stated upper age limit. Young age groups are also excluded when they are so young as to preclude meaningful vocational planning and a continuous program of vocational rehabilitation services aimed at employment. There is no stated minimum age limit. Various studies and analyses have shown that age tends to be correlated with success in vocational rehabilitation. Thus, with any two individuals with an otherwise similar disability, a youthful person tends to have greater probability of success than an aging person. Therefore, advanced age could be a contributing factor to a determination of ineligibility for vocational rehabilitation services. In regard to the study population, or the provision of services under any future program, the question remains on the inclusion of people at the extreme ranges regarding age. The provision for this study is based upon the proposed new service program in Title II of the earlier (vetoed) legislation. Title II described an objective of services which retained a tie with employment. Individuals were to be served without regard to an employment objective, but there was a view to possible future employability even if such were highly tenuous. With regard to age parameters, then, the study population would include mainly a consideration of young people who are approaching the age and level of education where curriculum planning and other choices are made in view of vocational outlook. At the upper extreme, the study would include mainly a consideration of older people who may still look to vocational pursuits (disregarding the prevailing retirement age where people tend to leave their usual employment). This position does not, however, exclude all consideration of the needs of persons at the extreme ends of the age range. Population to be studied Two broad categories of potential service recipients are defined by the objectives of the Comprehensive Needs Study: (1) those MSH who have been exposed to the on-going vocational rehabilitation program, and who have either been rejected because of lack of vocational potential, plus those who have fallen short of vocational rehabilitation (placement in a gainful occupation) after provision of services because of severity of disability; and (2) other IMSH whose handicap is so severe that it limits their ability to live independently or to function normally in society and has apparently excluded them from rehabilitation goals because no vocational potential can be anticipated. The first group has been identified through the National Center for Social Statistics (NCSS) computer runs of 1972 R-300 data, and includes 65,503 clients. These are reported in Status 08, (closed ineligible after application screening), 30 (unsuccessful closure after completion of a rehabilitation plan), and 28 (unsuccessful closure after receiving some services). It should be noted that about 51,000 are 08 closures. Data concerning this population are to be studied in depth. A second population category of concern in this Study are individuals who have never been in contace with a State-Federal vocational rehabilitation agency. Discussions concerning the populations have led to a conclusion that the Study's limitations necessitate a gathering, utilization, and assessment of existing sets of data resources which include the population whose needs are being studied. It has been determined that perhaps 24 sets of such data could be made available for comparison, analysis, and study. These data and related surveys then will study the aforementioned clients who have been judged ineligible for vocational rehabilitation services. Within this group are those who are not and have not been in contact with the vocational rehabilitation programs, including clients in various institutions, comprehensive rehabilitation centers, nursing homes, homebound and other such facilities. One of the surveys will attempt to locate IMSH who appear to be "lost" from the purview of service delivery elements. - 15 A Conceptual Framework for the Study The primary assumptions underlying this Study are (a) that there are a considerable number of people with severe handicaps who can benefit from additional rehabilitation services which will prepare them to become vocationally productive or can improve their condition for independent living, and (b) that the most severely handicapped offer a unique challenge to current rehabilitation programs under the Act and are not receiving services sufficient to enable them to live less dependent upon the family, community and the general public. The ultimate goal for such a study is to obtain and organize information which can be utilized for the planning and coordination of services which might lead to increasing capabilities for employment and independent living, or more normal functioning in family and community and the improvement of the quality of life for the most severely handicapped. The Study proper will necessarily involve an investigation of characteristics and needs of individuals most severely handicapped (IMSH) as they relate to their vocational or independent living potentials. Parallel to this endeavor will be an inquiry into the types of services available and those which might be developed to meet the needs of the IMSH population. It is essential that a comprehensive investigation of this nature consider the unmet needs of the severely handicapped and the barriers which constitute deterrents to need satisfaction. The following chart depicts the types of variables and indicates the information resources necessary for its successful completion. Ancillary activities implied in the Study include: a. b. c. IMSH characteristics IMSH needs (vocational rehabilitation, non-vocational rehabilitation) Service providers (vocational rehabilitation, non-vocational rehabilitation) d. Gaps: needs vs. services e. Barriers (costs, technology, architectural, employment, etc.) f. Data resources (Federal, State, local, private) A study of this nature should result in suggestions for DHEW coordination of rehabilitation efforts to assist the severely handicapped and produce a report which will be of use to legislators by providing rehabilitation resource data utilizable as a viable aid in policy formulation. Study Tasks, Issues, and Questions of the IMSH Population 1.0 Identify the Demographic Characteristics of the IMSH Population 1.1 1.2 1.3 What demographi character- The IMSH population must be differentiated from other populations? from other populations through the use of What is the extent of the The dependency of the IMSH population must What is the geographic The distribution of the IMSH population must 1.4 In what way is the inci The incidence rate for severely handicapping |