I would like to ask Dr. Newman and Mr. Twiname if you have anything to add at this point. Do you have any comments? Mr. NEWMAN. Just one note. I do not have any other formal opening statement, Senator, but I believe this is the first time that we have had a major change or potential change in the vocational rehabilitation program in which Senator Hill has not been sitting here. We are all, as you know, very indebted to his work on behalf of this target population and this program. Senator CRANSTON. I have quite a series of questions. I will direct them generally to all of you, and whoever chooses to respond, please do so. First, do you believe there is a need for better vocational rehabilitation coordination of efforts with those of voluntary agencies such as the Easter Seal Society? Mr. KURZMAN. Let me answer as a matter of policy, Mr. Chairman, that we certainly do. In fact, as you know, the administration has placed a great deal of stress on utilizing the capacity, the great capacity, of the private, voluntary sector, for maximizing Federal, State, and local governmental efforts with regard to human needs. And Í think it is probably fair to say that nowhere are such efforts more valuable and a larger multiplier of governmental work than in the area of the handicapped. Senator CRANSTON. What, specifically, do you do to increase coordination? Mr. TWINAME. I would like to speak to that one point. I think our basic philosophy is to try to develop a more intensive planning effort at the State and local levels in rehabilitation. We want to affirm the fact, as Secretary Kurzman has said, that this program in particular has been noteworthy for the network of relationship with voluntary agencies that make up the rehabilitation system. While we are intensifying our dialog with outside voluntary and public groups for instance, the most recent was on Friday when we met with major representatives of the facilities operations the real coordination needs to occur at the local level in service areas or in State areas. At this level, these voluntary and public agencies, along with universities doing research and training, can come together and assess the needs in that area. Through planning efforts in local areas, we hope to address coordination in more than a rhetorical way. Senator CRANSTON. What is the total dollar expenditure now from non-Federal sources for grants to private, nonprofit groups under existing legislation? Mr. TWINAME. We will have to submit that. Senator CRANSTON. What is the total dollar expenditure now for nonFederal sources for grants to nonprofit groups under existing legislation? Mr. NEWMAN. Are you referring specifically to the matching moneys which are available and which can be spent by voluntary agenciesthat is, nonpublic resources under the regular program? Senator CRANSTON. That is one question. Can you provide an answer to that? Mr. NEWMAN. We will have that figure for you. As you know, there are two ways in which the voluntary sector combines with public moneys. One has to do with the share, the State and local share, under the matching formula, in which moneys, other than those which are appropriated by the State legislatures, for example, can be used for this purpose; and, of course, the other is moneys which are used in conjunction with the public moneys by voluntary agencies and private, nonprofit agencies. That would be a more difficult figure for us to give. But we can make an estimate of that. Senator CRANSTON. We would like two figures: Federal share of grants to nonprofit organizations and the expenditures by nonprofit organizations. You don't have those with you? Would you give them to us for the record? (The information, subsequently supplied for the record, follows:) WHAT IS THE AMOUNT OF NON-FEDERAL FUNDS PROVIDED BY PRIVATE NONPROFIT ORGANIZATIONS AND AGENCIES? QUESTION REPHRASED BY RSA Under Section 2 Basic Support Program, the matching rate is 80 percent Federal and 20 percent State funds. State funds can be comprised of State appropriations, transfer of funds from other State agencies, and contributions by public or private nonprofit organizations and agencies. We have no solid facts on the amounts of State funds that are derived from the private nonprofit organizations and agencies. However, it appears their contribution would not exceed 5 percent of the total State funds of $141,700,000 in FY 1972, or approximately $7,000,000. This does not reflect the services provided VR clients at no cost by these organizations. At an 80-20 percent match, these $7 million would earn $28,000,000 in Federal funds. Under Section 4(a)(1) research funds, the total expenditure from non-Federal sources for grants to private non-profit agencies was as follows: Fiscal year 1970_. Fiscal year 1971. $8,738, 508 7, 244, 860 The amounts were used to match Federal funds, generally at a 90-10% ratio. Federal funds earned at this ratio would be: $78,646,572 $65, 203, 200 Mr. KURZMAN. The provision which the House committee added to the bill, which would authorize State vocational rehabilitation agencies to designate local agencies to actually administer the program, will aid in the development of coordination, tying into what Administrator Twiname said earlier. Senator CRANSTON. Why shouldn't vocational rehabilitation adopt jurisdiction over the types of very severely disabled cases-those without a real vocational future--that many of these voluntary agencies now deal with? Would such an expanded role for RSA be authorized under existing legislation? Mr. KURZMAN. As my statement indicated, Mr. Chairman, we think that there is a problem here of incentives and of definition. We believe that there is a tendency under existing mechanisms to administer the program under strictly interpreted existing language, and some severely disabled persons not to be served because a close enough look is not taken at their true employment potential. We want to overcome the tendency to make the numbers look as good as possible in the existing program by instituting a new weighted case closure system, which will give greater credit to an agency which undertakes a difficult case than it would if it undertook an easier case. We think that we can set a higher target than the approximately one-quarter or so of the caseload now falling into the severely disabled category. We are setting as a target something close to 40 percent of the caseload. We think that that will have an effect. The second point I would like to make is that we think it would be a mistake for the program to abandon its vocational outcome objective. That really is the thrust of our position. We feel more people who are severely disabled could qualify for services than do now in reaching a vocational objective, and we want to do everything we can to make sure that that is the case. Our primary objective is to serve those who can be helped to self-sufficiency with what will always be limited funds, as compared with the total need to serve those who need the services most. Those include the severly disabled, as well as handicapped individuals who are economically and otherwise disadvantaged. But we think it would be a mistake for this program to lose that primary objective and to get off into nonvocational objectives, which are essentially the province of other programs already on the books. These programs are very heavily funded by the Federal Government, particularly social service programs under the Social Security Act, health services under the Social Security Act, (medicaid and medicare) and many other authorities under the Public Health Service Act. Senator CRANSTON. You have focused that response mainly on those where there is some hope for vocational opportunity. What about where there is little hope? Mr. TWINAME. We should distinguish between program authorities under the statute and organizational capability. The rehabilitation agency in the State, with its expertise in disability, should not be constrained from a real contribution in helping the severely disabled who require services that may not lead to a vocational outcome, but may, for example, allow someone to leave an institution and be self-sufficient in his own home. I think the point Mr. Kurzman is making that we have other very substantial funds. For example, in the social services we now spend a billion and a half dollars. We acknowledge these programs are not well enough focused on disabled people, but they are available to serve the disabled, and through the purchase of service arrangements between social service agencies and rehabilitation agencies in the State. We have been trying to encourage rehabilitation agencies to pick up on these services as an organization, and thereby to command more of the resources of the Social Security Act, and the Developmental Disabilities Act and from other program authorities to use as an organization specializing in disability. So we are saying here we don't want title III of this particular act to be an excuse for not utilizing these other programs and these other authorities which should be going to disabled people. Senator CRANSTON. Don't you think we need a program that is pinpointed on the needs of the people who are virtually totally disabled? It doesn't seem to me we really have that pinpointing on that aspect of the problem. We can't rely on other agencies to do it. There has got to be a Federal program to make sure it gets done. Mr. KURZMAN. I think the problem here, Mr. Chairman, in many ways, is how to maximize the effect of a lot of public and private agencies which are out there in communities all over the country doing specific jobs. The severely disabled fall into a category which tends to crosscut other categories of programs that are already in place. We find this in a great many HEW programs. Our focus on this is really to try to get those agencies, which are dealing with specific types of constituencies, to work together at the local level so that people who do not neatly fit into one category or another, will be served; that they will not fail to receive the services simply because they don't neatly qualify within the definitions of a particular agency. That is why we are emphasizing here the responsibility and the need to encourage vocational rehabilitation agencies to first make sure that they try to qualify the clients under the employment objective of the VR act. We think many who are turned away could qualify if a more careful look were taken. Second, if there is truly no possibility of vocational outcome, we want to make sure that the responsibility is picked up by the VR agency to make sure that services are provided to that person by other public and private agencies in the community who have that authority and are funded federally under other acts, rather than starting an entirely new program which will overlap the programs that exist out there already, and which will again have their own exclusions. This is the thrust of what the President was talking about in the Allied Services Act recommendations that he made in the State of the Union message this year. It is a drive which Secretary Richardson had been making with all HEW programs: to build incentives into the programs for local agencies to work together to treat people not as merely statistics in line with their own program objectives, but as people and whole families who deserve service in the communities in which they live. Senator CRANSTON. Senator Stafford, I suggest we work under the 10-minute rule. I now yield to you. DESCRIPTION OF PERSONS REHABILITATED Senator STAFFORD. Thank you, Mr. Chairman. Mr. Secretary, I would like to direct some questions to you or your colleagues, whoever feels most qualified to answer. My first question is, would you please describe for us persons who have been rehabilitated under this act? Mr. KURZMAN. I would be happy to, Senator Stafford. I could submit for the record a table which will show by severity of disability those who have been served by the program and have been rehabilitated, during fiscal years 1966 through 1970. For example, they include categories such as blindness, deafness, orthopedic impairments, absence or amputation of extremities, mental illness, mental retardation, respiratory system conditions, and speech impairments, and other vocationally disabling conditions. As I say, approximately a quarter of these are now in the category which might be considered, depending upon one's definition, as severely disabled. Senator CRANSTON. Would you provide that chart for the record? (The information, subsequently supplied for the record, follows:) ESTIMATE OF THE NUMBER OF SEVERELY DISABLED PERSONS WHO ARE REHABILITATED BY THE VOCATIONAL REHABILITATION PROGRGAM NOTE Severity of disability must be assessed in relationship to all of the factors that impinge on the individual-such as physical or mental, social, economic, educational, age, sex, and race-as well as the environmental variables operative in his immediate situation-such as services available, general economic conditions, climate, transportation, and type of employment opportunities. Even given these factors, some physical or mental conditions are more handicapping than others. In order to give some idea of the extent to which individuals with particular physical or mental limitations are being served, the attached chart was developed from data routinely reported by the State vocational rehabilitation agencies at the time the case is closed. These data reflect the abstract physical or mental status of the individual, and do not take into account the other personal and environmental qualities that might be affecting the individual. Hence, the data are probably a very conservative estimate of the numbers of severely disabled served. These data do not reflect the cause of the physical or mental limitation. For example, an individual with cerebral palsy may be recorded as having three or more limbs affected, or one lower and one upper extremity involved, etc., depending on the actual limitation. Further, the data does not accurately reflect multiple problems, but only the major disabling condition, so that if a person were both blind and mildly mentally retarded, for example, he would probably be recorded as blind, in a subjective estimate by the counselor of which was the greater disabling condition. Attached to the table is a full statement of disability codes so that the reader can evaluate the degree to which the codes which have been extracted actually reflect severe disability. |