .21   .35    3.09(**)
Urban                        106   43%   .25

Local human service agencies do not work well together
Rural                        215   29%   .22   .47    3.96(**)
Urban                        107   40%   .26

(a) Effect size.

(*) p < .05

(**) p < .01

Discussion

The results of this study indicate that rural and urban VR counselors encounter both positive and negative experiences and that there are differences in the experiences of the two groups. When a strength was common, there was no difference between the two groups. However, urban counselors reported more strengths, including greater access to assessment and evaluation services, interdisciplinary professionals, educational and training programs, and assistive technology. In contrast, rural counselors indicated only one positive aspect of their work that surpassed their urban counterparts: that local human service programs worked well together.

Most of the strengths common to both groups are in areas VR controls such as providing counselors with sufficient authority, training on ADA, training on the psychological and medical aspects of disability, opportunities to access professional development, and the opportunity to advocate for people with disabilities. This is positive news for state VR agencies because it indicates that in areas the agencies control they provide both rural and urban counselors with consistent training, information, responsibility, and professional development opportunities.

The following were problematic for both groups: inadequate employment opportunities, an area's economy, inadequate transportation, and the inadequacy of consumers' finances. In general, if something was a problem for both groups, it most often was more of a problem for the rural counselors. For example, rural counselors reported they experience more difficulty with public transportation, locally-available jobs and work evaluation services, the number of job coaches, and access to an independent living center. Rural counselors also reported problems with the lack of on-the-job training options.

When these problems are contrasted with those that are greater for urban counselors - consumers do not understand they are responsible for finding and keeping their own job and that human service agencies in their service area do not work well together - it appears rural counselors work in situations that are less conducive to achieving VR goals.

Demographically rural and urban counselors served the same size caseload, had the same education level, and had been counselors for the same length of time. Therefore the differences between the two groups cannot be attributed to one group having more experience than the other.

These results are based on counselor perceptions. VR administrators, field services directors, or consumers may have different perceptions. Although counselor perceptions are the basis of analyses, perceptions are important because they are a direct measure of reality for the counselor.

Conclusion

This research was conducted to identify major issues and indicate priorities for developing solutions. Clearly, rural VR counselors and consumers experience greater problems with the economy, employment, and transportation. These should become priorities for future rural research and demonstration projects. For example one line of exploration might focus on VR's role in community economic development efforts to increase employment opportunities through job creation. Another might focus on developing transportation solutions or on conducting demonstration projects that explore the use of self-employment as a means of creating job opportunities in areas with few employment opportunities.

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Authors' Notes

Nancy L. Arnold is a research associate, and Tom Seekins is the director, both at the Research and Training Center on Rural Rehabilitation Services, Rural Institute on Disabilities, The University of Montana, Missoula.

This work was supported by a grant from the National Institute on Disability and Rehabilitation Research (NIDRR: #H133B2002-96) and is part of a larger effort supported by NIDRR to develop effective strategies for providing rehabilitation services in rural areas. The opinions expressed are those of the authors and do not reflect the position of the agency.

The authors thank Mark Cumming and John Collins, both of the Montana Vocational Rehabilitation Services Division. Mr. Cumming's expertise was instrumental in developing the survey instrument.

Nancy L. Arnold, Research and Training Center on Rural Rehabilitation Services, Rural Institute on Disabilities, University of Montana, Missoula, MT 59812