Vocational rehabilitation in rural America: challenges and opportunities.

This article examines issues vocational rehabilitation service delivery to people with disabilities who live in rural communities. Topics are reviewed in terms of the unique challenges and opportunities encountered by rural rehabilitation counselors nd their clientele. Also discussed are implications for current and future VR service delivery to rural areas.

A substantial portion of the United States population resides in nonmetropolitan communities. Current statistics show that 56 million Americans, roughly one-quarter of this nation's population, live in areas of the country identified as rural. Of this total, there are an estimated 15 million people with disabilities (William T. Grant Foundation, 1988). Demographic projections have also shown that disability rates are proportionately higher in rural areas than in metropolitan regions (Leland & Schneider, 1982). Due to these, and related factors, it is imperative that vocational rehabilitation professionals develop an understanding and awareness of rehabilitation practices designed for people with disabilities in rural areas.

Rural Americans tend to experience other problems that accentuate the need for appropriate vocational rehabilitation services. For instance, people living in rural areas tend to be more economically, educationally, and vocationally disadvantaged than their urban counterparts (Lam, Chan, Parker, & Carter, 1987). Americans in rural areas have the country's highest rates of poverty with over 14 million people living at or below the poverty line. A report by the William T. Grant Foundation (1988) declared that "poverty anywhere is often accompanied by illiteracy, unemployment, underemployment, inadequate health care, high rates of early and unplanned pregnancies and infant mortality, and substandard housing and education".

People living in rural areas must also contend with limited community resources and fewer educational and employment opportunities (Lam et al., 1987; Lowrey, 1980). As a result, people in rural communities tend to have lower levels of educational attainment, personal and professional goals, and earnings in relation to people in urban settings (White, 1990).

Despite the myriad of problems experienced by the rural population, there is only minimal understanding and limited empirical research available on the problems and conditions that surround the vocational rehabilitation needs of people in rural and sparsely populated areas or on the effectiveness of rehabilitation programs and the differential service needs of rural clients (Lam et al., 1987).

Definition and Characteristics

There is no clear consensus regarding a definition of the term "rural" (Helge, 1984; Parrish & Lynch, 1990); however, the United States Office of Management and Budget (OMB) designation of standard metropolitan statistical areas (SMSA) is often cited to distinguish between urban and rural areas. A SMSA is a "single county area or group of contiguous counties that includes at least one |central city' of 50,000 inhabitants or in some instances contiguous twin cities that together meet this population minimum." Areas that fall outside of commuting distance to SMSA's are considered rural (U.S. Dept. of Commerce, 1983, p. xviii). The U.S. Census defines rural as "open country" or towns with fewer than 2,500 inhabitants (White, 1990).

Rural areas are poorly understood and largely forgotten. As such, there are a number of misperceptions held about rural America. For example, the term "rural" has traditionally been viewed as being synonymous with "farm." However, less than 3 percent of the entire rural population live and earn a wage on ranches or farms (Jansen, 1988). Another commonly held belief is that rural America is only a sparsely populated version of urban America and the implication that solutions to rural problems are smaller scale versions of urban solutions (William T. Grant Foundation, 1988). However, Stephens (1988) cautions that it is not useful or appropriate to view rural America as merely the opposite of urban America.

Just as urban and rural areas differ, all areas designated as rural are not the same. Contrary to the stereotypic views of rural Americans, they are a heterogeneous group with great diversity in culture, business and industry, occupations, economic wealth, life-styles, and physical geography (Helge, 1984; Parrish & Lynch, 1990; Murray & Keller, 1991). In fact, the diversity among rural areas is more pronounced today than at any time since World War II (Stephens, 1988). White (1990) painted a rather bleak description of rural America saying that "high unemployment rates, pervasive poverty, and an exodus of jobs and youth in many ways define rural communities in the late 1980's". Jansen (1988), on the other hand, suggested that low population density and small, closely knit communities that have always typified rural America remain active and vital.

Differences in Rural and Urban

Vocational Rehabilitation

Available research literature suggests that vocational rehabilitation efforts for rural-based clients differ significantly from urban-based approaches (Page, Bornhoeft, Barcome, & Knowlton, 1985). Differences are not necessarily in the types of counseling techniques or general procedures used by rehabilitation counselors, but rather in the types of client outcomes, services and alternatives available, and logistical concerns involved in providing appropriate vocational rehabilitation programs. Three significant differences between urban and rural-based rehabilitation are:

* Rural rehabilitation clients often face drastically reduced employment options due to the lack of business and industry and, hence, limited job availability in many rural areas (Clark, 1973; Jansen, 1988; Lowrey, 1980; Parrish & Lynch, 1990).

* Geographic distances between rural rehabilitation clients and required services are a problem not often encountered by people in metropolitan areas. This problem is compounded by a lack of other appropriate services (e.g., public transportation). When services are available, they are often provided by itinerant professionals; this results in fragmented and infrequent service (Page et al., 1985).

* Rural rehabilitation counselors must be generalists and have a working knowledge of a variety of diverse rehabilitation issues. In rural areas, vocational rehabilitation personnel must often be able to perform a variety of rehabilitation and placement duties, as opposed to the specialization that occurs in urbanized settings (e.g., work adjustment counselor, independent living skills specialist, placement personnel, etc.).

In addition to these major differences, several authors have questioned the relevance of traditional vocational rehabilitation practices for rural clients. Seekins, Ravesloot and Dingman (1989) viewed rehabilitation practices as having an urban orientation and suggested that they may not be relevant or acceptable in rural rehabilitation practice.

Fifteen years earlier, Bitter (1972) also described traditional rehabilitation approaches as being based on an urban service delivery model. In doing so, he too questioned the effectiveness of rehabilitation service delivery in rural America: Though the traditional approach has many merits including its sequential organization, individualization, and concrete goal-orientation, the state-federal rehabilitation program has generally operated on the premise that it is dependent upon the availability of rehabilitation facilities (i.e., traditional resources). This approach has worked best in urban areas where rehabilitation services are widely available. However, the traditional resource base in inadequate or nonexistent in rural areas.

To gain an increase understanding and appreciation for rural clientele and the unique rehabilitation needs of this population professionals must expand their examination of rural vocational rehabilitation efforts (Leland & Schneider, 1982). The remainder of this article will provide an overview of select problems and solutions in rural vocational rehabilitation.

Challenges Facing Rural habilitation 

Despite the limited data base available for rural rehabilitation practices, we do know that rural clients tend to have different programming needs than their urban counterparts (Lam et al., 1987). Service delivery settings and methods, the range of disabilities served, helping styles, consumer needs, goal orientation, and available support services and resources differ between urban and rural clients (Seekins et al., 1989).

Leland and Schneider (1982) summarized the state of the art: The delivery of human services in rural areas is often plagued by problems - lack of transportation, few qualified personnel, local attitudes toward outsiders, client and community attitudes toward obtaining assistance from "welfare" agencies.... In addition, rehabilitation service providers have a special set of problems - lack of employment opportunities for clients in rural communities, employer prejudices toward hiring disabled people, and direct resistance toward relocation for skill training and employment.

Earlier, several problems were identified that underscore the need for appropriate vocational rehabilitation services for rural Americans. These same problems create barriers to successful involvement in rehabilitation programs Several factors that have a significant impact on the delivery of vocational rehabilitation services in rural areas are examined.

Employment. Perhaps the biggest barrier to successful vocational rehabilitation in rural areas centers on the high rates of unemployment and limited job availability. Bitter (1972) believed that while "the employment objective is one of the real strengths of the public rehabilitation program in general, the widespread lack of rural job opportunities makes it a distinct service delivery problem in sparsely populated areas".

Unemployment rates among all rural residents, including rehabilitation clients, are high (Stephens, 1988). In addition, proportionately more rural workers lose their jobs and also experience longer periods of unemployment between jobs. When new employment is found, wages received by rural workers are likely to be far less than in their previous jobs (Podgursky, 1989). Lam et al. (1987) studied clients that had received rehabilitation services in rural Wisconsin. They found that 60 percent of those surveyed were unemployed and concluded that "one of the most significant problems rehabilitation counselors face in providing services to rural clients is the lack of employment opportunities in rural areas".

Rural employment has grown by only 4 percent since 1979 compared to a 13 percent employment growth rate for urban areas (William T. Grant Foundation, 1988). As a result, most rural areas offer very limited employment opportunities. These regions simply do not have a variety of business and industry to provide job training and future employment for people with disabilities (Leland & Schneider, 1982; Lowrey, 1980; Parrish & Lynch, 1990; Schwartz, 1987). Clark (1973) declared that "if there are no cooperative employers, no choices in available jobs, or even no jobs little can be achieved in vocational rehabilitation according to the traditional (urban) model".

Economics. Due to high unemployment rates and lack of investment in rural communities by business and industry, rural Americans are twice as likely to live in poverty and have the country's highest poverty rates (Kerwood & Starsen, 1988; White, 1990; William T. Grant Foundation, 1988). Even employment does not offer the promise of ending the poverty experienced by many rural citizens, because many of those who are employed tend to earn only slightly more than the minimum wage (Podgursky, 1989). The lack of economic vitality also results in a minimal tax base from which to support a variety of governmental programs and services. This causes a major problem, since rural services also cost more than similar ones in urban areas due to the high costs of transportation requirements and scarce professional resources (Helge, 1984).

Limited Community Services. Most rural areas offer few community services and may experience situations such as a lack of appropriate education (especially specialized services), poor or nonexistent public transportation systems, few social-welfare agencies, and severe shortages of adequate health care and other resources that are usually available in metropolitan areas (Fardig, Algozzine, Schwartz, Hensel, & Westling, 1985; Leland & Schneider, 1982; Lowrey, 1980). The result of limited service availability is that people requiring assistance must typically seek it outside of the rural area, often at great personal and financial sacrifice (Page et al., 1985).

Geographic Distance and Isolation. Professionals have argued that a significant barrier to the delivery of all forms of social services in rural settings is geography. Wide expanses of land tend to isolate professionals both geographically and socially. Problems with work-related professional communication and a general lack of access to diagnostic, informational, or instructional materials are often caused by geography. Vocational rehabilitation professionals may experience problems related to the amount of time consumed by travel, the timeliness of information they receive or provide to others, and meshing of schedules for service delivery or for system wide professional activities (Helge, 1984; Kirmer, Lockwood, Mickler, & Sweeney, 1984; Murray & Keller, 1991).

Bitter (1972) observed that geographic distances between rural clients and traditional rehabilitation resources complicated the job of rehabilitation counselors: rural clients are often sent many miles for diagnostic, adjustment, training, and medical services. This utilization of traditional resources by rural counselors generally necessitates relocation by a client to an unfamiliar environment. Though relocation for services can be a very successful approach, particularly when it is strongly related to client goals and motivation, it very often leads to many more adjustment problems for the client than it helps to resolve.

Other Barriers. There is a general lack of information (e.g., research, dissemination, staff development activities), on issues related to vocational rehabilitation practices in rural areas. And, even if exemplary service delivery models exist, limited dissemination presents barriers to replication efforts or improvement by others.

Finally, professionals must be mindful of the urban orientation of vocational rehabilitation (Leland & Schneider, 1982), especially in light of problems caused by the attitudes and cultural variations of people living in rural areas. As sense of mistrust or reluctance to seek assistance from those considered "outsiders" may be encountered. People in rural communities often feel a responsibility for helping their own, further reducing their willingness to seek assistance. Many times, rural citizens perceive postsecondary vocational or educational goals as impossible to achieve due to a fear of the unknown or a reluctance to venture outside the safety of their local community (Parrish & Lynch, 1990; Rojewski, 1990; William T. Grant Foundation, 1988). To be successful, rehabilitation professionals must be aware of and able to adequately address these cultural expectations and concerns.

Service Delivery Alternatives

for Rural Areas

Two distinct strategies have been undertaken to address the problems commonly encountered in rural rehabilitation. One approach merely expands traditional service delivery programming; another involves the development of innovative, nontraditional approaches to service delivery (Leland & Schneider, 1982). This section will briefly examine these different approaches to rural rehabilitation service delivery.

Traditional Service Delivery. The traditional approach to vocational rehabilitation emphasizes delivery of a planned sequence of services usually purchased from various rehabilitation providers. Studies have demonstrated that traditional approaches to rehabilitation service delivery can effectively serve rural clients, but only with a significant expansion of available resources (services) and modification of services that are delivered (Bitter, 1972; Lowrey, 1980). Leland and Schneider (1982) concluded: Almost all programs demonstrated that it is possible to extend rehabilitation services into rural areas and that there is a need for the services offered - counseling, medical, psychological evaluation, consulting, vocational training, and job placement. Traditional methods of service delivery can be effective if staff and funding are adequate.

A pressing concern for rural vocational rehabilitation professionals has been how to deal with the limited job availability encountered in sparsely populated areas. Due to geographic distance and the scarcity of appropriate services and resources in rural areas, one of the few viable alternatives is relocation to a more populous area to receive services and obtain employment. While this approach can be very successful, the costs can often be quite high for both the rehabilitation agency and client. In some circumstances, it can lead to more adjustment problems than it resolves (Bitter, 1972).

Not all rehabilitation clients will elect to leave their home for services and/or employment. Clark (1973) argued that the alternatives for those unwilling to relocate are not encouraging. She felt that it is "more a question of how to help clients successfully adapt to existing opportunities even though at times some of them may be working beneath their potentials or in vocations for which they are only minimally suited". An alternative to underemployment for those residents not willing to relocate may be through the development of entrepreneurial opportunities (White, 1990).

Interagency service coordination, spurred by the transition from school to work initiative, can also enhance and maximize service delivery options for people with disabilities living in rural areas (Jansen, 1988; Rojewski, 1990). First, vocational rehabilitation personnel are becoming actively involved with students prior to graduation from high school. This should allow for needed services to be delivered starting at an earlier age. Second, rural-based schools can provide a reference point for students, parents, and rehabilitation professionals, especially for those scattered across a large geographic area. Third, the use of multi-agency staffings (e.g., transition planning) can bring other service providers together for the benefit of the individual, thereby minimizing time, travel and problems with communications. As a result, plans can be developed that will take advantage of existing and more easily attainable community services and resources.

Nontraditional Vocational Rehabilitation Services. A variety of nontraditional approaches have been proposed to address the unique problems experienced by rural vocational rehabilitation professionals. One strategy has been the use of alternate staffing patterns (e.g., volunteers, aides, paraprofessionals, or outreach workers). Supplemental staff are generally used to enable counselors to be service oriented by reducing their involvement in subprofessional activity (Bitter, 1972). Specialized caseload assignments have also been studied as a means of providing efficient and effective rural rehabilitation.

Mobile units have been used to provide rehabilitation services. Itinerant teams of human service professionals (including a vocational rehabilitation counselor) and mobile assessment or physical restoration vans have demonstrated their effectiveness for some rural-based regions of the county (Bitter, 1972; Leland & Schneider, 1982). Lowrey (1980) reported on a successful program in southwest New Mexico that used mobile service units, visiting service teams, small scattered centers, and transportation programs to deliver vocational rehabilitation services.

As an alternative to traditional urban-based rehabilitation services, many rural counselors place greater reliance on local community resources (Bitter, 1972). This may include soliciting involvement from other community professionals (e.g., physicians, employers, or local human service professionals), as well as individual clients and their families. Increasingly, this also means developing resources and assistance available from local employers through education and public awareness efforts. Assistance from area business and industry can range from permission to conduct onsite vocational evaluation and skills training activities to employment for qualified persons with disabilities.

Recommendations and Conclusions

The unique needs and challenges of serving rural rehabilitation clients necessitates a renewed commitment to providing quality and appropriate rehabilitation programs. Unfortunately, rural vocational rehabilitation services are still sometimes marked by arbitrary and isolated efforts that have produced mixed success (Leland & Schneider, 1982). In an effort to enhance the quality of rural-based rehabilitation services, the following recommendations are proposed:

* The role(s) of vocational rehabilitation in rural America must be examined and clarified by national and local rehabilitation leaders.

* Training on issues related to rural vocational rehabilitation (e.g., client needs, service delivery alternatives, rural labor trends, employment options in rural regions, techniques for improving business-industry collaboration) must be increased at preservice and inservice (staff development) levels.

* It is imperative that empirical research be conducted on a number of issues related to rural vocational rehabilitation, especially exemplary program models and practices.

* As research and related information on rural rehabilitation issues become available, professionals in the field must place a priority on the dissemination of this information, especially in the professional literature.

* Policymakers must be made aware of current challenges to an effective service alternatives for vocational rehabilitation in rural areas. This awareness must be translated into legislative provisions that will serve to strengthen and advance the delivery of rural vocational rehabilitation services; this, of course, would also include training and research to improve service delivery.

Comprehensive vocational rehabilitation services must be provided to strengthen both the employability (actual job skills) and placeability (job seeking skills) of people with disabilities in rural areas (Lam et al., 1987). This article has provided an overview of select issues surrounding the delivery of vocational rehabilitation services to rural areas, including current challenges and potential solutions . Ultimately, vocational rehabilitation professionals must examine the needs of their rural clients and develop appropriate service alternatives based on those needs (Lowrey, 1980). The result of improved service delivery will be greater opportunity for meaningful employment and an enhanced quality of life rural Americans with disabilities.

Bibliography

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Dr. Rojewski is Assistant Professor, Department of Vocational Education, Universtiy of Georgia, Athens, Georgia.