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Community resource utilization in rehabilitation: the shape of the future.

Using community resources has long been an essential practice of rehabilitation professionals for providing appropriate and timely help to people with disabilities. As we near the 21st century, community resource utilization will play an even larger role in the rehabilitation process that supports a person's progress toward specific vocational and life goals. New technologies, new community-based programs, changes in existing programs, new budgetary guidelines, the Americans with Disabilities Act (ADA), and reauthorization of the Rehabilitation Act may all interact to reshape the ways in which rehabilitation professionals will identify and bring into play specific resources at the community, state, and national levels.

This article examines some of the ways in which rehabilitation professionals can meet the demands of the coming era and can conceptualize their own knowledge, skills, and values about timely resource utilization to allow them to provide future rehabilitation services in an orderly, individually-tailored fashion for maximum benefit.

In a comprehensive sense, rehabilitation professionals will meet the challenge of the future by being community resources themselves. The knowledge of resources that the professional possesses can alter the "environment" of service delivery by giving it flexibility and depth, thus enhancing the responsive capability of the entire community. This knowledge in action, as a form of client advocacy, also serves the important educational function of helping a person to learn self-advocacy related to resource utilization.

Many people with disabilities discover a wide variety of resources for themselves as they look to the community for ways to satisfy their specific needs. Knowledge of such discoveries may in turn be passed along to other people with disabilities, as well as to rehabilitation professionals. Most of what the professional eventually learns about resources in a particular community may originate in the day-to-day experiences of people with disabilities and may be augmented continuously.

The concept of the professional serving as a resource for his or her own community is a particularly exciting aspect of the future as it relates to ADA. As the business community is called upon to find new and creative solutions to reasonable accommodation issues, meaningful information and insights will be generated. While an individual business might discover or develop an unusual and proactive solution tailored for its specific business, the solution might remain a local phenomenon.

The rehabilitation professional, however, is in a unique position to glean "lessons learned" from such business experiences and to extrapolate the principles to other settings. Thus, the rehabilitation professional accumulates knowledge based on actual community experiences and passes it along for the benefit of people working in other parts of the community. In this sense, the professional serves as a repository of community wisdom and professional knowledge related to disability and the world of work.

Characteristics of Community Resources

Extensive use of community resources has always been closely related philosophically to the basic rehabilitation model that emphasizes a diagnostic approach centered upon a person's skills and supports. As inclusive, expansive assessment categories, the skills and supports aspects of the client's life are not meant to be reductionistic; they combine to present a holistic picture of functionality and life quality. Identification and utilization of appropriate resources thus gives the rehabilitation professional the means by which he or she can act directly to help improve natural support systems and enhance personal skill levels.

Resources in any community are diverse; they exist in large part as a response to community demand and need and thus may vary from one community to the next. Still, in order to be called rehabilitation resources, programs and services generally share the following characteristics:

* They are available within the consumer's natural community or extended community.

* They are available to the professional rehabilitation community for service provision and share a common rehabilitation orientation.

* They support the client's goals and aspirations (such as vocational goals).

* They are growth-oriented.

* They are durable in the sense that they are available for the client, when appropriate, throughout the rehabilitation process.

* They respect the consumer' s rights to quality service and confidentiality.

* They provide useful feedback to the client and to the rehabilitation professional.

* They do not exacerbate the client' s condition or contribute harmfully to his/her stress level.

* They are appropriate for each individual's needs and life-situation.

* They are supportive of the collaborative effort between the consumer and the rehabilitation professional.

Rehabilitation Diagnosis for Resource Allocation

The modern rehabilitation professional knows the community as a viable network of resources the consumer may call upon for specific services. The professional knows which resources exist, which are related to rehabilitation, which are oriented toward skills and supports, and which facilitate positive outcomes. With such knowledge, the professional can "diagnose" resource needs in conjunction with the client's situation.

Creativity is perhaps the greatest attribute a rehabilitation professional can have to determine what a particular person needs in the way of community resources. The art or the skill of matching resources to specific individual needs is in many instances that which distinguishes the exemplary professional from the average.

In VR settings, for example, the eligibility decisions concerned with reasonable expectations are directly related to how well the rehabilitation counselor recognizes available resources that improve the probability of success. In other words, the concept of reasonable expectation is partially dependent upon the professional's skill in identifying and using resources to help the consumer. Part of the knowledge that makes the professional a professional has to do with how he or she envisions in a creative way how particular resources can be used to offset a client's problems or to enhance a client's attributes. The end result is that expectations are actually based on what is "reasonable," fair, and objective, given the individual situation and the community's capacity to respond to that situation.

What is not reasonable may be made more reasonable when seen from the perspective of how growth-oriented resources can improve the client's situation. This is particularly true in instances involving severe disability; part of what the consumer seeks from the professional is that person's knowledge of community resources that could bring greater independence and/or vocational opportunity to the consumer. In making an eligibility determination, the professional must use information provided by the consumer in conjunction with his or her own knowledge; this approach can best achieve a reasonable expectation that the client's employability will improve through the provision of services.

Issues of Resource Accessibility

The impact of community-resource knowledge on eligibility determinations is dependent upon resource accessibility. As more communities develop localized resources for their own citizens, resources may become more specialized and varied in regard to populations served, eligibility criteria, and interagency cooperation. For rehabilitation consumers and professionals alike, issues of accessibility become paramount. Federal legislation and polices have sparked the move toward total accessibility for people with disabilities, yet subtle forms of environmental and attitudinal barriers may persist well into the future.

In the role of client advocate, the rehabilitation professional first makes certain that his or her own program or facility is accessible. The following issues of accessibility are the most obvious ones which are of concern to professionals and people seeking services:

Physical Accessibility. The impetus provided by the Rehabilitation Act and ADA will create a new environment for physical accessibility. Yet general modifications aimed at a barrier-free environment may not guarantee complete accessibility for a specific person. The rehabilitation professional must possess specific knowledge of actual living environments and of his or her clients before physical accessibility can be assessed. For example, in one instance an institution provided curb cuts and ramps for its customers who use wheel-chairs, but failed to provide timely snow removal during winter months. So the facility remained physically inaccessible during severe weather, though fully accessible in concept.

Transportation Accessibility. Even if a particular site is fully accessible in the physical sense, clients still must be able to get there. Public transportation continues to improve, but exact routes, operational schedules, and distances between facility and transportation stopping points must be taken into consideration. The client's ability to board or exit a vehicle affects accessibility at the personal level. A related issue is that of effort; how much energy does a person have to expend to make use of transportation? For example, a wheel-chair, which provides adequate short-distance transportation, would be unsuitable for a trip across town.

Financial Accessibility. Financial accessibility encompasses more than the capacity to pay for a particular service. There may be hidden costs or peripheral expenses which the client may have to pay. Additionally, budgetary policies may require that a particular resource be used instead of another merely because of the cost. That is not to say that cost of the service dictates its use, but rather that the professional must recognize the finite character of agency resources and must try to locate the best service at the lowest cost.

Psychological Accessibility. Very little research has centered upon psychological accessibility as a separate concept. However, the issue becomes important when viewed from the perspective of multicultural service provision or even from that of community value diversity. From the consumer's point of view, is the resource looked upon favorably in light of benefit? Certain resources that seem appropriate and routine for the professional may be perceived by the client as inappropriate, unhelpful, intimidating, stressful, patronizing, inhumane, or culturally alien. Although individual counseling and education may help resolve some of these reactions, the professional also needs to weigh the actual characteristics of a resource as "reality" that may reduce the resource's usefulness in a specific case. The client's negative reaction may be warranted.

Attitudinal Accessibility. This is dearly related to psychological accessibility, except that it centers upon attitudes within the community that may contribute to nonphysical barriers for clients. Stereotypical, negative attitudes toward people with disabilities, for example, may minimize social mobility of clients and may lead to the psychological barriers described above.

Fortunately, rehabilitation professionals can help influence and change such attitudes through their efforts in community education. Stereotypes are generally the result of limited contact with people who have disabilities; actual, positive contacts initiated by the rehabilitation professional may nullify these attitudes as the client becomes a "real" person to others in the community.

Rehabilitation Planning for Resource Utilization

Rehabilitation planning automatically involves simultaneous planning for resource utilization. Rehabilitation case management is not centered upon managing the client, but rather upon identifying and seeking to provide the resources needed to achieve identified goals. An Individualized Written Rehabilitation Program (IWRP), for example, identifies the actual resources the professional will call upon to provide services to the client. The careful planning for utilization of available resources adds depth to the written plan and helps ensure that the consumer will successfully achieve his or her vocational objective or independent living goal.

The holistic flavor of the rehabilitation model encourages professionals to consider resources in terms of their flexibility to meet client needs. Some community programs, for instance, may have very specific help to offer. Other programs may be more general in nature and may offer rudimentary services to a diverse population. Diagnostic facilities identify specific resources at their disposal which will help fulfill their mission to provide quality service. Utilization and planning are thus consumer- and need-driven. The rehabilitation professional may envision how an established service can be modified without undue difficulty to meet specific, individual needs.

Resource flexibility, then, arises first from the creative ideas of the professional which is then translated into interagency or interprogram cooperation. This cooperation within the rehabilitation community to match services with the client's precise needs is that brand of human services practice which generates exponentially those possibilities and opportunities for client successes.

Conclusion

This brief discussion on the creative use of community resources is far from exhaustive. It does, however, illustrate a rehabilitation ideal that will help move service delivery concepts into the next century. For many years now, rehabilitation professionals have been viewed by some as coordinators of resources and services. This view is equally accurate for the future.

However, another facet of the professional's role needs to be emphasized here. In becoming an authentic resource to his or her community and clients, the rehabilitation practitioner functions as a creative educator to bring change and flexibility to existing community programs and services. Often, a community may expand its ability to meet the needs and desires of people with disability only when it is asked to do so. This is not meant to imply that communities do not want to help, but only that they are often uncertain about what kind of help to provide.

The rehabilitation professional can call upon the community with specific, practical ideas that will give the community a positive direction in which to shape its response. The professional thus helps educate the community to organize itself in such a way that the needs of citizens can more easily be met. In reality, that is how community is defined--people meeting the needs of one another in a joint effort to share life.

Mr. Holmes is an instructor, Dr. Karst is an associate professor and Coordinator of Rehabilitation Services Education, and Dr. Kuehn is a professor and Director of Rehabilitation Programs. All are on the faculty of the Division of Counselor Education and Rehabilitation Programs, The Teachers College, Emporia State University, Emporia, Kansas.
COPYRIGHT 1992 U.S. Rehabilitation Services Administration
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1992, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:AMERICA 2000
Author:Kuehn, Marvin D.
Publication:American Rehabilitation
Date:Sep 22, 1992
Words:2204
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