RESTORING DISABLED PEOPLE TO JOBS AND USEFUL LIVING

PART I. THE NATION'S PROGRAM OF VOCATIONAL REHABILITATION

The public program of vocational rehabilitation for disabled men and women now has reached a record level of achievement in its 45-year history, with the rehabilitation of almost 135,000 disabled people to productive living and employment, in the 12 months ended June 1965. This program has signified the Nation's recognition of our social obligation to restore the disabled citizen to the mainstream of life, along with our recognition of the compelling economic necessities involved in rehabilitation. Operating on a comparatively small scale, but with highly imaginative and versatile approaches to the problems of restoring the disabled to employment, it has proved the worth of the investment in rehabilitation time and again.

From a small start in 1920, the growth and broadening of the program have been remarkable. Drawing upon the experience gained from the results of two major wars and from a range of physical and social science resources, the rehabilitation program has opened wide our perceptions of what we can do to restore the mentally and physically disabled persons among us to full participation in economic, family, and community life. Particularly remarkable strides have come in what we see as possible both in terms of the disabled individual's potential and his adaptability to the labor market.

The basic concepts of the nationwide rehabilitation program continue mainly unchanged, with considerable enlargement of scope and effectiveness in legislative authority in 1943 and in 1954. The program has at its core an enduring partnership between the Federal Government and the governments of the States, the District of Columbia, Puerto Rico, Guam, and the Virgin Islands, in which vocational rehabilitation agencies provide rehabilitation services to prepare physically and mentally disabled people for employment. The Federal Government, through the Vocational Rehabilitation Administration of the Department of Health, Education, and Welfare, provides leadership and grants-in-aid to the States.

The Vocational Rehabilitation Administration also administers a program of project grants in rehabilitation research and demonstration to develop new knowledge and methods; a national grant program to train professional rehabilitation personnel; an international research program; and certain other specialized activities.

From the start, and particularly in the last 11 years, the public vocational rehabilitation agencies, State and Federal, have been closely involved with the many national and local organizations concerned with rehabilitation of the disabled. A number of these organizations appeared before the House Committee on Education and Labor in 1965 to express their support of pending legislation and to make some proposals of their own.

A. A DECADE OF PROGRESS: 1955-64

The years following the 1954 legislation were especially fruitful years in many areas of rehabilitation where new authority was provided:

1. With the impetus of new incentives to the States to broaden and increase support for their rehabilitation activities, the number of disabled persons rehabilitated annually more than doubled, from 55,000 in 1954 to 135,000 in 1965. Čombined Federal and State spending went from $35.4 million in 1954 to $157.5 million in 1965. 2. Under new legislative authority to support research and demonstration projects aimed at solving problems in the rehabilitation of disabled persons, the number of such projects grew from 18 in 1955 to 943 in 1965, with Federal grant funds for this purpose increasing from almost $300,000 in 1955 to $17.1 million in 1965.

3. With new provisions for support of training more professional workers skilled in delivering vocational rehabilitation services, training activities grew from 77 teaching programs and 201 student traineeships supported in 1955 to 526 teaching programs and 3,780 traineeships and research fellowships in 1965. The appropriation for training rose from $900,000 in 1954 to $19.8 million in 1965.

B. WHAT IS "VOCATIONAL REHABILITATION FOR THE DISABLED"? Vocational rehabilitation is a combination of services provided to s physically or mentally disabled person, as needed, to fit him for employment and productive useful living. These services are provided to disabled persons at or near working age, whose disability is a vocational handicap in that it interferes with getting or keeping employ(See fig. 1.)

ment.

The range of services includes:

Full evaluation, including medical diagnosis, to learn the nature and degree of disability and to help evaluate the individual's work capacities.

Counseling and guidance in achieving good vocational adjust

ment.

Medical, surgical, psychiatric, and hospital care and related therapy, to reduce or remove the disability.

Artificial limbs and other prosthetic and orthotic devices needed to increase work ability.

Training, including training for a vocation, prevocational and personal adjustment training, and remedial education.

Service in comprehensive or specialized rehabilitation facilities. including sheltered workshops and adjustment centers. Maintenance and transportation during rehabilitation.

Tools, equipment, and licenses for work on a job or in establishing a small business.

Placement in a job suited to the individual's highest physical and mental capacities and postplacement followup to see to it that the placement is satisfactory to the employee and the employer.

FIGURE 1.-WHAT STATE REHABILITATION AGENCIES DO FOR CLIENTS ($139 MILLION SPENT IN 1964)

The essence of the program is to marshal all resources, in a coordinated way, to bring the disabled person to his best functioning level. In the Federal-State program the rehabilitation counselor is the key staff member, making the determination as to whether the individual is eligible, arranging with the individual the development of a plan for his rehabilitation, managing the arrangements for the necessary services, counseling and guiding the individual, and staying with him through successful placement on the job.

Services are obtained, often by purchase, from virtually the full span of community resources, depending on what the individual needs. Private physicians, public and private hospitals, specialized clinics, rehabilitation centers, workshops, public and private educational institutions, and employers, are but some of the resources which are regularly drawn into effective rehabilitation.

C. WHAT ARE THE VALUES OF VOCATIONAL REHABILITATION? Expansion of the Nation's vocational rehabilitation program has brought important values and gains to the disabled who are rehabilitated, to their families, and to their communities. Over and above the enhancement of the personal dignity of the disabled individual who is restored to employment, and the value of preserving family life which is often threatened or destroyed by disability, are the calculable values which are mainly economic.

The Nation gains in the man-hours added to its productive effort. The total group of almost 120,000 persons rehabilitated in 1964 will contribute an estimated 167 million man-hours per year to the Nation's productive effort. The manpower pool in the professional occupations, such as engineering, teaching, medicine, and related health activities, was increased by about 5,000 as a result of the disabled persons rehabilitated in 1964. Nearly 14,000 went into the skilled trades, and 8,000 into agriculture.

The 120,000 persons will have paid about $19 million in Federal taxes in the first year after rehabilitation, not including State and local taxes. Estimates are that there will be over $24 million savings in the cost of institutional care and public aid, to which must be added incalculable savings in aid from voluntary agencies and families.

An added dimension becomes graphic with the realization that in the successful rehabilitation of these 120,000 persons in 1964, altogether some 285,000 people were involved, including the disabled persons and their dependents. Many of the disabled individuals were freed from constant attendance and dependence. For many who do not make it to full vocational rehabilitation but who do make it to full mobility, the gain is their ability to participate in family and community life.

In terms of the Nation's drive to bring poverty under control and to prevent poverty where possible, this program of vocational rehabilitation makes a significant contribution. Almost 75 percent of the 120,000 persons rehabilitated in 1964 were not working when they started their rehabilitation. Others were in marginal or otherwise unsatisfactory employment.

About 16,000 of the persons rehabilitated in 1964 were receiving public assistance at the start of or during their rehabilitation, and about 5,200 were living in tax-supported institutions. Public assistance payments to the 16,000 persons were about $18 million annually.

The conversion of most of these persons from tax consumers to economic independence through the public vocational rehabilitation program cost about $16 million, with savings of millions of dollars in Federal and State public assistance funds.

Also not to be overlooked is the reduction or the prevention of disability which can result from the prompt rendering of rehabilitation services. This preventive contribution has been dramatically demonstrated in the case of stroke victims and amputees for example. There is moreover a preventive force at work when a rehabilitated disabled person is able to maintain his gains from rehabilitation and to ward off deterioration of his physical or mental condition.