Rehabilitation Service Patterns: A Rural/urban Comparison of Success Factors

Rural Vocational rehabilitation counselors typically encounter difficulties when assisting individuals with disabilities obtain employment because of a lack of transportation, limited employment opportunities, inadequate training and education options, and limited vocational rehabilitation services (Arnold, Seekins, & Nelson, 1997; RTC Rural, 1995; RTC Rural, n.d.). Rural vocational rehabilitation counselors also report advantages over their urban counterparts. For example, rural counselors report that agencies in their area work well together and have more networking opportunities (Arnold et al., 1997; RTC Rural, 1995). An important question for rehabilitation counselors is to determine the factors that impact successful vocational outcomes for participants (BoRon, Bellini, & Brookings, 2000; Lustig, Strauser, Rice, & Rucker, 2002). One factor that may impact vocational outcomes is the density of population in the consumer's place of residence (RTC Rural, 1998). This study investigated key variables which effect employment outcomes in rural areas. The impact of these variables in rural areas are compared with the impact of these variables in urban areas. In 2000 the U.S Census Bureau reported that 226 million Americans (80%) lived in a metropolitan area with 55 million people (20%) living in rural areas (U.S. Census Bureau, n.d.). It is estimated that 23% of individuals in rural areas have a disability compared to 18% in metropolitan areas (RTC Rural, 1998). Rural America experiences higher unemployment, lower wages, higher rates of poverty, lower educational levels, limited public transportation, and reduced access to health care (Arnold et al., 1997; Davidson, 1995; Killian & Beaulieu, 1995; U.S. Bureau of Labor Statistics, n.d; U.S. Census Bureau, n.d; U.S. Congress, 1990). Problems endemic in rural areas also effect service delivery in rural rehabilitation. First, rural rehabilitation consumers typically face higher rates of unemployment than their urban counterparts (Arnold & Seekins, 1998; Rojewski, 1992; RTC Rural, 1995). Second, lack of public transportation has been identified as a critical problem (Arnold & Seekins, 1998; Rojewski, 1992; RTC Rural, 1995). Inaccessible and unresponsive transportation is problematic both in the consumers' ability to access rehabilitation services and to travel to work sites (Rojewski, 1992; RTC Rural, 1995). Forty percent of rural residents live in counties with no public transportation (RTC Rural, 1999). Third, rural rehabilitation consumers have more limited access to rehabilitation services (Rojewski, 1992). For example, rural areas may have fewer educational options, and more limited access to vocational evaluation, job placement specialists, supported employment, and independent living services (Arnold & Seekins, 1998; Rojewski, 1992). Rural rehabilitation consumers may also have to travel long distances for vocational evaluation services or training options (Rojewski, 1992). Fourth, mental health services in rural areas are more limited with fewer than 10% of rural counties having a psychiatrist (RTC Rural, 2002). In addition rural residents are more likely to underutilize mental health services because of a lack of anonymity, stigma associated with treatment, and valuing independence and privacy (Badger, Robinson, & Farley, 1999). Fifth, while access to community-based hospitals is similar to urban residents, rural individuals have higher rates of health problems (McNeil, 1993; U.S. Congress, 1990). Finally, in a study conducted over thirty years ago, the greater geographic distance between counselor and consumer negatively impacts the consumer--counselor relationship because it is more difficult for consumers to travel to appointments and services and counselors to coordinate services (Bitter, 1972; Rojewski, 1992). Research also provides evidence that there are strengths associated with provision of rehabilitation services in rural areas. …