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Streamlining in Vermont and New Hampshire.

This article describes how the state agencies in Vermont and New Hampshire embraced the concept of streamlining to revitalize their organization and reposition their resources for improved services. It examines how the changes introduced in Vermont and New Hampshire contribute a new understanding of choice and consumerism as promoted by the Rehabilitation Act Amendments of 1992 and reviews the process by which Vermont and New Hampshire decided to streamline. The procedures used to accomplish streamlining, staff reactions, and consumer contributions, methods of evaluation, and perceived results will also be discussed.

The Rehabilitation Act Amendments of 1992 redirected the focus of the public vocational rehabilitation (VR) program to employment and reestablished the primacy of the relationship between the individual with a disability and the VR counselor. The emphasis on consumer participation and choice, however, promised more fundamental change. The expanded choice requirements called for greater consumer participation in the rehabilitation process and it increased the potential for parity in the relationship between the counselor and consumer.

By updating the public VR program in this way, Congress underscored the need for quantitative and qualitative changes in the 82 VR programs operating in the United States and the trust territories. To prepare for the changes, the Council for State Administrators of Vocational Rehabilitation (CSAVR) and the Rehabilitation Services Administration (RSA) began meeting to restructure and redesign the VR program. While the leadership of CSAVR continued seeking agreement on a methodology to streamline the program, each state administrator began to think about possible approaches to the challenge of increasing quantity and improving quality within existing resources.

In 1993, the state agencies in Vermont and New Hampshire, each adopting a different approach, committed themselves to a streamlining process in order to increase productivity and to improve quality. Vermont and New Hampshire are small rural mountainous states bordered by the Connecticut River; their scenic landscapes attract tourists throughout the summer and winter months. In many respects, they have a seasonal, service economy. They enjoy a countryside made up of classic New England villages. While Southern New Hampshire and Burlington, Vermont, have attracted a significant urban population, they are thus far atypical. Both states have been successful in meeting their goals. The direction and design of the streamlining efforts reflect the states' individuality. Differences in management styles and philosophies also influence the strategies the organizations have chosen to implement change.

Vermont's Approach

In Vermont, the formal planning process began with a 2-day retreat. All agency managers were invited to participate in the development of a new 5-year plan. The goal was to increase productivity and to improve the quality of the vocational rehabilitation experience for the consumer. The state agency was interested in identifying and eliminating delays in the delivery of services, forming closer relationships with consumers, and removing some pressures from the counselors. The management team hoped to use the planning conference to engage in some creative problem solving. They retained a consultant--a motivational speaker--to set the tone for the conference. He began his presentation as a dialogue, by asking the participants four simple questions; these and the participants' responses follow:

QUESTION ONE: How does the state agency measure success?

ANSWER: We measure success by the number of people employed.

QUESTION TWO: How many people were employed last year?

ANSWER: About 500.

QUESTION THREE: How many people will you employ this year?

ANSWER: About 500.

QUESTION FOUR: How many people do you expect to employ next year?

ANSWER: About 500.

Within the time required to ask and answer four questions, the consultant had convinced the management team of the need to commit to change. The participants developed a new mission to become a consumer directed agency by 1999; and before the 2 days ended, the management team had developed a strategic 5-year plan to realize that mission. They called it Vision 2000.

The complexity of directing a change process that involved a comprehensive needs assessment of all agency customers quickly became self-evident. While the commitment to change had occurred rapidly, the actual implementation was much slower. Consumers, employees, and providers all expressed different needs. The challenge was to sort out the conflicting needs into a single strategic plan. That process encompassed many meetings and resulted in many drafts of the document. A consultant from GC Consulting was hired as a neutral party to provide an objective assessment of organizational progress toward change and to continue the momentum set in motion at the management retreat. The management team had interviewed eight consulting firms before they made their selection. They were pleased with the progress made the first year, during which the Vermont Division of Vocational Rehabilitation also applied for and received a demonstration grant from RSA entitled: "Vermont's Consumer Choice Demonstration Project." By the end of 1994, the management team and GC Consulting had heard from all constituency groups and completed a draft plan. Meanwhile, the consultant prepared all agency staff for the eventuality of change. He concentrated on building communication skills. Staff learned how to resolve interoffice issues and to feel more comfortable with the organizational change process.

In September 1995, the Vermont Rehabilitation Advisory Council (VRAC) met to outline their recommendations for a more consumer directed organization. It is the purpose of the VRAC, which is made up of a cross-section of consumers, employers, and service providers, to promote the most effective practices in the treatment of consumers, in the design of physical environments and in the provision of services. They identified organizational barriers and brain-stormed solutions to removing them.

The Future Directions Task Force

That same month, the Vermont Division of Vocational Rehabilitation (VDVR) created a task force to build a new strategic plan based on the recommendations of the VRAC. The Future Directions Task Force, consisting of 20 individuals, consumers and staff members, met for a 3-day retreat and developed a draft 3-year strategic plan. At the recommendation of the VRAC, the Future Directions Task Force forwarded the draft plan to the Policies and Procedures Subcommittee, which is made up of consumers and the Client Assistance Program director. This subcommittee was charged with the responsibility of making final recommendations to the full VRAC. VDVR also shared the plan with the Vermont Coalition for Disability Rights (VCDU), an organization made up of 30 statewide consumer groups who also provided grassroots support of the plan throughout the implementation process. Two months later, the VDVR Administrator, Diane Dalmasse, held two statewide meetings to talk about the VDVR Strategic Plan. Invitations were extended to all staff to review Vision 2000 and share their thoughts with the Future Directions Task Force and the Vermont Rehabilitation Advisory Council. Through a series of simulations, staff were encouraged to try different service delivery approaches. Some were consumer friendly; others were not. As a result of these experiences, staff in different locations initiated independent projects to make their offices more welcoming to visitors. Not everyone at the meetings was receptive to the new direction the agency had embraced, but most could see the benefits of working more closely with the consumers. At the end of November, the Future Directions Task Force combined the recommendations of all DVR staff, the Policy and Procedures Subcommittee, and the VRAC into a final version of Vision 2000. By the middle of December, the Vermont Rehabilitation Advisory Council approved Vision 2000.

The state administrator instituted quarterly meetings with all staff using interactive video. At these meetings, they would discuss the progress and problems in implementing Vision 2000. Additional feedback and followup on Vision 2000 occurred early in 1996 through four regional consumer focus groups held to review and react to the VDVR Strategic Plan. A series of regional meetings were held among regional office staff for the same purpose.

Within 1 year of the first 2-day retreat initiating the streamlining process, Vermont had articulated a vision for the future, had designed strategic goals, embarked on a process of regular monitoring of agency progress, retained a professional systems change consultant, developed plans for new configurations for a streamlined agency structure, and began experimenting with new strategies to expand consumer choice.

Some staff believe that many of these changes would not have been feasible to even contemplate were it not for recent advances in technology. The personal computer, connections to the Internet, voice mail, and fax machines provided the flexibility to convert secretarial positions to human service aides. The interactive video made it possible for staff in all locations to meet regularly with the management team. In other instances, innovations in one area seemed to trigger changes in another. Counselors turned their attention to consumers and services based on choice; supervisors turned their attention to working in the field with the counselors and consumers.

It is clear that the major force for change within the service delivery system was the choice project. The management team regarded the choice project as a laboratory for new service strategies. The director of the choice project and four counselors revamped the role of the VR counselor. Once the primary decisionmaker, the counselor stepped back to promote decisionmaking as a consumer/educator. The counselor would facilitate the decisionmaking process by presenting the full range of choices available, assess the contributions that each good or service might make to the VR process, and provide timely opinion as choices were made. By turning the process on its head, the choice team can exact more consumer interest and participation. At the same time, it remains interesting to the counselors, because they learned how to best prepare each individual to make the best available choices. Every interaction presented an opportunity to learn more about the consumer and his experience and readiness for choice. Learning to assess accurately those areas where consumers required no assistance and identifying areas where individuals needed more information and support became crucial for success. In Vermont, they now believe that counselors need more skills, not less, to effectively function as a counselor/educator. Counselors do not want consumers to fail. They do however want them to have the joy of making their own choices. State Administrator Diane Dalmasse expresses the philosophy of the choice project this way: "We don't want to be doing anything for anybody that they could be doing for themselves."

As new strategies for choice demonstrate success, the agency tries to introduce them into the Title I VR Program. Rather than expanding the choice project, the agency selects strategies that have proven effective. The agency is careful to educate all staff. People who never come face to face with a consumer are routinely informed of innovations. In this way, support staff understand the importance of their role in the change process and they can identify what needs to be done to implement changes. Since demonstration projects are not bound by the usual financial and program regulations that apply to the Title I program, each counselor in the choice program has a checkbook to purchase goods and services for consumers, as needed, throughout the rehabilitation process. The ability to write a check for a necessary good or service eliminates any delay that might occur in a state system of purchasing. Checkbooks have speeded up the process and made it possible, in some instances, to provide the services the same day that the Individualized Written Rehabilitation Program (IWRP) is developed.

Some staff say that the most difficult aspect of streamlining is introducing the proposed changes into the government system. When the state agency sought to implement the checkbook strategy into the Title I program, they had mixed results but were pleasantly surprised by the enthusiasm of the business unit to market this idea to their state counterparts. On the other hand, the agency learned that not every counselor is skilled in balancing a checkbook. Now, each district office has a checkbook, but not necessarily each counselor.

In some field offices, consumers who return to the agency after many years express some confusion at all the changes and the pace of progress. As a result, the administration stresses that each person should be encouraged to go at his/her own pace. Just because there is the capability to decide, develop a plan, and make a purchase the same day doesn't mean that it will work for everyone. Staff, on the other hand, are quite invested and excited about their new agency. One person said that it was the most exciting thing that he has seen in 25 years.

Initially there was concern that some more senior staff might not adjust to the changes. In actuality, senior staff are frequently in the forefront making the changes. Richard Hutchins, a regional manager in Burlington, reflecting on the streamlining initiative, stresses that the process has not been a linear one with discrete identifiable steps. He describes it as a process of evolution in which changes occur concurrently. In his mind, the success of the streamlining process is due to the original goal of increasing consumer direction of the agency and injecting more ideas into the process. He views the choice project, the initiation of consumer satisfaction surveys, and focus groups as mechanisms to increase feedback. He feels the opinion is very helpful to assess agency performance, to know what the agency is doing right, and to identify areas in which the agency could improve.

Throughout this change process, the management team has successfully communicated its interest in hearing and implementing new ideas. The state agency has contacted other states for as much information on streamlining as possible and agency personnel have visited other states to exchange ideas. Staff say that the volume of consumer input coupled with the influx of new ideas has enabled them to look at the entire VR process and that they feel comfortable asking questions about every aspect of it. For example, they question why it should take 60 days to determine eligibility and why should one counselor meet with one consumer when one counselor, or several counselors, can meet with several consumers. In another location, counselors and consumers have designed a one-page IWRP that they describe as more user friendly. Jim Alexander, regional manager in Waterbury, believes that the agency would not have come as far without the structure that was set up in 1993.

When Vermont VR personnel initiated their streamlining initiative, they framed some general objectives. They hoped to serve more people effectively, increase productivity, and increase the quality of the relationship with their consumers. They have evaluated the choice project every 6 months, evaluated agency progress on established goals every 3 months, and instituted consumer satisfaction surveys on a regular basis. When they started the planning process in 1993, they had achieved 546 rehabilitations. That changed to 581 rehabilitations in the second year and 664 in the third year. In FY 1996, they rehabilitated 683 people. Of particular interest is that the state agency reports that they have doubled the annual earnings of rehabilitated consumers. In 1995, they conducted a 5-year survey on duration of employment, and they found that 78 percent of consumers remained on the job 5 years after placement. The state agency takes great pride in the degree to which the process to date has been consumer directed, and Diane Dalmasse is equally pleased with the way staff have seized the initiative for streamlining the process and given it their full support.

This year, the agency is working with a new 360 degree evaluation process in which each employee is evaluated by his/her supervisor and the consumers, providers, and peers with which the individual works. Vermont staff have not finished with their streamlining initiative. They will continue to experiment with new ways of opening up the new process. Enthusiasm is high, and the 40 percent increase in rehabilitations since 1992 is certainly noteworthy.

New Hampshire

In 1993, the director of the VR agency in New Hampshire retired after a 30-year career with the agency. Paul Leather, a senior administrator in vocational rehabilitation became the director. The Department of Education underwent a reorganization and its staff began looking for strategies of becoming more consumer responsive. In January 1993, the changes pursuant to the Rehabilitation Act, as amended, became operational. These three external events culminated in New Hampshire's decision to streamline the agency.

New Hampshire staff developed three goals. They wanted to promote faster and more efficient services, produce more employment outcomes with the same resources, and place more focus on the customer.

During the first year, a consultant was hired to work with the newly established 10-member leadership team. The consultant helped the agency develop a mission, a vision, organizational values, and standards of performance; and he continued working with the agency as the streamlining process was carried out. The agency eliminated the role of the regional supervisor. Regional supervisors became regional leaders, with whom counselors could consult for help in responding expeditiously to a consumer when confronted with obstacles. The regional leader assumed a combination trouble shooter, service support, and personnel generalist function. In the spring of 1994, Paul Leather requested technical assistance from RSA Regional Commissioner John Szufnarowski on New Hampshire's plans for reorganization. The technical assistance was provided and additional technical assistance on the development of a streamlined policy manual was requested and granted. In the fall of 1994, the agency invited the University of Georgia Human Resources Institute to offer consultation on developing standards of performance and baselines for the standards. Consultation was also provided to the leadership team on policy development, a case review process, and consensus building. In 2 years, New Hampshire had reorganized from a traditional organizational hierarchy to a flatter team structure; had developed a vision, mission statement, and values; revised their policy manual to 30 pages; and developed standards of performance. The state also had begun a multiyear training and consultation effort to phase in self-directed teams in each regional office across the state. Agency staff were hard at work developing a case review guide and learning the dynamics of consensus. Throughout this process, New Hampshire used training and consultation. Each member of the leadership team attended the executive leadership program at the University of Oklahoma. As each team member cycled through the program, that person would select a specific agency project for him/herself. In this way, each member of the leadership team contributed to the viability of the team effort while simultaneously developing personal skills and exploring individual capabilities. Gradually, the program was made available locally through Assumption College. Two classes have now participated in the New England Leadership Series. The proximity has opened up the program to every person in the agency.

In January of 1996, the vice chair of the Rehabilitation Advisory Council advocated for the development of benchmarks in quality standards. Standards were also developed with the community rehabilitation providers through the leadership of the Rehabilitation Advisory Council. In May 1996, a Regional Conference on Streamlining was held at Assumption College. New Hampshire sent seven representatives to the conference. During the conference, the delegates from New Hampshire really enjoyed hearing what other New England states were doing to streamline. They had an opportunity to meet as a group and decided to hold a statewide meeting in June to synthesize the new learning that had occurred in the leadership team into a shared learning experience for the rest of the agency. Interested in an informal setting, the leadership team selected a camp as the site for this meeting. For 3 days in June, state agency staff assembled at a remote camp-ground near Wolfeboro, New Hampshire. Through a series of workshops, discussion forums, and outdoor team-building exercises, the leadership team members, regional leaders, and counselors brain stormed, debated, and created new plans for their regional offices and new roles for themselves.

The location and the timing of the event provided a needed opportunity for the entire staff to view the progress and plans of the agency as a single team. For 3 years, the agency leadership team had trained, consulted, and implemented a series of continuous changes in the organization. Staff communicated with one another in a formal way through various committees, but as the committee assignments changed, the staff members changed and the message communicated could change with the messenger. As a result, some field staff were experiencing confusion or ambivalence about the changes. They did not always hear a consistent message or always feel confident that they were an integral part of the change. The statewide meeting allowed every person to hear for him/herself that the leadership team valued everyone's participation. As informal organizational communication and learning occurred, the values and expectations for authentic participation became more clear. As the field staff gained confidence in the process, they participated more actively and contributed a series of original ideas and solutions. The participants maximized the experience. They seemed to emerge from the deliberations more closely linked to the streamlining process, their customers, and each other. This meeting initiated the 1997 financial and program planning process for the agency.

Each regional team returned to the office to develop new plans for customer-friendly services. The teams developed individual team proposals, suggested budgets, and listed any other equipments or supports that they would need to accomplish their goals. They then met with the leadership team to negotiate budgets and commit to outcomes for the year.

New Hampshire rehabilitated 1,150 people in 1993, 1,217 in 1994, 1,275 in 1995, and 1,401 in 1996; this represents an increase of 27 percent in the number of rehabilitations since 1992.

The number of severely disabled individuals placed has increased by 40 percent. Three other state agencies in New England have come to New Hampshire to learn about its streamlining process. New Hampshire does not feel that it has finished with its process. The 1997 fiscal year was the first year that all locations initiated their own program plans as part of the agency budget and planning process. New Hampshire has had the fastest growing economy in New England and, because it does not have an income tax, many employers find it a desirable location for business. The employment outlook for the state is promising and the potential of the VR agency to increase rehabilitations looks equally good.

Vermont and New Hampshire have contributed to the region's understanding of the possibilities of streamlining. Shortly after the regional conference in May 1996, New England CSAVR charged a continuous improvement workgroup with the task of developing a regional plan and regional benchmarks for streamlining. Because of the experiences each has had over the last 3 years, both states were able to provide strong leadership in this group. Vermont's most visible successes have developed from its choice project and its employment program with industry. It has developed a possible prototype for the public rehabilitation agency of the future. New Hampshire has modeled the concept of teaming and continuous improvement, suggesting new possibilities for providing customer friendly services through regional self-directed work teams.

The VR agencies in New England have benefited from the streamlining initiatives underway in Vermont and New Hampshire. These two states have melded traditional program values with newer values. . . they have strengthened their programs and helped us envision new organizations becoming the future of the public VR program.

RELATED ARTICLE: President's Committee on Employment of People with Disabilities Now on the Internet

The President's Committee on Employment of People with Disabilities is now accessible on the Internet via the World Wide Web.

Using the committee's website address-- may tap into information on a variety of disability employment issues, including fact sheets on statistical data, job accommodations, the Americans with Disabilities Act, recruitment, interviewing, hiring, and communicating with people with disabilities.

Additional resources available online include a list of the President's Committee's current projects and staff contacts; press releases; publications; speeches by Chairman Tony Coelho, President Clinton, and others; conference information; and a directory of state commissions, committees, and councils.

The President's Committee on Employment of People with Disabilities is a small federal agency based in Washington, DC. The committee's mission is to facilitate the communication, coordination, and promotion of public and private efforts to enhance the employment of people with disabilities. The committee provides information, training, and technical assistance to America's business leaders, organized labor, rehabilitation and service providers, advocacy organizations, families, and individuals with disabilities. It also operates the Job Accommodation Network (JAN), a toll free information service on the Americans with Disabilities Act and employment accommodations.

Ms. Langton is a Rehabilitation Services Program Specialist for the Rehabilitation Services Administration in the Boston Regional Office.
COPYRIGHT 1997 U.S. Rehabilitation Services Administration
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1997, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:Streamlining Service Delivery; improving vocational rehabilitation services for the disabled
Author:Langton, Maryanne S.
Publication:American Rehabilitation
Date:Jun 22, 1997
Previous Article:Streamlining: moving beyond the quick fix.
Next Article:Organizational transformation: a bold journey, not a guided tour.

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