This presentation moves through the history of the Vocational Rehabilitation program in the United States.

1. Vocational Rehabilitation Services:
Service Development
Presented By:
Michael Walsh, Ph.D, LPC, CRC, CPRP
and
Kimberly Tissot, Executive Director: Able South
Carolina

2.  Agenda
 Welcome and Introductions
 Your Thoughts and Questions
 History: Vocational Rehabilitation Services in
the U.S.
 Disability Rights Movement
 Types of VR Services
 Customization of VR Services by States
 Customization of VR Services by Consumer

3. "Tell me and I'll forget;
Show me and I may
remember; Involve me and I'll
understand."
-Chinese Proverb

4.  What do you hope to get from today’s
meeting?
 How may we be most helpful to you?
 (Open Discussion)

5.  VR service development typically follows
economic need--
◦ History as a blueprint
 Early 1900’s- World War One: Dawn of Industrial Age:
People with disabilities begin to be seen as needed by
industry, especially as casualties mount. Medical advances
allow for increased survival rates, leading to more people
with disabilities returning from war.
 Soldiers with Disabilities Rehabilitation Act of 1918-First
public funding for VR training for new jobs post-disability.
Expanded in 1920 to include all people with disabilities.

6.  VR service development typically follows
economic need--
◦ History as a blueprint
 Soldiers with Disabilities Act and 1920 expansion
matched programs already in place in many states.
 Only for people with physical disabilities.
 State by state model begins to be seen as a way to
tailor services to local need/custom.

7.  VR service development typically follows need
◦ History as a blueprint—State by State model retained for
feasibility reasons. Optional Blind/Low Vision Services.
 1940’s-World War II: As more people with disabilities return
from war, and as industrial needs multiply. Interest in adaptive
equipment expands as well as interest in expanding the
workforce to meet need.
 Expansion of Rehab Act in 1943 led to service eligibility for
people with mental illness and developmental disabilities, as
well as blindness/low vision (Optional by state).
 Expansion of financial support for rehabilitative medical services
(surgeries, corrective procedures, etc.) in support of
employment.

8.  VR service development typically follows need
◦ History as a blueprint
 1950’s and 1960’s-Korean War/Vietnam: Interest in
economic expansion and industrial needs peak. VR
programs are further expanded as service needs
become more complex.
 1954 Amendments to the Rehab Act
 Funded scientific research
 Led to development of National Institute on Disability and
Rehabilitation Research (NIDRR)

9.  VR service development typically follows need
◦ History as a blueprint
1950’s
 Initial results promising:
 For every $1 spent on VR services at that time, $7 was
returned in paid taxes by newly employed clients.

10.  VR service development typically follows need
◦ History as a blueprint
 1960’s-
 Rehab Act Amendments of 1965: Definition of
disability dramatically expanded.
 Services had to be “streamlined” and became less
flexible and choices more limited as expansion grew.
 People with most severe disabilities were often not
getting what they needed.

11.  VR service development typically follows need
◦ History as a blueprint
 Early 1970’s: Interest in rehabilitation expands as does
interest in civil rights of individuals.
 Completely new Rehabilitation Act of 1973:
 Dictates VR serve those with most significant disabilities.
 Counselors and consumers directed to work together to tailor
VR services to each individual. The Individualized Written
Rehabilitation Program (IWRP) was born.

12.  VR service development typically follows need
◦ History as a blueprint
 Mid to Late 1970’s: Disability Rights Movement:
Interest in rehabilitation expands as does interest in
civil rights of individuals.
 Disability advocates begin to call for increased
community inclusion for people with disabilities as well
as enhanced consumer choice.
 Independent living becomes a priority.

13.  Kimberly Tissot,
 Executive Director of able-South Carolina

14.  VR service development typically follows need
◦ History as a blueprint
 Some of these ideas come to fruition in the
Rehabilitation Act of 1986
 Shifted the focus from sheltered workshops to competitive
employment in typical jobs in the community.

15.  VR service development typically follows need
◦ History as a blueprint
◦ Rehabilitation Act of 1992
 Created a new section of the Act that detailed many of
the principles and definitions involved in rehabilitation.
 Created locally-based state Rehabilitation Councils
designed to enhance local and consumer involvement
in the design and implementation of VR services.
 Increased the role of the consumer and mandated
training and outcome measures for VR services.

16.  VR service development typically follows need
◦ History as a blueprint
◦ Rehabilitation Act of 1998
 Increased consumer choice.
 Streamlined processes.
 Mandated partnerships between VR and other state
and federal agencies providing VR services.

17.  VR is fundamentally based on two guiding
principles:
◦ Employment and productivity lead to independence.
◦ Independence is a fundamental right of every
American citizen.

18.  VR service development typically follows need
◦ History as a blueprint
◦ Rehabilitation Act Amendments of 1998
◦ Rehab Act becomes Title IV of the Workforce
Investment Act
◦ Provides specific services for people with
disabilities whose needs are not met by other work-related
programs.

19.  Train and Place
◦ Equipping the consumer with new of different
knowledge and skills prior to job placement.
 Involves “work hardening” prior to placement.
 Instruction
 Development of skills prior to going on a job site
 Assumes the ability to generalize information from one
setting to another.

20.  Place and Train
◦ Placing the client on the job site first and allowing
the client to learn in place.
 Often used in conjunction with Supported Employment
(Job Coach accompanies consumer to job site and
facilitates learning).
 Utilizes situational assessment for real-time
information on work performance.
 Often used for people who have a difficult time
generalizing information from one setting to another

21.  Different service types utilize different
Models.
◦ Traditional VR services are based on a Train and
Place Model.
◦ Supported Employment and many services specific
to people with intellectual disabilities or mental
illness are based on a Place and Train model.

22.  Service Choice is driven by the functional impact of
disabilities as well as the strengths and capabilities of the
individual:
◦ Physical disabilities: Train and Place (Traditional Services)
◦ Psychiatric Disabilities: Place and Train/Supported Employment
◦ Learning Disabilities: Train and Place with Situational Assessment
◦ Developmental Disabilities: Place and Train/Supported Employment
◦ Vision-Related Disabilities: Train and Place and Initial Supports
◦ Hearing-related disabilities: Train and Place and Initial Supports
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23.  Supported Employment and Vocational
Outcomes
 Individual Placement and Support augmented
with social skills training superior to
traditional VR services among people with SMI
(Tsang, et al, 2009).
 Supported Employment services are more
cost-effective than work center-based
services (Cimera, 2010)
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24.  Supported Employment and Vocational
Outcomes
 Among individuals with brain injuries, the type of
initial placement was the best predictor of
vocational outcomes and early intervention was
shown to be a best practice (Malec, et. al, 2000).
 RCT’s (Tsang, 2009) have demonstrated the
effectiveness of Integrated Supported Employment
Services (IPS plus social skills training) as compared
to IPS alone among people with mental illness.
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25.  Maximizing Natural and Systemic Supports in
SE Services
◦ Family Supports
◦ Infrastructure supports (transportation, social
decision making)
◦ Fostering social supports
◦ Fostering social decision making skills
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26.  Models and types of services are highly
individualized.
 Designed to enhance independence and
function.
 Development of effective services continues
to evolve.

27.  We welcome your questions and comments.
 For more information, please contact:
 Michael Walsh, Ph.D, LPC, CRC, CPRP
 E-mail: michael.walsh@uscmed.sc.edu
 Phone: 843-304-1662
 Kimberly Tissot, Executive Director: able South
Carolina
 E-mail: ktissot@able-sc.org
 Phone: 803-779-5121, Ext. 124