4.

b. Non-vocational goal

1) Can existing human service programs be coordinated to meet these ends through the vocational rehabilitation or other program structures?

Should the State-Federal vocational rehabilitation program, through expanded legislation and regulations modify the current program, broadening its eligibility base and increase the service components to meet the needs of the most severely handicapped individuals, including the attainment of nonvocational goals?

What responsibilities would such an expanded vocational rehabilitation agency have with respect to the nonfinancial needs of the most severely disabled children and adults in the community as well as those receiving benefits under the SSA program of SSI, SSDI and OASI, some of whom may be vocationally rehabilitated and others assisted toward increased independent living skills and community life?

5. Under a concept such as allied services or other coordinated service systems, what agency or combination of agencies in DHEW or in other Federal departments could the Federal government use to fund and/or provide the vocational and nonvocational services to the most severely disabled?

Should both vocational and non-vocational services be
lodged in one agency or be separated in different
agencies?

b. What mechanism would be required to provide the intra
and/or inter-agency or departmental coordination to
provide the comprehensive services needed by the most
severely handicapped?

C.

What cooperative arrangements would be required to
bring about effective changes in job development, job
placement, housing, transportation, and other environ-
mental practices in behalf of the most severely
handicapped?

43-192 O 75-32

Definitions

494

1. "Individuals with the most severe handicaps"

Background. There are three terms in the Act regarding people with handicaps:

A. "Handicapped individual" describes the basic eligibility criteria for vocational rehabilitation services. Such an individual is handicapped in terms of employability. Among the handicapped individuals so described, there is a continuum of degree of handicap. The Act provides that the program shall emphasize services to the severely handicapped.

B. "Severely handicapped" is defined in terms of disability
and categories of conditions and diseases. These are evi-
denced by medically discernible impairments and limitations.
A severely handicapped individual, then, is a person who has
a severe disability. A further defining characteristic is
that such individuals generally require multiple services
over an extended period of time. Intensive and extensive
services are usually required. Such severe disability
seriously limits functional capacities (muscular movement
and control, mobility, communication, self-care, self-
direction, work tolerance, etc.) to the extent that the
person is unable, to a substantial degree, to cope with
the physical or mental demands of employment.

C. "Individuals with the most severe handicaps," as defined
below, applies only to the special study provided for in
Part D of Title I. The terms under A and B above apply
to individuals who are currently eligible for vocational
rehabilitation services. This third group to not. The
degree of severity is such that these individuals would
be judged as not having a reasonable expectation, after
providing vocational rehabilitation services, to enter
a gainful occupation. The determination that no voca-
tional potential exists also excludes from this group
those who would be accepted for extended evaluation.

This third group is partially defined by the two objectives set forth in the Act:

"(1) to prepare individuals with the most severe handicaps for entry into programs under this Act who would not otherwise be eligible to enter such programs due to the severity of their handicap,

and (2) to assist individuals with the most severe
handicaps who, due to the severity of their handi-
caps or other factors such as their age, cannot
reasonably be expected to be rehabilitated for
employment but for whom a program of rehabilitation
could improve their ability to live independently
or function normally within their family and
community."

The three definitions, then, are related. They are successively more severe groupings of handicap, each tied to disability. "Individuals with the most severe handicaps," therefore, are defined so as to include the factors described under "severely handicapped" (B, above), but who are further defined in that severity of disability is even greater to the extent that they are excluded from the vocational rehabilitation program on the basis that they cannot reasonably be expected to benefit in terms of employability from vocational rehabilitation services. Working Definition. "Individual with a most severe handicap" means a person (a) with a medically discernible disability and resultant impairment which for such individual is so severe as to seriously limit ability to live independently or to function normally within his family and community, or which renders him ineligible for initial or continued vocational rehabilitation services, and (b) who can reasonably be expected to benefit from rehabilitation services in terms of reduction of impairment so that such person could improve his ability to live independently or function normally within his family and community, or so that he may enter the program of vocational rehabilitation services.

2. "Rehabilitation services"

"Rehabilitation services" means any goods or services necessary to improve ability to live more independently or function more normally within the family and community or necessary to enable an individual to enter the program of vocational rehabilitation services. Such services include, but are not limited to, vocational rehabilitation services.

"Live independently" refers to a goal of improvement in ability to function by the most severely handicapped. The increment of improvement expected may include, for example, deinstitutionalization, release of attendants, progress from bed to wheelchair, improved ability to communicate, and increased capacity for selfcare. That is, the term includes movement from one level of dependence to a level of less dependence rather than being restricted to movement to complete independence.

"Function normally"

"Function normally" is an extension in degree of functional ability intermediate between "live independently" and the level of vocational adjustment as described for the vocational rehabilitation program. The term refers to an increment of improvement rather than being restricted to movement to complete normal functioning (as with a person who is not handicapped).

5. "Needs"

"Needs" means the services and other assistance, as well as societal and environmental adaptations, required by the most severely handicapped in order to improve their ability to live independently or to function normally within their family and community or to allow them to enter the vocational rehabilitation program.

6. "Comprehensive"

"Comprehensive," with regard to needs, indicates that the study will go beyond the needs related to vocational rehabilitation and extend to the broader scope of rehabilitation wherein the objective is not restricted to vocational objectives but also includes improvement in function to the maximum degree obtainable according to individual circumstances.

7. "Comprehensive"

"Comprehensive," with regard to describing the study, means that the needs of the more severely handicapped will be studied in terms of the broader concept of needs and broader objectives of services, as well as a consideration of societal and environmental factors and methods of public and private intervention, financing, and coordination of programs.

"Feasibility of methods" encompasses: methods inherent in the
state of the art; a consideration of current service delivery
systems at the community level (facilities, agencies, prac-
titioners) with regard to effectiveness and possible indicated
modifications; the financial and administrative systems at
higher levels (city-wide, county, State, Federal), including
private, charitable, and governmental operations; the nature
and effectiveness of the current and potential contribution
of programs administered by DHEW to the objectives set forth
regarding the most severely handicapped; the methods by which
DHEW programs can be coordinated at the Federal, State, and
local levels with those carried out under the Rehabilitation
Act of 1973; and the contribution, effectiveness, and needed
coordination of other governmental programs (outside DHEW)
impacting or potentially impacting on the needs of the most
severely handicapped.

9. "Other factors such as their age"

This phrase recognizes that any two persons with an identical
basic clinical presentation may have differing handicaps as
a result of individual differences in other attendant factors.
Other factors, in regard to a determination of eligibility for
and nature and scope of vocational rehabilitation services
needed, include age (see below), physical impairment when the
primary disability is mental, psychological impairment when
the primary disability is physical, vocational, educational,
cultural, social, environmental, personality, intelligence
level, and other factors which bear on the individual's handi-
cap to employment and rehabilitation potential. It is empha-
sized, however, that the definition of severely handicapped
requires major consideration of a medically discernible dis-
ability which directly results in functional incapacity.
Therefore, an individual with a minor disability who is not
eligible for vocational rehabilitation because of a pre-
ponderance of negative "other factors" would not be included
in the population of this study.

Aging as an "other factor" needs special consideration. In regard to vocational rehabilitation, a person becomes excluded from the program, as a practical matter, when "retirement age" is approached unless the person has a desire for work and other circumstances make continued employment feasible. There is no