Service, resource and training needs of American Indian vocational rehabilitation projects.

Service, Resource and Training Needs of American Indian Vocational Rehabilitation Projects

This study was conducted to identify the training and technical assistance needs of 17 American Indian vocational rehabilitation projects. Two survey instruments were developed to assess what types and levels of training would be needed to enhance staff development and promote successful rehabilitation of American Indians with disabilities. One survey was developed for project director/coordinator response and the other was developed for support staff response. Geographic locations, tribal representation and cultural demographics were greatly considered since varied rehabilitation services are offered by each project. Obtaining data from each project gives an all-inclusive view of the service, resource and training needs of the projects.

The United States grants federal recognition to 309 American Indian tribes and 197 tribal villages in Alaska (Federal Register, 1986). The 1980 U.S. Bureau of Census reported a population of 1.4 million American Indians. This compares with a population of 827,268 in 1970, and 551,669 in 1960. The American Indian population has nearly tripled in the 20 years from 1960 to 1980 (U.S. Congress, Office of Technology Assessment, 1986). A recent BIA report (1989), titled Indian Service Population and Labor Force Estimates, lists the on or near reservation population at 949,075. The 1989 BIA report does not include the tribal members who are located in communities or urban areas outside reservations.

American Indians With Disabilities

American Indians, as a group, have disabling conditions at a disproportionately high rate. The 1980 U.S. Census data indicates a rate of work-related disability for American Indians at about one and one-half times that of the general population and at a higher rate than any other minority group (U.S. Bureau of Census, 1983). An analysis of national Rehabilitation Services Administration (RSA) data shows that the rate at which the state-federal rehabilitation system provided services to American Indians was substantially lower than for the U.S. population as a whole (Morgan & O'Connell, 1985).

Efforts to Improve Vocational Rehabilitation Services

In recent years, there have been concerted strategies by RSA to establish and improve vocational rehabilitation services to American Indians living on or near reservations. The 1986 reauthorization of the Rehabilitation Act authorized the continued funding of vocational rehabilitation service grants to the "governing bodies of Indian tribes located on Federal and State reservations (and consortia of such governing bodies) to pay 90 percent of the costs of vocational rehabilitation services for handicapped American Indians residing on such reservations." (Sec. 130 (a)).

White (1987) previously reported mixed reactions by state VR administrators toward improving/expanding VR services to American Indians with disabilities. One-fourth of the respondents saw the special project funding as an opportunity to improve VR services to American Indians. The remaining three-fourths were not supportive of the separate funding and were reserving judgment until interpretations of the state VR role and responsibility were clarified.

Less than one-fifth of those surveyed responded that improving VR services for American Indians was a high priority. Sixty-six percent of the administrators reported that the best strategy for improving services was to build VR services for Indians within existing state structures. This compares to 9 percent who responded that the best strategy was to help tribes secure funding for creating tribally-administered programs. Sixty-one percent of the state VR administrators reported that they did not have any existing policies/initiatives specifically targeted to meeting the needs of the Indians.

Two state VR agencies that have initiated unique services to American Indians are Arizona and New Mexico. The Arizona Rehabilitative Services Administration has been involved in the development of service delivery systems to American Indians since 1963 through an RSA-funded Research and Demonstration Project which was located on the campus of Arizona State College (presently Northern Arizona University) (Powers, 1989). As a result, through state and district assistance, the Navajo Vocational Rehabilitation Program was established to serve Navajo people with disabilities and has been in existence since 1975.

In 1986, a study was funded by the New Mexico Division of Vocational

Rehabilitation (NMDVR) and conducted by the All Indian Pueblo Council in collaboration with the Native American Research and Training Center of Northern Arizona University to identify innovative strategies to improve delivery of services to American Indians residing in the 18 pueblos of New Mexico (Martin & O'Connell, 1986). Since completion of the study, NMDVR administrators have initiated unique strategies which included the hiring of a Native American Coordinator to work closely with Pueblo tribal leadership through local bilingual rehabilitation technicians to provide peer counseling services.

With the passage of legislation to improve service delivery to American Indians with disabilities, new American Indian vocational rehabilitation projects (Section 130) have been developed. Many professionals and paraprofessionals are first-time employees in the field of rehabilitation. Various diciplines have joined forces to manage these innovative programs. The wide range of reported work experience and educational background of project staff members demonstrates the need for training and technical assistance.

A survey of the three American Indian Vocational Rehabilitation Projects which existed in 1987 showed staff development and inservice training as important priorities and essential to providing services comparable to state VR agencies (White, 1987). To address these essential priorities, this study was proposed and conducted to survey the current and future training and technical assistance needs of the newly funded Section 130 projects (N = 14). Data sensitive to tribal characteristics and demographics needed to be gathered collectively to obtain an overall impression of programmatic needs and to assess the current rehabilitation service delivery efforts of the American Indian Vocational Rehabilitation projects.

Method

Obtaining data focusing on current activities and prevalent training and technical assistance needs provides a comprehensive view of what rehabilitation services exist for American Indians who are disabled. Two survey instruments were developed for this study. One survey instrument, Project Profile, was developed for project director responses and another survey, Project Staff Profile, was developed for support staff responses to identify what type of training and technical assistance would be needed to implement the project objectives of the American Indian VR Projects. Both closed and open-ended formats were used as response choices. A modified Likert scale with five response choices from "essential" to "not important" was used for the training and technical assistance needs section of the survey.

A research project committee was formed to review, critique, add, delete, and recommend changes to the survey drafts prior to conducting the pilot survey. Upon approval of the drafted survey forms, copies of the surveys were mailed to the three veteran projects to pilot the study. Followup on the pilot responses caused delays in meeting timeliness and required numerous phone calls which ultimately resulted in an 85 percent return rate.

A different approach was initiated for the remaining 14 projects. Appointments were scheduled to conduct telephone interviews to gather data. Each project received the appropriate number of survey forms for each staff person to complete prior to the telephone interviews. This method resulted in a 100 percent response rate from all project personnel.

The responses of project directors and staff were analyzed separately by total responses, responses by federal regions and responses by length of each project's existence. Data was entered in the Macintosh SE StatView Graphics program for statistical analyses. There were 161 variables analyzed for the Project Profile and 74 variables for the Project Staff Profile. Each variable was analyzed using frequency distributions based upon the total responses in the two samples. Information recorded was as complete as possible; however, some items were not answered because specific information was not available or questions were not pertinent to certain projects.

Results

Seventeen projects including the pilots were reported. Region IV had one project in Mississippi. Region VI had one project in Oklahoma and one project in New Mexico. Region VIII had eight projects in four states: Colorado, one; Montana, five; South Dakota, one; and Wyoming, one. Region IX had two projects in Arizona. Region X had four projects in three states; Idaho, one; Washington, one; and Alaska, two.

Characteristics of Project Directors

A total of 19 responses were received from project directors/coordinators. In the pilot phase of the survey, respondents consisted of three rehabilitation counselors who manage field offices in the Navajo Vocational Rehabilitation Program, the director of the Fort Hall Vocational Rehabilitation Program and the director of the Rocky Boy Vocational Rehabilitation Project. The remaining 14 project directors represented the other American Indian VR projects.

Sixty-three percent (12) of the project directors were female and 37 percent (7) were male. Sixty-three percent (12) were of American Indian descent (including one Alaska Native), 32 percent (6) were Caucasian and 5 percent (1) Hispanic.

Forty-two percent (8) had master's degrees, 42 percent (8) had bachelor's degrees and 16 percent (3) reported having high school diplomas. Four of the project directors had master's degrees in rehabilitation, three had master's degrees in education and one had a master's degree in business administration. Five project directors had bachelor's degrees in the social sciences and three had bachelor's degrees in education. Past employment information given by project directors cited job titles within the following disciplines: education (six); counseling (five); social services (two); administration (two); and no response (four).

Characteristics of Project Staff

Forty-five project staff were surveyed. Twenty-seven percent (12) were pilot respondents. The remaining 33 staff respondents represented the other ongoing projects except 2 projects that did not have any support staff. Seventy-six percent (34) were female and 24 percent (11) were male. Eighty-seven percent (39) were of American Indian descent (including one Alaska Native), 9 percent (4) were Caucasian and 4 percent (2) were Hispanic.

Sixteen percent (7) reported having master's degrees, 20 percent (9) bachelor's degrees, 16 percent (7) Associate degrees, and 44 percent (20) high school diplomas. Four percent (two) did not respond. Project staff with master's degrees were in the following fields: vocational rehabilitation (one), counseling psychology (one), criminal justice administration (one), regional planning (one), agricultural education (one), and two did not specify. Project staff with bachelor's degrees were in the following fields: social sciences (two), psychology (one), business administration (one), geography (one), history (one), and three did not specify degrees. Staff members with associate degrees were in the fields of: secretarial sciences (two), human services (two), and three did not specify degree majors. Twenty of the remaining staff had high school diplomas and two chose not to respond.

Most of the work experience reported by project staff were in the disciplines of clerical (11), education (5), social services (3), medical services (3), employment training (3), administration (3), research (2), industrial (2), and the remaining 13 did not respond.

Tribal Affiliations

Project directors were asked to identify which American Indian tribes were being served by their projects. Thirty-nine different tribes and four villages of Alaska Natives were reported as being served. The federal regions represented by American Indian VR projects serving different tribes were Region IV (1), Region VI (6), Region VIII (23), Region IX (3), Region X (6), and 4 Alaska Native villages. These figures indicate that rehabilitation services were reaching 13 percent of the 309 federally-recognized American Indian tribes and 2 percent of the 197 tribal villages of Alaska. These two percentage figures represent the total number of tribes reported as being served by the Section 130 projects in relation to the number of tribes that are federally recognized.

The populations served by each project differed in size, tribal representation and location. Population statistics from the 1989 BIA Report were used to demonstrate the diversity among the projects surveyed. The data collected is based on enrollment living on or adjacent to reservations. According to the 1989 BIA Report, the total American Indian population representing the 11 states of the federal regions surveyed for this study is 778,725. The total American Indian population categorized as unable to work within the confines of the 11 states with Section 130 projects is 80,989. The population of American Indians categorized as unable to work includes those who must care for children, retired people and people with disabilities. According to the 1980 U.S. Census data, 12.7 percent of American Indians of working age (16-65) were work disabled. This would mean that within the 11 states where American Indian VR projects exist, an estimated American Indian population total of 10,286 would be work disabled. The estimated figure of 10,286 does not include the remaining states that do not have American Indian VR projects.

Employment Opportunities

Factors attributing to the lack of employment opportunities on and near reservations has been established through prior studies. American Indians with disabilities who reside on federal Indian reservations and trust lands are located in remote and rural areas which limit access to rehabilitation services. The response of project directors surveyed for this study reiterate the lack of employment prospects.

Project directors were asked what employment opportunities exist on or near reservations. The Standard Industrial Classification (SIC) was utilized to categorize survey responses. Two of the 10 major industrial classifications providing the most employment on the reservations were public administration and services. The three main providers of employment within public administration were tribal government, Bureau of Indian Affairs and Indian Health Services. The main provider within the services category was education.

Three of the major industrial divisions providing employment off the reservation were agriculture, manufacturing and mining. The response totals indicated low levels of employment opportunities on and near reservations.

Reported Referral Sources

Knowing community resources is important for establishing contacts and identifying agencies, organizations and professionals who can provide needed services and/or refer potential clients. Nineteen types of community resources were listed on the survey form for project directors to report how many clients were referred by other agencies. The list was not exhaustive of possible or existing contacts. Five hundred seventy-four referral contacts were reported for 1987 and 846 were reported for 1988. The combined sums total 1,420 referral contacts for the 2-year period.

Indian Health Services, Social Security, self, and other provided the most referrals during 1987. In 1988, referral contacts increased. Seventy-six percent (643) of the referrals reported were from Social Security, Indian Health Services, tribal organizations, Social Welfare, self, and other.

When referral results were analyzed in terms of project duration, definite differences occurred. Project duration is represented by + 3 years (in existence for 3 years or more), + 1 year (in existence for 1 year or more) and - 1 year (in existence for less than 1 year). The + 3 year projects (5 projects) showed a decrease from 362 referral contacts reported for 1987 down to 230 in 1988. The + 1 year projects (10) reported 212 contacts for 1987, and showed a substantial increase to 567 contacts for 1988. The beginning - 1 year projects (4) reported zero contacts for 1987 but reported 49 contacts for 1988.

Disabilities Served

Fourteen examples of different disabilities were listed on the survey form with the opportunity to specify "other" disabling conditions served. The number of disabilities that were served during 1987 and 1988 totaled 1,035.

The disabling conditions most reported by project directors in rank order were: alcoholism (272), "other" disabilities (187), orthopedic/musculoskeletal (113), mentally retarded (96), learning disabled (84), spinal cord injury (43), mental illness/psychological (42), and arthritis (41).

Twenty-two different disabilities with low totals were reported as "Other Disabilities (Specified)." Of the 187 clients listed, the 7 most reported disabilities (with 3 or more references) were heart conditions, renal conditions, cancer, respiratory related, speech disorders, diabetes, and back injuries.

Services Rendered

Twelve types of rehabilitative services were listed on the survey form for directors to report the number of clients receiving specific services provided by the Section 130 projects. Combinations of services may be required to meet each person's needs. The services rendered data included individual totals of each type of service provided per client but not combined totals of services provided per client. Services rendered for the benefit of clients totalled 2,243. Fifty-eight percent (1,312) of the most provided types of services were personal counseling (451), vocational counseling (371), vocational evaluations (267), and psychological testing (223). Work adjustment training, job placement and independent living skills followed closely with totals a little less than 200.

Six projects reported that 85 clients received "other" services. The other services rendered were resource management (31), training (22), transportation (18), on-the-job training (6), education (2), physical capacity evaluation (1), and not specified (5).

Nine hundred eighty-four clients were served in 1987 and 1988. In 1987, 341 American Indian clients were reported as having been served by 9 of the Section 130 projects. In 1988, 643 clients were reported as having been served by 16 projects. This total is 436 less than the total number of referral contacts reported.

Thirteen project directors collectively provided the following reasons for unsuccessful closures: failure to cooperate (seven), ineligible (five), moved (four), and dropped out and/or loss of contact (four). Closure totals were not reported. The mean percentage for clients not willing to relocate was also calculated at 60 percent with a standard deviation of 32.985.

Training and Technical Assistance

Twenty-four different components of rehabilitation services were listed on the survey instruments to ascertain the scope of training and technical assistance needs of project staff. The data provides determinants of resources which will aid in raising levels of staff competence in rehabilitation.

Respondents were given the to rate each item listed by prioritizing what they perceived would meet their programmatic needs. A rating scale of 1 to 5 was used (1 representing the greatest need). The response levels were: 1 = essential, 2 = very important, 3 = important, 4 = less important, and 5 = not important. Response totals varied in both groups. Some items were not ranked by all respondents.

The results were analyzed according to total group response of both administrative and support staff, by federal region and by the length of existence of projects (+ 3 years, + 1 year and - 1 year). The factors rated as "essential" and "very important" were combined to produce the rank order of the surveyed training and technical assistance needs. As a result of this rating analysis, 81 percent (18) of the project directors rated Individualized Written Rehabilitation Plan as the top training need and 80 percent (8) rated job placement as the top technical assistance need. Project staff rated medical aspect of disabilities as the top training need at 79 percent (26) and confidentiality as the top technical assistance need at 85 percent (23).

Discussion and Recommendations

Review of the study results gives a confirmed indication of the need for rehabilitation services training and technical assistance from several levels and perspectives. Cooperative efforts among state VR, federal RSA and tribal agencies are essential to address the needs resulting from the data presented. Although increased efforts have been mandated, the need to coordinate efforts among state, federal, local, and tribal agencies remains.

Administrators of the American Indian vocational rehabilitation projects may be considering expanding on the types of services presently offered. An overall assessment of prevalent disabilities and rehabilitative service needs would determine what services should be considered to meet the needs of the targeted population to be served.

The results of this study gives an over-view of what rehabilitation services the American Indian vocational rehabilitation projects presently address and what would enhance program development and professional growth. Considering the federal, regional, state, and tribal entities involved in providing programmatic support to American Indians, the scope of recommendations encompasses all groups involved. The following recommendations encourage cooperative efforts for all concerned with addressing rehabilitation of people with disabilities.

Recommendations:

* Involve American Indian Vocational Rehabilitation staff, tribal officials and community/tribal members in the capacity of advocacy and advisory roles. This could be accomplished by apprising tribal officials of existing needs and by seeking their involvement and support through resolutions and personal commitment. In addition, tribal parents and members of health and education committees can lend support through participation and personal commitment. A current assessment of present state VR initiatives and cooperative agreements with tribal groups is needed. This type of information will help identify successful approaches to establish working relationships and interagency linkages to address the needs of American Indians with disabilities.

* American Indians vocational rehabilitation projects should collaborate with state VR agencies, Regional Rehabiliation Continuing Education Programs, university rehabilitation programs, and Rehabilitation Research and Training Centers to address the identified training and technical assistance survey results. Educational and training materials which have been developed by many state and federal VR agencies, university programs, material development centers, and research and training centers are available for dissemination. Section 130 projects could contact these agencies to be included on mailing lists to receive bulletins, media material and information of upcoming training.

* State VR agencies should create statewide American Indian liaison positions to network rehabilitation efforts that may have been hampered in the past. Positions could also be created for rehabilitation counselors in Indian Health Services facilities on American Indian reservations to work closely with state VR agencies, physicians, physical therapists, occupational therapists, and other service providing agency personnel.

* Increased efforts should be undertaken to involve state VR agency personnel in heightening their understanding about social, linguistic and cultural differences that exist between tribes. Not only does one have individual needs related to one's disability, but his/her language, customs and cultural values vary in many ways from that of other tribes within the same geographical regions. One cannot generalize that all tribes are the same.

* Steps should be taken to develop relationships between American Indian vocational rehabilitation projects and prospective employers. Local labor market surveys can be conducted to determine what type of employment possibilities exist. Project staff can initiate contact with fraternal organizations, public service groups, personnel management, and business associations to promote job placement and job development for American Indians with disabilities. Project staff can contact small, medium-sized and big businesses to introduce the prospect of creating or restructuring jobs and explain the advantages of hiring disabled workers.

* Tribal officials and tribal employees need to familiarize themselves with the prevalent types of disabilities that exist among their people and learn about the VR process by establishing working relationships with state and regional VR agencies. Studies should be conducted to assess what disabilities exist among different tribes and what the tribal attitudes are toward disabilities. Attitudes, morals and values vary among different tribal groups. Attitudinal studies would help determine what type of services would best meet the needs of the disabled population among the different tribal groups with Section 130 projects. Needs assessments and surveys should also be conducted to obtain a more accurate account of American Indians with disabilities on and near the reservations. This information would justify the need for expanding or improving rehabilitation service delivery efforts.

* Careful consideration should be given to commitment by American Indian vocational rehabilitation staff in view of continuation and longevity of programs. Section 130 staff should be willing to make a commitment toward achieving stability and development of the project. Turnover of staff only hinders and delays progress and success.

Ms. Lonetree is Research Assistant, American Indian Rehabilitation Research and Training Center, Institute of Human Development, Northern Arizona University, Flagstaff, Arizona.