Attachment 4.11 (a)

Maine Division of Vocational Rehabilitation
Comprehensive Statewide Needs Assessment

May 2006

4.11 (a)
I. INTRODUCTION

Maine Division of Vocational Rehabilitation (DVR) assists eligible individuals with disabilities to prepare for, achieve and retain employment in integrated community settings.  DVR administers the General Vocational Rehabilitation program in Maine for the Rehabilitation Services Administration.  A separate program is available to individuals who are blind or have visual impairments through the Maine Division for the Blind and Visually Impaired.  This comprehensive needs assessment focuses on the General Vocational Rehabilitation program and on the needs of individuals eligible for those services.

The assessment is designed to answer important questions about the population eligible for DVR services that live in Maine and their vocational rehabilitation needs. It will also help the agency to strategically plan and develop goals for the Division in 2007 and beyond.  Specifically, the report responds to federal regulations requiring Maine’s Division of Vocational Rehabilitation (DVR) to jointly conduct a “comprehensive statewide assessment” with the State Rehabilitation Council (SRC) every three years that describes the rehabilitation needs of individuals with disabilities residing within the State, particularly the vocational rehabilitation services needs of:

1.	individuals with the most significant disabilities
2.	individuals with disabilities who are minorities and individuals with disabilities who have been unserved or underserved by the vocational rehabilitation program
3.	individuals with disabilities served through other components of the statewide workforce investment system as identified by those individuals and personnel assisting those individuals through the components of the system.

To address these issues, we rely on a variety of publicly available sources including survey information from the United State Census Bureau, the Social Security Administration, and recent statewide assessments carried out in Maine examining services delivered to people with disabilities.   

II.  BACKGROUND

 A.  Maine’s Economy and Workforce   

Maine is a large geographical state, which spans 33,215 square miles with a dispersed population of 1.3 million people.   Historically, the economic health of the state was based on manufacturing and natural resources, but a significant shift to a service-based economy has occurred that has placed different demands for the skills and abilities of its workers.  Employment in health care, education, tourism, business and professional services, retail and government has resulted in a workforce that is better educated than its predecessors, yet globalization, technology and business restructuring are current trends in Maine. 

The Maine Department of Labor (MDOL) estimates that nearly 700,000 people participate in the Maine workforce today, and that 68,000 new jobs will be created between 2002 and 2012.  The annual seasonally adjusted unemployment rate has averaged 4.8% in the civilian labor force over the last three years.  Job opportunities will likely continue to occur unevenly across the state with most growth in the southern and coastal regions, and interior and northern sections of the state continuing to lose traditional industries.  Demographically, Maine is notable for its aging workforce, slow population growth and lack of diversity.  These all create formidable challenges for the future and Maine will only prosper if it can supply a workforce that has the needed skills and abilities for the 21st century.  Individuals with disabilities are one population that has been identified as an emerging workforce by MDOL that could be developed to support a growing Maine economy. 

Like other Maine businesses, DVR experiences the challenge of finding a well-educated and skilled workforce as it strives to meet the federal mandate of the Rehabilitation Act and required Comprehensive System of Personnel Development.  DVR has made significant gains in assuring that fully qualified vocational rehabilitation counselors with master’s level rehabilitation training are providing services to DVR eligible individuals, but the Division’s aging workforce, turnover rate (approximately 15% annually) and competition with the private sector pose daily challenges.  These factors have significant implications for the method and delivery of quality vocational rehabilitation services.

B.  Federal and State Landscape

Over the last forty years there has been an evolution in the vocational rehabilitation program and community inclusion of people with disabilities in the United States.  This is evident in the social activism and civil rights movement in the 1960’s, rise in independent living services and demand for access and empowerment by people with severe disabilities.  Supporting legislation, such as the Rehabilitation Act of 1973, as amended, the Americans with Disabilities Act of 1990, the Workforce Investment Act of 1998, and the Ticket to Work and Work Incentives Improvement Act of 1999, has continued to shape the opportunities available to individuals with disabilities in their communities.  Specifically, the themes of consumer choice, transition of youth to adulthood services, and expanded responsibility of State Rehabilitation Councils have gained prominence, as well as an emphasis on connecting employment, education, and training services through a mandated “One-Stop” system as part of the Workforce Investment System.  Unlike many states, Maine’s DVR is co-located with other workforce system partners in “CareerCenters” across the state under the umbrella of the Maine Department of Labor.  At issue for all states is how well these emerging One-Stops are able to fulfill their disability-oriented obligations.   

Funding for DVR is fixed by formula and established by federal appropriation based upon a four-to-one federal and state match.  The Division has historically been successful in sustaining its maintenance of effort (MOE) in state funding to acquire the maximum federal funds available.  The federal portion of funding for the Title I Vocational Rehabilitation (VR) program has maintained modest increases over the last several years with Maine averaging 1.5% increases annually, but in 2006 this ceased to be the case.  Although nationally the Title I VR Program received a 3.2% cost of living increase in federal funding, the formula used to distribute funding to the states, which is based upon population growth and state average per capita earnings, resulted in a 0.6% decrease in funding, a loss of $81,412 to Maine DVR.  

C. Availability of Employment-Related Services to People with Disabilities in Maine

Individuals with disabilities often need a broad array of services and supports to reach and maintain their vocational goals, such as health care, housing, and transportation. The Division of Vocational Rehabilitation is an important part of this service system, but it is only one component of a larger service system in Maine.  There have been several recent federally funded projects that collected statewide information on the availability of employment-related services to people with disabilities: the Maine Ability Partnership, AbleMe and the Maine CHOICES CEO (Comprehensive Employment Opportunity) project.

The Maine Ability Partnership (MAP) was established through a planning grant awarded by the U.S Department of Labor in 2003, and focused on an assessment of Maine’s One-Stop CareerCenters.  The MAP assessment found that the CareerCenter system could not meet the demand for vocational services among Maine residents with disabilities, citing the 1400 individuals on the DVR wait list at the time of the assessment.  MAP also identified several specific areas of concern regarding awareness and knowledge of disability issues among CareerCenter staff, a need for training and professional development to address misinformation and stereotyping, and obsolete and inaccessible technology at many of the CareerCenters.  Further, despite stated goals of universal access, there was a general perception among both CareerCenter staff and individuals with disabilities themselves that CareerCenters could not (or should not) serve all people with disabilities; Vocational Rehabilitation was viewed by some as the best and only viable source of vocational services for people with disabilities.  

The Maine Department of Labor received a follow-up grant (AbleME) to implement a variety of activities designed to address the findings of the MAP.  Two project-funded Program Navigators are currently engaged in enhancing professional development activities for CareerCenter staff, upgrading assistive technology, and improving physical accommodation at several sites.  The grant also supports two Benefits Specialists to hold office hours at CareerCenters, providing benefits counseling to people with disabilities who are considering returning to or entering the workforce.

The Maine CHOICES CEO project is a four year grant to the Department of Health and Human Services from the federal Centers for Medicare and Medicaid Services, with a goal of developing and implementing a comprehensive statewide plan to support more people with disabilities who work, or would like to work.  The project began in 2005 with a full-year strategic planning process that gathered a broad range of information about Maine’s workforce development and service systems, including: Vocational Rehabilitation; Workforce Investment Boards; benefits planning; K-12 education/school-to-work transition planning; post-secondary education; developmental disabilities service system; mental health service system; Social Security Administration (SSA); MaineCare (Medicaid); and transportation.  Using the information collected, the project’s leadership groups – the Commission on Disability and Employment and the CHOICES CEO Strategic Plan Leadership Group – deliberated and identified six priority areas of focus for the project to focus on in 2006 and beyond:

1.	Create an employer outreach and education plan. 
2.	Ensure that Maine state government is a model employer for people with disabilities.
3.	Better support young people with disabilities who are transitioning from school to work.
4.	Improve and expand vocational rehabilitation services.
5.	Expand benefits counseling to people with disabilities who work, or who want to work.
6.	Enhance data collection about workers with disabilities and ensure that data can be shared by relevant agencies providing services.

The Bureau of Rehabilitation Services and the Division of Vocational Rehabilitation were active project partners in the development of principal product from the CHOICES CEO Project: Working Together: Maine’s Strategic Plan to Maximize the Employment of People with Disabilities.  All six priority areas of the plan directly impact individuals served by DVR, and DVR will continue to participate in the implementation of the plan over the next three years.

III.  VOCATIONAL REHABILITATION PROCESS

The journey of an applicant through the publicly funded vocational rehabilitation services from application through eligibility, comprehensive assessment of rehabilitation needs, individual employment plan development and provision of appropriate services to employment is mandated by federal statute.  Any individual with a disability and an interest in employment may apply.  Each applicant can expect an eligibility decision within 60 days of application.   An individual is eligible for DVR services if that person:
 
•	has a physical or mental impairment which, for the individual, constitutes or results in a substantial impediment to employment (Note: Substantial impediment to employment means that a physical or mental impairment hinders an individual from preparing for, engaging in, or retaining employment consistent with the individual’s abilities and capabilities); and
•	requires vocational rehabilitation services to prepare for, secure, retain, or regain employment consistent with the applicant’s unique strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice. Required VR services must be necessary to overcome disability related barriers. Lack of resources by itself does not constitute a disability related barrier.

In addition, there is a presumption of benefit.  It shall be presumed the individual can benefit in terms of an employment outcome from vocational rehabilitation, unless the DVR counselor can demonstrate by clear and convincing evidence that such individual is incapable of benefiting from vocational rehabilitation services due to the severity of the disability of the individual.   Individuals who receive SSI or SSDI are presumed to be eligible for DVR services.

DVR uses a set of “status” codes to track individuals as they move through the VR process. Figure 1 outlines the general way in which individuals move through the VR program, including the status codes that are assigned to each stage. 

Each individual who applies for services has a determination of eligibility and works with a qualified VR counselor and others to determine goals, services, job search, and job placement among other things.  Every applicant coming to DVR has different abilities, goals, expectations and barriers for employment; therefore, each plan is individualized for each eligible consumer.  The successful conclusion of the VR process is an individual working in a job consistent with their capabilities for 90 days with the supposition of continued employment.  No consumer’s journey is the same and the process is flexible enough to attend to new barriers as they arise.

Figure 1: Vocational Rehabilitation Process

Application and Eligibility Determination (Status 02)
•	Applicant fills out and signs document requesting DVR services
•	Within 60 days of receiving signed application, VR Counselor determines if applicant:
a.	Has a physical or mental impairment which results in a substantial impediment to employment, and 
b.	Requires Vocational Rehabilitation services for employment.
c.	Presumed able to benefit from VR services.

Individualized Plan for Employment (IPE) Developed (Status 12)
Written plan that includes vocational goals, services and supports is completed and signed by DVR counselor and individual.

Individuals are taken off the Wait List by Category and Application date (Category #1 are always served first)

Successful Case Closure (Status 26)
Once individual has worked successfully in an integrated setting for at least 90 days, DVR case can be closed.

IPE Implemented (Status 14-24)
DVR provides consumer with training, education, transportation, supported employment and other services to meet vocational goals.

Applicant determined eligible, but insufficient funds to serve all; Order of Selection Category assigned.

Wait List (Status 04)
•	“While You Are Waiting” plan established
•	Encouraged to visit the CareerCenter 

Comprehensive Assessment of Rehabilitation Needs (Status 10)
DVR counselor works with individual to identify strengths and career needs and vocational goal.

Other Closures
Cases can be closed for a variety of reasons, such as if the individual…
•	Is found not eligible
•	Decides to leave the program
•	Refuses to cooperate or can’t be located
•	Is shown unable to benefit from VR services

The Rights of Appeal are given to all applicants as well as contact information for the Client Assistance Program (CAP)

Post Employment Services (Status 32)
Individual has been closed successfully, but needs limited services to retain, regain or advance in employment.

In 2002, Maine’s DVR was forced to implement a waiting list for all individuals found eligible for services.  By federal statute, any VR program that institutes a wait list must also implement an Order of Selection.  Under the Order of Selection, eligible individuals are assigned to a priority category, based on the severity of their disability and vocational barriers.

The highest priority, Category 1, is given to individuals with the most significant disabilities and highest level of rehabilitation needs.  Categories 2 and 3 are assigned to individuals with disabilities, but who have fewer functional limitations or less complex rehabilitation needs than those in Category 1.  Time on the waiting list peaked at 53 weeks in June 2005 and had been reduced to 26 weeks at the time of this assessment.

Maine DVR provides career information to eligible individuals while on the wait list.  With the help of the State Rehabilitation Council, a pamphlet entitled, “While You Are Waiting,” was developed for planning steps individuals could take until there are sufficient funds available to serve them and it is available in a variety of formats. Individuals are also encouraged to use the resources of the CareerCenters.  A U.S. Department of Labor grant, entitled AbleME, has funded training of CareerCenter employees to work more effectively with individuals with disabilities.  The grant has also funded the installation of appropriate assistive technology in the centers to improve their accessibility.

While helping individuals obtain employment is the ultimate success of the VR program, many VR cases are closed each year before the individual reaches the 90-day employment goal.  These closures happen for a variety of causes and can occur at any step in the VR process.  Some individuals who apply are found not eligible because they do not have a qualifying disability.  Others, after being found eligible, leave the VR program for several reasons, such as they find employment on their own, have an exacerbation of a chronic condition, do not want to remain on the waiting list, or cannot be found by their VR counselor for an extended period of time while developing or implementing the Individual Plan for Employment (IPE).  Everyone who applies for VR services has the right to appeal any decision made by the agency, including the decision to close a case.

Individuals can receive further support through post-employment services after becoming successfully employed if services are necessary to maintain, regain or advance in employment.  This assistance is limited in scope to two or less services and duration of six months or less.  If more comprehensive services are required, and/or there is a new disabling condition and/or it has been longer than three years since the case was closed successfully, a new application for DVR services must be completed.

IV.  DVR SERVICES TO INDIVIDUALS IN MAINE

The Division of Vocational Rehabilitation collects a variety of information about individuals when they enter the program, tracks their progress and services they receive, and records a successful closure of the case if the individual successfully completes at least 90 days of employment in an integrated setting.  In this section, we use DVR data to provide an overview of the characteristics of the current VR population, to describe the flow of individuals into and out of the DVR program, to examine outcomes of the VR program in terms of rehabilitation rates, and to outline the costs of DVR services from FFY 2003 to 2005.

DVR Population Characteristics

In Federal Fiscal Year (FFY) 2003, Maine DVR closed a total of 2,906 cases and in FFY 2005, Maine DVR closed a total 2,847 cases.   Table 1 outlines the characteristics of the individuals represented among all closed cases in both years, as well as the change in the proportion of clients with a given characteristic (last column).

TABLE 1 

Findings
•	As part of the eligibility determination process, DVR staff record applicants’ primary disability type.  In FFY 2005, there were 990 (35%) cases closed where the individual had a mental illness, 821 (29%) with a physical disability, 785 (28%) with a cognitive disability, and 193 (7%) where the individual was deaf or hard of hearing.  A small fraction (2%) of closed cases were for individuals with no impairment (and who were deemed ineligible for services).  

•	Transition-age individuals made up a substantial portion of VR closures – with about 31% under age 23 at the time they applied for DVR services.

•	Over a third of VR individuals did not have a high school education at application in both FFY 2003 and 2005.

•	There are more men than women (57% versus 43%) in the VR population.

•	The vast majority (96%) of the VR population is white, and only 4% belonged to a racial or ethnic minority.

•	In FFY 2005, almost 600 of all VR cases closed, or over one in five, were for people who received SSI.  In addition, 668 or 24% received SSDI. 

•	Between FFY 2003 and 2005, there were several small but notable changes in the characteristics of the DVR population.  
o	Both the number and proportion of cases closed for individuals with cognitive disabilities increased from FFY 2003 to 2005; there were 706 individuals with cognitive disabilities in FFY 2003 and 785 in FFY 2005.
o	The proportion of the DVR caseload made up by young people under age 23 grew by more than 2% from 2003 to 2005, and the number of closures for individuals under age 23 at application grew by 6%, from 832 to 878.
o	There was a slight increase in the racial and ethnic diversity of the VR population.  In 2003, 81 individuals were members of a racial or ethnic minority group that number increased to 105 in 2005.

DVR Process Flow

As described in Figure 1 (on page 6), the VR process begins when a person fills out and submits an application to the Division of Vocational Rehabilitation, and ends with the closure of the case.  Chart 1 below outlines the number of individuals who passed through several key steps in the VR process across three federal fiscal years: New Applications, New Plans Developed, and Case Closures.  The solid lines in the chart represent incoming individuals, and the dotted lines represent individuals leaving the DVR program (case closures).

Findings
•	The number of new applicants fell by 23% from FFY 2003 to 2005, from 3,587 down to 2,754.  Over the same period, the number of individuals on the wait list (Status 04) increased by 58%, from 1,354 up to 2,136 (see Chart 2 page 11).  It is likely that the large and persistent wait-list for DVR services during this timeframe has contributed to the declining number of new applications.

•	The development of new Individualized Plans for Employment (IPE) slowed considerably, dropping from 1,644 in FFY 2003 down to 1,146 in FFY 2005, a 30% decrease.  There are several possible reasons for this decline, but the most likely explanations are turnover among VR Counselors, increasing caseload sizes and the growing numbers of individuals served who are transitioning from high school to adulthood (see Table 1).  Younger individuals are likely to need a longer time to develop and complete an IPE.

•	In FFY 2005, for the first time in three years, the number of case closures exceeded the number of new applicants, allowing for a small decline in the wait list.

CHART 1

Chart 2 looks more closely at the active DVR caseload (Status 02 – 24) at the end of the Federal Fiscal Year from FFY 2003 to 2005, and breaks out active cases by the number of individuals who are: waiting for an eligibility determination (Status 02), on the waiting list (04), off the wait list but waiting for IPE development (Status 10), and the remainder who have completed IPE’s and are in plan implementation (Status 12 – 24).  

Findings
•	The number of active cases has grown only slightly from FFY 2003 to 2005, from 7,500 to 7,800 cases. 

•	The number of individuals on the wait list increased substantially from 2003 to 2004, from 1,354 to 2,201, and then decreased in 2005 to 2,136. 

•	Another significant trend is that the number of active cases who are engaged in plan implementation fell steadily from FFY 2003 to 2005, from about 3,600 down to 3,000.  Similarly, the percentage of the active cases in plan implementation fell from 50% to less than 40% over this period. 

CHART 2

The goal of the VR process is for an individual to achieve and maintain employment consistent with their capabilities.  However, many individuals exit the program before reaching that employment goal.  Chart 3 details the number of individuals whose cases were closed in Federal Fiscal Years 2003 to 2005, according to the type of closure.  The different closure types noted indicate how far in the VR process the individual had progressed when their case was closed.

Findings
•	The number of successful closures (Status 26) declined by 24% from FFY 2003 to 2005, from 857 to 655.

•	The number of closures in cases where the individual had developed and participated in an IPE, but did not achieve 90 days of employment (Status 28 closures), fell from 825 to 715.  

•	Significantly, the number of closures to cases where the individual had been determined eligible but had not yet developed an IPE (Status 10-30 closures) grew by 36%, from 814 to 1,106.    

•	There were no significant changes among the remaining types of closures during this period.
 
CHART 3

Another way to examine the flow of individuals through the VR program is to look at the length of time that individuals spend in the overall process, and in the various steps along the way.  Chart 4 below shows the length of time (in months) that it took successfully rehabilitated (Status 26) individuals to move through the VR process.

Findings
•	Overall, the number of months it took a VR applicant to complete the entire process increased by 17% from 2003 to 2005, from 31 to 36 months – an average of 3 years. 

•	Over the same period, there has been some improvement in the length of time it takes to determine eligibility, dropping from three months in 2003 down to two in 2005 (Application to Eligibility).  

•	However, gains in the eligibility determination process were eclipsed by a doubling in the length of time it took for eligible individuals to move from eligibility determination to completion of their IPE (Eligibility to IPE), from 4 months to more than 9 months.  Note that this period includes both time spent on the wait list as well as time spent on development of the IPE (Status 10).

•	There was little change in the average time spent in Plan Implementation from 2003 to 2005 (IPE to Closure).  Thus, the growth in the overall time in the VR process can be directly attributed to the increase in time spent on the wait list and in IPE development.

CHART 4

Keep in mind that Chart 4 represents the best-case scenario, in that it only includes individuals who successfully completed the VR process.  It is also instructive to examine the length of time that people who did not have a successful outcome spent in the VR process.

Overall time in the VR process has increased not only for successful closures, but also across other closure types as well.  Chart 5 shows average time from application to closure for cases closed after the individual received IPE services, for successful closures, and for cases closed before the individual’s IPE was completed. 

Findings
•	The time a person spends in these three closure categories has increased.

•	The length of time to closure among individuals who did not yet have an IPE increased from 15 to 20 months from FFY 2003 to 2005.  This probably helps explain the observed trend in Chart 3, where we saw a marked increase in the number of closures of this type; Having waited for more than a year and a half to get an IPE and to have VR services authorized, an increasing number of people may be giving up and dropping out of the program.

CHART 5

DVR Outcomes

An important measure of the success of the Vocational Rehabilitation program is to look at employment outcomes for individuals.  A standard federal measure is the rehabilitation rate, which represents the total number of successful (Status 26) closures, divided by the total number of closures following the development of an IPE (including both successful (Status 26) and unsuccessful (Status 28) closures).  The following Chart 6 breaks out the rehabilitation rate by disability type.

Findings
•	The proportion of DVR cases that were rehabilitated (i.e. worked for at least 90 days in an integrated setting) declined slightly between FFY 2003 and 2005, from 51% to 48%

•	The rates remained roughly constant for individuals with physical disabilities or mental illness, but there was a decrease of 10 percentage points in the rehabilitation rate for individuals who are deaf or hard of hearing. 

•	There was a small (5 percent) decrease in the rehabilitation rate of individuals with cognitive disabilities between 2003 and 2005.   (Note: In the past few years Maine’s Department of Health and Human Services (DHHS) has reduced funding for long term support services for people with cognitive disabilities due to declines both in federal Medicaid revenues and the State General Fund, which has restricted the employment plans of those individuals going forward.) 
 
CHART 6

(Source data for this chart is available in Appendix 3)

A second outcome measure for the Division of Vocational Rehabilitation is the change in earnings among individuals who successfully meet their employment goal.  Chart 7 below describes the change in average earnings among all successful closures in FFY 2003, 2004 and 2005.

Findings
•	Average weekly earnings increased by more than 260% among 2005 closures, from $75 at time of application up to $274 at closure date.  Similar increases were observed in FFY 2003 and 2004.  

CHART 7

Another important outcome of the VR program is the change in education level among individuals who are served.  The following Chart 8 (Page 17) compares the education level of all closures from FFY 2005 at the time they applied for services to their education level at closure.

Findings
•	It should be noted 470 individuals who did not have a high school education at application achieved a high school diploma or equivalency or more through participation in the VR program.

•	More than 220 people increased their education level to postsecondary courses, degrees or certifications, and 55 achieved a college degree.

Evaluating the effectiveness of increased education in helping individuals to achieve employment outcomes is an important follow-up question.  Data comparing change in education level against closure type was not available at the time the needs assessment was conducted, but will be examined by the agency in the coming year. 

CHART 8

DVR Service Costs

Maine’s DVR program and the recent amendments to the Rehabilitation Act emphasize the importance of informed consumer choice – namely, providing DVR individuals with the information they need to choose vocational goals and determine the available services appropriate to meet those goals.  Thus, cost information can serve as an indicator for the mix of services that Maine’s DVR individuals have asked and received approval for over the past few fiscal years. 

DVR spending has also been influenced by several agency initiatives over the past few years, including an effort in FFY 2005 to close long-term high cost cases, and an adjustment in the financial control and management system made to bring case service expenditures in line with total available resources for that year.  

This section highlights trends in annual costs of DVR services and the service areas where these costs are concentrated.  DVR classifies services into more than thirty categories.  For presentation purposes in this report, these categories are aggregated into a smaller set of eleven service groups, described below in Figure 2.

FIGURE 2
Description of Vocational Rehabilitation Service Groups

VR Service Group	Example Services	
Job Development & Placement	Job Development, Job Seeking Skills Training	
College or University Training	Tuition, fees, books, school supplies for college/university 	
On-the-Job Supports	Job coaching both at the worksite and off site, On the Job Training	
Rehabilitation Technology	Computer equipment, software, home or building modifications	
Occupational / Vocational & Other Training	Adult Education, Truck driving school	
Transportation	Cab/bus fares, car repair, gas	
Assessment	Community based situational assessments, and disability related evaluations	
Hearing Aid	Provision of hearing aids, molds and repair	
Maintenance	Clothing, food and shelter to enable IPE	
Diagnosis & Treatment	Medical treatment, therapy & counseling 	
All Other Services	Readers/interpreters, worksite modification, services to family members	

Table 2 (page 19) details DVR paid authorizations from FFY 2003 through 2005, broken out by service group.

Findings
•	The results indicate that overall DVR expenditures fell by 20%, from $8.8 million down to $7.1 million.  Things of note in this time period include a DVR initiative to close long-term high cost cases, and an adjustment in the BRS financial control and management system that was made in 2005 to bring case service expenditures in line with total available resources for that year.  

•	Spending on almost all major service groups declined by 20 percent or more over these three years.  The largest reductions in case costs were for On-the-Job Supports, Rehabilitation Technology, and Transportation services.  (Note: Changes in DVR Policy, effective 7/1/04, identified transportation as a support service that can only be addressed in an IPE or Post- employment plan in association with VR Core Services.) 

•	Job Development & Placement is the largest single service group, representing 20 percent of total DVR case costs each year.  Spending on this group decreased by only 7 percent from FFY 2003 to 2005.

•	College or University Training is the only major service group that has grown; total expenditures grew from $1.1 million in FFY 2003 to $1.3 million in FFY 2005.

TABLE 2

Chart 9 shows the percent of all DVR expenditures in FFY 2005 that were spent on each type of service.

Findings
•	Job Development & Placement, College or University Training, and On-the-Job Supports were the top three service groups in terms of case costs in FFY 2005, with a total of $3.6 million – over half of the $7.1 million in total DVR expenditures that year.

CHART 9

Chart 10 outlines the trends in service costs over the past three federal fiscal years, FFY 2003 to 2005.

Findings
•	The chart underscores the increase in College or University Training.
 
•	Expenditures in all other major service groups showed a decline. 

CHART 10

Chart 11 shows the average cost of a successful closure for FFY 2003 – 2005.

Findings
•	The average rehabilitation cost has held fairly constant over the past three federal fiscal years, at about $5,700 per successful closure.  

CHART 11

Individual Satisfaction with DVR Services:

Maine DVR has been surveying individuals regarding service satisfaction at the time of closure since 1997, but recognized in 2003 that the return rate was not providing statistically reliable data that could help improve agency services.  Thus, a decision was made to join other New England States in a Rehabilitation Services Administration sponsored Customer Satisfaction Survey conducted by Market Decisions, a research organization in South Portland, Maine.   DVR found the information provided by the survey extremely valuable and decided to engage Market Decisions to conduct the survey again in 2006.  A random, stratified sample was utilized that included all current active clients (status 12 and above), all individuals closed successfully from a plan (status 26) and all individuals closed unsuccessfully after an IPE was implemented (status 28) in the previous twelve month period prior to each survey.  Individuals were contacted by telephone, but given the option of responding to a mailed survey.  

Table 3 (page 22) shows the results of measures used to determine overall satisfaction with DVR.   Clearly, the overall level of satisfaction of individuals served by DVR is very high and has not changed significantly between 2003 and 2006.

Findings
•	Satisfaction with services provided by DVR was very high.  The summarized differences are not statistically significant comparing surveys of 2003 to 2006.

•	Based upon the views and attitudes of the large majority of people surveyed, there were not any systemic problems identified with DVR or the services it provides. Hence, the results suggest there is no need for dramatic changes in what the agency is currently doing to meet the needs of its clients.

•	However for DVR as a whole and for all regions, most client issues, concerns or problems focus on communication, staff issues, finding employment and the desire for more information.  Staff turnover and the need for individuals to switch counselors might be a growing problem.  Related to this issue is the client perception that the staff is overburdened, busy and overworked.

•	In 2003 there was barely a mention of problems associated with having more than one counselor or having to switch counselor frequently.  In 2006, 13% of the individuals surveyed mentioned issues or concerns resulting from having more than counselor in their verbatim comments.  In response to a specific question, 46% indicated that they had more than one counselor and 33% felt this affected their ability to get services.  Table 3 provides information specific to satisfaction with services and expectations of the VR program.

•	It also shows that individuals going through the VR process are treated with dignity and respect so that they would recommend VR to others with similar disabilities. 

TABLE 3
MAINE DIVISION OF VOCATIONAL REHABILITATION
OVERALL SERVICE SATISFACTION

	2003	2006	
Number of completed surveys	726	741	
			
Percentage of individuals: 			
Very or somewhat satisfied with Maine DVR Program	85%	83%	
Satisfied with the services received	82%	82%	
Services provided by Maine DVR compared favorably to services offered through their ideal program	85%	79%	
Would tell their friends with similar disabilities to go Maine DVR for help	94%	94%	
Services met expectations	79%	80%	
Maine DVR staff treated them with dignity and respect.	97%	94%	

V.  ESTIMATING POPULATION ELIGIBLE FOR DVR SERVICES

To estimate the number of people eligible for DVR services in Maine, we use information from the American Community Survey (ACS), conducted each year by the United States Census Bureau.  The ACS is designed to provide both national and State level data on demographic, social, economic and housing characteristics of US households.  Included in the survey are six questions that can be used to identify the population of people with disabilities (see Appendix 2).

The Census defines anyone who responds affirmatively to the following question as having a work disability: 

“Because of a physical, mental, or emotional condition lasting 6 months or more, does this person have any difficulty in doing any of the following activities: working at a job or business?”  

We use the work disability question as an indicator for individuals who could meet the DVR eligibility criterion of “having a physical or mental impairment which results in a substantial impediment to employment.”  And, because many individuals with disabilities are already successfully employed and do not require vocational rehabilitation services, we further limited our ACS sample to those who were not currently working or on temporary leave from a job.

Table 4 (page 24) details the sample selection process used to identify the ACS work disability population. 

Findings
•	In the 2003 and 2004 ACS, which we use to estimate the DVR-eligible population in the State, the first row indicates that in both 2003 and 2004 over 5,500 working-age adults in Maine between the ages of 16 and 64 were interviewed for the ACS.  Based on the sample from 2004, the Census estimated that there were a total of 852,877 working age adults living in the State.

•	The second row adds the work disability criterion, showing that in 2004, a total of 478 respondents in the ACS reported a work disability, representing an estimated 77,418 Maine adults (9.1% of all Maine adults).

•	The final row adds the requirement that sample members be currently unemployed.  In 2004, we identified a total of 388 individuals in the ACS sample with a work disability who were not already working.  Based on these 388 individuals, we estimate that in 2004 there were a total of 62,000 DVR-eligible adults in Maine (81% of all adults with a work disability). 

TABLE 4

Limitations

There are several important limitations to note about using the ACS work disability population to estimate and describe the VR-eligible population in Maine.  First, while over 95% of individuals in Maine’s DVR program are between the ages of 16 and 64, there is technically no lower or upper age eligibility limit, so our estimates do not adequately describe potential young or elderly individuals who are eligible for DVR services.  Second, the ACS also currently does not include anyone living in “group quarters” – meaning individuals who live in institutions, college dormitories, or other types of group quarters.  This is a fairly serious limitation because a substantial number of individuals with disabilities live in group homes or institutional settings in Maine.  Approximately, 91% of individuals served by DVR reside in private residences.  According to DHHS data 1,281 individuals with mental illness live in group homes or institutional settings.  There are 879 individuals with mental retardation who live residential homes with a capacity of three to six beds.  These individuals are not represented in the ACS.  
These factors could lead to an underestimate of the number of people eligible for DVR services. 
 
However, there are also potential reasons why using the ACS could lead to an overestimate of the numbers of people in Maine who are eligible for DVR services.  The Census work disability question asks whether the person’s condition causes “difficulty…in working at a job or business”, as opposed to the VR eligibility criterion that requires a “substantial impediment to employment.”  The ACS work disability definition may therefore be too general, and include a number of individuals who would not be eligible for VR because they:
•	are unavailable to participate in VR or the workforce;
•	are not interested in getting a job or participating in VR; or
•	have a difficulty working but their condition is not so limiting as to constitute a "substantial impediment to employment”.

In addition, individuals with blindness or visual impairments are not served by DVR, but instead receive services from the Division of Blind and Visually Impaired (DVBI).  Over the last three years, the DBVI VR cases have averaged a little less than 10% of all VR individuals served under the Bureau of Rehabilitation Services. The percentage of individuals who are blind or visually impaired in the general population is 1.8% or 23,400 people in Maine.  The ACS includes a question that identifies sensory disabilities, but it does not allow for differentiating between individuals with hearing versus visual impairments, so persons potentially eligible for DVBI services may also be included in our work disability population.  

Despite the limitations, the ACS is the best source available for state-level estimates of the population eligible for DVR services.  The large sample size (over 5,000 each year for Maine alone) and statewide coverage make it unique among federal surveys.  Also, the survey will be repeated each year, allowing for examination of trends in the work disability population in Maine in the future.

ACS Work Disability Population Characteristics

To describe the population of individuals eligible for DVR services, we again use the American Community Survey and the sample of individuals with a work disability described above.  The ACS includes a number of demographic and socioeconomic characteristics that are useful for this purpose.  To improve the reliability of our estimates, we combined respondents from both the 2003 and 2004 ACS who met the work disability definition, for a total sample of 795 individuals.  The results are shown in Table 5, along with 90% confidence intervals for each characteristic.

Findings
•	90% of individuals (all of whom report a work disability) also reported at least one additional Census disability type.  One-third reported two types of disability (meaning they have a work disability and one other disability type), and over half reported three or more different types of disability (work + 2 or more others).

•	The most common type of disability among the work disability population is physical, at 69%.

•	About half report a mental disability.

•	Over a third report difficulty in going outside their home alone.

•	 One quarter have difficulty performing self-care activities.

•	Sensory disabilities (hearing and/or visual impairments) are the least prevalent disability type, at 16% of the ACS work disability population.

•	Almost two-thirds of the population is ages 45 to 64.

•	Over one quarter of individuals with a work disability did not complete high school or pass an equivalency test.  About 3 in 10 have some post-secondary training or have a college diploma.

•	Only 15% of the population has recent work experience.  Over half have not worked in the past five years or never worked.  (Remember that people who are currently working were deliberately excluded from this sample.)

•	5.6% belong to a racial or ethnic minority.

•	One quarter received Supplemental Security Income in the past year, the federal program that provides cash assistance to low-income individuals with severe disabilities.

•	Just over one third received Social Security Disability Insurance.

•	The poverty rate among people with a work disability is extremely high, at 35%.  Over half of the population lives at or below 150% of the Federal Poverty Level.

TABLE 5

Are DVR Services Reaching the Eligible Population?

To determine if there are certain segments of the eligible population that are not being reached by the DVR program, we compare the characteristics of ACS work disability sample (Table 5) against information collected by the agency on current DVR individuals (Table 1).  The result is Table 6 (page 29) a combination of the information from two prior tables where comparable information is available.  Disability type is omitted from the ACS column because the ACS disability measures are not comparable to the way that DVR collects primary disability type from each applicant.

•	Table 6 indicates that individuals in the DVR program are much more likely to be under age 23 at application than individuals in the ACS work disability sample.

•	DVR participants are generally less educated than the eligible population, with 38% lacking a HS degree versus only 28% in the ACS work disability sample.

•	DVR individuals are also more likely to be male (57% versus 50%).

•	Historically, only a very small proportion of Social Security beneficiaries who qualify under a disability category have participated in the labor market, due largely to disincentives associated with the potential loss of cash and health benefits.  Recent federal laws like the Ticket to Work and Work Incentive Improvement Act and associated changes to Social Security program rules have reduced these disincentives, but many beneficiaries remain fearful about pursuing work.  Not surprisingly, recipients of Social Security cash benefits are therefore less likely to participate in the DVR program than the numbers in the ACS work disability would suggest:  DVR participants are less likely to be SSI recipients (21% versus 25%) and less likely to receive SSDI (24% versus 38%).  Maine’s SSI and SSDI participation rates are at or above the average of all New England Vocational Rehabilitation agencies (data not shown.)

•	Table 6 indicates that DVR serves proportionally fewer individuals of racial or ethnic minorities than those identified in the ACS work disability population.  It can be noted in 2003, 81 individuals who were members of a racial or ethnic minority group were closed and the number increased to 105 in 2005.

TABLE 6

Social Security Recipients in Maine

An alternative source of information that can be used to estimate the number of people in Maine who are eligible for DVR services comes from the Social Security Administration.  Maine residents who receive SSI or SSDI are presumed to be eligible for vocational rehabilitation services, as long as the individual is interested in getting a job.  Therefore, all SSI and SSDI recipients who qualify for payments from the Social Security Administration under a disability eligibility category are potentially eligible for DVR services.  

Table 7 lists the number of Maine recipients of both programs by VR Region from December 2004.

Findings
•	It shows that there were more than 29,000 SSI recipients, and more than 44,000 SSDI recipients living in Maine.

•	Because many of these individuals are dually eligible for both SSI and SSDI, we cannot compute a precise total, but we estimate that there are approximately 60,500 Social Security beneficiaries with disabilities living in Maine, all of whom would meet the DVR eligibility definition of “substantial impediment to employment.”

TABLE 7

Because the Social Security data includes breakdowns by county, we can also use it as a proxy to examine whether DVR is reaching the geographically dispersed population of people with disabilities in Maine.  Chart 12 compares the distribution of open Maine DVR cases, SSI recipients, and SSDI recipients from December 2004.  First of all, it shows that the geographic distribution of both SSI and SSDI recipients is fairly similar; Region I (Cumberland and York counties) has a slightly higher concentration of SSDI recipients than SSI recipients (28% versus 24%), but the other Regions are essentially the same.  This concurrence supports the idea that the Social Security information is a reasonable indicator of where in the State of Maine people with severe disabilities are living.  

Comparing the distribution of Open DVR Cases against the Social Security program information, we see that there is a higher concentration of DVR Cases in Region III (33% of all cases) relative to the SSI and SSDI populations (25 and 24%, respectively).  Conversely, there is a much lower proportion of open DVR cases who lived in Regions IV and V (19%) relative to SSI and SSDI recipients (31% and 29%).  This difference may indicate a higher level of unmet need for VR services in these areas.

CHART 12 

VII.  CONCLUSION 

A. Discussion 

In Maine, DVR services enable hundreds of individuals with disabilities to find, return to or retain their jobs in the community.  Clearly, there are many people with disabilities who could benefit from participation in the DVR program throughout the state. 

DVR participants are generally very satisfied with their interactions with DVR staff and the services they receive. However, given the fiscal climate and federal mandates, DVR has focused its efforts on meeting the vocational rehabilitation needs of people with the most significant disabilities, as evidenced by the Order of Selection prioritization process. The resulting waiting list and increasingly frequent counselor changes have been detrimental to the daily operations and success of the VR program. 

DVR has initiated good partnerships with other components of the statewide workforce investment system, but that system has also experienced significant resource reductions that have impacted services. 

Over the past few years, DVR has served an increasing number of people who belong to racial/ethnic minorities; however, the racially/ethnically diverse population in Maine is a very small percentage of the overall population. 

While DVR has reduced both the number of people and time spent on the waiting list, this assessment indicates that there is a bottleneck developing in the step that occurs immediately following removal from the waiting list. This step is the development of an Individualized Plan for Employment (IPE). This plan is developed with the participant’s VR counselor. A bottleneck at this stage will add additional waiting time for plan implementation since most DVR services can only be provided once the IPE is completed. 

Reducing the number of people on the waiting list and in the plan development stage will require more IPEs to be developed each year — a reversal of the downward trend in IPE development shown in Chart 1. 

Chart 2 shows that the number of people in IPE development increased from about 1,800 to 2,100 between 2004 and 2005. This indicates that people were being removed from the waiting list faster than DVR counselors could develop IPEs and move individuals into Plan Implementation.

Charts 3 and 5 indicate that the level of unmet need for IPE development may be even greater than suggested by Chart 2, since an increasing number of people are dropping out of Status 10 (Plan Development) after waiting for an average of 20 months from the time they applied for services. 

Not surprisingly, VR counselor workloads increased as more people were taken off the waiting list. Caseload sizes have a direct impact on the time a counselor has available to work with any single individual. 

The nature of the population being served also impacts the flow of the rehabilitation process. For example, the numbers of VR participants who are transitioning from high school to adulthood are on the increase (Table 1). This population is more likely to require a longer time to develop an IPE and achieve successful employment than other participants.  

As stated in the introduction of this assessment, staff turnover is approximately 15% annually. This is of particular concern as it contributes directly to a loss of experience and productivity. Remaining VR counselors have seen their caseloads increase, which results in counselors being less available to participants. Additionally, staff turnover results in decreased oversight as front-line supervisors take on caseloads and counseling functions in some regions. 

B. RECOMMENDATIONS

Given the unlikelihood of increased federal or state funding, Maine DVR must find ways to do business differently if it is to be successful in addressing the unmet vocational needs of people with disabilities. 

This needs assessment suggests that DVR needs to clarify its purpose, better target resources, streamline services, develop a broader systems-approach to VR along with other state and community partners, and pursue additional funding sources. 

Additionally, specific areas that need further consideration and action planning include: 
•	increasing the recruitment, retention and availability of skilled staff; 

•	enhancing the success of people with disabilities through the DVR process by more effectively maximizing the resources of other state and federal government entities, community organizations, and support systems; 

•	implementing new strategies to increase the number of successful employment outcomes; 

•	evaluating post-secondary education services from a cost-benefit perspective; 

•	implementing innovative methods to effectively meet increasing demands for youth transition services; and

•	increasing alternative funding sources, such as the SSA Ticket to Work program and other federal opportunities.

APPENDIX 1
Order of Selection

Category 1
A.	Individuals with the most significant disabilities as defined as an individual:

	(1)	whose disability is of a permanent, chronic or cyclical nature;

	(2)	who has a significant physical or mental impairment that seriously limits two or more functional capacities (mobility, communication, self-care, self- direction, interpersonal skills, work tolerance, or work skills) in terms of employment outcome; and

	(3)	whose vocational rehabilitation can be expected to require multiple vocational rehabilitation services over an extended period of time. 

Category 2
B.	Individuals with significant disabilities as defined by the Rehabilitation Act of 1973, as amended, as an individual: 

	(1)	who has one or more physical or mental disabilities resulting from amputation, arthritis, autism, blindness, burn injury, cancer, cerebral palsy, cystic fibrosis, deafness, head injury, heart disease, hemiplegia, hemophilia, respiratory or pulmonary dysfunction, mental retardation, mental illness, multiple sclerosis, muscular dystrophy, muscular-skeletal disorders, neurological disorders (including stroke and epilepsy), spinal cord conditions (including paraplegia and quadriplegia), sickle cell anemia, specific learning disabilities, end-stage renal disease, or other disabilities or combination of disabilities determined on the basis of an assessment for determining eligibility and vocational rehabilitation needs which cause substantial functional limitation; 

	(2)	who has a significant physical or mental impairment that seriously limits one functional capacity (mobility, communication, self-care, self-direction, interpersonal skills, work tolerance, or work skills) in terms of employment outcome; and

	(3)	whose vocational rehabilitation can be expected to require multiple vocational rehabilitation services over an extended period of time. 

Category 3
(C)	All other individuals with non-significant disabilities.

APPENDIX 2
Disability Definitions from the 2003 American Community Survey

Census Term	Question	Ages	
	Q15. Does this person have any of the following long lasting conditions:
		
Impairment: 
Sensory Disability	a. Blindness, deafness, or a severe vision or hearing impairment?

	Ages 5 and older	
Impairment: Physical Disability	b. A condition that substantially limits one or more basic physical activities such as walking, climbing stairs, reaching, lifting, or carrying?
	Ages 5 and older	
	Q16. Because of a physical, mental, or emotional condition lasting 6 months or more, does this person have any difficulty in doing any of the following activities:
		
Impairment:
Mental Disability	a. Learning, remembering, or concentrating?

	Ages 5 and older	
Activity Limitation:
Self-care Disability	b. Dressing, bathing, or getting around inside the home?

	Ages 5 and older	
	Q17. Because of a physical, mental, or emotional condition lasting 6 months or more, does this person have any difficulty in doing any of the following activities:
		
Participation
Restriction: 
Go-Outside-the-Home Disability
	a. Going outside the home alone to shop or visit a doctor's office?
	Ages 15 and older	
Participation Restriction:
Employment
Disability
	b. Working at a job or business?	Ages 15 and older	
Disability	If a person responds yes to at least one of the six questions found in Q15, Q16 and Q17, then the Census classifies the person as having a disability.
	Ages 5 and older	
Source: Weathers, Robert.  2005.  A Guide to Disability Statistics from the American Community Survey.  Table 1a.  Cornell University, Employment & Disability Institute.  http://digitalcommons.ilr.cornell.edu/edicollect/129

APPENDIX 3.