Cerebral Palsy and Vocational Rehabilitation

The Federal/state vocational rehabilitation (VR) system has been in existence since 1920, funding for which is mandated by the Federal Rehabilitation Act. The VR program was originally designed to serve people with physical disabilities until the Federal statute was amended in 1943, allowing services for people with mental illnesses and developmental disabilities. The structure and guidelines of the current VR system, however, remain better suited to the needs of people with stable, non-declining physical disabilities such as cerebral palsy, than to those with relapsing disabilities such as long-term mental illness.

The Federal Rehabilitation Act defines a disability as any mental or physical condition that substantially interferes with a major life function. Areas of functioning identified in the statute include mobility, communication, the ability to set and pursue goals, work endurance, the ability to acquire and express work skills, and the ability to form and support interpersonal relationships.

At the Federal level, the VR program is administered by the Rehabilitation Services Administration (RSA), which awards annual grants to each state to operate its own VR program. In each state and territory a designated state unit administers the VR program (for example, in Illinois, it is administered by the Illinois Department of Human Services), with considerable autonomy in how these services are operated. State-employed vocational rehabilitation counselors determine eligibility for VR services based on Federal guidelines, provide vocational and supportive counseling and job placement services, purchase or locate alternative sources of funding for services to help people achieve vocational goals, monitor and coordinate the delivery of these services, and monitor individuals’ progress. Among the services funded by state VR agencies are: situational, on-the-job assessments of work performance; personal adjustment training to assess and build the "soft skills" (e.g. co-worker relationships) needed for job success; work adjustment training to build stamina, attendance, etc.; on-the-job training that pays the employee’s salary for a limited time after job placement; and time-limited job coaching to provide employee/employer support on and off-site.

In addition, supported employment, allocated to states on a formula grant basis, has been incorporated into the VR program as a supplement to services provided under the standard VR program. Supported employment closure is achieved when the person with the disability maintains employment for 90 days or more under Federal criteria. The key standard by which the Federal government judges the success of the state VR programs is the number of successful closures generated each year.

Since all categories of people with severe mental or physical disabilities are potentially eligible for VR services, state rehabilitation counselor caseloads often are large and may include individuals with a wide range of disabilities. These include individuals with cerebral palsy, spinal cord injuries, HIV, histories of alcohol and substance abuse, neurological disorders, musculoskeletal disorders, cancer, heart disease, mental illnesses, developmental disabilities, those who are deaf and/or blind, among other disabling conditions. In addition, state rehabilitation counselors are expected to be conversant with a daunting array of technologies and with the professions that employ them.

The short-term goals of the national rehabilitation program are to enable people with impairments to function at their highest possible physical, social, and psychological level. The longer-term goals have to do with society’s desire to increase an individual’s ability to work or otherwise function independently, thereby decreasing public expenditures. Thus, rehabilitation counselors often face competing priorities in terms of furthering the social mission of the program within the context of the agency’s competing political concerns and fiscal limitations.

Individual Employment Plans (IEPs) require active involvement of individuals and significant others and allow individuals to choose their vocational goals, the services needed to achieve them, and their preferred service provider. Since VR establishes contracts with private vendors, it can connect individuals with agencies offering specialized services. IEPs represent an effective way to ensure that services are appropriate to meeting personal employment goals and can be modified to incorporate new and improved vocational rehabilitation services.

Individualized VR services can be the basis of continuing system improvement. Private community rehabilitation programs, in competing for VR funds, have a stronger incentive to seek more efficient and effective methods of helping consumers find jobs. VR counselors, encouraged by limited budgets, are likely to select providers that offer the greatest chance for successful closures.