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A regional survey of rehabilitation cultural diversity within CILs: a ten-year follow-up.

The Rehabilitation Cultural Diversity Initiative (RCDI), which emanated from Section 21 of the 1992 Rehabilitation Act, targeted all programs within public rehabilitation as a part of a five- year initiative. Section 21 identified issues and problems associated with the provision of services to minorities within the public rehabilitation system. It was noted that "patterns of inequitable treatment of minorities have been documented in all major junctures of the vocational rehabilitation process. Minorities are provided less training than their white counterparts. Consistently, less money is spent on minorities than their white counterparts" (Section 21 (a)(3), Rehabilitation Act Amendments, 1992). Further, Section 704(1) specifically required centers funded under Title VII of the Act to "set forth steps to be taken regarding outreach to populations that are unserved or underserved ... including minority groups, urban and rural populations" (p.101). The intent of the RCDI, as observed by Middleton, Flowers and Zawaiza (1996), was for rehabilitation leaders and organizations "to assume greater responsibility" (p 11).

As Patterson, Allen, Parnell, Crawford and Beardall (2000) reported, "the body of literature contributing to and resulting from Section 21 is extensive" (p.14). Smart and Smart (1997), for example, examined the link between the disproportionately higher disability rates of racial/ethnic minorities. Wilson, Harley and Alston (2001) studied the statistically significant difference in VR acceptance rates between races, while Hasnain, Sotnik and Ghiloni (2003) examined the underutilization of available vocational rehabilitation services by ethnic and cultural diverse individuals with disabilities "as compared to their Caucasian mainstream counterparts" (p. 10). In other professional venues, the theme of cultural diversity as related to equitable rehabilitation facility hiring patterns (Hafer & Riggar, 1981), as part of testing and employment (Riggar, Maki, & Flowers, 1991), and as a management strategy for implementing organizational pluralism (Riggar, Eckert, & Crimando, 1993) has a long history. This study, then, had a two-fold purpose: first, to determine how the RCDI has emerged on the part of public rehabilitation, over a decade of effort; and second, to assess the current level of cultural diversity within CILs. This article includes a comparison of the results of two surveys which described diversity within independent living centers in a federal Rehabilitation Services Administration (RSA) region. The surveys were conducted in 1993 and 2003, about 10 years apart, and the results are compared herein.

Independent Living Center Survey

In RSA Region V (Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin), 53 centers of independent living (CILs) were in operation when the RCDI project was initiated in 1993. Those 53 Region V CILs represent one of the largest groups of centers within any of the 10 RSA Regions. By 2003, the number of CILs within the region totaled had grown to 56, with all centers being contacted to request their participation in a survey of demographics of administration and management personnel. Additionally, the survey requested information on boards of directors and consumer demographics, as well as the disability types among persons receiving services. Also included in the survey were statements designed to assess (a) whether the center's management perceived their staff demographics to be reflective of the communities in which they were located, and (b) whether centers had assessed or implemented strategic plans related to increasing cultural diversity among staff, boards of directors and consumers served. Representatives from the region's Independent Living Council (ILC), comprised of the chairpersons of state independent living center consortium, were originally consulted on key areas and wording of statements in the survey (Flowers et al., 1996). In 2003, the National Centers of Independent Living directory revealed that 56 CILS were in operation in RSA Region V. These 56 centers comprised the sample for the replication study.

The return rate was calculated by first eliminating from the sample the ten 'Unknown' returns/bad addresses which had been obtained from the Directory, leaving a total of 46 in the sample. Of these 46, 11 returned the "Opt Out" cover letter, which university research committee requirements now mandate as a means for potential survey participants to return the cover letter, but not the survey. Following university research requirements, those centers deciding to 'opt out' are thus removed from future survey follow-up mailings lists. Of the total of 46 known and identified from the national registry, and available and willing to participate in this study, a total of 21 useable surveys were returned, representing an effective response rate of 45.6%. This compares in 2003 with the 1993 study in which 32 of 53 centers (60%) of the centers returned the survey instrument in two mailings over a period of three months. Surveys were completed by Executive Directors or their designees.

Administrative Staff Demographics. Staff were categorized as either administrative staff-persons who had minimal contact with clients/consumers-or management staff-persons who had contact with administrative staff and clients/consumers. As shown in Table 1, in the 1993 study, fewer than 20% of the 141 individuals reported in administrative positions were identified as members of ethnically or racially diverse groups (n = 23, 16.3%). In contrast to the 1993 study, findings from the current study indicated that 20.9% (n = 17) of the 82 similar positions were held by persons of color. Thus, there was no significant change in percentage of administrators of color, [[chi].sup.2.sub.1,1] = 69, p = 4. Position titles in the administrative staff classification included the traditional manager-upper management positions, that is, executive director, program manger, assistant director, associate director, finance director, and bookkeeper. Several other position titles, related to various administrative duties and roles, were reported, including secretary, typist, accounting assistant, and office manager. In the 2003 survey, additional positions were named by respondents concerning computer systems, comptroller, administrative service manager, and so on.

With regard to diversity, none of the respondents in the 1993 survey under the Program Manager/Director (n = 17) position title were reported as being members of a culturally diverse group. In contrast, one individual of ethnicity other than Caucasian American was reported as being employed in that position (n = 15) in the 2003 survey. In 1993, for the Executive Director position, 6 of 32 respondents reported being members of a minority group (18.7%); the number dropped in 2003, with 2 (9.5%) of the 21 Executive Directors identified as such. However, the change was not statistically significant, [[chi].sup.2.sub.1,1] 1.08, p = .29

Data from the survey suggest that mixed progress has been made at the upper administrative positions concerning disability and gender. In 1993, 54.6% (n = 77) of those in administrative positions at CILs in Region V reported having a disability, while in 2003 that number rose to 59 (71.9%), [[chi].sup.2.sub.1,1] = 6.55, p = .01. However, although more than three-quarters (n = 108, 76.6%) of administrative positions were held by women in 1993, while in 2003 the percentage had risen to 80.5% (n = 66), chi-square was not significant, [[chi].sup.2.sub.1,1] = .46, p = .5.

Management Staff Demographics. Demographic information for management position titles was also reported in both 1993 and 2003. Position titles in this category, as summarized in Table 2, ranged from Accessibility Coordinator to ADA Coordinator to Employment Training Specialist Manager to Youth Services Supervisor. Compared survey results for management positions were mixed. In 1993, of the 106 persons identified in management positions, 12.3% (n = 13) were reportedly ethnic or racial minorities. In 2003, with 73 responses to this question, the percentage of ethnic or racial minorities had risen, non-significantly, to 16.4% (n = 12), [[chi].sup.2.sub.1,1] = 63, p = .43. In 1993, females occupied 70.8% of identified management positions (n = 75), while in 2003 the percentage was 65.7% (n = 48), [[chi].sup.2.sub.1,1] = .32, p = .57. Finally, in 1993 73.4% (n = 78) of management positions were held by persons with disability, while in 2003, the percentage was 70.1% (n = 54), [[chi].sup.2.sub.1,1] = .26, p = .61. Thus there were no significant changes in diversity in management positions.

Board of Director Demographics. Board members are the guiding forces within CILs, with position titles in this category typically including president, vice-president, treasurer, secretary, as well as other board members. In 1993, a total of 12% (n = 46) of the 382 members of the Boards of Directors within the region were reported to be ethnic or racial minorities. In 2003, with board membership reported as totaling 222, this percentage climbed to 14.8% (n = 33), [[chi].sup.2.sub.1,1] = .98,p = .32. Results in 1993 (males = 222, 58%; female = 160, 42%) indicate less gender diversity than currently, with gender make up on Boards of Directors as almost even (males=112, 50.5%; females = 110, 49.5%), although the apparent change was non-significant, [[chi].sup.2.sub.1,1] = 3.33, p = .07. Membership of individuals with a disability on the Boards of Directors does appear to have progressed. In 1993, persons with disabilities (PWD) accounted for 65% of the board members (n = 382) and in 2003 accounted for 72.1% (n = 308) [[chi].sup.2.sub.1,1]= 5.48, p = .02.. There was virtually no change from 1993 (n = 3/28, 10.7%) to 2003 (n = 2/21, 10.5%) in centers reporting having a board president who was an ethnic or racial minority.

Consumer Demographics. The ethnic and racial population in RSA Region V in 1993, as reported by the 1990 census, may offer some clue as to the effectiveness of cultural diversity initiatives in the region. African-Americans, who represented 9.1% of the population, now represent 17.3% of CIL consumer base. Asian-Americans, who represented .9% of the population, still constitute less than 1% (.6) of the total currently served. Hispanic-Americans, who represented 2.23% of the population in the region, are currently 2.8% of CIL consumers. When questioned in 2003 as to how reflective administration, management and board members are to the community, 64.3% respondents believed that their administration, management, and board member composition were reflective of community demographics.

Outreach Efforts. The 1993 RCDI survey queried center administrators about processes for developing outreach strategies for targeted underrepresented groups (e.g., staff, consumers and board members) in their catchment area. More than one-half (n = 19, 58%) of responding administrators reported that their centers did not have plans/programs in place focusing on outreach to culturally diverse consumers in 1993. That lack of plans/programs has changed over the past 10 years, as data from the 2003 study indicate that most centers (93%) have developed plans/programs to address outreach to culturally diverse consumers. Additionally, in the 1993 study, administrators indicated that the focus of plans was "effective" in 25% of cases, while respondents in 2003 reported a much higher effective rate for their outreach efforts (42.8%). In 2003, 57.1% of Region V CILs had a plan/strategy for recruitment of underserved race/ethnic groups as staff, which represented an increase from 37% in 1993.

Cultural Diversity Issues

While studies have suggested that race and ethnic demography are negatively related to degree of disability, vocational rehabilitation acceptance, utilization of resources, equitable treatment in the rehabilitation process, and so on, new perspectives have espoused that in fact harm might come from the most traditional, mainstream and long held rehabilitation methodologies. D'Andrea (2004), for example, recognizes that traditional counseling theories and intervention strategies "are harmful to many clients who come from diverse groups and backgrounds" (p .26). He contends that "increasing numbers of counselors are beginning to entertain the notion that traditional counseling interventions may indeed be harmful to many culturally different persons in our society" (p. 26). Not only direct service providers are involved but administrators and managers as well. Lowrey (1983) makes it clear that "any manager of people needs understanding of the people he [or she] is attempting to manage. This understanding must be based on the unique history, culture, and values of the people to be managed" (p. 48). In support of Lowrey (1983), Dixon and Flowers (1996) point out that the lack of minority counseling professionals in the rehabilitation service delivery system, a lack of minority faculty and educators, and a lack of minority role models simply compounds the inherent problems.

Because cultural diversity is "an often neglected imperative for continued effectiveness and efficiency in rehabilitation" (Riggar, Eckert, & Crimando, 1993, p. 52), diversity becomes "a business and economic imperative ... not a social program" (Overman, 1991, p. 34). Clearly, then, failure to achieve appropriate cultural diversity in a rehabilitation organization, facility or agency has negative effects on both our clients and consumers, and to the business and economy of the rehabilitation organization.

Discussion

Having found evidence that a lack of diversity may harm clients/consumers, and in fact the effectiveness and efficiency of the organization, the question must be asked: What of the professional staff?. One possible answer may be found in the work of Barrett et al. (1997) who discovered an insidious problem that has plagued rehabilitation for decades. Their data suggest that in RSA Region V, the area of both CIL studies herein, the average annual staff turnover rate for rehabilitation administrators and managers was 18.3%, for direct service staff, within the six-state region in 1995, the turnover rate was 28.6%. If these turnover rates were not bad enough, an earlier study by Riggar, Hansen and Crimando (1987) examining rehabilitation employee organizational withdrawal behavior, which examined two RSA regions, including Region V, discovered that when asked "Why did they leave?" of administrators/managers, and then "Why did you leave?" of those who actually withdrew (turnover) that the top 4 reasons of each group did not match. To wit: administrators/managers of rehabilitation facilities, organizations and agencies held different opinions than those of ex-rehabilitation employees who quit as to why personnel left the job(s). While a wide range of research has been conducted in rehabilitation as to personnel burnout and organizational cures for the problem(s) (Riggar, Garner, & Hafer, 1984), it is clear that neither simple job satisfaction (Riggar, Godley, & Hafer, 1984) nor the perception of "little advancement potential" (Riggar, Hansen, & Crimando, 1987) are the only vital issues. If the administrators and managers do not in fact know why their employees are quitting at such high rates, as evidenced above, what chance do they have to retain them, and what does this factor bode for important cultural diversity issues and appropriate organizational pluralism.

With more specific regard to the underrepresentation of minorities in management within VR and CILs, and the populations they serve, another question may also be raised: Will the issue of inequities within of services offered, received and outcomes between minorities and the non-minority counterparts ever be completely ameliorated. The answer is a qualified 'maybe.'

As detailed by Flowers et al. (1996), "while no single area should be considered as the 'end all' answer to the issues of outreach and improved services delivery, training of staff should be considered one of the most important" (p. 26). Indeed, the first and most immediate approach to implement the cultural diversity initiative is to retrain current rehabilitation professionals, and to train future professionals in the racial/demography of disability (Barrett et al., 1997; Riggar, Crimando, & Pusch, 1993). A second solution for increasing cultural diversity is obvious: To hire and train those racial and ethnic minorities, as rehabilitation professionals, to address these issues from an experiential knowledge base (Riggar, Crimando, & Bordieri, 1991; Schmidt, Riggar, Crimando, & Bordieri, 1992). From a results perspective, the former approach is more likely to yield success sooner; as the second solution is not one that can be accomplished in the short term, but rather will eventually result in equitable services and outcomes.

Consumer-focused empowering organizational changes (Riggar, Flowers, & Crimando, 2002) depend largely on our requirements, mandates and values. The intent and ability to meet "the needs of racial and ethnic minorities with disabilities" (Flowers et al., 1996, p. 22) via the RCDI was originally promulgated by the 1993 General Accounting Office (GAO) report Vocational Rehabilitation: Evidence of Federal Programs Effectiveness is Mixed. In this report, based on 1988 case service records, evidence of inequity in service is documented. That 1993 report and the examination of the compared 1993/2003 data herein both found mixed results as to the success of rehabilitation cultural diversity efforts.

We are not just required and mandated by Section 21 of the 1992 Rehabilitation Act, and Section 704(1) to solve this problem, these values are the cornerstones of rehabilitation -the concepts of equitable treatment and doing no harm. Our values "act as standards or beliefs that guide actions and judgments across situations and time (Curtis, 1998, p. 42). For a decade this initiative has been part of the value system of rehabilitation and has served as a motivating force.

What then are the solutions? As noted, the issues involved are varied and disparate. The first specific issue examined herein-the negative impact of mainline, majority, traditional methods with minority, non-traditional consumers-is evidenced in the 1988 case records review GAO data, the 1993 data and the 2003 data herein. The approaches used for over a decade have, at best, seen mixed results over situations and time.

Secondly, professional personnel concerns as indicated by turnover research makes it clear that rehabilitation personnel who develop, plan, support and convert these integrated emerging initiatives and programs must be there to implement and operate them. This can only occur if rehabilitation administrators and managers are "sensitive to the job related needs of those who serve people with disabilities" (Garske, 2000, p. 10). A negative variable, even within this issue, which compounds the already high personnel turnover rates, is the observation by Burkhalter (2001) that "the gradual leadership void created by a large number of rehabilitation leaders inching their way into retirement has become pervasive and will beset our field for decades to come" (p. 65).

Of note in this 10-year follow-up study is a comment from the Conclusions section of the Flowers et al. (1996) article: "However, it should be noted that nearly 40% of the IL centers in the region failed to respond to the survey, for one reason or another. The failure of such a large percentage of the IL centers to respond may also be interpreted as an indication of their unresponsiveness to the concerns and issues raised in the survey" (p. 27).

Limitations and Recommendations

The conclusions of the current study are limited by one major consideration: the response rate among centers in the region. As noted above, this was a major concern noted by the authors in the earlier study and remains a concern, and thus noted as a limitation of the current student. While the overall response rate for the 1993 student was acceptable, the response rate for the current study was less than 50%. As noted earlier, this response rate was based on the potential sample of 56 centers, and was reduced due to of Unknown/Bad address. The resulting effective response rate (45.65 %) may be a limitation in that there may have been CILs with effective outreach programs (i.e., 10) and whose staff and consumer demographics might have positively influenced the findings, but which were not included based on bad addresses. That limitation being noted, it is particularly interesting that 11 (24%) of the CILs that did respond choose to "Opt Out'--checking and returning the cover letter in the self-addressed stamped return envelope and thereby rejecting participation and further study mailings, as noted above. As such, these collective decisions not to respond, opt out and refuse further mailings must be considered limitations which also have the potential to impact the generalizability of the findings.

Future research in this area should include a national survey of all centers to compare against results against one region of the country. While a survey of all centers in the country might be viewed as a daunting task, a stratified sampling of centers would provide additional information on this important area. Additionally, a second replication of the current study in 5 to 10 years is recommended to assess the progress and status of minorities and individuals with disabilities in key decision-making roles within independent living. A qualitative study which examines issues associated with non participation by centers for independent living is another recommendation worth consideration.

Conclusion

From 1993 to 2003, the cultural diversity initiative within CILs must be seen as having mixed results, at best. Culture and ethnicity, gender, and disability, as three factors surveyed, showed, at best, minimal, but positive movement. While the current status of the rehabilitation system may be viewed as effective in the traditional way, for some, such as American Indians, whose "worldview is vastly different from the dominant cultural worldview" (Pichette et al., 1999, p. 3) the system may be less equitable.

The way to initiate cultural diversity is to retrain current rehabilitation professionals and to train future professionals in the racial/demography of disability. For new rehabilitation employees one must hire, and train, those racial and ethnic minorities to address the cultural and ethnic issues from an experiential knowledge base. Current training of personnel, and new hires, through "mentoring/coaching, articulating change strategies, and addressing succession planning" (Griswold et al., 2001, p. 78), and through delegation as a means of succession planning (Crimando, Riggar, & Bernard, 2002) may reduce the negative past history of traditional approaches and bring experiential knowledge to the fore.
Table 1
Administrative Staff Ethnicity

 1993

Ethnicity 1 2 3 4 5 6

Position Title

Executive Director 4 26 1 1
Program Director/Manager 17
Assistant Director 1 1
Finance Director 4 2 1
Human Resource Coordinator 1 3
Marketing & Development Director 1 4 1
Public Relations Director 1
ACG Coordinator 1
Maintenance Director 1
Administrative Assistant 2 2 18
Project Assistant 2
Office Manager 1 7
Finance Assistant 1
Office Assistant 1
Staff Assistant 1
Bookkeeper 3
Secretary/Receptionist 3 14
Clerical/Support Staff 3 9
Typist 1
Staff Intern 1 2
Administrative Service Manager
Associate Director
Computer Systems
Executive Assistant
Director of Outreach & Marketing
Comptroller

 2003

Ethnicity 1 2 3 4 5 6

Position Title

Executive Director 1 19 1
Program Director/Manager 14 1
Assistant Director 1
Finance Director 5 1 1
Human Resource Coordinator 2 1 1
Marketing & Development Director
Public Relations Director
ACG Coordinator
Maintenance Director
Administrative Assistant 3 12
Project Assistant
Office Manager 3
Finance Assistant 1
Office Assistant
Staff Assistant
Bookkeeper 1
Secretary/Receptionist 3 2
Clerical/Support Staff
Typist
Staff Intern
Administrative Service Manager 1
Associate Director 1
Computer Systems 1
Executive Assistant 1
Director of Outreach & Marketing 1
Comptroller 1

Ethnicity Legend

1 = African American
2 = Asian American
3 = Caucasian American
4 = Hispanic American
5 = Native American
6 = Other

Table 2
Management Staff Ethnicity
 1993

Ethnicity 1 2 3 4 5 6

Position Title

Accessibility Coordinator/Consultant 1
ADA Director/Coordinator 1 1
Advocacy Director/Specialist 1 4
Blind Services Coordinator 3
Brain Injury Services Coordinator 1
CLSA Coordinator 1
Community Education Director 1
Consumer Services Director/Coordinator 4
Deaf Services Coordinator 11
Disability Rights Coordinator 2 1
Employment Training Specialist Manager 4
Follow Along Coordinator 2
Independent Living Coordinator 2 20
Independent Living Skills Coordinator 1
Information & Referral Director/Coordinator 2
Interpreter Services Coordinator 1
Interpreter Referral Coordinator 2
Outreach Services Coordinator 4
Peer Counseling Coordinator 2
Personal Assistant Coordinator 2 13
Resources Coordinator 1
Satellite Program Coordinator 1
Staff Representative 1
Technical Assistance Coordinator 1
Transitional Services Coordinator 1
Traumatic Brain Injury Services Coordinator 1
Volunteer Coordinator 4
Wisconsin Tech Coordinator 1
Youth Services Coordinator 1
Personal Assistant Caseworker
Director of Home Services
Community Living Advocate
Youth & Family Advocate
Skill Training Specialist
Community Service Coordinator
Community Education Coordinator
Reintegration
Maintenance
Travel Training Coordinator
Office Manager 1
Peer Counselor/Volunteer Manager
Assistive Technology Manager
Deaf Service Assistant
Independent Living Specialist
Home Service Advocate
Personal Assistant Director
Independent Living Advocate
Benefits Coordinator
Advocate
SSA Benefits Counselor
Peer Counselor/Advocate
Sign Language Interpreter
Driver Staff Associate
Resource Counselor
Romp Project Coordinator

 2003

Ethnicity 1 2 3 4 5 6

Position Title

Accessibility Coordinator/Consultant
ADA Director/Coordinator
Advocacy Director/Specialist 1
Blind Services Coordinator 3
Brain Injury Services Coordinator
CLSA Coordinator
Community Education Director
Consumer Services Director/Coordinator
Deaf Services Coordinator 1 6 1
Disability Rights Coordinator
Employment Training Specialist Manager 1 1
Follow Along Coordinator
Independent Living Coordinator 3
Independent Living Skills Coordinator 1
Information & Referral Director/Coordinator 1
Interpreter Services Coordinator
Interpreter Referral Coordinator 1
Outreach Services Coordinator
Peer Counseling Coordinator 1
Personal Assistant Coordinator 7
Resources Coordinator
Satellite Program Coordinator
Staff Representative
Technical Assistance Coordinator 1
Transitional Services Coordinator 1
Traumatic Brain Injury Services Coordinator 2
Volunteer Coordinator
Wisconsin Tech Coordinator
Youth Services Coordinator
Personal Assistant Caseworker 1
Director of Home Services 1
Community Living Advocate 3 1
Youth & Family Advocate 1
Skill Training Specialist 1
Community Service Coordinator 1
Community Education Coordinator 1
Reintegration 2
Maintenance 1
Travel Training Coordinator 1 1
Office Manager
Peer Counselor/Volunteer Manager 1
Assistive Technology Manager 1
Deaf Service Assistant 1
Independent Living Specialist 3
Home Service Advocate 1
Personal Assistant Director 1
Independent Living Advocate 1 4
Benefits Coordinator 1
Advocate 2
SSA Benefits Counselor 1
Peer Counselor/Advocate 1
Sign Language Interpreter 4
Driver Staff Associate 1
Resource Counselor 3
Romp Project Coordinator 1

Ethnicity Legend

1 = African American
2 = Asian American
3 = Caucasian American
4 = Hispanic American
5 = Native American
6 = Other


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Carl R. Flowers

Southern Illinois University Carbondale

W. S. Forbes

Southern Illinois University Carbondale

W. Crimando

Southern Illinois University Carbondale

T.F. Riggar

Southern Illinois University Carbondale

Carl Flowers; Southern Illinois University, Rehabilitation Institute-SIUC, Mailcode: 4609, Carbondale, IL 62901. E-mail: cflowers@siu.edu
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Title Annotation:Centers for Independent Living
Author:Riggar, T.F.
Publication:The Journal of Rehabilitation
Geographic Code:1USA
Date:Apr 1, 2005
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