Number range CHAPTER

**Longitudinal Study of the Vocational\
Rehabilitation Services Program**

Final Report 2: VR Services and Outcomes

**SUBMITTED TO:**

Rehabilitation Services Administration

U.S. Department of Education

in partial fulfillment of requirements under

ED Contract No. HR92022001

**May 2003**

![](media/image1.wmf){width="2.0in" height="0.8013888888888889in"}

**Longitudinal Study of the Vocational**

**Rehabilitation Services Program**

Final Report: VR Services and Outcomes

Becky J. Hayward

Holly Schmidt-Davis

ED Contract No. HR92022001

Table of Contents

**Page**

> **Executive Summary ES-1**

# Chapter 1 Introduction 1-1

> Overview of the Study's Mandate and Design 1-2
>
> The Study's Information Goals, Conceptual Framework, and Reporting
>
> Design 1-3
>
> Conceptual Framework 1-4
>
> Reporting Design 1-9
>
> Limitations of the Study's Data 1-10

# Chapter 2 VR Services and the VR Process 2-1

> Overview of Services That VR Consumers Receive 2-1
>
> Overview of the VR Process 2-8
>
> Organization of the Counselor's Functions 2-9
>
> Eligibility and IPE Development Activities 2-10
>
> The Consumer-Counselor Relationship 2-12

# Chapter 3 Receipt of Specific VR Services 3-1

> Cognitive/Psychological Assessment Services 3-1
>
> Education/Training Assessment Services 3-5
>
> Medical or Function Assessment Services 3-8
>
> Mobility Assessment Services 3-12
>
> Employment-Development Services 3-15
>
> Cognitive or Psychological Services 3-20
>
> Medical or Function Services 3-23
>
> Mobility-Related Services 3-25
>
> Postsecondary and Other Education Services 3-29
>
> Miscellaneous Support Services 3-33
>
> Case Management 3-36
>
> Summary 3-37

Table of Contents (continued)

**Page**

**Chapter 4 VR Services and Primary Disability 4-1**

> Service Patterns Among Persons With Orthopedic Impairments 4-2
>
> Service Patterns Among Persons With Mental Illness 4-3
>
> Service Patterns Among Persons With Nonorthopedic Physical Impairments
> 4-4
>
> Service Patterns Among Persons With Mental Retardation 4-5
>
> Service Patterns Among Persons With Hearing Impairments 4-6
>
> Service Patterns Among Persons With Learning Disabilities 4-7
>
> Service Patterns Among Persons With Vision Impairments 4-8
>
> Service Patterns Among Persons With Substance Abuse Disabilities 4-9
>
> Service Patterns Among Persons With Traumatic Brain Injuries 4-10
>
> Service Patterns Among Persons With Other Conditions 4-11
>
> Relationships Between Services and Disability Type 4-12
>
> Summary 4-16

**Chapter 5 VR Services and Vocational Goal 5-1**

> Professional, Managerial, and Technical Occupations 5-4
>
> Service Occupations 5-5
>
> Clerical or Sales Occupations 5-6
>
> Benchwork Occupations 5-7
>
> Miscellaneous Occupations 5-8
>
> Homemaking 5-9
>
> Structural Occupations 5-10
>
> Machine Trades Occupations 5-11
>
> Relationship Between Services and Vocational Goal 5-12
>
> Summary 5-13

**Chapter 6 VR Services and Consumer Outcomes 6-1**

> Short- and Longer-Term Economic Outcomes of Participation in VR 6-2
>
> Relationship of Earnings to the Federal Poverty Level 6-9
>
> Relationship Between Specific Services and Consumer Outcomes 6-21
>
> Short- and Longer-Term Noneconomic Outcomes of Participation in VR
> 6-27

**References**

**Appendix**

> A Overview of the VR Program
>
> B Tables on Relationships Between VR Services and Disability Type
>
> C Tables on Relationships Between VR Services and Vocational Goal
>
> D Tables of Odds Ratios

List of Tables

**Table Page**

> 2-1 Services Delivered to VR Consumers, by Category 2-3
>
> 2-2 Average Number of Services Received by VR Consumers Who Received
> That Service, by Category of Service 2-5
>
> 2-3 Percentage of VR Consumers Receiving Each Category of VR Services,
> with Indication of Delivery Arrangements 2-7
>
> 2-4 Organization of the Counselor Function: Time Spent On Counselor
> Activities per Month 2-9
>
> 2-5 Details of Eligibility Determination Process 2-10
>
> 2-6 Details of IPE Process 2-11
>
> 2-7 Documentation of IPE Components Among Consumers Who Completed an
> IPE 2-12
>
> 2-8 Consumers' Perspectives on the Amount of Choice and Control They
> Exercised in Working with Their VR Counselor to Develop and Implement
> Their IPE 2-14
>
> 2-9 Consumers' Perspectives on the Quality of Their Relationship with
> their VR Counselor 2-15
>
> 3-1 Percentage of Consumers Receiving Cognitive or Psychological
> Assessment Services, by Type of Service, Delivery Arrangements, and
> Duration 3-3
>
> 3-2 Costs of Purchased Services and Comparable Benefits for Cognitive
> or Psychological Assessment Services 3-3
>
> 3-3 Results of Cognitive Assessment Services Among VR Consumers Who
> Received Those Services 3-4
>
> 3-4 Percentage of Consumers Receiving Education or Training Assessment
> Services, by Type of Service, Delivery Arrangements, and Duration 3-6
>
> 3-5 Costs of Purchased Services and Comparable Benefits for Education
> and Training Assessment Services 3-6
>
> 3-6 Results of Education or Training Assessment Services Among
> Consumers Who Received Those Services 3-7
>
> 3-7 Percentage of Consumers Receiving Medical or Physical Function
> Assessment Services, by Type of Service, Delivery Arrangements, and
> Duration 3-9
>
> 3-8 Costs of Purchased Services and Comparable Benefits for Medical or
> Physical Function Assessment Services 3-10
>
> 3-9 Results of Medical or Physical Function Assessment Services Among
> Consumers Who Received Those Services 3-11
>
> 3-10 Percentage of Consumers Receiving Mobility Assessment Services,
> by Type of Service, Delivery Arrangements, and Duration 3-13
>
> 3-11 Costs of Purchased Services and Comparable Benefits for
> Mobility-Related Assessment Services 3-13

List of Tables (continued)

**Table Page**

> 3-12 Results of Mobility Assessment Services Among Consumers Who
> Received Those Services 3-14
>
> 3-13 Percentage of Consumers Receiving Employment-Development
> Services, by Type of Service, Delivery Arrangements, and Duration 3-17
>
> 3-14 Costs of Purchased Services and Comparable Benefits for
> Employment-Development Services 3-18
>
> 3-15 Results of Employment-Development Services Among Consumers Who
> Received Those Services 3-19
>
> 3-16 Percentage of Consumers Receiving Cognitive or Psychological
> Services, by Type of Service, Delivery Arrangements, and Duration 3-21
>
> 3-17 Costs of Purchased Services and Comparable Benefits for Cognitive
> or Psychological Treatment Services 3-21
>
> 3-18 Results of Cognitive or Psychological Services Among Consumers
> Who Received Those Services 3-22
>
> 3-19 Percentage of Consumers Receiving Medical or Physical Function
> Services, by Type of Service, Delivery Arrangements, and Duration 3-23
>
> 3-20 Costs of Purchased Services and Comparable Benefits for Medical
> or Physical Function Treatment Services 3-24
>
> 3-21 Results of Medical or Physical Function Services Among Consumers
> Who Received Those Services 3-24
>
> 3-22 Percentage of Consumers Receiving Mobility-Related Services, by
> Type of Service, Delivery Arrangements, and Duration 3-26
>
> 3-23 Costs of Purchased Services and Comparable Benefits for
> Mobility-Related Services 3-27
>
> 3-24 Results of Mobility-Related Services Among Consumers Who Received
> Those Services 3-28
>
> 3-25 Percentage of Consumers Receiving Postsecondary Education
> Services, by Type of Service, Delivery Arrangements, and Duration 3-30
>
> 3-26 Costs of Purchased Services and Comparable Benefits for
> Postsecondary Education and Other Education Services 3-30
>
> 3-27 Results of Postsecondary Education Services Among Consumers Who
> Received Those Services 3-31
>
> 3-28 Percentage of Consumers Receiving Other Education Services, by
> Type of Service, Delivery Arrangements, and Duration 3-32
>
> 3-29 Results of Other Education Services Among Consumers Who Received
> Those Services 3-32
>
> 3-30 Miscellaneous Support Services, by Type of Service, Delivery
> Arrangements, and Duration 3-34
>
> 3-31 Costs of Purchased Services and Comparable Benefits for
> Miscellaneous Support Services 3-35
>
> 3-32 Results of Miscellaneous Support Services Among Consumers Who
> Received Those Services 3-35

List of Tables (continued)

**Table Page**

> 3-33 Percentage of Consumers Receiving Case Management Services, by
> Type of Service, Delivery Arrangements, and Duration 3-36
>
> 3-34 Results of Case Management Services Among VR Consumers Who
> Received Those Services 3-37
>
> 4-1 Primary Disability of VR Consumers 4-1
>
> 4-2 VR Services Most Frequently Obtained by Consumers with a Primary
> Disability of Orthopedic Impairments 4-2
>
> 4-3 VR Services Most Frequently Obtained by Consumers with a Primary
> Disability of Mental Illness 4-3
>
> 4-4 VR Services Most Frequently Obtained by Consumers with a Primary
> Disability of Nonorthopedic Physical Impairments 4-4
>
> 4-5 VR Services Most Frequently Obtained by Consumers with a Primary
> Disability of Mental Retardation 4-5
>
> 4-6 VR Services Most Frequently Obtained by Consumers with a Primary
> Disability of Hearing Impairments 4-6
>
> 4-7 VR Services Most Frequently Obtained by Consumers with a Primary
> Disability of Learning Disability 4-7
>
> 4-8 VR Services Most Frequently Obtained by Consumers with a Primary
> Disability of Vision Impairments 4-8
>
> 4-9 VR Services Most Frequently Obtained by Consumers with a Primary
> Disability of Substance Abuse 4-9
>
> 4-10 VR Services Most Frequently Obtained by Consumers with a Primary
> Disability of Traumatic Brain Injury 4-10
>
> 4-11 VR Services Most Frequently Obtained by Consumers with a Primary
> Disability of Other Conditions 4-11
>
> 4-12 VR Services Most Frequently Obtained by Consumers 4-16
>
> 5-1 Occupational Type of Consumers\' Vocational Goal 5-1
>
> 5-2 Determinants of Consumers\' Vocational Goal and of Subsequent
> Changes in Goal 5-2
>
> 5-3 Occupational Type of Consumers\' Initial and Final Vocational Goal
> for Consumers Who Changed Goals 5-3
>
> 5-4 VR Services Most Frequently Obtained by Consumers with a
> Vocational Goal in Professional, Managerial, or Technical Occupations
> 5-4
>
> 5-5 VR Services Most Frequently Obtained by Consumers with a
> Vocational Goal in Service Occupations 5-5
>
> 5-6 VR Services Most Frequently Obtained by Consumers with a
> Vocational Goal in Clerical/Sales Occupations 5-6
>
> 5-7 VR Services Most Frequently Obtained by Consumers With a
> Vocational Goal in Benchwork Occupations 5-7

List of Tables (continued)

**Table Page**

> 5-8 VR Services Most Frequently Obtained by Consumers with a
> Vocational Goal in Miscellaneous Occupations 5-8
>
> 5-9 VR Services Most Frequently Obtained by Consumers with a
> Vocational Goal in Homemaking 5-9
>
> 5-10 VR Services Most Frequently Obtained by Consumers with a
> Vocational Goal in Structural Occupations 5-10
>
> 5-11 VR Services Most Frequently Obtained by Consumers with a
> Vocational Goal in Machine Trades Occupations 5-11
>
> 6-1 Employment Status of Former VR Consumers Over Time, by VR Exit
> Status 6-4
>
> 6-2 Employment Status Over Time of Former VR Consumers, by Competitive
> and Noncompetitive Employment Outcome 6-5
>
> 6-3 Occupational Field of Jobs at Closure and One, Two, and Three
> Years Later, by Exit Status 6-6
>
> 6-4 Percentage of Consumers Not Working at Follow Up Among Persons Who
> Exited VR with an Employment Outcome 6-7
>
> 6-5 Earnings of Former VR Consumers Over Time, by VR Exit Status 6-8
>
> 6-6 Earnings of Former VR Consumers Over Time, by Competitive and
> Noncompetitive Employment Outcomes 6-9
>
> 6-7 Relationship of Earnings to the Federal Poverty Level at Exit and
> One, Two, and Three Years Later, by Type of Exit 6-10
>
> 6-8 Hours Worked Per Week of Former VR Consumers Working Over Time, by
> VR Exit Status 6-11
>
> 6-9 Hours Worked Per Week of Former VR Consumers, by Competitive and
> Noncompetitive Employment Outcome 6-12
>
> 6-10 Percentage of Former VR Consumers with Benefits Provided by Their
> Employer, by VR Exit Status 6-13
>
> 6-11 Percentage of Former VR Consumers with Benefits Provided by Their
> Employer, by Competitive and Noncompetitive Employment Outcome 6-14
>
> 6-12 Receipt of Financial Assistance at Entry to VR and Following
> Exit, by Type of Exit 6-16
>
> 6-13 Receipt of Transfer Payments at Entry to VR and Following Exit,
> by Job Type at Exit 6-18
>
> 6-14 Receipt of Transfer Payments at Entry to VR and Following Exit,
> by Job Type at Exit Among Former Consumers Exiting VR with an
> Employment Outcome but Not Working at Follow Up 6-19
>
> 6-15 Percentage of Former VR Consumers Reporting Satisfaction with
> Selected Aspects of Their Employment, for Consumers with Competitive
> or Noncompetitive Jobs and Those Without an Employment Outcome 6-20
>
> 6-16 Receipt of Services Following Exit from VR, Among Persons Who
> Received Services 6-29

List of Tables (continued)

**Table Page**

> 6-17 Self-Reported Measures of Community Integration at Entry to VR
> and Following Exit from VR, Among Persons Who Received Services 6-31
>
> 6-18 Self-reported Measures of Community Integration at Entry to VR
> and Following Exit, Among Persons Who Exited VR with an Employment
> Outcome but Were Not Working at Follow-up, by Type of Employment
> Outcome 6-32
>
> 6-19 Self-Reported Measures of Increased Integration and Independence
> Following Exit From VR, Among Persons Who Received VR Services 6-33
>
> 6-20 Overall Perspectives on VR Services, Among Persons Who Received
> Services 6-35

List of Exhibits

**Exhibit Page**

> 1-1 Conceptual Framework 1-5
>
> 4-1 Relationship Between Service Patterns and Type of Disability 4-14
>
> 5-1 Relationship Between Service Patterns and Vocational Goal 5-12
>
> 6-1 Services That Lead to Employment 6-23
>
> 6-2 Services That Lead to Competitive Employment 6-26
>
> 6-3 Services That Lead to Earnings Outcome 6-27
>
> 6-4 Services That Lead to Receipt of Health Benefits with Employment
> 6-28

Number range CHAPTERExecutive Summary

This report is the second in a series of four final reports and several
research briefs that present the findings of the Longitudinal Study of
the Vocational Rehabilitation (VR) Services Program, a study that RTI
International is conducting for the Rehabilitation Services
Administration (RSA), U.S. Department of Education, under contract
number HR92022001. The broad purpose of the study is to assess the
performance of the state-federal VR services program in assisting
eligible individuals with disabilities to achieve positive, sustainable
economic and noneconomic outcomes as a result of their receipt of VR
services. This report contains details of the services that VR consumers
receive from VR and analyzes the relationships between receipt of those
services and short- and longer-term economic and other outcomes.

Initiated in fall 1992, the longitudinal study has tracked VR
participation and post-VR experiences, for up to three years following
exit from the program, of a nationally representative sample of
applicants to and consumers of VR services. The study's sample
acquisition and data collection activities began in January 1995 and
were completed in January 2000, with sample acquisition occurring over a
two-year period and each of the study's 8,500 participants tracked for
3 years.

The study implemented a multistage design that involved selection of a
random sample (with probability proportional to size) of 40 local VR
offices (located in 32 state VR agencies in a total of 30 states) and,
among those offices, a sample of 8,500 applicants and current and former
consumers of VR services. The study implemented a cohort design that
involved randomly selecting 25 percent of the sample from the population
of persons at application to VR, 50 percent of the sample from the
population of persons who were already accepted for and receiving
services, and 25 percent of the sample from the population of persons at
exit or after they exited VR services.

Data collection included computer-aided interviews with study
participants, abstraction of data from consumers' case records, and mail
surveys to VR agencies. A battery of baseline interviews conducted with
each study participant at the time of entry into the study obtained
information on work history, functioning, vocational interests and
attitudes, independence and community integration, and consumer
perspectives on their VR participation. Follow-up interviews
administered for three subsequent years varied according to the
individual's stage in the VR process at the time of interview. Records
abstraction included consumer characteristics and detailed information
on services; records were abstracted at the time the consumer entered
the study and quarterly until that person exited VR. Agency instruments
included mail surveys of office managers in participating VR offices,
counselors, and other office staff, as well as a state policies and
procedures form. These instruments were administered at initiation and
termination of the study's data collection activities, with annual
updates from the local office manager surveys.

Specific study questions that this report addresses are as follows:

**To what extent does receipt of specific VR services contribute to
successful consumer outcomes?**

> What service inputs do state VR agency consumers receive, including:
>
> P the amount, type, duration, and dollar value of purchased services;
>
> P the amount, type, duration, and dollar value of comparable benefits;
>
> P the amount, type, duration, and dollar value of agency-provided
> consumer services; and
>
> P the amount of counselor time devoted to individual cases?

How long do most consumers retain their jobs, and are post-employment
services utilized adequately to maximize consumers' job retention?

> **What short- and long-term economic and noneconomic outcomes do VR
> applicants and consumers achieve as a result of their participation in
> VR?**
>
> How do consumers perceive the quality and utility of the services they
> receive and the employment they ultimately obtain, as well as other
> outcomes (independence and community integration)?
>
> What are the long-term outcomes after VR closure, including:
>
> P employment status at one, two, and three years following the
> consumer's exit from VR services;
>
> P the extent that earnings, adjusted for inflation, changed over time;
>
> P employment as it relates to employee benefits (e.g., health or life
> insurance, etc.) and opportunities for advancement; and
>
> P the extent that consumer independence and community integration are
> enhanced?

The report's organization is as follows. Chapter 1 provides a brief
overview of the longitudinal study,[^1] addressing the study's
authorization, information goals, conceptual framework, and plan for the
series of final reports. Chapter 2 comprises an overview of VR services
and the VR process through which counselors work with consumers to
develop and implement service plans to assist consumers in achieving
their vocational goal. Chapter 3 contains findings regarding specific
services that VR consumers receive during their VR experience. Chapter 4
addresses patterns of services consumers receive according to their
primary disability, and Chapter 5 examines service patterns according to
occupational type of consumers' vocational goal. Chapter 6 contains
analyses of consumer outcomes, including analysis of the relationships
among services received, consumer characteristics, and short- and
longer-term economic and other outcomes.

Overview of VR Services

As specified in Section 103(a) of the Rehabilitation Act, as amended in
1998, VR services for individuals include ". . .any services described
in an individualized plan for employment necessary to assist an
individual with a disability. . . ." achieve his or her vocational goal.
The longitudinal study collected detailed information on 57 different
services identified as available to VR consumers, including:

+-----------------------------------+-----------------------------------+
| > P assessments (14 different     | > P mobility-related services     |
| > types of assessment),           | > (7 services),                   |
| >                                 | >                                 |
| > P employment-development        | > P postsecondary education (3    |
| > services (8 services),          | > services),                      |
| >                                 | >                                 |
| > P cognitive/psychosocial        | > P other education (7 services), |
| > services (4 services),          | >                                 |
| >                                 | > P miscellaneous support (7      |
| > P medical/function services     | > services), and                  |
| > (4 services)                    | >                                 |
|                                   | > P case management services (3   |
|                                   | > services).                      |
+-----------------------------------+-----------------------------------+

Overall, consumers who received VR services averaged 12 services (median
9.0) during their participation in VR. The service most frequently
delivered to consumers was medical/physical function evaluation, with
62 percent of consumers receiving this type of service. Other frequently
delivered services included cognitive/psychological assessment and
services (35 percent of consumers), employment-development services
(33 percent), postsecondary education (33 percent), and miscellaneous
support services, such as transportation or maintenance (38 percent).
Delivery arrangements differed widely among services, including services
that agency staff provided directly, those purchased from vendors, and
those arranged through comparable benefits. Most services can be
provided through more than one mechanism (e.g., vocational evaluation,
which agency staff sometimes provided directly and sometimes purchased
from vendors).

The VR Process

VR counselors spent about 14 percent of their time on eligibility
determination activities and an additional 14 percent on Individualized
Plan for Employment (IPE) development. Counseling/guidance took up
23 percent, and file management and documentation, about one-fourth of
their available time. Consumers reported active involvement in decision
making and control over the process, with 81 percent believing that they
had sufficient choice in selection of vocational goal and 81 percent
commenting that the counselor provided adequate information regarding
available services and service providers. Half reported being in charge
of decisions to a great extent, and an additional 41 percent to some
extent. Consumers also reported satisfaction with their involvement in
activities related to planning and delivery of services. For example,
nearly three-fourths of consumers reported that their counselor always
showed sufficient concern for their needs, and over three-fourths
reported that their counselor was willing to listen to their ideas and
suggestions. Three-fourths were very or mostly satisfied with their
counselor's efforts to help them work toward obtaining employment. A
relatively small percentage of consumers, around 10 percent, were
consistently dissatisfied with their interactions with their counselor,
with their counselor's efforts and concern, and with their control over
their VR services.

Receipt of Specific VR Services

Over 80 percent of VR consumers received at least one assessment service
in connection with their VR participation. Over half received medical
evaluation services; 30 percent received psychological or psychiatric
evaluation, 28 percent received a vocational assessment, and 13 percent
received a vision assessment. Eighty-six percent of consumers received
at least one service other than assessment or case management. The most
frequently received of these services were counseling (30 percent),
transportation (27 percent), assistive technology (AT) devices
(21 percent), and business or vocational training (16 percent). Finally,
95 percent of consumers' case files documented activities associated
with eligibility determination and IPE development and amendment.

VR Services and Primary Disability

The most important factor that affected the specific services
individuals received from VR was their primary disability, both in terms
of the types of services persons received and in terms of the average
number of services they received. For example, consumers with mental
illness received more different services than did any other group,
followed by consumers with traumatic brain injury (TBI) and those with
learning disabilities. Conversely, persons with vision impairments
received the fewest different services, followed by consumers with
hearing impairments or those with mental retardation. The implications
of this finding may include the possibility that persons with a variety
of psychological or cognitive impairments may require relatively more
assessment services to assist them in selecting a vocational goal and
more employment-development or educational services to prepare for a
career than do persons who have other more specific needs. For example,
consumers with vision or hearing impairments typically obtained
assessment services and subsequent assistive devices, and received
relatively fewer other services than did persons with other
disabilities. Persons with mental retardation received fewer assessment
services than other consumers and received a relatively larger number of
employment-development services such as supported employment, work
adjustment, job development, and job placement.

Analysis of relationships between services and disability type reveals
that service patterns do differ by disability type, thus supporting the
hypothesis that the VR program individualizes services to meet
consumers' needs and preferences.

VR Services and Vocational Goal

A substantial majority of consumers' vocational goals were in three
fields: professional, managerial, or technical occupations (35 percent);
service occupations (21 percent); and clerical or sales occupations
(18 percent). According to data in consumers' files, consumer preference
was the single most important determinant of both initial and final goal
for the 18 percent who changed goals over the course of VR services.
Interviews with consumers indicated that four-fifths of consumers were
generally satisfied with the process of goal setting, their control over
the decision regarding vocational goal, and the goal itself. Consumers
were also generally satisfied with decision making regarding services
and the services they received, although they were somewhat less
satisfied with the providers of services.

For all occupational types, medical evaluation was the most frequent
service received by consumers with goals in those areas. Although most
of the same services were frequently received by all consumers, their
distribution varied somewhat according to goal, and some services (e.g.,
supported employment, four-year college) occurred infrequently and did
not appear as frequent services for most goal areas. Given the impetus
to individualized services that characterizes the VR program, the
similarities in service patterns across occupational areas of vocational
goal are perhaps more striking than the differences, however.

Economic Outcomes of VR Services

On all measures of economic outcomes, VR consumers who achieved a
competitive employment outcome fared better than did those who achieved
a noncompetitive employment outcome and persons who exited without an
employment outcome. For example, at the third annual follow up,
78 percent of persons exiting into competitive employment were still
working, compared with 70 percent of those exiting into noncompetitive
employment, 37 percent of those who received services but exited VR
without an employment outcome, and 40 percent of those who were eligible
but dropped out before receiving VR services. In terms of earnings, by
the end of the third year after exit, persons exiting into competitive
employment were much less likely than other consumers to have earnings
below the federal poverty level and much more likely to have earnings
more than 200 percent of the poverty level:

  ------------------------ ----------------------- ----------------------
  **VR exit status**       Percent of VR consumers **Percent of VR
                           below poverty           consumers
                                                   \>200 percent of
                                                   poverty level**

  Competitive employment   20                      46

  Noncompetitive           63                      20
  employment                                       

  No employment outcome    32                      28
  following services                               

  No employment outcome,   34                      40
  exited prior to services                         
  ------------------------ ----------------------- ----------------------

For the same fiscal year (1996, using constant dollars), 14 percent of
the general population was below poverty, while 62 percent had earnings
greater than 200 percent of poverty.

Controlling for consumer characteristics (e.g., disability type and
significance, receipt of SSI/SSDI, etc.), we found that a number of
services increased (or decreased) the likelihood that consumers would
achieve competitive employment. Those that increased the likelihood of
such employment were:

> P job development, job placement, on-the-job training;
>
> P business/vocational school, four-year college/university;
>
> P tools/uniforms/equipment; and
>
> P IPE amendment.

Those that decreased the likelihood of competitive employment were:

> P supported employment, and
>
> P medical services.

As detailed in Chapter 6, our analyses, controlling for differences in
consumer characteristics, found that a number of specific VR services
contributed to a consumer's likelihood to achieve an employment outcome
and a competitive employment outcome. An important part of services
leading to these outcomes was a relationship between the consumer and
counselor that the consumer believed was productive and helpful, with
flexibility to amend the consumer's service plan as appropriate to
facilitate achievement of the vocational goal. The quality of the
consumer-counselor relationship also contributed to higher earnings,
both at closure and at subsequent follow-up points.

As preliminary findings from the study have indicated in the past,
enrollment in postsecondary education was associated with achievement of
competitive employment, which is likely to offer greater return over
time in terms of earnings, benefits, and career advancement potential.
Our analytic models indicate the utility of these services, along with
others, in leading to better employment-related outcomes.

Other Outcomes

For up to three years following exit from VR services, persons who
achieved competitive employment consistently reported less frequent use
of a variety of services than did persons who exited into noncompetitive
employment or those who exited VR without an employment outcome
following services. Comparable figures for the first year after exit
were 8 percent of those exiting into competitive employment, 25 percent
for those with a noncompetitive job, and 18 percent for those exiting
services without an employment outcome. By the end of year three,
the percentages were 7, 24, and 16 percent, respectively.

In terms of community integration, at study entry fewer persons who
later exited into competitive employment reported that their disability
restricted their ability to participate fully in social and community
activities than did those exiting into noncompetitive employment or
those exiting services without an employment outcome (32 percent versus
42 and 43 percent, respectively). Further, those exiting into
competitive employment reported that these restrictions continued to
decline (i.e., become less of a problem) over time; by the end of the
third year, only 22 percent reported that their disability restricted
their participation in social or community activities.

An interview collected information on the extent to which consumers
believed that VR contributed to improvement on selected aspects of
community integration, independence, self-advocacy, and other factors
with which VR might be expected to help consumers. Consumers who exited
following services without an employment outcome reported a greater need
for help from VR on these dimensions than did persons who exited into
competitive employment. Further, they more often reported that VR was
not at all helpful than did persons who exited into competitive
employment. Thus they were consistently less pleased with the assistance
they received from VR in terms of these noneconomic outcomes.
Conversely, on many of the dimensions, persons exiting into competitive
employment and those exiting into noncompetitive employment had similar
perspectives. For example, about the same percentage of both groups
reported that VR either helped them a great deal (49 and 45 percent,
respectively) or somewhat (39 and 41 percent) in gaining
self-confidence. Similarly, among persons reporting that they needed
help in coping with disability, about the same percentage of these two
groups (those entering competitive or noncompetitive employment)
reported that VR helped a great deal (47 and 50 percent) or somewhat (38
and 35 percent). For both of these factors, more than twice as many
persons exiting without an employment outcome reported that VR did not
help them at all. For self-confidence, 13 percent of each group exiting
into employment reported that VR was not at all helpful, compared with
30 percent of those without an employment outcome. Comparable figures on
coping with disability were 16 and 15 percent versus 36 percent.

Overall Perspective on the VR Experience

In addition to a number specific questions regarding consumers'
perspectives on their VR experience, consumers who received VR services
offered their overall perspective on VR through responses to items about
whether they would, should the opportunity arise, want to obtain the
same or different rehabilitation services. The interview occurred at or
shortly after exit from VR services. Nearly two-thirds of persons
exiting into competitive jobs responded that if they had to pay for
services, they would purchase "exactly the same" services they received
from the VR program. Twenty-seven percent would purchase better or
different services, while 9 percent would spend the money on something
other than rehabilitation services. Figures for persons entering
noncompetitive employment were slightly, but nonsignificantly,
different, with a slightly higher percentage (71 percent) indicating
that they would buy exactly the same services that they received from
the VR program. Conversely, persons who exited services without an
employment outcome were distinctly less positive about their VR
experience. Only 42 percent reported that they would buy the same
services; slightly more than that reported that they would buy different
or better services from the ones VR provided (44 percent), and more
consumers than those exiting into competitive jobs indicated they would
buy something other than rehabilitation services (14 versus 9 percent).
These findings parallel those from earlier reports (e.g., Hayward,
Interim Report 2, 1996) in that persons who exited services with an
employment outcome, whether competitive or noncompetitive, had
considerably more positive perspectives regarding most aspects of their
VR experience than did persons who were not successful in achieving an
employment outcome. Additional analyses planned for subsequent reports
may help to reveal the extent to which motivation, service quality, or
other factors may play a part in these perspectives independent of
whether the consumer achieved an employment outcome as a result of VR
services.

Number range CHAPTERChapter 1

Introduction

This report is the second in a series of four final reports and several
research briefs that present the findings of the Longitudinal Study of
the Vocational Rehabilitation (VR) Services Program, a study that RTI is
conducting for the Rehabilitation Services Administration (RSA), U.S.
Department of Education, under contract number HR92022001. The broad
purpose of the study is to assess the performance of the state-federal
VR services program in assisting eligible individuals with disabilities
to achieve positive, sustainable economic and noneconomic outcomes as a
result of their receipt of VR services. This report contains details of
the services that VR consumers receive from VR and analyzes the
relationships between receipt of those services and short- and
longer-term outcomes.

The report's organization is as follows. The remainder of this chapter
provides a brief overview of the longitudinal study,[^2] addressing the
study's authorization, information goals, conceptual framework, and plan
for the series of final reports. Chapter 2 comprises an overview of VR
services and the VR process through which counselors work with consumers
to develop and implement service plans to assist consumers in achieving
their vocational goal. Chapter 3 contains findings regarding specific
services that VR consumers receive during their VR experience. Chapter 4
addresses patterns of services consumers receive according to their
primary disability, and Chapter 5 examines service patterns according to
occupational type of consumers' vocational goal. Chapter 6 contains
analyses of consumer outcomes, including analyses of the relationships
among services received, consumer characteristics, and short- and
longer-term economic and other outcomes.

Overview of the Study's Mandate and Design

Initiated in fall 1992, the Longitudinal Study of the Vocational
Rehabilitation Services Program addresses key questions of interest to
Congress, RSA, state VR agencies, and consumers about the performance of
the state-federal VR program.[^3] The study's congressional mandate,
contained in Section 14 of the Rehabilitation Act, as amended in 1992,
directs the Secretary of the U.S. Department of Education to conduct a
longitudinal study of the VR program:

> \(f\) (1) To assess the linkages between vocational rehabilitation
> services and economic and noneconomic outcomes, the Secretary shall
> continue to conduct a longitudinal study of a national sample of
> applicants for services.
>
> \(2\) The study shall address factors related to attrition and
> completion of the program through which the services are provided and
> factors within and outside the program affecting results. Appropriate
> comparisons shall be used to contrast the experiences of similar
> persons who do not obtain services.
>
> \(3\) The study shall be planned to cover the period beginning on the
> application of the individuals for the services, through the
> eligibility determination and provision of services for the
> individuals, and a further period not less than 2 years after
> termination of services (Section 14 (f)).

In response to this mandate, the study tracked VR participation and
post-VR experiences, for up to three years following exit from the
program, of a nationally representative sample of applicants to and
consumers of VR services. The study's sample acquisition and data
collection activities began in January 1995 and were completed in
January 2000, with sample acquisition occurring over a two-year period
and each of the study's 8,500 participants tracked for three years.

The study implemented a multistage design that involved selection of a
random sample (with probability proportional to size) of 40 local VR
offices (located in 32 state VR agencies in a total of 30 states), and,
among those offices, a sample of 8,500 applicants and current and former
consumers of VR services. The study implemented a cohort design that
involved randomly selecting 25 percent of the sample from the population
of persons at application to VR, 50 percent of the sample from the
population of persons who were already accepted for and receiving
services, and 25 percent of the sample from the population of persons at
or after they exited VR services.

Data collection included computer-aided interviews with study
participants, abstraction of data from consumers' case records, and mail
surveys to VR agencies. A battery of baseline interviews conducted with
each study participant at the time of entry into the study obtained
information on work history, functioning, vocational interests and
attitudes, independence and community integration, and consumer
perspectives on their VR participation. A follow-up interview
administered for three subsequent years varied according to the
individual's stage in the VR process at the time of interview. Records
abstraction included consumer characteristics and detailed information
on services; records were abstracted when the consumer entered the study
and quarterly until that person exited VR. Agency instruments included
mail surveys of office managers in participating VR offices, counselors,
and other office staff, as well as a state policies and procedures form.
These instruments were administered at initiation and termination of the
study's data collection activities, with annual updates from the local
office manager surveys.

The Study's Information Goals, Conceptual Framework,\
and Reporting Design

The VR longitudinal study has been designed to answer the following
questions. (The questions that are addressed in this report \[Report 2\]
appear in bold text below.)

> P **What short- and long-term economic and noneconomic (e.g.,
> independent living, community integration) outcomes do VR applicants
> and consumers achieve as a result of their participation in VR?**
> **(Report 2)**
>
> P What characteristics of individuals with disabilities affect their
> (1) access to and receipt of VR services, and (2) short- and long-term
> outcomes? (Report 1)
>
> P **To what extent does receipt of specific VR services contribute to
> successful consumer outcomes?** **(Report 2)**
>
> P In what ways and to what extent do local environmental factors
> influence VR consumers' services and outcomes? (Report 3)
>
> P In what ways and to what extent do the operations, resources, and
> organizational climate of VR agencies influence consumers' services
> and outcomes? (Report 3)
>
> P Given the relationship among consumer characteristics, contextual
> factors, and VR services, what are the results of the VR program?
> (Report 4)

Specific issues that this report addresses include the following:

> **To what extent does receipt of specific VR services contribute to
> successful consumer outcomes?**
>
> What service inputs do state VR agency consumers receive, including:
>
> P the amount, type, duration, and dollar value of purchased services;
>
> P the amount, type, duration, and dollar value of comparable benefits;
>
> P the amount, type, duration, and dollar value of agency-provided
> consumer services; and
>
> P the amount of counselor time devoted to individual cases?
>
> How long do most consumers retain their jobs, and are post-employment
> services utilized adequately to maximize consumers' job retention?
>
> **What short- and long-term economic and noneconomic outcomes do VR
> applicants and consumers achieve as a result of their participation in
> VR?**
>
> How do consumers perceive the quality and utility of the services they
> receive and the employment they ultimately obtain, as well as other
> outcomes (independence and community integration)?
>
> What are the long-term outcomes after VR closure, including:
>
> P employment status at one, two, and three years following the
> consumer's exit from VR services;
>
> P the extent that earnings, adjusted for inflation, changed over time;
>
> P employment as it relates to employee benefits (e.g., health or life
> insurance, etc.) and opportunities for advancement; and
>
> P the extent that consumer independence and community integration are
> enhanced?
>
> Conceptual Framework

The study's conceptual framework, which organizes the study's
information goals and research questions, starts with the assumption
that the outcomes of VR services are a function of the types of
consumers entering the program, the economic conditions affecting the
local labor market, the organizational resources and culture of the VR
agency and its local service offices, and the services that consumers
receive. Exhibit 1-1 is a representation of the conceptual framework,
with its components and the relationships among them shown as
interconnected boxes. Each of the study's four final reports focuses on
a different subset of the framework's components, as explained later in
this chapter. The present report examines the relationships among
consumer characteristics, services, and outcomes, as highlighted in
Exhibit 1-1.

  -----------------------------------------------------------------------
  Exhibit 1-1. Conceptual Framework

  ![](media/image2.wmf){width="5.477777777777778in"
  height="3.686111111111111in"}
  -----------------------------------------------------------------------

The model described in this framework can be expressed as follows:

*Outcomes* are a function of:

> P the characteristics of *applicants and consumers*,
>
> P *services* and service costs,
>
> P *local economic and population characteristics*, and
>
> P the *organizational culture and resources* in the local agency
> office,

where *outcomes* are defined as: earnings, employment, other economic
outcomes, consumer satisfaction, community integration, and other
noneconomic outcomes.

This general model has been used as the basis for analysis in numerous
other VR studies. However, other studies have not had access to the
wealth of data that the longitudinal study has collected, including
important pre- and post-program measures of consumer experience and
long-term outcomes. In addition, there have been few efforts to examine
the impact of the VR system itself on consumer outcomes. This
longitudinal study offered the opportunity to collect extensive data on
individuals, services, and outcomes, expanding previous analytical bases
and allowing a more thorough assessment of VR results. For each of the
major components in the model, we discuss conceptual and design issues
relevant to this study.

We developed the conceptual framework to organize the hypotheses we held
about the relationships among the concepts represented by the components
and to guide the study activities. Elaborating the variables within each
component helped determine the data collection plans and the study
questions. This, along with the hypothesized relationships among the
components, led to our analytic activities.

Each of the study's major questions focuses on relationships between two
or more components of the conceptual framework. For example, to answer
the question, "To what extent does receipt of specific VR services
contribute to successful consumer outcomes?", our analyses examine the
data from the *Services and Service Costs* component, the *Outcomes*
component, and the statistical relationships among those variables. As
described below, each of the longitudinal study's final reports focuses
on a different subset of study questions and components of the
conceptual framework.

***Applicants/Consumers.*** The VR system is not an entitlement program,
but serves eligible applicants in an environment of funding and service
constraints. The effect of the VR program is in part due to the range of
disabilities, the severity of the caseload, the degree of work
experience, and the work attitudes that consumers bring to the VR
experience. There are also identified differences in the likelihood of
acceptance, and successful closure, related to age, sex, race, education
level, disability type and significance, and other consumer descriptors
(See *Report 1: How Consumer Characteristics Affect Access to, Receipt
of, and Outcomes of VR Services*).

To date, most analyses of the state-federal VR system have been limited
to differential patterns of achieving an employment outcome. They also
have been limited to existing consumer descriptors as available in RSA's
R-911 data files. The VR consumer base has been changing significantly,
moving from a consumer base with needs for physical restoration
(industrial accidents, war injuries) to an increasing percentage of
persons with learning disability, mental illness, traumatic brain
injury, and other cognitive disabilities, and to persons with limited or
no work history, problematic work behaviors, and other barriers to
employment. The traditional indicators of consumer disability type, or
nominal indicators of "significance," do not adequately differentiate
among consumers or applicants. Additional measures (such as functional
level, work history, interests and motivation, and receipt of financial
assistance) will contribute greatly to our understanding of differences
in caseloads, differences in applicants and accepted consumers, and
explanation of outcomes.

***Services and Service Costs.*** We use "services" broadly to include
the consumer\'s VR process, including work with the counselor,
assessment specialists, and others from application through exit from VR
and postemployment services. This list of services includes equipment,
adaptive devices, supplies, and professional and other services directly
paid for by the agency through purchase of services, as well as internal
resources such as counselor time, assessor time, and other staff time
directly spent with the consumer, and services arranged with other
providers and funding sources, as "comparable benefits." This study
gathered data on a list of services that is much more detailed than
normally reported to RSA in the R-911 and other RSA reporting, and also
allows for a basis for estimating service costs.

***Postemployment Services.*** Postemployment services are available to
consumers after completing the VR program, if such services will
facilitate retention of the placement. While a wide range of counseling
and services are available to consumers after VR exit that assist
consumers with job retention, these services are unevenly provided.
Provision of adequate postemployment services may affect both job
retention and recidivism.

***Organizational Culture and Resources.*** The VR program comprises 80
general, combined, and blind state VR agencies, each with its own
resources (in light of differences in state levels of support for VR),
internal organization, management philosophy, and organizational
culture. Resources include fiscal resources available for purchase of
services, a critical mass of effective service delivery professionals,
and availability and accessibility of service providers or vendors.

In addition to the availability of resources is the existence of an
organizational culture, or climate, that supports effective service
delivery. In recent years, attention has increasingly focused on the
influence of organizational culture within agencies on the effectiveness
of their programs. Established in early work by Deming, the field of
quality management as a whole has shifted from a concern with
information and control to a concern with human factors. In human
service agencies, human factors are especially important for delivering
high-quality services (Bowen and Schneider, 1988). The human
organization that creates quality is characterized by its culture of
quality; key elements of the culture of quality are training and
participation. The following indicators are important to measure in
assessing organizational climate: management commitment to quality,
extent of barriers to employee participation and teamwork, effectiveness
of communication between supervisors and employees, practices in
numerical goals and quotas for employees, and company-wide training and
education in quality. The organizational culture is viewed as an
influencing factor on both quality of services and resulting service
outcomes.

***Local Population and Economic Environment.*** Within the national
state-federal program, VR services are delivered under widely varying
conditions. Localities vary in their urban or rural nature, in the
availability of jobs, and even in the prevalence of work disability in
the state population. In examining the success of the VR program, it is
useful to control for those external factors that may affect services or
likelihood of outcomes. Thus, external conditions---exogenous factors in
terms of VR discretion---should be taken into consideration in our
conceptual framework.

***Outcomes.*** A range of outcomes is relevant to this study, including
both economic and noneconomic outcomes. VR traditionally has reported
one outcome, the achievement of an employment outcome, as the key
measure of program success. Within this measure is a variety of types of
successful outcomes, from placement in a job in the competitive labor
market to work as a homemaker or unpaid family worker. Amount of
earnings at closure is another available outcome measure in the existing
information system. Many of the previous analytical and theoretical
efforts in this field have recommended gathering income data
longitudinally to measure more accurately both the magnitude and the
duration of employment-related outcomes. A variety of economic measures
of outcomes is relevant to this study, including employment at exit from
VR services and at one, two, and three years following closure;
competitive employment at each of those time points; and earnings at
each of those time points.

In addition to measures of income and job retention, a number of
noneconomic outcomes can serve as indicators of success or gain in VR.
These include independent living, community integration, satisfaction
with employment, and satisfaction with VR services.

> Reporting Design

Definitive findings that address the study's research questions are the
focus of a series of final reports. In addition to four final reports,
other study products will include a series of research briefs that
address more restricted topics of interest relevant to the operations
and performance of the VR program. These reports, in combination with
the four interim reports[^4] already completed and numerous research
memoranda prepared over the study period, will yield comprehensive
answers to the study's primary research questions and to a number of
other topics of interest to policy makers, researchers, consumers, and
practitioners. In addition to the final reports of study findings, other
study deliverables include a methodology report and public use data
files with full documentation.

The First Final Report focused on the *Applicants/Consumers* component
of the framework and the relationship of those variables to portions of
the *Outcomes* component, specifically eligibility for VR, receipt of VR
services, and achievement of an employment outcome, including
achievement of competitive employment.

The Second Final Report---the present report---examines the relationship
between the *Services and Service Costs* component and the *Outcomes*
component of the framework, taking into account the findings of the
first report regarding consumer characteristics. It describes the
services consumers receive and the short- and long-term outcomes they
achieve.

The Third Final Report will build on the prior two reports by looking at
the additional influence of two other components of the framework on
consumer outcomes---that is, the *Local Economic and Population
Characteristics* and the *Organizational Culture and Resources*
components and their relationship to consumers' short- and long-term
outcomes. The Fourth Final Report will encompass the entire conceptual
framework by synthesizing all study findings and by addressing the
following overall study question: Given the relationship among consumer
characteristics, contextual factors, and VR services, what are the
results of the VR program? We have also planned two research briefs,
*Analysis of Consumer Referral and Acceptance* *Rates* and *Costs of
Eligibility Determination*, that will examine issues of more limited
scope than those in the longer reports.

Limitations of the Study's Data

As noted earlier, the longitudinal study implemented a design that
permits national estimates of characteristics, services, and outcomes
among persons with disabilities who applied for VR services, including
persons who received VR services and those who applied for services but
exited prior to receipt of services. The study implemented a carefully
designed two-stage, stratified random sampling design that would permit
development of the best available national estimates of the VR consumer
population. In reviewing the findings in the study's reports, the reader
should be aware of the following limitations of this design.

P Study findings reflect the study's data collection period, which
occurred between 1995 and the end of 1999; therefore, findings do not
reflect recent changes in the program that may be having an effect on VR
services and outcomes;

P In instances where sample sizes are very small (e.g., less than one
percent of the sample), findings should be viewed with caution; in
general, we do not describe such findings other than including them in
tables (e.g., blind reader services, received by 0.3 percent of VR
consumers). Small sample sizes may affect findings for groups in which
the incidence of disability is small and for analyses that involve
reporting of various characteristics in combination;

P The study was designed to provide national estimates of VR services
and outcomes and does not provide estimates at the level of State VR
agencies or local VR offices. No statements can be made about
participants, services, or outcomes for individual agencies or offices.

P The study is not experimental in nature; that is, we studied
participants as they received the services that agencies would normally
provide---participants were not randomly assigned to specific services.
Thus, we cannot conclude that specific services cause specific outcomes.
Nevertheless, our analyses, in which we control for differences in
individual characteristics, provide an indication of the relationships
among services and outcomes.

Number range CHAPTERChapter 2\
VR Services and the VR Process

This chapter presents findings on services that VR consumers received
during their participation in the program. First is an overview of the
types of services that the VR program makes available to applicants and
consumers. Services are grouped into several categories that are useful
for analytic purposes, including assessments (four categories), medical,
psychological, and mobility-related services (three categories),
educational and employment-development services (three categories),
miscellaneous support services (one category), and case management
services (one category). Next is an overview of consumers' receipt of
services within those groups that describes numbers of consumers
receiving services overall and the average number of services that
consumers received in each of the 12 groups. This chapter also presents
findings regarding delivery arrangements for the groups of services.

Then, to provide a context for subsequent chapters that examine specific
services in detail for VR consumers overall and for subgroups of
interest, the final section of the chapter examines the VR process. This
discussion addresses (1) the nature of the relationship between the
consumer and counselor in the process of eligibility determination, IPE
development, and service delivery; (2) the organization of the counselor
function; and (3) consumer perspectives on VR services and outcomes.

Overview of Services That VR Consumers Receive

As specified in Section 103(a) of the Rehabilitation Act, as amended in
1998, VR services for individuals are

> . . . any services described in an individualized plan for employment
> necessary to assist an individual with a disability in preparing for,
> securing, retaining, or regaining an employment outcome that is
> consistent with the strengths, resources, priorities, concerns,
> abilities, capabilities, interests, and informed choice of the
> individual. . . .

Such services can include a variety of medical, psychosocial, and other
types of assessment; employment-development services like job search
training or work adjustment training; vocational training and education
(including undergraduate or graduate degree programs); transportation or
housing assistance; technical assistance in development of business
plans; tools, licenses, and equipment; services for family members; and
virtually any other service that will assist the individual to achieve
an employment goal consistent with his or her Individualized Plan for
Employment (IPE).

Because one of the key questions of interest to RSA and Congress
regarding the operations and effects of the VR program is the
relationship between services received and such consumer outcomes as
employment, earnings, and other benefits, the VR longitudinal study
collected voluminous detail on the services provided to consumers. In
all, the study collected detailed information on 57 different services.
For analytic purposes, we have organized these services into
12 categories (as shown in Table 2-1):

+-----------------------------------+-----------------------------------+
| > P cognitive/psychological       | > P medical/function services (4  |
| > assessment (3 services),        | > services),                      |
| >                                 | >                                 |
| > P education/training assessment | > P mobility-related services (7  |
| > (2 services),                   | > services),                      |
| >                                 | >                                 |
| > P medical/function evaluation   | > P postsecondary education       |
| > (5 services),                   | > services (3 services),          |
| >                                 | >                                 |
| > P mobility assessment (4        | > P other education services (7   |
| > services),                      | > services),                      |
| >                                 | >                                 |
| > P employment-development        | > P miscellaneous support         |
| > services (8 services),          | > services (7 services), and      |
| >                                 | >                                 |
| > P cognitive/psychosocial        | > P case management services      |
| > services (4 services),          | > (3 services).                   |
+-----------------------------------+-----------------------------------+

For each of these services, field data collectors recorded the following
information from consumers' case files:

> P delivery arrangement of service (whether provided, purchased, or
> arranged);
>
> P dates, duration, and frequency of service;
>
> P actions resulting from the service (i.e., what decisions or next
> steps in the VR process occurred as a result of the service); and
>
> P costs of services (costs to VR of purchased service, source and
> estimated amount of comparable benefits, and estimated costs of
> services provided by agency-employed staff).

Table Number range CHAPTER2-1. Services Delivered to VR Consumers, by
Category

+-------------------------------+--------------------------------------+
| Number range                  | Number range                         |
| CHA                           | CHAPTER**Mobility-related services** |
| PTER**Cognitive/psychological |                                      |
| assessment**                  | AT devices                           |
|                               |                                      |
| Neuropsychological evaluation | AT services                          |
|                               |                                      |
| Psychological/psychiatric     | Orientation-mobility therapy         |
| evaluation                    |                                      |
|                               | Physical therapy                     |
| Social/psychological          |                                      |
| adjustment evaluation         | Independent living services          |
|                               |                                      |
| **Education/training          | Personal assistance services         |
| assessment**                  |                                      |
|                               | Driver training/licensing            |
| Vocational evaluation         |                                      |
|                               | **Postsecondary education services** |
| Educational status evaluation |                                      |
|                               | Four-year college/university         |
| **Medical/function            |                                      |
| evaluation**                  | Two-year community college           |
|                               |                                      |
| Medical evaluation            | Business/vocational training         |
|                               |                                      |
| Dental evaluation             | **Other education services**         |
|                               |                                      |
| Hearing assessment            | Instruction in English as a second   |
|                               | language                             |
| Vision assessment             |                                      |
|                               | Literacy instruction                 |
| Speech/communication          |                                      |
| assessment                    | Instruction in lip reading           |
|                               |                                      |
| **Mobility assessment**       | Instruction in reading Braille       |
|                               |                                      |
| Assistive technology          | Elementary/secondary education       |
| assessment                    |                                      |
|                               | General Educational Development      |
| Independent living skills     | (GED) preparation                    |
| assessment                    |                                      |
|                               | Tutoring                             |
| Orientation/mobility          |                                      |
| assessment                    | **Miscellaneous support services**   |
|                               |                                      |
| Driving assessment            | Transportation                       |
|                               |                                      |
| **Employment-development      | Vehicle maintenance/repair           |
| services**                    |                                      |
|                               | Maintenance                          |
| Job development               |                                      |
|                               | Housing assistance                   |
| Job placement                 |                                      |
|                               | Tools/uniforms/equipment/stock       |
| Job search training           |                                      |
|                               | Post-employment services             |
| Work adjustment               |                                      |
|                               | Services to other family members     |
| Work hardening                |                                      |
|                               | **Case management services**         |
| On-the-job training/job trial |                                      |
|                               | Counseling for eligibility           |
| Transitional employment       | determination                        |
|                               |                                      |
| Supported employment (as a    | IPE development                      |
| service)                      |                                      |
|                               | IPE amendment                        |
| **Cognitive/psychosocial      |                                      |
| services**                    |                                      |
|                               |                                      |
| Counseling                    |                                      |
|                               |                                      |
| Psychological/psychiatric     |                                      |
| treatment                     |                                      |
|                               |                                      |
| Substance abuse treatment     |                                      |
|                               |                                      |
| Occupational therapy          |                                      |
|                               |                                      |
| **Medical/function services** |                                      |
|                               |                                      |
| Medical services              |                                      |
|                               |                                      |
| Speech/communication therapy  |                                      |
|                               |                                      |
| Interpreter services          |                                      |
|                               |                                      |
| Blind reader services         |                                      |
+-------------------------------+--------------------------------------+

Number range CHAPTERThe study provides substantially more detailed
information than has been available previously on services, delivery
arrangements, and, in particular, the role that individual services play
in the consumer's progress.

Data on services came from study participants' VR case files. At the
time an individual entered the study, the field data collector
abstracted information from the case file; subsequently, the data
collector reviewed the case file on a quarterly basis until the
individual exited VR and once again one quarter following exit. While
generally the files contained sufficient information to support
collection of details on services as outlined above, the level of detail
and completeness, particularly for such items as comparable benefits,
varied widely among the VR offices that participated in data collection
activities. Throughout sections of this report that address services, we
indicate those items for which data are limited by their lack of
availability in consumers' case files.

Over the study's data collection period (January 1995 through December
1999), data collection forms for a total of 88,324 services were
completed. Weighted according to the study's sample design, these
services represent approximately 9,901,375 services delivered to an
estimated 844,013 VR consumers, representing 97.6 percent of all VR
consumers whose records indicated that they received VR services. (For
2.4 percent of consumers reported to have received services, case
records did not contain sufficient information to determine types or
amount of services received.) In some instances (e.g., for ongoing
enrollment in universities or community colleges), data collectors
completed a separate service form for each year of enrollment.
Consequently, the number of services reported above includes some amount
of duplication for persons who remained enrolled in an education or
training program over several years. Unless otherwise noted, in the
chapters of this report that address services the unit of analysis is
the individual consumer whose case file indicated that he or she was
eligible for VR services and received VR services under an IPE.[^5]

Consumers who received VR services averaged 12 services (median 9.0)
during their participation in VR (Table 2-2). Assessment services
comprise at least 14 different types of individual services, which were
organized into four categories. Most frequent was medical/ physical
function evaluation, with 62 percent of consumers receiving this type of
service. Thirty-five percent received cognitive/psychological assessment
services, and nearly one-third (31 percent) received educational or
vocational assessment. Very few consumers (6 percent) received
mobility-related assessment services.

+-----------------------------+---------+-----------+---+----+----------+
| Table 2-2. Average Number   |         |           |   |    |          |
| of Services Received by VR  |         |           |   |    |          |
| Consumers Who Received That |         |           |   |    |          |
| Service, by Category of     |         |           |   |    |          |
| Service                     |         |           |   |    |          |
+-----------------------------+---------+-----------+---+----+----------+
| Number range                | **Co    |           |   | ** |          |
| CHAPTER**Service category** | nsumers |           |   | Nu |          |
|                             | re      |           |   | mb |          |
|                             | ceiving |           |   | er |          |
|                             | se      |           |   | of |          |
|                             | rvice** |           |   | in |          |
|                             |         |           |   | di |          |
|                             |         |           |   | vi |          |
|                             |         |           |   | du |          |
|                             |         |           |   | al |          |
|                             |         |           |   | se |          |
|                             |         |           |   | rv |          |
|                             |         |           |   | ic |          |
|                             |         |           |   | es |          |
|                             |         |           |   | re |          |
|                             |         |           |   | ce |          |
|                             |         |           |   | iv |          |
|                             |         |           |   | ed |          |
|                             |         |           |   | ** |          |
+-----------------------------+---------+-----------+---+----+----------+
|                             | **Pe    | *         |   | ** | **       |
|                             | rcent** | *Weighted |   | Me | Median** |
|                             |         | n**       |   | an |          |
|                             |         |           |   | ** |          |
+-----------------------------+---------+-----------+---+----+----------+
| > Overall\*                 | 97.6    | 844,013   |   | 11 | 9.0      |
|                             |         |           |   | .5 |          |
+-----------------------------+---------+-----------+---+----+----------+
| > Cognitive/psychological   | 34.8    | 301,201   |   | 1  | 1.0      |
| > assessment                |         |           |   | .3 |          |
+-----------------------------+---------+-----------+---+----+----------+
| > Education/training        | 30.9    | 266,810   |   | 1  | 1.0      |
| > assessment                |         |           |   | .4 |          |
+-----------------------------+---------+-----------+---+----+----------+
| > Medical/physical function | 61.8    | 533,984   |   | 2  | 2.0      |
| > assessment                |         |           |   | .4 |          |
+-----------------------------+---------+-----------+---+----+----------+
| > Mobility assessment       | 6.1     | 52,493    |   | 1  | 1.0      |
|                             |         |           |   | .4 |          |
+-----------------------------+---------+-----------+---+----+----------+
| > Employment-development    | 32.8    | 283,652   |   | 2  | 1.0      |
| > services                  |         |           |   | .2 |          |
+-----------------------------+---------+-----------+---+----+----------+
| > Cognitive/psychological   | 34.6    | 299,604   |   | 1  | 1.0      |
| > services                  |         |           |   | .8 |          |
+-----------------------------+---------+-----------+---+----+----------+
| > Medical/physical function | 16.9    | 142638    |   | 3  | 2.0      |
| > services                  |         |           |   | .7 |          |
+-----------------------------+---------+-----------+---+----+----------+
| > Mobility-related services | 25.6    | 221,642   |   | 2  | 1.0      |
|                             |         |           |   | .6 |          |
+-----------------------------+---------+-----------+---+----+----------+
| > Postsecondary education   | 32.9    | 284,810   |   | 3  | 2.0      |
| > services                  |         |           |   | .7 |          |
+-----------------------------+---------+-----------+---+----+----------+
| > Other education services  | 3.0     | 25,722    |   | 1  | 1.0      |
|                             |         |           |   | .6 |          |
+-----------------------------+---------+-----------+---+----+----------+
| > Miscellaneous support     | 37.7    | 325,718   |   | 4  | 2.0      |
| > services                  |         |           |   | .0 |          |
+-----------------------------+---------+-----------+---+----+----------+
| > Case management           | 94.8    | 819,498   |   | 2  | 2.0      |
|                             |         |           |   | .4 |          |
+-----------------------------+---------+-----------+---+----+----------+
| \* For 2.4 percent of       |         |           |   |    |          |
| persons whose status        |         |           |   |    |          |
| indicated receipt of        |         |           |   |    |          |
| services, data on services  |         |           |   |    |          |
| were missing from the case  |         |           |   |    |          |
| files. These persons        |         |           |   |    |          |
| represent 20,602 consumers. |         |           |   |    |          |
+-----------------------------+---------+-----------+---+----+----------+

Number range CHAPTEROne-third of consumers received
employment-development services, such as work adjustment training and
job development or placement. Slightly over one-third (35 percent)
received cognitive or psychological services. One-fourth received
mobility-related services (e.g., assistive technology devices or
services), while 17 percent received medical services.

One-third of consumers participated in postsecondary education, while
only 3 percent received other education services (e.g., GED preparation,
tutoring, instruction in Braille). Nearly two-fifths (38 percent) of
consumers received miscellaneous support services, such as
transportation or maintenance. Finally, nearly all consumers
(95 percent) received case management services, which include activities
that occur at the outset of the VR process such as eligibility
determination activities and development of the IPE, as well as
amendment to the IPE as necessary. Overall, other than case management
services, consumers most often received medical evaluation services,
followed by miscellaneous support services. About one-third received
cognitive/psychological assessment, cognitive/psychological treatment,
employment development, or postsecondary education, and one-quarter
received mobility-related services.

With regard to service delivery arrangements, the VR program most
frequently purchases services from vendors, such as postsecondary
institutions, community rehabilitation programs, physicians, and many
other providers, to assist consumers in achieving their vocational
goals. For a number of services, VR agency staff may deliver services
directly or may purchase them (e.g., job development and placement
services). Finally, the program may arrange services for consumers who
may be eligible to have the costs of those services paid by some other
means (e.g., Pell grants for postsecondary tuition). Overall, 96 percent
of VR consumers received services that the agency provided directly
(Table 2-3); 87 percent received services that the agency purchased;
28 percent received services arranged by agency staff to be covered
under comparable benefits; and 44 percent received a service for which
the agency obtained existing records from other sources (e.g., a medical
evaluation) in connection with that service.

Delivery arrangements varied substantially according to the category of
services delivered (Table 2-3). Predictably, VR agency staff provided
all case management services directly. Conversely, VR purchased the
majority of assessment services that consumers received. Most of the
mobility assessments, cognitive/psychological assessments, and medical
evaluations were purchased, as were over half of the education/training
assessments. Among assessment services, the category of service that
consumers most often received directly from agency staff was educational
or vocational assessment. For over half of consumers, the VR agency
obtained existing records to document medical status (60 percent); a
smaller percentage (39 percent) obtained records in connection with
psychological/cognitive assessments.

With the exception of cognitive/psychological services, which included
counseling that VR staff provided directly to 84 percent of consumers
who received that service, VR obtained needed services through purchase
for most consumers. In terms of postsecondary education, for example,
for nearly all consumers receiving such services (33 percent), the
agency purchased the service (96 percent); about one-fourth also
received such services through comparable benefits. Similarly, for
nearly three-fourths of consumers receiving employment-development
services (about one-third of consumers overall), the agency purchased
the Number range CHAPTERservice; for about one-third of consumers
receiving services in this category, the agency provided the service

+---------------------------+--------+---+-----------------------+-------+
| Table 2-3. Percentage of  |        |   |                       |       |
| VR Consumers Receiving    |        |   |                       |       |
| Each Category Number      |        |   |                       |       |
| range CHAPTERof VR        |        |   |                       |       |
| Services, with Indication |        |   |                       |       |
| of Delivery               |        |   |                       |       |
| Arrangements\*            |        |   |                       |       |
+===========================+========+===+=======================+=======+
| Number range              | **% of |   | **Service category**  | **%   |
| CHAPTER**Service          | consu  |   |                       | of    |
| category**                | mers** |   |                       | c     |
|                           |        |   |                       | onsum |
|                           |        |   |                       | ers** |
+---------------------------+--------+---+-----------------------+-------+
| ###### All services\*\*   | **     |   | ###### Medical/physi  | **1   |
|                           | 97.6** |   | cal function services | 6.9** |
+---------------------------+--------+---+-----------------------+-------+
| Agency provided           | 95.9   |   | Agency provided       | 3.0   |
+---------------------------+--------+---+-----------------------+-------+
| Purchased                 | 87.4   |   | Purchased             | 77.9  |
+---------------------------+--------+---+-----------------------+-------+
| Comparable benefits       | 28.1   |   | Comparable benefits   | 16.3  |
+---------------------------+--------+---+-----------------------+-------+
| VR obtained existing      | 44.0   |   | VR obtained existing  | 0.0   |
| record                    |        |   | record                |       |
+---------------------------+--------+---+-----------------------+-------+
| **Cognitive/psychological | **     |   | **Mobility-related    | **2   |
| assessment**              | 34.8** |   | services**            | 5.6** |
+---------------------------+--------+---+-----------------------+-------+
| Agency provided           | 8.1    |   | Agency provided       | 7.0   |
+---------------------------+--------+---+-----------------------+-------+
| Purchased                 | 72.0   |   | Purchased             | 92.9  |
+---------------------------+--------+---+-----------------------+-------+
| Comparable benefits       | 9.8    |   | Comparable benefits   | 11.6  |
+---------------------------+--------+---+-----------------------+-------+
| VR obtained existing      | 38.9   |   | VR obtained existing  | 0.0   |
| record                    |        |   | record                |       |
+---------------------------+--------+---+-----------------------+-------+
| **Education/training      | **     |   | **Postsecondary       | **3   |
| assessment**              | 30.9** |   | education services**  | 2.9** |
+---------------------------+--------+---+-----------------------+-------+
| Agency provided           | 42.4   |   | Agency provided       | 2.0   |
+---------------------------+--------+---+-----------------------+-------+
| Purchased                 | 54.3   |   | Purchased             | 96.3  |
+---------------------------+--------+---+-----------------------+-------+
| Comparable benefits       | 7.1    |   | Comparable benefits   | 25.2  |
+---------------------------+--------+---+-----------------------+-------+
| VR obtained existing      | 0.0    |   | VR obtained existing  | 0.0   |
| record                    |        |   | record                |       |
+---------------------------+--------+---+-----------------------+-------+
| **Medical/physical        | **     |   | **Other education     | **    |
| function assessment**     | 61.8** |   | services**            | 3.0** |
+---------------------------+--------+---+-----------------------+-------+
| Agency provided           | 15.2   |   | Agency provided       | 7.8   |
+---------------------------+--------+---+-----------------------+-------+
| Purchased                 | 71.0   |   | Purchased             | 71.2  |
+---------------------------+--------+---+-----------------------+-------+
| Comparable benefits       | 11.9   |   | Comparable benefits   | 18.7  |
+---------------------------+--------+---+-----------------------+-------+
| VR obtained existing      | 60.1   |   | VR obtained existing  | 0.0   |
| record                    |        |   | record                |       |
+---------------------------+--------+---+-----------------------+-------+
| **Mobility assessment**   | *      |   | **Miscellaneous       | **3   |
|                           | *6.1** |   | support services**    | 7.7** |
+---------------------------+--------+---+-----------------------+-------+
| Agency provided           | 19.2   |   | Agency provided       | 19.5  |
+---------------------------+--------+---+-----------------------+-------+
| Purchased                 | 77.8   |   | Purchased             | 91.7  |
+---------------------------+--------+---+-----------------------+-------+
| Comparable benefits       | 6.5    |   | Comparable benefits   | 2.8   |
+---------------------------+--------+---+-----------------------+-------+
| VR obtained existing      | 1.6    |   | VR obtained existing  | 0.1   |
| record                    |        |   | record                |       |
+---------------------------+--------+---+-----------------------+-------+
| **Employment-development  | **     |   | **Case management     | **9   |
| services**                | 32.8** |   | services**            | 4.8** |
+---------------------------+--------+---+-----------------------+-------+
| Agency provided           | 32.5   |   | Agency provided       | 100.0 |
+---------------------------+--------+---+-----------------------+-------+
| Purchased                 | 72.5   |   | Purchased             | 0.0   |
+---------------------------+--------+---+-----------------------+-------+
| Comparable benefits       | 11.5   |   | Comparable benefits   | 0.0   |
+---------------------------+--------+---+-----------------------+-------+
| VR obtained existing      | 0.0    |   | VR obtained existing  | 0.0   |
| record                    |        |   | record                |       |
+---------------------------+--------+---+-----------------------+-------+
| **Cognitive/psychological | **     |   |                       |       |
| services**                | 34.7** |   |                       |       |
+---------------------------+--------+---+-----------------------+-------+
| Agency provided           | 83.8   |   |                       |       |
+---------------------------+--------+---+-----------------------+-------+
| Purchased                 | 13.0   |   |                       |       |
+---------------------------+--------+---+-----------------------+-------+
| Comparable benefits       | 17.8   |   |                       |       |
+---------------------------+--------+---+-----------------------+-------+
| VR obtained existing      | 0.0    |   |                       |       |
| record                    |        |   |                       |       |
+---------------------------+--------+---+-----------------------+-------+
| \* Most services could be |        |   |                       |       |
| provided through more     |        |   |                       |       |
| than one mechanism (e.g., |        |   |                       |       |
| vocational evaluation     |        |   |                       |       |
| services were\            |        |   |                       |       |
| sometimes purchased and   |        |   |                       |       |
| sometimes provided        |        |   |                       |       |
| directly by VR agency     |        |   |                       |       |
| staff).                   |        |   |                       |       |
|                           |        |   |                       |       |
| \*\* For 2.4 percent of   |        |   |                       |       |
| persons whose status      |        |   |                       |       |
| indicated receipt of      |        |   |                       |       |
| services, data on         |        |   |                       |       |
| services were missing     |        |   |                       |       |
| from the\                 |        |   |                       |       |
| case files. These persons |        |   |                       |       |
| represent 20,602          |        |   |                       |       |
| consumers.                |        |   |                       |       |
+---------------------------+--------+---+-----------------------+-------+

directly. In the category of miscellaneous support services (e.g.,
transportation, housing assistance, or maintenance), nearly all such
services were purchased for consumers (92 percent), although VR agency
staff did provide such services directly to 20 percent of consumers who
received them. Similarly, VR purchased most of the mobility-related
(93 percent) or medical services (78 percent) that consumers received.

Overview of the VR Process

Persons with disabilities who apply for VR services typically work with
a VR counselor to establish eligibility for VR services. During this
time the applicant may receive a variety of assessments to support a
determination of eligibility. Following acceptance for services, VR
consumers work with their VR counselor to select a vocational goal and
develop a plan of services with the intent to enable the consumer to
achieve that goal. To support this planning process, consumers may
undergo further assessments (e.g., vocational evaluation to help the
consumer select a vocational goal and a plan of services) to clarify
service needs. Consumer and counselor, with help from others as
appropriate, plan the services, set a timetable for receipt of services,
determine intermediate objectives to keep the process moving toward the
vocational goal, and select the service providers. While the process is
generally the same for all consumers, the service plans vary
considerably, given the statutory requirement that each consumer will
have an *individualized* plan that meets his or her specific goals and
needs.

As this overview suggests, the relationship between the consumer and the
counselor is at the heart of the VR program; the counselor serves as a
gatekeeper for the system, exercising the responsibilities of statute
and regulation regarding program eligibility, services, and outcomes;
acting as a case manager to arrange a reasonable scope and sequence of
services to meet the consumer's needs; and working as a counselor and,
often, as an advocate to assist the consumer in his or her movement
through the VR service plan and into employment that optimally results
in long-term labor force participation. A number of prior studies have
documented the importance of the counselor not only as a case manager
but also as a key to consumers' persistence in following through with
the VR service plan---by working closely with consumers to assist in
resolving issues that may pose a challenge to success (e.g., Tashjian et
al., 1995; Hayward et al., 1991). In this section, we review data from
the study that may provide some insight into that process, including
consumers' perspectives on the relationship.

Organization of the Counselor's Functions

According to a survey of VR counselors in offices participating in the
longi­tudinal study, counselors divide their time among a variety of case
management, services, and administrative functions. As shown in
Table 2-4, during a typical month counselors spend an average of
23 hours on eligibility determination activities, and an additional
average of 13 hours on vocational evaluation, which often occurs in
support of eligibility determination. IPE development requires 24 hours,
on average. Counseling with consumers requires nearly a week per month
(38 hours, on average), and job development and placement services about
19 hours. Counselors spend over one week per month (44 hours) on file
management and documenta­tion, and around 21 hours per month on other
activities (including staff meetings or development).

+--------------------+---------------+---------------+---------------+
| Table 2-4.         |               |               |               |
| Organization of    |               |               |               |
| the Counselor      |               |               |               |
| Function: Time     |               |               |               |
| Spent on Counselor |               |               |               |
| Activities per     |               |               |               |
| Month              |               |               |               |
+--------------------+---------------+---------------+---------------+
| Number range       | **[Time per   | **Hours per   | **Average     |
| C                  | month]{       | month**       | minutes per   |
| HAPTER**Activity** | .underline}** |               | month per     |
|                    |               |               | case**        |
|                    | *             |               |               |
|                    | *Percentage** |               | **(caseload = |
|                    |               |               | 123)**        |
+--------------------+---------------+---------------+---------------+
| **Eligibility      |               |               |               |
| determination**    |               |               |               |
+--------------------+---------------+---------------+---------------+
| Mean               | 13.7          | 23.0          | 11.2          |
+--------------------+---------------+---------------+---------------+
| Median             | 10.0          | 16.7          |               |
+--------------------+---------------+---------------+---------------+
| **Cou              |               |               |               |
| nseling/guidance** |               |               |               |
+--------------------+---------------+---------------+---------------+
| Mean               | 22.7          | 37.9          | 18.5          |
+--------------------+---------------+---------------+---------------+
| Median             | 20.0          | 33.4          |               |
+--------------------+---------------+---------------+---------------+
| **Vocational       |               |               |               |
| evaluation**       |               |               |               |
+--------------------+---------------+---------------+---------------+
| Mean               | 8.0           | 13.4          | 6.5           |
+--------------------+---------------+---------------+---------------+
| Median             | 5.0           | 8.4           |               |
+--------------------+---------------+---------------+---------------+
| **IPE              |               |               |               |
| development**      |               |               |               |
+--------------------+---------------+---------------+---------------+
| Mean               | 14.1          | 23.5          | 11.5          |
+--------------------+---------------+---------------+---------------+
| Median             | 10.0          | 16.7          |               |
+--------------------+---------------+---------------+---------------+
| **Job development  |               |               |               |
| and placement**    |               |               |               |
+--------------------+---------------+---------------+---------------+
| Mean               | 11.1          | 18.5          | 9.0           |
+--------------------+---------------+---------------+---------------+
| Median             | 10.0          | 16.7          |               |
+--------------------+---------------+---------------+---------------+
| **File management  |               |               |               |
| and                |               |               |               |
| documentation**    |               |               |               |
+--------------------+---------------+---------------+---------------+
| Mean               | 26.2          | 43.8          | 21.3          |
+--------------------+---------------+---------------+---------------+
| Median             | 20.0          | 33.4          |               |
+--------------------+---------------+---------------+---------------+
| **Other            |               |               |               |
| activities**       |               |               |               |
+--------------------+---------------+---------------+---------------+
| Mean               | 12.3          | 20.5          | 10.0          |
+--------------------+---------------+---------------+---------------+
| Median             | 10.0          | 16.7          |               |
+--------------------+---------------+---------------+---------------+

Number range CHAPTERAs this table also reports, VR counselors average a
case load of 123 persons. While the flow of persons into and through the
system is not constant (i.e., the number of persons applying for VR or
exiting VR varies from month to month), given the average case load
size, the typical counselor has relatively little time available to
provide services to any one consumer. On average, a counselor spends
less than 15 minutes per person per month on eligibility deter­mina­tion,
less than 20 minutes on counseling activities, and about 20 minutes per
month on file management. It is useful to consider these constraints in
an examination of the VR process and the range of services that VR
consumers receive either directly from their counselor or through the
counselor's efforts to arrange and facilitate services to meet
consumers' vocational goals and other related needs.

Number range CHAPTEREligibility and IPE Development Activities

Number range CHAPTERVR counselors devote over one-third of their time to
services associated with eligibility determination and IPE develop­ment,
not including required file documentation. As shown in Table 2-5, the VR
counselor was the principal agency staff person involved in eligibility
determination (99 percent of consumers' counselors worked with the
consumer to assess eligibility). Other staff involved included a
psychologist (for 10 percent of consumers), casework technician
(8 percent), or vocational evaluator (6 percent). Counselors most
frequently consulted a medical evaluation to support eligibility
decisions (80 percent of consumers), followed by other evaluations
(e.g., psychological or educational) (60 percent) and vocational
evaluation (22 percent). Consumer input was a key source of information
for 88 percent of consumers. Other sources of input for eligibility
decisions included service providers (28 percent), family, friends, or
advocates (17 percent), or education or training staff (12 percent).
Nearly all files (94 percent) contained clear evidence of consumer
involvement in the eligibility determination process.

Number range CHAPTERAs noted earlier in this chapter, to support both
eligibility and planning decisions, VR counselors often purchase,
arrange, or conduct assessments of consumers' medical or other status.
Data from the study indicated that 74 percent of consumers received some
form of assessment service in connection with eligibility determination,
and 50 percent received assessment services in connection with selection
of vocational goal and other activities associated with IPE development.
(Overall, 81 percent of VR consumers received at least one assessment
service during their VR services.) Systemwide, 62 percent of assessment
services delivered to VR applicants and consumers occurred at the
eligibility determination stage, while 38 percent were associated with
service planning.Number range CHAPTER

Tables 2-6 and 2-7 report information on the service planning and
imple­mentation process. Key staff working with the consumer to develop
the IPE included the VR counselor, a vocational evaluator, casework
technician, and a VR counselor other than the consumer's counselor
(typically a supervisor). In addition to the vocational goal, IPEs
typically included three intermediate objectives. As shown in Table 2-6,
IPE documentation indicated that consumers achieved 43 percent of those
intermediate objectives and failed to achieve about 12 percent. Nearly
one-third were still in process at the time study data collection ended
for the consumer.

Nearly all (96 percent) IPEs were signed by the consumer or a
representative (Table 2-7); 92 percent identified the providers of
services to be delivered under the IPE; 88 percent identified related
services and benefits to be delivered; and 88 percent specified delivery
of services in an appropriately integrated setting. In cases where
appropriate, 99 percent of IPEs

+-----------------------------------------------------------+----------+
| **Table 2-7. Documentation of IPE Components Among        |          |
| Consumers Who Completed an IPE**                          |          |
+-----------------------------------------------------------+----------+
| Number range CHAPTER**IPE component**                     | **P      |
|                                                           | ercent** |
+-----------------------------------------------------------+----------+
| > Signature of consumer or representative                 | 95.9     |
+-----------------------------------------------------------+----------+
| > Specification of terms for provision of services in the | 87.6     |
| > most integrated setting possible                        |          |
+-----------------------------------------------------------+----------+
| > List of providers of services                           | 92.2     |
+-----------------------------------------------------------+----------+
| > Identification of related services and benefits to      | 88.0     |
| > enhance consumer\'s capacity to achieve IPE objectives  |          |
+-----------------------------------------------------------+----------+
| > Preparation of the IPE in the consumer\'s native        | 99.1     |
| > language                                                |          |
+-----------------------------------------------------------+----------+
| > Statement of rehabilitation technology services to be   | 37.5     |
| > provided                                                |          |
+-----------------------------------------------------------+----------+
| > List of specific on-the-job or other personal           | 39.2     |
| > assistance services to be provided                      |          |
+-----------------------------------------------------------+----------+
| > Statement of consumer involvement in selection of goals | 69.4     |
+-----------------------------------------------------------+----------+
| > Statement of consumer involvement in setting of         | 63.3     |
| > intermediate objectives                                 |          |
+-----------------------------------------------------------+----------+
| > Statement of consumer involvement in selecting services | 63.6     |
+-----------------------------------------------------------+----------+
| > Statement of consumer involvement in selecting service  | 59.7     |
| > providers                                               |          |
+-----------------------------------------------------------+----------+
| > Statement of consumer involvement in determining the    | 59.1     |
| > process through which services would be provided        |          |
+-----------------------------------------------------------+----------+
| Multiple responses were possible.                         |          |
+-----------------------------------------------------------+----------+

Number range CHAPTERwere in the consumer's native language. Around
two-fifths listed specific other services to be provided, including
on-the-job or other personal assistance and rehabilitation technology
services. Around two-thirds of IPEs documented consumers' involvement in
IPE development activities, including selection of goals (69 percent),
setting of intermediate objectives (63 percent), selection of services
(64 percent) and providers (60 percent), and decisions regarding the
service process (59 percent). Overall, 24 percent of VR consumers
amended their IPE at least once during VR services; 18 percent changed
their vocational goal.

The Consumer-Counselor Relationship

We examined two aspects of the relationship between the consumer and his
or her VR counselor from the perspective of consumers. First was a
series of items designed to assess the extent to which consumers
believed they had sufficient control of decisions about goals, services,
and providers, and had adequate choices available in making decisions
during planning and services. The second was a series of items examining
consumers' perspectives on the quality of the relationship with the
counselor as the two worked together to plan and implement services.
Together, these topics provide insight on the importance of the
consumer-counselor relationship as one factor in whether the VR
experience is a productive one for consumers.

Table 2-8 reports findings regarding the decision process associated
with selection of the vocational goal, determination of services to be
provided, and availability of service providers. As shown, over
one-third of consumers indicated that they selected their vocational
goal; an additional 46 percent reported that the decision on vocational
goal was a joint one between consumer and counselor. Only 7 percent
believed that the counselor made the decision on his/her own. Overall,
81 percent of consumers believed that they had enough choice in
selection of the goal, and 80 percent were either very or mostly
satisfied with that goal. Six percent were very dissatisfied.

In terms of services, 20 percent of consumers reported making the
decisions about services, and 67 percent reported that they and their
counselor made the decision together. Ten percent reported that the
counselor made the decision. Nearly 50 percent were very satisfied with
available services, and 29 percent were mostly satisfied. Six percent
were very dissatisfied. The findings regarding selection of providers,
however, were somewhat different. Two-fifths of consumers reported that
their counselor was the primary decision maker regarding service
providers; an additional two-fifths reported that they made the decision
either alone or in concert with their counselor. Nevertheless,
81 percent believed that the counselor had provided sufficient
information regarding providers to permit the consumer to make the best
choices. This apparent discrepancy may be explained in part by the fact
that in many localities, a limited number of providers for specific
services are available, thus reducing the range of options that a
consumer can consider. Overall, one-half of consumers reported the
perception that they were in charge of decisions during the VR process
to a great extent; an additional 41 percent reported being in charge to
some extent. Nine percent did not believe they were in charge of
decision making regarding their VR services.

As shown in Table 2-9, 89 percent of VR consumers reported that their VR
counselor was sufficiently attentive to their needs, showing interest,
attention, and concern. Eleven percent commented that their counselor
rarely or never showed adequate concern. Seventy-seven percent of
consumers reported that their counselor was always willing to listen to
their ideas and suggestions regarding their VR services; an additional
15 percent commented that their counselor sometimes listened. Regarding
the eligibility process, 79 percent of consumers believed that VR made
the deter­mination of eligibility quickly enough. Overall, three-quarters

  -----------------------------------------------------------------------------
  Table 2-8. Consumer's Perspectives on the Amount of Choice and  
  Control They Exercised in Working with Their VR Counselor to    
  Develop and Implement Their IPE                                 
  --------------------------------------------------------------- -------------
  Number range CHAPTER**Consumer perspective**                    **Percent**

  **Decision process for selection of vocational goal**           

  Consumer made the decision                                      35.6

  Consumer and counselor decided together                         45.8

  VR counselor made the decision                                  6.5

  Consumer already had a job                                      5.6

  Other                                                           6.9

  **Consumer believed he/she had enough choice in selection of    
  vocational goal**                                               

  Yes                                                             81.3

  No                                                              18.7

  **Consumer's level of satisfaction with services**              

  Very satisfied                                                  55.3

  Mostly satisfied                                                24.5

  Indifferent                                                     7.9

  Somewhat dissatisfied                                           6.8

  Very dissatisfied                                               5.5

  **Decision process for selection of services**                  

  Consumer made the decision                                      19.9

  Consumer and counselor decided together                         67.4

  VR counselor made the decision                                  9.5

  Other                                                           3.3

  **Consumer's level of satisfaction with available services**    

  Very satisfied                                                  48.4

  Mostly satisfied                                                29.3

  Indifferent                                                     8.4

  Somewhat dissatisfied                                           8.2

  Very dissatisfied                                               5.7

  **Decision process for selection of service providers**         

  Consumer made the decision                                      21.9

  Consumer and counselor decided together                         17.8

  VR counselor made the decision                                  41.4

  Other                                                           19.0

  **Consumer's level of satisfaction with available service       
  providers**                                                     

  Very satisfied                                                  58.3

  Mostly satisfied                                                25.1

  Indifferent                                                     6.0

  Somewhat dissatisfied                                           6.0

  Very dissatisfied                                               4.6

  **Counselor provided adequate information about service         
  providers so that consumer could make the best choices**        

  Yes                                                             80.6

  No                                                              19.4

  **Consumer's overall perception of being in charge of decisions 
  during the VR process**                                         

  To a great extent                                               50.1

  To some extent                                                  40.8

  Not at all                                                      9.1
  -----------------------------------------------------------------------------

of consumers were very or mostly satisfied with their counselors'
efforts to help them work toward achieving an employment outcome;
8 percent were very dissatisfied with their counselor's efforts. In
general, consumers reported relatively high levels of satisfaction with
the quality of their relationship with their VR counselor, believing
that the counselor was working for them to assist in meeting their
employment-related and support needs as they moved through the VR
process. A relatively small percentage, around 10 percent, were
consistently dissatisfied with their interactions with their counselor,
with their counselor's efforts and concern, and with their control over
their VR services. Later chapters of this report explore the
implications of the consumer-counselor relationship as it affects the
likelihood that consumers are able to achieve their vocational goals
through exiting VR with an employment outcome.

Number range CHAPTERChapter 3\
Receipt of Specific VR Services

This chapter reports, for each of the 12 broad categories of services
described in Chapter 2, details of individual services that consumers
received during their participation in VR. Within each category of
services, we report the specific details that follow:

> P number and percentage of consumers who received each service;
>
> P delivery arrangements;
>
> P duration;[^6]
>
> P costs of purchased services and estimated costs of services arranged
> through comparable benefits, where sufficient data were available;
>
> P average number of each service for consumers receiving those
> services; and
>
> P actions resulting from the service in terms of consumers' progress
> through VR services.

For services that very few consumers received (generally less than
10,000 or 1 percent of VR consumers), we have limited data contained in
the report regarding the numbers and percentages of persons who received
the services; the size of the sample representing the group is too small
to warrant reporting of other details regarding those services.

Cognitive/Psychological Assessment Services

Cognitive or psychological assessment included psychological/psychiatric
evaluation, neuropsychological evaluation, and social/psychosocial
evaluation. Thirty percent of VR consumers received psychological or
psychiatric evaluation (Table 3-1), conducted over a period of between
one day and approximately one month.[^7] VR agencies purchased these
evaluations for most of their consumers (71 percent) with an average
cost of \$215 (median \$170)

(Table 3-2 ), although they also often obtained existing records in
connection with these assessments (40 percent). Very few consumers
received either a neuropsychological evaluation (4 percent of consumers)
or an assessment of social/psychosocial adjustment (3 percent). Among
those who did receive such assessments, VR typically purchased the
service, though again the agency often obtained existing records in
connection with the assessment. Average costs to VR for
neuropsychological assessment was \$412 (median \$420) and \$430 (median
\$150) for social/psychosocial adjustment assessment.

Consumers receiving any of these assessments generally received only one
(Table 3-3). The most frequent action resulting from psychological
evaluation was acceptance for VR services (92 percent of consumers
receiving this service); the resulting action for 30 percent of
consumers was ongoing counseling. Actions resulting from
neuropsychological evaluation included acceptance for VR services
(81 percent of consumers receiving this service), psychological
counseling (19 percent), cognitive rehabilitation (17 percent), or
vocational training (17 percent). Social adjustment evaluations,
received by a very small number of consumers, most often resulted in
recommendation of an occupational area (39 percent) or ongoing
counseling (38 percent).

  ------------------------------ ------------------- ------------ ------------
  Table 3-1. Percentage of                                        
  Consumers Receiving Cognitive                                   
  or Psychological Assessment                                     
  Services, by Type of Service,                                   
  Delivery Arrangements,\* and                                    
  Duration                                                        

  Number range CHAPTER           **% of consumers    **Duration   
  **Services (weighted n)**      receiving service** (in days)**  

                                                     **Mean**     **Median**

  **Psychological/psychiatric    **30.4**            **35.6**     **1.0**
  evaluation (262,943)**                                          

  Agency provided                8.3                              

  Purchased                      70.8                             

  Comparable benefits            9.5                              

  VR obtained existing record    39.8                             

  **Neuropsychological           **4.2**             **33.6**     **1.0**
  evaluation (36,392)**                                           

  Agency provided                2.5                              

  Purchased                      77.5                             

  Comparable benefits            11.2                             

  VR obtained existing record    27.1                             

  **Social/psychosocial          **2.7**             **61.1**     **1.0**
  adjustment evaluation                                           
  (23,039)**                                                      

  Agency provided                9.2                              

  Purchased                      52.8                             

  Comparable benefits            12.9                             

  VR obtained existing record    42.5                             

  \* Most services could be                                       
  provided through more than one                                  
  mechanism (e.g., vocational                                     
  evaluation services were                                        
  sometimes purchased and                                         
  sometimes provided directly by                                  
  VR agency staff). For some                                      
  services the number of                                          
  consumers receiving the                                         
  service precluded reporting of                                  
  details.                                                        
  ------------------------------ ------------------- ------------ ------------

  ------------------------------ ------------------- ----------- ------------
  Number range CHAPTERTable 3-2.                                 
  Costs of Purchased Services                                    
  and Comparable Benefits for                                    
  Cognitive or Psychological                                     
  Assessment Services                                            

  **Services (weighted n)**      **% receiving       **Costs**   
                                 service**                       

                                                     **Mean**    **Median**

  **Psychological/psychiatric    30.4                            
  evaluation (262,943)**                                         

  Purchased                                          \$215       \$170

  Comparable benefits                                N/A         N/A

  **Neuropsychological           4.2                             
  evaluation (36,392)**                                          

  Purchased                                          \$412       \$420

  Comparable benefits                                N/A         N/A

  **Social/psychosocial          2.7                             
  adjustment evaluation                                          
  (23,039)**                                                     

  Purchased                                          \$430       \$150

  Comparable benefits                                N/A         N/A
  ------------------------------ ------------------- ----------- ------------

  ------------------------------------------ ------------ ------------ -------------
  Table 3-3. Results of Cognitive Assessment                           
  Services Among VR Consumers Who Received                             
  Those Services                                                       

  Number range CHAPTER**Services (weighted   **Services                
  n)**                                       received**                

                                             **Mean**     **Median**   **Percent**

  **Psychological/psychiatric evaluation     **1.2**      **1.0**      **30.4**
  (262,943)**                                                          

  Ongoing counseling                                                   30.0

  Drug intervention                                                    8.7

  Hospitalization or other residential care                            2.6

  Acceptance for VR services                                           91.8

  Extended evaluation                                                  5.8

  Other                                                                14.9

  **Neuropsychological evaluation (36,392)** **1.1**      **1.0**      **4.2**

  Cognitive rehabilitation                                             16.7

  Psychological counseling                                             18.5

  Further education                                                    11.8

  Vocational training                                                  16.7

  Physical therapy                                                     5.6

  Social/recreational therapy                                          4.2

  Acceptance for VR services                                           81.3

  Extended evaluation                                                  6.6

  Other                                                                22.4

  **Social/psychosocial adjustment           **1.1**      **1.0**      **2.7**
  evaluation (23,039)**                                                

  Personal adjustment training                                         15.7

  Work adjustment training                                             17.2

  Ongoing counseling                                                   38.1

  Occupational fields                                                  39.3

  Other                                                                43.5

  Multiple responses were possible.                                    
  ------------------------------------------ ------------ ------------ -------------

Number range CHAPTEREducation/Training Assessment Services

Over one-fourth of consumers received a vocational assessment as part of
eligibility determination or IPE development (Table 3-4), while
relatively few consumers (7 percent) participated in an evaluation of
educational status or needs. In terms of vocational evaluation,
9 percent of consumers received this service at the office from which
they received VR services, working with their counselor and other VR
agency staff, while 21 percent received this service off-site, primarily
as a purchased service from a vendor (74 percent). Average cost of
purchased vocational evaluation was \$964 (median \$475) (Table 3-5).
In-house evaluations averaged 27 days (median 4.0), while off-site
evaluations were longer (mean 49 and median 18 days). As shown in
Table 3-6 , the principal actions resulting from vocational evaluation
were determination of an appropriate occupational area (84 percent of
consumers who received this service on-site; 77 percent for off-site)
and establishment of a vocational goal (73 percent on-site and
61 percent off-site). Other actions included recommendation of
counseling (65 and 37 percent), work adjustment services (16 and
22 percent), and vocational training (26 percent in both cases).

Agency staff provided nearly half (47 percent) of the educational status
evaluations that consumers received, with 25 percent purchased, at an
average cost of \$296 (median \$130) and 20 percent arranged through
comparable benefits. These evaluations extended over a period of 95
days, on average (median of 15) (see Tables 3-4 and 3-5). For
educational status evaluation, the chief resulting actions were
enrollment in an education program: 22 percent receiving this service
enrolled in vocational training; 11 percent in a 2-year postsecondary
program, and 9 percent in a 4-year postsecondary program (see
Table 3-6).

+-------------------------------+-------------------+--------+--------+
| Table 3-4. Percentage of      |                   |        |        |
| Consumers Receiving Education |                   |        |        |
| or Training Assessment        |                   |        |        |
| Services, by Type of Service, |                   |        |        |
| Delivery Arrangements,\* and  |                   |        |        |
| Duration                      |                   |        |        |
+-------------------------------+-------------------+--------+--------+
| Number range                  | **% of consumers  | **Du   |        |
| CHAPTER**Services (weighted   | receiving         | ration |        |
| n)**                          | service**         | (in    |        |
|                               |                   | d      |        |
|                               |                   | ays)** |        |
+-------------------------------+-------------------+--------+--------+
|                               |                   | **     | **Me   |
|                               |                   | Mean** | dian** |
+-------------------------------+-------------------+--------+--------+
| **Vocational evaluation**     |                   |        |        |
+-------------------------------+-------------------+--------+--------+
| > **In-house (78,278)**       | **9.0**           | **     | *      |
|                               |                   | 27.0** | *4.0** |
+-------------------------------+-------------------+--------+--------+
| > Agency provided             | 100.0             |        |        |
+-------------------------------+-------------------+--------+--------+
| > Purchased                   | 0.0               |        |        |
+-------------------------------+-------------------+--------+--------+
| > Comparable benefits         | 0.0               |        |        |
+-------------------------------+-------------------+--------+--------+
| > **Off-site (177,837)**      | **20.6**          | **     | **     |
|                               |                   | 48.6** | 18.0** |
+-------------------------------+-------------------+--------+--------+
| > Agency provided             | 19.8              |        |        |
+-------------------------------+-------------------+--------+--------+
| > Purchased                   | 74.4              |        |        |
+-------------------------------+-------------------+--------+--------+
| > Comparable benefits         | 4.2               |        |        |
+-------------------------------+-------------------+--------+--------+
| > VR obtained existing record | 0.0               |        |        |
+-------------------------------+-------------------+--------+--------+
| **Educational status          | **7.1**           | **     | **     |
| evaluation (61,160)**         |                   | 95.4** | 15.0** |
+-------------------------------+-------------------+--------+--------+
| > Agency provided             | 46.7              |        |        |
+-------------------------------+-------------------+--------+--------+
| > Purchased                   | 25.2              |        |        |
+-------------------------------+-------------------+--------+--------+
| > Comparable benefits         | 19.5              |        |        |
+-------------------------------+-------------------+--------+--------+
| > VR obtained existing record | 0.0               |        |        |
+-------------------------------+-------------------+--------+--------+
| \* Most services could be     |                   |        |        |
| provided through more than    |                   |        |        |
| one mechanism (e.g.,          |                   |        |        |
| vocational evaluation         |                   |        |        |
| services were sometimes       |                   |        |        |
| purchased and sometimes       |                   |        |        |
| provided directly by VR       |                   |        |        |
| agency staff). For some       |                   |        |        |
| services the number of        |                   |        |        |
| consumers receiving the       |                   |        |        |
| service precluded reporting   |                   |        |        |
| of details.                   |                   |        |        |
+-------------------------------+-------------------+--------+--------+

Number range CHAPTER

  ------------------------------- -------------------- ----------- ------------
  Table 3-5. Costs of Purchased                                    
  Services and Comparable                                          
  Benefits for Education and                                       
  Training Assessment Services                                     

  **Services (weighted n)**       **% receiving        **Costs**   
                                  service**                        

                                                       **Mean**    **Median**

  **Vocational evaluation         **28.3**                         
  (238,856)**                                                      

  Purchased                                            \$964       \$475

  Comparable benefits                                  N/A         N/A

  **Educational status evaluation **7.1**                          
  (61,160)**                                                       

  Purchased                                            \$296       \$130

  Comparable benefits                                  N/A         N/A
  ------------------------------- -------------------- ----------- ------------

Number range CHAPTER

  ------------------------------------------ ------------ ------------ -------------
  Table 3-6. Results of Education or                                   
  Training Assessment Services Among                                   
  Consumers Who Received Those Services                                

  **Services (weighted n)**                  **Services                
                                             received**                

                                             **Mean**     **Median**   **Percent**

  **Vocational evaluation**                                            28.0

  **In-house (78,278)**                      **1.1**      **1.0**      **9.1**

  Determined occupational areas                                        84.0

  Set vocational goal                                                  73.0

  Work adjustment training                                             16.4

  Educational program                                                  30.4

  Vocational training                                                  26.2

  Counseling                                                           64.7

  Job placement                                                        13.6

  Extended evaluation                                                  6.5

  Supported employment                                                 2.0

  Closed, not eligible                                                 0.4

  **Off-site (177,837)**                     **1.2**      **1.0**      **20.6**

  Determined occupational areas                                        77.3

  Set vocational goal                                                  61.2

  Work adjustment training                                             22.3

  Educational program                                                  17.1

  Vocational training                                                  26.2

  Counseling                                                           37.0

  Job placement                                                        14.6

  Extended evaluation                                                  9.1

  Supported employment                                                 6.9

  **Educational status evaluation (61,160)** **1.1**      **1.0**      **7.1**

  Enrolled in basic skills/literacy program                            4.8

  Enrolled in GED/high school program                                  7.3

  Enrolled in vocational training program                              21.9

  Enrolled in 2-year academic program                                  10.9

  Enrolled in 4-year academic program                                  9.4

  Enrolled in other program                                            44.2

  Multiple responses were possible.                                    
  ------------------------------------------ ------------ ------------ -------------

Number range CHAPTERMedical or Function Assessment Services

Over half of VR consumers received medical or function evaluations
(62 percent, see Table 2-2), including medical evaluation (54 percent),
assessment of vision function (13 percent), hearing function
(9 percent), speech/communication function (1 percent), or dental
evaluation (2 percent) (Table 3-7). The agency purchased medical
evaluations (63 percent) and obtained extant records (61 percent) as
supporting documentation. For a small percentage of consumers, the
agency conducted a medical evaluation (15 percent) or arranged this
service through comparable benefits (10 percent). The cost of purchased
evaluations averaged \$170; those arranged through comparable benefits
averaged \$541 (Table 3-8). Duration of service was typically 2 days
(median 1.0). Consumers mostly had vision or hearing assessments
purchased on their behalf (90 percent and 85 percent, respectively),
although agency staff provided some vision assessments to consumers
(19 percent). Purchased vision assessments averaged \$86, while those
arranged through comparable benefits averaged \$39. Comparable cost for
purchased hearing assessment services was \$115, on average. Some
consumers spent extensive time in these assessments (33 days for vision
and 45 days for hearing assessments), although generally the assessment
occurred in 1 day. Nearly 60 percent of hearing assessments occurred in
one-day; the comparable figure for vision assessment was 52 percent.

The chief action resulting from medical evaluations was acceptance for
VR services (87 percent of consumers who received this service)
(Table 3-9). Other resulting actions included restrictions on
occupational areas or activities (34 percent), further evaluation
(30 percent), or medical treatment (20 percent). For most consumers
receiving a vision assessment, the resulting action was purchase of a
low vision aid (57 percent), while for those with a hearing assessment
it was purchase of a hearing aid (67 percent).

Number range CHAPTER

  -------------------------------- ------------------- ------------ ------------
  Table 3-7. Percentage of                                          
  Consumers Receiving Medical or                                    
  Physical Function Assessment                                      
  Services, by Type of Service,                                     
  Delivery Arrangements,\* and                                      
  Duration                                                          

  **Services (weighted n)**        **% of consumers    **Duration   
                                   receiving service** (in days)**  

                                                       **Mean**     **Median**

  **Medical evaluation (467,784)** **54.1**            **2.0**      **1.0**

  Agency provided                  14.5                             

  Purchased                        63.0                             

  Comparable benefits              10.2                             

  VR obtained existing record      60.9                             

  **Vision assessment (107,936)**  **12.5**            **32.7**     **1.0**

  Agency provided                  19.1                             

  Purchased                        89.8                             

  Comparable benefits              12.3                             

  VR obtained existing record      39.2                             

  **Hearing assessment (77,547)**  **9.0**             **44.8**     **1.0**

  Agency provided                  4.4                              

  Purchased                        85.4                             

  Comparable benefits              7.5                              

  VR obtained existing record      26.7                             

  **Dental evaluation (16,217)**   **1.9**             **1.4**      **1.0**

  Agency provided                  0.8                              

  Purchased                        96.1                             

  Comparable benefits              1.6                              

  VR obtained existing record      11.8                             

  **Speech/communication           **1.1**                          
  assessment\* (9,346)**                                            

  \* Most services could be                                         
  provided through more than one                                    
  mechanism (e.g., vocational                                       
  evaluation services were                                          
  sometimes purchased and                                           
  sometimes provided directly by                                    
  VR agency staff). For some                                        
  services the number of consumers                                  
  receiving the service precluded                                   
  reporting of details.                                             
  -------------------------------- ------------------- ------------ ------------

  ----------------------------------- ------------------ ----------- ------------
  Number range CHAPTERTable 3-8.                                     
  Costs of Purchased Services and                                    
  Comparable Benefits for Medical or                                 
  Physical Function Assessment                                       
  Services                                                           

  **Services (weighted n)**           **% receiving      **Costs**   
                                      service**                      

                                                         **Mean**    **Median**

  **Medical evaluation (467,784)**    **54.1**                       

  Purchased                                              \$170       \$46

  Comparable benefits                                    \$541       \$100

  **Vision assessment (107,936)**     **12.5**                       

  Purchased                                              \$86        \$60

  Comparable benefits                                    \$39        \$16

  **Hearing assessment (77,547)**     **9.0**                        

  Purchased                                              \$115       \$87

  Comparable benefits                                    N/A         N/A

  **Dental evaluation (16,217)**      **1.9**                        

  Purchased                                              \$315       \$58

  Comparable benefits                                    N/A         N/A
  ----------------------------------- ------------------ ----------- ------------

Number range CHAPTER

  ----------------------------------------- ------------ ------------ -------------
  Table 3-9. Results of Medical or Physical                           
  Function Assessment Services Among                                  
  Consumers Who Received Those Services                               

  **Services (weighted n)**                 **Services                
                                            received**                

                                            **Mean**     **Median**   **Percent**

  **Medical evaluation (467,784)**          **2.0**      **1.0**      **54.1**

  Assistive technology assessment                                     9.6

  Restricted occupational areas/activities                            33.8

  Medical treatment                                                   20.1

  Physical, occupational, or other therapy                            8.8

  Acceptance for VR services                                          86.9

  Acceptance for extended evaluation                                  5.7

  Further evaluation                                                  30.3

  Other                                                               15.9

  **Vision assessment (107,936)**           **1.7**      **1.0**      **12.5**

  Low vision aid                                                      57.2

  Referral for medical treatment                                      8.4

  Rehabilitation teaching                                             6.0

  Orientation and mobility instruction                                5.8

  Rehabilitation technology                                           3.8

  Other                                                               50.8

  **Hearing assessment (77,547)**           **1.4**      **1.0**      **9.0**

  Hearing aids                                                        67.0

  Closed captioned TV                                                 0.8

  TTY/TDD                                                             5.6

  Signaling devices                                                   3.8

  Pocket talker                                                       0.2

  Computer-assisted note taking devices                               0.4

  Hearing ear dog                                                     0.0

  Other                                                               29.6

  **Dental evaluation (16,217)**            **1.4**      **1.0**      **1.9**

  Dental treatment                                                    76.7

  Corrective device                                                   24.8

  Further evaluation                                                  15.3

  Other                                                               33.0

  Multiple responses were possible.                                   
  ----------------------------------------- ------------ ------------ -------------

Number range CHAPTERMobility Assessment Services

Mobility assessments included evaluation of the need for assistive
technology (AT), orientation/mobility assessment, driving assessment,
and independent living skills assessment. Very few consumers received
such assessments: 3.3 percent received an AT assessment, and slightly
over 1 percent received the other services (Table 3-10). When consumers
did receive these assessments, the VR agency generally purchased the
service: 78 percent for AT assessment, 68 percent for
orientation/mobility status, and 92 percent for driving assessment. As
shown in Table 3-11 , AT assessments averaged \$481;
orientation/mobility assessments averaged \$354; and driving assessments
cost \$334, on average. Length of service ranged from an average of 41
days (median 1) for AT assessment[^8] to 50 days (median 1) for driving
assessment. Actions resulting from these assessments were generally a
service: the result for 75 percent of consumers receiving AT assessment
was an AT device, while 52 percent of consumers receiving
orientation/mobility assessment were recommended for
orientation/mobility services (Table 3-12). For driving assessment, the
resulting action for 33 percent of consumers was a driver's license; for
59 percent the action was enrollment in driver's training.

Number range CHAPTER

  ------------------------------- ------------------- ------------ ------------
  Table 3-10. Percentage of                                        
  Consumers Receiving Mobility                                     
  Assessment Services, by Type of                                  
  Service, Delivery                                                
  Arrangements,\* and Duration                                     

  **Services (weighted n)**       **% of consumers    **Duration   
                                  receiving service** (in days)**  

                                                      **Mean**     **Median**

  **Assistive technology          **3.3**             **41.4**     **1.0**
  assessment (28,185)**                                            

  Agency provided                 19.0                             

  Purchased                       77.8                             

  Comparable benefits             5.5                              

  VR obtained existing record     0.0                              

  **Orientation/mobility          **1.4**             **31.7**     **5.0**
  assessment (12,280)**                                            

  Agency provided                 19.2                             

  Purchased                       67.8                             

  Comparable benefits             5.0                              

  VR obtained existing record     0.0                              

  **Driving assessment (12,208)** **1.4**             **50.1**     **11.0**

  Agency provided                 9.2                              

  Purchased                       91.5                             

  Comparable benefits             4.4                              

  VR obtained existing record     0.0                              

  **Independent living skills     **1.0**                          
  assessment\* (8,679)**                                           

  \* Most services could be                                        
  provided through more than one                                   
  mechanism (e.g., vocational                                      
  evaluation services were                                         
  sometimes purchased and                                          
  sometimes provided directly by                                   
  VR agency staff). For some                                       
  services the number of                                           
  consumers receiving the service                                  
  precluded reporting of details.                                  
  ------------------------------- ------------------- ------------ ------------

  ------------------------------- ------------------- ----------- ------------
  Number range CHAPTERTable 3-11.                                 
  Costs of Purchased Services and                                 
  Comparable Benefits for                                         
  Mobility-Related Assessment                                     
  Services                                                        

  **Services (weighted n)**       **% receiving       **Costs**   
                                  service**                       

                                                      **Mean**    **Median**

  **Assistive technology          **3.3**                         
  assessment (28,185)**                                           

  Purchased                                           \$481       \$246

  Comparable benefits                                 N/A         N/A

  **Orientation/mobility          **1.4**                         
  assessment (12,280)**                                           

  Purchased                                           \$354       \$311

  Comparable benefits                                 N/A         N/A

  **Driving assessment (12,208)** **1.4**                         

  Purchased                                           \$334       \$283

  Comparable benefits                                 N/A         N/A
  ------------------------------- ------------------- ----------- ------------

  -------------------------------------- ------------ ------------ -------------
  Number range CHAPTERTable 3-12.                                  
  Results of Mobility Assessment                                   
  Services Among Consumers Who Received                            
  Those Services                                                   

  **Services (weighted n)**              **Services                
                                         received**                

                                         **Mean**     **Median**   **Percent**

  **Assistive technology assessment      **1.2**      **1.0**      **3.3**
  (28,185)**                                                       

  Assistive technology device                                      74.8

  Assistive technology service                                     37.9

  Work site modification                                           17.4

  Job accommodation                                                12.2

  Residential modification                                         15.1

  Other                                                            34.9

  **Orientation/mobility assessment      **1.1**      **1.0**      **1.4**
  (12,280)**                                                       

  Orientation/mobility services                                    51.9

  Job modification                                                 12.0

  Residential accommodation                                        15.7

  Physical therapy                                                 19.0

  Other                                                            53.5

  **Driving assessment (12,208)**        **1.2**      **1.0**      **1.4**

  Approved for driver\'s license                                   32.8

  Driver\'s training                                               58.5

  Disapproved for driver\'s license                                12.9

  Other                                                            38.2

  Multiple responses were possible.                                
  -------------------------------------- ------------ ------------ -------------

Number range CHAPTERNumber range CHAPTERNumber range
CHAPTEREmployment-Development Services

A number of the services that VR makes available to consumers through
direct provision or through purchase have the objective to support
employability, facilitate movement into the labor force, and improve the
likelihood that consumers will be successful at maintaining labor force
attachment. Such services include job development and placement, job
search training, work adjustment or hardening, on-the-job training or
job trials, and supported or transitional employment. These services
differ from those we have classified as education services in that their
focus is not on specific training for specific occupations, but rather
on ability to learn the "culture" of work and to obtain, maintain, and
advance in a career. As shown in Table 3-13 , the employment-development
service that consumers most often received was job placement; over
90,000 persons (11 percent) received this service, averaging nearly 140
days (median of 95 days). For about half of these consumers the agency
purchased the service at an average cost of \$995 (Table 3-14); other
delivery arrangements included agency provided service (37 percent) or
arranging the service through comparable benefits (18 percent). The
average was 1.2 among persons who received job placement services
(median 1.0) (Table 3-15). The action resulting from this service was an
employment outcome for 63 percent of consumers.

Somewhat fewer consumers (10 percent) received job development services.
The agencies purchased this service for 63 percent of consumers who
received it at an average cost of \$1,119, and provided it directly for
39 percent. The average length of time from initiation to completion of
the service was 155 days (median of 93 days). This service resulted in
the offer of placement in a specific job for 45 percent of consumers
receiving the service; 31 percent exited with an employment outcome
(Table 3-15).

Eight percent of consumers received work adjustment training over an
average of 168 days (median of 91 days). Consumers receiving work
adjustment averaged 1.8 such services (median of 1.0). The agency
purchased 80 percent of these services at an average cost of \$2,342,
and also provided services directly for 25 percent of consumers
receiving this service. Two-thirds of participants completed their work
adjustment training; for 43 percent, the service resulted in job
placement; an additional 11 percent entered supported employment
following work adjustment services, while 13 percent entered vocational
training.

The agency purchased nearly all of the supported employment services
(93 percent) that consumers received, with an average cost of \$3,141.
Seven percent (around 62,000) received such services, with an average
duration of 166 days (median of 110 days). The most frequent action
resulting from receipt of supported employment services was maintenance
of the supported employment placement; 37 percent were placed in a
specific job, while 19 percent dropped out of supported employment
services. Forty-three percent exited VR with an employment outcome
following services.

Approximately 61,000 persons (7 percent of consumers) participated in
job search training; the agency purchased this service for 61 percent of
these consumers, with cost averaging \$646, and provided it directly to
40 percent. Training lasted 69 days on average (median of 45 days); with
consumers averaging 1.3 services (median of 1.0), indicating that a
small number of persons received the service at least twice. The most
frequent action resulting from this service was placement in a job
(48 percent of consumers who received the service), and one-third exited
the program with an employment outcome.

Finally, around 31,000 persons (3.6 percent) participated in on-the-job
training or job trails, nearly always purchased from a vendor
(81 percent of those receiving the service). The average cost of this
service was \$1,497. The participation period averaged 116 days (median
62). The most frequent action resulting from this participation was
placement in a job (55 percent of consumers who received the service),
with 40 percent achieving an employment outcome.

  -------------------------------- ------------------- ------------ ------------
  Number range CHAPTERTable 3-13.                                   
  Percentage of Consumers                                           
  Receiving Employment-Development                                  
  Services, by Type of Service,                                     
  Delivery Arrangements,\* and                                      
  Duration                                                          

  **Service (weighted n)**         **% of consumer     **Duration   
                                   receiving service** (in days)**  

                                                       **Mean**     **Median**

  **Job placement (91,400)**       **10.6**            **138.2**    **95.0**

  Agency provided                  37.4                             

  Purchased                        49.9                             

  Comparable benefits              17.8                             

  **Job development (83,686)**     **9.7**             **155.1**    **93.0**

  Agency provided                  39.1                             

  Purchased                        62.7                             

  Comparable benefits              7.0                              

  **Work adjustment (69,495)**     **8.0**             **168.2**    **91.0**

  Agency provided                  24.9                             

  Purchased                        79.1                             

  Comparable benefits              9.8                              

  **Supported employment           **7.2**             **165.5**    **110.0**
  (61,821)**                                                        

  Agency provided                  5.6                              

  Purchased                        92.9                             

  Comparable benefits              4.4                              

  **Job search training (61,145)** **7.1**             **68.7**     **45.0**

  Agency provided                  40.1                             

  Purchased                        60.8                             

  Comparable benefits              4.0                              

  **On-the-job training/job trial  **3.6**             **116.2**    **62.0**
  (31,244)**                                                        

  Agency provided                  11.5                             

  Purchased                        81.1                             

  Comparable benefits              7.2                              

  **Transitional employment\*      **0.6**                          
  (5,081)**                                                         

  **Work hardening\* (5,648)**     **0.4**                          

  \* Most services could be                                         
  provided through more than one                                    
  mechanism (e.g., vocational                                       
  evaluation services were                                          
  sometimes purchased and                                           
  sometimes provided directly by                                    
  VR agency staff). For some                                        
  services the number of consumers                                  
  receiving the service precluded                                   
  reporting of details.                                             
  -------------------------------- ------------------- ------------ ------------

  ------------------------------------ -------------- ----------- ------------
  Number range CHAPTERTable 3-14.                                 
  Costs of Purchased Services and                                 
  Comparable Benefits for                                         
  Employment-Development Services                                 

  **Services (weighted n)**            **% receiving  **Costs**   
                                       service**                  

                                                      **Mean**    **Median**

  **Job placement (91,400)**           **10.6**                   

  Purchased                                           \$995       \$600

  Comparable benefits                                 N/A         N/A

  **Job development (83,686)**         **9.7**                    

  Purchased                                           \$1,119     \$490

  Comparable benefits                                 N/A         N/A

  **Work adjustment (69,495)**         **8.0**                    

  Purchased                                           \$2,342     \$1,350

  Comparable benefits                                 N/A         N/A

  **Supported employment (61,821)**    **7.2**                    

  Purchased                                           \$3,141     \$2,000

  Comparable benefits                                 N/A         N/A

  **Job search training (61,145)**     **7.1**                    

  Purchased                                           \$646       \$258

  Comparable benefits                                 N/A         N/A

  **On-the-job training/job trial      **3.6**                    
  (31,244)**                                                      

  Purchased                                           \$1,497     \$1,022

  Comparable benefits                                 N/A         N/A
  ------------------------------------ -------------- ----------- ------------

  -----------------------------------------------------------------------------------
  Number range CHAPTERTable 3-15. Results of                            
  Employment-Development Services Among                                 
  Consumers Who Received Those Services                                 
  ------------------------------------------- ------------ ------------ -------------
  **Service (weighted n)**                    **Services                
                                              received**                

                                              **Mean**     **Median**   **Percent**

  **Job placement (91,400)**                  **1.2**      **1.0**      **10.6**

  Exited with employment outcome                                        62.9

  Exited without employment outcome                                     2.9

  Other                                                                 33.7

  **Job development (83,686)**                **1.4**      **1.0**      **9.7**

  Offered a specific job                                                45.7

  Exited with employment outcome                                        30.6

  Exited without employment outcome                                     5.2

  Other status change                                                   1.3

  Other                                                                 39.9

  **Work adjustment (69,495)**                **1.8**      **1.0**      **8.0**

  Completed program                                                     67.2

  Dropped out                                                           16.4

  Entered training                                                      12.6

  Entered education                                                     3.3

  Job placement                                                         42.7

  Supported employment                                                  10.6

  Exited with employment outcome                                        25.2

  Exited without employment outcome                                     7.0

  Exited other                                                          1.0

  Other                                                                 43.8

  **Supported employment (61,821)**           **1.9**      **1.0**      **7.2**

  Started a specific job                                                36.5

  Maintained a job placement                                            70.0

  Dropped out                                                           18.9

  Exited with employment outcome                                        42.8

  Exited without employment outcome                                     6.2

  Exited other                                                          1.3

  Other                                                                 38.3

  **Job search training (61,145)**            **1.3**      **1.0**      **7.1**

  Job placement                                                         48.3

  Exited with employment outcome                                        32.9

  Exited without employment outcome                                     6.7

  Exited other                                                          0.2

  Other                                                                 38.6

  **On-the-job training/job trial (31,244)**  **1.5**      **1.0**      **3.6**

  Dropped out                                                           8.9

  Job placement                                                         54.6

  Exited with employment outcome                                        40.2

  Exited without employment outcome                                     4.4

  Exited other                                                          0.9

  Other                                                                 35.5

  Multiple responses were possible.                                     
  -----------------------------------------------------------------------------------

Number range CHAPTERCognitive or Psychological Services

As shown in (Table 3-16), nearly 30 percent of VR consumers (257,237
persons) participated in counseling, most of the time with their VR
counselor (97 percent); a small percentage of counseling was purchased
(3 percent), with an average cost of \$540 (Table 3-17), and 12 percent
of the service was arranged through comparable benefits. The duration of
this service was nearly a year, averaging 349 days (median 197). Among
the actions resulting from participation in counseling (Table 3-18) were
job placement (33 percent), enrollment in an educational program
(23 percent), enrollment in vocational training (22 percent), and a
change in vocational goal (17 percent). For 35 percent of consumers, the
resulting action was achievement of an employment outcome.

Six percent of consumers received psychological or psychiatric treatment
services, either purchased on their behalf (49 percent) at an average
cost of \$531 or arranged through comparable benefits (31 percent).
Duration of the service among participants was 211 days, on average
(median 109). Among the actions resulting from this service were job
placement (14 percent), interruption of VR services (10 percent),
enrollment in work adjustment training (9 percent), and achievement of
an employment outcome (13 percent). For a substantial percentage of
consumers (51 percent) case records indicated other outcomes.

Among the 14,000 persons who received substance abuse services (less
than 2 percent of VR consumers), the service was most frequently
arranged through comparable benefits (47 percent). Average cost when
purchased by VR was \$290. Actions resulting from this service included
job placement (23 percent), interruption of services (11 percent),
achievement of an employment outcome (25 percent), and other actions
(44 percent).

Number range CHAPTER

  -------------------------------- ------------------- ------------ ------------
  Table 3-16. Percentage of                                         
  Consumers Receiving Cognitive or                                  
  Psychological Services, by Type                                   
  of Service, Delivery                                              
  Arrangements,\* and Duration                                      

  **Services (weighted n)**        **% of consumers    **Duration   
                                   receiving service** (in days)**  

                                                       **Mean**     **Median**

  **Counseling (257,237)**         **29.8**            **348.6**    **197.0**

  Agency provided                  96.9                             

  Purchased                        2.8                              

  Comparable benefits              12.2                             

  **Psychological/psychiatric      **6.1**             **210.6**    **109.0**
  treatment (52,595)**                                              

  Agency provided                  5.5                              

  Purchased                        49.0                             

  Comparable benefits              30.7                             

  **Substance abuse treatment      **1.6**             **146.4**    **63.0**
  (13,989)**                                                        

  Agency provided                  3.1                              

  Purchased                        29.5                             

  Comparable benefits              46.8                             

  **Occupational therapy (6,539)** **0.8**                          

  \* Most services could be                                         
  provided through more than one                                    
  mechanism (e.g., vocational                                       
  evaluation services were                                          
  sometimes purchased and                                           
  sometimes provided directly by                                    
  VR agency staff). For some                                        
  services the number of consumers                                  
  receiving the service precluded                                   
  reporting of details.                                             
  -------------------------------- ------------------- ------------ ------------

  --------------------------------- --------------- ----------- ------------
  Number range CHAPTERTable 3-17.                               
  Costs of Purchased Services and                               
  Comparable Benefits for Cognitive                             
  or Psychological Treatment                                    
  Services                                                      

  **Services (weighted n)**         **% receiving   **Costs**   
                                    service**                   

                                                    **Mean**    **Median**

  **Counseling (257,237)**          **29.8**                    

  Purchased                                         \$540       \$390

  Comparable benefits                               N/A         N/A

  **Psychological/psychiatric       **6.1**                     
  treatment (52,595)**                                          

  Purchased                                         \$531       \$240

  Comparable benefits                               N/A         N/A

  **Substance abuse treatment       **1.6**                     
  (13,989)**                                                    

  Purchased                                         \$290       \$195

  Comparable benefits                               N/A         N/A
  --------------------------------- --------------- ----------- ------------

  ----------------------------------------- ------------ ------------ -------------
  Number range CHAPTERTable 3-18. Results                             
  of Cognitive or Psychological Services                              
  Among Consumers Who Received Those                                  
  Services                                                            

  **Services (weighted n)**                 **Services                
                                            received**                

                                            **Mean**     **Median**   **Percent**

  **Counseling (257,237)**                  **1.6**      **1.0**      **29.8**

  Change in vocational goal                                           17.0

  Enrollment in vocational training                                   21.5

  Enrollment in educational program                                   23.3

  Supported employment                                                5.1

  Job placement                                                       33.0

  Exited with employment outcome                                      34.7

  Exited without employment outcome                                   7.5

  Exited other                                                        0.2

  Other                                                               43.6

  **Psychological/psychiatric treatment     **1.8**      **1.0**      **6.1**
  (52,595)**                                                          

  Dropped out of VR services                                          6.5

  Job placement                                                       14.0

  Interruption of VR services                                         9.6

  Work adjustment                                                     8.4

  Exited with employment outcome                                      13.4

  Exited without employment outcome                                   4.0

  Other                                                               51.3

  **Substance abuse treatment (13,989)**    **1.3**      **1.0**      **1.6**

  Dropped out of VR services                                          9.4

  Interruption of VR services                                         11.1

  Job placement                                                       23.1

  Exited with employment outcome                                      25.3

  Exited without employment outcome                                   5.2

  Other                                                               43.5

  Multiple responses were possible.                                   
  ----------------------------------------- ------------ ------------ -------------

Number range CHAPTERMedical or Function Services

Fifteen percent of consumers received medical services, which the agency
purchased in most cases (77 percent of such services); 18 percent also
utilized comparable benefits (Table 3-19). Agency-purchased medical
services averaged \$2,306 (median \$1,010), while those arranged through
comparable benefits averaged \$4,529 (median \$2,229) (Table 3-20). On
average, medical services extended over 168 days (median 21 days).
Actions resulting from these services included correction or maintenance
of a medical condition (52 and 55 percent, respectively) and specific VR
services (56 percent) (Table 3-21). Fewer than 2 percent of consumers
received interpreter services, which the agency typically purchased
(85 percent) at an average cost of \$1,673 (median \$127), although in
some instances (18 percent) agency staff provided these services.

  ------------------------------ -------------------- ----------- ----------
  Number range CHAPTERTable                                       
  3-19. Percentage of Consumers                                   
  Receiving Medical or Physical                                   
  Function Services, by Type of                                   
  Service, Delivery                                               
  Arrangements,\* and Duration                                    

  Services (weighted n)          \% of consumers      Duration    
                                 receiving service    (in days)   

                                                      Mean        Median

  Medical services (128,934)     14.9                 168.3       21.0

  Agency provided                1.4                              

  Purchased                      77.0                             

  Comparable benefits            17.8                             

  **Interpreter services         **1.6**              **166.3**   **34.0**
  (13,991)**                                                      

  Agency provided                17.9                             

  Purchased                      84.8                             

  Comparable benefits            3.4                              

  **Speech/communication therapy **0.6**                          
  (4,974)**                                                       

  **Blind reader services\*      **0.3**                          
  (2,586)**                                                       

  \* Most services could be                                       
  provided through more than one                                  
  mechanism (e.g., vocational                                     
  evaluation services were                                        
  sometimes purchased and                                         
  sometimes provided directly by                                  
  VR agency staff). For some                                      
  services the number of                                          
  consumers receiving the                                         
  service precluded reporting of                                  
  details.                                                        
  ------------------------------ -------------------- ----------- ----------

  -------------------------------- --------------- ----------- ------------
  Number range CHAPTERTable 3-20.                              
  Costs of Purchased Services and                              
  Comparable Benefits for Medical                              
  or Physical Function Treatment                               
  Services                                                     

  **Services (weighted n)**        **% receiving   **Costs**   
                                   service**                   

                                                   **Mean**    **Median**

  **Medical services (134,558)**   **14.9**                    

  Purchased                                        \$2,306     \$1,010

  Comparable benefits                              \$4,529     \$2,229

  **Interpreter services           **1.6**                     
  (13,991)**                                                   

  Purchased                                        \$1,673     \$127

  Comparable benefits                              N/A         N/A
  -------------------------------- --------------- ----------- ------------

+-----------------------------------------+--------+--------+--------+
| Number range CHAPTERTable 3-21. Results |        |        |        |
| of Medical or Physical Function         |        |        |        |
| Services Among Consumers Who Received   |        |        |        |
| Those Services                          |        |        |        |
+-----------------------------------------+--------+--------+--------+
| **Services (weighted n)**               | **Se   |        |        |
|                                         | rvices |        |        |
|                                         | rece   |        |        |
|                                         | ived** |        |        |
+-----------------------------------------+--------+--------+--------+
|                                         | **     | **Me   | **Per  |
|                                         | Mean** | dian** | cent** |
+-----------------------------------------+--------+--------+--------+
| **Medical services (128,934)**          | *      | *      | **     |
|                                         | *3.8** | *2.0** | 14.9** |
+-----------------------------------------+--------+--------+--------+
| Correction of condition                 |        |        | 51.6   |
+-----------------------------------------+--------+--------+--------+
| Maintenance of condition                |        |        | 55.2   |
+-----------------------------------------+--------+--------+--------+
| Recommended VR services                 |        |        | 55.6   |
+-----------------------------------------+--------+--------+--------+
| Recommended extended evaluation         |        |        | 4.2    |
+-----------------------------------------+--------+--------+--------+
| Interruption of VR services             |        |        | 6.1    |
+-----------------------------------------+--------+--------+--------+
| Change in vocational goal               |        |        | 5.9    |
+-----------------------------------------+--------+--------+--------+
| Exited with employment outcome          |        |        | 11.7   |
+-----------------------------------------+--------+--------+--------+
| Exited without employment outcome       |        |        | 1.6    |
+-----------------------------------------+--------+--------+--------+
| Exited other                            |        |        | 0.5    |
+-----------------------------------------+--------+--------+--------+
| Other                                   |        |        | 27.1   |
+-----------------------------------------+--------+--------+--------+
| **Interpreter services\* (13,991)**     |        |        |        |
+-----------------------------------------+--------+--------+--------+
| Multiple responses were possible.       |        |        |        |
|                                         |        |        |        |
| \* No results were listed for this      |        |        |        |
| service.                                |        |        |        |
+-----------------------------------------+--------+--------+--------+

Number range CHAPTERMobility-Related Services

Services associated with consumer mobility (Table 3-22) included AT
devices (21 percent of consumers) or services (2 percent), independent
living services (3 percent of consumers), physical therapy (3 percent),
personal assistance services (2 percent), orientation/mobility training,
and driver training (fewer than 2 percent in each). VR generally
purchased these services for consumers, with the percentage of services
purchased ranging from 96 percent for assistive devices to 69 percent
for physical therapy. Otherwise, VR staff arranged such services through
comparable benefits, with the exception of independent living services;
for about one-third of these services agency staff provided the service
directly. The cost of purchased AT devices averaged \$1,469; those
arranged through comparable benefits averaged \$2,048 (Table 3-23).
Independent living services averaged \$735; when purchased, physical
therapy cost \$773; AT services, \$860; and personal assistance
services, \$1,925. As noted previously, very few consumers received
orientation/mobility therapy or driver training services; the cost of
these services averaged \$1,164 and \$563, respectively.

Receipt of AT devices resulted in consumers' initiation of training
services (29 percent); one-fifth of consumers receiving this service
exited with an employment outcome (Table 3-24). For other services,
resulting actions included achievement of an employment outcome
(28 percent of persons receiving independent living services and
13 percent of persons receiving personal assistance services), job
placement, and obtaining a driver's license.

Number range CHAPTER

  ----------------------------- ------------------ ------------ ------------
  Table 3-22. Percentage of                                     
  Consumers Receiving                                           
  Mobility-Related Services, by                                 
  Type of Service, Delivery                                     
  Arrangements,\* and Duration                                  

  **Service (weighted n)**      **% of consumers   **Duration   
                                receiving          (in days)**  
                                service**                       

                                                   **Mean**     **Median**

  **Assistive technology        **20.7**           **42.9**     **3.0**
  devices (178,808)**                                           

  Agency provided               1.1                             

  Purchased                     95.8                            

  Comparable benefits           10.1                            

  **Independent living services **3.2**            **129.2**    **93.0**
  (27,655)**                                                    

  Agency provided               29.2                            

  Purchased                     71.5                            

  Comparable benefits           8.0                             

  **Physical therapy (24,266)** **2.8**            **103.5**    **47.0**

  Agency provided               5.7                             

  Purchased                     68.9                            

  Comparable benefits           17.3                            

  **Assistive technology        **2.3**            **58.9**     **31.0**
  services (19,684)**                                           

  Agency provided               13.9                            

  Purchased                     87.5                            

  Comparable benefits           4.3                             

  **Personal assistance         **2.0**            **323.5**    **39.0**
  services (17,621)**                                           

  Agency provided               3.1                             

  Purchased                     88.2                            

  Comparable benefits           1.8                             

  **Orientation/mobility        **1.2**            **142.4**    **89.0**
  therapy (10,682)**                                            

  Agency provided               27.7                            

  Purchased                     80.1                            

  Comparable benefits           5.8                             

  **Driver training/licensing   **1.2**            **103.1**    **47.0**
  (10,533)**                                                    

  Agency provided               4.3                             

  Purchased                     93.0                            

  Comparable benefits           3.7                             
  ----------------------------- ------------------ ------------ ------------

  ----------------------------------- --------------- ----------- ------------
  Number range CHAPTERTable 3-23.                                 
  Costs of Purchased Services and                                 
  Comparable Benefits for                                         
  Mobility-Related Services                                       

  **Services (weighted n)**           **% receiving   **Costs**   
                                      service**                   

                                                      **Mean**    **Median**

  **Assistive technology devices      **20.7**                    
  (178,808)**                                                     

  Purchased                                           \$1,469     \$573

  Comparable benefits                                 \$2,048     \$852

  **Independent living services       **3.2**                     
  (27,655)**                                                      

  Purchased                                           \$735       \$336

  Comparable benefits                                 N/A         N/A

  **Physical therapy (24,266)**       **2.8**                     

  Purchased                                           \$773       \$466

  Comparable benefits                                 N/A         N/A

  **Assistive technology services     **2.3**                     
  (19,684)**                                                      

  Purchased                                           \$860       \$263

  Comparable benefits                                 N/A         N/A

  **Personal assistance services      **2.0**                     
  (17,621)**                                                      

  Purchased                                           \$1,925     \$300

  Comparable benefits                                 N/A         N/A

  **Orientation/mobility therapy      **1.2**                     
  (10,682)**                                                      

  Purchased                                           \$1,164     \$673

  Comparable benefits                                 N/A         N/A

  **Driver training/licensing         **1.2**                     
  (10,533)**                                                      

  Purchased                                           \$563       \$379

  Comparable benefits                                 N/A         N/A
  ----------------------------------- --------------- ----------- ------------

  ---------------------------------------------------------------------------------
  Number range CHAPTERTable 3-24. Results                             
  of Mobility-Related Services Among                                  
  Consumers Who Received Those Services                               
  ----------------------------------------- ------------ ------------ -------------
  **Service (weighted n)**                  **Services                
                                            received**                

                                            **Mean**     **Median**   **Percent**

  **Assistive technology devices            **2.1**      **1.0**      **20.7**
  (178,808)**                                                         

  Initiation of training services                                     29.2

  Exited with employment outcome                                      20.2

  Exited without employment outcome                                   1.6

  Exited other                                                        0.6

  Other                                                               49.9

  **Independent living services (27,655)**  **1.9**      **1.0**      **3.2**

  Exited with employment outcome                                      27.7

  Exited without employment outcome                                   1.1

  Exited other                                                        0.5

  Other                                                               78.5

  **Physical therapy (24,666)**             **1.7**      **1.0**      **2.8**

  Referral for AT assessment/services                                 9.8

  Work adjustment                                                     6.8

  Exited with employment outcome                                      6.1

  Exited without employment outcome                                   4.0

  Other                                                               55.4

  **Assistive technology services           **1.5**      **1.0**      **2.3**
  (19,684)**                                                          

  Job placement                                                       15.9

  Movement in active status                                           26.6

  Other                                                               63.6

  **Personal assistance services (17,621)** **2.5**      **1.0**      **2.0**

  Job placement                                                       11.6

  Supported employment                                                3.6

  Exited with employment outcome                                      13.1

  Exited without employment outcome                                   2.8

  Exited other                                                        0.3

  Other                                                               62.6

  **Orientation/mobility therapy (10,682)** **1.7**      **1.0**      **1.2**

  Change in vocational goal                                           1.5

  Job placement                                                       6.3

  Exited with employment outcome                                      19.2

  Other                                                               75.8

  **Driver training/licensing (10,533)**    **1.4**      **1.0**      **1.2**

  Completed training                                                  71.8

  Obtained driver\'s license                                          63.2

  Exited with employment outcome                                      15.0

  Other                                                               41.0

  Multiple responses were possible.                                   
  ---------------------------------------------------------------------------------

Number range CHAPTERPostsecondary and Other Education Services

As noted earlier, one-third of consumers participated in postsecondary
education as part of their VR services. Of those consumers, 16 percent
attended business school or other vocational training program
(Table 3-25), 12 percent enrolled in a two-year community college, and
10 percent attended a four-year college or university. For nearly all
consumers enrolling in postsecondary education, the agency purchased the
services: 94 percent for business/vocational training, 97 percent for
community college, and 99 percent for college/university. Additionally,
comparable benefits were available for some consumers: 14 percent,
28 percent, and 34 percent, respectively. As shown in Table 3-26, when
the VR agency purchased business or vocational training, the average
cost was \$2,755; the average cost of this service when obtained through
comparable benefits was \$3,199. Total average cost per service
(purchased and comparable benefits) was \$3,367. Average cost of
two-year community college was \$1,570 through purchase and \$3,325
through comparable benefits, with average cost across the two at
\$2,231. For four-year college or university the purchase cost averaged
\$4,771, with the comparable benefits cost averaging \$6,970, and a
total average of \$6,796. Finally, for persons who received tutoring,
the VR agency purchased the service at an average cost of \$482.

The most frequent action resulting from postsecondary enrollment was
continuing the following year: 38 percent in the case of
business/vocational school, 66 percent for community college, and
77 percent for college/university students (Table 3-27). Because of the
logistics of reporting these services (i.e., data collectors completed
one service form per year for the duration of enrollment), the data also
indicated completion of a degree/certificate for some consumers.
One-quarter of students enrolled in business/vocational school completed
a degree. Comparable percentages for community college and
college/university were 11 and 21 percent, respectively. Twelve percent
of business/vocational students dropped out of school, as did 19 percent
of community college students and 13 percent of those attending
college/university.

As shown in Tables 3-28 and 3-29, very small percentages of consumers
received other education services, which included, for example,
tutoring, GED preparation, elementary/ secondary education, and other
services. Small sample sizes for these services preclude discussion of
details regarding their delivery and effects.

Number range CHAPTER

  ------------------------------ ----------------- ------------ ------------
  Table 3-25. Percentage of                                     
  Consumers Receiving                                           
  Postsecondary Education                                       
  Services, by Type of Service,                                 
  Delivery Arrangements,\* and                                  
  Duration                                                      

  **Service (weighted n)**       **% of consumers  **Duration   
                                 receiving         (in days)**  
                                 service**                      

                                                   **Mean**     **Median**

  **Business/vocational training **15.6**          **221.6**    **151.0**
  (134,558)**                                                   

  Agency provided                4.3                            

  Purchased                      93.8                           

  Comparable benefits            14.3                           

  **Two-year community college   **12.0**          **340.0**    **238.0**
  (103,688)**                                                   

  Agency provided                0.0                            

  Purchased                      97.0                           

  Comparable benefits            27.9                           

  **Four-year college/university **9.9**           **508.7**    **389.0**
  (85,251)**                                                    

  Agency provided                0.0                            

  Purchased                      99.2                           

  Comparable benefits            33.6                           

  \* Most services could be                                     
  provided through more than one                                
  mechanism (e.g., vocational                                   
  evaluation services were                                      
  sometimes purchased and                                       
  sometimes provided directly by                                
  VR agency staff). For some                                    
  services the number of                                        
  consumers receiving the                                       
  service precluded reporting of                                
  details.                                                      
  ------------------------------ ----------------- ------------ ------------

Number range CHAPTER

  ------------------------------------- -------------- ------------- -------------
  Table 3-26. Costs of Purchased                                     
  Services and Comparable Benefits for                               
  Postsecondary Education and Other                                  
  Education Services                                                 

  **Services (weighted n)**             **% receiving  **Costs**     
                                        service**                    

                                                       **Mean**      **Median**

  **Business/vocational training        **15.6**                     
  (134,558)**                                                        

  Purchased                                            \$2,755       \$1,140

  Comparable benefits                                  \$3,199       \$2,184

  Total (purchased + comparable                        **\$3,367**   **\$1,352**
  benefits)                                                          

  **Two-year community college          **12.0**                     
  (103,688)**                                                        

  Purchased                                            \$1,570       \$966

  Comparable benefits                                  \$3,325       \$2,101

  Total (purchased + comparable                        **\$2,231**   **\$1,159**
  benefits)                                                          

  **Four-year college/university        **9.9**                      
  (85,251)**                                                         

  Purchased                                            \$4,771       \$3,326

  Comparable benefits                                  \$6,970       \$4,094

  Total (purchased + comparable                        **\$6,796**   **\$4,144**
  benefits)                                                          

  **Tutoring (10,617)**                 **1.2**                      

  Purchased                                            \$482         \$254

  Comparable benefits                                  N/A           N/A

                                                                     
  ------------------------------------- -------------- ------------- -------------

  ----------------------------------------- ------------ ------------ -------------
  Number range CHAPTERTable 3-27. Results                             
  of Postsecondary Education Services Among                           
  Consumers Who Received Those Services                               

  **Service results (weighted n)**          **Services                
                                            received**                

                                            **Mean**     **Median**   **Percent**

  **Business/vocational training            **2.3**      **1.0**      **15.6**
  (134,558)**                                                         

  Continued following year                                            37.6

  Completed degree                                                    23.8

  Dropped out                                                         11.9

  Job placement                                                       21.1

  Exited with employment outcome                                      16.5

  Exited without employment outcome                                   4.5

  Exited other                                                        0.1

  Other                                                               46.9

  **Two-year community college (103,668)**  **2.9**      **2.0**      **12.0**

  Continued following year                                            66.4

  Completed degree                                                    11.3

  Dropped out                                                         18.8

  Job placement                                                       11.2

  Exited with employment outcome                                      7.2

  Exited without employment outcome                                   5.1

  Other                                                               42.2

  **Four-year college/university (85,251)** **4.0**      **3.0**      **9.9**

  Continued following year                                            76.8

  Completed degree                                                    20.6

  Dropped out                                                         12.8

  Job placement                                                       11.0

  Exited with employment outcome                                      8.3

  Exited without employment outcome                                   4.0

  Exited other                                                        0.1

  Other                                                               33.2

  Multiple responses were possible.                                   
  ----------------------------------------- ------------ ------------ -------------

Number range CHAPTER

  ------------------------------ ------------------- ------------ ------------
  Table 3-28. Percentage of                                       
  Consumers Receiving Other                                       
  Education Services, by Type of                                  
  Service, Delivery                                               
  Arrangements,\* and Duration                                    

  **Education or training        **% of consumers    **Duration   
  services (weighted n)**        receiving service** (in days)**  

                                                     **Mean**     **Median**

  **Tutoring (10,617)**          **1.2**             **179.5**    **100.0**

  Agency provided                0.0                              

  Purchased                      90.9                             

  Comparable benefits            10.2                             

  **GED preparation\* (6,410)**  **0.7**                          

  **Elementary/secondary         **0.6**                          
  education\* (4,781)**                                           

  **Literacy instruction\*       **0.2**                          
  (2,068)**                                                       

  **Instruction in reading       **0.2**                          
  Braille\* (1,430)**                                             

  **Instruction in English as a  **0.1**                          
  second language\* (1,066)**                                     

  **Instruction in lip reading\* **0.1**                          
  (723)**                                                         

  \* Most services could be                                       
  provided through more than one                                  
  mechanism (e.g., vocational                                     
  evaluation services were                                        
  sometimes purchased and                                         
  sometimes provided directly by                                  
  VR agency staff). For some                                      
  services the number of                                          
  consumers receiving the                                         
  service precluded reporting of                                  
  details.                                                        
  ------------------------------ ------------------- ------------ ------------

  ------------------------------------------- ------------ ------------ -------------
  Number range CHAPTERTable 3-29. Results of                            
  Other Education Services Among Consumers                              
  Who Received Those Services                                           

  Service results (weighted n)                **Services                
                                              received**                

                                              **Mean**     **Median**   **Percent**

  **Tutoring (10,617)**                       **1.8**      **1.0**      **1.2**

  Successfully completed work in topic area                             61.2

  Continued in program                                                  50.7

  Completed program                                                     36.0

  Entered further education                                             19.9

  Exited with employment outcome                                        16.3

  Exited without employment outcome                                     0.0

  Exited other                                                          0.0

  Other                                                                 41.3

  Multiple responses were possible.                                     
  ------------------------------------------- ------------ ------------ -------------

Number range CHAPTERMiscellaneous Support Services

As noted earlier (Chapter 2, Table 2-2), nearly 40 percent of consumers
received some form of support services as part of their VR experience,
including transportation (27 percent), tools/uniforms/equipment/stock
(12 percent), maintenance (11 percent) or vehicle maintenance
(2.4 percent) (Table 3-30). VR purchased these services in most cases,
although the agency provided transportation services directly to about
one-quarter of consumers who received this service. Purchased costs for
transportation averaged \$610; the average for transportation arranged
through comparable benefits was \$2,104 (Table 3-31). For other support
services, average purchase costs were \$826 for tools and equipment,
\$400 for maintenance, and \$1,379 for vehicle maintenance or repair.
Very few consumers received post-employment services, services to other
family members, or housing assistance. Consumers most often used
transportation services to travel to education or training institutions
(62 percent), the location of assessment services (34 percent), or job
search or placement services (31 percent) (Table 3-32). Data collection
did not include listing of actions resulting from receipt of these
ancillary services.

Number range CHAPTER

+-------------------------------+----------------+---------+---------+
| Table 3-30. Miscellaneous     |                |         |         |
| Support Services, by Type of  |                |         |         |
| Service, Delivery             |                |         |         |
| Arrangements,\* and Duration  |                |         |         |
+-------------------------------+----------------+---------+---------+
| **Service (weighted n)**      | **% of         | **D     |         |
|                               | consumers      | uration |         |
|                               | receiving      | (in     |         |
|                               | service**      | days)** |         |
+-------------------------------+----------------+---------+---------+
|                               |                | *       | **M     |
|                               |                | *Mean** | edian** |
+-------------------------------+----------------+---------+---------+
| **Transportation (230,928)**  | **26.7**       | **      | **      |
|                               |                | 221.0** | 113.0** |
+-------------------------------+----------------+---------+---------+
| Agency provided               | 27.0           |         |         |
+-------------------------------+----------------+---------+---------+
| Purchased                     | 82.1           |         |         |
+-------------------------------+----------------+---------+---------+
| Comparable benefits           | 2.1            |         |         |
+-------------------------------+----------------+---------+---------+
| **Too                         | **12.2**       | *       | *       |
| ls/uniforms/equipment/stock** |                | *97.4** | *17.0** |
|                               |                |         |         |
| **(105,540)**                 |                |         |         |
+-------------------------------+----------------+---------+---------+
| Agency provided               | 0.0            |         |         |
+-------------------------------+----------------+---------+---------+
| Purchased                     | 98.2           |         |         |
+-------------------------------+----------------+---------+---------+
| Comparable benefits           | 2.6            |         |         |
+-------------------------------+----------------+---------+---------+
| **Maintenance (90,769)**      | **10.5**       | **      | *       |
|                               |                | 137.5** | *62.0** |
+-------------------------------+----------------+---------+---------+
| Agency provided               | 0.0            |         |         |
+-------------------------------+----------------+---------+---------+
| Purchased                     | 100.0          |         |         |
+-------------------------------+----------------+---------+---------+
| Comparable benefits           | 0.0            |         |         |
+-------------------------------+----------------+---------+---------+
| **Vehicle                     | **2.4**        | **      | *       |
| maintenance/repair/\          |                | 109.5** | *43.0** |
| insurance (20,721)**          |                |         |         |
+-------------------------------+----------------+---------+---------+
| Agency provided               | 0.0            |         |         |
+-------------------------------+----------------+---------+---------+
| Purchased                     | 99.1           |         |         |
+-------------------------------+----------------+---------+---------+
| Comparable benefits           | 7.2            |         |         |
+-------------------------------+----------------+---------+---------+
| **Post-employment services\*  | **0.7**        |         |         |
| (6,432)**                     |                |         |         |
+-------------------------------+----------------+---------+---------+
| **Services to other family    | **0.8**        |         |         |
| members\* (7,216)**           |                |         |         |
+-------------------------------+----------------+---------+---------+
| **Housing assistance\*        | **1.0**        |         |         |
| (8,393)**                     |                |         |         |
+-------------------------------+----------------+---------+---------+
| \* Most services could be     |                |         |         |
| provided through more than    |                |         |         |
| one mechanism (e.g.,          |                |         |         |
| vocational evaluation         |                |         |         |
| services were sometimes       |                |         |         |
| purchased and sometimes       |                |         |         |
| provided directly by VR       |                |         |         |
| agency staff). For some       |                |         |         |
| services the number of        |                |         |         |
| consumers receiving the       |                |         |         |
| service precluded reporting   |                |         |         |
| of details.                   |                |         |         |
+-------------------------------+----------------+---------+---------+

Number range CHAPTER

  ------------------------------------- -------------- ----------- ------------
  Table 3-31. Costs of Purchased                                   
  Services and Comparable Benefits for                             
  Miscellaneous Support Services                                   

  **Services (weighted n)**             **% receiving  **Costs**   
                                        service**                  

                                                       **Mean**    **Median**

  **Transportation (230,928)**          **26.7**                   

  Purchased                                            \$610       \$240

  Comparable benefits                                  \$2,104     \$350

  **Tools/uniforms/equipment/stock      **12.2**                   
  (105,540)**                                                      

  Purchased                                            \$826       \$231

  Comparable benefits                                  N/A         N/A

  **Maintenance (90,769)**              **10.5**                   

  Purchased                                            \$400       \$143

  Comparable benefits                                  N/A         N/A

  **Vehicle                             **2.4**                    
  maintenance/repair/insurance                                     
  (20,721)**                                                       

  Purchased                                            \$1,379     \$485

  Comparable benefits                                  N/A         N/A
  ------------------------------------- -------------- ----------- ------------

+--------------------------------------------+-------+-------+-------+
| Number range CHAPTERTable 3-32. Results of |       |       |       |
| Miscellaneous Support Services Among       |       |       |       |
| Consumers Who Received Those Services      |       |       |       |
+--------------------------------------------+-------+-------+-------+
| **Service (weighted n)**                   | **Ser |       |       |
|                                            | vices |       |       |
|                                            | recei |       |       |
|                                            | ved** |       |       |
+--------------------------------------------+-------+-------+-------+
|                                            | **M   | **Med | *     |
|                                            | ean** | ian** | *Perc |
|                                            |       |       | ent** |
+--------------------------------------------+-------+-------+-------+
| **Transportation (purpose) (230,928)**     | **    | **    | **2   |
|                                            | 3.2** | 2.0** | 6.7** |
+--------------------------------------------+-------+-------+-------+
| Diagnostic or evaluation services          |       |       | 33.9  |
+--------------------------------------------+-------+-------+-------+
| Physical or mental restoration services    |       |       | 6.9   |
+--------------------------------------------+-------+-------+-------+
| Education or training services             |       |       | 62.1  |
+--------------------------------------------+-------+-------+-------+
| Job search or placement services           |       |       | 31.3  |
+--------------------------------------------+-------+-------+-------+
| Counselor meetings                         |       |       | 22.9  |
+--------------------------------------------+-------+-------+-------+
| Maintenance                                |       |       | 8.2   |
+--------------------------------------------+-------+-------+-------+
| To maintain employment                     |       |       | 12.4  |
+--------------------------------------------+-------+-------+-------+
| Other                                      |       |       | 9.0   |
+--------------------------------------------+-------+-------+-------+
| **Tools/uniforms/equipment/stock\*         | **    | **    | **1   |
| (105,650)**                                | 2.2** | 1.0** | 2.2** |
+--------------------------------------------+-------+-------+-------+
| **Maintenance\* (90,769)**                 | **    | **    | **1   |
|                                            | 2.8** | 1.0** | 0.5** |
+--------------------------------------------+-------+-------+-------+
| **Vehicle maintenance/repair\* (20,721)**  | **    | **    | **    |
|                                            | 2.5** | 2.0** | 2.4** |
+--------------------------------------------+-------+-------+-------+
| Multiple responses were possible.          |       |       |       |
|                                            |       |       |       |
| \* No results were listed for this         |       |       |       |
| service.                                   |       |       |       |
+--------------------------------------------+-------+-------+-------+

Number range CHAPTERCase Management

Case management services included activities associated with eligibility
determination, IPE development, and IPE amendment. (Counselors may also
provide other counseling and guidance services over the course of a
consumer's VR services; these activities are included in
cognitive/psychological services.) As shown in Table 3-33, consumers'
case files documented eligibility determination and IPE development
services for 92 percent of consumers who received VR services.
Twenty-four percent of consumers' case files indicated amendment of the
IPE over the course of services.[^9] The period of eligibility
determination averaged 64 days (median of 9.0), and the IPE development
period averaged 68 days (median 1.0). The 24 percent of consumers who
amended the IPE during services averaged 3.4 (median 2.0) such
amendments (Table 3-34).

  ------------------------------- ------------------- ------------ ------------
  Number range CHAPTERTable 3-33.                                  
  Percentage of Consumers                                          
  Receiving Case Management                                        
  Services, by Type of Service,                                    
  Delivery Arrangements,\* and                                     
  Duration                                                         

  **Service (weighted n)**        **% of consumers    **Duration   
                                  receiving service** (in days)**  

                                                      **Mean**     **Median**

  **Counseling for eligibility    **92.1**            **64.3**     **9.0**
  determination (796,268)**                                        

  Agency provided                 100.0                            

  Purchased                       0.0                              

  Comparable benefits             0.0                              

  **IPE development (797,106)**   **92.2**            **67.9**     **1.0**

  Agency provided                 100.0                            

  Purchased                       0.0                              

  Comparable benefits             0.0                              

  **IPE amendment (205,318)**     **23.8**            **N/A**      **N/A**

  Agency provided                 100.0                            

  Purchased                       0.0                              

  Comparable benefits             0.0                              

  \* Most services could be                                        
  provided through more than one                                   
  mechanism (e.g., vocational                                      
  evaluation services were                                         
  sometimes purchased and                                          
  sometimes provided directly by                                   
  VR agency staff). For some                                       
  services the number of                                           
  consumers receiving the service                                  
  precluded reporting of details.                                  
  ------------------------------- ------------------- ------------ ------------

Number range CHAPTER

  ------------------------------------------ ------------ ------------ -------------
  Table 3-34. Results of Case Management                               
  Services Among VR Consumers Who Received                             
  Those Services                                                       

  **Service results (weighted n)**           **Services                
                                             received**                

                                             **Mean**     **Median**   **Percent**

  **Counseling for eligibility determination **N/A**      **N/A**      **92.1**
  (796,268)**                                                          

  Accepted for services                                                98.4

  Placed in extended evaluation                                        5.0

  Determined ineligible                                                0.2

  Placed on waiting list                                               0.9

  Declined services                                                    0.3

  Other                                                                3.5

  **IPE development (797,106)**              **N/A**      **N/A**      **92.2**

  IPE completed                                                        100.0

  **IPE amendment (205,318)**                **3.4**      **2.0**      **23.8**

  IPE amendment completed                                              100.0

  Multiple responses were possible.                                    
  ------------------------------------------ ------------ ------------ -------------

Number range CHAPTERSummary

Over 80 percent of VR consumers received at least one assessment service
in connection with their VR participation. Over half of all consumers
received medical evaluation services; 30 percent received psychological
or psychiatric evaluations, 28 percent received a vocational assessment,
and 13 percent received a vision assessment. Relatively fewer received
other forms of assessments. Eighty-six percent of consumers received at
least one service other than assessment or case management. The most
frequently received of these services were counseling (30 percent),
transportation (27 percent), AT devices (21 percent), and business or
vocational training (16 percent). Finally, 95 percent of consumers' case
files documented activities associated with eligibility determination
and IPE development and amendment.

Number range CHAPTERChapter 4\
VR Services and Primary Disability

As noted previously, persons with disabilities who apply for VR services
may receive a variety of assessments to support a determination of
eligibility. Following acceptance for services, VR consumers work with
their VR counselor to select a vocational goal and develop a plan of
services whose intent is to enable the consumer to achieve that goal. To
support this planning process, consumers may undergo further assessments
(e.g., vocational evaluation to help the consumer select a vocational
goal and a plan of services) to clarify service needs.[^10] Consumer and
counselor, with the help of others as appropriate, plan the services,
establish a time table for receipt of services, articulate intermediate
objectives to keep the process moving toward the vocational goal, and
select providers of services. While the process is more or less the same
for all consumers, the service plans vary considerably, given the
statutory requirement that each consumer have an *individualized* plan
that meets his or her specific goals and needs.

The most important factor that affects the specific services individuals
receive from VR is their primary disability. Earlier chapters of this
report provide details on patterns of service delivery overall. Given
the importance of primary disability to considerations of vocational
goal and services, this chapter describes the service patterns among
major disability types. To establish a context for these analyses, data
in Table 4-1 report the distribution of VR consumers by disability type.
As shown, persons with orthopedic impairments, including amputation,
constitute the largest single category of disability type; 28 percent of
consumers have this type of impairment as the primary disability.
Twenty percent of consumers have mental illness as a primary disability,
followed by nonorthopedic physical impairments (12 percent), mental
retardation (9 percent), hearing impairments (9 percent), learning
disability (8 percent), vision impairments (6 percent), substance abuse
(6 percent), and traumatic brain injury (TBI) (slightly less than
2 percent). In this chapter, we present findings on the service patterns
of VR consumers with each of these primary disabilities. For each group
of consumers, we record all services that at least 10 percent of
consumers in that group received.

Number range CHAPTERService Patterns Among Persons With Orthopedic
Impairments

The services that persons with a primary disability of orthopedic
impairments, including amputation, most frequently received were medical
evaluation (65 percent of all persons with these disabilities) and
vocational evaluation (35 percent) (Table 4-2). They also often received
psychological/psychiatric evaluation (21 percent), counseling services
(31 percent), and transportation (27 percent). One-fifth received
medical services as well. These consumers often enrolled in various
types of postsecondary programs: 19 percent enrolled in
business/vocational training, 17 percent in community college, and
13 percent in four-year college or university. Addition­ally, these
consumers received assistive devices (19 percent) and maintenance
(12 percent). In terms of case management services, 28 percent amended
their IPE at least once. Nearly all of their files documented counseling
for eligibility determination and IPE development activities.

Number range CHAPTERService Patterns Among Persons With Mental Illness

Persons with a primary disability of mental illness received relatively
more services with greater frequency than did persons with orthopedic
impairments (Table 4-3). Exclusive of case management services, more
than 10 percent of these consumers received 16 different services,
compared with 12 services among persons with orthopedic impairments.
Services that persons with mental illness most often received included
psychological or psychiatric evaluation (50 percent received this
service), medical evalua­tion (45 percent), and vocational evaluation
(32 percent). One-third received transportation services, 31 percent
participated in counseling, and 18 percent received psychological or
psychiatric treatment. In the area of postsecondary education,
21 percent of consumers with mental illness enrolled in
business/vocational training, 13 percent in two-year community college,
and 11 percent enrolled in four-year college or university. VR provided
tools or equipment to 15 percent, maintenance to 13 percent, and job
development and job placement services to 12 percent each.
Eleven percent received medical services and supported employment, while
10 percent participated in work adjustment training. Nearly one-quarter
amended their IPE at least once, and over 90 percent of these consumers'
case files documented eligibility determination and IPE development
activities.

Number range CHAPTERService Patterns Among Persons With Nonorthopedic
Physical Impairments

Consumers with physical disabilities most often received medical
evaluation (61 percent) and medical services (34 percent) (Table 4‑4).
One-quarter received vocational evaluation, and 21 percent a
psychological/psychiatric evaluation. Other frequent services were
counseling (32 percent), transportation (23 percent), AT devices
(12 percent), and tools/uniforms/equipment/stock (11 percent). They also
enrolled in postsecondary education: 16 percent took business or
vocational training, 14 percent enrolled in 4-year college or
university, and 13 percent in a two-year community college. Nearly
one-quarter amended their IPE at least once, and for most, the case
files documented eligibility determination and IPE development
activities (93 and 94 percent, respectively).

Number range CHAPTERService Patterns Among Persons With Mental
Retardation

Consumers with mental retarda­tion as a primary disability received
relatively fewer services with the specified frequency than did
consumers with other disabilities: at least 10 percent of these
consumers received one or more of 10 different services, compared with
12 for persons with orthopedic impairments, 16 for persons with mental
illness, and 11 for persons with nonorthopedic physical disabilities
(Table 4-5). Again, however, the most frequently received service was
medical evaluation (42 percent), followed by psychological/psychiatric
evaluation (41 percent), and vocational evaluation (39 percent).
Thirty-two percent entered supported employment, by far the
largest percentage among the various disability groups. One-quarter
received counseling and work adjustment training. Less than one-fifth
received transportation (18 percent), job development (16 percent),
educational status evaluation (14 percent), or job placement services
(12 percent). One-quarter amended their IPE at least once, and over
90 percent had case documentation of other case management services.

In addition to receiving relatively fewer services overall than did
consumers with some other types of disabilities, fewer persons with
mental retardation received some of the specific services and more of
others. For example, 71 percent of consumers with vision impairments and
66 percent of consumers with TBI received a medical evaluation, compared
with 42 percent of these consumers. Conversely, somewhat more consumers
with mental retardation received vocational evaluation services than
consumers with some other disabilities (e.g., vision or hearing
impairments) and considerably more received supported employment
(32 percent versus 11 percent of persons with mental illness---no other
disability group entered supported employment with any frequency).

Number range CHAPTERService Patterns Among Persons With Hearing
Impairments

As shown in Table 4-6, a very high percentage of consumers with hearing
impairments received a hearing assessment (74 percent) and an assistive
device (71 percent), generally a hearing aid. Almost half received a
medical evaluation; one-fifth received a vision assessment; 14 percent
received a psychological/psychiatric assessment; and 14 percent, a
vocational evaluation. (Thus, five of the most frequent 10 services were
assessments.) Other services included counseling (26 percent),
transportation (21 percent), interpreter services (16 percent), and job
placement services (15 percent). As did persons with mental retardation,
consumers with hearing impairments received relatively fewer services
than did consumers in other groups; 10 of the services they received met
the 10 percent criterion. Twenty-one percent of consumers with hearing
impairments amended their IPE, and nearly all case files documented
eligibility determination activities (93 percent) and IPE development
(95 percent).

Number range CHAPTERService Patterns Among Persons With Learning
Disabilities

The three most frequent services that persons with learning disabilities
received (Table 4-7) were psychological/psychiatric evaluation
(48 percent), medical evaluation (40 percent), and vocational evaluation
(35 percent). They also often received educational status evaluation
(16 percent). Of the other 14 most frequent services that these
consumers received were counseling (27 percent), transporta­tion
(23 percent), job placement (13 percent), maintenance (12 percent),
tools and uniforms (11 per­cent) job development (11 percent), and work
adjustment training (10 percent). In terms of education, 16 percent
attended business/vocational school; 15 percent attended community
college; and 13 percent, 4-year college or university. Over one-quarter
amended their IPE at least once, and over 90 percent of their case files
documented other case management-related services.

Number range CHAPTERService Patterns Among Persons With Vision
Impairments

Like consumers with hearing impair­ments, disability-related assessment
was the most frequent service that consumers with vision impairments
received (83 percent), and three-fourths received an AT device,
typically a low-vision aid (Table 4-8). Seventy-one percent received a
medical evaluation, and 14 percent received a vocational evaluation.
Other services that consumers with vision impairments received included
independent living services (41 percent), transportation (31 percent),
counseling (29 percent), orientation/mobility therapy (16 percent), and
medical services (11 percent). These consumers did not frequently enroll
in postsecondary or other education services, and they received
relatively fewer services at or above the 10 percent criterion than did
consumers with other disabilities (9 different services). Consumers with
a vision impairment as a primary disability rarely amended their
IPE---only 11 percent amended the IPE at least once, and relatively
fewer of their case files documented eligibility determination
activities (85 percent) or IPE development services (86 percent).

**Number range CHAPTERService Patterns Among Persons With Substance
Abuse Disabilities**

Consumers with a primary disability of substance abuse received medical
(45 percent) or psychological/psychiatric evaluation (36 percent) more
frequently than other services (Table 4-9), as well as vocational
evaluation (22 percent). Other frequent services included counseling
(32 percent), transportation (32 percent), tools and equipment
(22 percent), substance abuse treatment (17 percent), maintenance
(14 percent), and medical services (13 percent). They also enrolled in
business/vocational training (16 percent of consumers in this group) and
community college (15 percent) relatively often, though not in four-year
college or university. They relatively rarely amended their IPE
(19 percent). Approximately 90 percent of their files documented receipt
of services associated with eligibility determination and IPE
development.

Number range CHAPTERService Patterns Among Persons With Traumatic Brain
Injuries

Very few consumers (2 percent, or around 16,000 persons) had a primary
disability of TBI. Consumers with this disability received 15 different
services that met the criterion that at least 10 percent of consumers in
the group had received the service (Table 4-10). The four most frequent
of these services were assessments: 66 percent received a medical
evaluation; 44 percent, a vocational evaluation; 38 percent, a
psychological/psychiatric evaluation; and 32 percent, a
neuropsychological evaluation. They much less frequently received an
assessment of educational status (13 percent). Other services they
received included counseling (31 percent), transportation (25 percent),
medical services (18 percent), and such employment-development services
as job placement, supported employment (13 percent each), and job
development (11 percent). They sometimes enrolled in business/vocational
programs (15 percent), but did not often enter two-year or four-year
colleges. Fewer than one-quarter amended their IPE, and documentation of
eligibility determination activities more often appeared in their case
files than did indication of IPE development services (95 versus
89 percent).

Number range CHAPTERService Patterns Among Persons With Other Conditions

Table 4-11 reports that consumers with other conditions most often
received medical evaluation services (47 percent), transportation
(46 percent), or psychological/psychiatric evaluation (42 percent). They
also frequently received counseling services (28 percent); tools,
uniforms, and equipment (21 percent); or enrolled in two-year community
college (21 percent). Other services that consumers in this group
received included vocational evaluation, maintenance, job search
training, supported employment, and vision assessment. They did not
often amend their IPE (18 percent amended their IPE at least once).
Their files documented eligibility determination activities more
frequently than activities associated with IPE development (90 versus
84 percent).

Number range CHAPTERRelationships Between Services and Disability Type

In the previous sections of this chapter, we reported the percentages of
consumers who received each type of service within groups defined by
disability type. Those findings demonstrated that the patterns of
services differ noticeably across those groups; these differences are an
indication of the extent to which services are customized to individual
needs. To understand this relationship more completely, we used a
multivariate statistical technique called discriminant analysis. The
purpose of our discriminant analyses was to study statistically
significant differences among service patterns for groups of consumers
by disability type; it allows us to separate the disability groups on
the basis of services they received and to determine how well these
service patterns discriminate among the groups. To accomplish this,
discriminant analysis creates a set of variables, called canonical
variables, made up of weighted combinations of the characteristics of
interest. In the text below we refer to the canonical variables as
"subsets of services" because even though each variable contains
information on all services, each gives the largest weights to a small
subset of services, and those are the ones on which the disability types
differ. The meaning of these canonical variables is open to
interpretation, similar to factor analysis.

Our interpretation of these findings is based on our understanding of
the nature of the services, of the disabilities, and of the VR process,
and it is founded upon our conceptual framework in which we hypothesize
that services are provided based on the needs and characteristics of
individual consumers. Each group (in this case, based on disability
type) has a mean score on each canonical variable, and the set of means
indicates which groups are most strongly differentiated by that
canonical variable. In other words, if one group (say, persons with
orthopedic disabilities) has the highest mean and another group (say,
persons with learning disabilities) has the lowest mean, we can conclude
that these groups are the farthest apart on the set of services
represented by the canonical variable. In conducting these analyses, we
created canonical variables that differentiate among individuals with
different types of disabilities using weighted combinations of services.
While certain disability types may be very different on one variable,
they can be very similar on another. Our analysis revealed seven
significant canonical variables, described below, which means that there
are seven ways of combining the services that will show differences
among the groups. The first canonical variable has the greatest
explanatory power (separates the groups the most), followed by the
second, the third, etc. Appendix B contains tables listing the weights
for each service on each canonical variable and the means of each group
on those same canonical variables. Exhibit 4-1 is a graphical
representation of these findings.

On the first subset of services (i.e., first canonical variable),
individuals with vision and hearing impairments had very similar
patterns of service and were most different from individuals with mental
retardation, mental illness, learning disabilities, substance abuse, and
the category "all other conditions." The services on which they differed
the most were independent living services, assistive technology devices,
and orientation/mobility therapy (which were received more often by
those with vision and hearing impairments) and tutoring and driver
training and licensing (which were received more often by those with
mental retardation, mental illness, learning disabilities, and substance
abuse.

The second subset of services discriminated between individuals with
mental retardation and individuals with hearing impairments on a
different combination of services. Services associated more closely with
mental retardation than with hearing impairments included supported
employment, orientation/mobility therapy, and independent living
services. Services associated more closely with hearing impairments
included interpreter services and physical therapy.

On the third subset of services, individuals with hearing impairments
had different services patterns from individuals with vision
impairments, orthopedic disabilities, and substance abuse. Services
associated with vision impairments, orthopedic disabilities, and
substance abuse included orientation/mobility therapy and independent
living services. The primary service associated with hearing impairments
within this subset was interpreter services.

On the fourth subset of services, individuals with substance abuse and
mental illness had similar service patterns, and these service patterns
differed from those of individuals with mental retardation and
orthopedic disabilities. Individuals with substance abuse and mental
illness received substance abuse treatment and psychological/psychiatric
treatment more

  -----------------------------------------------------------------------
  ![](media/image3.wmf){width="5.893055555555556in"
  height="7.813888888888889in"}Exhibit 4-1. Relationship Between Service
  Patterns and Type of Disability

  -----------------------------------------------------------------------

Number range CHAPTERoften, while individuals with mental retardation and
orthopedic disabilities received physical therapy, driver training and
licensing, and tutoring more often.

The fifth subset of services differentiated individuals with mental
illness and TBI from individuals with substance abuse. Individuals with
substance abuse received substance abuse treatment more often, while
individuals with mental illness and TBI received
psychological/psychiatric treatment, driver training and licensing, and
job placement more often.

On the sixth subset of services, individuals with TBI differed from
individuals with nonorthopedic physical disabilities. The primary
service associated with TBI was physical therapy, while services
associated with nonorthopedic physical disabilities included
orientation/mobility therapy, independent living services, job search
training, tutoring, and medical services.

The seventh subset of services discriminated individuals with TBI,
nonorthopedic physical disabilities, and mental retardation from
individuals with learning disabilities. The services on which they
differed the most were substance abuse treatment and supported
employment (which were received more often by individuals with TBI,
nonorthopedic physical disabilities, and mental retardation) and
tutoring, job placement, on-the-job training/job trial, and independent
living services (which were received more often by individuals with
learning disabilities).

No single canonical variable (subset of services) is sufficient to
discriminate among all types of disabilities. For example, individuals
with substance abuse and mental illness were similar on the fourth
canonical variable but very different on the fifth canonical variable.

In general, this analysis does reveal that service patterns differ
greatly by disability type and that the differences are complex in
nature, requiring numerous combinations of services to describe the ways
in which they differ. Further, within disability types there is a great
deal of variation among services received, as demonstrated in the tables
earlier in this chapter. Given the diverse demographic and educational
background of VR consumers, along with the possibility of secondary
disabilities, these findings further support the hypothesis that
services are individualized to consumer needs.

Summary

To examine patterns of services among persons according to primary
disability, we analyzed the group of services that at least 10 percent
of the subgroup received during his or her VR participation and
conducted discriminate analysis to investigate further relationships
between services and disability type. To facilitate consideration of
these patterns, Table 4-12 reports service patterns for VR consumers
overall.[^11] As shown, of the 13 different services that at least
10 percent of VR consumers received, they most frequently received
medical evaluation services (54 percent). This finding is attributable
at least in part to the VR program's requirement to document presence of
a disability as a condition of program eligibility, a requirement in
place at the time of the study's data collection, although recent
statutory changes have affected this requirement and may change the
extent to which medical evaluation continues as the most frequent
service that consumers receive. Other assessment services that VR
applicants and consumers frequently receive are
psychological/psychiatric evaluation (30 percent), the second most
frequently received service, vocational evaluation (28 percent), and
vision assessment (13 percent).

In terms of services other than assessments, 30 percent of VR consumers
received counseling services as a part of their VR program, and
15 percent received medical treatment. Sixteen percent enrolled in
business/vocational programs, while 12 percent attended two-year
community college. Consumers also often received a variety of support
services, including transportation (27 percent), tools, uniforms,
equipment, or stock necessary for the employment the consumer wished to
enter (12 percent), and maintenance (11 percent). Eleven percent
received job placement services. About one-quarter amended their IPE at
least once during their receipt of VR services, and nearly all of
consumers' case files documented activities associated with eligibility
determination and IPE development.

One of the findings that our examination of service patterns by type of
primary disability reveals is the variability in the number of different
services that a substantial number of consumers received while
participating in VR. Consumers with mental illness received more
different services (16 in all met the 10 percent criterion) than did any
other group, followed by consumers with TBI (15 different services) and
those with learning disabilities (14 different services). Conversely,
persons with vision impairments received the fewest different services
overall, with nine. Consumers with hearing impairments received 10
different services, as did consumers with mental retardation. The
implications of this finding may include the possibility that persons
with a variety of psychological or cognitive impairments may require
relatively more assessment services to assist them in selecting a
vocational goal and more employment-development or educational services
to prepare for a career than do persons who have other more specific
needs. For example, consumers with vision or hearing impairments
typically obtained assessment services and subsequent assistive devices,
and received relatively fewer other services than did persons with other
disabilities, and persons with mental retardation received fewer
assessment services than other consumers and received a relatively
larger number of employment-development services such as supported
employment, work adjustment, job development, and job placement.

As noted earlier in this chapter, the analysis of relationships between
services and disability type reveals that service patterns do differ by
disability type and that these differences are complex in nature,
requiring numerous combinations of services to describe the ways in
which they differ. Further, within disability types there is a great
deal of variation among services received, as demonstrated in the tables
earlier in this chapter. Given the diverse demographic and educational
background of VR consumers, along with the possibility of secondary
disabilities, these findings further support the hypothesis that VR
services are individualized to consumer needs.

Number range CHAPTERChapter 5\
VR Services and Vocational Goal

Key to the development and implementation of a plan of VR services is
selection of a vocational goal---typically the type of employment that
the consumer desires to enter, or, in some instances, to maintain,
through receipt of services that will support achievement of that goal.
For analysis of the relationship between vocational goal and services
that consumers receive, we have aggregated data on vocational goal into
the primary categories of occupations contained in the Dictionary of
Occupational Titles (DOT), the classification system in use at the time
of the study's data collection.[^12] Because the vocational goal is at
the heart of the VR process, one topic of interest to the VR program and
policy makers is the types of services that support achievement of
various goals. This chapter examines the relationship between vocational
goal and services that consumers receive. As with the previous chapter,
we examine patterns of services through review of services for which at
least 10 percent of consumers with a vocational goal in one of the broad
occupational categories received that service.

Number range CHAPTERTo provide a context for the examination of service
patterns by occupational type of vocational goal, we first review the
goals of consumers who received services, including factors associated
with selection of the goal. As shown in Table 5-1, 35 percent of VR
consumers selected a vocational goal in professional, managerial, or
technical occupations; 21 percent selected a goal in service
occupations; 18 percent selected a goal in clerical or sales
occupations; and 7 percent selected benchwork occupations.

Relatively fewer consumers selected goals in other occupations:
3 percent in structural work; 4 percent in miscellaneous occupations
(including motor freight, transportation, packaging and materials
handling, and mining fields and others) or home­making, and 3 percent in
machine trades. As reported in Table 5-2, analysis of data in consumers'
case files indicated that the consumer's choice was the principal
determinant of the vocational goal. This finding is consistent with data
reported in earlier sections of the report. For example, in an interview
toward the end of VR services, 82 percent of consumers reported that
either they alone or they together with their VR counselor selected the
vocational goal. Eighty-one percent believed they had sufficient choice
in selection of the goal, and 80 percent were very or mostly satisfied
with the goal. Other factors associated with selection of a specific
vocational goal included the job that the consumer held prior to or at
application for VR services, counselor judgment, and employment prior to
onset of disability (6 percent).

As noted in the Table 5-2, 18 percent of consumers changed their initial
goal during their VR services. Principal reasons for change included
consumers' preference (62 percent), significance of disability
(11 percent), or lack of available jobs (8 percent). Table 5-3 reports
the nature of change in vocational goal for consumers who changed their
goal during VR services. As shown, 35 percent of consumers who changed
goals selected an initial goal in professional, managerial, or technical
occupations. Following the change, this percentage declined to
29 percent. Conversely, the percentage with a goal in service
occupations increased from initial to final goal, from 22 to 27 percent,
and those selecting clerical or sales occupations also increased
slightly, from 15 to 18 percent. The percentage selecting homemaking as
a goal remained the same.

The remainder of this chapter examines patterns of services among
persons with vocational goals in seven types of occupations (for the two
others, sample sizes were too small to permit analysis) and homemaking.
Later chapters of the report explore the relationships between services
and consumer outcomes.Number range CHAPTER

  ------------------------------------ ----------------- -----------------
  Table 5-3. Occupational Type of                        
  Consumers\' Initial and Final                          
  Vocational Goal for Consumers Who                      
  Changed Goals                                          

  **Occupational type**                **Percent**       

                                       **Initial goal**  **Final goal**

  Professional, managerial, technical  34.5              28.9

  Service                              21.8              27.4

  Clerical/sales                       15.4              17.9

  Benchwork                            7.1               7.6

  Structural work                      4.7               5.0

  Miscellaneous                        3.7               3.0

  Machine trades                       3.1               3.6

  Homemaker                            3.1               3.1

  Agriculture/fishing/forestry         1.8               1.4

  Processing                           1.4               1.1

  Other                                3.3               0.9
  ------------------------------------ ----------------- -----------------

Number range CHAPTERProfessional, Managerial, and Technical Occupations

Nearly 60 percent of consumers with a vocational goal in these fields
received medical evaluation as the most frequent service (Table 5-4).
Other frequently received assessment services included vocational
evaluation (31 percent), psychological or psychiatric evaluation
(31 percent), and vision assessment (13 percent). Thus, four of the 13
most frequently received services were assessments. In terms of services
other than assessments, these consumers often received counseling
services (36 percent), transportation (24 percent), AT devices
(22 percent), or medical services (16 percent). Some enrolled in
business or vocational school (13 percent) or two-year community college
(13 percent).[^13] More than one-quarter of these consumers amended
their IPE at least once during their VR services.

  ----------------------------------------------------- -----------------
  Number range CHAPTERTable 5-4. VR Services Most       
  Frequently Obtained by Consumers with a Vocational    
  Goal in Professional, Managerial, or Technical        
  Occupations (34.8 Percent of Consumers)               

  **Service**                                           **Percent**

  Medical evaluation                                    58.7

  Counseling                                            36.4

  Vocational evaluation                                 30.7

  Psychological/psychiatric evaluation                  30.6

  Transportation                                        24.2

  Assistive technology devices                          22.4

  Medical services                                      15.6

  Business/vocational training                          13.2

  Two-year community college                            12.6

  Vision assessment                                     12.5

  Job placement                                         11.1

  Tools/uniforms/equipment/stock                        11.0

  Maintenance                                           10.5

  **Case management services**                          

  Eligibility determination                             95.2

  IPE development                                       94.9

  IPE amendment                                         28.8
  ----------------------------------------------------- -----------------

Number range CHAPTERService Occupations

Consumers selecting a vocational goal in service occupations frequently
received 15 different services, four of which were assessment services
(Table 5-5). The most frequent assessment service was medical
evaluation; 52 percent of consumers with a goal in service occupations
received this type of evaluation. They often received counseling
services (30 percent), transportation (28 percent), and AT devices
(20 percent). In terms of education, consumers with a service
occupations goal enrolled in business or vocational schools
(18 percent), community college (12 percent), or college or university
programs (11 percent). Approximately one-quarter amended their IPE at
least once during services.Number range CHAPTER

  -------------------------------------------------------- --------------
  Table 5-5. VR Services Most Frequently Obtained by       
  Consumers with a Vocational Goal in Service Occupations  
  (21.8 Percent of Consumers)                              

  **Service**                                              **Percent**

  Medical evaluation                                       51.8

  Psychological/psychiatric evaluation                     32.4

  Counseling                                               30.3

  Transportation                                           27.6

  Vocational evaluation                                    25.0

  Assistive technology devices                             20.1

  Business/vocational training                             17.5

  Vision assessment                                        14.8

  Medical services                                         14.6

  Maintenance                                              13.8

  Two-year community college                               12.4

  Tools/uniforms/equipment/stock                           11.5

  Four-year college/university                             10.9

  Job development                                          10.2

  Job search training                                      10.2

  **Case management services**                             

  Eligibility determination                                94.1

  IPE development                                          94.4

  IPE amendment                                            23.5
  -------------------------------------------------------- --------------

Number range CHAPTERClerical or Sales Occupations

The most frequent service received by consumers whose vocational goal
was clerical or sales occupations was medical evaluation (58 percent)
(Table 5-6). They also often received psychological or psychiatric
assessment services (32 percent), vocational evaluation (27 percent),
vision assessment (14 percent), or hearing assessment (12 percent).
Among frequently received services other than assessments were
counseling, transportation, and AT devices. Some consumers with a goal
in these occupations enrolled in business or vocational school
(16 percent) or community college (11 percent). About one-quarter
amended their IPE at least once during VR services.Number range CHAPTER

  ------------------------------------------------- ---------------------
  Table 5-6. VR Services Most Frequently Obtained   
  by Consumers with a Vocational Goal in            
  Clerical/Sales Occupations (17.5 Percent of       
  Consumers)                                        

  **Service**                                       **Percent**

  Medical evaluation                                57.6

  Counseling                                        32.4

  Psychological/psychiatric evaluation              32.2

  Transportation                                    30.2

  Vocational evaluation                             26.5

  Assistive technology devices                      24.5

  Business/vocational training                      16.0

  Medical services                                  15.1

  Vision assessment                                 14.3

  Job placement                                     12.1

  Hearing assessment                                12.0

  Tools/uniforms/equipment/stock                    11.9

  Two-year community college                        11.3

  Job development                                   10.3

  **Case management services**                      

  Eligibility determination                         95.9

  IPE development                                   95.5

  IPE amendment                                     24.6
  ------------------------------------------------- ---------------------

Number range CHAPTERBenchwork Occupations

As shown in Table 5-7, consumers with vocational goals in benchwork
occupations frequently received various assessment services, including
medical evaluation (62 percent), vocational evaluation (39 percent),
psychological/psychiatric evaluation (29 percent), vision assessment
(19 percent), and educational status evaluation (14 percent). The most
frequent services these consumers received were counseling (38 percent)
and transportation (28 percent). Some of them enrolled in educational
institutions: 20 percent enrolled in business or vocational training;
15 percent in community college; and 11 percent in college or
university. They much more often amended their IPE at least once during
VR services than did consumers with other types of vocational goals
(35 percent, compared with an overall average of 24 percent).

  ------------------------------------------------------ ----------------
  Number range CHAPTERTable 5-7. VR Services Most        
  Frequently Obtained by Consumers With a Vocational     
  Goal in Benchwork Occupations\                         
  (7.3 Percent of Consumers)                             

  **Service**                                            **Percent**

  Medical evaluation                                     62.0

  Vocational evaluation                                  38.8

  Counseling                                             38.4

  Psychological/psychiatric evaluation                   28.6

  Transportation                                         27.8

  Business/vocational training                           19.9

  Assistive technology devices                           19.0

  Vision assessment                                      18.7

  Two-year community college                             14.8

  Educational status evaluation                          14.3

  Job placement                                          13.7

  Tools/uniforms/equipment/stock                         11.3

  Medical services                                       10.9

  Four-year college/university                           10.7

  **Case management services**                           

  Eligibility determination                              92.5

  IPE development                                        93.0

  IPE amendment                                          34.5
  ------------------------------------------------------ ----------------

Number range CHAPTERMiscellaneous Occupations

Consumers with goals in miscellaneous occupations (e.g., transportation,
motor freight, packaging and materials handling) received fewer
different services that met the 10 percent criterion than did consumers
with goals in other fields (Table 5-8). Of the 10 different services
meeting the 10 percent criterion, three were assessments (medical,
psychological, and vocational). Three were educational: four-year
college or university (15 percent), community college (12 percent), and
business or vocational school (11 percent). The remainder was such
supportive services as counseling (29 percent) and transportation
(21 percent), among others. About 20 percent amended their IPE at least
once during their participation in VR.Number range CHAPTER

  ------------------------------------------------- ---------------------
  Table 5-8. VR Services Most Frequently Obtained   
  by Consumers with a Vocational Goal in            
  Miscellaneous Occupations\                        
  (3.9 Percent of Consumers)                        

  **Service**                                       **Percent**

  Medical evaluation                                53.4

  Psychological/psychiatric evaluation              29.3

  Counseling                                        28.9

  Vocational evaluation                             24.8

  Transportation                                    20.6

  Assistive technology devices                      18.2

  Medical services                                  17.8

  Four-year college/university                      15.2

  Two-year community college                        11.9

  Business/vocational training                      10.9

  **Case management services**                      

  Eligibility determination                         97.1

  IPE development                                   96.2

  IPE amendment                                     19.1
  ------------------------------------------------- ---------------------

Number range CHAPTERHomemaking

Four percent of consumers listed the vocational goal as homemaking. As
shown in Table 5‑9, consumers with this goal received relatively more
different services (15 overall) than did consumers with goals in other
occupations (the average was 13 overall and for consumers interested in
some occupations was as low as 10). Four of the most frequent services
were assessments. These consumers enrolled in educational institutions
relatively often, including business or vocational school (20 percent)
and community college (13 percent). Among the types of programs they
enrolled in were computer occupations, small business development,
literacy, and early childhood development. They also received such
services as transportation (31 percent), job placement (25 percent), AT
devices (22 percent), and supported employment (17 percent), among
others. They rarely amended their IPE (13 percent).Number range CHAPTER

  ------------------------------------------------------- ---------------
  Table 5-9. VR Services Most Frequently Obtained by      
  Consumers with a Vocational Goal in Homemaking (3.9     
  Percent of Consumers)                                   

  **Service**                                             **Percent**

  Medical evaluation                                      52.2

  Vocational evaluation                                   33.3

  Psychological/psychiatric evaluation                    32.2

  Transportation                                          31.4

  Job placement                                           24.6

  Assistive technology devices                            22.1

  Counseling                                              21.1

  Business/vocational training                            20.4

  Tools/uniforms/equipment/licenses                       17.6

  Supported employment                                    16.6

  Vehicle maintenance/repair/insurance                    14.9

  Two-year community college                              13.1

  Medical services                                        10.8

  Hearing assessment                                      10.5

  Job search training                                     10.0

  **Case management services**                            

  Eligibility determination                               97.7

  IPE development                                         98.5

  IPE amendment                                           12.6
  ------------------------------------------------------- ---------------

Number range CHAPTERStructural Occupations

Table 5-10 reports the service patterns among consumers with a
vocational goal in structural occupations (3.4 percent of consumers who
received VR services). The most frequently received services were
medical evaluation (57 percent) and psychological assessment
(35 percent). These consumers also often received counseling,
transportation, and medical services. In terms of education, consumers
with this vocational goal enrolled in business or vocational training
(19 percent) or community college (11 percent). They also received such
employment-development services as job development and supported
employment, and support services such as maintenance and tools or
uniforms.

Number range CHAPTER

  -------------------------------------------------------- --------------
  Table 5-10. VR Services Most Frequently Obtained by      
  Consumers with a Vocational Goal in Structural           
  Occupations (3.4 Percent of Consumers)                   

  **Service**                                              **Percent**

  Medical evaluation                                       57.1

  Psychological/psychiatric evaluation                     34.6

  Counseling                                               31.4

  Vocational evaluation                                    30.7

  Transportation                                           25.7

  Business/vocational training                             18.7

  Medical services                                         17.8

  Job development                                          17.4

  Assistive technology devices                             16.5

  Tools/uniforms/equipment/stock                           14.6

  Supported employment                                     11.7

  Two-year community college                               11.1

  Maintenance                                              10.3

  **Case management services**                             

  Eligibility determination                                96.6

  IPE development                                          95.6

  IPE amendment                                            25.8
  -------------------------------------------------------- --------------

Number range CHAPTERMachine Trades Occupations

Three percent of consumers listed vocational goals in machine trades
occupations (Table 5‑11). As with consumers interested in other fields,
these consumers most frequently received medical evaluation
(52 percent), along with psychological evaluation (27 percent),
vocational evaluation (24 percent), and vision assessment (15 percent).
They enrolled in business or vocational school (16 percent), community
college (11 percent), or four-year college or university (10 percent).
Examples of programs in which persons with a goal in this occupation
enrolled were graphic design, computer sciences, undergraduate studies,
and broadcasting. As with all other consumers, they often received
transportation to facilitate their VR services (23 percent).Number range
CHAPTER

  -------------------------------------------------------- --------------
  Table 5-11. VR Services Most Frequently Obtained by      
  Consumers with a Vocational Goal in Machine Trades       
  Occupations\                                             
  (2.9 Percent of Consumers)                               

  **Service**                                              **Percent**

  Medical evaluation                                       51.5

  Counseling                                               42.0

  Psychological/psychiatric evaluation                     27.4

  Vocational evaluation                                    24.3

  Transportation                                           23.0

  Medical services                                         17.9

  Assistive technology devices                             17.2

  Business/vocational training                             15.8

  Vision assessment                                        15.4

  Two-year community college                               10.9

  Tools/uniforms/equipment/stock                           10.5

  Maintenance                                              10.1

  Four-year college/university                             10.0

  **Case management services**                             

  Eligibility determination                                96.0

  IPE development                                          95.1

  IPE amendment                                            23.2
  -------------------------------------------------------- --------------

Number range CHAPTERRelationship Between Services and Vocational Goal

We used discriminant analyses to study statistically significant
differences among service patterns for groups of consumers with varying
vocational goals. For ease of interpretation, we limited our analysis to
consumers with the five most common vocational goals---professional,
managerial, or technical; service; clerical or sales, benchwork, and
structural work. Our analysis revealed two significant canonical
variables, described below, which means that there are two ways of
combining the services that will show differences among the groups.
Appendix C contains tables listing the weights for each service on each
canonical variable and the means of each group on those same canonical
variables.

On the first subset of services (i.e., first canonical variable),
individuals with vocational goals in service occupations were most
different from individuals with benchwork goals. As shown in
Exhibit 5-1, services associated with goals in service occupations
included on-the-job training or job trials, driver training and
licensing, physical therapy, job search training, tutoring, and
orientation/mobility therapy. Services associated with benchwork
included job placement, substance abuse treatment, interpreter services,
independent living services, and IPE amendment.

  -----------------------------------------------------------------------
  Exhibit 5-1. Relationship Between Service Patterns and Vocational Goal

  ![](media/image4.wmf){width="6.5in" height="2.798611111111111in"}
  -----------------------------------------------------------------------

Number range CHAPTERThe second subset of services discriminated between
individuals with vocational goals in structural occupations and
individuals with goals in benchwork or service occupations on a
different combination of services. Individuals with goals in structural
occupations received work adjustment services more often, while
individuals with benchwork or service goals received substance abuse
treatment, assistive technology services, driver training and licensing,
and job search training more often.

These discriminant analyses reveal that, while service patterns differ
somewhat according to vocational goals, these differences are relatively
few and can be captured by fewer combinations of services than the
differences associated with disability type.

Summary

A substantial majority of consumers' vocational goals were in three
fields: professional, managerial, or technical occupations; service
occupations; and clerical or sales occupations (see Table 5-1). These
three types of occupations comprised the vocational goals of
three-quarters of VR consumers, with goals in professional occupations
most frequently selected. According to data in consumers' files,
consumer preference was the single most important determinant of both
initial and final goal for the 18 percent who changed goals over the
course of VR services. Interviews with consumers indicated that
four-fifths of consumers were generally satisfied with the process of
goal setting, their control over the decision regarding vocational goal,
and the goal itself. Consumers were also generally satisfied with
decision making regarding services and the services they received,
although they were somewhat less satisfied with the providers of
services.

For all occupational types, medical evaluation was the most frequent
service received by consumers with goals in those areas. Other frequent
services differed somewhat by occupational field of vocational goal.
Although most of the same services were frequently received by all
consumers, their distribution varied somewhat according to goal, and
some services (e.g., supported employment, four-year college) occurred
infrequently and did not appear as frequent services for most goal
areas. Given the impetus to individualized services that characterizes
the VR program, the similarities in service patterns across occupational
areas of vocational goal are perhaps more striking than the differences,
however.

Number range CHAPTERChapter 6\
VR Services and Consumer Outcomes

The key question regarding the VR program is the extent to which receipt
of VR services improves the labor force participation and prospects of
persons with disabilities. Previous chapters of this report have
presented details of the VR process whose intent is to assist consumers
to (1) select a vocational goal and criteria to measure progress toward
that goal, (2) work with a counselor and other professionals to develop
a plan of services and activities that optimally will eventuate in
achievement of that vocational goal, (3) complete the various services
that in combination will prepare the consumer to enter the labor force,
and (4) achieve an employment outcome that is consistent with the
consumer's preferences and capabilities. The earlier chapters examine in
detail the services that the program is able to make available to
consumers and the details of consumers' receipt of those services. In
this chapter, we present findings on the economic outcomes of
participation in that VR process. The chapter includes findings on
economic outcomes of participation in VR services, the relationship
between services and outcomes, and such other outcomes as community
participation.

Among the measures of labor force participation that the VR longitudinal
study examined are:

> P *employment* at exit from VR and at one, two, and three years
> following exit;
>
> P *earnings* at exit from VR and at one, two, and three years
> following exit;
>
> P relationship of earnings to the *federal poverty level* at exit and
> one, two, and three years following exit;
>
> P *hours worked* per week at exit from VR and at one, two, and three
> years following exit;
>
> P receipt of *benefits* through the job at exit from VR and at one,
> two, and three years following exit; and
>
> P *receipt of financial assistance* at study entry and at one, two,
> and three years following exit.

Data on these measures came from a combination of consumers' case
records and annual interviews with the consumer or representative.

Given that the principal purpose of this report is to examine two
research questions---first, the short- and longer-term outcomes that
consumers achieve as a result of the VR services they receive, and,
second, the extent to which specific VR services contribute to
successful outcomes---we have approached these topics in two ways. To
examine the outcomes that VR consumers achieve, in comparison with
persons who did not receive VR services, we present findings that show
differential employment, earnings, and hours worked in a series of
tables. These tables report outcomes for persons who achieved an
employment outcome, those who received services but did not achieve an
employment outcome, those who were eligible but did not receive
services, and those who were not eligible for VR services. Additionally,
we present these findings separately for VR consumers who achieved a
competitive versus a noncompetitive employment outcome. We report
findings on receipt of benefits and job satisfaction for persons who
achieved an employment outcome, those who received services but did not
achieve an employment outcome but were working one or more years after
exit from VR, and VR consumers who achieved a competitive versus a
noncompetitive employment outcome.

Following the reports of these comparative analyses, we report findings
from a series of inferential analyses whose purpose is to examine the
extent to which specific services, given consumer characteristics (as
reported in detail in Final Report 1), contribute to successful consumer
outcomes. These analyses look at employment, competitive employment,
earnings, and health benefits, respectively. The final section of the
chapter addresses noneconomic outcomes.

Short- and Longer-Term Economic Outcomes of Participation in VR

Key economic outcomes reported in this section include retention of
employment, changes in earnings, changes in hours worked, and receipt of
a variety of employer-provided benefits. We also examine such other
outcomes as job satisfaction, community integration, and independent
living. (Study findings regarding consumers' perspectives on their VR
experience appear in Chapter 2 in the section on the VR process.)

Achievement and Retention of Employment

The traditional measure of success among VR consumers and performance of
the VR program overall is achievement of an employment outcome, defined
as having entered employment and experienced 90 continuous days of
employment thereafter. To examine both the program's performance in
terms of employment outcomes at exit from the program and for a period
thereafter, the study collected information on retention of employment
among consumers who achieved an employment outcome. In addition, to
examine the differential effects of VR services on short- and
longer-term employment outcomes, the study collected information on the
post-VR employment experiences of others who did not achieve an
employment outcome when they exited. Finally, to examine the quality of
employment, we examined outcomes for persons who achieved competitive
and noncompeti­tive jobs and report the occupational fields of the jobs
that VR consumers held at closure and over time.

Data on employment outcome at exit from VR are from VR case files.
Persons whose files indicated that they exited VR without having
achieved an employment outcome after receiving services may or may not
have been working at the time their VR counselor closed their file,
since in some instances (19 percent of persons exiting without an
employment outcome after services) counselors closed files because they
were unable to locate the consumer. Data on employment status among all
study participants in subsequent years (annually up to three years after
exit from VR), came from an annual interview with the consumer.

Table 6-1 reports findings on achieve­ment and retention of employment
over time. Among persons who achieved an employment outcome as a result
of VR services (by definition, all of these consumers were working at
exit from VR), 83 percent were working one year after exit, 79 percent
were working two years after exit, and 76 percent were working three
years after exit. In comparison, among persons who received services but
failed to achieve an employment outcome, a much smaller percentage were
working at one year (27 percent), two years (35 percent), or three years
(37 percent) after exit from VR. The experience of these consumers is
similar to that of persons who were eligible for services but did not
choose to participate in VR. Slightly higher percentages of these
persons were working at one, two, or three years after their exit from
VR. They were much less often working than were persons who achieved an
employment outcome, who were more than twice as likely to have retained
employment over time. Finally, the study conducted one follow up of
persons who applied for but were not eligible for VR services. Among
this group, 37 percent reported that they were working one year later;
somewhat more of them were working at that point than were persons in
the other two groups of individuals who failed to achieve an employment
outcome.

Table 6-2 reports findings on retention of employment over time for
persons who achieved competitive or noncompetitive employment.[^14]
(Seventy-six percent of employment outcomes were competitive.)[^15]
The percentage of both groups who were still working after exit from VR
services is about the same for all three years.

One-quarter of consumers whose employment outcome was in competitive
employment entered a job in the professional, managerial, or technical
fields (Table 6-3). By the end of the third year, 35 percent of the jobs
these former VR consumers held were in these fields. The percentage with
jobs in services occupations remained the same over the period, at one-

quarter of consumers, and the percentage of those with jobs in clerical
or sales occupations declined somewhat, from 25 percent at exit from VR
to 18 percent three years later. Among persons whose employment outcome
was in a noncompetitve job, more held jobs in miscel­laneous fields
(including transportation, materials handling, and the like) than in
other fields (45 percent at exit and 42 percent three years later),
followed by service occupations and benchwork (24 percent and
18 percent, respectively, at exit; 26 percent and 12 percent three years
later).

Among consumers who exited VR without an employment outcome, but who
reported at subsequent follow-up interviews that they were working, the
most frequent occupational fields were service (23 percent one year
after exit and 29 percent the third year after exit); professional,
managerial, or technical occupations (22 percent at year one, rising to
26 percent at year three); and miscellaneous occupations (21 percent at
exit and 18 percent three years later). Among persons who were eligible
for VR services but elected not to pursue services and who reported on
their work status in subsequent years, the most frequent field of jobs
held was service occupations (31 percent one year after exit from VR and
37 percent at the third-year follow up). They also held progressively
more jobs in professional, managerial, or technical fields (from
17 percent to 23 percent over time) and progressively fewer jobs in
clerical or sales occupations (from 22 percent one year after exit to
11 percent by the third year).

We also examined the experience of persons who exited VR with an
employment outcome but reported that they were not working at subsequent
annual follow-up interviews. Table 6‑4 reports the percentage of persons
not working at each of the three annual follow-up interviews separately
for individuals whose initial employment outcome was in competitive
employment and for those whose initial outcome was in noncompetitive
employment. As shown, 16 percent of persons exiting into competitive
employment reported not working one

Number range CHAPTERTable 6-3. Occupational Field of Jobs at Closure and
One, Two, and Three Years Later, by Exit Status

+---------------------------------+--------+--------+--------+--------+
| **Occupational field of job**   | **     |        |        |        |
|                                 | Percen |        |        |        |
|                                 | tage** |        |        |        |
+---------------------------------+--------+--------+--------+--------+
|                                 | **At   | **1    | **2    | **3    |
|                                 | exit** | year   | years  | years  |
|                                 |        | l      | l      | l      |
|                                 |        | ater** | ater** | ater** |
+---------------------------------+--------+--------+--------+--------+
| **Achieved a competitive        |        |        |        |        |
| employment outcome**            |        |        |        |        |
+---------------------------------+--------+--------+--------+--------+
| Professional, managerial,       | 25.1   | 31.1   | 30.0   | 34.8   |
| technical                       |        |        |        |        |
+---------------------------------+--------+--------+--------+--------+
| Service                         | 24.4   | 23.2   | 24.2   | 24.1   |
+---------------------------------+--------+--------+--------+--------+
| Clerical/sales                  | 25.0   | 18.3   | 18.5   | 17.9   |
+---------------------------------+--------+--------+--------+--------+
| Benchwork                       | 6.0    | 4.4    | 4.1    | 4.5    |
+---------------------------------+--------+--------+--------+--------+
| Structural work                 | 5.6    | 2.2    | 2.5    | 2.5    |
+---------------------------------+--------+--------+--------+--------+
| Miscellaneous                   | 7.1    | 14.1   | 15.7   | 12.9   |
+---------------------------------+--------+--------+--------+--------+
| Machine trades                  | 3.9    | 3.7    | 3.4    | 2.1    |
+---------------------------------+--------+--------+--------+--------+
| Agriculture/fishing/forestry    | 1.8    | 1.1    | 0.6    | 0.3    |
+---------------------------------+--------+--------+--------+--------+
| Processing                      | 1.1    | 1.9    | 1.0    | 0.8    |
+---------------------------------+--------+--------+--------+--------+
| **Achieved a noncompetitive     |        |        |        |        |
| employment outcome**            |        |        |        |        |
+---------------------------------+--------+--------+--------+--------+
| Professional, managerial,       | 2.7^^ | 7.1^^ | 1      | 1      |
| technical                       |        |        | 0.1^^ | 1.4^^ |
+---------------------------------+--------+--------+--------+--------+
| Service                         | 23.7   | 22.8   | 23.8   | 25.5   |
+---------------------------------+--------+--------+--------+--------+
| Clerical/sales                  | 7.3^^ | 6.9^^ | 7.2^^ | 6.8^^ |
+---------------------------------+--------+--------+--------+--------+
| Benchwork                       | 1      | 9.2    | 1      | 1      |
|                                 | 7.5^^ |        | 1.8^^ | 1.8^^ |
+---------------------------------+--------+--------+--------+--------+
| Structural work                 | 0.7^^ | 0.6^^ | 1.0^^ | 1.1    |
+---------------------------------+--------+--------+--------+--------+
| Miscellaneous                   | 4      | 4      | 4      | 4      |
|                                 | 4.6^^ | 8.9^^ | 3.6^^ | 1.8^^ |
+---------------------------------+--------+--------+--------+--------+
| Machine trades                  | 0.2^^ | 2.9    | 0.7^^ | 1.3    |
+---------------------------------+--------+--------+--------+--------+
| Agriculture/fishing/forestry    | 1.7    | 0.9    | 0.7    | 0.3    |
+---------------------------------+--------+--------+--------+--------+
| Processing                      | 1.7^^ | 0.9    | 1.2    | 0.0^^ |
+---------------------------------+--------+--------+--------+--------+
| **Received VR services, failed  |        |        |        |        |
| to achieve an employment        |        |        |        |        |
| outcome**                       |        |        |        |        |
+---------------------------------+--------+--------+--------+--------+
| Professional, managerial,       | N/A    | 21.9   | 22.1   | 26.0   |
| technical                       |        |        |        |        |
+---------------------------------+--------+--------+--------+--------+
| Service                         | N/A    | 23.1   | 33.6\* | 28.5   |
+---------------------------------+--------+--------+--------+--------+
| Clerical/sales                  | N/A    | 15.9   | 13.9   | 20.9   |
+---------------------------------+--------+--------+--------+--------+
| Benchwork                       | N/A    | 5.4    | 7.7    | 2.8    |
+---------------------------------+--------+--------+--------+--------+
| Structural work                 | N/A    | 1.9\*  | 2.1    | 0.0\*  |
+---------------------------------+--------+--------+--------+--------+
| Miscellaneous                   | N/A    | 21.4   | 15.5   | 17.6   |
+---------------------------------+--------+--------+--------+--------+
| Machine trades                  | N/A    | 3.5\*  | 2.4    | 3.3    |
+---------------------------------+--------+--------+--------+--------+
| Agriculture/fishing/forestry    | N/A    | 1.1    | 1.2    | 0.0    |
+---------------------------------+--------+--------+--------+--------+
| Processing                      | N/A    | 1.7    | 1.4    | 0.9    |
+---------------------------------+--------+--------+--------+--------+
| **Eligible for VR services, but |        |        |        |        |
| dropped out before services**   |        |        |        |        |
+---------------------------------+--------+--------+--------+--------+
| Professional, managerial,       | N/A    | 16.5   | 20.6   | 22.7   |
| technical                       |        |        |        |        |
+---------------------------------+--------+--------+--------+--------+
| Service                         | N/A    | 30.6   | 27.9\* | 36.8   |
+---------------------------------+--------+--------+--------+--------+
| Clerical/sales                  | N/A    | 21.7   | 19.9   | 11.4   |
+---------------------------------+--------+--------+--------+--------+
| Benchwork                       | N/A    | 5.0    | 4.8    | 5.8    |
+---------------------------------+--------+--------+--------+--------+
| Structural work                 | N/A    | 2.0\*  | 1.8    | 1.6\*  |
+---------------------------------+--------+--------+--------+--------+
| Miscellaneous                   | N/A    | 18.3   | 21.5   | 16.8   |
+---------------------------------+--------+--------+--------+--------+
| Machine trades                  | N/A    | 3.3\*  | 3.5    | 3.1    |
+---------------------------------+--------+--------+--------+--------+
| Agriculture/fishing/forestry    | N/A    | 1.4    | 0.0    | 1.3    |
+---------------------------------+--------+--------+--------+--------+
| Processing                      | N/A    | 1.1    | 0.0    | 0.5    |
+---------------------------------+--------+--------+--------+--------+
| ^^ Indicates a significant     |        |        |        |        |
| difference (p \<.05) between    |        |        |        |        |
| this value and the              |        |        |        |        |
| corresponding value for         |        |        |        |        |
| individuals who receive VR      |        |        |        |        |
| services and achieved a         |        |        |        |        |
| competitive employment outcome. |        |        |        |        |
|                                 |        |        |        |        |
| \* Indicates a significant      |        |        |        |        |
| difference (p \<.05) between    |        |        |        |        |
| this value and the              |        |        |        |        |
| corresponding value for         |        |        |        |        |
| individuals who received VR     |        |        |        |        |
| services and achieved an        |        |        |        |        |
| employment outcome.             |        |        |        |        |
+---------------------------------+--------+--------+--------+--------+

year later; this percentage increased to 20 percent two years after exit
and 22 percent three years after exit. Among persons exiting into
noncompetitive employment, 20 percent reported not working one year
later; 28 percent, two years later; and 31 percent, three years later.
At all four time points, the preponderance of persons who had achieved
an employment outcome had exited into competitive jobs (73 percent at
exit). Over time, the distribution declined slightly to 71 percent of
all persons exiting into employment who were not working at follow up by
the end of the third year.

***Status of persons exiting with an employment outcome, but not working
at follow up***. In terms of status following exit, 12 percent of
persons exiting with a competi­tive employment outcome who were not
working one year later reported that they were working as a homemaker;
30 percent of those who exited into noncom­petitive employment were
home­makers one year later. About half of those who exited into
competitive employment reported that they were looking for work; the
comparable percentage for those exiting into noncompeti­tive employment
was 27 percent. Slightly less than one-quarter (24 percent) of those
whose employment outcome had been competitive reported that they were
not working and not looking for work; the percentage among those exiting
into noncompetitive employment was 28 percent. The most frequent reason
for not working or looking for work was health problems: 41 percent of
those exiting into competitive employment and 59 percent of those
exiting into noncompetitive employment cited this reason at the first
annual follow-up interview. (For the competitive employment group, this
percentage increased in later years to 63 percent at the second
follow-up interview and 65 percent at the third annual interview.) The
small numbers of persons not working at subsequent follow-up points,
combined with the relatively large numbers of response options,
precludes description of findings regarding status or reasons for not
working at the end of the second and third years for these groups.

Achievement and Retention of Earnings

At exit from VR, consumers who achieved an employment outcome as a
result of VR services earned an average of \$7.33 per hour (median
\$6.00) (Table 6-5). This hourly rate increased steadily over time, to
\$9.62 (median \$7.65) per hour at the end of year three. The study
collected information on subsequent employment experience of persons
exiting without an employment outcome following VR services. The
earnings of this group also progressed, although at each time point they
earned less per hour than did persons with an employment outcome.
Similarly, persons eligible for but not receiving VR services were
earning about the same at the end of one year that consumers with an
employment outcome were earning at exit. While their earnings increased
from year one to year two, the average increase leveled off from year
two to year three. These persons earned considerably less than those
with an employment outcome at each time point. They also earned less
each year, on average, than did persons exiting without an employment
outcome after services, although in later years their median hourly wage
was slightly higher.

As shown in Table 6-6, the difference in hourly wage between competitive
and noncompetitive jobs is substantial. Consumers in competitive jobs
earned an average of \$7.63 per hour at closure (median \$6.30) and
progressed steadily to an average of \$10.06 (median \$8.00) three years
following exit from VR. Consumers who entered noncompetitive jobs
started at \$4.98 per hour (median \$4.25) and by the end of three years
were averaging \$4.63 per hour (median \$4.90). Thus, they were earning
a little less than one-half the salary of persons in competitive jobs.
These analyses do not include persons who entered jobs without earnings,
such as homemaking or unpaid family work.

Relationship of Earnings to the Federal Poverty Level

In addition to analysis of hourly wage as a measure of earnings,
analysis of wages in the context of the federal poverty level is useful
in a consideration of the benefits that consumers receive as a result of
VR services. We based this analysis on the Census Bureau's poverty level
criterion for a single person's monthly income in FY 1996, which was
\$666.25, or \$7,995 per year, and used constant 1996 dollars. We
included in these analyses only persons who were working (i.e., had
earnings) at each of the relevant time points.

As shown in Table 6-7, 14 percent of the general population in the
United States was below the poverty level in FY 1996, compared with 22
percent of persons who exited VR into competitive employment and 81
percent of those exiting VR into noncompetitive employment. Percentages
of each group earning more than 200 percent of the poverty level (at
least \$1,333 per month, or \$15,990 per year), were 62 percent of the
general population, 32 percent of persons who exited VR with a
competitive employment outcome, and 6 percent of persons who exited VR
into noncompetitive employment.

+----------------------+--------+--------+--------+--------+--------+
| Table 6-7.           |        |        |        |        |        |
| Relationship of      |        |        |        |        |        |
| Earnings to the      |        |        |        |        |        |
| Federal Poverty      |        |        |        |        |        |
| Level at Exit and    |        |        |        |        |        |
| One, Two, and Three  |        |        |        |        |        |
| Years Later, by Type |        |        |        |        |        |
| of Exit              |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| **Income relative to | **     |        |        |        |        |
| federal poverty      | Percen |        |        |        |        |
| levels\*\***         | tage** |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
|                      | **G    | **P    | **P    | **P    | **P    |
|                      | eneral | ersons | ersons | ersons | ersons |
|                      | popu   | e      | e      | e      | e      |
|                      | lation | xiting | xiting | xiting | xiting |
|                      | (FY    | VR     | VR     | VR     | VR     |
|                      | 1      | with a | w      | w      | with a |
|                      | 996)** | compe  | ithout | ithout | non    |
|                      |        | titive | an     | an     | -compe |
|                      |        | empl   | empl   | empl   | titive |
|                      |        | oyment | oyment | oyment | empl   |
|                      |        | out    | o      | o      | oyment |
|                      |        | come** | utcome | utcome | out    |
|                      |        |        | after  | before | come** |
|                      |        |        | serv   | serv   |        |
|                      |        |        | ices** | ices** |        |
+----------------------+--------+--------+--------+--------+--------+
| At exit from VR      |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| Less than federal    | 14.0   | 21.7   |        |        | 81.0\* |
| poverty level        |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| More than 200% of    | 61.5   | 31.5   |        |        | 6.4\*  |
| poverty level        |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| One year after exit  |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| Less than federal    |        | 22.3   | 33.1\* | 36.3\* | 66.1\* |
| poverty level        |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| More than 200% of    |        | 38.3   | 25.0\* | 25.1\* | 13.7\* |
| poverty level        |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| Two years after exit |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| Less than federal    |        | 18.6   | 33.1\* | 28.1\* | 64.1\* |
| poverty level        |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| More than 200% of    |        | 45.8   | 30.0\* | 36.7   | 13.9\* |
| poverty level        |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| Three years after    |        |        |        |        |        |
| exit                 |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| Less than federal    |        | 20.2   | 31.9\* | 33.9\* | 62.5\* |
| poverty level        |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| More than 200% of    |        | 46.2   | 28.2\* | 39.5   | 20.1\* |
| poverty level        |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+
| \* Indicates a       |        |        |        |        |        |
| significant          |        |        |        |        |        |
| difference (p        |        |        |        |        |        |
| \<.05).              |        |        |        |        |        |
|                      |        |        |        |        |        |
| \*\* Poverty level   |        |        |        |        |        |
| information is based |        |        |        |        |        |
| on the Census        |        |        |        |        |        |
| Bureau\'s criteria   |        |        |        |        |        |
| for a single person  |        |        |        |        |        |
| in FY 1996 (\$666.25 |        |        |        |        |        |
| per month). The      |        |        |        |        |        |
| analysis uses        |        |        |        |        |        |
| constant 1996        |        |        |        |        |        |
| dollars.             |        |        |        |        |        |
+----------------------+--------+--------+--------+--------+--------+

Number range CHAPTERAmong persons exiting into competitive employment,
the percentage below poverty remained relatively stable over time,
ranging between 19 and 22 percent across the three years. The percentage
with earnings more than 200 percent of poverty increased over time, to
46 percent by the end of three years. In comparison with other groups,
including persons exiting without an employment outcome after services,
those dropping out before services, and those exiting into
noncompetitive employment, fewer competitively employed persons were
below the poverty level at one, two, and three years after exit. More
were above 200 percent of the poverty level at each time point as well.
For example, one year after exit, 22 percent of competitively employed
persons were below poverty, compared with 33 percent of those who had
exited VR without an employment outcome after services, 36 percent of
those who had dropped out before services, and 66 percent of persons who
had exited into noncompetitive employment. Conversely, while 38 percent
of persons exiting into competitive employment had earnings over
200 percent of poverty, fewer of those who had exited after services
without an employment outcome, had dropped out, or had exited into
noncompetitive employment had earnings at this level (25 percent,
25 percent, and 14 percent, respectively). These patterns generally
persisted in years two and three, as well.

Number range CHAPTERHours Worked Per Week

Another consideration in terms of employment and earnings is whether or
not jobs are full time; this issue is particularly important in that
many part-time jobs do not include benefits to the extent that full-time
jobs do; additionally, they often pay less. As shown in Table 6‑8,
consumers who achieved an employment outcome as a result of VR services
averaged 33.7 hours (median 40.0) at exit from VR; the average increased
somewhat, to 34.5 hours per week (median 40.0) by the end of the third
year. The fact that the average is lower than the median indicates that
a fair number of consumers were working in jobs that were less than full
time, although that number declined somewhat over time. Among persons
who exited without an employment outcome, the average hours worked was
32.3 one year after closure, among the 27 percent of these consumers who
were working at that point. Their average and median hours worked
declined slightly from year one to year three, with an average at the
end of year three of 31.9 and a median of 35.0. Persons who were
eligible but did not receive services, in comparison with persons who
achieved an employment outcome, averaged fewer hours per week one year
after exit from VR (31.6 compared with 33.7; median 35.0 versus 40.0),
and worked slightly about an hour less per week by the end of year
three, on average (33.4 versus 34.5). Conversely, persons who were not
eligible for VR services averaged an hour more per week by the end of
one year than did persons who exited with an employment outcome (35.5
versus 34.5).

Persons with competitive jobs increased their average hours worked per
week by one hour over the three year period (34.6 to 35.9); the median
at each time point was 40 hours, or full time (Table 6-9). Persons in
noncompetitve jobs, however, did not typically work full time. At exit
from VR, they averaged 28.7 (median 30.0) hours per week; by the end of
three years, they were averaging 28.8 hours (median remained at 30.0).

Health and Other Benefits

Less than one-third of consumers who exited VR with an employment
outcome entered a job with health insurance benefits (Table 6-10). At
exit, as noted earlier, 83 percent of persons achieving an employment
outcome were still working one year later. At that point, 41 percent of
these former consumers received health insurance through their job. That
percentage increased over time, to 46 percent at the end of the second
year and to 50 percent by the end of the third year. National figures
are around 52 percent (Hayward and Tashjian, 1996), indicating that VR
consumers who achieved an employment outcome are nearly as well off in
terms of health insurance by the end of three years of employment as are
other workers. Other employment benefits of these workers also increased
over time. Sick leave mirrored health insurance, and somewhat more
workers (51 percent after one year and 58 percent after three years)
held jobs that provided vacation leave. Lower percentages held jobs with
life insurance, retirement plans, or dental insurance.

Number range CHAPTERTable 6-10. Percentage of Former VR Consumers with
Benefits Provided by Their Employer, by VR Exit Status

  ------------------------------- ---------------- ------------- ------------- ---------------
  Number range                    **Percentage**                               
  CHAPTER**Benefits**                                                          

                                  **At exit**      **One-year\   **Two-year\   **Three-year\
                                                   follow up**   follow up**   follow up**

  **Received VR services,                                                      
  achieved an employment                                                       
  outcome**                                                                    

  Health insurance                31.8             40.5          46.2          49.6

  Vacation leave                                   50.7          56.0          57.8

  Sick leave                                       41.7          46.7          49.3

  Life insurance                                   31.8          37.3          40.1

  Retirement plan                                  28.9          36.8          39.7

  Dental insurance                                 27.7          34.2          35.7

  Other benefits                                   12.5          11.7          11.7

  **Received VR services, failed                                               
  to achieve an employment                                                     
  outcome**                                                                    

  Health insurance                N/A              26.0\*        32.3\*        41.5

  Vacation leave                                   35.3\*        37.3\*        41.7\*

  Sick leave                                       25.0\*        28.3\*        34.8\*

  Life insurance                                   21.5\*        24.2\*        26.6\*

  Retirement plan                                  18.1\*        20.8\*        27.4\*

  Dental insurance                                 19.4\*        24.2\*        27.9

  Other benefits                                   6.6\*         6.7\*         10.2

  \* Indicates a significant                                                   
  difference (p \<.05) between                                                 
  this value and the                                                           
  corresponding value for                                                      
  individuals who received VR                                                  
  services and achieved an                                                     
  employment outcome.                                                          
  ------------------------------- ---------------- ------------- ------------- ---------------

Number range CHAPTERConsumers who left VR services prior to achieving an
employment outcome and who were working one year after exit less often
held jobs with health insurance; 26 percent after one year, progressing
to 42 percent after three years. Similarly, they less often received
sick leave (25 percent after one year and 35 percent after three years)
or vacation leave (35 percent after one year and 42 percent after three
years) and did not often receive other job-related benefits such as life
insurance or retirement plans.

Predictably, consumers whose job was in the competitive labor market
much more often had employer-provided benefits than did those entering
noncompetitive employment (Table 6‑11). At exit from VR, 36 percent
entered jobs with health insurance benefits, and 58 percent of
competitively employed consumers had health insurance by the end of
three years of employment; 56 percent had sick leave, and 65 percent had
vacation leave by the end of three years. Almost half had life insurance
or a retirement plan. Conversely, very few noncompetitvely employed
former VR consumers had benefits; the most frequent was vacation leave,
with 25 percent having this benefit by the end of their first year of
employment and 29 percent by the end of their third year. Given the
importance of lack of health insurance as a deterrent to employment
among persons with disabilities, the advantages of obtaining competitive
employment are clear.

Number range CHAPTERTable 6-11. Percentage of Former VR Consumers with
Benefits Provided by Their Employer, by Competitive and Noncompetitive
Employment Outcome

  ---------------------------------- ---------------- ------------ ------------ ----------
  Number range CHAPTER**Benefits**   **Percentage**                             

                                     **At exit**      **One-year   **Two-year   **Three-
                                                      follow up**  follow up**  year
                                                                                follow
                                                                                up**

  **Achieved a competitive                                                      
  employment outcome**                                                          

  Health insurance                   36.4             47.0         54.0         57.9

  Vacation leave                                      57.4         63.4         65.4

  Sick leave                                          48.1         53.1         56.3

  Life insurance                                      36.9         43.2         47.3

  Retirement plan                                     34.2         43.1         46.5

  Dental insurance                                    32.5         40.3         42.4

  Other benefits                                      14.1         13.2         13.7

  **Achieved a noncompetitive                                                   
  employment outcome**                                                          

  Health insurance                   9.5^^           15.0^^      15.6^^      17.9^^

  Vacation leave                                      24.6^^      27.2^^      28.5^^

  Sick leave                                          16.8^^      22.0^^      22.1^^

  Life insurance                                      12.3^^      14.3^^      12.9^^

  Retirement plan                                     8.4^^       12.3^^      13.7^^

  Dental insurance                                    9.2^^       10.3^^      10.3^^

  Other benefits                                      6.4^^       5.8^^       4.1^^

  ^^ Indicates a significant                                                   
  difference (p \<.05) between this                                             
  value and the corresponding value                                             
  for individuals who receive VR                                                
  services and achieved a                                                       
  competitive employment outcome.                                               
  ---------------------------------- ---------------- ------------ ------------ ----------

Number range CHAPTERReceipt of Financial Assistance

In addition to retention of earnings, changes in health benefits, and
other outcomes, another measure of the economic effects of VR services
is change in receipt of public financial assistance over time.
Table 6-12 reports findings on changes in receipt of any financial
assistance from entry to one, two, and three years after exit from VR
services. It also reports findings on changes in receipt of
SSI/disabled, SSDI, Worker's Compensation, and other public assistance
(e.g., TANF, general assistance). For this analysis, we tested the
significance of differences between persons with an employment outcome
and two other groups: those exiting VR without an employment outcome
following services and those accepted for services who dropped out of VR
prior to services. The group with an employment outcome included both
persons who entered competitive employment and those whose employment
outcome was noncompetitive.

As shown in the table, fewer persons who subsequently exited VR services
with an employment outcome were receiving financial assistance at entry
than were those who later exited VR after services without an employment
outcome or those exiting before services (44 percent versus 55 and
57 percent, respectively). These differences continued over time: by the
end of the third year after exit, 33 percent of those with an employment
outcome continued to receive assistance, while the percentages of the
other two groups remained about the same (55 percent and 54 percent,
respectively). At study entry, 14 percent of all consumers who received
services and later achieved an employment outcome were receiving
SSI-disabled; this percentage remained relatively stable over time,
increasing slightly to 17 percent by the end of three years. In
comparison, those exiting after services without an employment outcome
and those dropping out before services more often received SSI-disabled
at entry (22 and 21 percent). By the third year following exit,
these percentages had risen to 34 and 27 percent.

The situation was similar for SSDI benefits, although the percentage of
all groups receiving these benefits was lower: 10 percent at entry for
those with an employment outcome (which declined slightly to 9 percent
by the third year following exit), compared with 15 percent of those
without an employment outcome and 16 percent of those who dropped out
before services. For the latter two groups, receipt of SSDI had risen by
the third year to 21 percent for each group.

  --------------------------- ---------------- -------------- --------------
  Table 6-12. Receipt of                                      
  Financial Assistance at                                     
  Entry to VR and Following                                   
  Exit, by Type of Exit                                       

  Number range CHAPTER        **Percentage**                  

                              **Persons        **Persons      **Persons
                              exiting VR with  exiting VR     exiting VR
                              an employment    without an     without an
                              outcome**        employment     employment
                                               outcome after  outcome before
                                               services**     services**

  **Receiving any financial                                   
  assistance**                                                

  At study entry              43.9             55.1\*         56.8\*

  One year after exit         30.0             58.5\*         58.2\*

  Two years after exit        29.9             57.4\*         52.4\*

  Three years after exit      32.6             55.3\*         54.1\*

  **Type of financial                                         
  assistance, percentage of                                   
  all consumers**                                             

  **SSI/disabled**                                            

  At study entry              13.7             22.3\*         20.9\*

  One year after exit         14.5             33.1\*         27.3\*

  Two years after exit        15.2             34.4\*         27.8\*

  Three years after exit      17.2             33.7\*         27.0\*

  **SSDI**                                                    

  At study entry              9.7              14.9\*         15.8\*

  One year after exit         9.2              20.2\*         19.1\*

  Two years after exit        9.3              20.3\*         17.2\*

  Three years after exit      9.1              20.5\*         20.6\*

  **Worker\'s Compensation**                                  

  At study entry              2.9              4.0            6.3\*

  One year after exit         0.7              1.6\*          3.5\*

  Two years after exit        1.1              1.5            2.4

  Three years after exit      0.9              1.8            2.3

  **Other public assistance**                                 

  At study entry              15.0             17.3           21.6\*

  One year after exit         7.1              13.8\*         19.1\*

  Two years after exit        4.5              11.2\*         13.1\*

  Three years after exit      5.7              9.8\*          12.3\*

  \* Indicates a significant                                  
  difference from persons                                     
  with an employment outcome                                  
  (p \<.05).                                                  
  --------------------------- ---------------- -------------- --------------

Number range CHAPTERAt entry, more consumers who dropped out prior to
services were receiving Worker's Compensation, although the percentage
was low (6 percent compared with 3 percent of those who subsequently
exited with an employment outcome). More of the dropouts continued on
this benefit one year following exit (4 percent), although
the percentage did decline somewhat. Finally, consumers with an
employment outcome less often received other public assistance than did
those who dropped out before services (15 versus 22 percent). This
pattern continued following exit, with both those exiting without an
employment outcome following services and those who exited before
services more often receiving this assistance than were persons with an
employment outcome. The relative percentages by the third year were 6,
10, and 12 percent, respectively.

Persons whose employment outcome was in the competitive labor market
also differed from those who entered noncompetitive employment on most
of these measures. As shown in Table 6-13, 39 percent of consumers who
later exited into competitive employment were receiving some form of
financial assistance at entry, compared with 62 percent of consumers who
later entered noncompetitive jobs. By the third year after exit, more
than twice as many in noncompetitive employment were receiving some form
of financial assistance (55 versus 26 percent). In terms of
SSI/disabled, for both groups the percentage who received this benefit
increased somewhat from entry to three years after exit: from 10 to
12 percent for those in competitive jobs and from 27 to 35 percent for
those in noncompetitive jobs. At each time point, more noncompetitively
employed persons were receiving this benefit than were those in
competitive jobs. Similarly, more noncompetitively employed persons were
receiving SSDI at each time point, although for this benefit and for
each group the percentage receiving SSDI remained about the same over
time (9 percent at entry and 8 percent at three years after exit for
competitively employed persons; 14 percent at entry and 15 percent at
three years after exit for noncompetitively employed persons).

Among persons who exited VR with an employment outcome but were not
working at subsequent annual follow-up interviews, the pattern of
financial assistance differed somewhat. As shown in Table 6-14, about
the same percentage of these consumers as those retaining employment at
follow up were receiving financial assistance at study entry: 41 percent
of those later exiting into competitive employment and 71 percent of
those later exiting into noncompetitive employment. However, the
percentages of consumers in both groups more often reported receipt of
financial assistance at follow up. Among persons whose employment
outcome was competitive but who were not working at follow up, 49
percent reported receipt of financial assistance one year after exit; 47
percent, two years later; and 45 percent, three years later. Comparable
figures among those whose employ­ment outcome was noncompetitive were 76
percent one year after exit; 75 percent at two years, and 76 percent at
three years. As shown in the table, percentage of persons reporting
receipt of SSI-disabled increased over time for both groups, as did
receipt of SSDI among persons whose outcome had been competitive
employment. (Numbers were too small for reporting of other findings on
financial assistance.)

+------------------------------+-------------------+-------------------+
| Table 6-13. Receipt of       |                   |                   |
| Transfer Payments at Entry   |                   |                   |
| to VR and Following Exit, by |                   |                   |
| Job Type at Exit             |                   |                   |
+------------------------------+-------------------+-------------------+
| Number range CHAPTER         | **Percentage**    |                   |
|                              |                   |                   |
| **Type of benefit**          |                   |                   |
+------------------------------+-------------------+-------------------+
|                              | **Persons exiting | **Persons exiting |
|                              | VR with a         | VR with a         |
|                              | competitive       | noncompetitive    |
|                              | employment        | employment        |
|                              | outcome**         | outcome**         |
+------------------------------+-------------------+-------------------+
| **Receiving any financial    |                   |                   |
| assistance**                 |                   |                   |
+------------------------------+-------------------+-------------------+
| At study entry               | 38.7              | 62.4\*            |
+------------------------------+-------------------+-------------------+
| One year after exit          | 23.3              | 54.2\*            |
+------------------------------+-------------------+-------------------+
| Two years after exit         | 23.6              | 51.8\*            |
+------------------------------+-------------------+-------------------+
| Three years after exit       | 26.0              | 54.7\*            |
+------------------------------+-------------------+-------------------+
| **Type of financial          |                   |                   |
| assistance, percentage of    |                   |                   |
| all consumers**              |                   |                   |
+------------------------------+-------------------+-------------------+
|                              |                   |                   |
+------------------------------+-------------------+-------------------+
| **SSI/disabled**             |                   |                   |
+------------------------------+-------------------+-------------------+
| At study entry               | 10.0              | 27.3\*            |
+------------------------------+-------------------+-------------------+
| One year after exit          | 10.1              | 30.9\*            |
+------------------------------+-------------------+-------------------+
| Two years after exit         | 11.0              | 30.2\*            |
+------------------------------+-------------------+-------------------+
| Three years after exit       | 11.8              | 35.1\*            |
+------------------------------+-------------------+-------------------+
| **SSDI**                     |                   |                   |
+------------------------------+-------------------+-------------------+
| At study entry               | 8.5               | 14.3\*            |
+------------------------------+-------------------+-------------------+
| One year after exit          | 6.8               | 18.0\*            |
+------------------------------+-------------------+-------------------+
| Two years after exit         | 6.6               | 18.7\*            |
+------------------------------+-------------------+-------------------+
| Three years after exit       | 7.5               | 14.6\*            |
+------------------------------+-------------------+-------------------+
| **Worker\'s Compensation**   |                   |                   |
+------------------------------+-------------------+-------------------+
| At study entry               | 3.4               | 1.0\*             |
+------------------------------+-------------------+-------------------+
| One year after exit          | 0.7               | 0.6               |
+------------------------------+-------------------+-------------------+
| Two years after exit         | 1.3               | 0.2\*             |
+------------------------------+-------------------+-------------------+
| Three years after exit       | 1.0               | 0.4               |
+------------------------------+-------------------+-------------------+
| **Other public assistance**  |                   |                   |
+------------------------------+-------------------+-------------------+
| At study entry               | 13.1              | 22.0\*            |
+------------------------------+-------------------+-------------------+
| One year after exit          | 6.0               | 11.3\*            |
+------------------------------+-------------------+-------------------+
| Two years after exit         | 4.2               | 5.5               |
+------------------------------+-------------------+-------------------+
| Three years after exit       | 5.2               | 7.3               |
+------------------------------+-------------------+-------------------+
| \* Indicates a significant   |                   |                   |
| difference from persons with |                   |                   |
| a competitive employment     |                   |                   |
| outcome (p \<.05).           |                   |                   |
+------------------------------+-------------------+-------------------+

Number range CHAPTERJob Satisfaction

At each of the annual follow-up interviews conducted with study
participants following their exit from VR,[^16] the y responded to a
series of questions concerning various aspects of their employment,
including their relative satisfaction with earnings, fringe benefits,
extent to which they felt integrated in the workplace, opportunity for
advancement in their job, and level of support they believed they had
from their employer. Table 6-15 reports findings on these issues.
Regarding earnings, nearly one-third of consumers with a competitive
employment outcome indicated that they were not satisfied with their
earnings levels at the end of the first and second years of employment;
this percentage declined slightly to around one-quarter by

<table>
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<col style="width: 1%" />
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</colgroup>
<tbody>
<tr class="odd">
<td colspan="12">Table 6-15. Percentage of Former VR Consumers Reporting
Satisfaction with Selected Aspects of Their Employment, for Consumers
with Competitive or Noncompetitive Jobs and Those Without an Employment
Outcome</td>
</tr>
<tr class="even">
<td rowspan="3"><strong>Number range CHAPTERJob
characteristics</strong></td>
<td colspan="11"><strong>Percentage</strong></td>
</tr>
<tr class="odd">
<td colspan="3"><strong>One-year follow up</strong></td>
<td></td>
<td colspan="3"><strong>Two-year follow up</strong></td>
<td></td>
<td colspan="3"><strong>Three-year follow up</strong></td>
</tr>
<tr class="even">
<td><strong><em>Very</em> satisfied</strong></td>
<td><strong>Satisfied</strong></td>
<td><strong><em>Not</em> satisfied</strong></td>
<td></td>
<td><strong><em>Very</em> satisfied</strong></td>
<td><strong>Satisfied</strong></td>
<td><strong><em>Not</em> satisfied</strong></td>
<td></td>
<td><strong><em>Very</em> satisfied</strong></td>
<td><strong>Satisfied</strong></td>
<td><strong><em>Not</em> satisfied</strong></td>
</tr>
<tr class="odd">
<td><strong>Achieved a competitive employment outcome</strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>Earnings</td>
<td>11.8</td>
<td>55.6</td>
<td>32.6</td>
<td></td>
<td>10.7</td>
<td>57.5</td>
<td>31.9</td>
<td></td>
<td>11.1</td>
<td>62.3</td>
<td>26.6</td>
</tr>
<tr class="odd">
<td>Fringe benefits</td>
<td>15.4</td>
<td>45.5</td>
<td>39.0</td>
<td></td>
<td>15.3</td>
<td>49.9</td>
<td>34.8</td>
<td></td>
<td>17.7</td>
<td>51.2</td>
<td>31.0</td>
</tr>
<tr class="even">
<td>Integration in the workplace</td>
<td>30.3</td>
<td>56.8</td>
<td>12.9</td>
<td></td>
<td>26.3</td>
<td>62.0</td>
<td>11.7</td>
<td></td>
<td>29.0</td>
<td>61.5</td>
<td>9.6</td>
</tr>
<tr class="odd">
<td>Opportunity for advancement</td>
<td>14.5</td>
<td>51.2</td>
<td>34.3</td>
<td></td>
<td>10.2</td>
<td>54.7</td>
<td>35.1</td>
<td></td>
<td>11.4</td>
<td>56.4</td>
<td>32.3</td>
</tr>
<tr class="even">
<td>Employer support</td>
<td>31.5</td>
<td>53.2</td>
<td>15.4</td>
<td></td>
<td>28.2</td>
<td>56.5</td>
<td>15.3</td>
<td></td>
<td>32.4</td>
<td>58.1</td>
<td>9.5</td>
</tr>
<tr class="odd">
<td><strong>Achieved a noncompetitive employment outcome</strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>Earnings</td>
<td>12.6</td>
<td>59.9</td>
<td>27.6</td>
<td></td>
<td>11.7</td>
<td>58.7</td>
<td>29.6</td>
<td></td>
<td>10.6</td>
<td>68.8</td>
<td>20.5</td>
</tr>
<tr class="odd">
<td>Fringe benefits</td>
<td>9.8<sup></sup></td>
<td>41.3</td>
<td>48.9<sup></sup></td>
<td></td>
<td>12.4</td>
<td>49.9</td>
<td>37.7</td>
<td></td>
<td>11.7</td>
<td>57.3</td>
<td>31.0</td>
</tr>
<tr class="even">
<td>Integration in the workplace</td>
<td>28.0</td>
<td>60.0</td>
<td>12.0</td>
<td></td>
<td>35.0<sup></sup></td>
<td>57.3</td>
<td>7.7</td>
<td></td>
<td>30.1</td>
<td>57.2</td>
<td>12.7</td>
</tr>
<tr class="odd">
<td>Opportunity for advancement</td>
<td>11.2</td>
<td>52.4</td>
<td>36.4</td>
<td></td>
<td>9.3</td>
<td>63.8<sup></sup></td>
<td>26.9<sup></sup></td>
<td></td>
<td>8.0</td>
<td>71.5<sup></sup></td>
<td>20.5<sup></sup></td>
</tr>
<tr class="even">
<td>Employer support</td>
<td>37.0</td>
<td>50.6</td>
<td>12.4</td>
<td></td>
<td>35.5</td>
<td>57.2</td>
<td>7.3<sup></sup></td>
<td></td>
<td>31.3</td>
<td>61.9</td>
<td>6.8</td>
</tr>
<tr class="odd">
<td><strong>Received VR services, failed to achieve an employment
outcome</strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>Earnings</td>
<td>10.7</td>
<td>52.1</td>
<td>37.2</td>
<td></td>
<td>8.1</td>
<td>51.3</td>
<td>40.6*</td>
<td></td>
<td>5.9</td>
<td>55.8</td>
<td>38.3*</td>
</tr>
<tr class="odd">
<td>Fringe benefits</td>
<td>8.8</td>
<td>37.1</td>
<td>54.1</td>
<td></td>
<td>7.3</td>
<td>39.3</td>
<td>53.4*</td>
<td></td>
<td>8.2</td>
<td>47.9</td>
<td>43.9*</td>
</tr>
<tr class="even">
<td>Integration in the workplace</td>
<td>25.1</td>
<td>58.8</td>
<td>16.2</td>
<td></td>
<td>21.8</td>
<td>58.5</td>
<td>19.6*</td>
<td></td>
<td>20.0</td>
<td>65.5</td>
<td>14.6*</td>
</tr>
<tr class="odd">
<td>Opportunity for advancement</td>
<td>13.6</td>
<td>43.9</td>
<td>42.5*</td>
<td></td>
<td>7.3</td>
<td>50.8</td>
<td>41.9*</td>
<td></td>
<td>7.4</td>
<td>53.3</td>
<td>39.4</td>
</tr>
<tr class="even">
<td>Employer support</td>
<td>23.7</td>
<td>59.7</td>
<td>16.6</td>
<td></td>
<td>23.4</td>
<td>56.2</td>
<td>20.4*</td>
<td></td>
<td>28.2</td>
<td>50.2</td>
<td>21.5*</td>
</tr>
<tr class="odd">
<td colspan="12"><p> Indicates a significant difference (p &lt;.05)
between this value and the corresponding value for individuals who
received VR services and achieved a competitive employment outcome.</p>
<p>* Indicates a significant difference (p &lt;.05) between this value
and the corresponding value for individuals who received VR services and
achieved an employment outcome.</p></td>
</tr>
</tbody>
</table>

Number range CHAPTERthe end of the third year. Somewhat more consumers
without an employment outcome who reported they were working at the
follow-up points were dissatisfied with their earnings, around
two-fifths in all three years following exit from VR. Among both groups,
around half reported satisfaction with earnings, but very few responded
that they were "very satisfied." Consumers in noncompetitive employment
reported increasing satisfaction with earnings over time, from
60 percent at the end of year one to 69 percent at the end of year
three. Among the three groups, persons who had exited VR without an
employment outcome and those in noncompeti­tive employment were less
satisfied with fringe benefits than were those in competitive
employment, who, as noted earlier, had relatively more fringe benefits
than did the other two groups. In terms of opportunity for advancement,
around one-half of persons in competitive jobs reported satisfaction
with their opportunities at year one; this percentage increased
slightly, to 56 percent, by the end of year three. Those in
noncompetitive jobs, however, were increasingly satisfied with their
opportunities; ranging from 52 percent at the end of the first year to
72 percent at the end of the third year. Persons who had exited VR
without a job were generally less satisfied, but did indicate their
satisfaction with their prospects improved over time, from 44 percent to
53 percent.

Over half of all groups reported satisfaction with their level of
integration in the workplace: by the end of year three, 62 percent of
persons in competitive employment, 57 percent of persons in
noncompetitive employment, and 66 percent of those who had exited
without an employment outcome were satisfied with this aspect of their
jobs. More were very satisfied with this dimension of their working life
than with any other; between 20 and 35 percent were very satisfied,
although for the group without an employment outcome, this percentage
declined over time. For those with an employment outcome who were in
competitive or noncompetitive employment, satisfaction with level of
employer support was also relatively high, increasing from 53 percent at
year one to 58 percent at year three among those with competitive jobs
and from 51 percent to 62 percent for those in noncompetitive jobs.
Conversely, persons working who had exited without an employment outcome
were less satisfied with the level of employer support over time, from
60 percent at year one to 50 percent at year three. Overall, consumers
in all groups were less satisfied with fringe benefits than with other
aspects of the job; most were satisfied or very satisfied with
integration in the workplace.

Relationship Between Specific Services and Consumer Outcomes

Previous sections of this report have described the varying patterns of
services that VR consumers receive and how these services differ
according to disability characteristics and vocational goals. In this
section we address one of the key study questions: To what extent do
specific VR services contribute to successful consumer outcomes? To
learn which services contribute to positive consumer outcomes, we used
relational analyses that examine the multiple correlations between
services and outcomes while holding consumer characteristics constant.
As we reported in the First Final Report of this study, a number of
consumer characteristics are positively or negatively related to
achievement of an employment outcome. Building upon those findings, we
included the following characteristics as covariates in the analyses
reported here:

> P significance of disability,
>
> P type of disability,
>
> P receipt of SSDI/SSI financial assistance,
>
> P self-esteem (as measured by a scale of self-reported items),
>
> P working at application to VR,
>
> P number of dependents, and
>
> P race/ethnicity other than white.

Our analyses asked the question, "Given that these individual
characteristics affect consumer outcomes, how much do specific services
additionally contribute to the outcomes?" We conducted regression
analyses[^17] to investigate the unique effects of the services, using
the above listed characteristics as covariates, meaning that we
controlled for their effects. For these analyses we included services in
the following categories: employment-development services;
cognitive/psychosocial services; medical/functional services;
mobility-related services; postsecondary education services; other
education services; and miscellaneous support services. We also included
IPE amendment from the case management services category. We did not
include services that virtually all consumers received (eligibility
determination and IPE development), nor did we include assessments,
since we did not believe that assessments alone (that is, not followed
by a related service) would affect consumer outcomes. In addition to
services, we included one other variable mentioned elsewhere in this
report---the quality of the consumer/counselor relationship, as we
believe it has the potential to be an important aspect of the services a
consumer receives.

The outcome variables^4^ for which we conducted these analyses included:

> P employment at closure and at one and two years after closure,
>
> P competitive versus noncompetitive employment at closure and at one
> and two years after closure,
>
> P earnings at closure and at one and two years after closure, and
>
> P health benefits with employment at closure and at one and two years
> after closure.

Achievement of an Employment Outcome

As shown in Exhibit 6-1, the logistic regression analyses for the first
class of outcomes above (working versus not working) revealed a number
of services that are related to an increased likelihood that a VR
consumer would achieve an employment outcome. (Odds ratios are shown in
Appendix D, Tables D-1 to D-3). Specifically, the services shown in the
exhibit accounted for a significant proportion of the variance in
employment, controlling for the effects of the listed covariates. At
exit from VR, and with a sample size of 3,237 consumers (those
individuals for whom data were available on all variables in the model),
these variables accounted for 23 percent of the variance (that is, R^2^
= 0.23) in employment outcome. This is an impressively high R^2^ value
for social science research. The proportion of variance accounted for by
this model at one and two years following closure is somewhat less (0.16
and 0.18, respectively) but still significant and substantively
important.

  -----------------------------------------------------------------------
  Exhibit 6-1. Services That Lead to Employment

  ![](media/image5.wmf){width="5.9375in" height="3.558333333333333in"}
  -----------------------------------------------------------------------

We need to interpret carefully the results of this analysis (and those
reported below) because we cannot infer that these specific services
would be of benefit to all consumers. Specific consumers in the sample
received these services, presumably because the services were
appropriate to their needs and goals. We believe that these should be
looked at as potentially

important services for consumers and counselors to consider, unless they
are counter to the individual's specific vocational goal and individual
needs related to that goal.

With the above cautions in mind, Exhibit 6-1 suggests a number of
implications. First, having a good consumer/counselor relationship is
important, and so is having an opportunity to change one's IPE during
the course of services if such a change becomes appropriate. Especially
important services (in terms of leading to employment) in the categories
of education and employment development include participation in
business or vocational training programs, job placement, supported
employment, and on-the-job training. Receipt of independent living
services contributes to achievement of an employment outcome, as does
driver training/licensing and the provision of job-related materials
such as tools, uniforms, equipment, and stock. Receipt of counseling for
personal or psychosocial problems reduces the likelihood of an
employment outcome, however, although it does not appear to reduce
employment retention over time.

Achievement of Competitive Employment

The next set of outcomes we considered was achievement of competitive
versus noncompeti­tive employment at closure and at one and two years
after closure. We conducted these analyses for consumers who were
working at each of those time points and looked at the relationship
between services (the same list of services as described above) and the
likelihood of being competitively employed. As Exhibit 6-2 depicts, we
found significant relationships for a group of services similar to that
found for any employment, above. (Odds ratios are shown in Appendix D,
Tables D-4 to D-6.) That is, services found to be important for
competitive employment that were also important for any employment
included: the quality of the consumer/counselor relationship and
preparation of an IPE amendment; employment-development services
including job development, job placement, and on-the-job training. We
note that within employment-development services, receipt of supported
employment services reduced the likelihood of a competitive employment
outcome. Postsecondary education services---business or vocational
training and four-year college or university---were important for
competitive employment. Among mobility-related and other support
services, provision of tools, uniforms, and equipment contributed to
competitive employment. We note that receipt of independent living
services showed a negative relationship with competitive employment at

  -----------------------------------------------------------------------
  **Exhibit 6-2. Services That Lead to Competitive Employment**

  ![](media/image6.wmf){width="6.5in" height="3.9in"}
  -----------------------------------------------------------------------

closure, and a positive relationship at one and two years after VR exit.
We interpret this finding to mean that individuals for whom independent
living services were needed were less likely to be able to be employed
initially in a competitive situation than in a noncompetitive one. We
believe it is unlikely that receipt of independent living services was
itself detrimental to the outcome. Receipt of medical services was
negatively related to achievement of competitive employment at closure.

Earnings

The services that we found to be important for amount of earnings (at
exit and one and two years after exit from VR services) are somewhat
different from those reported for achievement of competitive employment.
As shown in Exhibit 6-3, quality of the relationship between the
consumer and counselor was significantly related to employment and to
competitive employment, and also differentiated among earnings levels
for those consumers who were working. Consumers who received
employment-development services---job placement and on-the-job
training---were likely to have higher earnings than other working
consumers. However, enrollment in various forms of postsecondary
education was associated with lower earnings at closure and
subsequently, possibly because such consumers were entering first jobs
or were younger. Receipt of medical services or counseling also was
associated with lower earnings. The services that appear to be important
for higher earnings include AT services, tools/uniforms/equipment/stock,
interpreter services, and substance abuse treatment.

  -----------------------------------------------------------------------
  Exhibit 6-3. Services That Lead to Earnings Outcome

  ![](media/image7.wmf){width="5.35in" height="3.0625in"}
  -----------------------------------------------------------------------

Health Benefits

We anticipated that similar groups of services would be important for
both higher earnings and receipt of health benefits with employment. The
model depicted in Exhibit 6-4 is, in fact, similar to that in Exhibit
6-3, with some exceptions. In addition to consumers who received
supported employment services, those who received medical services and
counseling services were also less likely than other working consumers
to have employment that offered health benefits. Receipt of AT devices
and services and enrollment in postsecondary education led to a higher
likelihood of receiving health benefits, as did receipt of maintenance
services, transportation, and orientation/mobility training. (Odds
ratios are shown in Appendix D, Tables D-7 to D-9.)

In summary, our analyses found that a number of specific VR services
appear to contribute to a consumer's likelihood to achieve an employment
outcome and a competitive employment outcome. An important part of
services leading to these outcomes is a relationship between the
consumer and counselor that the consumer believes is productive and
helpful, with flexibility to

  -----------------------------------------------------------------------
  Exhibit 6-4. Services That Lead to Receipt of Health Benefits with
  Employment

  ![](media/image8.wmf){width="5.659722222222222in"
  height="3.3895833333333334in"}
  -----------------------------------------------------------------------

amend the consumer's service plan as appropriate to facilitate
achievement of the vocational goal. As preliminary findings from the
study have indicated in the past, enrollment in postsecondary education,
including business or vocational school, community college, and
four-year college or university, is associated with achievement of
competitive employment, which is likely to offer greater return in terms
of benefits and career advancement potential (although not in earnings
in the first few years), as noted in earlier sections of this chapter.
Our models indicate the utility of these services, along with others, in
leading to better employment-related outcomes. Also notable is the
importance of mobility-related services, AT devices and services in
particular, as a factor in achievement of employment, higher earnings,
and jobs with health insurance benefits.

Short- and Longer-Term Noneconomic Outcomes of Participation in VR

In addition to outcomes related to employment and earnings over time,
the study also collected data on other outcomes that may be expected to
result from receipt of VR services. Among the outcomes reported in this
chapter are receipt of services following exit from VR, community
integration and independence, and consumers' overall perspectives on
their VR services. Data on these outcomes came from annual interviews
with VR consumers both during and following their VR services. For these
analyses, we include individuals who were eligible for and received VR
services, separated into the following groups: persons who exited VR
with a competitive employment outcome, persons who exited VR with a
noncompetitive employment outcome, and persons who exited VR without an
employment outcome following receipt of VR services.

Receipt of Services Following Exit from VR

At annual interviews at one, two, and three years following exit from
VR, former consumers indicated whether or not they were receiving
services at the time of the interview. Potential services they might be
receiving included medical treatment, counseling, independent living
services, personal assistance services, transportation, AT devices or
services, job coaching, or education. Table 6-16 reports the findings
regarding ongoing receipt of services. In comparison with consumers in
competitive employment, more persons exiting VR into noncompetitive
employment or exiting without having achieved an employment outcome
reported receipt of services. This finding was consistent for each group
for each of the three time points. For example, one year after VR exit,
8 percent of persons with a competitive job were receiving some type of
services, compared with 25 percent of former consumers in noncompetitive
jobs and 18 percent of persons without an employment outcome. By the end
of the third year, 7 percent of competitively employed persons were
receiving services, compared with 24 percent of persons exiting into
noncompetitive jobs and 16 percent of those exiting VR without an
employment outcome. In sum, persons who exited VR into competitive
employment had significantly less need for ongoing services in the first
several years following their VR participation than did persons who
exited into noncompetitive jobs or without an employment outcome after
having received VR services---a finding that suggests the desirability
of competitive employment outcomes in comparison with other outcomes of
VR services.

Table 6-16 also reports types of services that former consumers received
after their exit from VR. These findings are for all consumers in each
group rather than only for consumers in each group who reported receipt
of any services at each of the time points. Eighteen percent of persons
exiting into noncompetitive employment used transportation services, a
percentage that did not vary much over the three-year period. Persons
exiting without an employment outcome also used this service more
frequently than did those exiting into competitive jobs (9 versus 2
percent at first follow up and 9 versus 3 percent by third followup).
Other services

+-------------------------------+------------+------------+------------+
| Table 6-16. Receipt of        |            |            |            |
| Services Following Exit from  |            |            |            |
| VR, Among Persons Who         |            |            |            |
| Received Services             |            |            |            |
+-------------------------------+------------+------------+------------+
| Number range CHAPTER          | **Pe       |            |            |
|                               | rcentage** |            |            |
| **Type of service**           |            |            |            |
+-------------------------------+------------+------------+------------+
|                               | **Persons  | **Persons  | **Persons  |
|                               | exiting VR | exiting VR | exiting VR |
|                               | with a     | with a     | without an |
|                               | c          | nonc       | employment |
|                               | ompetitive | ompetitive | outcome    |
|                               | employment | employment | after      |
|                               | outcome**  | outcome**  | services** |
+-------------------------------+------------+------------+------------+
| **Received any services**     |            |            |            |
+-------------------------------+------------+------------+------------+
| One year after exit           | 7.6        | 25.1\*     | 18.0\*     |
+-------------------------------+------------+------------+------------+
| Two years after exit          | 8.5        | 22.5\*     | 17.1\*     |
+-------------------------------+------------+------------+------------+
| Three years after exit        | 7.4        | 23.5\*     | 16.4\*     |
+-------------------------------+------------+------------+------------+
| **Percentage of all consumers |            |            |            |
| in group**                    |            |            |            |
+-------------------------------+------------+------------+------------+
| **Counseling**                |            |            |            |
+-------------------------------+------------+------------+------------+
| One year after exit           | 5.4        | 13.2\*     | 13.9\*     |
+-------------------------------+------------+------------+------------+
| Two years after exit          | 6.2        | 10.2       | 11.4\*     |
+-------------------------------+------------+------------+------------+
| Three years after exit        | 5.2        | 9.2        | 10.7\*     |
+-------------------------------+------------+------------+------------+
| **Medical treatment**         |            |            |            |
+-------------------------------+------------+------------+------------+
| One year after exit           | 3.9        | 12.8\*     | 10.7\*     |
+-------------------------------+------------+------------+------------+
| Two years after exit          | 3.2        | 10.0\*     | 7.9\*      |
+-------------------------------+------------+------------+------------+
| Three years after exit        | 2.8        | 9.8\*      | 8.0\*      |
+-------------------------------+------------+------------+------------+
| **Independent living**        |            |            |            |
+-------------------------------+------------+------------+------------+
| One year after exit           | 1.1        | 4.7\*      | 2.4\*      |
+-------------------------------+------------+------------+------------+
| Two years after exit          | 0.8        | 3.8\*      | 1.1        |
+-------------------------------+------------+------------+------------+
| Three years after exit        | 0.3        | 5.2\*      | 1.4        |
+-------------------------------+------------+------------+------------+
| **Personal assistance**       |            |            |            |
+-------------------------------+------------+------------+------------+
| One year after exit           | 0.5        | 3.9\*      | 2.2\*      |
+-------------------------------+------------+------------+------------+
| Two years after exit          | 0.6        | 3.8\*      | 0.9        |
+-------------------------------+------------+------------+------------+
| Three years after exit        | 0.4        | 3.7\*      | 1.1        |
+-------------------------------+------------+------------+------------+
| **Transportation**            |            |            |            |
+-------------------------------+------------+------------+------------+
| One year after exit           | 2.3        | 17.8\*     | 8.5\*      |
+-------------------------------+------------+------------+------------+
| Two years after exit          | 3.8        | 16.7\*     | 7.4\*      |
+-------------------------------+------------+------------+------------+
| Three years after exit        | 3.0        | 17.4\*     | 9.1\*      |
+-------------------------------+------------+------------+------------+
| **Assistive technology        |            |            |            |
| devices or services**         |            |            |            |
+-------------------------------+------------+------------+------------+
| One year after exit           | 0.6        | 2.4\*      | 2.4\*      |
+-------------------------------+------------+------------+------------+
| Two years after exit          | 0.5        | 2.6\*      | 1.3        |
+-------------------------------+------------+------------+------------+
| Three years after exit        | 0.7        | 2.5        | 2.1        |
+-------------------------------+------------+------------+------------+
| **Job coaching**              |            |            |            |
+-------------------------------+------------+------------+------------+
| One year after exit           | 1.4        | 10.5\*     | 1.6        |
+-------------------------------+------------+------------+------------+
| Two years after exit          | 0.9        | 9.2\*      | 1.9        |
+-------------------------------+------------+------------+------------+
| Three years after exit        | 1.0        | 7.1\*      | 1.2        |
+-------------------------------+------------+------------+------------+
| **Education**                 |            |            |            |
+-------------------------------+------------+------------+------------+
| One year after exit           | 0.7        | 3.5\*      | 2.8\*      |
+-------------------------------+------------+------------+------------+
| Two years after exit          | 0.7        | 2.1        | 1.7\*      |
+-------------------------------+------------+------------+------------+
| Three years after exit        | 0.7        | 0.6        | 1.4        |
+-------------------------------+------------+------------+------------+
| \* Indicates a significant    |            |            |            |
| difference from persons with  |            |            |            |
| a competitive employment      |            |            |            |
| outcome (p \<.05).            |            |            |            |
+-------------------------------+------------+------------+------------+

that persons exiting into noncompetitive employment and those exiting
without an employment outcome received more frequently than persons with
competitive jobs included counseling (13 and 14 percent versus 5 percent
at first follow up) and medical treatment (13 and 11 percent versus 4
percent at first follow up). Persons in noncompetitive jobs more often
received job coaching (11 versus 1 percent at first follow up), although
the percentage using this service declined from 11 to 7 percent by the
end of the third year.

As these data suggest, a relatively small percentage of former consumers
were receiving various services in the first few years after VR exit.
For each of the three groups, the percentages remained relatively stable
over time in terms of receipt of any services---between 7 and 9 percent
for persons who exited into a competitive job, about one-quarter of
those exiting into noncompetitive employment, and under 20 percent among
those exiting without an employment outcome. In general, use of any one
service tended to decline slightly over time, with the exception of such
services as transportation, where for persons using this service, the
need for it remained relatively stable.

Community Integration and Independence

Table 6-17 reports consumers' perspectives at exit from VR and at three
annual follow-up interviews regarding the extent to which they believed
that their disability restricted their ability to participate fully in
social and community activities and constrained their ability to reach
their full potential. As shown, at study entry fewer persons who later
exited into competitive employment reported that their disability
restricted their activities than did persons who exited into
noncompetitive employment or those who exited VR services without an
employment outcome (32 percent versus 42 and 43 percent). Further,
persons exiting into competitive employment reported that these
restrictions became less of a problem over time: by the end of the third
year, only 22 percent reported that their disability restricted their
participation in social or community activities. The other two groups
reported only slight change over time on this dimension, however. In
terms of reaching potential, over half of persons later exiting into
competitive or noncompetitive employment reported this challenge at
study entry (57 percent for persons who exited into competitive
employment, 56 percent for persons who exited into noncompetitive
employment); significantly more persons exiting without an employment
outcome reported this issue (71 percent). Again, by the end of the third

+---------------------------+-------------+-------------+-------------+
| Table 6-17. Self-Reported |             |             |             |
| Measures of Community     |             |             |             |
| Integration at Entry to   |             |             |             |
| VR and Following Exit     |             |             |             |
| from VR, Among Persons    |             |             |             |
| Who Received Services     |             |             |             |
+---------------------------+-------------+-------------+-------------+
| Number range CHAPTER      | **P         |             |             |
|                           | ercentage** |             |             |
+---------------------------+-------------+-------------+-------------+
|                           | **Persons   | **Persons   | **Persons   |
|                           | exiting VR  | exiting VR  | exiting VR  |
|                           | with a      | with a      | without an  |
|                           | competitive | non         | employment  |
|                           | employment  | competitive | outcome     |
|                           | outcome**   | employment  | after       |
|                           |             | outcome**   | services**  |
+---------------------------+-------------+-------------+-------------+
| **Disability restricts    |             |             |             |
| social and community      |             |             |             |
| activities**              |             |             |             |
+---------------------------+-------------+-------------+-------------+
| At study entry            | 31.5\*\*    | 42.4\*      | 42.8\*      |
+---------------------------+-------------+-------------+-------------+
| One year after exit       | 24.6        | 43.6\*      | 42.0\*      |
+---------------------------+-------------+-------------+-------------+
| Two years after exit      | 21.6        | 40.8\*      | 37.2\*      |
+---------------------------+-------------+-------------+-------------+
| Three years after exit    | 21.5        | 36.8\*      | 38.2\*      |
+---------------------------+-------------+-------------+-------------+
| **Disability or health    |             |             |             |
| problems prevent reaching |             |             |             |
| full potential**          |             |             |             |
+---------------------------+-------------+-------------+-------------+
| At study entry            | 56.7\*\*    | 56.4\*\*    | 70.7\*      |
+---------------------------+-------------+-------------+-------------+
| One year after exit       | 47.2        | 58.9\*      | 66.0\*      |
+---------------------------+-------------+-------------+-------------+
| Two years after exit      | 42.2        | 56.7\*      | 61.0\*      |
+---------------------------+-------------+-------------+-------------+
| Three years after exit    | 41.8        | 50.6\*      | 58.9\*      |
+---------------------------+-------------+-------------+-------------+
| \* Indicates a            |             |             |             |
| significant difference    |             |             |             |
| from persons with a       |             |             |             |
| competitive employment    |             |             |             |
| outcome (p \<.05).        |             |             |             |
|                           |             |             |             |
| \*\* Indicates a          |             |             |             |
| significant difference    |             |             |             |
| from entry to third       |             |             |             |
| follow up.                |             |             |             |
+---------------------------+-------------+-------------+-------------+

year, persons who exited into competitive employment reported this issue
significantly less frequently, with a change from 57 to 42 percent of
the group reporting this issue, as did persons exiting into
noncompetitive employment, with a change from 56 to 51 percent. Fewer
persons without an employment outcome after services reported the
problem over time (not significant).

Table 6-18 contains comparable data for persons with a competitive or
noncompetitive employment outcome who reported that they were not
working in the annual follow-up interview. As shown, one-third of those
who exited into competitive employment, and one-half of those exiting
into noncompetitive employment but who were not working at follow up,
reported at study entry that their disability restricted their social
and community activities. These percentages declined over time for those
not working at follow up whose employment outcome was competitive, to 23
percent of those not working three years later; but the percentages
remained about the same for persons whose employment outcome had been
noncompetitive. Perspectives of these groups regarding whether their
disability or health problems prevented them from reaching their full
potential are also reported in the table. As shown, nearly 60 percent of
both groups had agreed with this view at study entry; percentages
declined slightly over time, to 50 percent of those whose employment
outcome had been competitive and 52 percent of those whose employment
outcome had been noncompetitive.

Table 6-19 reports consumers' responses at VR exit to a number of more
detailed questions regarding the influence of VR services on selected
aspects of community integration, independence, self-advocacy, and other
factors with which VR might be expected to help consumers. Among the
issues addressed in this interview were:

> P community and social participation (e.g., feeling more comfortable
> in public places, feeling more comfortable socially and in developing
> friendships);
>
> P independence (e.g., more effective management of personal and
> financial affairs, greater ability to state needs and feelings
> clearly, gains in goal setting and planning); and
>
> P self-advocacy (e.g., standing up for one's rights, feeling more
> self-confident).

For these items, respondents indicated whether they needed assistance
from VR and, if they did need assistance, how helpful VR had been in
terms of helping them make positive changes. Response options were as
follows: VR helped a great deal, VR helped somewhat, VR did not help at
all. Percentages reported in the table apply to persons in each group
who reported that they did need help in the area.

  -------------------------------- ---------------- ---------------- ------------
  Table 6-19. Self-Reported                                          
  Measures of Increased                                              
  Integration and Independence                                       
  Following Exit From VR, Among                                      
  Persons Who Received VR Services                                   

  **Type of change**               **Percentage**                    

                                   **Persons        **Persons        **Persons
                                   exiting VR with  exiting VR with  exiting VR
                                   a competitive    a noncompetitive without an
                                   employment       employment       employment
                                   outcome**        outcome**        outcome
                                                                     after
                                                                     services**

  **Gain in self-confidence**                                        

  Did not need assistance          15.5             14.6             14.4\*

  VR helped a great deal           48.7             45.4             26.7\*

  VR helped somewhat               38.9             41.3             43.3

  VR did not help at all           12.5             13.3             30.0\*

  Total                            100.0            100.0            100.0

  **Gain in coping with                                              
  disability**                                                       

  Did not need assistance          12.3             7.1\*            9.5\*

  VR helped a great deal           46.7             49.8             23.2\*

  VR helped somewhat               37.7             35.3             40.9

  VR did not help at all           15.6             14.9             35.9\*

  Total                            100.0            100.0            100.0

  **Gain in feeling comfortable in                                   
  public**                                                           

  Did not need assistance          29.5             24.9\*           22.1\*

  VR helped a great deal           41.9             39.2             20.9\*

  VR helped somewhat               36.7             37.0             37.4

  VR did not help at all           21.4             23.9             41.7\*

  Total                            100.0            100.0            100.0

  **Gain in feeling comfortable                                      
  socially**                                                         

  Did not need assistance          30.7             27.6             21.5\*

  VR helped a great deal           37.5             38.2             17.4\*

  VR helped somewhat               38.7             33.4             41.3

  VR did not help at all           23.8             28.4             41.3\*

  Total                            100.0            100.0            100.0

  **Gain in developing more                                          
  friendships**                                                      

  Did not need assistance          34.2             34.1             23.6\*

  VR helped a great deal           32.8             29.5             18.1\*

  VR helped somewhat               37.1             33.1             30.8\*

  VR did not help at all           30.1             37.4             51.2\*

  Total                            100.0            100.0            100.0

  **Gain in stating needs and                                        
  feelings clearly**                                                 

  Did not need assistance          17.5             24.1             11.7\*

  VR helped a great deal           41.8             35.3             23.0\*

  VR helped somewhat               42.5             42.2             44.0

  VR did not help at all           15.7             22.4             33.0\*

  Total                            100.0            100.0            100.0

  **Gain in standing up for                                          
  rights**                                                           

  Did not need assistance          25.5             26.6             16.4\*

  VR helped a great deal           41.0             30.0\*           26.1\*

  VR helped somewhat               37.9             42.0             35.0

  VR did not help at all           21.2             28.0             38.9\*

  Total                            100.0            100.0            100.0

  **Gain in learning how to                                          
  develop goals and plans for                                        
  their achievement**                                                

  Did not need assistance          16.8             18.4             11.0\*

  VR helped a great deal           40.2             32.6             25.2\*

  VR helped somewhat               42.7             41.3             41.1

  VR did not help at all           17.1             26.1\*           33.8\*

  Total                            100.0            100.0            100.0

  **Gain in effective management                                     
  of personal and financial                                          
  affairs**                                                          

  Did not need assistance          32.2             21.9\*           21.4\*

  VR helped a great deal           31.8             33.3             14.5\*

  VR helped somewhat               33.6             34.5             28.9

  VR did not help at all           34.5             32.2             56.5\*

  Total                            100.0            100.0            100.0

  \* Indicates a significant                                         
  difference from persons with a                                     
  competitive employment outcome                                     
  (p \<.05).                                                         
  -------------------------------- ---------------- ---------------- ------------

Number range CHAPTERAs shown in Table 6-19, for all of the nine factors,
consumers who exited following services without an employment outcome
reported a greater need for help from VR than did persons who exited
into competitive employment. For all nine, they more often reported that
VR was not at all helpful than did persons who exited into competitive
employment. Thus they were consistently less pleased with the assistance
they received from VR in terms of these noneconomic outcomes.
Conversely, on many of the factors, persons exiting into competitive
employment and those exiting into noncompetitive employment had similar
perspectives. For example, about the same percentage of both groups
reported that VR either helped them a great deal (49 and 45 percent,
respectively) or somewhat (39 and 41 percent) in gaining
self-confidence. Similarly, among persons reporting that they needed
help in coping with disability, about the same percentage of these two
groups reported that VR helped a great deal (47 and 50 percent) or
somewhat (38 and 35 percent). For both of these factors, more than twice
as many persons exiting without an employment outcome reported that VR
did not help them at all. For self-confidence, 13 percent of each group
exiting into employment reported that VR was not at all helpful,
compared with 30 percent of those without an employment outcome.
Comparable figures on coping with disability were 16 and 15 percent
versus 36 percent.

Overall Perspective on the VR Experience

In addition to a number specific questions regarding consumers'
perspectives on their VR experience,[^18] consumers who received VR
services offered their overall perspective on VR through responses to
items about whether they would, should the opportunity arise, want to
obtain the same or different rehabilitation services. Table 6-20 reports
these findings, for the three groups of consumers who received services
(i.e., those exiting into competitive employ­ment, those exiting into
noncompetitive employment, and those exiting without an employ­ment
outcome). The interview occurred at or shortly after their exit from VR
services. As shown in the table, nearly two-thirds of persons exiting
into competitive jobs responded that if they had to pay for services,
they would purchase "exactly the same" services they received from the
VR program. Twenty-seven percent would purchase better or different
services, while 9 percent would spend the money on something other than
rehabilitation services. Figures for persons entering noncompetitive
employment were slightly, but nonsignificantly, different, with a

  --------------------------- ---------------- ---------------- --------------
  Table 6-20. Overall                                           
  Perspectives on VR                                            
  Services, Among Persons Who                                   
  Received Services                                             

  **Perspective**Number range **Percentage**                    
  CHAPTER                                                       

                              **Persons        **Persons        **Persons
                              exiting VR with  exiting VR with  exiting VR
                              a competi­tive    a noncompetitive without an
                              employment       employment       employment
                              outcome**        outcome**        outcome after
                                                                services**

  If I had to pay for it,     63.9             71.1             41.5\*
  I\'d buy exactly the same                                     
  rehabilitation services                                       
  that I received from the VR                                   
  program.                                                      

  If I had the money to buy   27.0             22.2             44.2\*
  my own rehabilitation                                         
  services, I\'d try to buy                                     
  better or different                                           
  services from the ones I                                      
  received through the VR                                       
  program.                                                      

  If I had the money, I       9.1              6.8              14.2\*
  wouldn\'t have spent it on                                    
  rehabilitation services at                                    
  all; I would have used it                                     
  for other things I needed.                                    

  Total                       100.0            100.0            100.0

  \* Indicates a significant                                    
  difference from persons                                       
  with a competitive                                            
  employment outcome (p                                         
  \<.05).                                                       
  --------------------------- ---------------- ---------------- --------------

slightly higher percentage (71 percent) indicating that they would buy
exactly the same services that they received from the VR program.
Conversely, persons who exited services without an employment outcome
were distinctly less positive about their VR experience. Only 42 percent
reported that they would buy the same services; slightly more than that
reported that they would buy different or better services from the ones
VR provided (44 percent), and more consumers than those exiting into
competitive jobs indicated they would buy something other than
rehabilitation services (14 versus 9 percent). These findings parallel
those from earlier reports (e.g., Hayward, Interim Report 2, 1996) in
that persons who exit services with an employment outcome, whether
competitive or noncompetitive, have considerably more positive
perspectives regarding most aspects of their VR experience than do
persons who are not successful in achieving an employment outcome.
Additional analyses planned for subsequent reports may help to reveal
the extent to which motivation, service quality, or other factors may
play a part in these perspectives.

References

Hayward, B. (1998). A Longitudinal Study of the Vocational
Rehabilitation Service Program. Third Interim Report: Characteristics
and Outcomes of Former VR Consumers with an Employment Outcome. Research
Triangle Park, NC: Research Triangle Institute.

Hayward, B. & Schmidt-Davis, H. (2000). A Longitudinal Study of the
Vocational Rehabilitation Service Program. Fourth Interim Report:
Characteristics and Outcomes of Transitional Youth in VR. Research
Triangle Park, NC: Research Triangle Institute.

Hayward, B. & Tashjian, M. (1995). A Longitudinal Study of the
Vocational Rehabilitation Service Program. First Interim Report.
Research Triangle Park, NC: Research Triangle Institute.

Hayward, B. & Tashjian, M. (1996). A Longitudinal Study of the
Vocational Rehabilitation Service Program. Second Interim Report:
Characteristics and Perspectives of VR Consumers. Research Triangle
Park, NC: Research Triangle Institute.

Hayward, B.J., et al. (1991). Evaluation of Vocational Assessment
Procedures and the IWRP Process Used by State VR Agencies: Data Analysis
Report. Research Triangle Park, NC: Research Triangle Institute.

APPENDIX A

OVERVIEW OF THE VR PROGRAM

The state-federal VR program has served persons with disabilities since
its inception in 1920, when Congress passed the Smith-Fess Act (P.L.
66-236) to provide rehabilitation services to World War I veterans with
physical disabilities. The program's authorization, in the
Rehabilitation Act of 1973 (P.L. 93-113, as amended), assigns
responsibility for program administration to the Rehabilitation Services
Administration (RSA) in the U.S. Department of Education. The goal of VR
services funded under Title I of the Act is:

> *. . .to assist States in operating a comprehensive, coordinated,
> effective, efficient, and accountable program of vocational
> rehabilitation that is designed to assess, plan, develop, and provide
> vocational rehabilitation services for individuals with disabilities,
> consistent with their strengths, resources, priorities, concerns,
> abilities, and capabilities so that such individuals may prepare for
> and engage in gainful employment (1992 Amendments to the
> Rehabilitation Act, Sec. 100 (a) (2)).*

Over the VR program's 80-year history, Congress has periodically
expanded VR's focus in a number of ways. The Barton La-Follette
Amendments of 1954 specified that the program extend services to
individuals with mental retardation or mental illness. At present, state
VR agencies provide services to individuals with the full range of
physical, sensory, or cognitive disabilities. The Rehabilitation Act of
1973 mandated that VR agencies (1) place priority on meeting the needs
of persons with significant disabilities, and (2) ensure that program
consumers have maximum involvement in planning and implementing their
rehabilitation programs. Other recent changes have expanded the
program's focus beyond time-limited, employment-related services leading
to competitive employment. For example, current emphases include
supported employment and post-closure services to assist consumers who
have achieved an employment outcome to maintain their employment. The
1992 Amendments contained significant changes in the purposes of Title
I, changed the eligibility determination process, called for VR agencies
to target services to persons with the most significant disabilities,
established a requirement for implementing program evaluation standards
and performance indicators, and made numerous modifications whose
general focus was to increase the program's responsiveness to the
preferences of individuals with disabilities and their families.
Finally, in 1998 Congress incorporated the Rehabilitation Act into the
Workforce Investment Act (P.L. 105-220) as part of a broad movement to
improve coordination among the nation's employment training programs.

VR services are administered by state VR agencies within guidelines
established by the Act and associated regulations found at 34 CFR Part
361, supplemented by other policy and programmatic guidelines. RSA is
responsible for national administrative direction, policy guidance, and
evaluation of state VR agencies, while the state agencies are
responsible for activities associated with determination of eligibility
for services and subsequent development and implementation of
individualized service plans (called Individualized Plans for
Employment, or IPEs) that will help consumers achieve their vocational
goals. Among the specific activities that RSA is authorized to undertake
in fulfilling its administrative responsibilities for the program are
monitoring, technical assistance, research, and evaluation.

Within the framework of federal statute and regulations, state VR
agencies establish policies and procedures to govern the VR program
according to the characteristics of states and the agencies themselves.
These can include specification of procedures to be followed by
rehabilitation counselors in determining and documenting eligibility and
in working with consumers to develop and implement IPEs, including
selecting and arranging or purchasing services for consumers. Examples
of the types of standards and procedures that state VR agencies have
implemented to ensure the quality and effectiveness of VR services
include the following:

• counselor performance standards (e.g., number employment outcomes,
time-in-status limits);

> • case review systems; and

• timelines for counselor contacts with consumers.

The state-federal VR program is funded approximately 78 percent by the
federal government, with a minimum 22 percent supplied by each state.
Currently, 82 state VR agencies in the United States, District of
Columbia, Puerto Rico, and territories administer services to
individuals, with 26 states operating both a "blind services" program
for persons with visual disabilities and a "general" program for
individuals with all other disabilities. The remainder operate a
"combined" program serving all persons with disabilities.

The organizational location of the rehabilitation agency (or agencies)
in a state varies. In about half of the states, VR is located in an
umbrella human services agency. Other locations include state education
agencies and departments of labor. In part as a reflection of
organizational changes resulting from enactment of the Workforce
Investment Act (WIA), consolidation of VR agencies with state-level
entities responsible for employment training (e.g., workforce
development departments) has recently occurred in many states.

Within the constraints of these changes, most states administer and
deliver VR services through a trilevel structure. The "central office,"
or administrative offices of the director and other management staff, is
usually located in the state capital. The state is then divided into
regions, or districts, with an office housing both regional staff and
service delivery personnel (rehabilitation counselors, vocational
evaluators, placement specialists). The third level is local, or field,
offices, which house service delivery staff and office administrators.
Thus persons with disabilities receive VR services (meet with
counselors) at both district and local offices.

States vary greatly in the numbers of regional and local offices,
depending on geographic size, relative population density, and other
factors. A state like North Carolina, for example, with an annual
caseload of about 37,000 in the general agency, has four regional and 30
local offices. California, with a caseload of over 82,000 (FY 1989), has
19 regional offices, each of which typically serves between three and
five local offices. (Given ongoing changes from state to state in
organizational structure, these numbers should be viewed as
illustrations of the variety among states rather than as accurate
descriptions of the current structure of the states.) This structure
permits supervisory, training, special services (e.g., rehabilitation
engineering), and technical assistance support to be located closer to
counselors and consumers throughout the state than would be possible
with a two-level structure and also permits housing of service delivery
staff in relatively close proximity to consumers through the system of
local, or field, offices.

Number range CHAPTER**APPENDIX B**

**\
TABLES ON RELATIONSHIPS BETWEEN VR SERVICES AND DISABILITY TYPE**

Number range CHAPTER**Table B-1. Analysis of Relationships Between VR
Services and Type of Disability: Subset 1**

+--------------------------+-----------+--------------------------+----+
| **Service**              | **Coef    | > **Disability type**    | ** |
|                          | ficient** |                          | Me |
|                          |           |                          | an |
|                          |           |                          | ** |
+--------------------------+-----------+--------------------------+----+
| Independent living       | 0.77      | > Vision impairment      | 2. |
| services                 |           |                          | 70 |
+--------------------------+-----------+--------------------------+----+
| Assistive technology     | 0.76      | > Hearing impairment     | 0. |
| devices                  |           |                          | 47 |
+--------------------------+-----------+--------------------------+----+
| Orientation/mobility     | 0.61      | > Orthopedic, amputation | -  |
| therapy                  |           |                          | 0. |
|                          |           |                          | 15 |
+--------------------------+-----------+--------------------------+----+
| Interpretation services  | 0.13      | > Traumatic brain injury | -  |
|                          |           |                          | 0. |
|                          |           |                          | 23 |
+--------------------------+-----------+--------------------------+----+
| Transportation           | 0.02      | > Nonorthopedic physical | -  |
|                          |           | > disability             | 0. |
|                          |           |                          | 26 |
+--------------------------+-----------+--------------------------+----+
| Tools/                   | 0.02      | > All other conditions   | -  |
| uniforms/equipment/stock |           |                          | 0. |
|                          |           |                          | 32 |
+--------------------------+-----------+--------------------------+----+
| Maintenance              | 0.00      | > Substance abuse        | -  |
|                          |           |                          | 0. |
|                          |           |                          | 32 |
+--------------------------+-----------+--------------------------+----+
| Medical services         | -0.01     | > Learning disability    | -  |
|                          |           |                          | 0. |
|                          |           |                          | 34 |
+--------------------------+-----------+--------------------------+----+
| Counseling               | -0.01     | > Mental illness         | -  |
|                          |           |                          | 0. |
|                          |           |                          | 38 |
+--------------------------+-----------+--------------------------+----+
| Four-year                | -0.02     | > Mental retardation     | -  |
| college/university       |           |                          | 0. |
|                          |           |                          | 38 |
+--------------------------+-----------+--------------------------+----+
| IPE amendment            | -0.05     |                          |    |
+--------------------------+-----------+--------------------------+----+
| Business/vocational      | -0.06     |                          |    |
| training                 |           |                          |    |
+--------------------------+-----------+--------------------------+----+
| Supported employment     | -0.07     |                          |    |
+--------------------------+-----------+--------------------------+----+
| Work adjustment          | -0.07     |                          |    |
+--------------------------+-----------+--------------------------+----+
| Two-year community       | -0.07     |                          |    |
| college                  |           |                          |    |
+--------------------------+-----------+--------------------------+----+
| Substance abuse          | -0.07     |                          |    |
| treatment                |           |                          |    |
+--------------------------+-----------+--------------------------+----+
| Job development          | -0.09     |                          |    |
+--------------------------+-----------+--------------------------+----+
| Job search training      | -0.09     |                          |    |
+--------------------------+-----------+--------------------------+----+
| Job placement            | -0.09     |                          |    |
+--------------------------+-----------+--------------------------+----+
| Vehicle                  | -0.09     |                          |    |
| maintenance/repair       |           |                          |    |
+--------------------------+-----------+--------------------------+----+
| Personal assistance      | -0.11     |                          |    |
| services                 |           |                          |    |
+--------------------------+-----------+--------------------------+----+
| P                        | -0.12     |                          |    |
| sychological/psychiatric |           |                          |    |
| treatment                |           |                          |    |
+--------------------------+-----------+--------------------------+----+
| Physical therapy         | -0.12     |                          |    |
+--------------------------+-----------+--------------------------+----+
| Assistive technology     | -0.12     |                          |    |
| services                 |           |                          |    |
+--------------------------+-----------+--------------------------+----+
| On-the-job training/job  | -0.13     |                          |    |
| trial                    |           |                          |    |
+--------------------------+-----------+--------------------------+----+
| Tutoring                 | -0.25     |                          |    |
+--------------------------+-----------+--------------------------+----+
| Driver                   | -0.27     |                          |    |
| training/licensing       |           |                          |    |
+--------------------------+-----------+--------------------------+----+

**Table B-2. Analysis of Relationships Between VR Services and Type of
Disability: Subset 2**

+------------------------+----------+-------------------------+-------+
| **Service**            | **Coeff  | > **Disability type**   | **M   |
|                        | icient** |                         | ean** |
+------------------------+----------+-------------------------+-------+
| Supported employment   | 0.88     | > Mental retardation    | 0.85  |
+------------------------+----------+-------------------------+-------+
| Orientation/mobility   | 0.80     | > Vision impairment     | 0.25  |
| therapy                |          |                         |       |
+------------------------+----------+-------------------------+-------+
| Independent living     | 0.75     | > All other conditions  | 0.25  |
| services               |          |                         |       |
+------------------------+----------+-------------------------+-------+
| Work adjustment        | 0.46     | > Traumatic brain       | 0.23  |
|                        |          | > injury                |       |
+------------------------+----------+-------------------------+-------+
| On-the-job training    | 0.38     | > Mental illness        | 0.14  |
+------------------------+----------+-------------------------+-------+
| Job development        | 0.29     | > Learning disability   | 0.09  |
+------------------------+----------+-------------------------+-------+
| Job placement          | 0.16     | > Substance abuse       | -0.12 |
+------------------------+----------+-------------------------+-------+
| Psy                    | 0.15     | > Nonorthopedic         | -0.14 |
| chological/psychiatric |          | > physical impairment   |       |
| treatment              |          |                         |       |
+------------------------+----------+-------------------------+-------+
| Driver                 | 0.13     | > Orthopedic,           | -0.24 |
| training/licensing     |          | > amputation            |       |
+------------------------+----------+-------------------------+-------+
| Tutoring               | 0.09     | > Hearing impairment    | -0.53 |
+------------------------+----------+-------------------------+-------+
| Substance abuse        | 0.03     |                         |       |
| treatment              |          |                         |       |
+------------------------+----------+-------------------------+-------+
| Maintenance            | 0.01     |                         |       |
+------------------------+----------+-------------------------+-------+
| Counseling             | -0.01    |                         |       |
+------------------------+----------+-------------------------+-------+
| Vehicle                | -0.01    |                         |       |
| maintenance/repair     |          |                         |       |
+------------------------+----------+-------------------------+-------+
| Personal assistance    | -0.01    |                         |       |
| services               |          |                         |       |
+------------------------+----------+-------------------------+-------+
| Transportation         | -0.03    |                         |       |
+------------------------+----------+-------------------------+-------+
| Medical services       | -0.04    |                         |       |
+------------------------+----------+-------------------------+-------+
| Tools/un               | -0.05    |                         |       |
| iforms/equipment/stock |          |                         |       |
+------------------------+----------+-------------------------+-------+
| Four-year              | -0.05    |                         |       |
| college/university     |          |                         |       |
+------------------------+----------+-------------------------+-------+
| Business/vocational    | -0.07    |                         |       |
| training               |          |                         |       |
+------------------------+----------+-------------------------+-------+
| Two-year community     | -0.07    |                         |       |
| college                |          |                         |       |
+------------------------+----------+-------------------------+-------+
| IPE amendment          | -0.08    |                         |       |
+------------------------+----------+-------------------------+-------+
| Assistive technology   | -0.20    |                         |       |
| devices                |          |                         |       |
+------------------------+----------+-------------------------+-------+
| Assistive technology   | -0.25    |                         |       |
| services               |          |                         |       |
+------------------------+----------+-------------------------+-------+
| Job search training    | -0.28    |                         |       |
+------------------------+----------+-------------------------+-------+
| Physical therapy       | -0.45    |                         |       |
+------------------------+----------+-------------------------+-------+
| Interpretation         | -0.55    |                         |       |
| services               |          |                         |       |
+------------------------+----------+-------------------------+-------+

**Table B-3. Analysis of Relationships Between VR Services and Type of
Disability: Subset 3**

+----------------------+-----------+-------------------------+--------+
| **Service**          | **Coef    | > **Disability type**   | **     |
|                      | ficient** |                         | Mean** |
+----------------------+-----------+-------------------------+--------+
| Orientation/mobility | 0.96      | > Vision impairment     | 0.23   |
| therapy              |           |                         |        |
+----------------------+-----------+-------------------------+--------+
| Independent living   | 0.85      | > Orthopedic,           | 0.20   |
| services             |           | > amputation            |        |
+----------------------+-----------+-------------------------+--------+
| Physical therapy     | 0.41      | > Substance abuse       | 0.20   |
+----------------------+-----------+-------------------------+--------+
| Substance abuse      | 0.39      | > Nonorthopedic         | 0.15   |
| treatment            |           | > physical impairment   |        |
+----------------------+-----------+-------------------------+--------+
| Driver               | 0.23      | > Mental illness        | 0.06   |
| training/licensing   |           |                         |        |
+----------------------+-----------+-------------------------+--------+
| Tools/unif           | 0.17      | > Learning disability   | 0.00   |
| orms/equipment/stock |           |                         |        |
+----------------------+-----------+-------------------------+--------+
| Vehicle              | 0.13      | > All other conditions  | -0.11  |
| maintenance/repair   |           |                         |        |
+----------------------+-----------+-------------------------+--------+
| Two-year community   | 0.13      | > Traumatic brain       | -0.13  |
| college              |           | > injury                |        |
+----------------------+-----------+-------------------------+--------+
| IPE amendment        | 0.12      | > Mental retardation    | -0.37  |
+----------------------+-----------+-------------------------+--------+
| Business/vocational  | 0.10      | > Hearing impairment    | -0.91  |
| training             |           |                         |        |
+----------------------+-----------+-------------------------+--------+
| Medical services     | 0.08      |                         |        |
+----------------------+-----------+-------------------------+--------+
| Psych                | 0.06      |                         |        |
| ological/psychiatric |           |                         |        |
| treatment            |           |                         |        |
+----------------------+-----------+-------------------------+--------+
| Maintenance          | 0.06      |                         |        |
+----------------------+-----------+-------------------------+--------+
| Four-year            | 0.05      |                         |        |
| college/university   |           |                         |        |
+----------------------+-----------+-------------------------+--------+
| Counseling           | 0.05      |                         |        |
+----------------------+-----------+-------------------------+--------+
| Personal assistance  | 0.04      |                         |        |
| services             |           |                         |        |
+----------------------+-----------+-------------------------+--------+
| Transportation       | -0.03     |                         |        |
+----------------------+-----------+-------------------------+--------+
| Tutoring             | -0.03     |                         |        |
+----------------------+-----------+-------------------------+--------+
| Job development      | -0.09     |                         |        |
+----------------------+-----------+-------------------------+--------+
| Job placement        | -0.12     |                         |        |
+----------------------+-----------+-------------------------+--------+
| Job search training  | -0.19     |                         |        |
+----------------------+-----------+-------------------------+--------+
| Work adjustment      | -0.22     |                         |        |
+----------------------+-----------+-------------------------+--------+
| On-the-job training  | -0.23     |                         |        |
+----------------------+-----------+-------------------------+--------+
| Assistive technology | -0.24     |                         |        |
| services             |           |                         |        |
+----------------------+-----------+-------------------------+--------+
| Assistive technology | -0.25     |                         |        |
| devices              |           |                         |        |
+----------------------+-----------+-------------------------+--------+
| Supported employment | -0.32     |                         |        |
+----------------------+-----------+-------------------------+--------+
| Interpretation       | -1.14     |                         |        |
| services             |           |                         |        |
+----------------------+-----------+-------------------------+--------+

**Table B-4. Analysis of Relationships Between VR Services and Type of
Disability: Subset 4**

+-------------------------+-----------+--------------------------+---+
| **Service**             | **Coef    | > **Disability type**    | * |
|                         | ficient** |                          | * |
|                         |           |                          | M |
|                         |           |                          | e |
|                         |           |                          | a |
|                         |           |                          | n |
|                         |           |                          | * |
|                         |           |                          | * |
+-------------------------+-----------+--------------------------+---+
| Substance abuse         | 1.50      | > Substance abuse        | 0 |
| treatment               |           |                          | . |
|                         |           |                          | 4 |
|                         |           |                          | 0 |
+-------------------------+-----------+--------------------------+---+
| Ps                      | 0.85      | > Mental illness         | 0 |
| ychological/psychiatric |           |                          | . |
| treatment               |           |                          | 3 |
|                         |           |                          | 3 |
+-------------------------+-----------+--------------------------+---+
| Orientation/mobility    | 0.23      | > Hearing impairment     | 0 |
| therapy                 |           |                          | . |
|                         |           |                          | 0 |
|                         |           |                          | 6 |
+-------------------------+-----------+--------------------------+---+
| Job search training     | 0.19      | > Vision impairment      | 0 |
|                         |           |                          | . |
|                         |           |                          | 0 |
|                         |           |                          | 4 |
+-------------------------+-----------+--------------------------+---+
| Transportation          | 0.13      | > All other conditions   | 0 |
|                         |           |                          | . |
|                         |           |                          | 0 |
|                         |           |                          | 3 |
+-------------------------+-----------+--------------------------+---+
| Interpretation services | 0.13      | > Learning disability    | - |
|                         |           |                          | 0 |
|                         |           |                          | . |
|                         |           |                          | 0 |
|                         |           |                          | 5 |
+-------------------------+-----------+--------------------------+---+
| Independent living      | 0.09      | > Traumatic brain injury | - |
| services                |           |                          | 0 |
|                         |           |                          | . |
|                         |           |                          | 0 |
|                         |           |                          | 6 |
+-------------------------+-----------+--------------------------+---+
| Business/vocational     | 0.08      | > Nonorthopedic physical | - |
| training                |           | > impairment             | 0 |
|                         |           |                          | . |
|                         |           |                          | 0 |
|                         |           |                          | 9 |
+-------------------------+-----------+--------------------------+---+
| Vehicle                 | 0.08      | > Orthopedic, amputation | - |
| maintenance/repair      |           |                          | 0 |
|                         |           |                          | . |
|                         |           |                          | 2 |
|                         |           |                          | 1 |
+-------------------------+-----------+--------------------------+---+
| Counseling              | 0.03      | > Mental retardation     | - |
|                         |           |                          | 0 |
|                         |           |                          | . |
|                         |           |                          | 2 |
|                         |           |                          | 6 |
+-------------------------+-----------+--------------------------+---+
| Four-year               | 0.02      |                          |   |
| college/university      |           |                          |   |
+-------------------------+-----------+--------------------------+---+
| Tools/u                 | 0.02      |                          |   |
| niforms/equipment/stock |           |                          |   |
+-------------------------+-----------+--------------------------+---+
| Two-year community      | 0.00      |                          |   |
| college                 |           |                          |   |
+-------------------------+-----------+--------------------------+---+
| Maintenance             | 0.00      |                          |   |
+-------------------------+-----------+--------------------------+---+
| Assistive technology    | -0.03     |                          |   |
| devices                 |           |                          |   |
+-------------------------+-----------+--------------------------+---+
| Personal assistance     | -0.04     |                          |   |
| services                |           |                          |   |
+-------------------------+-----------+--------------------------+---+
| On-the-job training     | -0.05     |                          |   |
+-------------------------+-----------+--------------------------+---+
| Work adjustment         | -0.07     |                          |   |
+-------------------------+-----------+--------------------------+---+
| Medical services        | -0.07     |                          |   |
+-------------------------+-----------+--------------------------+---+
| Job placement           | -0.13     |                          |   |
+-------------------------+-----------+--------------------------+---+
| Assistive technology    | -0.15     |                          |   |
| services                |           |                          |   |
+-------------------------+-----------+--------------------------+---+
| Job development         | -0.18     |                          |   |
+-------------------------+-----------+--------------------------+---+
| Supported employment    | -0.22     |                          |   |
+-------------------------+-----------+--------------------------+---+
| IPE amendment           | -0.26     |                          |   |
+-------------------------+-----------+--------------------------+---+
| Tutoring                | -0.46     |                          |   |
+-------------------------+-----------+--------------------------+---+
| Driver                  | -0.62     |                          |   |
| training/licensing      |           |                          |   |
+-------------------------+-----------+--------------------------+---+
| Physical therapy        | -0.99     |                          |   |
+-------------------------+-----------+--------------------------+---+

**Table B-5. Analysis of Relationships Between VR Services and Type of
Disability: Subset 5**

+-------------------------+-----------+--------------------------+----+
| **Service**             | **Coef    | > **Disability type**    | ** |
|                         | ficient** |                          | Me |
|                         |           |                          | an |
|                         |           |                          | ** |
+-------------------------+-----------+--------------------------+----+
| Ps                      | 0.65      | > Mental illness         | 0. |
| ychological/psychiatric |           |                          | 20 |
| treatment               |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Driver                  | 0.38      | > Traumatic brain injury | 0. |
| training/licensing      |           |                          | 17 |
+-------------------------+-----------+--------------------------+----+
| Job placement           | 0.28      | > Nonorthopedic physical | 0. |
|                         |           | > impairment             | 08 |
+-------------------------+-----------+--------------------------+----+
| Tutoring                | 0.17      | > Vision impairment      | 0. |
|                         |           |                          | 01 |
+-------------------------+-----------+--------------------------+----+
| Counseling              | 0.12      | > Hearing impairment     | 0. |
|                         |           |                          | 00 |
+-------------------------+-----------+--------------------------+----+
| Business/vocational     | 0.11      | > Orthopedic, amputation | 0. |
| training                |           |                          | 00 |
+-------------------------+-----------+--------------------------+----+
| Four-year               | 0.09      | > Learning disability    | -  |
| college/university      |           |                          | 0. |
|                         |           |                          | 01 |
+-------------------------+-----------+--------------------------+----+
| Medical services        | 0.04      | > Mental retardation     | -  |
|                         |           |                          | 0. |
|                         |           |                          | 13 |
+-------------------------+-----------+--------------------------+----+
| Personal assistance     | 0.04      | > All other conditions   | -  |
| services                |           |                          | 0. |
|                         |           |                          | 13 |
+-------------------------+-----------+--------------------------+----+
| Assistive technology    | 0.03      | > Substance abuse        | -  |
| devices                 |           |                          | 0. |
|                         |           |                          | 74 |
+-------------------------+-----------+--------------------------+----+
| Two-year community      | 0.02      |                          |    |
| college                 |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Work adjustment         | 0.02      |                          |    |
+-------------------------+-----------+--------------------------+----+
| Supported employment    | 0.02      |                          |    |
+-------------------------+-----------+--------------------------+----+
| Maintenance             | 0.01      |                          |    |
+-------------------------+-----------+--------------------------+----+
| Transportation          | 0.01      |                          |    |
+-------------------------+-----------+--------------------------+----+
| Independent living      | 0.01      |                          |    |
| services                |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Orientation/mobility    | -0.01     |                          |    |
| therapy                 |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Interpretation services | -0.02     |                          |    |
+-------------------------+-----------+--------------------------+----+
| Job development         | -0.03     |                          |    |
+-------------------------+-----------+--------------------------+----+
| On-the-job training     | -0.05     |                          |    |
+-------------------------+-----------+--------------------------+----+
| IPE amendment           | -0.05     |                          |    |
+-------------------------+-----------+--------------------------+----+
| Assistive technology    | -0.09     |                          |    |
| services                |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Job search training     | -0.10     |                          |    |
+-------------------------+-----------+--------------------------+----+
| Physical therapy        | -0.12     |                          |    |
+-------------------------+-----------+--------------------------+----+
| Tools/u                 | -0.13     |                          |    |
| niforms/equipment/stock |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Vehicle                 | -0.24     |                          |    |
| maintenance/repair      |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Substance abuse         | -3.43     |                          |    |
| treatment               |           |                          |    |
+-------------------------+-----------+--------------------------+----+

**Table B-6. Analysis of Relationships Between VR Services and Type of
Disability: Subset 6**

+-------------------------+-----------+---------------------------+----+
| **Service**             | **Coef    | > **Disability type**     | ** |
|                         | ficient** |                           | Me |
|                         |           |                           | an |
|                         |           |                           | ** |
+-------------------------+-----------+---------------------------+----+
| Physical therapy        | 1.77      | > Traumatic brain injury  | 0. |
|                         |           |                           | 26 |
+-------------------------+-----------+---------------------------+----+
| Driver                  | 0.58      | > Orthopedic, amputation  | 0. |
| training/licensing      |           |                           | 13 |
+-------------------------+-----------+---------------------------+----+
| Ps                      | 0.46      | > All other conditions    | 0. |
| ychological/psychiatric |           |                           | 06 |
| treatment               |           |                           |    |
+-------------------------+-----------+---------------------------+----+
| Assistive technology    | 0.25      | > Mental illness          | 0. |
| services                |           |                           | 06 |
+-------------------------+-----------+---------------------------+----+
| On-the-job training     | 0.22      | > Mental retardation      | 0. |
|                         |           |                           | 01 |
+-------------------------+-----------+---------------------------+----+
| Vehicle                 | 0.17      | > Hearing impairment      | 0. |
| maintenance/repair      |           |                           | 00 |
+-------------------------+-----------+---------------------------+----+
| Supported employment    | 0.17      | > Vision impairment       | -  |
|                         |           |                           | 0. |
|                         |           |                           | 02 |
+-------------------------+-----------+---------------------------+----+
| Tools/u                 | 0.16      | > Substance abuse         | -  |
| niforms/equipment/stock |           |                           | 0. |
|                         |           |                           | 02 |
+-------------------------+-----------+---------------------------+----+
| IPE amendment           | 0.16      | > Learning disability     | -  |
|                         |           |                           | 0. |
|                         |           |                           | 10 |
+-------------------------+-----------+---------------------------+----+
| Assistive technology    | 0.15      | > Nonorthopedic physical  | -  |
| devices                 |           | > impairment              | 0. |
|                         |           |                           | 38 |
+-------------------------+-----------+---------------------------+----+
| Substance abuse         | 0.13      |                           |    |
| treatment               |           |                           |    |
+-------------------------+-----------+---------------------------+----+
| Job development         | 0.13      |                           |    |
+-------------------------+-----------+---------------------------+----+
| Personal assistance     | 0.09      |                           |    |
| services                |           |                           |    |
+-------------------------+-----------+---------------------------+----+
| Two-year community      | 0.07      |                           |    |
| college                 |           |                           |    |
+-------------------------+-----------+---------------------------+----+
| Transportation          | 0.06      |                           |    |
+-------------------------+-----------+---------------------------+----+
| Business/vocational     | 0.05      |                           |    |
| training                |           |                           |    |
+-------------------------+-----------+---------------------------+----+
| Counseling              | -0.01     |                           |    |
+-------------------------+-----------+---------------------------+----+
| Maintenance             | -0.02     |                           |    |
+-------------------------+-----------+---------------------------+----+
| Work adjustment         | -0.03     |                           |    |
+-------------------------+-----------+---------------------------+----+
| Interpretation services | -0.03     |                           |    |
+-------------------------+-----------+---------------------------+----+
| Job placement           | -0.14     |                           |    |
+-------------------------+-----------+---------------------------+----+
| Four-year               | -0.16     |                           |    |
| college/university      |           |                           |    |
+-------------------------+-----------+---------------------------+----+
| Medical services        | -0.21     |                           |    |
+-------------------------+-----------+---------------------------+----+
| Tutoring                | -0.21     |                           |    |
+-------------------------+-----------+---------------------------+----+
| Job search training     | -0.23     |                           |    |
+-------------------------+-----------+---------------------------+----+
| Independent living      | -0.28     |                           |    |
| services                |           |                           |    |
+-------------------------+-----------+---------------------------+----+
| Orientation/mobility    | -0.34     |                           |    |
| therapy                 |           |                           |    |
+-------------------------+-----------+---------------------------+----+

**Table B-7. Analysis of Relationships Between VR Services and Type of
Disability: Subset 7**

+-------------------------+-----------+--------------------------+----+
| **Service**             | **Coef    | > **Disability type**    | ** |
|                         | ficient** |                          | Me |
|                         |           |                          | an |
|                         |           |                          | ** |
+-------------------------+-----------+--------------------------+----+
| Substance abuse         | 0.94      | > Traumatic brain injury | 0. |
| treatment               |           |                          | 10 |
+-------------------------+-----------+--------------------------+----+
| Supported employment    | 0.58      | > Nonorthopedic physical | 0. |
|                         |           | > impairment             | 09 |
+-------------------------+-----------+--------------------------+----+
| Ps                      | 0.27      | > Mental retardation     | 0. |
| ychological/psychiatric |           |                          | 06 |
| treatment               |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Driver                  | 0.27      | > Substance abuse        | 0. |
| training/licensing      |           |                          | 03 |
+-------------------------+-----------+--------------------------+----+
| Medical services        | 0.20      | > Mental illness         | 0. |
|                         |           |                          | 02 |
+-------------------------+-----------+--------------------------+----+
| Interpretation services | 0.18      | > Orthopedic, amputation | 0. |
|                         |           |                          | 02 |
+-------------------------+-----------+--------------------------+----+
| Physical therapy        | 0.18      | > Hearing impairment     | 0. |
|                         |           |                          | 01 |
+-------------------------+-----------+--------------------------+----+
| Counseling              | 0.16      | > Vision impairment      | -  |
|                         |           |                          | 0. |
|                         |           |                          | 01 |
+-------------------------+-----------+--------------------------+----+
| Assistive technology    | 0.16      | > All other conditions   | -  |
| devices                 |           |                          | 0. |
|                         |           |                          | 07 |
+-------------------------+-----------+--------------------------+----+
| Job development         | 0.12      | > Learning disability    | -  |
|                         |           |                          | 0. |
|                         |           |                          | 37 |
+-------------------------+-----------+--------------------------+----+
| Personal assistance     | 0.12      |                          |    |
| services                |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Job search training     | 0.08      |                          |    |
+-------------------------+-----------+--------------------------+----+
| Transportation          | 0.08      |                          |    |
+-------------------------+-----------+--------------------------+----+
| Maintenance             | 0.05      |                          |    |
+-------------------------+-----------+--------------------------+----+
| Tools/u                 | 0.04      |                          |    |
| niforms/equipment/stock |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| IPE amendment           | 0.01      |                          |    |
+-------------------------+-----------+--------------------------+----+
| Assistive technology    | -0.05     |                          |    |
| services                |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Business/vocational     | -0.08     |                          |    |
| training                |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Four-year               | -0.12     |                          |    |
| college/university      |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Two-year community      | -0.18     |                          |    |
| college                 |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Work adjustment         | -0.18     |                          |    |
+-------------------------+-----------+--------------------------+----+
| Vehicle                 | -0.20     |                          |    |
| maintenance/repair      |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Orientation/mobility    | -0.31     |                          |    |
| therapy                 |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Independent living      | -0.41     |                          |    |
| services                |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| On-the-job training     | -0.42     |                          |    |
+-------------------------+-----------+--------------------------+----+
| Job placement           | -0.55     |                          |    |
+-------------------------+-----------+--------------------------+----+
| Tutoring                | -0.69     |                          |    |
+-------------------------+-----------+--------------------------+----+

Number range CHAPTER**APPENDIX C**

**TABLES ON RELATIONSHIPS BETWEEN VR SERVICES AND VOCATIONAL GOAL**

Number range CHAPTER**Table C-1. Analysis of Relationships Between VR
Services and Vocational Goal: Subset 1**

+-------------------------+-----------+--------------------------+----+
| **Service**             | **Coef    | > **Vocational Goal**    | ** |
|                         | ficient** |                          | Me |
|                         |           |                          | an |
|                         |           |                          | ** |
+-------------------------+-----------+--------------------------+----+
| Job placement           | 1.08      | > Benchwork              | 0. |
|                         |           |                          | 36 |
+-------------------------+-----------+--------------------------+----+
| Substance abuse         | 0.95      | > Profession             | 0. |
| treatment               |           | al/managerial/technology | 01 |
+-------------------------+-----------+--------------------------+----+
| Interpretation services | 0.64      | > Structural work        | -  |
|                         |           |                          | 0. |
|                         |           |                          | 02 |
+-------------------------+-----------+--------------------------+----+
| Independent living      | 0.61      | > Clerical/sales         | -  |
| services                |           |                          | 0. |
|                         |           |                          | 04 |
+-------------------------+-----------+--------------------------+----+
| IPE amendment           | 0.52      | > Service                | -  |
|                         |           |                          | 0. |
|                         |           |                          | 11 |
+-------------------------+-----------+--------------------------+----+
| Assistive technology    | 0.26      |                          |    |
| services                |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Supported employment    | 0.13      |                          |    |
+-------------------------+-----------+--------------------------+----+
| Two-year community      | 0.10      |                          |    |
| college                 |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Assistive technology    | 0.06      |                          |    |
| devices                 |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Maintenance             | 0.03      |                          |    |
+-------------------------+-----------+--------------------------+----+
| Tools/                  | 0.02      |                          |    |
| uniform/equipment/stock |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Medical services        | 0.01      |                          |    |
+-------------------------+-----------+--------------------------+----+
| Counseling              | 0.01      |                          |    |
+-------------------------+-----------+--------------------------+----+
| Transport               | 0.00      |                          |    |
+-------------------------+-----------+--------------------------+----+
| Business/vocational     | 0.00      |                          |    |
| training                |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Personal assistance     | -0.01     |                          |    |
| services                |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Work adjustment         | -0.01     |                          |    |
+-------------------------+-----------+--------------------------+----+
| Four-year               | -0.01     |                          |    |
| college/university      |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Vehicle                 | -0.03     |                          |    |
| maintenance/repair      |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Ps                      | -0.13     |                          |    |
| ychological/psychiatric |           |                          |    |
| treatment               |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Job development         | -0.22     |                          |    |
+-------------------------+-----------+--------------------------+----+
| Orientation/mobility    | -0.45     |                          |    |
| therapy                 |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| Tutoring                | -0.56     |                          |    |
+-------------------------+-----------+--------------------------+----+
| Job search training     | -0.57     |                          |    |
+-------------------------+-----------+--------------------------+----+
| Physical therapy        | -0.57     |                          |    |
+-------------------------+-----------+--------------------------+----+
| Driver                  | -0.64     |                          |    |
| training/licensing      |           |                          |    |
+-------------------------+-----------+--------------------------+----+
| On-the-job training     | -0.65     |                          |    |
+-------------------------+-----------+--------------------------+----+

**Table C-2. Analysis of Relationships Between VR Services and
Vocational Goal: Subset 2**

+--------------------------+----------+--------------------------+----+
| **Service**              | **Coeff  | > **Vocational Goal**    | ** |
|                          | icient** |                          | Me |
|                          |          |                          | an |
|                          |          |                          | ** |
+--------------------------+----------+--------------------------+----+
| Substance abuse          | 1.20     | > Benchwork              | 0. |
| treatment                |          |                          | 12 |
+--------------------------+----------+--------------------------+----+
| Assistive technology     | 1.09     | > Service                | 0. |
| services                 |          |                          | 12 |
+--------------------------+----------+--------------------------+----+
| Driver                   | 1.05     | > Clerical/sales         | 0. |
| training/licensing       |          |                          | 04 |
+--------------------------+----------+--------------------------+----+
| Job search training      | 0.87     | > Profession             | -  |
|                          |          | al/managerial/technology | 0. |
|                          |          |                          | 10 |
+--------------------------+----------+--------------------------+----+
| On-the-job training      | 0.36     | > Structural work        | -  |
|                          |          |                          | 0. |
|                          |          |                          | 18 |
+--------------------------+----------+--------------------------+----+
| Physical therapy         | 0.36     |                          |    |
+--------------------------+----------+--------------------------+----+
| Interpretation services  | 0.30     |                          |    |
+--------------------------+----------+--------------------------+----+
| Independent living       | 0.24     |                          |    |
| services                 |          |                          |    |
+--------------------------+----------+--------------------------+----+
| Tutoring                 | 0.18     |                          |    |
+--------------------------+----------+--------------------------+----+
| Transport                | 0.16     |                          |    |
+--------------------------+----------+--------------------------+----+
| Business/vocational      | 0.16     |                          |    |
| training                 |          |                          |    |
+--------------------------+----------+--------------------------+----+
| Two-year community       | 0.11     |                          |    |
| college                  |          |                          |    |
+--------------------------+----------+--------------------------+----+
| Personal assistance      | 0.02     |                          |    |
| services                 |          |                          |    |
+--------------------------+----------+--------------------------+----+
| Supported employment     | 0.02     |                          |    |
+--------------------------+----------+--------------------------+----+
| Tools                    | 0.00     |                          |    |
| /uniform/equipment/stock |          |                          |    |
+--------------------------+----------+--------------------------+----+
| P                        | 0.00     |                          |    |
| sychological/psychiatric |          |                          |    |
| treatment                |          |                          |    |
+--------------------------+----------+--------------------------+----+
| Four-year                | -0.02    |                          |    |
| college/university       |          |                          |    |
+--------------------------+----------+--------------------------+----+
| Medical services         | -0.04    |                          |    |
+--------------------------+----------+--------------------------+----+
| Assistive technology     | -0.06    |                          |    |
| devices                  |          |                          |    |
+--------------------------+----------+--------------------------+----+
| Maintenance              | -0.09    |                          |    |
+--------------------------+----------+--------------------------+----+
| Job placement            | -0.10    |                          |    |
+--------------------------+----------+--------------------------+----+
| Job development          | -0.10    |                          |    |
+--------------------------+----------+--------------------------+----+
| IPE amendment            | -0.13    |                          |    |
+--------------------------+----------+--------------------------+----+
| Counseling               | -0.14    |                          |    |
+--------------------------+----------+--------------------------+----+
| Vehicle                  | -0.22    |                          |    |
| maintenance/repair       |          |                          |    |
+--------------------------+----------+--------------------------+----+
| Orientation/mobility     | -0.23    |                          |    |
| therapy                  |          |                          |    |
+--------------------------+----------+--------------------------+----+
| Work adjustment          | -0.60    |                          |    |
+--------------------------+----------+--------------------------+----+

Number range CHAPTER**APPENDIX D**

**TABLES OF ODDS RATIOS**

  ----------------------------------------------- -----------------------
  Number range CHAPTERTable D-1. Odds Ratios      
  Predicting *Employment Outcome* at Closure      
  (R^2^ = .23)                                    

  **Variables**                                   ***Employment outcome*
                                                  odds ratios**

  **Case Management Services and Relationship**   

  Quality of the consumer/counselor relationship  1.722

  IPE amendment                                   1.227

  **Education and Employment Development          
  Services**                                      

  Job placement                                   2.355

  Supported employment                            1.437

  On-the-job training                             1.865

  **Mobility-Related and Other Support Services** 

  Independent living services                     3.566

  Driver training/licensing                       2.319

  Tools/uniforms/equipment/stock                  1.354

  **Medical and Psychosocial Services**           

  Counseling                                      0.893

  **Covariates**                                  

  Vision                                          2.311

  Hearing impairment                              2.502

  Nonorthopedic physical                          0.956

  Mental illness                                  1.012

  Mental retardation                              1.864

  Substance abuse                                 1.209

  Learning disability                             0.803

  Traumatic brain injury                          0.705

  Other                                           3.091

  Significance                                    0.844

  SSI/SSDI                                        0.510

  Self-esteem                                     1.535

  Working at application                          2.191

  Number of dependents                            1.063

  Non-white                                       0.693
  ----------------------------------------------- -----------------------

  ----------------------------------------------- -----------------------
  Table D-2. Odds Ratios Predicting *Employment   
  Outcome* at One-Year Follow-Up (R^2^ = .16)     

  **Variables**                                   ***Employment outcome*
                                                  odds ratios**

  **Case Management Services and Relationship**   

  Quality of the consumer/counselor relationship  1.350

  IPE amendment                                   1.125

  **Education and Employment Development          
  Services**                                      

  Business/vocational training                    1.140

  **Mobility-Related and Other Support Services** 

  Independent living services                     2.442

  Tools/uniforms/equipment/stock                  1.144

  **Covariates**                                  

  Vision                                          1.286

  Hearing impairment                              1.416

  Nonorthopedic physical                          0.757

  Mental illness                                  1.043

  Mental retardation                              2.069

  Substance abuse                                 1.515

  Learning disability                             1.582

  Traumatic brain injury                          0.569

  Other                                           2.031

  Significance                                    0.823

  SSI/SSDI                                        0.490

  Self-esteem                                     1.641

  Working at application                          2.143

  Number of dependents                            1.051

  Non-white                                       0.808
  ----------------------------------------------- -----------------------

  ----------------------------------------------- -----------------------
  Table D-3. Odds Ratios Predicting *Employment   
  Outcome* at Two-Year Follow-Up (R^2^ = .18)     

  **Variables**                                   ***Employment outcome*
                                                  odds ratios**

  **Case Management Services and Relationship**   

  Quality of the consumer/counselor relationship  1.286

  IPE amendment                                   1.168

  **Education and Employment Development          
  Services**                                      

  Job placement                                   1.441

  On-the-job training                             1.700

  **Mobility-Related and Other Support Services** 

  Independent living services                     2.810

  **Covariates**                                  

  Vision                                          0.677

  Hearing impairment                              1.433

  Nonorthopedic physical                          0.791

  Mental illness                                  1.147

  Mental retardation                              2.308

  Substance abuse                                 1.907

  Learning disability                             2.585

  Traumatic brain injury                          0.783

  Other                                           6.283

  Significance                                    0.596

  SSI/SSDI                                        0.567

  Self-esteem                                     2.282

  Working at application                          2.077

  Number of dependents                            1.060

  Non-white                                       0.708
  ----------------------------------------------- -----------------------

  --------------------------------------------- -------------------------
  Table D-4. Odds Ratios Predicting             
  *Competitive Employment* at Closure (R^2^ =   
  .34)                                          

  **Variables**                                 ***Competitive
                                                employment* odds ratios**

  **Case Management Services and Relationship** 

  IPE amendment                                 1.265

  **Education and Employment Development        
  Services**                                    

  Job placement                                 1.461

  Supported employment                          0.551

  On-the-job training                           1.662

  **Mobility-Related and Other Support          
  Services**                                    

  Independent living services                   0.510

  Tools/uniforms/equipment/stock                1.363

  **Medical and Psychosocial Services**         

  Medical services                              0.948

  **Covariates**                                

  Vision                                        0.125

  Hearing impairment                            1.366

  Nonorthopedic physical                        1.119

  Mental illness                                0.992

  Mental retardation                            0.474

  Substance abuse                               1.561

  Learning disability                           1.419

  Traumatic brain injury                        1.753

  Other                                         1.639

  Significance                                  0.635

  SSI/SSDI                                      0.564

  Self-esteem                                   0.781

  Working at application                        1.761

  Number of dependents                          1.197

  Non-white                                     1.015
  --------------------------------------------- -------------------------

  --------------------------------------------- -------------------------
  Table D-5. Odds Ratios Predicting             
  *Competitive Employment* at One-Year          
  Follow-Up (R^2^ = .19)                        

  **Variables**                                 ***Competitive
                                                employment* odds ratios**

  **Case Management Services and Relationship** 

  Quality of the consumer/counselor             1.334
  relationship                                  

  **Education and Employment Development        
  Services**                                    

  Job development                               1.241

  Job placement                                 1.518

  Business/vocational training                  1.152

  Four-year college/university                  1.136

  **Mobility-Related and Other Support          
  Services**                                    

  Independent living services                   1.547

  Tools/uniforms/equipment/stock                1.149

  **Covariates**                                

  Vision                                        1.321

  Hearing impairment                            1.218

  Nonorthopedic physical                        0.790

  Mental illness                                1.007

  Mental retardation                            0.821

  Substance abuse                               1.485

  Learning disability                           1.512

  Traumatic brain injury                        0.546

  Other                                         1.787

  Significance                                  0.840

  SSI/SSDI                                      0.379

  Self-esteem                                   1.593

  Working at application                        2.112

  Number of dependents                          1.087

  Non-white                                     0.812
  --------------------------------------------- -------------------------

  --------------------------------------------- -------------------------
  Table D-6. Odds Ratios Predicting             
  *Competitive Employment* at Two-Year          
  Follow-Up (R^2^ = .23)                        

  **Variables**                                 ***Competitive
                                                employment* odds ratios**

  **Case Management Services and Relationship** 

  Quality of the consumer/counselor             1.294
  relationship                                  

  IPE amendment                                 1.158

  **Education and Employment Development        
  Services**                                    

  Job development                               1.356

  Job placement                                 1.668

  On-the-job training                           1.668

  **Mobility-Related and Other Support          
  Services**                                    

  Independent living services                   3.106

  Tools/uniforms/equipment/stock                1.182

  **Covariates**                                

  Vision                                        0.589

  Hearing impairment                            1.350

  Nonorthopedic physical                        0.784

  Mental illness                                0.919

  Mental retardation                            0.709

  Substance abuse                               1.520

  Learning disability                           1.903

  Traumatic brain injury                        0.816

  Other                                         2.756

  Significance                                  0.567

  SSI/SSDI                                      0.415

  Self-esteem                                   2.160

  Working at application                        2.076

  Number of dependents                          1.083

  Non-white                                     0.705
  --------------------------------------------- -------------------------

  ------------------------------------------------ ----------------------
  Table D-7. Odds Ratios Predicting *Receipt of    
  Health Benefits* at Closure (R^2^ = .19)         

  **Variables**                                    ***Receipt of health
                                                   benefits* odds
                                                   ratios**

  **Education and Employment Development           
  Services**                                       

  Business/vocational training                     1.184

  Four-year college/university                     1.158

  **Medical and Psychosocial Services**            

  Medical services                                 0.919

  Counseling                                       0.791

  **Mobility-Related and Other Support Services**  

  Interpreter services                             0.294

  Assistive technology devices                     1.188

  Maintenance payments                             1.101

  **Covariates**                                   

  Vision                                           0.313

  Hearing impairment                               1.193

  Nonorthopedic physical                           0.655

  Mental illness                                   0.694

  Mental retardation                               0.387

  Substance abuse                                  1.105

  Learning disability                              0.982

  Traumatic brain injury                           0.561

  Other                                            0.510

  Significance                                     1.065

  SSI/SSDI                                         0.557

  Self-esteem                                      1.147

  Working at application                           1.433

  Number of dependents                             1.141

  Non-white                                        0.654
  ------------------------------------------------ ----------------------

  ------------------------------------------------ ----------------------
  Table D-8. Odds Ratios Predicting *Receipt of    
  Health Benefits* at One-Year Follow-Up (R^2^ =   
  .16)                                             

  **Variables**                                    ***Receipt of health
                                                   benefits* odds
                                                   ratios**

  **Education and Employment Development           
  Services**                                       

  Supported employment                             0.710

  Business/vocational training                     1.115

  Four-year college/university                     1.211

  **Medical and Psychosocial Services**            

  Medical services                                 0.936

  **Mobility-Related and Other Support Services**  

  Interpreter services                             0.306

  Orientation/mobility                             5.398

  Transportation                                   1.075

  **Covariates**                                   

  Vision                                           0.558

  Hearing impairment                               1.557

  Nonorthopedic physical                           0.902

  Mental illness                                   0.870

  Mental retardation                               0.765

  Substance abuse                                  1.262

  Learning disability                              1.293

  Traumatic brain injury                           1.701

  Other                                            0.677

  Significance                                     0.868

  SSI/SSDI                                         0.437

  Self-esteem                                      1.031

  Working at application                           1.412

  Number of dependents                             1.056

  Non-white                                        0.837
  ------------------------------------------------ ----------------------

  ------------------------------------------------ ----------------------
  Table D-9. Odds Ratios Predicting *Receipt of    
  Health Benefits* at Two-Year Follow-Up (R^2^ =   
  .21)                                             

  **Variables**                                    ***Receipt of health
                                                   benefits* odds
                                                   ratios**

  **Education and Employment Development           
  Services**                                       

  Job placement                                    1.482

  Business/vocational training                     1.241

  **Medical and Psychosocial Services**            0.941

  Medical services                                 

  **Mobility-Related and Other Support Services**  

  Interpreter services                             0.479

  Assistive technology services                    2.342

  **Covariates**                                   

  Vision                                           0.259

  Hearing impairment                               1.845

  Nonorthopedic physical                           0.743

  Mental illness                                   0.870

  Mental retardation                               0.554

  Substance abuse                                  0.924

  Learning disability                              1.492

  Traumatic brain injury                           0.991

  Other                                            1.197

  Significance                                     0.965

  SSI/SSDI                                         4.490

  Self-esteem                                      1.224

  Working at application                           1.429

  Number of dependents                             1.110

  Non-white                                        0.642
  ------------------------------------------------ ----------------------

[^1]: 1 A later report will provide details on the study's design and
    methodology.

[^2]: 1 A later report will provide details on the study's design and
    methodology.

[^3]: 2 Appendix A contains an overview of the VR program, which focuses
    on the program as implemented during the study's data collection
    period (December 1994 through December 1999).

[^4]: 3 The first interim report (Hayward and Tashjian, 1995) contained
    profiles of the local offices participating in the study and their
    environments based primarily on analyses from the 1990 decennial
    census and a mail survey of each of the 37 local VR offices
    participating in the study. The second interim report (Hayward and
    Tashjian, 1996) described (1) characteristics of current and former
    VR consumers; (2) history of labor force participation among VR
    consumers; and (3) consumers' perspectives of their VR services,
    service providers, and other aspects of their involvement with the
    VR program. The third interim report (Hayward, 1998) contained
    descriptive findings on characteristics of persons who achieved an
    employment outcome, including work history and details of post-VR
    employment and earnings status. The final interim report (Hayward
    and Schmidt-Davis, 2000) contained findings regarding the VR
    participation of transitional youth with disabilities.

[^5]: 1 Case records also indicate that individuals who were not
    accepted for services and individuals who were accepted but exited
    VR before completion of an IPE also received some services,
    principally associated with eligibility determination. Persons not
    accepted for services averaged 2.5 (median 2.0) services, while
    those accepted who exited prior to initiation of services under an
    IPE averaged 3.6 (median 3.0) services. Among the most frequent of
    these were medical evaluation (27 percent of persons), counseling
    for eligibility determination (21 percent), and
    psychological/psychiatric assessment (11 percent).

[^6]: 1 In many instances, multiple delivery arrangements occurred. For
    example, for community or four-year college, the services might be
    purchased, as in the case of books or supplies, and arranged under
    comparable benefits (a Pell grant for tuition and fees).
    Hence percentages showing delivery arrangements may sum to less than
    or more than 100 percent.

[^7]: 2 For most (69 percent) consumers, this service occurred over one
    day; comparable percentages were 52 percent for neuropsychological
    evaluations and 65 percent for evaluation of social/psychological
    adjustment.

[^8]: 3 For slightly over half (52 percent) of consumers receiving these
    services, the service lasted one day.

[^9]: 4 In all, 18 percent of consumers changed their vocational goal
    during services; other reasons for amendments included change of
    services or other adjustments to the IPE.

[^10]: 1 Overall, 62 percent of assessment services that the VR program
    delivers occur prior to consumers' acceptance for VR services;
    39 percent occur following consumers' acceptance for services.

[^11]: 2 Preceding tables in this chapter have described service
    patterns by type of disability. This summary table describes
    services that all persons receiving services most frequently
    received.

[^12]: 1 The U.S. Department of Labor is a major sponsor of an ongoing
    project to develop a new classification system, called O\*NET, which
    classifies jobs according to functional requirements. This system,
    when available, will be particularly useful for analyzing the
    employment goals and options among individuals with disabilities.

[^13]: 2 Slightly under 10 percent (9.7 percent) enrolled in four-year
    college or university.

[^14]: "Noncompetitive employment" includes employment with earnings in
    jobs with supports for which the individual does not have to compete
    in the open labor market. Examples of noncompetitive employment
    include extended employment and supported employment. Jobs in
    homemaking or unpaid family work are excluded.

[^15]: It should be noted that the regulations published after the 1998
    Amendments to the Act now require that, in order to be considered an
    "employment outcome," the individual must enter into or retain
    competitive employment in the integrated labor market, supported
    employment, or any other type of employment in an integrated
    setting. Extended employment is no longer counted as an employment
    outcome.

[^16]: 2 The number of post-exit follow-up interviews varied from none
    to three, depending on when a consumer exited VR in comparison to
    how long he or she had been in the study at exit. For example,
    persons who entered the study as applicants for VR services may have
    continued to receive services over the three-year period of study
    participation and not have received any post-exit follow-up
    interviews. Those who entered the study at or after exit from VR
    would have been eligible to receive three annual follow-up
    interviews.

[^17]: 3 We used logistic regression when the outcome was a dichotomous
    variable (employment outcome, competitive employment outcome, and
    receipt of benefits).

[^18]: 5 A detailed analysis of these data will be the focus of a
    research brief, anticipated for summer 2002.