Section Two: NIDDR Research Agenda

Several significant principles guide this discussion of NIDRR’s research agenda. First, a research agenda must allow for flexibility to facilitate response to evolving research questions. In a world where technological innovations and new research results can affect the relevance of other ongoing research, NIDRR must be ready to update its response to changes in the field as they occur and to readily incorporate its response into the research program. NIDRR research will focus on demonstrating outcomes that expand the knowledge base and that meet the needs of people with disabilities. Documenting outcomes is critical to demonstrating value, which is increasingly important in a resource-limited society. As mentioned earlier, NIDRR-sponsored research also must balance the demands of consumers for useful solutions with the demands of science for careful and rigorous methodology.

Overview

Unemployment and under-employment among working-age Americans with disabilities are ongoing and seemingly intractable problems. Data from the Census Bureau on the labor force status of people ages 16 to 64 in fiscal year 1996 highlight the magnitude of this problem. While four-fifths of working-age Americans are in the labor force and more than three-fourths are working full-time, less than one-third of people with disabilities are in the labor force, and less than one-quarter are working full-time (see figure 1). Fully two-thirds of working-age people with disabilities are not in the labor force. Some research suggests that a substantial portion of this staggering figure can be attributed to disincentives inherent in social and health insurance policies, to discouragement, and to a lack of physical access to jobs.

While the comparative rates of labor force participation and full-time employment are two indicators of the workforce status of individuals with disabilities, a comparison of earnings is even more striking. In figure 2, SIPP data illustrate the discrepancies in earnings between disabled and nondisabled working men and women.

Even when people with disabilities are employed full-time, their earnings are substantially lower than those of people without disabilities. The severity of disability also correlates inversely with the level of earnings. Disparities in employment rates and earnings are even greater for disabled individuals from minority backgrounds and those with the most significant disabilities (Stoddard, Jans, Ripple, & Kraus 1998).

Figure 1: Labor Force Participation of persons ages 16 to 64 in fiscal year 1996

Figure 2: Monthly Earnings of Working People By Disability Status

Economy and Labor Force Issues

Several emerging characteristics of the nation’s labor market exacerbate the difficulties that people with disabilities experience in their attempts to gain employment and even in their motivation to seek employment. Downsizing, for example, has led to a lower percentage of people with stable, long-term jobs with benefits. Many businesses and industries are moving to other configurations that fill their labor needs without requiring a long-term commitment on the part of the employer. The contingent workforce takes many forms, including on-call workers and those in temporary help agencies, workers provided by contract firms, and independent contractors who receive their wages or salaries directly from the company. Many of these jobs lack security and benefits, particularly health insurance, which most people with disabilities require to participate in the labor force.

In addition, many business spokespeople and educators point to the need for highly educated, highly skilled workers if the nation is to succeed in an increasingly competitive global economy. The reality, however, is more complex. On the one hand, the availability of jobs requiring specialized skills combined with rapid advances in technology may improve the employment prospects of people with disabilities as well as other workers, through such work arrangements as telecommuting and an expanding market for self-employment or small businesses. On the other hand, the labor market appears to be moving toward increasing bifurcation, with top-tier technocracy jobs for people with sophisticated work skills and lower-tier unskilled service and maintenance jobs for the less-prepared.

Assisting individuals with significant disabilities in moving from dependency on public benefits or family support, or from episodic, poor-paying jobs into stable jobs that will allow them to become self-supporting, is a complex challenge. This challenge involves a number of economic sectors, and service and support systems, and must include an examination of social policies. Providing appropriate assistance requires an extensive knowledge base encompassing economic trends, education and job training strategies, job development and placement techniques, workplace supports and accommodations, and empirical knowledge of the impact of social and health insurance policies on job-seeking behaviors.

State-Federal Vocational Rehabilitation Program

For the past 75 years, the primary source of publicly funded employment-related services to improve the employment status of disabled people––especially those with significant disabilities––has been the State-Federal Vocational Rehabilitation (VR) service program.

The program is currently authorized under the Rehabilitation Act of 1973, as amended, most recently in 1998. Funded at $2.2 billion in fiscal year 1998 in federal funds with a 22 percent state match for a total of about $2.7 billion, the program is implemented primarily as a case management system at the state and local levels. The rehabilitation counselors negotiate, on behalf of and in consultation with the consumer, the purchase of a package of services, such as medical interventions and support services (e.g., training, assistive technology, and help obtaining the appropriate tools) that will enable the consumer to find and keep a job.

In 1997, the OSERS Assistant Secretary testified before Congress on “Barriers Preventing Social Security Recipients from Returning to Work.” She noted, “As a group, people who achieve an employment outcome as a result of vocational rehabilitation services each year show notable gains in their economic status.” The percentage of people with disabilities who reported their earnings as their primary source of support increased from 18 percent at the time they applied to the VR program to 82 percent at the time they left the program (OSERS Assistant Secretary 1997). The percentage with earned income of any kind increased from 22 percent at entry to 92 percent at exit. The percentage working at or above minimum wage rose from 15 percent to 80 percent.

Nevertheless, federal policy-makers, consumers, advocates, and rehabilitation professionals remain concerned that people with disabilities often are excluded from full participation in the nation’s labor force. In the past several years, for example, SSA has experienced a very large increase in the number of people qualifying for SSI and SSDI. In addition, the public costs of these cash benefits are substantially increased by the addition of public support for associated Medicare and Medicaid programs. Further, neither SSA nor the VR system has experienced notable success in returning beneficiaries to the labor force. The VR system, while accepting SSI and SSDI beneficiaries for services at a proportionally higher rate than nonbeneficiaries, typically has less success with this group; that is, relatively fewer SSI and SSDI beneficiaries than nonbeneficiaries achieve employment outcomes as a result of VR services.

One of the major changes in the employment sector over the past three decades is the diversification of the labor force. Workers with disabilities are among the previously underrepresented groups entering the labor market in increasing numbers with raised expectations and legal protections for equal opportunity in employment. Even within the disability community, there is great diversity in the subgroups that have obtained or desire employment. It is very important that future research and service programs demonstrate in their design and implementation appropriate sensitivity to and adequate representation of the range of cultural and disability subgroups.

This issue should be examined not merely as a response to the current consciousness about multiculturalism, but also because the basic, implicit foundations of vocational rehabilitation counseling were developed for people who, in terms of demographic characteristics, work-related experience, and service needs, were quite different from today’s rehabilitation customers. Specifically, vocational rehabilitation techniques were originally imported from the earlier established disciplines of secondary vocational education and college counseling psychology. Recipients of services from these disciplines tended to have mainstream acculturation and tolerance for the competitive standards, verbal testing, and guidance common in academic environments. Given the cognitively compromised or socially disadvantaged status of many of today’s clients, additional scrutiny of the appropriateness and adequacy of the strategies and tools for vocational rehabilitation assessment, counseling, and training is imperative. Rehabilitation counselors need new marketing strategies to reach out to prospective employers to develop job opportunities for this diverse population of people with disabilities.

Community-Based Employment Services

NIDRR’s research agenda concerning employment addresses, but is not limited to, the State-Federal VR program, administered by NIDRR’s sister agency, the Rehabilitation Services Administration (RSA). While the VR program plays an important role, there is a wide range of other federal, state, and local funding sources for, and providers of, employment programs. These include approximately 7,000 community-based rehabilitation programs (CRPs), which serve about 800,000 people daily, and are funded by VR and/or such diverse sources as the Job Training Partnership Act (JTPA), worker’s compensation, or private insurance. Legislation such as the Workforce Investment Act and the Workforce Consolidation Act further diversifies the sources of support.

The role of community rehabilitation programs in the overall service delivery system may be enhanced even further if federal employment programs devolve to states and communities and if the intent to increase consumer choice in selecting service providers becomes more widely implemented. To respond to these developments, community rehabilitation programs must prepare to offer a full range of vocational services to an increasingly heterogeneous consumer population. Moreover, as return-to-work programs that base provider payments on successful consumer outcomes are implemented, new relationships between service providers and funding sources may emerge over the next few years. These new relationships will require that community rehabilitation programs adapt their current structure and operations in significant ways.

There are still a number of questions about how these changes may potentially influence the delivery of community rehabilitation services. For instance, the efficacy of different models designed to maximize competitive employment outcomes for people with significant disabilities or with specific types of disabilities is unknown. In addition, the impact of consumer choice on service delivery models is unknown. Finally, whether new funding mechanisms will promote increased competition and innovation in service delivery by community rehabilitation programs is a major question. Gaining knowledge in these important areas will allow validation of the assumptions upon which pending reforms are predicated. This knowledge may also shape the future direction of initiatives to enable more people with significant disabilities to obtain and retain meaningful employment.

Employer Roles and Workplace Supports

Employers play a key role in deciding employment outcomes for disabled people by establishing policies for recruitment, screening, hiring, training, promoting, accommodating, and retaining disabled individuals in the workforce. The provisions of Title I of the ADA prohibit discrimination against qualified job applicants with disabilities. Applicants are considered qualified if they can perform the essential functions of a job with or without reasonable accommodations. This statute creates duties for employers by requiring them to make the employment process accessible, provide reasonable accommodations, and focus on essential functions of jobs. These employer responsibilities cover all aspects of the pre-employment and post-employment phases. Through the requirements of workers’ compensation laws, bargaining unit agreements, and insurance provisions, employers have additional obligations to employees who become disabled.

Strategies to assist employers in meeting workplace obligations include disability management and workplace supports. Disability management is a term used to describe an array of support mechanisms and benefits that employers use to maintain employment for disabled workers.

Workplace supports are programs or interventions provided in the workplace to enable people with disabilities to be successful in securing and maintaining employment. Accommodations such as job restructuring, worksite adaptations, and improved accessibility are examples. Supported employment is a specific approach to improve employment outcomes for some people with disabilities, usually involving a job coach employed by a rehabilitation service provider to provide on-the-job assistance.

Technology can play a major role in making workplaces accessible and in enabling individuals with disabilities to complete work tasks by adapting tools and processes. Ergonomics, universal design, and assistive technology devices are all strategies to enhance workplace performance.

Transition from School to Work

NIDRR, along with RSA, OSEP, and the entire Department of Education, is particularly interested in the process by which disabled students make the transistion to productive work, rather than settle into a lifetime of dependency. This is a critical concern because the transition period presents a distinct opportunity to help students embark on a career, thus enhancing their community integration, independence, and quality of life. The transition into work occurs at many points: prevocational experiences, on-the-job training, secondary vocational education and other secondary education programs, along with postsecondary education at technical institutions, community colleges, or universities. These various transition points present opportunities for research on strategies for success in transferring from a learning environment to a work environment.

Research is ongoing regarding issues of postsecondary education for people with disabilities. This research shows that youth with disabilities face tremendous difficulties in accessing postsecondary education and making the transition from school to work. Most of the nation’s institutions of higher education offer support services to students with disabilities; however, this support is less certain for other types of postsecondary schools. When offered, services vary widely and may include customized academic accommodation, adaptive equipment, case management and coordination, advocacy, and counseling. A number of issues have been raised concerning the delivery of these services. Among these are issues of disclosure, accessibility of a range of services, and the extent and type of transition services needed to move from school to work.

Directions of Future Employment-Related Research

Given the magnitude of changes in the nature and structure of the world of work and possible changes in the characteristics of the disabled population, NIDRR’s employment-related research agenda for the next five years must extend beyond prior research efforts to discover mechanisms that will make the labor market more amenable to full employment for people with disabilities. That research agenda must incorporate economic research, service delivery research, and policy research.

Most important, NIDRR’s research must relate to the context in which employment outcomes are determined. Among the key policy issues that will affect the evolution of this agenda are SSA reform; restructured funding and payment mechanisms, including the use of vouchers; the impact of workforce consolidation; radical restructuring of employment training services at state and local levels; employment-related needs of unserved and underserved groups; linkage of health insurance benefits to either jobs or benefit programs; and transition from school to work among youth with disabilities.

An important focus for research will be changes in the environment (e.g., the workplace, information technology, telecommunications, and transportation systems) that will make work more accessible, along with strategies for assisting individuals to achieve both the skill levels and the flexibility required for full labor force participation in the 21st century. Finally, as a departure from NIDRR’s historical emphasis on the service system and the quality of services, the agenda calls for examination of economic issues (e.g., benefits and costs of various incentive plans) associated with employment of people with disabilities, labor force projections and analyses, and an increased understanding of employer roles, perspectives, and motivational systems.

The purposes of NIDRR’s research in employment are to:

• assess the impact of economic policy and labor market trends on the employment outcomes of people with disabilities;
• improve the effectiveness of community-based employment service programs;
• improve the effectiveness of state employment service systems;
• evaluate the contribution of employer practices and workplace supports to the employment outcomes of people with disabilities; and
• improve school-to-work transition outcomes.

Future Research Priorities for Employment

Economic Policy and Labor Market Trends.

As noted earlier in this chapter, NIDRR recognizes that the impact of macroeconomic trends on employment of people with disabilities, and public policy responses to these trends, is a large and complex topic, one that will require increased policy research attention in the next 5 to 10 years.
A coordinated research effort must examine such labor market demand issues as the changing structure of the workforce, skill requirements, and recruitment channels, in addition to issues on the supply side such as job preparation and skills, competencies, demographics, and incentives and disincentives to work. Specific research priorities include:

• an analysis of the implications for employment outcomes of cross-agency and multiagency developments and initiatives, including welfare reform, workforce consolidation, SSA reform, Medicare and Medicaid changes, the Department of Education-Department of Labor school-to-work program, and Executive Order No. 13078 (1998);
• an analysis of the dissonance between the ADA concept of essential elements of a job and the new employer emphasis on core competencies, flexibility, and work teams, and the impact of these differences on job acquisition and retention; and
• an analysis of the impact of labor market changes on employment of people with disabilities, including alternative employment arrangements such as small business entrepreneurship, self-employment, telecommuting, part-time work, and contractual work.

Community-Based Employment Service Programs.

Proposed restructuring of the financing of employment-related services for individuals with disabilities posits a major role for new or different service delivery arrangements. The capacity of the existing provider system, represented in part by the 7,000 community-based rehabilitation programs (CRPs) in the nation, to assume this role requires thorough investigation.

Specific research priorities include:

• an evaluation of provisions for accountability and control, and protections for difficult-to-serve individuals; an analysis of the costs and benefits of services; and a measurement of the quality of employment outcomes for consumers with disabilities;
• an analysis of the extent to which the services that CRPs deliver to VR consumers (about one-third of services received by VR consumers come from CRPs) differ in quality, quantity, costs, or outcomes from those provided to consumers of other financing systems (e.g., workers’ compensation or private insurance); and
• an evaluation of the potential of this community-based employment system to assume greater responsibility for service delivery under block grants, in consolidation into umbrella agencies, and in one-stop shop service configurations.

State Service Systems.

Amendments to the Rehabilitation Act in 1992 and 1998 called for a number of management and service delivery changes in the State-Federal VR program. These include expanded consumer choices regarding vocational goals, services, and service providers; the implementation of performance standards and accountability indicators to ensure improvement in the system; a greater role for consumer direction through State Rehabilitation Advisory Councils (RACs); and changes in the eligibility determination process that include presumptive eligibility and the order of selection procedures, among others.

The order of selection requires that individuals with the most significant disabilities receive priority for services, significantly altering the characteristics of VR clientele.

Specific research priorities include the following:

• an analysis of the impact of management and service delivery changes in the State-Federal VR program on the quality and outcomes of VR services;
• an evaluation of the impact of professionalization of the rehabilitation counselor workforce;
• an assessment of the efficacy of various methods of case management;
• the development and evaluation of outcomes measures for VR consumers under one-stop configurations;
• the identification and evaluation of marketing strategies to assist VR counselors in helping people with disabilities obtain jobs in a variety of employer settings;
• an assessment of interagency coordination in delivering services to multiagency consumers;
• an assessment of the outcomes of small business entrepreneurship and self-employment as strategies to improve outcomes for vocational rehabilitation clients; and
• an assessment of the applicability of traditional VR approaches for minority and emerging universe populations.

Employer and Workplace Issues.

One area that has received insufficient research is the workplace, including both the physical environment (e.g., job site accommodations, technological aids, and the like) and the social environment, comprising roles of co-workers, supervisors, and employers.

Specific research priorities include:

• the investigation of employers’ hiring and promotion practices;
• an evaluation of models of collaboration between rehabilitation professionals and employers;
• the development and evaluation of cost-effective strategies for improving the receptivity of the workplace environment to workers with disabilities;
• the development and evaluation of strategies for encouraging employers to hire disabled workers (e.g., tax credits, arrangements regarding partial support for medical benefits);
• an evaluation of the impact of new structures of work, including telecommuting, flexible hours, and self-employment on employment outcomes;
• the identification and evaluation of disability management practices by which employers can assist workers who acquire or aggravate disabilities to remain employed, transfer employment, or remain in the workforce and out of public benefits programs; and
• an analysis of the role and potential of the ADA in increasing job opportunities.

School-to-Work Transition.

Moving into employment from educational institutions is one of the most important transitions that people make during their lifetimes. The academic levels at which transitions to the labor market occur include during secondary school, at secondary school completion, and at completion of some level of post-secondary education. In recent years, the U.S. Departments of Education and Labor have collaborated to support the development of state and local systems whose broad mission is to prepare youth for success in the global marketplace.

Specific research priorities include:

• the determination of the impact of these state and local educational system initiatives on work opportunities for the nation’s youth with disabilities;
• the evaluation of whether school reform initiatives––such as academic-vocational integration, Tech Prep, career academies, work-based learning, and rigorous preparation in terms of critical thinking and communication skills––are accessible to and effective with youth who have disabilities;
• the identification of systemic and environmental barriers to full labor force participation;
• an assessment of whether inovations in school-to-work practices are accessible to youth with disabilities and determination of the impact of these practices on employment outcomes; and
• an assessment of the efficacy of employment and transition services for youth from diverse backgrounds and new disability groups.

Future employment research will provide information to develop new VR approaches for helping disabled individuals become competitive in the changing, global labor market. These new methods will focus on provision of culturally relevant services for clients, attainment of competitive job skills by clients, and the application of accommodations in the workplace.

Chapter 4: Health and Function