In the last 10 years, the Congress has expanded federal efforts to promote employment for people with more severe disabilities by creating new programs, expanding existing programs, and providing employment protections. In the past, social attitudes toward people with mental retardation or psychiatric conditions often labeled them as unemployable outside of institutions or sheltered workshops and thus unable to benefit from job training or vocational rehabilitation. However, recent advances in assistive technology, particularly in computers, have made many personal limitations less prohibitive barriers to work. Voice recognition software, for example, allows those who do not have use of their hands to produce documents on a computer. In addition, the development of supported employment, in which ongoing on-the-job support is provided to people with disabilities through a job coach, has demonstrated that many people previously considered unemployable could work alongside people without disabilities. In response to these developments, the Congress has created new programs to promote the increased use of assistive technology and to provide states with funding specifically designated for supported employment. In addition, the Congress has amended the Rehabilitation Act to strengthen the requirement that states serve individuals with severe disabilities. In 1990, the Congress provided educational and employment protections to people with disabilities. For example, ADA prohibited employment discrimination on the basis of disability by state and local governments and many private-sector employers, as long as the person was qualified and able to perform the essential job functions “with or without reasonable accommodation.” Similarly, in the Individuals With Disabilities Education Act (IDEA), the Congress mandated that all children with disabilities be provided a “free, appropriate public education,” and courts interpreting the law have required that this education be provided in “the least restrictive environment.” This provision emphasized a clear presumption that children with disabilities should be mainstreamed—that is, taught in regular classrooms when possible. Over many years, public concern and congressional action have produced a broad continuum of services and policies designed to help people with disabilities. We identified 19 different federal departments or agencies that administered 130 programs targeting people with disabilities in 1994.These programs ranged from those for toddlers with disabilities, for example, Early Intervention State Grants for Infants and Toddlers With Disabilities—to those for the elderly with disabilities, for example, Independent Living Services for Older Blind Individuals. These many programs provided education, health care, and books and assisted with employment. (For a list of these programs, as well as targeting and funding information, see app. II.) Of the 130 programs, 69 were wholly targeted (targeted exclusively) to people with disabilities; the others were partially targeted—that is, they provided services to a wider clientele but nonetheless gave some priority or preference to people with disabilities. In 1994, the federal government spent over $60 billion through these 69 wholly targeted programs, including efforts such as the Disabled Veterans’ Outreach program, which helps disabled veterans. In addition, people with disabilities benefited from between $81 billion and $184 billion in federal spending through 61 partially targeted programs in areas such as income support, housing, and transportation. The federal commitment to helping people with disabilities has also attempted to facilitate their employment both directly and indirectly. Of the 130 programs available in 1994, 26 provided direct employment services such as skills training and job search assistance. For example, the Supported Employment program established by the Rehabilitation Act is employment focused because it provided training and placement services to people with severe disabilities. (Apps. II and III provide details about these programs.) Employment-focused programs in 1994 provided between $2.5 billion and $6.1 billion in services targeted to people with disabilities. In addition, we identified 57 of 130 programs as related to employment—that is, although not directed specifically at employment, these programs may have indirectly affected employment outcomes. These include federal programs that help finance purchases of assistive technology, such as specially designed wheelchairs or computer software, which are employment related because they can enable an individual with a disability to enter the workplace. In 1994, employment-related programs provided between $62 billion and $156 billion in services targeted to people with disabilities. The remaining 47 of the 130 federal programs were unrelated to employment. Federal efforts to promote early intervention services for toddlers with disabilities are an example of these types of programs. (See fig. 1.) Employment-related programs indirectly facilitate work through services such as assistive technology, transportation, health insurances, and the like. Many of these employment-focused and -related programs provided a specific service rather than a broad range of services to people with disabilities. For example, the Department of Transportation (DOT) funds capital improvements for local transit systems and also provides funds for paratransit services. The Job Training Partnership Act (JTPA) program, although only partially targeted to people with disabilities, emphasizes shorter term skill training and provides only a limited range and amount of support services. Important exceptions to this are the vocational rehabilitation programs; both the federal-state Vocational Rehabilitation program and the Veterans’ Vocational Rehabilitation program can provide a wide variety of services designed to promote employment. Although the federal government provides funds for all 130 programs, the extent of the federal role in their administration varies considerably. Federal programs provide assistance directly to the individual or indirectly through other public or private service providers at the state and local levels. Programs that provide assistance indirectly often involve limited responsibilities for the federal government in administering services. For some programs, assistance or services flow directly from the federal government to the individual with a disability. For example, income support payments under the Social Security Disability Insurance (DI) program flow directly to beneficiaries, and phone calls requesting information from the Education Department’s Information Clearinghouse are a direct service from the federal government. The largest federal programs in terms of spending—the income maintenance and health care programs—generally deliver assistance directly to individuals; however, if these programs are excluded, states receive a substantial amount of the funds provided through disability programs. For many programs, assistance or services flow indirectly from the federal government through state governments, which are responsible for delivering services to individuals with disabilities. For example, under the federal-state Vocational Rehabilitation program, the federal government allocates program funds to the states, which have authority to deliver services. For some programs, the states may provide funds to other entities, such as local governments or nonprofit or private agencies, to administer services. In the states we visited, funds from federal disability programs were further distributed to a wide range of state agencies— departments of rehabilitation services, employment and training, developmental disabilities, mental health, education, and those for the deaf and hard of hearing, or the blind, for example. For many other programs, assistance or services flow indirectly from the federal government to other organizations such as state or local agencies or nonprofit or private organizations. For example, the Projects With Industry (PWI) program may be administered through other public, private, or nonprofit agencies. Under these programs, federal agencies allocate grants on the basis of the application or proposal submitted by an organization or agency, which is then responsible for providing services. Federal funds allocated through these programs provide support for special projects in delivering disability services; others support research or train state or local professionals to work more effectively with people with disabilities. (See fig. 2.) Indirect - Government Agencies Only (Nonfederal) Although many federal programs have decentralized the provision of services to state governments, the programs have adopted a variety of funding mechanisms to do so, including funding formulas based on different criteria as well as varying procedures for awarding grants. The variation in these funding mechanisms affects the distribution of federal funds to states. States may receive more or less money depending on the size and characteristics of their targeted population as well as their success in pursuing grants and other awarded monies. In our analysis of statewide 1990 funding data for the eight wholly targeted employment- focused programs and statewide 1990 census data, we found that the disabled working-age population as a percentage of the total working-age population varied between 7 and 15 percent. Federal programs distributed to states between $200 and $1,100 per working-age person with a disability. Some states like Florida, Georgia, and South Carolina received between $200 and $350 per working-age person with a disability; sparsely populated states like Wyoming and Alaska received between $800 and $1,100 per working-age person with a disability. (See app. IV.) Promoting employment is one of the most important challenges confronting federal assistance to people with disabilities. People with disabilities constitute an underutilized workforce and a potential resource to the U.S. economy. Surveys have estimated that 18 to 40 percent of people with disabilities have jobs—far below the 73 percent of people without impairments. Yet in these surveys, most individuals with disabilities indicated that their disability did not prevent them from working. For example, although 8.2 percent of individuals were identified as having a work disability in the 1990 census, only a little over half of those said that they could not work. Increased employment would alleviate the poor economic condition of people with disabilities, many of whom struggle to get by on marginal resources. According to 1990 census estimates, 22 percent of working-age people with disabilities live on or below the poverty line, and an additional 12 percent can be classified as “near poor” (with incomes between 101 and 150 percent of the poverty line). Not surprisingly, many people with disabilities turn to public assistance. In 1992, approximately 3.5 million disabled workers participated in the Social Security Administration’s (SSA) DI program, and approximately 4 million people with disabilities participated in the Supplemental Security Income (SSI) program. Aside from Social Security income, census figures indicate that people with disabilities were also more likely to receive other forms of public assistance. Only 2 percent of working-age people without disabilities— those aged 16 to 64—reported receiving public assistance income, compared with 15 percent of working-age people with disabilities. Our discussions with disability experts, consumers, and officials from public and private agencies identified multiple barriers that contribute to the relatively low employment rates for people with disabilities. Some of the major employment barriers they identified are listed in table 1, which also includes examples of federal efforts addressing each barrier. For many individuals with disabilities, employment barriers can restrict the range of employment opportunities available. For example, the 40 percent of people with disabilities who have less than a high school education may find the job market particularly difficult, especially with the general decline in the number of lower skill jobs available in many industries. According to 1990 census figures, people with disabilities were nearly twice as likely to have less than a high school education (40 to 21 percent); similarly, individuals without impairments were more than twice as likely to have a college degree or more (21 to 9 percent). In contrast, although a lack of skill training can limit employment opportunities, access to appropriate technology can expand the range of possibilities. In a National Council on Disability (NCD) report, users of assistive technology reported that such equipment enabled them to work more productively for more hours, increase their earnings, and either keep their jobs or obtain employment. Obtaining access to supportive technologies, however, is often difficult for many people with disabilities. The Council reported that a person with severe disabilities may be considered eligible for, and benefit from, more than 20 federal programs in the area of assistive technology. Yet the report cites that the many inconsistencies between and within these programs lead to an extraordinary amount of confusion and frustration for individuals with disabilities and their families. Moreover, even if a person is clearly eligible for all services, he or she must negotiate multiple eligibility requirements— perhaps including medical examinations, additional documentation, and interviews with officials from multiple agencies—to get access to services under several narrowly focused programs. People with disabilities also face problems with accessing nongovernment-supported health care due to preexisting conditions. For example, while ADA does not allow employers to discriminate on the basis of health care costs, the President’s Committee on Employment of Persons With Disabilities cited employer discrimination in accessing nongovernment-supported health insurance as a major employment barrier. For example, employers, especially small businesses, may find that sometimes the premiums for employee group health insurance will increase significantly if an employee with a disability is included in the policy. Although measuring the extent of discrimination is difficult, several research studies have found that wages and hiring rates are lower for individuals with disabilities than for those without impairments, even after differences in education, experience, and other factors are accounted for. In addition to these barriers, people with disabilities face other obstacles in taking advantage of available employment opportunities. For example, many of the federal and state officials we spoke with, along with other experts, identified the lack of accessible transportation as especially problematic. The U.S. transportation system is heavily automobile based, but people with disabilities are less able to rely on cars than individuals without impairments. According to census data, 14 percent of people with disabilities did not have an automobile in the household, compared with 6 percent of people without disabilities. Some disabilities (such as blindness) make driving impractical; others require costly adjustments, such as hand controls or a lift, to a standard automobile. In addition, financial considerations may limit access to automobiles for many people with disabilities, especially for the over 10 million people with disabilities who reported incomes of less than $10,000 in 1990. The need to rely on public transportation may especially restrict employment options for people with disabilities who live in rural areas. People with disabilities who rely on income support programs such as Social Security DI or SSI may also be discouraged from attempting to work by the prospect of losing their benefits, particularly their health insurance coverage. Disability advocates and rehabilitation counselors believe that the fear of losing medical coverage is one of the most significant barriers to the participation of SSI and DI beneficiaries in the Vocational Rehabilitation program, their return to work, or both. In recent years, other initiatives have adopted additional procedures to mitigate these work disincentives, but relatively few beneficiaries have taken advantage of these provisions. Because people with disabilities may need a variety of services to seek or retain employment, and with federal assistance dispersed among many programs and agencies, coordination of these activities is especially important. Programs and agencies may coordinate in different ways, from sharing basic program information to establishing compatible eligibility criteria to cooperating in service provision. (See table 2.) Our review raised questions about the extent to which federal disability programs achieve coordination in any of these areas. Many of the agencies responsible for federal disability programs did not engage, or engaged very little, in basic informational coordination either with each other, state and local agencies, the private sector, or the disability community. Eligibility coordination was also lacking; similarly, service coordination appeared to be uncommon. Coordination in any of these areas appeared to be a formidable task for several reasons. First, many of the recent initiatives targeted to people with disabilities added to or expanded an already existing program structure organized to address the needs of nondisabled people. As a result, administrators, particularly those who manage partially targeted programs, often do not fully understand the needs of people with disabilities and do not place a high priority on coordinating with organizations serving their special needs. Second, many federal programs rely on service providers at the state and local levels for direct service delivery. In addition to the 130 federal programs overseen by 19 agencies in 1994, states distributed program administration and authority to a variety of agencies: state departments of employment and training; state rehabilitation departments; state education departments; state departments for the blind, deaf, or developmentally disabled; state health departments; and others. Many of these different agencies also apply their own eligibility criteria, creating even greater variation. One disability researcher reported that when he surveyed states and asked which departments provided disability-related services, he received almost as many different responses as there were respondents. Finally, federal and state officials also identified turf battles, different orientations and approaches, and competing program objectives as other impediments to coordination. Although federal assistance to people with disabilities is dispersed among many programs and service delivery agencies at the state and local level, limited informational coordination exists among agencies about these programs and how they fit together. Federal officials did not systematically share program information and ongoing developments with their counterparts at other federal, state, local, and nonprofit agencies or with the private sector or the disability community. Some federal officials we interviewed did not know of the existence of other federal programs helping people with disabilities. Although others knew of these programs, they seldom or never talked with agency officials from other programs nor did they keep up with ongoing program developments. Limited informational coordination by federal administrators was common, particularly among those who manage partially targeted programs. For example, one Labor official, commenting on the department’s lack of outreach to the disability community, said that the Department “does not even talk to its customers.” Similarly, we consistently heard from disability advocates, state and local officials, service providers, and private employers that JTPA does not effectively serve the needs of people with disabilities. State officials told us that, in fact, some JTPA offices were situated in locations that were inaccessible to people with mobility limitations. One consequence of this limited informational coordination was the difficulty people with disabilities experienced in getting reliable information about federal services. In particular, although the majority of SSI field offices and their staff reported that they spent time providing program information, according to our 1991 study, state and local officials told us that consumers often received inconsistent answers to commonly asked questions about SSI, work, and rehabilitation. The lack of consistent, accurate information about SSI, work, and rehabilitation could magnify some of the work disincentives created by provisions of income support programs. One consumer we interviewed stated that getting answers to questions about work and rehabilitation was difficult because SSI/DI administrators did not understand the needs that were specific to her disability. She also told us that getting incomplete information made employment a risky proposition because she could lose her health benefits and not have the earning power to replace them. Lack of informational coordination also has negative consequences for employers and service providers, both public and private. For example, in some states, counselors from vocational rehabilitation programs do not have access to job listings from agencies that administer employment and training programs. The absence of such linkages for sharing information can present undue burdens on employers. For example, without such information sharing, counselors from separate agencies may independently contact the same employer to develop employment opportunities for people with disabilities. Having different service providers—a vocational rehabilitation counselor, an employment training specialist, a supported employment job developer, or a representative from PWI—contact one employer can undermine the relationship between service providers, employers, and the disability community. Eligibility coordination is similarly limited among federal programs and agencies. Each federal program has congressionally authorized eligibility and scope-of-service requirements. Differences in eligibility criteria can make access to services a complex process, however, and could confuse people with disabilities as well as those who serve them. We identified at least 14 different definitions of disability used by federal programs alone, and many of these definitions provided considerable agency and state discretion in eligibility determination. For example, in assessing eligibility for services, one program permitted each of its 300 field offices considerable discretion in defining disability. State officials who serve people with disabilities told us that the requirements for participating in this program are very strenuous and a paper chase is required to apply. Even when programs may have well-defined criteria within their own departments, these criteria may differ from those used by other agencies. For example, programs administered through the Department of Education, such as Vocational Education and Vocational Rehabilitation, defined eligibility in terms of physical or mental impairments, whereas the programs administered through Social Security (DI and SSI) defined disability in terms of the inability to work. (See app. V.) In addition to the federal eligibility definitions, many states have the flexibility to develop and apply additional eligibility criteria and standards. For example, according to federal officials, theoretically, each state can have its own definition of developmental disabilities. State agencies may use the federal definition of developmental disabilities or the state’s definition. For someone to be eligible for services in one state, mental retardation has to be the primary disability. Other states define developmental disability in terms of intelligence quotient with differing thresholds. A 1988 report from the Training and Research Institute for People With Disabilities cited that among state agencies serving the mentally retarded or developmentally disabled population, only 40 percent evaluated their consumers using the relevant federal definitions and standards and none of the state vocational rehabilitation agencies evaluated their consumers according to federal criteria. We also found in a recent study that state vocational rehabilitation agencies used criteria that were more restrictive than federal standards in screening SSI/DI participants. Restrictive standards allowed state rehabilitation agencies to limit the referrals they receive from the Social Security offices to those they considered to be the best rehabilitation candidates. The wide variation in eligibility standards limits the possibilities for linkages among programs, such as reciprocal referrals or eligibility agreements, in which agencies or programs can establish that eligibility for one program would expedite service provision from another. Such linkages could reduce confusion and service delays to consumers, despite the variation in eligibility, yet we found few examples of such reciprocal agreements. For example, few linkages exist between state vocational rehabilitation programs and federal or state employment and training agencies. In our 1992 study of support services under JTPA, only 24 percent (131 of 557) of local organizations surveyed said that they had coordination agreements with the state rehabilitation agencies. Although in many cases variation in eligibility requirements may be appropriate or necessary, collectively these differences make federal programs difficult for consumers to use. For example, in the area of assistive technology, consumers testified at public forums convened by NCD that one device or piece of equipment has to be defined in different ways to meet eligibility requirements under different programs, each with its own funding limitations. Different rules are further complicated by differences in interpretating guidelines in an agency within a state and across states. Even if a person is clearly eligible for all services, he or she must negotiate multiple eligibility requirements—perhaps including medical examinations, documentation, and interviews with officials from multiple programs—to access services under several narrowly focused programs. Routinely, people with disabilities must go to several different offices to get services. Similarly, different standards and criteria also increase costs for service providers and can limit their participation. For example, an international nonprofit organization that provides a variety of employment and rehabilitation services for the disabled told us that some local chapters of the organization choose not to participate in some programs that have a federal and state component. These local chapters would prefer to spend their resources on delivering services instead of negotiating different processes in a variety of agencies. Established, well-maintained service coordination among programs also appears uncommon, resulting in inefficiencies and limiting private-sector participation and support. For example, many experts believe that increased access to regular fixed-route transportation facilitates the employment of people with disabilities. Transportation continues to be problematic, however, particularly in rural areas. Although different federal and state programs provided separate transportation funding for the elderly and the disabled, these services were not required to be coordinated at the local level. Thus, federal and state officials told us that, for example, in one county a half-empty van providing transportation for the elderly and another half-empty van providing transportation for the disabled may be traveling the same routes at the same time. Poor service coordination can also discourage employer efforts to work with programs and help people with disabilities. Private-sector partners involved with government programs told us that service coordination is essential for them. Officials from one corporate partner told us that having a single point of contact—rather than having to deal with multiple programs and administrators—is crucial to the company’s ability to participate in a program employing individuals with psychiatric disabilities. Another corporate official explained that lack of responsiveness and service coordination among multiple employment programs—along with reductions in financial incentives—contributed to her company’s decision to discontinue its efforts to participate in job training programs for the disadvantaged and for people with disabilities. The diffusion of federal assistance to people with disabilities is not unique to these programs, and efforts to address the resulting problems are not new. For more than 30 years, the Congress, federal agencies, and others have recognized that most public and private human service agencies are organized to address a narrow range of issues and individuals. Nevertheless, their periodic attempts to reorganize and reshape the way human services are delivered have met with only marginal success. Public and private officials from all levels of government and service delivery have tried different approaches to change the way human services are planned, funded, and administered. As we identified in a previous study, however, broad-based efforts to eliminate fragmentation by creating a new service delivery system have faced many obstacles and met with limited success. Mandates alone are unlikely to secure the significant time and resource commitments needed from officials to initiate and sustain systemwide reform. In contrast, less ambitious efforts to improve coordination among service providers have succeeded somewhat in enhancing services. These efforts did not try to reorganize agencies’ administrative structures; they improved services by taking a more modest, practical approach, focusing on the point of delivery and adapting to local conditions. Specifically, they linked individuals, services, and programs by (1) convincing service providers and officials of the need to cooperate and developing incentives for them to participate in the effort, (2) getting key participants to agree to the goals of the initiative and the role of each party in implementing changes, and (3) establishing a forum to institutionalize changes and continue ongoing communication. Some states have developed strategies that use the practical and modest approach that we had previously identified as improving coordination. For example, in California, one rural county we visited appeared to be improving services and reducing program costs. Despite significant barriers to coordination, state and local officials were improving communication among service providers and linking people with disabilities to the services they need in a comprehensive manner. Officials reported that their coordination efforts had reduced time and expense for administrators and consumers by 40 to 50 percent. In this case, state and local officials created a collaborative forum—the School-to-Work Interagency Transition Partnership (SWITP)—that uses interagency linkages at the local level to help students with disabilities successfully transition from school to work. Officials formed a transition team composed of the student, parents, school counselors, representatives from the local JTPA program, and the state vocational rehabilitation agency. The team meets to identify a student’s employment goals and devises a plan to tailor available services to the student’s aspirations for achieving independent living. Representatives from almost all of the necessary services usually attend the meeting, and they work with the student and his family to identify priorities and overcome barriers. For example, one student could not take needed computer classes because of a lack of access to public transportation, but buying a car would have jeopardized the student’s income maintenance and health care benefits. Because the agencies were working together in a team format to coordinate services, they quickly identified and implemented a solution. Transition team members said that students liked being part of the team because it gave them greater personal independence. One of the students who participated in the transition team told us it had been indispensable in guiding him from high school to independent living. The student had only work experience as a janitor, but the team helped him to identify his skill strengths and weaknesses as well as his own aspirations for other vocations. School counselors provided insights about the student’s disability, and the JTPA staff identified relevant training the student needed. The end product of the meeting was a strategic plan, which gave the employment specialist a basis on which to approach employers, emphasizing the student’s skills and their benefits to employers. Despite initial employer reluctance, the team placed the student temporarily for on-the-job training and continued to support both the employer and the student after the placement. The student’s enthusiasm and willingness to learn impressed the employer, and, 4 years later, the student was still employed there as a custom upholsterer—at well above the minimum wage. Although SWITP’s comprehensive team assessment and planning process is targeted to youth with disabilities, it mirrors the challenges and strategies that have faced other programmatic efforts to improve services. Like administrators of adolescent drug prevention programs, SWITP service providers faced tasks of coordinating diverse external agency procedures, documentation, and personalities. SWITP service providers noted that they often need conflict management skills, a strong focus on the student’s needs, and patience to overcome the turf concerns of specialized professionals and their agencies to provide the full range of services necessary for their participants. SWITP providers also found that coordination was enhanced by using a master document containing the information necessary for each agency to meet each program’s data requirements. Although the master document does not replace all other documentation, it condenses the multiple intake documents previously required from students. In addition, service providers regularly consult each other about changes in their programs and consumers, which has enhanced their ability to follow up with their students long after they have left the program. SWITP service providers reported strong support for the process because it fosters trust (“we don’t feel threatened by one another”), noting that this trust has given them greater flexibility in helping their students achieve their goals. States are also exploring other strategies to improve communication and overcome organizational barriers. For example, Massachusetts has created interagency agreements establishing forums in which state agency personnel can discuss and systematically train each other about their respective missions, procedures, standards, and target populations. Nevada and Massachusetts have also reported arrangements for exchanging electronic information between vocational rehabilitation and employment and training agencies, which has facilitated reciprocal referrals. While the variety of programs and agencies engaged in serving people with disabilities raises questions about the efficiency of federal efforts, the effectiveness of these efforts is also unclear. Most of the 26 employment- focused programs we examined have not been formally evaluated. For many of the employment-focused programs, no statutory or agency data collection requirements exist. Federal officials explained that few formal evaluations have been conducted because of the lack of data collection, limited resources, and in many instances the data collection problems posed by federal and state program flexibility. The absence of legislative and agency data collection requirements, coupled with limited available resources, precludes effectiveness studies for many of the programs we visited. Many of the agencies administering these 26 employment-focused programs did not require or collect data on program outcomes—specifically, data on whether participants got jobs and kept them, what wages they received, and whether they received employee benefits such as health insurance. For example, JTPA has no statutory requirement for service delivery areas to report the characteristics of the services delivered to people with disabilities or how they are delivered. Program officials told us that, with the limited resources of most agencies, they lack the capabilities to initiate data collection efforts. For some of the programs that did collect outcome data, the information collected was not sufficient to adequately link outcomes to the services provided. For example, although service providers for the Supported Employment program provided detailed information on program participant performance and initial placement, they were not required to track consumers after an 18-month period, making any long-term assessment of the linkage between training and employment difficult. Without a concurrent effort to improve coordination at all service levels, however, imposing reporting or assessment requirements may not improve the basis for evaluation. Given the flexibility each state has in choosing its own standards and definitions, outcome tracking can be a formidable task. In many instances, service providers, both public and private, use different intake data, eligibility criteria, paperwork requirements, software, and confidentiality rules. Consequently, “people aren’t talking the same language,” as one state official summarized, and considerable investments would be required to develop more uniform documentation and data to accommodate the many definitions and standards used. For example, different agencies and organizations at the state level provide funds for supported employment services. Federal officials told us, however, that mental health agencies have a different definition of services that constitute supported employment than do the vocational rehabilitation agencies. Without better coordination, data collection and tracking will remain a costly endeavor, and program administrators will lack confidence that their programs are effective, either individually or in combination with other services. The Congress has in the past directed agencies involved in research and evaluation of programs serving people with disabilities to improve their coordination. For example, according to a report from the Office of Technology Assessment (OTA), Education’s Rehabilitation Services Administration signed a memorandum of understanding in 1993 with other agencies involved in similar research and evaluation. The memorandum was intended to initiate collaboration of service delivery, staff training, and evaluation activities for the rehabilitation and employment of people with psychiatric disabilities. Similarly, the National Task Force on Rehabilitation and Employment of Psychiatric Disabilities tried to promote collaboration in the research and evaluation of federal rehabilitation and employment efforts. The task force met quarterly for 3 years, but attendance declined significantly, with many members complaining about its voluntary nature and limited impact on policies. The OTA report stated that experts and advocates commented to them that such efforts had achieved only mixed success, leading to OTA’s conclusion that “while mechanisms for communicating across agencies have or do exist, they lie moribund at the present time.” Our review raises questions about the efficiency of federal efforts to help people with disabilities. In 1994, the federal government provided a broad range of services to people with disabilities through 130 different programs, 19 federal agencies, and a multitude of public and private agencies at the state and local levels. Although research groups and independent panels have stressed the need to simplify and streamline programs serving people with disabilities, suggestions for creating a new system to deliver services may be difficult to implement. In 1992, we urged caution when the Congress considered initiatives for federal, state, and local organizations to make fundamental changes in human service delivery systems, and we also urge caution for programs serving people with disabilities. Although the potential benefits of creating a new system to deliver services more comprehensively to people with disabilities may be great, so are the barriers and the risks of failure. Obstacles preventing officials from reorganizing service agencies, creating new funding and service agreements, and divesting authority from their own agencies are difficult to overcome. Mandates alone are unlikely to secure the significant time and resource commitments needed from officials—whether they are charged with directing reforms or have responsibility for administering services. In the current fiscal environment, a renewed focus by federal agencies on improving coordination would be a useful step toward improving services and enhancing the customer orientation of their programs. Given the multifaceted federal effort, better coordination is crucial to any strategy to eliminate duplication and service gaps and to enhance the efficiency of programs administered by the many public agencies at all levels of government. Without such an effort, assessing the impact of the federal commitment to people with disabilities and the relevance of improvement measures, such as program consolidation, becomes virtually impossible. We have identified several state and local initiatives that have shown promise in meeting the challenges of coordination; other initiatives most likely exist throughout the nation. These efforts appear to have succeeded somewhat in reducing duplication and service gaps, while saving agencies money. In light of these initiatives, the major Departments serving people with disabilities—Education, Labor, and Health and Human Services (HHS)—have an opportunity to identify, encourage, support, and learn from the innovative solutions being developed at the state and local levels. The Departments of Labor, Education, and Transportation provided comments on our draft report, agreeing with our findings and conclusions. (See app. VI for a copy of written comments from the Department of Labor.) Each of these agencies also provided technical comments, which we incorporated in the report as appropriate. HHS did not provide comments on the report within the time available. As arranged with your office, we are sending copies of this report to the Secretaries of Labor, Education, and Health and Human Services. GAO contacts and staff acknowledgments for this report appear in appendix VII. Please call me on (202) 512-7014 if you or your staff have any questions. This report identifies and describes federal programs designed to assist people with disabilities, with a special emphasis on programs promoting employment. Specifically, we focused on the following questions: (1) Which federal programs target people with disabilities, and how many of these programs provide employment-related services? (2) To what extent are information, eligibility, and services coordinated under these programs? (3) What does available evidence suggest about the efficiency or effectiveness of federal programs in promoting employment among people with disabilities? To accomplish these objectives, we integrated evidence from the literature, from analyses of available databases, and from interviews with consumers and public and private organizations. We interviewed officials of federal agencies that administer programs targeted to people with disabilities. We also interviewed disability advocates; officials of nonprofit groups; and state and local officials in Massachusetts, California, Virginia, and Nevada. We chose these states on the basis of expert opinions and agency officials to obtain a variety of geographic locations, program sizes, and administrative structures. In addition, we interviewed consumers and several private-sector participants in several of these states to obtain their perspectives on how these programs promote employment of people with disabilities. We reviewed the literature on labor economics and employment programs, generally, and on people with disabilities, in particular, to obtain information on the problems and employment barriers such individuals face and on federal efforts to surmount these barriers. We also reviewed agency documents and legislation to help determine the purpose, eligibility requirements, and services authorized under these programs. To profile the population of people with disabilities, we used several databases. In addition to relying on previously published results from the Current Population Survey (CPS), the Survey of Income and Program Participation (SIPP), and the 1995 National Organization on Disability/Louis Harris Survey on Employment of Persons With Disabilities, we analyzed information from the 1990 census and from the 1993 National Health Interview Survey (NHIS). Our estimates from the 1990 census were based on a 5-percent subset of the full census sample—approximately 15.9 percent of all U.S. housing units consisting of over 12 million people and 5 million housing units. These households received the long form of the census questionnaire, which collects detailed information on many variables, including several different ways of measuring disability status. The 1993 NHIS is a personal interview household survey using a nationwide sample of 109,671 civilian noninstitutionalized people in the United States. The two surveys differ in the content of their disability-related questions as well as in the other information gathered. For example, NHIS was useful in estimating the prevalence of chronic conditions, information the census does not gather. The census database provided more precise information on the geographic distribution of people with disabilities. The major sources used to identify federal programs were the Catalog of Federal Domestic Assistance (CFDA), agency documents, and interviews with federal officials. We defined a federal program as a function of a federal agency that provides assistance or benefits to a state or states, territorial possession, county, city, other political subdivision, or grouping or instrumentality thereof; or to any domestic profit or nonprofit corporation, institution, or individual, other than an agency of the federal government. We defined the scope of our review to include those programs meeting one or more of the following criteria: (1) people with disabilities are specifically mentioned in the legislation as a targeted group; (2) people are eligible for the program wholly or partially because of a disability; (3) people with disabilities are given special consideration in eligibility assessments; or (4) program officials are directed to give priority to serving people with disabilities. In general, we included all programs that explicitly recognized disability or handicap, regardless of how (or whether) the program or legislation defined disability. Programs that serve individuals without respect to disability but that serve some individuals with disabilities (for example, Aid to Families With Dependent Children) are beyond the scope of this report. We also omitted those programs that exclusively funded medical research. Our definition of federal programs also excluded federal legislation that does not authorize the direct expenditure of federal funds but instead provides indirect support or imposes mandates on federal or nonfederal entities. For example, the Javits-Wagner-O’Day Act of 1971 authorizes federal agencies to procure selected goods and services from sheltered workshops for blind or severely disabled individuals. Although we excluded these types of federal efforts from our analysis of federal programs, we described some of the most important of these efforts in the report. To analyze in more detail those programs that affect employment issues, we divided these federal programs into three groups: (1) employment- focused programs that provide services such as job training, supported employment, job placement, and employment counseling; (2) employment-related programs that provide services that could reduce barriers to employment—such as transportation, health care, or assistive technology; (3) programs unrelated to employment that provide services that are unconnected (or could have only a remote connection) to employment—such as services to infants and toddlers. We gathered information on 1990 and 1994 expenditures using the Consolidated Federal Funds Report (CFFR) compiled by the Bureau of the Census. The CFFR tracks the majority of federal domestic outlays and is the best information available on expenditures or obligations. For some programs, agencies had not reported information to the Census Bureau; we attempted to gather the information from the agencies. In other cases, this information was not available. For many of these cases, the agency performed the program’s activity in conjunction with other agency activities, and we could not distinguish funds spent for one activity from funds spent for the other. For this reason, our estimates of total expenditures on disability-related programs are likely to be underestimated. In addition, our estimates reflect federal outlays only and exclude any supplements from states and localities. (These estimates, which appear in table II.1 in app. II, reflect the federal expenditures/obligation for the entire program unless noted otherwise.) Many federal programs are partially targeted toward people with disabilities—that is, the programs target multiple groups of individuals, with people with disabilities being only one and not necessarily the most important one. For some of these programs, agency officials track program expenditures by target group. For example, the Health Care Financing Administration tracks Medicare expenditures for the aged and for the disabled. Many partially targeted programs, however, do not track expenditures by targeted group. For example, the Transportation Department’s Federal Transit Administration finances public transit systems, along with capital improvement funds to make mass transit more accessible to people with disabilities. Agency officials have found it impractical to track disability-related expenditures under this program, particularly since it is impossible to know riders’ disability status and whether or not they are using public transportation for work or some other activity. Because we could not distinguish expenditures under many partially targeted programs, we created an interval estimate of disability- related expenditures. At the lower bound, none of the expenditures for these programs were included; at the upper bound, all expenditures for these programs were included. This appendix presents an overview in table II.1 of the 130 federal programs that we identified as targeted to people with disabilities. Each program’s administering department or agency, services, and the individuals or groups who ultimately benefit from these services are included. Each program’s 1994 funding, the degree of targeting, and the type of applicant are also included. The order we used to list programs corresponds to the five-digit program identification number assigned by the Catalog of Federal Domestic Assistance (CFDA). The first column of table II.1 contains the CFDA five-digit program identification number. The first two digits identify the federal department or agency that administers the program, and the last three digits are unique codes identifying a program. For example, programs starting with “14” are administered by the Department of Housing and Urban Development (HUD) and those starting with “96” by the Social Security Administration (SSA). For programs not listed in the CFDA, the table uses the alphanumeric code the Bureau of the Census has assigned. For example, Funding for the American Printing House for the Blind is allocated through the Department of Education. All Education programs start with “84” as a program identification, and the additional alpha codes “JJJ” or “JAW” are assigned by the Bureau of the Census. Column 2 identifies the descriptive title listed in the CFDA. Column 3 shows the federal department, agency, commission, council, or instrumentality of the government with direct responsibility for program management. Column 4 provides the most prominent services authorized under each program. Although other services may also be available, the table cites those services relevant to people with disabilities. Column 5 describes the ultimate beneficiaries of federal assistance. Although other groups or individuals may benefit from a program, the table only describes characteristics relevant to people with disabilities. Column 6 shows information about targeting: All programs that are partially targeted have a “P” in column 6. A partially targeted program is one that serves people with disabilities and others; a wholly targeted program provides assistance only to people with disabilities. Programs with a “W” in this column are considered wholly targeted. Column 7 shows federal expenditures and/or obligations for the entire program in 1994, unless noted otherwise. Broadly, the CFDA specifies three categories of federal assistance: financial, nonfinancial, or a combination of both. For programs that provide any financial assistance, the table shows the total amount spent or obligated in 1994 as identified through the Bureau of the Census. Programs that provide nonfinancial assistance have “NF” in column 7 because the census only tracks financial assistance for each program. Some programs have “NA” in column 7 because expenditure information was unavailable. Column 8 identifies the applicant for each program. The CFDA defines applicants as any entity or individual eligible to receive funds from a federal program. Generally, the applicant and the beneficiary will be the same individual or group for programs that provide assistance directly from a federal agency. However, financial assistance that passes through state or local governments will have different applicants and beneficiaries. We classified applicants into the following five groups: individuals, nonfederal governmental entities, nongovernmental entities, other, and the general public. Expenditures or obligations for 1994 (in dollars) (continued) Expenditures or obligations for 1994 (in dollars) (continued) Federal Transit Capital Improvement Grants Capital Assistance Program for Elderly Persons and Persons With Disabilities Federal Employment for Individuals With Disabilities Employment Discrimination—Title 1 of the Americans With Disabilities Act (ADA) Books on tape, braille, large type, etc. Expenditures or obligations for 1994 (in dollars) (continued) Expenditures or obligations for 1994 (in dollars) (continued) Expenditures or obligations for 1994 (in dollars) (continued) Expenditures or obligations for 1994 (in dollars) (continued) Expenditures or obligations for 1994 (in dollars) (continued) Expenditures or obligations for 1994 (in dollars) (continued) Funding for Construction at National Technical Institute for the Deaf Model Secondary Schools for the Deaf Architectural and Transportation Barriers Compliance Board (ATBCB) National Council on Disability (NCD) Expenditures or obligations for 1994 (in dollars) (4,020) (continued) Expenditures or obligations for 1994 (in dollars) (continued) Expenditures or obligations for 1994 (in dollars) (disabled only) 7,800,000,000 (disabled only) (disabled only) (disabled only) (continued) Expenditures or obligations for 1994 (in dollars) X See introduction to this app. for explanation of beneficiary. Over several decades, congressional concern about employment opportunities for people with disabilities has led to more than two dozen federal employment-focused programs. In addition, the Congress has provided certain employment protections to people with disabilities, for example, by barring discrimination in employment on the basis of disability. Finally, several laws also provide a variety of mechanisms that indirectly support the employment of people with disabilities, for example, by authorizing federal purchases from nonprofit organizations that employ people with disabilities. These federal employment initiatives incorporate three approaches toward employing individuals with disabilities: In sheltered employment, individuals with disabilities work in a “sheltered workshop,” which is a controlled environment providing job operations involving a limited set of tasks. Sheltered employment is most frequently used with individuals with severe functional limitations, although the blind have a long history of working in sheltered employment operations. Under supported employment, individuals with disabilities are integrated into a work setting but are provided postemployment services, frequently including job coaches or on-the-job training, to help facilitate the transition to employment. Federal initiatives for supported employment are intended for individuals with relatively severe disabilities. Competitive employment most often refers to a regular job, in which an individual does not receive postemployment services. The majority of federal placement initiatives for people with disabilities are aimed at placing individuals with disabilities in competitive employment. Services provided under such federal efforts include job training, educational support, counseling, assessment, and placement. Federal efforts to promote the employment of people with disabilities are largely aimed at competitive employment. Some of the federal programs with a goal of competitive employment are designed exclusively for people with disabilities. Others, however, are part of the wider federal effort to promote job opportunities for people who are disadvantaged in the labor market. For example, the Job Training Partnership Act (JTPA) provides job training services mainly to the economically disadvantaged, but people with disabilities who are not economically disadvantaged may also qualify. Both wholly and partially targeted federal employment programs rely heavily on leveraging support from the private sector to place individuals in jobs and move them toward economic self-sufficiency. The largest federal effort focused exclusively on facilitating employment of people with disabilities is the Vocational Rehabilitation program. Vocational rehabilitation formula grants are provided to a state on the basis of the state’s per capita income and overall population. States are required to submit a plan for providing services to the Commissioner of Rehabilitation Services Administration and to match 21.3 percent of federal funds. Services that can be provided with these grant funds include job training, assessment, counseling, maintenance during rehabilitation, personal assistance, placement or rehabilitation technology, and assistance in operating a business. Vocational rehabilitation counselors must draw up an Individual Employment Plan for each client to specify what that client needs to move toward employability. The program provides services as specified in the plan; these services can include virtually anything deemed necessary to facilitate a positive employment outcome. The emphasis of the program remains on competitive employment, but it can place individuals in supported or sheltered employment as well. A number of other programs support the Basic State Grants for Vocational Education. For example, several programs provide funding to train vocational rehabilitation personnel through state agencies or other public or private organizations. An estimated 44,034 people participated in training (including continuing education programs) in fiscal year 1993. Another support program for the vocational rehabilitation system provides funding for special projects and demonstration efforts. In fiscal year 1994, this program funded 11 new grants and 87 continuation projects in supported employment. These efforts emphasized (among other areas) services to individuals with specific learning disabilities, for example, individuals with long-term mental illness and transition services for youths with special needs. In addition, other federal programs provide grants to Native American tribes for vocational rehabilitation services to individuals living on reservations; another provides vocational rehabilitation services to migrant and seasonal farmworkers. The Projects With Industry (PWI) program is one of the few federal efforts that engages the private sector as a partner in expanding employment opportunities for people with disabilities. Services provided to individuals with disabilities vary with different projects but generally include evaluation, counseling, training, job development, and job placement. Services may also be provided to employers, sometimes including job-site or equipment modification. The PWI program may involve grants or contracts with individual employers, state vocational rehabilitation units, or other public or private organizations. Each grantee must develop and work with a Business Advisory Council, with representatives from private industry and organized labor, and individuals with disabilities. The Department of Veterans Affairs (VA) has established two programs to provide vocational rehabilitation services to veterans with disabilities. VA generally provides services to honorably discharged veterans who have received a 20-percent or higher VA disability rating for a service- connected disability. Under a second program, veterans who are receiving a VA pension may also qualify for vocational rehabilitation services. Case managers in these programs can provide whatever services the veteran needs to facilitate employment. Some of these services include evaluation, counseling, education, training, and job placement assistance; many veterans with disabilities receive financing for higher education. However, these vocational services are time limited. Veterans must generally complete the training portion of their vocational rehabilitation plan within 48 months; participants generally cannot receive services after 12 years from the date on which their eligibility was established. In program year 1995, approximately 48,000 veterans with disabilities received vocational rehabilitation services. JTPA provides job training and employment-seeking skills. It is primarily directed to economically disadvantaged people but also includes others who face employment barriers. JTPA features a unique partnership of the federal government, the states, and the private sector. Although JTPA does provide support services such as child care and transportation, local JTPA providers are restricted in the amount they can spend and they often spend less than permitted. Thus, people with disabilities who require more extensive support services may need to access other programs to supplement JTPA services. In addition to its primary training program, JTPA also encompasses the residential Job Corps program and research, pilot, and demonstration efforts. Individuals with disabilities can be served under all these JTPA programs, and the needs of individuals with disabilities receive special consideration in the awarding of discretionary JTPA projects. For example, in 1995, special project grants were awarded to organizations, such as Goodwill Industries and the American Rehabilitation Association, to provide job search assistance and job placement to people with disabilities. In addition, people with disabilities can sometimes qualify for JTPA without meeting income guidelines because they face a barrier to employment. JTPA’s focus for its clients with disabilities remains competitive employment, although JTPA funds can be used for supported employment efforts as well. Established by the Depression-era Wagner-Peyser Act, the state-federal employment service (ES) provides employment offices to assist individuals looking for jobs and employers looking for workers. Through many local offices, the ES program offers an array of services, including job counseling, skills assessment and testing, job search workshops, job opening identification, and referrals to employers. Services provided by ES, however, are frequently limited to job listings and some counseling. Although these services are available to everyone, states are required to give special consideration to people with disabilities by requiring every local ES office to designate at least one staff member to help individuals with disabilities locate employment or training. In program year 1994, ES provided assistance to an estimated 625,133 people with disabilities, which accounted for approximately 3.3 percent of ES’ total clientele. With a joint Education/Vocational Rehabilitation plan approved by the Department of Education, states can receive project grants to provide school-to-work transition services to secondary students (14 and older) with disabilities. Many of these projects implement the Individuals With Disabilities Education Act’s (IDEA) requirement to provide transition services. Other institutions, such as colleges and universities and other nonprofit organizations, are also eligible for project grants to improve the school-to-work transition for students with disabilities. Although vocational rehabilitation programs can also provide financing for small businesses, competitive employment remains that program’s primary emphasis. The Handicapped Assistance Loan program awards loans to small businesses that are 100-percent owned by individuals with disabilities to provide construction or working capital. Under this program, the Small Business Administration (SBA) guarantees commercial loans with extended repayment periods to businesses. This program can also be used for sheltered workshops, as described in more detail later. Since 1947, the President’s Committee on Employment of Persons With Disabilities has made efforts to develop public-private partnerships and encourage businesses to hire individuals with disabilities. The committee’s activities include information dissemination and coordination as well as operating the Job Accommodation Network (JAN). JAN provides information on workplace accommodations to employers, rehabilitation professionals, and individuals through a toll-free number. The Office of Personnel Management operates the federal Selective Placement Program, which provides federal agencies with assistance in placing federal employees who have become disabled and in recruiting employees with disabilities to federal service. Under this program, people with disabilities can apply for federal employment without going through the normal competitive process. The Americans With Disabilities Act (ADA) of 1990 established a clear and comprehensive prohibition against discrimination on the basis of disability. Among other protections, ADA established regulations focused on removing architectural, communications, and transportation barriers. Regarding employment, ADA essentially prohibits organizations employing 15 or more employees from discriminating against a qualified individual with a disability because of the disability in the job application or hiring process, in advancement or discharge of employees, employee compensation, job training, or other conditions of employment. ADA protects individual applicants or employees as long as they can perform all essential functions of the job with or without reasonable accommodation. To be reasonable, an accommodation must not impose an undue hardship on the employer and must enable the individual with a disability to perform the necessary work. For example, a reasonable accommodation for an individual in a wheelchair might be to raise his or her desk so that the wheelchair can fit comfortably beneath it. ADA is a mandate and not a federal program as such, although programs have been set up to enforce the provisions of the law. Nonetheless, the ADA remains a key part of the federal commitment to promote employment of people with disabilities. Through several different legislative actions, the federal government has prohibited employment discrimination solely on the basis of disability for federal contractors, state and local governments, and private businesses with 15 or more employees. Several programs have been set up to enforce these provisions. The Office of Federal Contract Compliance Programs is responsible for investigating complaints against federal contractors. The Department of Justice is responsible for investigating and prosecuting cases of employment discrimination under ADA against state and local governments, and the Equal Employment Opportunity Commission is responsible for ADA cases involving private-sector employees. These bodies may prosecute a case, decide that no cause for suit exists, or give clearance for an individual to file the case in federal court on his or her own. The Randolph-Sheppard Act in 1936 set up a program for blind individuals that gives organizations working with the blind preference in operating vending facilities on federal property. Under this program, these organizations may be granted rights to place vending machines or sell other items in federal buildings. The gross receipts of Randolph-Sheppard vending facilities totaled $388.8 million during fiscal year 1990. The Targeted Jobs Tax Credit (TJTC), which expired in 1994, was established by the Congress to promote employment for disadvantaged people. The Congress authorized this special tax credit to induce private businesses to employ people who were chronically unemployed, disadvantaged youth, welfare recipients, and people with disabilities. The tax credit amounted to 40 percent of the first $6,000 in wages during the first year of employment. For an employer to qualify for the tax credit, the worker must have been employed for at least 90 days or have completed at least 120 hours of work. Approximately 8 percent of the individuals benefiting from the TJTC were people with disabilities. Two federal programs provide financing for supported employment programs: one program provides aid to state programs, the other finances projects directly. In addition, many states finance some supported employment services through state grant programs that receive funds from HHS to provide services to individuals with developmental disabilities. These programs provide ongoing (although generally time-limited) postemployment support to individuals with disabilities to help them maintain community employment. Under this program, states are given formula grants to provide supported employment services. This program is intended to provide services to individuals with severe disabilities to allow them to get jobs. These services can include job coaches, ongoing supports, training for coworkers, and a variety of other services designed to enable individuals to adjust to the workplace. Services provided under this program are generally limited to 18 months; after this time, states must either find additional funds to pay for continuing services or discontinue the services and see if the individual can continue without the additional support. This program awards grants to public and nonprofit agencies, including states, to conduct special projects and demonstrations to expand or assist supported employment services to individuals with the most severe disabilities. In fiscal year 1993, this program supported 13 new community-based projects, 14 continuing community-based projects, and 16 grants to states for systems-change projects. Services under this program are like services provided under the state grant and can include assistance to employers in training coworkers, assistive technology, and job coaches. Like the formula grants to states program, this program allows recipients to use these funds to build community capacity to provide these services. Federal financial help also supports sheltered workshop employment for people with disabilities. This support, however, is generally somewhat indirect, coming from federal purchases, exemptions from federal wage laws, and some business loans. The Javits-Wagner-O’Day Act established an initiative under which federal agencies may purchase selected goods and services from sheltered workshop providers. In fiscal year 1991, $431.55 million in contracts were awarded to 497 such workshops. Under the Fair Labor Standards Act, sheltered workshops may apply to the Secretary of Labor for exemptions from the minimum wage law. SBA may award handicapped assistance loans to sheltered workshops for construction or working capital. For workshops to be eligible, at least 75 percent of the work hours for the direct production must be performed by people with disabilities. The Handicapped Assistance Loan program also provides loans to small businesses wholly owned by people with disabilities. The disability programs we examined differ in their services, objectives, size and scope, and in how they distribute program dollars. Although many of these federal programs allocate their funding to state governments or local providers, the programs generally have established different mechanisms for doing so. For example, the federal-state Vocational Rehabilitation program allocates its funding to state governments on the basis of a formula that includes state population and per capita income. By contrast, the Labor Department’s Special Projects for Employment of Persons With Disabilities program awards grants to states or local providers on the basis of applications and proposals. Thus, the aggregate distribution of funds among states and geographic areas reflects these different allocation mechanisms in combination and may not resemble the distribution that would result from any one mechanism in particular. In addition, the aggregate distribution of funds among states under a multiple program structure may not represent the distribution that would have been chosen under a more integrated system. To illustrate the distribution effects of the allocation mechanisms currently used by disability programs, we examined the state distribution of funds for those wholly targeted, employment-focused programs that channel funds to locations nationwide. We compared this distribution with the distribution of people with disabilities by state and then looked at the per capita amounts available to each state under these programs. Our analysis focused on eight programs that represent the majority of funds distributed under employment-focused programs. We chose to limit our illustration to wholly targeted programs because people with disabilities represent a relatively small portion of clients served by many of the partially targeted programs. Without reliable data on state-by-state spending on people with disabilities only, we could not incorporate partially targeted programs without distorting the analysis. Of the 26 employment-focused programs that we identified, 9 were partially targeted and thus excluded from our analysis. An additional four programs provided advice to people with disabilities and their employers from central locations, and five programs did not report state-by-state spending information. Thus, eight programs remained for our analysis. Table IV.1 shows 1990 federal expenditures of eight wholly targeted, employment-focused programs. Funding mechanism/ cost sharing or matching (Y/N) Formula grants (N) Direct loans (N) Direct payments (N) Formula grants (Y) Project grants (Y) Project grants (Y) Project grants (N) Formula grants (N) We obtained the information in this appendix from publicly available data through the Bureau of the Census. Specifically, we derived summary statistics from the Census of Population and Housing, 1990, and we derived expenditure data from the Consolidated Federal Funds Report (CFFR). Our selection of employment programs was based on the availability of expenditure data for wholly targeted programs. As shown in table IV.1, approximately $2.3 billion was distributed in 1990 through eight employment programs that were wholly targeted to people with disabilities. Many of these programs funded state, local, private, or nonprofit entities that administered services in their area. These organizations included institutions of higher learning, state vocational rehabilitation agencies, job training councils, local educational agencies, or other appropriate public or private nonprofit institutions. No single agency or department had both the responsibility and authority to administer these employment programs. Of the eight we selected, the Department of Labor, the Small Business Administration (SBA), and the Department of Veterans Affairs (VA) administered one program each. The remaining five programs were administered through the Department of Education, including the largest, Vocational Rehabilitation (see table IV.1). Programs that used a decentralized program structure distribute funds through a formula or project proposals (see table IV.1). The largest program, Rehabilitation Services—Vocational Rehabilitation Grants to States, distributes funds through a formula and accounts for over 80 percent of the total amount available for people with disabilities in employment assistance. Formulas are also used by the Supported Employment and the Disabled Veterans’ Outreach programs. Under these programs, the states’ annual allotment is based on population characteristics such as per capita income, total population, or the number of disabled veterans in the state. Programs that used project grants to make allotments include Rehabilitation Services—Service Projects, Rehabilitation Long-Term Training, and Secondary Education and Transitional Services for Youth With Disabilities. For each of these, the state or service provider must apply for funding. Consequently, the variation in expenditures may relate to the population characteristics as well as the success of these local organizations in pursuing additional funds. As shown in figure IV.1, in 1990, the disabled working-age population as a percentage of the total working-age population across states varied between 7 and 15 percent. Southern states had the highest concentration of the disabled. For example, the percentage of working-age disabled people in West Virginia was around 15 percent of the total working-age population. Other southern states were also in the higher end of the distribution. States such as Kentucky and Alabama registered a disabled working-age population around 13 percent. In highly populated states like California, New York, Texas, Florida, and Illinois, the disabled working- age population was generally between 10 and 11 percent. In contrast, sparsely populated states, such as Wyoming, and states in the High Plains, such as North Dakota and South Dakota, had disabled working-age populations of less than 10 percent. As shown in figure IV.2, in 1990, these programs distributed to states between $200 and $1,100 per working-age person with a disability. Approximately 40 states have less than $500 available per person in the working-age disabled population. Although southern states have higher percentages of people with disabilities in their working-age population, these states were in the lower end of the expenditure distribution. Florida, Georgia, and South Carolina, for example, have between $200 and $350 available per disabled person. Large, highly populated states such as California and New York, were also in the lower end of the distribution, although sparsely populated states, such as Wyoming and North Dakota, were in the higher end. The distribution of federal dollars must be interpreted cautiously due to limitations in the availability of data for several reasons. First, data derived from the CFFR are the best estimates of federal obligations or outlays available. Because these data are estimates, however, in any given year, actual outlays may be higher or lower because program funds may be deobligated at any time. Similarly, although this analysis accounts for the majority of federal expenditures on employment-focused programs, we could not obtain sufficiently reliable data to allow us to analyze expenditures on partially targeted programs. Moreover, per capita amounts may conceal reasonable underlying factors not captured by our data sets such as money that states or local jurisdictions raise. For example, the largest employment program, Vocational Rehabilitation, requires state and local jurisdictions to provide a matching component. While these funds increase the overall expenditures available, our estimates reflect only federal outlays. One of the most contentious aspects of disability research is also the most basic—the definition of disability. Different federal programs use different operational definitions of disability, as do researchers, advocacy groups, and other interested parties. Some of this variation occurs because many groups define disability for different purposes and thus use different criteria for evaluating a definition. For example, a relatively broad definition of disability would encompass a wide array of people with disabilities; however, some broader definitions can be quite subjective. Researchers may prefer a definition that can be used with existing data sources; program officials must be concerned with definitions that can be measured and verified. Three fundamental issues about the nature of disability contribute to these definition and measurement differences: Scope of definition—Defining disability involves distinguishing between normal variations among individuals and conditions that are disabling. Duration of a condition—Because a person’s disability status may change over time, some researchers argue that disability should be continually re-evaluated and remeasured and that temporary or sporadic conditions should be considered in evaluating disability. Others contend that only permanent conditions should be considered. A condition (such as rheumatoid arthritis) may be limiting but may have only sporadic impact on an individual’s ability to function—so even differentiating between permanent and temporary disabilities can be difficult. Variation in application—Even with the most clear-cut definitions of disability, applying the criteria involves an inherent judgment. Two parties may agree on a definition of disability but may then apply different classifications of who is disabled. For example, a significant difference exists in the number of people identified as eligible for disability insurance by the state disability determination services and by administrative law judges. Not only is disability hard to determine under any given definition, but definitions of disability vary widely. We identified many different definitions used by programs, researchers, and advocacy groups. (Table V.1, at the end of this appendix, lists some examples of these definitions and their sources.) Relying on functional assessment, medical criteria, or individual perception, these definitions emphasize different aspects of disability—from the individual’s ability to work, for example, to the role of the person’s physical environment in shaping the degree of disability. The number of disability definitions combined with differences in measurement techniques have resulted in estimates of the number of people with disabilities that range from 3.5 million to 49 million. Although many definitions are similar, even subtle differences in the population included, the survey used, or the definition of disability can have far-reaching effects on how many individuals are counted as having a disability. For example, estimates from the 1990 Survey of Income and Program Participation (SIPP) indicated that 8.6 million Americans aged 16 to 67 were “unable to work” due to disability; the 1990 census estimated that 6.6 million Americans aged 16 to 64 were “unable to work” due to disability—a difference of nearly one-third. When the definition of disability is widened to include individuals who are “limited in work,” 1990 to 1993 estimates range from 12.9 million to 19.5 million. Table V.2, at the end of this appendix, shows the differences in the estimated disability prevalence in the United States using different definitions and sources. The most common method of defining disability—both for researchers and under federal programs—is based on functional limitation. Under this type of definition, an individual is considered to have a disability if he or she is limited in, or unable to perform, a certain activity or activities. The definition can be broad or narrow, depending on whether activities are specified narrowly or widely and on whether the individual must be unable to do the activity or must only be limited. The term “limited” may refer to the type or amount of activity. For instance, a person with arthritis may be unable to perform some types of household chores (such as sewing) but may be able to do other tasks (like laundry) without any problem. Similarly, a person with another condition may be able to do any chore for a short period of time but may need to rest before attempting to complete the task. Activities can also be specified widely or narrowly. For example, some survey questions leave the term “activities” to be defined by the respondent. Other instruments confine the definition of activities to a specific list, like the activities of daily living (ADL) or the independent activities of daily living (IADL). As an example, a broader definition of disability could characterize individuals with a disability as “limited in performing any of their usual activities;” a narrower definition could characterize individuals with a disability as being “unable to work at a full-time job.” Some disability advocates find a wide-ranging functional approach to disability definition appealing because it measures the impact on an individual’s condition without regard to the cause of that condition. Others have criticized many of these definitions, however, as being too general to make effective distinctions among individual cases. Although narrowing the scope of the activities considered would make the definition more specific, it would also increase the probability that individuals would be arbitrarily excluded. In addition, even when the activities are defined fairly narrowly—with ADLs or IADLs, for example—measuring or verifying disability can be difficult. Survey evidence demonstrates the effect of adopting a widely ranging functional definition as opposed to a narrower one. For example, when the 1990 census asked individuals if they were limited in their mobility (for example, going out of the house or to a store by themselves), an estimated 3.5 million individuals aged 16 to 64 were identified as disabled. However, in the 1991 SIPP, an estimated 27 million individuals aged 21 to 64 were identified as disabled when the definition included having a functional limitation in any activity; and an estimated 49 million individuals of all ages were considered disabled when the definition included having a functional limitation in any activity and when examples were provided. Several disability definitions take a narrow view of activity limitation, with employment as the only activity. For example, income maintenance and pension programs often define disability to include only those individuals who cannot work because of their impairment. These definitions allow programs to focus on individuals for whom employment is deemed unfeasible and thus may be in greater need. A “can’t work” definition, however, requires judgment not only of an individual’s physical conditions, but also of his or her capabilities in a wide variety of potential employment situations. This makes implementing the definition problematic, especially in recent years because improvements in information technology, an increased emphasis on accommodation in the workplace, and new models of working with individuals with disabilities (such as supported employment) have complicated assessments of the ability to work. Medical and legal determination of the ability to work is thus labor intensive. The emphasis on ability to work has also been criticized by analysts who believe that this definition creates a strong disincentive to employment. Because applicants must prove that they cannot work to receive benefits and may risk losing these benefits if they become employed, they may be reluctant to look for a job. In addition, having proved to the authorities that they are unable to work, disability beneficiaries may agree with this assessment and thus not try to enter the labor force. Many household surveys include questions that reflect this kind of broad “can’t work” definition, for example, “Do you have a health condition that limits your ability to work?” or “Are you unable to work because of a disability?” or “Do you have a condition that limits the type or amount of work you can do?” In 1990, the number of working-age individuals who reported they were unable to work or limited in work ranged from 12.9 million to 19.5 million; the number reported as unable to work ranged from 6.6 million to 14.2 million. Some definitions consider an individual disabled if he or she has one or more of a specified list of medical conditions. For example, vocational education programs define students as having a disability if they are “mentally retarded, hard of hearing, deaf, speech impaired, visually handicapped, seriously emotionally disturbed, orthopedically impaired, other health impaired, deaf-blind, multihandicapped, or have specific learning disabilities, who because of these impairments, need special education and related services, and cannot succeed in the regular vocational education program without special education assistance.” In addition, some functional definitions of disability specifically exclude certain conditions. For example, the definition of disability in the Americans With Disabilities Act (ADA) excludes psychoactive substance abuse, transsexualism, pedophilia, compulsive gambling, and kleptomania (among other disorders). These definitions are presumably relatively straightforward because they require only an assessment of a medical condition, not an evaluation of an individual’s ability to function with this impairment. However, a medical definition generally contains no information on the severity of the condition and ignores potentially debilitating conditions not included on the list. Thus, a medically based approach may sometimes be as arbitrary as a more subjective definition. In addition, medically based definitions would presumably require certification and may be expensive to verify. Relatively little up-to-date information on the prevalence of specific medical disorders exists in the United States. The data that are available, however, suggest that definitions of disability based on medical conditions may be quite distinct from definitions based on an individual’s functional ability, and may classify large numbers of individuals as having a disability. For example, the 1993 National Health Interview Survey (NHIS) reported that, of Americans aged 18 to 64, 13.2 million were hearing impaired; 5.8 million were visually impaired; and 0.9 million had palsy, cerebral palsy, or mental retardation. Fully 61 percent of the visually impaired and 65 percent of the hearing impaired reported no limitation in the kind or amount of work they could do—indicating that medical condition and self-perception of ability to work are distinct concepts. Results from the National Comorbidity Survey administered between 1990 and 1992 indicated that during the previous 12 months as many as 29 percent of individuals may have had at least 1 of 14 psychiatric disorders, including major depression, anxiety disorders, and substance abuse. Researchers have used two other types of disability definitions that are less practical for programmatic purposes. For example, individually defined disability is used in some survey data. This measure classifies an individual as disabled on the basis of self-assessment or on the opinions of others. No explicit definition of disability is used, so each individual answers the question using his or her own concept of what it means to be disabled. An individually defined concept of disability could capture some people who would not be included under more restrictive definitions, but this definition is likely to be inconsistent and thus unreliable to distinguish among individual cases. A second type of definition is an environmental/ societal-based definition of disability, which emphasizes the role of the surrounding environment in determining the extent of an individual’s limitations; that is, it assesses whether the person can function independently given the environment he or she must face. These definitions require consideration of both the individual’s physical or mental condition and the surrounding environment. For example, under such a definition, an individual in a wheelchair may be considered disabled if he or she lives in a city with no public transportation and no curb cuts but might not be considered disabled in a city that had these features. Assessing functional ability in the context of both the individual and the environment or society is not only subjective but extremely difficult—the environment is all encompassing and frequently changing. However, this type of definition does raise the public’s awareness of the role of the environment in determining individuals’ capabilities. Table V.1: Examples of Different Definitions of Disability, by Source and Type “. . . a limitation that affects an individual’s ability to perform certain functions.” “Had a disability or health problem that prevented him or her from participating fully in work, school, or other activities.” Louis Harris Survey and DeJong “Individuals with significant physical or mental impairments whose abilities to function independently in the families or communities or whose ability to obtain, maintain, or advance in employment is substantially limited. Eligibility shall not be based on the presence or absence of any one or more specific severe disabilities.” Centers for Independent Living Program (84.132) “. . . departure from normal role functioning attributable to a health-related condition.” Unable to perform at least three ADLs or IADLs without assistance. HUD Congregate Housing (14.170) World Health Organization (WHO) Functional “. . . a physical or mental impairment which substantially limits one or more of the major life activities of such individual; a record of having such an impairment; or being regarded as having such an impairment.” (excluding specific conditions, especially current substance abuse) “. . . are incapable of regularly pursuing any substantially gainful employment due to a disability that is likely to be of long or indefinite duration or is likely to result in death.” Also, “. . . unable to perform their usual occupation due to a disability that is likely to be of long or indefinite duration or is likely to result in death.” Canadian disability insurance/income maintenance program as reported in Maki “. . . individuals with mental or physical impairments that reduce their capacity to work by at least 50 percent; individuals who are at least 30 percent impaired and unemployed are also considered handicapped.” Either (a) receives benefits from a government disability program or (b) reports a limitation on his or her ability to work. Limited in the type or amount of work (or housekeeping if housekeeping is considered to be the “primary occupation”). The inability to engage in substantial gainful activity, by any medically determinable physical or mental impairment which can be expected to result in death or has lasted or is expected to last for a continuous period of not less than 12 months. Having one or more of the following physical conditions—“weakness/lack of strength; trouble with fingers; trouble walking, standing, or with stairs; in a wheelchair; trouble seeing/blind; trouble with leaving bed or leaving home; trouble lifting; deaf; trouble with stiffness or pain; trouble with seizures or spasms; mental illness; mental retardation.” (continued) “Mentally retarded, hard of hearing, deaf, speech impaired, visually handicapped, seriously emotionally disturbed, orthopedically impaired, other health impaired, deaf-blind, multihandicapped, or have specific learning disabilities, who because of these impairments, need special education and related services and cannot succeed in the regular vocational education program without special education assistance.” Having one or more of the following physical conditions—“major amputations, cerebral palsy, major head injury, Friedreich’s ataxia, muscular dystrophy, spina bifida, amyotrophic lateral sclerosis, cystic fibrosis, spinal cord injury, multiple sclerosis, post-polio, stroke.” Individuals with “mental retardation; hearing impairments; speech, or language impairments; visual impairments; serious emotional disturbance; orthopedic impairments; autism; traumatic brain injury; other health impairments; specific learning disabilities; . . . that need special education and related services.” “A person was defined as having a disability if he or she considered himself or herself to have a disability or said that other people would consider him or her to be a person with a disability.” How would you describe your health? (excellent, good, fair, poor) Disability is “. . . the expression of a physical or mental limitation in a social context—the gap between a person’s capabilities and the demands of the environment. People with such functional limitations are not inherently disabled, that is, incapable of carrying out their personal, familial, and social responsibilities. It is this interaction of their physical or mental limitations with social and environmental factors that determines whether they have a disability.” “The disadvantage or restriction of activity caused by a contemporary social organization which takes no or little account of people who have physical impairments and thus excludes them from the mainstream of social activities.” Population Survey (CPS) work or receiving disability benefits from government income maintenance program 1993 CPS definition—either unable to work or receiving disability benefits from government income maintenance program disability or a mobility limitation or a self-care limitation 1994 CPS definition—either unable to work or receiving disability benefits from government income maintenance program 1993 Work disability—either unable to work or limited in work 1990-91 Work disability—either unable to work or limited in work 1993 Functional—limited in either work or in some other activity (continued) Ages of population included in estimate 1991 Functional—limited in any activity 21-64 1993 Functional—limited in any activity 21-64 1992 Functional—limited in any activity All ages 1993 Functional—limited in any activity All ages 1990-91 Composite—limited in any activity or in self-care or has difficulty with one of listed tasks No sources predating 1990 were included. The Survey of Disability and Work (1972 and 1978), the National Long-Term Care Survey (1982-84), the Epidemiological Catchment Area survey (1981), and the SSA New Beneficiary Survey (1982) also provide some disability information. Some information on specific disabling conditions is available from the National Comorbidity Survey administered between 1990 and 1992, the 1990-1991 SIPP, and the 1993 NHIS. The Epidemiological Catchment Area survey (1981) also provides data on specific conditions. The following individuals also contributed to this report: Richard Kelley, Steven Machlin, and Mary Reich. Anderson, K., J. Mitchell, and J.S. Butler. “Effect of Deviance During Adolescence on Choice of Jobs.” Southern Economics Journal, Vol. 60, No. 2 (1993), pp. 341-56. Barker, P., et al. “Serious Mental Illness and Disability in the Adult Household Population: United States, 1989.” Advance Data, No. 218, Centers for Disease Control and Prevention: National Center for Health Statistics. Washington, D.C.: 1992, p. 11. Baldwin, M., and W. Johnson. “Labor Market Discrimination Against Men With Disabilities.” Journal of Human Resources, Vol. 29, No. 1 (1994), pp. 1-19. Berkowitz, Edward D. Disabled Policy: America’s Programs for the Handicapped (A Twentieth Century Fund Report) Cambridge, U.K.: Cambridge University Press, 1987. Bound, J. “Health and Earnings of Rejected Disability Insurance Applicants: Reply.” American Economic Review, Vol. 81, No. 5 (1991), pp. 1427-34. _____. “The Health and Earnings of Rejected Disability Insurance Applicants.” American Economic Review, Vol. 79, No. 3 (1989), pp. 482-503. _____ and T. Waidman. “Disability Transfers, Self-Reported Health, and Labor Force Attachment of Older Men: Evidence from the Historical Record.” The Quarterly Journal of Economics (1992), pp. 1393-1419. Burkhauser, R.V., and P. Hirvonen. “United States Disability Policy in a Time of Economic Crisis: A Comparison with Sweden and the Federal Republic of Germany.” Millibank Quarterly, Vol. 67, Suppl. 2, Pt. 1 (1989), pp. 166-95. Chirikos, T. “Accounting for the Historical Rise in Work-Disability Prevalence.” Millibank Quarterly, Vol. 64, No. 2 (1986), pp. 271-301. DeJong, G., A. Batavia, and R. Griss. “America’s Neglected Health Minority: Working-age Persons with Disabilities.” Millibank Quarterly, Vol. 67, Suppl. 2, Pt. 2 (1989), pp. 311-51. Haveman, R., and B. Wolfe. “The Economic Well-Being of the Disabled 1962-84.” Journal of Human Resources, Vol. 25, No. 1 (1990), pp. 32-54. Iams, H.M. “Characteristics of the Longest Job for New Disabled Workers: Findings from the New Beneficiary Survey.” Social Security Bulletin, Vol. 49, No. 12 (1986), pp. 13-18. Johnson, W., and J. Lambrinos. “Wage Discrimination Against Handicapped Men and Women.” Journal of Human Resources, Vol. 20, No. 2 (1985), pp. 264-77. Maki, D.R. “The Economic Implications of Disability Insurance in Canada.” Journal of Labor Economics, Vol. 11, No. 1 (1993), pp. S148-S169. Manton, K. “Epidemiological, Demographic, and Social Correlates of Disability Among the Elderly.” Millibank Quarterly, Vol. 67, Suppl. 2, Pt. 1 (1989), pp. 13-58. Mitchell, J.M., and R. Burkhauser. “Disentangling the Effect of Arthritis on Earnings: A Simultaneous Estimate of Wage Rates and Hours Worked.” Applied Economics, Vol. 22 (1990), pp. 1291-1309. Oi, Walter Y. “Disability and a Workfare-Welfare Dilemma,” in Disability and Work: Incentives, Rights and Opportunities, ed. Carolyn Weaver. Washington, D.C.: American Enterprise Institute, 1991. Oliver, Michael. The Politics of Disablement: A Sociological Approach, New York: St. Martin’s Press, 1990. Parsons, Donald. “The Decline in Male Labor Force Participation,” Journal of Political Economy, Vol. 88, No. 1 (1988), pp. 117-34. Ravaud, J.F., B. Madiot, and I. Ville. “Discriminiation Towards Disabled People Seeking Employment.” Social Science Medicine, Vol. 35, No. 8 (1992), pp. 951-58. Reisine, S., J. Fifield. “Expanding the Definition of Disability: Implications for Planning, Policy, and Research.” Millibank Quarterly, Vol. 70, No. 3 (1992), pp. 491-508. Rones, P. “Can the Current Population Survey Be Used to Identify the Disabled.” Monthly Labor Review, June (1981), pp. 37-39. Stern, S. “Measuring the Effect of Disability.” Journal of Human Resources, Vol. 24, No. 3 (1989), pp. 361-95. Wolfe, B.L. “How the Disabled Fare in the Labor Market.” Monthly Labor Review, (1980), pp. 48-52. Yelin, E. “Displaced Concern: The Social Context of the Work Disability Problem.” The Millibank Quarterly, Vol. 67, No. 2 (1989), pp. 114-65. _____, and P. Katz. “Labor Force Participation Among Persons With Musculoskeletal Conditions, 1970-1987.” Arthritis and Rheumatism, Vol. 34, No. 11 (1991), pp. 1361-70. Zeitzer, I.R. “Recent European Trends in Disability and Related Programs.” Social Security Bulletin, Vol. 57, No. 2 (1994), pp. 21-26. _____. “The Role of Assistive Technology in Promoting Return to Work for People with Disabilities: The U.S. and the Swedish Systems.” Social Security Bulletin, Vol. 54, No. 7 (1991), pp. 24-29. SSA Disability: Program Redesign Necessary to Encourage Return to Work (GAO/HEHS-96-62, Apr. 24, 1996). PASS Program: SSA Work Incentive for Disabled Beneficiaries Poorly Managed (GAO/HEHS-96-51, Feb. 28, 1996). Americans With Disabilities Act: Effect of the Law on Access to Goods and Services (GAO/PEMD-94-14, June 21, 1994). Social Security: Disability Rolls Keep Growing, While Explanations Remain Elusive (GAO/HEHS-94-34, Feb. 8, 1994). Vocational Rehabilitation: Evidence for Federal Program’s Effectiveness Is Mixed (GAO/PEMD-93-19, Aug. 27, 1993). Social Security: Disability: SSA Needs to Improve Continuing Disability Review Program (GAO/HRD-93-109, July 8, 1993). Americans With Disabilities Act: Initial Accessibility Good But Important Barriers Remain (GAO/PEMD-93-16, May 19, 1993). Vocational Rehabilitation: VA Needs to Emphasize Serving Veterans With Severe Employment Handicaps (GAO/HRD-92-133, Sept. 28, 1992). Integrating Human Services: Linking At-Risk Families With Services More Successful Than System Reform Efforts (GAO/HRD-92-108, Sept. 24, 1992). Vocational Rehabilitation: Better VA Management Needed to Help Disabled Veterans Find Jobs (GAO/HRD-92-100, Sept. 4, 1992). Job Training Partnership Act: Actions Needed to Improve Participant Support Services (GAO/HEHS-92-124, June 12, 1992). Adolescent Drug Use Prevention: Common Features of Promising Community Programs (GAO/PEMD-92-2, Jan. 16, 1992). Vocational Rehabilitation: Clearer Guidance Could Help Focus Services on Those With Severe Disabilities (GAO/HRD-92-12, Nov. 26, 1991). Social Security: District Managers’ Views on Outreach for Supplemental Security Income Programs (GAO/HRD-91-19FS, Oct. 30, 1990). The first copy of each GAO report and testimony is free. Additional copies are $2 each. Orders should be sent to the following address, accompanied by a check or money order made out to the Superintendent of Documents, when necessary. VISA and MasterCard credit cards are accepted, also. Orders for 100 or more copies to be mailed to a single address are discounted 25 percent. U.S. General Accounting Office P.O. Box 6015 Gaithersburg, MD 20884-6015 Room 1100 700 4th St. NW (corner of 4th and G Sts. NW) U.S. General Accounting Office Washington, DC Orders may also be placed by calling (202) 512-6000 or by using fax number (301) 258-4066, or TDD (301) 413-0006. 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Summary: Pursuant to a congressional request, GAO reviewed federal programs targeted to disabled persons, focusing on: (1) how many of the programs provide employment-related services; (2) coordination of information, eligibility criteria, and services among various programs; and (3) the programs' effectiveness in promoting employment among disabled persons. GAO found that: (1) 130 federal programs provide services to disabled persons; (2) in fiscal year 1994, federal agencies spent over $60 billion on 69 programs exclusively targeted to disabled persons and between $81 billion and $184 billion on 61 other programs targeted to a wider clientele that gave special consideration to disabled persons; (3) most program expenditures supported income maintenance and health care programs; (4) employment-oriented programs constituted only 26 of the 130 programs and received only 2.5 to 4 percent of total federal funding for such programs in 1994; (5) 57 other programs provided indirect employment assistance; (6) most programs provide services through states and local governments, and nonprofit and private organizations; (7) various program funding mechanisms affect the distribution of program funds among states; (8) the federal government funds a wide range of services to address major employment barriers; (9) disabled persons who need services from more than one program find the programs' differing eligibility criteria and numerous service providers burdensome; (10) the lack of program coordination and information sharing leads to service duplication and gaps, and past efforts to improve service coordination have only been marginally successful; (11) some state and local agencies have improved service delivery to disabled persons and reduced program costs; and (12) few programs have been evaluated for their effectiveness, since many agencies do not require or collect data on program outcomes.