Dr. C.Edwin Vaughan, Professor of Sociology at the University of Missouri at Colombia An Organizational Approach to the Evaluation of Rehabilitation Outcomes: Assessing Three Private Rehabilitation Agencies by C. Edwin Vaughan, Ph.D. ********** From the Editor: The following pilot study was conducted in 1997 and early 1998 by Professor C. Edwin Vaughan for the U.S. Office of Education. Those who have attended annual conventions of the National Federation of the Blind or who are long-time readers of the Braille Monitor are familiar with the many personal stories and anecdotes told by blind people lucky enough to have been students at one of the three private adult rehabilitation training centers conducted with Federation philosophy as the basis of the program. Here, however, is a look at these three programs and the ways in which they differ from traditional training facilities. Dr. Vaughan also suggests additional areas for fruitful investigation. This is what he says: ********** 1. Background
There are approximately one hundred residential programs for persons who are blind in the United States that provide vocational, pre-vocational, and independent-living services to consumers of the Title I Vocational Rehabilitation Services Program. A conservative estimate would suggest that in the last decade at least 30,000 clients participated in these residential programs--ranging from three- to nine-month enrollments. The most frequently stated goal is preparation for competitive employment. Other goals include preparation for additional education (including higher education) and independent living. These residential programs are relatively expensive, frequently costing from $2,700 to $3,000 or more per month for each student. Despite the economic cost and the human effort, there is little evidence that these programs have produced a significant improvement in the level of blind people's participation in the labor force.
During the period 1984 to 1988 three new residential rehabilitation centers were created by members of the largest consumer organization of blind people--the National Federation of the Blind. The reasons for developing these three residential rehabilitation centers was an awareness of the limitations of existing programs. Existing agencies were not, in the opinion of the members of this consumer organization, educating their students adequately for a life of independence, self-reliance, and full participation in society. These three agencies have flourished and are attracting clients from all over the United States and from several other countries.
Those in the field of blindness rehabilitation frequently discuss program evaluation; a fairly complete bibliography was commissioned by the National Accreditation Council for Agencies Serving the Blind and Visually Handicapped. Most traditional approaches to evaluation consider the staffing and other agency features and examine client progress in learning particular skills. No research has been done, however, comparing agency effectiveness. No evaluation procedures have effectively studied the holistic effects on the individual in terms of alterations in his or her subsequent life career.
Because of the public monies expended and the wasted human resources, it is important to learn whether these three agencies are more effective than others. As a first step this pilot study will analyze the philosophy, curriculum, and staffing that are all ingredients of the comprehensive rehabilitation experience which these agencies claim is quite effective. In this pilot study I interviewed representative graduates to learn, from the client perspective, the strengths and weaknesses of these programs. ********** 2. Objectives
1. Describe the three residential programs in terms of their philosophies, goals, curricula, personnel practices, services, and consumer outcomes.
2. Identify organizational features (philosophies, goals, curricula, personnel practices, and services) associated with high levels of consumers' vocational/educational success and independence.
3. Analyze the relationships between agency goals and personnel practices.
4. Analyze the relationships between organizational goals and the curriculum provided to the consumer.
5. Establish baseline data for judging the future success of these agencies. ********** 3. Procedures
1. I visited each of the three centers--the Louisiana Center for the Blind (Ruston, Louisiana); the Colorado Center for the Blind (Denver, Colorado); and BLIND, Inc.--Blindness: Learning in New Dimensions (Minneapolis, Minnesota).
2. I reviewed relevant documents at all three locations, including annual reports and contract proposals.
3. I interviewed each director, almost all members of the staff, and several members of the boards of directors of the three agencies.
4. As a participant/observer I visited several classes, including mobility, independent living, computer skills, industrial arts (woodworking), and group discussions about the philosophy of blindness.
5. Throughout my site visits I talked informally with clients.
6. From lists of graduates within the last twelve months, I selected nine students for extensive open-ended, unstructured, in-depth telephone interviews. They comprised a purposive sample- -generally reflecting the gender, ethnic, and economic diversity of the client group. From these interviews I tried to learn, from the client's point of view, aspects of the rehabilitation experience associated with the clients' subsequent occupational success and their overall satisfaction with the rehabilitation program.
7. From information gathered in conversations and interviews with students and site observations, I conducted a second round of interviews with the three directors. ********** Philosophy
The philosophy behind the programs of the three centers, for the most part, is similar.
(1) None of the three is associated with a sheltered workshop. This physical separation from sheltered workshops allows students to explore all employment options thoroughly without the appearance of being directed into a sheltered environment.
(2) All three centers address what Diane McGeorge (Director of the Denver Center) referred to as "the real issues" of blindness. These issues include what a person thinks of himself or herself and what ordinary people and some professionals think about blindness. To repeat a slogan frequently heard at these agencies, "We are changing what it means to be blind." Most students come from backgrounds of overprotection and have seldom reflected critically on their own goals and potentials. All three organizations provide experiences to challenge limiting self- concepts.
(3) All agree that programs must be extensive and comprehensive. Everything from attitudes to required skills must be addressed before an individual can participate fully in society. Students do not come to these residential rehabilitation programs to learn only a particular skill such as mobility or computer use.
(4) All three programs require sleep-shade training. Residual vision is to be used, but only after the skills of blindness have been mastered.
(5) All three continually stress positive images of blindness--"There is nothing wrong with being blind." If a student becomes skilled at alternative techniques to vision, blindness can be reduced to an inconvenience. You should make the best of what you have and reject society's negative images about blindness.
(6) Whenever possible, alternative techniques should be taught in real-life situations. For example, to teach cane travel as technique is not enough; the student is learning cane travel skills in order to go somewhere. The goal for students is that when they have become proficient in the use of alternative techniques and develop a positive self-concept, they move on to pursue vocational training, post-secondary education, employment, or a greater degree of independence.
(7) A wellness model is stressed. Students should focus on their potential, not their limitations. There is the expectation that with appropriate training most blind people will succeed in their chosen fields.
(8) Rehabilitation is viewed as part of a lifelong process, and students are expected to begin a long-term involvement with consumer organizations. In the case of these three agencies the preferred consumer organization is the National Federation of the Blind. The purpose is twofold: 1) to give the blind person an ongoing support group which will continually reinforce a positive philosophy about blindness and provide encouragement when difficulties emerge and 2) to involve the students in a commitment to pay back or contribute to the ongoing organization and to the lives of other blind people. The staff even refers to the desire of student outcome as a spiritual experience; rehabilitation will be so transforming you will want to share with others the aspects of your newly found independence and more positive self-image. One staff member in Louisiana mentioned that the staff communicates this urgency to getting on with the transforming of one's life.
Joanne Wilson, Director of the Louisiana Center, expanded the religious theme, describing the rehabilitation experience as somewhat like a traditional "religious revival." After the initial intense transforming experience some people "backslide." By becoming involved in an ongoing organization with positive role models and a positive philosophy, the individual can continually renew the original experience. The traditional community-based attitudes about blindness are so pervasive that it is easy once again to internalize negative self-images or to accept traditional low expectations of what a blind person can achieve. To quote Ms. Wilson again, "We have to teach the students to give back to something else--if we are going to be whole people, we cannot just take from this world, but we have to give back. This is particularly important for blind people; it is so easy never to give anything back because people have so often given everything to you--paid for your coffee or taken care of you through family, welfare, etc. The involvement in the consumer organization helps sustain the social movement which produces public education, legislation, litigation, new employment opportunities, etc., which may in turn help the individual in additional ways." Although encouraged, students are not required to join the National Federation of the Blind. ********** Curriculum
The three centers attempt to link philosophy to rehabilitation outcomes through both curriculum and staff involvement. For this discussion I have included the physical environment as part of the environment.
(1) All students in the residential rehabilitation program are encouraged to live independently. Furnished apartments are provided for students, usually two students sharing a two-bedroom unit. Students are responsible for cleaning the apartment and for cooking and preparing their own food. In all cases these apartments are considerably removed from the main rehabilitation facility. Students are required to work out their own transportation--usually public busses.
(2) All instruction is linked, as much as possible, to real life situations. If a student needs to open a checking account or make an appointment with a beauty shop, the task becomes part of mobility instruction. Students will not simply learn to cook; they will learn how to prepare a meal for all their fellow students at the center.
(3) All three centers include at least four hours each week in what is referred to as business seminars--the business of living. These are discussion groups involving both students and staff. They are intended to help students examine their own attitudes about blindness and to understand the reasons for the social and instructional arrangements they are experiencing. The intent is to change attitudes and broaden perspectives.
(4) There is a distinct approach to mobility instruction. Cane travel instruction is extensive throughout one's time at any of these three rehabilitation centers. At some traditional centers cane travel will be taught only one to four months. Only the basic techniques can be learned in this brief period; becoming a confident and safe traveler takes much longer. Russell Anderson is a travel instructor at the Minnesota Center. He prefers the word "travel" to "orientation and mobility." To him, travel means learning to go out, to go somewhere safely and on your own.
All three centers strongly recommend the use of the long lightweight, carbon-fiber cane. Not only is this cane a symbol of freedom, but it also enables the traveler to explore the travel surface one stride in advance of traditional shorter canes. According to the instructors this cane has many other advantages that go beyond the scope of this report.
(5) The curriculum includes social experiences that most students have never imagined. All three centers encourage their students to attend state and national conventions of the National Federation of the Blind. In this context students learn social skills, self-reliance, and independent travel in quite diverse settings. In 1997 all three centers sent students to attend the NFB convention at the Hyatt Regency Hotel in New Orleans, a five- day event with more than 3,200 registrants. To avoid criticism from funding sources, the Colorado, Minnesota, and Louisiana affiliates of the NFB provide scholarships for student attendance. Funds from the state agencies sponsoring each student are not used for this purpose.
(6) The student experience is based on more than an eight- hour day. The positive philosophy is taught and lived in a twenty-four-hour environment. Students learn from positive role models: roommates, instructors, citizens in the community, and board members. The staff accompany the students on a wide array of field trips. These field trips are intended to provide students with experiences they had never imagined or thought possible. These include wilderness camping, rock climbing, white water rafting, cave exploring, skiing, and attending festivals such as Mardi Gras. The intent is to increase self-confidence and promote a more positive self-image.
(7) Except for discussion groups much of the instruction is one-on-one. Typically between eighteen and twenty-four students are enrolled in the residential rehabilitation program. The staff-to-student ratio is usually around 1.5 to 1. All three centers thought twenty students to be the optimal number. These numbers are approximate, but below twelve students is less desirable because the number and variety of positive role models is restricted.
(8) All students are taught Braille without regard to residual vision. I met one student at the Louisiana Center who was excited about learning to read--at age twenty-three. He had experienced two rehabilitation centers in California, which did not instruct him in Braille. They tried to use his residual vision without success. Research has demonstrated that students who become literate in Braille are far more successful in employment and independent living than visually impaired students not learning Braille. Braille is an important feature of the curriculum for education, as is the long white cane for traveling. Proficiency in both is essential and required.
(9) Students also participate in several additional curricular areas, including computer skills, cooking, and woodworking. These are subjects important in their own right but also teach independence and self-reliance and provide a broader perspective on the capabilities of blind people.
(10) As previously mentioned, sleep shade use is required throughout the curriculum. Students are told this before they arrive, and it is clearly communicated in most brochures and informational material. All three directors agreed that there is no better way to teach the skills of independent living. Although programs are individualized for each student, all are told before they arrive that these programs teach a distinct philosophy about blindness.
(11) Students do not pick and choose preferred aspects of the curriculum; the training is both intensive and comprehensive. One staff member likened the experience to boot camp. Students must follow all specific rules, or their training will be discontinued. Students with problems other than blindness, if too disruptive, will be sent home. ********** Staff
(1) All staff members must have been competitively employed before being considered for employment in these three agencies. This is an additional dimension to the positive role modeling; students learn from their competent blind instructors about other employment opportunities that might be available.
(2) Blindness is not a requirement; however, most of the instructors are blind. If a competent blind instructor is available, this makes role modeling even stronger. At BLIND, Inc., Joyce Scanlan, Director, observed that many students come to the program initially having more confidence in the sighted members of the staff. This quickly changes and bonding occurs. Negative opinions of the sighted staff do not grow, but new levels of appreciation and respect develop concerning the qualities of the blind staff.
(3) All employees must share in the positive views reflected in the philosophy of the National Federation of the Blind-- otherwise they will not be retained. The agency in Louisiana is the only one of the three that requires all employees to participate in the National Federation of the Blind.
Such personnel policies differ dramatically from those frequently seen at larger private agencies. Sometimes it is difficult--if not impossible--for staff members from more traditional agencies to express in their behavior their philosophy of independence. They may encounter resistance in larger agencies dominated by sighted or blind individuals with traditional philosophies or practices involving custodial care. The effort of a teacher to become more effective and be a positive role model can become a threat in the traditional agency. In fact Scanlan observed that workers in larger centers are sometimes rewarded for their willingness to be dependent upon other staff members. They are rewarded for being led around rather than traveling independently because the former maintains the status quo. Also in more traditional agencies there is the additional problem of the accumulation of minimally competent people because it is difficult to remove them. According to the people I interviewed, learning from teachers who often appear to have little confidence in other blind people is one of the most deadening experiences a student can encounter. Staff members who demonstrate unnecessary dependence or anything less than the highest levels of accomplishment are not acceptable in these three agencies, where the example and contribution of each person is critical.
(4) Sighted employees undergo extensive sleep-shade training as part of their new-employee orientation program. For example, the sighted industrial arts teacher at BLIND, Inc., of Minnesota spent three months at the Louisiana Center learning the skills of blindness with the use of sleep shades. Sighted employees frequently use their sleep shades as part of the educational effort to teach a particular skill to a blind student.
(5) Although stated in several different ways, I frequently heard employees characterize themselves as believing in blind people. The intent of the staff is to accomplish more than teaching a particular skill. According to Diane McGeorge of the Colorado Center, a strong component of success is the commitment of each staff member to the success of each student, along with high expectations of what blind people can achieve. The program tries to communicate that clients can take control of their own lives.
(6) The staff expect self-reliance. Students are expected to learn to solve individual problems as they arise. At many more traditional residential rehabilitation centers things are done for students that are not even considered at these three centers. At some traditional centers I have observed students eating in cafeterias rather than preparing their own meals. At one of the other centers blind students raise their hands in the cafeteria and receive prompt assistance. At another center students can even request that meals be delivered to their rooms. To the staff of the three NFB-oriented centers, such behavior would be viewed as custodialism. Custodial treatment is detrimental to the acquisition of a positive self-concept and the expectation that a blind person can live independently. ********** Social Organization
All three of these agencies began during the period 1984 to 1988. Each was established without the assistance of the others. Each is closely linked to the state affiliate of the National Federation of the Blind (NFB). Each was started by individuals active in the NFB.
The NFB has affiliates throughout the fifty states and also in Puerto Rico and Washington, D.C. Each state affiliate is formally linked to the national organization. Each state can pursue its own way of promoting the interests of blind people and the education of the public about blindness.
Each of these three agencies was begun with the financial assistance of the state affiliates--the NFB of Colorado, Minnesota, and Louisiana. The reason for developing these three residential rehabilitation centers was an awareness of the limitations of existing programs. Existing agencies were not, in the opinion of these members of consumer organizations, preparing the students adequately for a life of independence, self- reliance, and full participation in society. They decided to create new agencies that would address these concerns by developing a curriculum and recruiting a staff that would embody a more positive view of blindness. I have mentioned these values, curriculum, and staffing patterns earlier in this report.
Each of these centers is a not-for-profit organization, and each is governed by a Board of Directors. In all cases at least half of the board must be comprised of blind people. The blind members of these boards must be competitively employed and active in local consumer organizations of blind people.
For most of the several hundred private blindness rehabilitation agencies in the United States, board memberships are based on wealth and social status--to help legitimate the agency in the local community and assist in fund raising. These are important issues to these three agencies as well; however, the overriding concern is to have a governing board that is sympathetic to and knowledgeable of the philosophies of these agencies. All board members are expected to be involved in some aspect of the agency's programs. ********** Assessing Outcomes
Data to judge one agency or to compare the performance of different agencies are rare. In a 1991 report BLIND, Inc., reviewed the subsequent experience of students graduated in the previous year. This agency focused on outcomes. This helps avoid wasting scarce resources and places emphasis on the frequently stated goals of the rehabilitation process. In the short run this means determining whether or not students have learned valued skills and attitudes. In the longer view it refers to the consequences the required skills and attitudes have for vocational success and independent living. For example, BLIND, Inc., in its annual report for 1991 listed the outcome of its rehabilitation efforts. **********
Twenty-six students participated in the comprehensive training program in 1991. Of those, three had not completed training. Those who have left the program are doing the following:
10--attending high school or college 6--employed 4--seeking employment 3--living independently (BLIND, Inc., 1991, pp. 2-3) Whatever else the future holds for these individuals, the report suggests that they have not become dependent on the agency and are living independently and continuing their education and employment. ********** Agencies Compared in Minnesota
Data comparing agencies on student outcomes are also rare. The Department of Jobs and Training, State Services for the Blind, contracts with three private agencies in Minnesota to provide alternative techniques for blind people to pursue their vocational and rehabilitation interests more efficiently. These are Blindness: Learning in New Dimensions (BLIND, Inc.), the Minneapolis Society for the Blind (MSB), and the Duluth Lighthouse for the Blind (DLB).
The following charts were based on data collected by the staff for the Minnesota State Services for the Blind. For the question concerning what students did with their lives after leaving the training facilities, the first chart shows that the difference in the outcomes for those involved in the three agencies was great.
Concerning the use of Braille, BLIND, Inc., reported more than twice the percentage of students using it every week. More than 55 percent from BLIND, Inc., reported weekly use, while only 12 percent from the Duluth Lighthouse for the Blind did so. Activities for daily living included grooming, upkeep of clothing, cooking, housekeeping, sewing, shopping, etc. Similarly, for these tasks there were pronounced differences among agencies. The Duluth Lighthouse for the Blind was the weakest on all measures, according to the NFB of Minnesota analysis of the data.
I have no ready access to additional data that would permit additional comparisons of the type mentioned above. It would doubtless be a sensitive issue in most states. However, the differences describing agency outcomes in Minnesota were so great that additional research is justified. . ********** Activity after Training: This bar chart represents the percentage of graduates from each agency engaged in each activity: Employment, BLIND 14 percent, MSB 5 percent, DLB 6 percent; Student, BLIND 43 percent, MSB 14 percent, DLB 11 percent; Planning, BLIND 28 percent, MSB 23 percent, DLB 6 percent; Looking for Job, BLIND 14 percent, MSB 5 percent, DLB 0 percent; Homemaking, BLIND 0 percent, MSB 10 percent, DLB 27 percent; Retired, BLIND 0 percent, MSB 5 percent, DLB 17 percent; Nothing, BLIND 0 percent, MSB 37 percent, DLB 33 percent] ********** Daily Living After Training. This bar chart shows the percentage of graduates from each agency engaged in the various activities charted: Banking, BLIND 79 percent, MSB 51 percent, DLB 50 percent; General shopping, BLIND 79 percent, MSB 51 percent, DLB 50 percent; Grocery shopping, BLIND 85 percent, MSB 42 percent, DLB 40 percent; Personal organization, BLIND 70 percent, MSB 56 percent, DLB 56 percent.] ********** I have no ready access to additional data that would permit additional comparisons of the type mentioned above. It would doubtless be a sensitive issue in most states. However, the differences describing agency outcomes in Minnesota were so great that additional research is justified. ********** Interviews with Individuals
I conducted more than thirty brief, casual interviews with currently enrolled students in the three agencies. I also conducted nine open-ended, in-depth interviews with individuals who had completed the residential programs within the previous twelve months. Of this group comprised of four women and five men ranging in age from nineteen to forty-two years, three were continuing their higher education and six were competitively employed.
Disclosure: I am a member of the NFB and am sympathetic to its previously mentioned general goals. I am aware of my own values and likely biases. I think my level of self-understanding and critical reflection enables me to look at these agencies and interview these individuals in a balanced manner. ********** Self-Selection
Before beginning site visits, I presumed the likelihood of a social network which might recruit clients to these three agencies. Some critics have argued that these agencies exist primarily to recruit members for the NFB. New members may be one outcome, but it does not appear to be an explanation for the level of staff commitment and the nature of student responses.
Of the approximately thirty informal interviews, only six individuals had previously been involved in NFB local organizations before attending these three centers. Only one of the nine individuals in the in-depth interviews had previous involvement in the NFB. Many of them had never heard of the NFB or the state affiliates where these three agencies are located. In all cases current clients are likely to come from the state where the agency is located. However, approximately one third come from other states scattered across the United States. Incidentally, there are occasionally students from other countries; staff from these three agencies have also been involved in transporting their programs and philosophies to other countries, most recently to Poland.
I repeatedly inquired why individuals selected these three agencies. The answers were quite varied. Some were referred by their local rehabilitation counselors. Others had heard of these programs from acquaintances who had either attended or had some knowledge of the agencies. One of my conclusions is that individuals do not come to these agencies through an NFB network. Any self-selection process biasing assessment outcomes is minimal. ********** In-depth Interviews
Based on my observations at the three sites and my informal conversations with resident clients, I was not surprised that the nine former students I interviewed by telephone were positive about their recent residential rehabilitation experience. All stated that the programs had helped them reach their individual goals. These goals included greater independence, preparation to pursue higher education more effectively, and employment. Those currently employed had received placement assistance from their rehabilitation center.
In various ways all nine indicated that they had left the programs with greater confidence in themselves and a more positive philosophy about their situations as blind people. Seven of the nine spoke in different ways of the importance of the "unusual things we did." They mentioned doing things that they never would have thought of previously, such as rock climbing, white-water rafting, and traveling to a distant city to participate in a national convention.
Although they expressed it in different ways, all of them thought that the stress on a positive philosophy (through staff example, other students, and the regularly scheduled discussions concerning a positive philosophy) were an extremely important feature of their experience. Two individuals stated that, however good they were, the specific techniques they learned were not as important as the overall impact of the programs on their lives.
Four of the nine students had different levels of residual vision. All valued the sleep-shade aspect of the training. They valued cane-travel training from a blind instructor. This was even the case for the two individuals who had encountered blindness within the previous two years.
All of the students valued the independent-living experience associated with their residence--having a roommate, being responsible for their abode, preparing their food, and having personal responsibility for things affecting their lives. One mentioned that the "bar was placed very high." The staff set high expectations and worked with each individual to this end. Other individuals mentioned the importance of informal group activities--the way in which students learned from each other's successes. Eight of the nine had become active in local chapters of the NFB. They developed ongoing friendships with their teachers as well as with other students. They had not been a part of a supportive social network before they came to these agencies, but following their graduation they continued their association with other blind people sharing a similar philosophy about blindness.
I had to look hard to find complaints. Some felt that the challenges in the early part of the rehabilitation process had been too great. However, as they worked through their fears, they retrospectively felt their anxiety to have been part of an old self-concept that they had left behind. I have no doubt that these nine individuals felt their lives had been permanently and positively changed. They had not only reached their specific goals in an important sense but felt that they had become different people.
Not every person attending these programs will have the same experience as these individuals. In my sample I tried to assure that the nine individuals did not have obvious personal or physical problems other than blindness. I obtained this information from the directors.
These agencies do accept students with physical and other problems as long as their behavior is not disruptive and as long as the individual has a possibility of benefiting from the rehabilitation experience. For example, one of the students I met was recently blinded at age twenty-five--injured by a shotgun blast while individuals disputed a drug transaction. While beginning his rehabilitation towards independent living, Braille, and mobility, he was required to attend programs to help him become free from drug and alcohol dependency. Relapses in chemical dependency would mean dismissal from the program. Other students have various levels of mental ability, determination, and ambition. They may not aspire to higher education and may have limited employment goals. Clear progress is more difficult to determine in these cases. ********** Repeat Visits to Residential Rehabilitation Centers
One of the unexpected findings of my informal interviews with students at the three centers was the number of clients who had previously attended one, two, or even three other residential rehabilitation centers. With hindsight and their obvious appreciation of their present situation, all of them said that their earlier residential rehabilitation experiences had been inadequate. They complained about various shortcomings, including failure to teach cane travel properly and short programs that were too brief to permit mastery of the skills of blindness.
If there is a national pattern to sequential visits to different rehabilitation programs, it merits further study. The costs of these visits are considerable; $3,000 per month is a commonly quoted figure. Assuming the earlier visits were inadequate, there may be unnecessary months and years when potential workers are not in the labor force. There also may be unnecessary months and years of individuals' living restricted lives and being unnecessarily dependent on others.
To obtain a broader perspective on this issue, I spoke with Ms. Suzanne Mitchell, Executive Director for Blind Services, Department of Social Services/Louisiana Rehabilitation Services for the Louisiana Office of Vocational Rehabilitation, Baton Rouge, Louisiana. She confirmed that the sequential visits do frequently occur, although she did not know of any research specific to this issue. She mentioned several possible reasons:
1) Some clients enjoy these experiences and request additional opportunities.
2) Some counselors easily grant requests or themselves suggest additional visits--it is something for the client to do.
3) Some visits are too brief to make significant rehabilitation possible.
4) Some visits may be for a specific technique such as to learn to develop computer skills or perhaps to train for a specific occupation.
5) Frequently those who are gradually losing eyesight receive rehabilitation services appropriate to their level of vision loss. A year later a new round may be deemed necessary to add additional skills of blindness.
I suggest other possible explanations. The first is the politics of spending public money. Residential rehabilitation centers are highly dependent on cash flow resulting from client fees. In some cases some rehabilitation counselors, through normal social networks, may be responsive to the needs of particular agencies to receive more clients. Second, some residential rehabilitation programs are not as effective as others. Even after many months, some other graduates may not have learned independent living skills or other skills necessary for employment (see data comparing the Minnesota agency presented earlier).
Finally, some blind individuals may have multiple problems as do others in American society. These additional problems may prevent significant progress. If some of these can be solved in another context, it may make sense to send the person for another session at a residential rehabilitation center.
The frequency of these sequential visits and the reasons for their occurrence merit further research. ********** Summary
My observations, reading of documents, and interviews persuade me that the three agencies--BLIND, Inc., of Minnesota; the Colorado Center for the Blind; and the Louisiana Center for the Blind are offering remarkably effective residential rehabilitation programs at this time. Main ingredients of this outcome include able leadership; careful staffing; a broad, positive, and yet realistic philosophy about blindness; and a curriculum that links philosophy to student development. The setting, including student residences, is also integrated into the overall rehabilitation program. There is a pervasive upbeat atmosphere which would be hard for any student to ignore. From the board of directors, director, staff, and students there is a strong commitment to the values and importance of these rehabilitation centers. Almost everyone sets high expectations, and everyone wants each student to succeed.
By the information these agencies present, the graduates of these residential rehabilitation programs are successful as measured by student goals for attending one of these centers. Many current students and a small sample of former students speak very well, almost without qualification, of these programs. Some present and former students speak of their experience as "life- transforming." In addition to particular skills, they have acquired a self-concept, a guiding philosophy, and a social network enabling them to sustain their ability to conquer future challenges.
In general I have a critical attitude toward almost everything and would have readily exposed any problems, discontent, or failure in performance that I observed or learned about. More research should be done in order to compare these three agencies with other not-for-profit private agencies or the few state-operated residential rehabilitation centers. Additional research should be conducted on the issue of why students frequently attend residential rehabilitation centers on multiple occasions. Is it because some centers are ineffective? Are the other reasons justified? Which reasons and why? **********