Assessing 3 Rehabilitation Agencies

Assessing 3 Rehabilitation Agencies

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.

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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?

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