Maine Division of Vocational Rehabilitation Comprehensive Statewide Needs Assessment I. Introduction: A. Purpose of Comprehensive Needs Assessment 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 guide in its strategic plan and goal development for the next three fiscal years, 2010 – 2012. Specifically, the report responds to federal regulations1 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 States Census Bureau and data from the Rehabilitation Services Administration and the Social Security Administration. We also gathered information through the Fall 2008 Consumer Satisfaction Survey, a forum held by the State Rehabilitation Council (SRC) for individuals placed in employment at its annual meeting, and did additional outreach to seventeen stakeholder groups to examine the services delivered to people with disabilities in Maine. B. Description of Division of Vocational Rehabilitation and the Vocational Rehabilitation Process The Division of Vocational Rehabilitation (DVR) is an agency within the Bureau of Rehabilitation Services (BRS) located within the Department of Labor (DOL). The mission of BRS is to provide full access to employment, independence and community integration for people with disabilities. The Division of Vocational Rehabilitation provides services that are governed by the federal Rehabilitation Act of 1973 as amended, by working together with individuals with disabilities to achieve or maintain gainful employment. Federal statute mandates that each applicant entering the publicly funded program follows an individual process from application through eligibility, comprehensive assessment of rehabilitation needs, individual employment plan development, and provision of appropriate services to achieve employment. Any individual with a disability and a commitment to find or maintain 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. 2 Individuals who receive SSI and/or SSDI are presumed to be eligible for DVR services. DVR uses a set of “status” codes to track an individual’s progress as they move through the VR process. This allows both the state agency and federal agency, Rehabilitation Services Administration (RSA), to collect data to ensure timely service delivery and fiscal accountability. Each individual who applies for services has a determination of eligibility and works with a qualified VR counselor and others to determine an employment goal and the appropriate services necessary to achieve that goal. The Individual Plan of Employment may include guidance and counseling, training, education, job search, and job placement among other things. Every applicant coming to DVR has different abilities, goals, expectations and barriers to 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 path is the same and the process is flexible enough to attend to new barriers as they arise. 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 1.3 Time on the waiting list peaked at 53 weeks in June 2005 and had been reduced to 26 weeks for individuals in Category 1 at the time of this assessment. Maine’s Division of Vocational Rehabilitation sees this as unacceptable and is embarking on a major initiative to eliminate the wait list and provide the “Right Service at the Right Time” to its consumers. Areas being assessed are the consumers’ progress through the system in: “Entering the VR system”, “VR Plan Development”, “VR Plan Accomplishment” and “Exiting the VR System”. The goal is to provide services to all eligible consumers at the time that they need them to achieve competitive community based employment. While in the mandated Order of Selection, Maine DVR provides information and resource advice to individuals on how they can prepare, secure or regain employment, including how to use the Career Centers that have a range of free employment services such as a Job Bank, workshops and the availability of Disability Program Navigators. With the help of the State Rehabilitation Council, a pamphlet entitled “While You Are Waiting” was developed and is used for planning steps an individual can take until DVR has sufficient funds available to provide services through an Individualized Plan for Employment (IPE). The pamphlet is available in a variety of formats. While helping individuals obtain employment is the ultimate success of the VR program, many VR cases are closed each year before the individual achieves and maintains employment for at least 90 days. 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 located by their VR counselor for an extended period of time. 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. II. BACKGROUND A. Maine’s Economy and Workforce Maine is a large geographical state, which spans 33,215 square miles. The state is primarily rural in nature with a dispersed population of 1.3 million people and density of 41 people per square mile. The largest population center can be found in southern Maine in the greater Portland area where approximately 87,300 individuals reside. The state’s population growth is largely dependent upon in-migration and is significantly slower than the rest of the country with a rate of 3.7% between 2000 and 2006 as compared to the national rate of 6.4%.4 Historically, Maine’s economy has been based on goods producing industries, such as manufacturing and natural resources, but the trend to a service-based economy has continued over the last several years. This combined with the influences of globalization, technological advances and business restructuring, places different demands for the skills and abilities of Maine workers. At the time of this report, Maine and the nation was in a recession that the Bureau of Economic Research determined began in December 2007. Unemployment rates had reached levels not seen since the early 1990’s. The Maine Department of Labor (MDOL) reported at the end of 2008 that the number of jobs in Maine was down 1.3% and that the unemployment rate was up to 6.3%. The fastest rate of job losses was in construction, but significant losses were seen in other sectors, such as wholesale and retail trade, accommodation and food services and real estate.5 Wages in Maine are lower than the rest of the country with a median wage of $14.29 per hour as compared to $15.10 per hour nationally and $17.19 per hour for other New England states. Recent spikes in the cost of gas, food and heating fuel and adjustment for inflation have resulted in Mainers losing even further ground in attaining a livable wage. 6 Maine is the state with the most aged population in the country with a median age of 41.1 years. Relative to that, the distribution of its workforce is also older with 20.3% of its workers being Age 55 or older. The anticipated retirement of baby boomers indicate a critical need to replace those workers in the future. Studies of educational attainment show that Maine has a larger percentage of high school graduates and individuals with some college than many other states, but fewer college graduates. Maine’s workforce has little ethnic diversity with over 95% being white, although there has been a slight combined increase of 1% of workers who are Hispanic, Asian/Pacific Islander and African American.7 On the short term, employment for all of Maine’s civilian labor force (estimated to be 707,000 individuals in November 2008), is in a down turn and making it even more difficult for people with disabilities to obtain and sustain community-based employment. Fortunately, the long term outlook appears more promising and the unique demographics in Maine will offer opportunities to under-represented populations in the workforce, including workers with disabilities. B. Federal and State Landscape of Vocational Rehabilitation Demand for community inclusion and access to employment for people with significant disabilities remains strong across the country. Legislation, including the Rehabilitation Act, the Americans with Disabilities Act, the Workforce Investment Act, and the Ticket to Work and Work Incentives Improvement Act, has continued to shape the opportunities available to individuals with disabilities in their communities. Consumer choice, transition of youth to adulthood, and expanded responsibility of State Rehabilitation Councils and Independent Living Councils are core pieces that are connected to employment, education, and training to assist people with disabilities in achieving full community participation. Even so, the employment of people with disabilities as one key component of community involvement remains extremely low. According to Cornell University in 2007, nationally only 36.9% of working-aged people with disabilities were employed as compared to 79.7% of their non-disabled peers. The rates are comparable in Maine with 38.6% working-aged people with disabilities employed as compared to 83.3% of non-disabled peers that same year. Of great concern at the time of this report is the economic recession mentioned above and its impact on the employment of people with disabilities. Not only are fewer jobs available, but services are being cut as agencies receive less funding. In Maine, State Government was forced to curtail expenditures in 2008 and was grappling with anticipated deficits in 2009 through 2011. Federal funding for DVR is fixed by a formula based upon population growth and state average population, and established by Federal appropriation with approximately a four to one state match.  Although the Division has historically been successful in meeting the state match and maintenance of effort requirements, this might not be possible in 2010 and 2011 as result of across the board state budget cuts.   Current projections are that DVR funding, both State and Federal combined, will lose $1,336,503 in SFY 2010 and $1,229,729 in SFY 2011.  C. Availability of Employment-Related Services to People with Disabilities in Maine As highlighted by the Maine Jobs Council’s Commission on Disability and Employment in their 2008 Annual and Progress Reports, many efforts in Maine attempt to address the availability of employment-related services to people with disabilities. With funding from a variety of sources, such as the Medicaid Infrastructure and Work Incentive Grants, initiatives are underway that are designed to increase the access to employment for people with disabilities through the engagement of employers, preparation of young people with disabilities from school to work, provision of accurate and timely benefits counseling, and the improvement of services provided to people with disabilities at Maine’s CareerCenters through Disability Program Navigators. Additionally, revisions in Social Security Administration’s Ticket to Work Program in July 2008 hold promise for increasing the availability of employment services to individuals who receive SSI and/or SSDI through Employment Networks. Clearly, individuals with disabilities often need a broad array of services and supports to reach and maintain their vocational goals. The Division of Vocational Rehabilitation is an important part of this service system, but it is only one component of the larger system in Maine that includes the Departments of Labor, Education, and Health and Human Services and numerous private non-profit agencies. Each month the Office of Adult Mental Health Services provides long term vocational support to an average of approximately 150 individuals with mental illness, and the Office of Adults with Cognitive and Physical Disabilities similarly provides employment supports to over 900 individuals through Medicaid waiver funding. Reports from the Bureau of Employment Services also indicate that the number of people with disabilities getting CareerCenter services each year is increasing, from 2,822 in 2006 to 4,525 in 2008, although it is notable that the percentage of people with disabilities served as part of the larger CareerCenter customer population remains relatively unchanged at 7.5%. Maine lacks an employment services data collection system that compiles information across departments or organizations, so it is unclear how the system works as a whole in serving people both individually and collectively. Additionally, for some employment services, such as that provided by the Bureau of Employment Services, disclosure of a disabling condition is not required and relies upon the self-reporting of individuals using the service. Hence, disability data may be inaccurate or incomplete. III. DVR SERVICES TO INDIVIDUALS IN MAINE The Division of Vocational Rehabilitation collects a variety of information about individuals when they enter the program, tracks the 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, competitive 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 through 2008. A. DVR Population Characteristics Examining data collected about individuals who have moved through the DVR process to closure yields valuable information about the population served. In Federal Fiscal Year (FFY) 2005, Maine DVR closed a total of 2,847 cases and in FFY 2008, Maine DVR closed a total 3,604 cases, an increase of 21%.8 Table 1 outlines the characteristics of the individuals represented among all closed cases in both years, the percentage change in the number of clients with a given characteristic (fifth column) and the change in the proportion of clients with a given characteristic (last column). Findings * As part of the eligibility determination process, DVR staff record applicants’ primary disability type. In FFY 2008, there were 1,289 (36%) cases closed where the individual had a mental illness, 1,102 (31%) with a cognitive disability, 850 (24%) with a physical disability, and 265 (7%) where the individual had a sensory disability, including either hearing or visual impairments. A small fraction (3%) of closed cases were for individuals with no impairment (and who were deemed ineligible for services.) * The majority (58%) of cases closed in FFY 2008 were for people between the ages of 23 and 54, although a substantial portion (29%) were transition-age individuals under age 23 at the time they applied for VR services. * More than 4 out of 10 cases closed were for clients who did not have a high school diploma or GED at application, and almost 8 out of 10 did not have more than a high school education. * There continue to be more men than women (58% versus 42%) receiving VR services. * The vast majority (97%) of the VR population is White, and only 3% are members of a racial or ethnic minority. * In FFY 2008, there were 735 (20%) cases closed for individuals who received Supplemental Security Income or SSI. In addition, 870 or 24% received Social Security Disability Insurance (SSDI). * Between FFY 2005 and 2008, there were several notable changes in both the characteristics of the DVR population. o Continuing a trend observed in the previous needs assessment, both the number and proportion of cases closed for individuals with cognitive disabilities have continued to increase; there were 785 individuals with cognitive disabilities in FFY 2005, and 1,102 in 2008, an increase of 29 percent. Cognitive disabilities actually overtook physical disabilities to become the second most common type of disability among DVR clients. o While older adults make up a relatively small part of the entire VR population, their numbers grew substantially from FFY 2005 to 2008. There were only 182 cases closed for adults over age 55 in 2005, and that number grew by more than sixty percent to 462 in 2008. TABLE 1 DVR Process Flow 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 applications has followed an uneven trajectory over the past six years. New applications fell from 3,587 in 2003 down to only 2,278 in 2007 before rebounding back to 3,158 in 2008. * The development of new Individualized Plans for Employment (IPE) decreased 30% from 2003 to 2005, from 1,644 in 2003 down to 1,146, but remained about the same from 2005 to 2008. CHART 1 Chart 2 looks more closely at the open DVR caseload (Status 02 – 24) at the end of the Federal Fiscal Year from FFY 2003 to 2008, and breaks out cases by the number of individuals who are: waiting for an eligibility determination (Status 02), on the waiting list (04), off the wait list and in IPE development (Status 10), and the remainder who have completed IPE’s and are in plan implementation (Status 12 – 24). The chart illustrates that, while the total number of active cases has stayed between 7,400 and 8,000 across all six years, the number of clients at each stage in the VR process has shifted. The number on the waiting list increased dramatically from 2003 to 2004, from 1,354 to 2,201, but was reduced even more dramatically in 2006 down to 1,188. However, the number of clients in plan development jumped from 2,118 in 2005 to more than 3,100 in 2006, and remained at similar levels through 2008. A significant ongoing trend across the entire period is the decline in the number of active cases involved in plan implementation. In September 2003, more than 3,500 active cases were in the plan implementation phase of the VR process, almost 50% of all open cases. That number declined to just over 3,000 in 2005, and was only 2,600 in September 2008, representing just over one third of all active cases. 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 2008, 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 from 2003 to 2006, where it reached a low of 643, but rose in 2007 and again in 2008 when there were 730 successful closures. * 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), followed a similar pattern as successful closures. From a high of 904 in FFY 2004, Status 28 closures declined to a low of 638 in 2006, and then rose to 759 in FFY 2008. * The most apparent trend in Chart 3 is the steady rise in the number closures to cases where the individual had been determined eligible but had not yet developed an IPE (Status 10-30 closures). Starting at 814 in FFY 2003, these closures grew by an average of 168 each year, reaching 1,655 in FFY 2008. * 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 from 2003 to 2008, from 31 to 39 months– an average of more than 3 years. * The length of time it takes to determine eligibility fell from 3 to 2 months in 2003 and 2004, and then remained at about 2 months through the remaining years. * The length of time it took for eligible individuals to move from eligibility determination to completion of their IPE (Eligibility to IPE) tripled from 2003 to 2006, from 4 months to 12 months. It remained at about 12 months through FFY 2008. 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 Keeping 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 the 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 * Regardless of the type of closure, time spent in the VR process increased from 2003 to 2008. Individuals whose case closed before receiving IPE services went from an average of 15 months in FFY 2003 to 22 months in 2008. And time in the VR process for Status 28 closures increased from 33 to 49 months over the same period. * Among the cases closed after receiving IPE services in FFY 2008, 42% were closed because the individual refused further services, and 40% were closed because the VR counselor was unable to locate or contact the individual (not shown). Similar proportions were observed among Status 28 closures (40% refused services, 37% could not be contacted). CHART 5 B. 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). 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) was an average of 49% from 2003 through 2008, and varied by only a few percentage points across this period. (See Appendix 3). * Rehabilitation rates are highest for clients with hearing loss, followed by those with cognitive, physical and mental illness-related disabilities. CHART 6 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 describes the change in average earnings among all successful closures. Findings * Average weekly earnings increased by more than 244% among 2008 closures, from $93 at time of application up to $320 at closure date. Similar increases were observed among cases closed in all of the other years as well. CHART 7 Looking at the earnings and hours worked per week among successful closures by type of disability (Charts 8 and 9), we find that clients who are deaf or hard of hearing have the highest average weekly wages ($508) and hours worked (35), followed by those with physical disabilities ($324/week and 27 hours), cognitive disabilities ($276/week and 27 hours), and mental illness ($245/week and 24 hours). CHART 8 CHART 9 Another important outcome of the VR program is the change in education level among individuals who are served. Chart 10 compares the education level of all closures from FFY 2008 at the time they applied for services to their education level at closure. Findings * It should be noted 507 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 242 people increased their education level to postsecondary courses, degrees or certifications, and 68 achieved a college degree. CHART 10 C. DVR Services and Expenditures Costs Maine’s DVR program and the 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. Based on the information gathered for the 2007 DVR State Plan Comprehensive Needs Assessment, the agency developed and deployed Procedural Directives and training for specific services such as; transportation and vehicle repair, post-secondary education and self-employment. An emphasis on stewardship of public funds was initiated in 2008, which tightened fiscal spending and enhanced case review. This section highlights trends in annual costs of DVR services and the service areas where these costs are concentrated. DVR classifies services into nearly 100 categories. For presentation purposes in this report, these categories are aggregated into a smaller set of eleven service groups, described below in Figure 1. FIGURE 1 Description of Vocational Rehabilitation Service Groups VR Service Group Example Services Job Development & Placement Job Development, Analysis, Placement & Referral College or University Training Tuition, boarding, fees, books, school supplies for college/university On-the-Job Supports Job coaching both at the worksite and off site & on the job training Assessment Community based situational assessments, and disability related evaluations Occupational / Vocational & Other Training Business/vocational training, books, supplies, boarding, tutoring, fees, adult education, literacy, mobility training, truck driving school, etc. Transportation Cab/bus fares, car repair, gas Hearing Aid Provision of hearing aids, molds and repair Rehabilitation Technology Augmentative computer equipment, software, training, home/ building or vehicle modifications Maintenance Clothing, child care, food and shelter to enable IPE Diagnosis & Treatment Medical exams, treatment, therapy & counseling All Other Services Readers/interpreters, occupational tools & equipment, services to family members, purchased counseling & guidance Table 2 details DVR paid authorizations from FFY 2006 through 2008, broken out by service group. Findings * Total expenditures increased from $7.7 million in FFY 2006 up to $8.6 million in FFY 2007, and then went back down to $7.4 million in FFY 2008. Total DVR expenditures can fluctuate from year to year. * Job Development & Placement is the largest single service group, representing 20 to 22 percent of total DVR case costs each year. Spending on this group grew by 6% from FFY 2006 to 2008, from $1.55 to 1.64 million. * Spending for College or University Training has grown significantly, continuing a trend that has been ongoing for the past six years; total expenditures grew from $1.27 million in FFY 2006 to $1.5 million in FFY 2008. * Assessment spending also grew significantly, from $479,000 to $661,000, overtaking both Occupational/Vocational training and transportation for the fourth highest service category. * A number of service groups saw large decreases in spending. Transportation costs were almost $740,000 in FFY 2006, increased slightly to $760,000 in FFY 2007, but then dropped by more than 40% to only $590,000 in FFY 2008. (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.) And spending for Rehabilitation Technology and Maintenance both declined by more than 60% from FFY 2006 to 2008. TABLE 2 Source: Tracker (SSA-VR Claims System) Chart 11 shows the percent of all DVR expenditures in FFY 2008 that were spent on each type of service group. 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 2008, with a total of $3.96 million – 53 percent of the $7.45 million in total DVR expenditures that year. CHART 11 Chart 12 outlines the trends in service costs over the past three federal fiscal years, FFY 2006 to 2008. The results underscore the growth in College or University Training and Assessment costs, and the decline in Occupational/Vocational Training and Transportation, particularly from FFY 2007 to 2008. CHART 12 On a per-person basis, the average rehabilitation cost has been rising over the past several years. Between FFY 2004 and 2008, the cost per successful closure rose from $5,282 to $6,611, increasing an average of $332 each year. Over the same period, the average cost for all types of closures declined slightly, from $2,394 to $2,356 as seen in Chart 13 below. CHART 13 D. Consumer Satisfaction Survey 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, LLC, 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 2008. In 2008, New Hampshire Vocational Rehabilitation and the Vermont Division of Vocational Rehabilitation were also surveyed with the same instrument allowing these New England states both a local a regional perspective on service delivery. 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. Alternative formats were available at the consumer’s request. Table 3 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, 2006, and 2008. Findings * While the level of satisfaction among all clients did not increase (and perhaps experienced a slight decline since 2006), there were certain trends in at least one region that did indicate a sizeable increase in client satisfaction. * The percentage of clients reporting problems has been steadily declining since 2003. Further, among those indicating they experienced problems, the percentage reporting the Division did work to resolve the problem has increased since 2006. * While clients raised a number of concerns or issues, for the most part these were minor issues that had to do with the need for some additional support, communication, providing information, and more responsiveness to clients’ needs. * It also shows that individuals going through the VR process are treated with dignity and respect and they would recommend VR to others with similar disabilities. * Among the clients indicating that working with more than one counselor affected the services they received, the most frequently cited concern was that they had to wait for a new counselor in order to get services (13%), and their new counselor was/is a disappointment (13%). Others mentioned their counselor was/is an improvement (11%), the counselors varied in enthusiasm, ability, and knowledge (11%), and months passed without a counselor or support (10%). TABLE 3 MAINE DIVISION OF VOCATIONAL REHABILITATION OVERALL SERVICE SATISFACTION 2003 2006 2008 Number of completed surveys 726 741 732 Percentage of respondents: Very or somewhat satisfied with Maine DVR Program 85% 83% 82% Satisfied with the services received 82% 82% 82% Services provided by Maine DVR compared favorably to services offered through their ideal program85%79%76% Would tell their friends with similar disabilities to go to Maine DVR for help94%94%94% Services met expectations 79% 80% 78% Maine DVR staff treated them with dignity and respect. 97% 94% 98% Clients reporting problems with the agency 29% 26% 24% Clients reporting having more than one counselor affected their ability to get services13%33%39%E. Consumer and Stakeholder Input At its 2008 Annual Meeting, the DVR State Rehabilitation Council (SRC) held a consumer forum and extended invitations to close to 500 individuals who had been successfully employed with assistance through VR in the previous 5 years. The consumer forum questions were: how was VR helpful, what were the barriers in your VR experience, and what could VR have done better. Three individuals attended and shared their personal experience with the VR process: * One individual was very happy with the result of his work with VR. He was still self-employed, his time in the program was short and he was happy. * Another individual’s initial experience was very positive and he was able to advance in employment. However, after a change in his abilities and moving to another location, he found it frustrating to be job-hunting again. His overall impression of VR was positive, but he felt it takes too long. * The last person’s path was more frustrating; getting a job was not a problem, but maintaining employment was. She felt her chronic, cyclical disability was her major barrier to maintaining employment and that VR was not a good fit. She, too, complained about the length time she had to wait for services. Given the low consumer turnout at the Annual Meeting, the SRC subsequently contacted 17 groups of agencies, providers and councils (stakeholders who represent and/or serve a broad spectrum of individuals with disabilities). Letters were sent that asked if the individuals with disabilities they knew were interested in employment and what services were needed. Additionally, the SRC inquired if individuals were being served by VR, what was helpful and what was not, and lastly, for the individuals in employment, what issues they were confronting. The SRC received responses from over 50% of those contacted. The responses included both agency and consumer input, representing multiple groups of individuals with disabilities. All groups mentioned a concern in the availability of transportation, both public and personal. Maine does not differ from other rural states in this respect. Other barriers to employment and/or VR services mentioned were the need to eliminate DVR’s waitlist, better career exploration, and the need for consumer friendly literature about the VR process and the purpose of VR services. Maine’s community of culturally Deaf individuals strongly requested that services and information about VR be made available in a more understandable format for them. Also identified was a need for VR Counselors and job coaches to have additional training to work with individuals with specific disabilities, such as autism spectrum disorder. Respondents also expressed a need for DVR to develop a partnership with the Veteran’s Administration and work with the CareerCenters to augment services to returning Veterans with disabilities. IV. ESTIMATING POPULATION ELIGIBLE FOR DVR SERVICES AND UNMET NEEDS A. American Community Survey 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.9 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.” 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 details the sample selection process used to identify the ACS work disability population. Findings * In the 2006 and 2007 ACS, which was used to estimate the DVR-eligible population in the State, the first row indicates that in both 2006 and 2007 over 8,000 working-age adults in Maine between the ages of 16 and 64 were interviewed for the ACS. Based on the sample from 2007, the Census estimated that there were a total of 869,000 working age adults living in the State. * The second row adds the work disability criterion, showing that in 2007, a total of 855 respondents in the ACS reported a work disability, representing an estimated 91,000 Maine adults (10.5% of all Maine adults). * The final row adds the requirement that sample members be currently unemployed. In 2007, we identified a total of 727 individuals in the ACS sample with a work disability who were not already working. Based on these 727 individuals, we estimate that in 2007 there were a total of 77,000 DVR-eligible adults in Maine (84.5% 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. This 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 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 (DBVI). Over the last three years, 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 DBVI 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.10 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 2006 and 2007 ACS who met the work disability definition, for a total sample of 1,398 individuals. The results are shown in the second column of Table 5. Findings * The most common type of disability among the work disability population is physical, at 66%. * About half report a mental disability (defined as difficulty learning, remembering or concentrating). * Over a third report difficulty in going outside their home alone. * Over one in five 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. * 89% of individuals (all of whom report a work disability) also reported at least one additional Census disability type11 (not shown). 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). * Over one third of the population is ages 55 to 64. * 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 13% 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.) * 5.3% belong to a racial or ethnic minority. * Twenty nine percent 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 38%. 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 not being reached by the DVR program, in Table 5 we compare the characteristics of ACS work disability sample against information collected by the agency on current DVR individuals (Table 1, on pg. 8). Disability type information is not presented as a side-by-side comparison because the ACS disability measures are not comparable to the way that DVR collects primary disability type from each applicant. * Table 5 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 42% lacking a HS degree versus only 25% in the ACS work disability sample. * DVR individuals are also more likely to be male (58% versus 45%). * 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 (20% versus 30%) and less likely to receive SSDI (24% versus 36%). Maine’s SSI and SSDI participation rates are higher than Vocational Rehabilitation programs in states with similar VR expenditures. * Table 5 indicates that DVR serves proportionately fewer individuals of racial or ethnic minorities than those identified in the ACS work disability population. B. 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.12 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 6 lists the number of Maine recipients of both programs by VR Region from December 2007. Findings * It shows that there were more than 31,000 SSI recipients, and almost 47,000 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 64,700 Social Security beneficiaries with disabilities living in Maine, all of whom would meet the DVR eligibility definition of “substantial impediment to employment.”13 TABLE 6 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 14 compares the distribution of open Maine DVR cases, SSI recipients, and SSDI recipients from December 2007. 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 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 14 Student population Students with disabilities currently enrolled in special education in Maine schools represent a current and potential future group of clients who will need services from the Division of Vocational Rehabilitation. The bars in the following chart, Chart 15, show the number of special education students who will need “vocational training and job placement” as of December 2007, broken out by VR Region. The number of transition counselors in each region is also displayed (in terms of Full Time Equivalents), as a measure of existing capacity in DVR to serve youth with disabilities. Region 1 has the largest number special education students needing VR services (1506), followed by Region 3 (1197), Region 4 (1079), Region 2 (1045) and Region 5 (268). For the most part, the number of transition counselors in each VR region mirrors the number of special education students who need VR services. Region 1 has the highest number of transition counselors (8), and Region 5 has the least (1.5 FTEs). The one exception to this pattern is Region 4, which has more special education students than Region 2, but fewer transition counselors. CHART 15 Source: Maine Department of Education - EF-S-05 Reports December 1, 2007 Child Count State Totals Report by Anticipated Services and County, Ages 14-21 at Data Collection http://www.maine.gov/education/speced/EFS05/public_reports.htm Downloaded 2/9/09. Transition Counselor information from Maine DVR. This is more clearly illustrated by comparing the number of special education students needing VR services per transition counselor in each VR region.14 Region 4 stands out clearly in this chart relative to the other parts of Maine, in that there is only 1 transition counselor for every 360 special education students needing VR services. In all other regions there is at least 1 counselor for every 209 students needing VR services, and the average is 1 counselor per 194 students. The relative lack of transition counselors in Region 4 does not appear to lead to worse employment outcomes, however. Chart 16 also shows the rehabilitation rate (Status 26 closures / Status 26 + 28 closures) for FFY 2008 among transition-age DVR clients. Overall, the rehabilitation rate for all clients under age 25 at application was 46 percent, and the rehabilitation rate for Region 4 was right at the state average. Transition youth in this region may be obtaining needed services from other parts of the vocational rehabilitation system, such as through schools or Career Centers. CHART 16 V. COMPARISON TO OTHER STATES Comparing Maine’s Division of Vocational Rehabilitation to its peer state VR agencies can provide further insight into areas for focus in the coming years. Maine’s peer states include Idaho, Montana, New Hampshire and Vermont. These states were selected as “peers” because each state’s VR program served between 4,100 and 7,900 individuals in FFY 2007, have grants of similar size ($13 to $17 million) from the Rehabilitation Services Administration, and are largely rural states with less than 1.5 million total population.15 It should be noted that the VR agencies in both Montana and New Hampshire serve individuals with blindness and visual impairments under a single combined agency, unlike Maine, Idaho and Vermont where these individuals are served by a separate unit. Also, Maine was the only state among this set of peers with a waiting list in effect during FFY 2007. The employment rate among individuals whose cases were closed after receiving services in FFY 2007 varied 51% to 68% as seen in Chart 17. Maine has the lowest overall rehabilitation rate among its peer states. CHART 17 Rehabilitation Rate, FFY 2007 Breaking out the FFY 2007 rehabilitation rate by disability type, we see that the same general pattern observed in Maine exists in all the peer states in Chart 18; individuals with communicative impairments tend to have the highest rehabilitation rates, and those with mental and emotional disabilities tend to have the lowest. (Note that individuals with visual impairments are not included in these figures.) Compared with the peer state average (far right bar), Maine’s rehabilitation rates (far left bar) are significantly lower for three of the four disability types. Only among individuals with communicative impairments does the Maine rehabilitation rate match its peers. CHART 18 Rehabilitation Rate by Disability Type FFY 2007 Among successful closures, Maine has the lowest average hours worked per week, but average earnings are actually the highest among any of its peer states Chart 19. CHART 19 Average Hours per Week and Hourly Earnings for Successful Closures, FFY 2007 Again breaking out the employment outcomes among successful closures by disability type, Charts 20 and 21, we find that in terms of average hours worked per week, Maine lags its peers only for clients with physical disorders and those with mental and emotional disabilities. Maine actually exceeds the peer averages among those with communicative impairments. And we find that average hourly earnings at case closure in Maine exceed the peer state average by more than $1 among those with physical disabilities, and among those with communicative impairments. CHART 20 Average Hours per Week for Successful Closures by Disability Type, FFY 2007 CHART 21 Average Hourly Earnings for Successful Closures by Disability Type, FFY 2007 Compared to its peer state VR agencies, Chart 22, DVR clients with successful employment outcomes spent an average of 14 months longer in the VR process. CHART 22 Average Time (in Months) between Application and Closure for Individuals with Successful Employment Outcomes, FFY 2007 VI. DISCUSSION Although challenged by an economic recession and severe state budget shortfalls, DVR continues to provide vocational rehabilitation services to thousands of Mainers with disabilities each year. In an effort to conduct a Comprehensive Statewide Needs Assessment, DVR and its State Rehabilitation Council gathered and analyzed a wide range of information, including the agency’s own performance data, existing disability population statistics, disability population projections, and input from stakeholders. As with the 2006 Needs Assessment, individuals served by DVR are generally very satisfied with the services that they receive and report feeling that they are treated with dignity and respect. In the last three years, however, increasing frustration has been noted with the wait for services and counselor turnover. Although time spent on the waiting list stabilized at six months, time to develop an employment plan (IPE) has increased. The overall average of time from application to closure is over three years, which is significantly longer than other peer states. In terms of case service expenditures, job development and college or university training remained DVR’s highest cost areas, consistent with the findings in 2006. Of note, is that a secondary analysis of the agency’s post-secondary expenditures found that individuals who were able to complete a post-secondary degree or certificate were more likely to find and keep a job, achieve fulltime employment and have a higher income. In considering the information provided by the Consumer Satisfaction Survey and various stakeholder inputs, things noted include: establishing clear expectations with consumers on what they can expect from the VR process; the importance of timely communications and the availability of counselors to respond to individual needs; the challenges of Maine’s inadequate transportation system; insufficient career exploration, job fit and range of employment options; and unfamiliarity of general VR Counselors with specific disabilities and impairments. In the areas of unserved and underserved groups, existing disability population statistics suggest that Maine has a large population of individuals with disabilities, including those receiving SSI and/or SSDI, who might benefit from services through DVR. Additionally, two other groups were identified in the assessment that should be anticipated as needing VR services in the future. The first is students with disabilities identified by the Department of Education as needing career services and education upon exiting high school. Many of these students have been identified as having Autism Spectrum Disorder. The other group is Veterans returning from Iraq and Afghanistan who have sustained injuries and are in need of vocational rehabilitation services. Services to minorities with disabilities in Maine have always been a challenge to DVR. DVR has long attempted to provide services to the state’s Native Americans and after several attempts, successfully supported the Houlton Band of Maliseets to be awarded a five-year Section 121 grant award in FY 2009. Through a memorandum of understanding, DVR has an opportunity to better serve tribal members. While the population of other minority groups is slowly increasing in Maine through resettlement programs and migrant employment, DVR outreach has not always been accepted or understood. DVR staff could benefit from continued cultural sensitivity training specific to the individuals in Maine, like the Somalis in Lewiston. VII. RECOMMENDATIONS Maine’s Division of Vocational Rehabilitation is embarking on a major initiative to eliminate the wait list and provide the “right service at the right time” to its consumers. Maine DVR plans to go “back to the basics” by evaluating each major process point with consumers. DVR has identified these points as: “Entering the VR System”, “VR Plan Development”, “VR Plan Accomplishment” and “Exiting the VR System”. The goal is to provide services to all eligible consumers at the time that they need them to achieve competitive, community-based employment. This Comprehensive Statewide Needs Assessment lends strong support to the importance of DVR’s initiative and clarifying its purpose, targeting resources, engaging other service providers, and streamlining services. As DVR proceeds, it is recommended that: * DVR review all the materials shared with consumers to ensure that that they are clear about the agency’s purpose and are accessible in multiple formats, both linguistically and culturally. * VR Counselors and community-based agencies engaged to provide employment services be provided training to increase skills in serving specific disability and ethnic populations. * DVR address the high numbers of individuals in Plan Development (Status 10) with a focus on those who drop out of the program and how the determination of a vocational goal can be improved, including through better career exploration. * DVR implement a community rehabilitation provider “report card” in compiling and communicating employment outcome results. * A Memorandum of Understanding (MOU) with the Veteran’s Administration be developed to better coordinate services for returning Vets with disabilities. * The MOU with the Department of Education be reviewed and revised as necessary to more efficiently serve students with disabilities in the transition to adulthood. * DVR evaluate and address issues in its case closure processes and recidivism. 1 34 CFR 361.29 2 Maine Department of Labor, Division of Vocational Rehabilitation Policy Manual 2007 Final Rules Last Amended October 25, 2008 http://www.maine.gov/rehab/dvr/vr.shtml Downloaded March 19, 2009 3 Ibid. 4 Wise, Kurt and Sarah Richards. September 2008. State of Working Maine 2008. Maine Center for Economic Policy. http://www.mecep.org/view.asp?news=412 Retrieved January 27, 2009. 5 Maine Department of Labor. December 2008. Research Brief: Maine’s Job Performance from the Beginning of the Recession through November 2008. http://www.maine.gov/labor/lmis/pdf/Maine's%20Job%20Performance.pdf Retrieved January 27, 2009. 6 Wise, Kurt and Sarah Richards. September 2008. State of Working Maine 2008. Maine Center for Economic Policy. http://www.mecep.org/view.asp?news=412 Retrieved January 27, 2009. 7 Ibid. 8Closures in Table 1 include all types of closures, including successful closures as well as cases where the individual was found not eligible, left the wait list, found their own employment, did not complete their VR plan, etc. 9 For more information on the ACS, see http://www.census.gov/acs/www/ 10 Weathers, Robert. 2005. A Guide to Disability Statistics from the American Community Survey. Cornell University School of Industrial & Labor Relations. http://digitalcommons.ilr.cornell.edu/edicollect/129 11 See Appendix 2 for the specific questions that the Census uses to identify each disability type. 12 Maine Division of Vocational Rehabilitation Policy Manual. (July 1, 2004) 13 To compute this estimate, we assume that the proportion of all Maine SSI recipients (both aged and disabled) who are also eligible for SSDI (42.7%) is the same for disabled SSI recipients only. So there are: 31,112 SSI Recipients with disabilities + 46,900 SSDI Recipients with disabilities - 13,288 SSI recipients with disabilities who are also eligible for SSDI -------------------- = 64,724 SSI and SSDI recipients in Maine with disabilities 14 This is computed by dividing the number of special education students who will need vocational training and job placement services by the number of transition counselors for each VR region. For example, in Region 1: 1,506 special education students needing VR services divided by 8 transition counselors = 188.3 students per counselor. 15 RSA Annual Review Report Table 1: Program Highlights, FFY 2007. Available at: http://rsamis.ed.gov/quick_tables.cfm ?? ?? ?? ??