DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, SOCIAL AND REHABILITATION SERVICE, Washington, D.C., November 6, 1973. To: State Rehabilitation Agencies (General), State Rehabilitation Agencies (Blind), Regional Commissioners, SRS.

Subject: Fiscal year 1974 rehabilitation training.

Content: Fiscal year 1974 phaseout plans for the rehabilitation training program have been revised to provide support for State vocational rehabilitation agency in-service training, short-term training and long-term training in highly specialized rehabilitation fields.

Inquiries: Commissioner, RSA.

The FY 1974 phaseout plan for the rehabilitation training program has been revised and funds have become available for the support of certain rehabilitation training activities this year. These activities include State vocational rehabilitation agency in-service training, short-term training, and long-term training in the areas of rehabilitation of the blind, rehabilitation of the deaf, post-entry rehabilitation counselor training, rehabilitation facilities administration, and prosthetics-orthotics.

Grants for State vocational rehabilitation agency in-service training will be available in FY 1974 at the FY 1973 national support level. Funds will be distributed Regionally on the basis of State agency manpower data, but the amount available to any individual State may vary from the FY 1973 level. It is expected that the FY 1974 staff development activities for which special grant support will be provided will emphasize the rehabilitation of the severely disabled, the rehabilitation of the disabled public support recipient, improving the placement function in State agencies, implementation of Title XVI of the Social Security Act and the implementation of the Rehabilitation Act of 1973.

Rehabilitation short-term training will also be conducted in FY 1974 and funds will be made available for the support of national and Regional workshops, conferences, and seminars focusing on priority interest areas of the public rehabilitation program.

Long-term training grant awards to supplement previously awarded phaseout grants will be available to selected projects in certain areas. These areas include non-academic training programs in which alternative student support under the general Office of Education student aid program is not available, and highly specialized and expensive academic training areas which are not normally maintained in university curricula.

CORBETT REEDY, Acting Commissioner.

Mr. BRADEMAS. Thank you very much, Dr. Hansen. First I want to express my appreciation for how clearly you put together your statement.

Perhaps you could comment on a couple of questions. What new burdens on rehabilitation training programs will be imposed by the requirement of the new law that counselors direct their work toward persons with the most severe handicaps? Will that new emphasis mean new directions in your own training programs in the counseling field? Dr. HANSEN. Let me answer that question from two standpoints. First, if we look historically over the 53 years that we have seen State and Federal funding for rehabilitation programs, we have seen the guidelines for rehabilitation counselors that read from the Federal Register, that counseling, guidance, referrals, and placement for handicapped individuals, including followup and follow-on, and postemployment services, are necessary to assist such individuals to maintain their employment. Basically the rehabilitation counselor has been involved with counseling, guidance, working with the community, working with followup, and placing disabled clients within the labor force.

Rehabilitation counselor training programs have oriented themselves in this manner for the last years. The problem we are now facing is that we are facing disabling populations who are more severely disabled and this will call for greater knowledge and insight on the part of the counselor to understand the medical, psychological, and whole social aspects relating to and concerned with the severely handicapped.

I would say historically one of the first directions that started rehabilitation counselors moving toward looking at more in-depth type of problems came a couple of years ago when there was a strong emphasis on the disabled, disadvantaged citizen within this country. Rehabilitation counselor education programs met this responsibility, I believe, by beginning to reorient their curriculum to include course work and to look at the needs of the disabled citizen within this country, the citizen that was on and receiving welfare. I believe this is what we need to see at this time, there will have to be a change in our curriculum to develop programs that will attune themselves to the more severely disabled as we move more and more into this program to serve these particular individuals.

Mr. BRADEMAS. I will not ask you to respond with figures now, but I would be grateful if you could submit for the record any indications, particularly any statistics or figures you can that substantiate the point you make on page 7 of your statement where you site studies that conclude that rehabilitation counselors trained at the masters degree level are more likely to accept high risk clients, that is those with the most severe handicaps, than would rehabilitation counselors who had not done their masters work.

Having said that, would you be able to give us some such figures? Dr. HANSEN. I would have to ask what type of figures are you asking for?

Mr. BRADEMAS. You cite studies on page 7 of your statement, several of them, to the effect that counselors who have been trained at the masters degree level are more likely to accept high risk clients than would rehabilitation counselors who have not had their masters work. What I am requesting is that you subsequently, not now, supply us the statistical evidence from those studies or, indeed, any other studies that may be relevant.

Dr. HANSEN. I understand.

Mr. BRADEMAS. Can you do that?

Dr. HANSEN. I will do that, I will supply that evidence and I believe we will see this evidence coming through when we talk about the severely handicapped, not only working with the population of the severely disabled but also the mentally ill and mentally retarded also. [The information requested follows:]

NATIONAL REHABILITATION COUNSELING ASSOCIATION,
Washington, D.C.

To: Congressman John Brademas.
From: Carl E. Hansen,

Re: Trained vs. nontrained counselors in the delivery of rehabilitation services. In testimony provided 11/30/73 mention was made that graduate trained counselors accept more clients for service than nontrained counselors. This information was taken from a national study of 84,699 applicants for services from vocational rehabilitation agencies in the United States involving 2,448

counselors (Dishart, 1965). Chart XII of this study indicates that Master's level trained counselors accepted for services 56% of their applicants. As the level of training decreased so did the acceptance of clients.

One of the important areas where graduate trained counselors have their greatest impact is in the area of counseling. Brinson & Alston (1973) point out the Master's trained counselors' ability to function effectively in a counseling situation is significantly better than non-trained counselors. Bronson, Butler, Thoreson, & Wright (1967) demonstrated that graduate education is significantly related to professional concern. Professional sensitivity and greater counseling expertise will be necessary in working with the more severely disabled client. With the thrust to develop more concentrated services for the severly disabled, rehabilitation counselors can expect this population to have more serious problems of adjustment calling for greater professional concern and counseling expertise.

This is further highlighted by studies and reports dealing with severe handicapped conditions.

(1) Kreideu, N. A case study of a chronic and progressive disability. Journal of Rehabilitation, November, 1968.

This article deals with the gradual worsening physical condition of a client who is continually forced to readjust mental and emotional and vocational plans. It is pointed out that this type of client is in continual need of the services of the vocational counselor so that the individual has a better understanding of himself and of his environment.

(2) Nolan, J. Vocational assessment of the coronary patient. Journal of Rehabilitation, March, 1966.

This particular article points out the important factors influencing the vocational adjustment of cardiac patients. Vocational assessment and vocational counseling are two important factors in helping individuals adjust to a traumatic disability such as a heart condition.

(3) Savino, M., Belchick, T., & Bureau, E. The quadraplegic in a university setting. Rehabilitation Record, November-December, 1970.

This particular article deals with the application of rehabilitation counseling services pointing out the needed coordination and continuity of services necessary to provide adequate rehabilitation planning for quadraplegics within a university setting.

(4) Overs, R. R. & Healy, J. Educating stroke patient families. Final Report, Media for Rehabilitation Research Reports, Curative Workshop of Milwaukee, Wisconsin.

This final report describes a four year project of which two years were an intensive counseling casework demonstration of stroke patients and their families. Many more studies and reports are available pertaining to the problems encountered by the severly handicapped. The aforementioned articles point to the greater concern and counseling expertise needed by the rehabilitation counselor in order to work with the severly disabled.

In a final study conducted by Johnson and Koch (1969) it was reported that rehabilitation clients were more satisfied with their rehabilitation programs when counseled by Master's trained counselors. They also reported that former clients of trained counselors were consistently more successful in obtaining promotions, and received greater increases in weekly salary, than were clients of untrained counselors.

BIBLIOGRAPHY

Brinson, L. & Alston, P. Graduate and undergraduate training: a comparison of the impact on counselor performance and job satisfaction. Journal of Applied Rehabilitation Counseling, 1973, 4 (2).

Bronson, W., Butler, A., Thoreson, R., & Wright, G. A factor analytic study of the rehabilitation counselor role: dimensions of professional concern. Rehabilitation Counseling Bulletin, 1967, 11 (2).

Dishart, M. Highlights of national studies at 90 state vocational rehabilitation agencies by the patterns of rehabilitation services project. Washington, D.C., National Rehabilitation Association, 1965.

Johnson, B. & Koch, R. A study of the effectiveness of rehabilitation counselor as related to their level and type of education. in: Muthard, J., Dumas, N., and Salomne, P. The Profession, Functions, Roles, and Practices of the Rehabilitation Counselor, University of Florida, Regional Rehabilitation Research Institute, Gainesville, Florida, 1969.

Kreideu, N. A case study of a chronic and progressive disability. Journal of Rehabilitation, November, 1968.

Nolan, J. Vocational assessment of the coronary patient. Journal of Rehabilitation, March, 1966.

Overs, R. R. & Healy, J. Educating stroke patient families. Final Report, Media for Rehabilitation Research Reports, Curative Workshop of Milwaukee, Wisconsin.

Savino, M., Belchick, T., & Bueau, E. The quadraplegic in a university setting. Rehabilitation Record, November-December, 1970.

Mr. BRADEMAS. My final question is a simple one, Dr. Hansen. Some persons have told me that perhaps one of the most effective ways to diminish the forward progress of the rehabilitation programs would be to cripple personnel training programs for rehabilitation counselors and others. Is that an unreasonable assessment or is that an overstatement?

Dr. HANSEN. I don't believe it is an unreasonable assessment. If we look closely at a way to eliminate rehabilitation programs in this country, they can be eliminated by the total elimination of funds to implement those programs. They can be eliminated by the curtailment of training funds so that individuals working within these agencies and organizations are not trained individuals. This, indeed, would curtail the effective delivery of services.

For example, in our new legislation we are looking at figures that would run over $600 million. If we are talking about sums this great in nature, it seems important to me that trained individuals that are going to implement the delivery of services and who are indeed responsible for the expenditure and authorization of funds are on a day-to-day basis with individual disabled clients, that these individuals be very carefully trained and be able in the best professional manner to administer rehabilitation counseling as well as to lead the disabled clients to rehabilitation.

Your question is true, this is one major way of elimination a rehabilitation program through the curtailment of training.

Mr. BRADEMAS. Thank you for a most useful statement.
Mr. Quie?

Mr. QUIE. Thank you, Mr. Chairman.

I just want to indicate-perhaps the chairman did while I was outevidently the Appropriations Committee feels as you do about the need of rehabilitation training and they have reinstated the money or increased over the budget request the amount available in 1972, so I think there is no doubt but that the Congress will approve it. When we have a witness up from the administration later we will find whether they intend to spend it. You ought to know it is not just us working on

the authorizing bill that get overzealous. The Appropriations Committee seems to be of the same mind on that and I think that indicates the support of the Congress for this type of program for that type training.

The question I would have is in the training area, to what extent is the regional office of benefit for providing training grants?

Dr. HANSEN. The regional office in relationship to training grants in its current structure, if we were not in the phaseout period of time, this would be the office to which we would turn for grant renewal on a continuing basis. They could give us input information with regard to our grant renewal program. Those grants that concern new programs or new directions, as I understand, would be sent to Washington, D.C., for review. I must preface this in the sense that in the past we have received support from the regional office from an individual that was assigned training duty responsibilities. He would review with us our program direction, he would review with us our grant application, and we would have a fairly comprehensive picture of how we are trying to meet the needs within the region and within the Nation in regard to curriculum and with regard to manpower development.

This is not true at this time. Within my own region I relate now to an SRS individual for the total and distinct purpose of financial discussions for the phaseout of the program.

At one time the regional office did serve a need in regard to having an individual that was a training specialist work with us, help us coordinate some of our needs with the State SRS program, coordinate regional and State program. This is not true now.

Mr. QUIE. How far back is that?

Dr. HANSEN. One year ago.

Mr. QUIE. What was the relationship prior to 1968 or 1967?

Dr. HANSEN. Prior to 1967-68 we would send our applications directly to Washington, D.C., and work directly with a central office. The problem incurred here is that the central office was very burdened with a very small staff. I understand that staff is even smaller since some of these responsibilities have been delegated to the regional office. At the present time it is difficult for me to relate how the central office or regional office can be of help to us in 1973 when the total thrust is toward the phaseout of the program.

Mr. QUIE. If there was not a phaseout of the program, you indicated by your answer you would prefer to have the services of an individual in the regional office rather than the central office?

Dr. HANSEN. That is right. One of the major reasons for this is that within a region such as my own region, composed of Texas, Oklahoma, Arkansas, and Louisiana, we are better able to coordinate some of the inservice training needs of those States within the Southwest region and we are better able to do it locally, I believe, than to depend heavily on a central office that sometimes is out of context with some of our needs and directions in the Southwest.

Mr. QUIE. Was there one individual for all of those States?

Dr. HANSEN. That is right.

Mr. QUIE. If he was located in the State, would that mean you would need too many individuals, that is if you had one located in the State?