
                     REHABILITATION DEFINED
                 by Nell C. Carney, Commissioner
             Rehabilitation Services Administration

     From the Editor: This article appeared in the March, 1991,
Newsletter of the National Rehabilitation Association. Nell
Carney, to the best of our belief and knowledge, has the highest
appointive office in the federal government which has ever been
held by a blind person and also the highest appointive office in
the federal government which has ever been held by a woman with a
disability.

     With reauthorization of the Rehabilitation Act on the
horizon, a few individuals and groups representative of single-
focused interests have suggested rehabilitation needs to be
reorganized, revamped, restructured, or redefined to provide
lifelong services and care for individuals with disabilities.
This is so, they say, because present rehabilitation programs are
not meeting the total needs of disabled people, most of whom need
lifelong care.
     Of the approximately 43 million Americans with physical and
mental disabilities, the majority do not need lifelong care.
Indeed, those of us who have received appropriate rehabilitation
services participate fully in society and need only the
opportunities and conveniences afforded to all citizens.
     People with disabilities now participate in every vocation
known to our civilization. We run for public office, hold public
office, participate in political activities, and influence
election outcomes. Vocational Rehabilitation, Independent Living,
and Supported Employment have all played a major role in gains
made in independence and integration into the work place and
community by disabled people. By no means, however, are these the
only services that may be needed by people with disabilities in
order to live full, productive, meaningful lives.
     The word rehabilitation suggests a process that is finite.
Rehabilitation services authorized in the Rehabilitation Act are
designed to be of relatively short duration because
rehabilitation service is an intervention process that moves in,
provides the necessary service, and moves out of the way to allow
the disabled person to integrate physically, socially,
psychologically, and economically into the environment. There are
provisions for extended services in cases where needed, but no
service is infinite nor should it be. The basic underlying
philosophy of rehabilitation is to increase independence, not
create dependence.
     Traditionally, rehabilitation has been defined as
individualized, structured, and a short-term human service
process that utilizes the case management method to provide
diagnostic, training, and referral and placement services to
people with disabilities.
     Rehabilitation services is a process that allows a human
interaction to take place between a person with a physical or
mental disability and a service provider. In the process, need
for adjustment to the disability, training needs, and other needs
including technological, social, and economic are identified. The
person with the disability and the service provider then jointly
agree on a plan to meet the identified needs, and the plan is
implemented, leading to competitive employment and/or
independence and increased quality of life for the person with
the disability. Throughout the process, the person with a
disability has input and choices and the service provider
provides guidance, resources, advocacy, and coordination of
services with other service providers. All rehabilitation
services are goal-oriented and are designed to create
independence.
     Irrespective of definitions, the programs authorized in the
Rehabilitation Act and administered by RSA have proven to be of
value to disabled people. The largest of these, the state/federal
Vocational Rehabilitation Program, has placed 15 million disabled
people in employment since it began as a small program 70 years
ago. Last year alone (1989), just under 1 million disabled people
were placed in employment. Two hundred twenty-six thousand of
these were placed in competitive employment. The program has
always had the support of the Congress and the various
administrations and has repeatedly proven to be cost-effective.
     Similarly, the Supported Employment program and the
Independent Living programs, although much newer authorities,
have established value to disabled people and to the community.
In 1989 the Supported Employment Program placed 51,000 severely
disabled individuals in employment. Many of these will go on to
natural support systems and to integration into the community.
     The preparation for and attainment of independence and
integration by disabled people is dependent on more than one
service delivery system. While rehabilitation is a key service
system because it offers the potential for economic and social
independence, other services, including health care, insurance,
affordable housing, recreation, accessible transportation, civil
rights, and advocacy are crucial to the goals of independence and
integration and ultimately choices and empowerment. To suggest
replacing rehabilitation services with other crucial programs
does not seem like a reasonable solution to the dilemma created
by services deficits. Rehabilitation services are critical to the
empowerment of disabled individuals, and to suggest that all of
the needs of the disabled population can be met by continuing to
expand the Rehabilitation Act is to suggest legislation so
diverse that major focus could not be directed to any single
program and effective and efficient administration would be
difficult if not impossible.
     Coordination among the various agencies providing services
for people with disabilities has become a routine function of
federal government for the current administration. We are already
seeing the positive effects. Rehabilitation and the President's
Committee on Employment of People with Disabilities are working
together to create additional opportunities for competitive
placement. RSA and EEOC are working together to provide technical
assistance to employers for compliance with the Americans with
Disabilities Act. Rehabilitation and Special Education are
joining efforts to create transition programs from school to work
for disabled people, and RSA and the Social Security
Administration are sitting down together to plan for future
endeavors that will bring the two agencies together to increase
opportunities for disabled people.
     The services provided through the present authorities in the
Rehabilitation Act are essential to the empowerment of people
with disabilities. Vocational Rehabilitation, Independent Living,
and Supported Employment create opportunities for economic and
social independence for millions of people with disabilities each
year. Maintaining and promoting these programs are
responsibilities in which we all share if we are sincere in our
commitment to choices and empowerment for people with
disabilities.

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