Predictors of Outcomes for African Americans in a Rehabilitation State Agency: Implications for...

Predictors of Outcomes for African Americans in aRehabilitation State Agency: Implications for National

Policy and Practice

Fabricio E. Balcazar

Ashmeet K. Oberoi

Yolanda Suarez-BalcazarUniversity of Illinois at Chicago

Francisco AlvaradoIllinois Division of Rehabilitation Services

A review of vocational rehabilitation (VR) data from a Midwestern state was conducted to iden-tify predictors of rehabilitation outcomes for African American consumers. The database in-cluded 37,404 African Americans who were referred or self-referred over a period of five years.Logistic regression analysis indicated that except for age and disability type, none of the otherdemographic variables were significant predictors of vocational rehabilitation for the individu-als in the sample. However, as the amount of money spent on a case increased, the probability ofgaining employment increased. Recommendations for VR practice with minority consumers aresuggested.

Balcazar et al. Keywords: African Americans, vocational rehabilitation outcomes, policy, practice

The Rehabilitation Act of 1973 as amended in 1998attempted to first increase the degree of consumer con-trol and also address the historical inequitable treatmentand outcomes of minorities with disabilities in allphases of the rehabilitation process. The Act affirmsthat “individuals with disabilities continually encountervarious forms of discrimination in such critical areas asemployment, housing, public accommodations, educa-tion, transportation, communication, recreation,institutionalization, health services, voting, and publicservices” (US Department of Education, n.d., p. 1).This landmark legislation has played a critical role inpromoting employment opportunities for individualswith all types of significant disabilities who qualify forVR services. For the purpose of the Rehabilitation Act,the term “individual with a significant disability”means an individual with a disability— (i) who has asevere physical or mental impairment which seriouslylimits one or more functional capacities (such as mobil-

ity, communication, self-care, self direction, interper-sonal skills, work tolerance, or work skills) in terms ofan employment outcome; (ii) whose vocational rehabil-itation can be expected to require multiple vocationalrehabilitation services over an extended period of time;and (iii) who has one or more physical or mental dis-abilities (resulting from multiple causes not listed here)on the basis of an assessment for determining eligibilityand vocational rehabilitation needs to cause compara-ble substantial functional limitation (Rehabilitation Actas amended section 7, part 21, A) (US Department ofEducation, n.d., p. 15).

The US Government Accountability Office [GAO](2005) report to Congress on the performance of voca-tional rehabilitation (VR) programs concluded that ofthe more than 650,000 individuals exiting the state VRprograms in fiscal year 2003, one-third (217,557) ob-tained a new job or maintained their existing job for atleast 90 days after receiving services (this is the criteria

Rehabilitation Education, Volume 26, Number 1, pp. 43-54, 2012

for successful rehabilitation). Rehabilitation ServicesAdministration (RSA) data showed that the remainingtwo-thirds exited the VR program without employmentmost often because the individual refused services orfailed to cooperate with the VR counselor (46 percentof the time) or could not be located or contacted (24percent) (General Accounting Office, 2005).

The GAO (2005) report also pointed out that RSA’sperformance measures are not comprehensive, and itsmonitoring of state VR agencies has not resulted intimely feedback. RSA does not comprehensively mea-sure the performance of certain key populations, suchas students transitioning from school to work, andtracks only the individuals who exit the program, notthose still receiving services. In addition, RSA’s perfor-mance measures do not take into consideration all thevariation among the state VR agencies or allow forcomparisons with other workforce programs. RSA’smonitoring reports, which are its primary means of pro-viding feedback to state VR agencies, are frequentlylate and based on data that are more than 2 years old.Consequently, state VR agencies do not receive thetimely feedback needed to improve the efficiency andeffectiveness of their programs. In managing the per-formance of the VR program, RSA also does not cen-sure poorly performing state VR agencies, rewardstrong performance, or take full advantage of opportu-nities to disseminate best practices.

Partially as a response to the previously stated chal-lenge, the state agency contracted with the University ofIllinois at Chicago to conduct an examination of theirvirtual case management database (VCM) in order toidentify trends and predictors of rehabilitation outcomes.The purpose of this paper is to analyze the outcomes ofAfrican American consumers in the VR system, includ-ing predictors of rehabilitation success or failure. The re-searchers first conduct a brief review of the literature re-garding racial disparities in VR services and outcomes,followed by an overview of the VR status progressionfor African Americans in a Midwestern state, and ananalysis of the personal and services characteristics asso-ciated with rehabilitation outcomes. At the end, somerecommendations for VR policy and practice are pro-vided. In this study we explore two main research ques-tions: What are the differences in progression outcomesbetween African American and White customers in theVR process? What demographic and VR service vari-

ables predict successful rehabilitation outcomes for Afri-can American consumers?

Racial Disparities in VocationalRehabilitation

VR disparities in access to services, quality of ser-vices and outcomes for individuals from minority back-grounds have been documented in previous research(e.g., Alston, Harley & Middleton, 2006; Wilson, Harley& Alston, 2001; Wilson & Senices, 2005). Tay-lor-Ritzler et al. (2010) argued that with few exceptions(see Wheaton, 1995; Whitfield, Venable, & Broussard,2010; Wilson, 1999), when compared to White consum-ers, ethnic minorities are significantly less likely to beaccepted for services or to obtain gainful employmentand when employed, they earn less income than Whites.

Martin (2010) pointed out that despite the numerousstudies that have indicated racial and ethnic disparitiesin the VR system, including differences in acceptance,services provided, closure types, and employment out-comes, few of these studies have used advancedmultivariate techniques or latent constructs to measurequality of employment outcomes (QEO) or tested hy-pothesized models for the relationship between race,personal characteristics, and VR employment out-comes. Martin used the 2006 RSA 911 data to test animplied conceptual model for the relationship betweenrace, personal characteristics, and QEO for White,Black, and Hispanic participants in the VR system. Theresults suggest that race/ethnicity, gender, educationalattainment, and public support are predictive of QEO.The results indicate that overall, White and Hispanicwomen earned lower wages and were less likely to re-ceive employment-provided medical insurance cover-age than their male counterparts. Educational attain-ment is structurally important for QEO for each ra-cial/ethnic group. For consumers in VR, having abachelor’s degree or higher at application is predictiveof increased QEO. The results also indicate small directeffects for significant disability on QEO for Whites andBlacks; however, the effect of significant disability wasnegative and not statistically significant for Hispanics.Finally, Black and White consumers receiving publicsupport had a medium and negative effect on QEO. Inother words, a decrease in QEO was predicted by publicsupport. As the author mentions, additional research isneeded to test the predictive nature of these variables

Rehabilitation Research, Policy, and Education

Page 44 Balcazar et al.

with regards to employment outcomes for the variousminority populations.

In a similar way, LeBlank and Smart (2007) con-ducted a systematic review of the outcome discrepan-cies among racially/ethnically diverse consumers ofVR services and found many methodological problemswith the research, including the use of archival data; theuse of univariate, nonparametric statistics; and the lackof precision in defining/operationalizing the independ-ent variable of race/ethnicity. The authors recommendthe use of hierarchical linear modeling in future re-search since many variables of interest can be studiedsimultaneously.

Mwachofi, Broyles, and Khaliq (2009) examinedVR’s effectiveness in assisting minorities to achievegainful employment. This study also used the RSA 911data from 2006, including 617,149 cases. The authorsexamined differences in access, employment, and earn-ings for White and ethnic minority clients (primarilyAfrican Americans and Latinos). The results show sig-nificant differences in employment and earnings out-comes for minority and White clients, with minoritiesfaring worse. Length of VR services and per capita ex-penditures appear to significantly influence employ-ment and earnings outcomes. The authors conclude thatVR services are more effective with Whites than withminority clients. They recommend the need to imple-ment policies or practices that ensure equity in access toservices that might translate into more equitable em-ployment and earnings outcomes for minority popula-tions.

Methods

Data Source for the Current Study

The data for the analyses were extracted from thevirtual case management (VCM) dataset of the VRagency. The VCM system contains personal character-istics, case history, types of services, and employmentoutcome information on all customers receiving VRservices in the state. These data were made available toUIC researchers through a data sharing agreement, andresearchers secured IRB approval in order to protect theprivacy of the individuals (by removing personal iden-tifiers) and the security of the data (using a computerwithout internet connection).

The data used for analysis in this report were ex-tracted for the period from July 2004 through June

2010. There were a total of 145,684 cases before the da-tabase was cleaned up. Some cases had data entry er-rors, which forced the deletion of 962 (0.66%) cases.There were 37,404 African Americans (25.67% of thetotal) and 81,110 Whites (55.67%) in the initial sample.The following were decision rules used to clean up thedatabase: (a) the VCM sample was limited to consum-ers who were 14 to 65 years old at closure; (b) whenconsumers had multiple closures (i.e., repeat users),only the record of the first entry was examined for con-sistence and in order to avoid multiple counts from thesame person (a total of 3,029 records from the entiredata were dismissed of which 465 were African Ameri-can [1.2% of the sample]); and (c) for the logistic re-gression, consumers whose cases were closed becausethey were deemed ineligible for VR services (VR status03 and status 01) were excluded (the agency followedRSA’s “order of selection guidelines” which gave pri-ority to cases on the basis of severity of the disabilityand employability); outcomes were classified into twomain categories (see Figure 1): Rehabilitated (VR sta-tuses 26 and 36) and Non-rehabilitated (VR statuses 07,28, 30, and 38).

Characteristics of the African AmericanSample

Of the 37,404 consumers in the initial sample, therewere more males (54%) than females (46%) in the data-base, a trend similar to other racial groups. The majorityof the African American consumers were 15 to 20 yearsold (31.7%), followed by 41 to 50 years old (21.5%).The next largest groups in terms of age were consumersfrom 21 to 30 years (17.2%) and 31 to 40 years(16.3%). In terms of education, most of the AfricanAmerican consumers were high school graduates orless (50%). Those with some college but no degreewere the next largest group (11%). However, for morethan 25% of the consumers, their education at entry intothe VR system was not reported. When it comes to thegeographical location, most consumers almost equallyresided in the suburbs (37.8%) or in a large city(35.5%). A substantial proportion of African Americanconsumers self-referred themselves to the VR system(65%). The next section examines the VR status pro-gression and outcomes for the African American con-sumers in the VCM system.


Predictors of Outcomes for African Americans Page 45

Results

Vocational Rehabilitation Progression in VRStatus for African Americans in the Sample

Figure 1 summarizes the status progression for theAfrican American consumers in the state database. Asmentioned, 37,404 cases came into the system as “Re-ferrals,” which included both referrals from agenciesand self-referrals. Of these consumers, 4,861 (13%)were “Closed from Referral” because the cases werenever opened, and 9,246 (24.7%) cases were “Closedfrom Application”. Therefore, 24,688 (66%) caseswere “Accepted/Eligible” for VR services and of these,16,447 had identifiable rehabilitation outcomes.

Using White consumers as a reference group, Afri-can Americans had a significantly higher percentage ofcases closed from referral status (13% vs. 10.64% forWhites); closed at application status (24.72% vs.16.81% for Whites); and closed as non-rehabilitated(16.5% vs. 13.41% for Whites). On the other hand,Whites had a significantly larger percentage of cases ineligibility for services status (74.39% vs. 66% for Afri-can Americans); cases with a rehabilitation plan(49.75% vs. 42.72% for African Americans); and casesclosed rehabilitated (24.69% vs. 16.16% for AfricanAmericans). Table 1 summarizes the status categories,frequencies and percentages for both groups of con-sumers.

Services Received

The DRS used a master list of 22 services availableto consumers (see complete list in Figure 2). Of thoseservices, African American consumers most commonlyreceived vocational rehabilitation guidance services(53.5% of the cases), followed by information and re-ferral (40.5%), and assessment (31%). Job search andjob placement assistance were also frequently provided(29.4% and 27.1%, respectively). A similar pattern ofdistribution of services was observed for White con-sumers. The most frequent number of services receivedwas 4 or 5 (at about 17% of consumers each).

Predictors of Rehabilitation Outcomes

A hierarchical logistic regression was conducted tofind out what demographic and VR level correlates pre-dicted successful rehabilitation1 for African Americanconsumers. All analyses were performed usingPSAW19 of the Statistical Package of Social Sciences

(SPSS). The outcome variable was a binomial variable(1, 0) based on whether a consumer’s case was success-fully rehabilitated (closed after rehabilitated and afterpost employment) or unsuccessfully rehabilitated(closed after trial work, non-rehabilitated, before indi-vidual plan, and closed after waiting list). A total of16,447 African American consumers with identifiableoutcomes were selected for advanced statistical analy-sis, of which 11,098 were not rehabilitated and 5,349were successfully rehabilitated. Successful rehabilita-tion was defined in the RSA-911 manual as employ-ment for at least 90 days in an integrated setting,self-employment, or employment in a state-managedBusiness Enterprise Program that is performed on afull-time or part-time basis for which an individual iscompensated at or above the minimum wage.

The analysis was broken down into two blocks ofpredictor variables. The first block was comprised ofdemographic variables – gender (Female

2 and Male);age (16 to 20 years, 21 to 30 years, 31 to 40 years, 41 to50 years, and 51 to 60 years); education (Less thanhigh school, high school diploma, some post-second-ary or associate degree, college degree or higher, andspecial education); disability type (Learning disabilityor behavioral disorders (LD/BD), Physical, Mentalillness, Sensory, and chronic illness); and geographiclocation (City, suburb, and mid-town). The secondblock was the VR service-related variables, includingthe 22 types of VR services (see complete list in Figure2); the number of services received; and the case expen-ditures.

The final model explained 37.6% of the variance inthe rehabilitation outcome3. This final model also had ahigh rate of accuracy – that is, for every 100 failurecases, this model predicted approximately 87 of theoutcomes correctly, and for every 100 successful cases,this model correctly predicted the outcome for 51% ofthe cases. Overall, this model correctly predicted theoutcomes of the cases closed 76.4% of the time. Exceptfor age and disability type, none of the other demo-graphic variables for the African American consumerswere significant predictors of vocational rehabilitation.All of the age groups older than 20 years (21 to 30years, 31 to 40 years, 41 to 50 years, and 51 to 60 years)had higher likelihood of a successful rehabilitation. Thelikelihood of rehab increased by about 10% for every10 years in age; for instance, African American con-sumers between the ages of 21 and 30 years had 48%


6 Balcazar et al.



Figure 1. Vocational Rehabilitation Status Progression of African Americans

higher chances of rehabilitation when compared to con-sumers who were less than 20 years old (OR = 1.48; p <.001), and the odds increased to 80% higher likelihoodfor consumers between 51 and 60 years old (OR = 1.80;p < .001). In terms of type of disability, when comparedto consumers with a learning disability and/or behav-ioral disorder, African American consumers with phys-ical disabilities had 15% less likelihood (OR = 0.85; p <.001), but those with sensory disabilities had a 72%higher likelihood of successful rehabilitation (OR =1.72; p < .001). The chances of vocational rehabilita-tion of African American consumers with chronichealth problems and mental illness were not signifi-cantly different from those with a learning disabilityand/or behavioral disorder.

Interestingly, none of the 22 types of services was asignificant predictor of vocational rehabilitation for Af-rican Americans with disabilities. For example, con-sumers who got “Vocational Rehabilitation Guidance”

as a service had the same chances of rehabilitation asthose who did not. However, the number of services acustomer received was a significant predictor, suchthat, each additional service received by a customer in-creased his/her chances of vocational rehabilitation by47% (OR = 1.47; p < .001). Further, the logistic regres-sion results suggest that as the amount of money spenton a case increases, the chances of successful rehabili-tation increases such that each additional thousand dol-lars spent on a case doubles the consumer’s likelihoodof successful rehabilitation. As can be seen in Figure 3,when $2,000 to $4,000 are spent on a case, there is a50-50 chance of rehabilitation. Any case expenditurebeyond $5,000 significantly increases both the rate andthe likelihood of rehabilitation success (540% highercompared to consumers with no expenditures [OR =6.40; p < .001]). Most importantly, according to theanalysis, spending between $5,000 and $8,000 per con-sumer is associated with the maximum rate of rehabili-



Table 1

Comparison of VR Status Between African Americans and Whites

p-value forChi-Square

Description Status Black Percent White % Difference4

Total Number of Cases 37404 81110

Referral 00 37404 100.00% 81110 100.00%

Closed from Referral 01 4861 13.00% 8633 10.64% <.001

Application 02 34401 91.97% 75051 92.53% ns

Closed Application 03 9246 24.72% 13638 16.81% <.001

Waiting List 04 190 0.51% 281 0.35% ns

Closed Waiting List 38 128 0.34% 216 0.27% ns

Interim Eligibility 06 480 1.28% 1177 1.45% ns

Closed Interim Eligibility 07 285 0.76% 611 0.75% ns

Eligibility 10 24688 66.00% 60334 74.39% <.001

Closed Eligibility 30 7137 19.08% 14622 18.03% ns

Rehabilitation Plan 18 15979 42.72% 40356 49.75% <.001

Interrupt Services 24 760 2.03% 1723 2.12% ns

Closed Rehabilitated 26 6046 16.16% 20030 24.69% <.001

Closed Non-Rehab 28 6172 16.50% 10877 13.41% <.001

Post Employment 32 63 0.17% 182 0.22% ns

Closed Post Employment 36 53 0.14% 163 0.20% ns

tation (a 1,360% higher likelihood of getting rehabili-tated [OR = 14.58; p < .001], compared to consumerson whose cases no money was spent). On the otherhand, expending more than $8,000 does not continue toimprove any further the likelihood of rehabilitationsuccess.

In sum, congruent with previous studies, AfricanAmericans were less likely to experience positive reha-bilitation outcomes and more likely to be closed fromreferral and application when compared to Whites. Onthe other hand, increases in case expenditures (between$5,000 and $8,000) and the resulting increases in the

number of services were associated with an 80% rate ofrehabilitation outcomes for the African American con-sumers in this study.

Policy Implications

As Mwachofi, Broyles and Khaliq (2009) con-cluded, there is a need to implement policies that ensureequity in access to services for minority populationsthat might translate into more equitable employmentand earnings outcomes. The process of service provi-sion is fraught with many challenges. Our findings sug-gest differences in the rates of rehabilitation plans and



Figure 2. Distribution of the Type of Services received by African American VR consumers

successful closures in favor of White consumers. Whatare some policies that could help reduce these gaps?

• We suggest that VR agencies make an extra effort topromote cultural competence among rehabilitationcounselors and staff in order to increase consumers’satisfaction with the quality of the relationships andbuild trust from the onset (see Balcazar,Suarez-Balcazar, Willis, & Alvarado, 2010). Con-sumers should be asked frequently about their satis-faction with the process and their progress, not just atthe end. Such feedback could also be beneficial tocounselors who could make adjustments in order toaddress consumers’ concerns, including making areferral to a colleague if the consumer is unhappy.This raises the issue of the role of supervisors in as-signing cases to counselors and the counselor’s free-dom to accept or reject some cases depending on thecircumstances of the case.

• Policies that promote and encourage a learning com-munity of counselors and the office supervisor couldbe helpful to deal with difficult cases. These casescould be reviewed in a group format and suggestions

for dealing with particular challenges or barriers dis-cussed in a group format. There are many benefits ofsharing experiences and learning from the more ex-perienced counselors, particularly for new counsel-ors.

How can access to services be improved by VR pol-icy?

• Policies need to be developed that better match theservices needed by a consumer, the expenditures percase, and the consumer likelihood of employment.Our findings suggest that increasing the number ofservices and therefore the expenditures per case in-creases their chances of rehabilitation. We recognizethat the rehabilitation process cannot dictate that ev-ery consumer receives a given number of services.However, counselors should be aware that providing6 to 8 services significantly increases the likelihoodof rehabilitation, which also implies a longer rela-tionship with the counselor and continuous engage-ments. It should be noted that the majority of theservices were provided directly by the counselorsthemselves (as shown in Figure 2), which in a time of



Figure 3. Rehabilitation Rates Associated with Case Expenditures for African American VR Consumers

budget constraints, maximizes the agency’s expen-ditures per case.

• As the relationship with the consumer progressesover time, counselors may conclude at some point inthe process that the consumer is not going to “makeit” and may gradually start decreasing their support.If the consumer becomes inactive, should the coun-selor try to close the case or find out and understandwhat is going on? How much time and effort can thecounselor dedicate to difficult cases or dealing withunanticipated barriers? How much support from thesupervisor is needed to save a case that may haveotherwise been closed? Should an additional inter-vention be introduced to try to “salvage” the case?There are no easy answers to these questions, butthey certainly should be part of the case file reviewbetween counselors and supervisors.

• Consumers have various degrees of understandingand awareness about the services and specially theirown role and responsibility in the rehabilitation pro-cess. Individuals with histories of oppression andmarginalization struggle a great deal when placed inpositions when they need to make decisions or setpersonal goals. These individuals may not have asense of entitlement and have no awareness of theirrights to appeal or challenge a decision made by theircounselor. In fact, many of these individuals are notable to challenge the decisions made by profession-als whom they perceive as having the knowledgeand experience that they lack. Policies that encour-age initial education and clarification of roles andexpectation early on in the process may help mini-mize these problems.

• Policies promoting consumer empowerment cannotassume that minority or marginalized individuals(by poverty or lack of education) understand whatthis is. In these cases, counselors need to spend timeearly on explaining the process and helping these in-dividuals understand their rights before the rehabili-tation process can begin. This process requiredadding some flexibility to the deadlines in the rulesthat dictate the beginning and end of some phases inthe process, particularly at the eligibility determina-tion and development of the employment plan.

Implications for Rehabilitation Practice

The results of this study confirm previous researchfindings (e.g., Capella, 2002; Mwachofi, Broyles, &

Khaliq, 2009) regarding poorer rehabilitation out-comes, as well as disparities in acceptance rates for Af-rican American consumers compared to Whites.African Americans are more often closed from referral,and particularly at application status. These rates sug-gest the need to provide better information to potentialconsumers about the eligibility criteria for services andto implement outreach and information campaigns thathelp potential consumers make informed decisionsabout applying for VR services. For example, we oftenhear of individuals who come to the first interview ex-pecting to get a name and an address for the job theywant, as if VR is a job-placement agency. Illinois hasemployed outreach workers to substantially increasethe rate of Latinos applying for VR services. The infor-mation that these paraprofessionals can convey to po-tential consumers could be very helpful and also reduceconfusion and misunderstanding. Similar outreach pro-grams for other minority groups, including AfricanAmericans, could also help minimize the prevalentrates of closure at referral and application status. Futureresearch efforts could help identify the factors that al-low African Americans to effectively engage with theVR system and those that hinder their engagement, in-cluding issues of cultural competence and cultural mis-trust and effective ways for building rapport early in theprocess.

In addition, agencies could also improve the qualityand amount of information available to consumers re-garding their rights and responsibilities in the rehabili-tation process. Many individuals do not have a clear un-derstanding of the expectations the system places on theindividual themselves and the kind of initiative and ef-fort they need to place in their own rehabilitation. Someindividuals from minority and low-income populationsoften have low expectations and passive attitudes thatcould be detrimental to their rehabilitation process.Early education and awareness could help removesome of these barriers early in the process.

Another strategy that could help consumers remainsuccessfully engaged in their rehabilitation process isreceiving peer mentoring support. Many consumersmay feel more comfortable talking with experiencedpeers about the complexities of setting goals and under-standing the rehabilitation process than talking to a pro-fessional who may or may not have much in commonwith them. We developed a peer mentoring program forindividuals with spinal cord injuries (SCI) in a rehabili-



tation hospital (see Balcazar, Hayes-Kelly, Keys, &Balfanz-Vertiz, 2011), and the hospital has incorpo-rated it as a model for new patients, particularly minor-ity individuals with acquired SCI due to violence. Thementors not only become employed, but they gain ex-perience over time and better themselves too(Hernandez, 2005 identified multiple benefits for boththe mentors and mentees).

As pointed out by Olney and Kennedy (2002), racialdifferences in VR service utilization and employmentoutcomes appear to stem primarily from socioeco-nomic disparities. However, employers’ discriminatorypractices toward individuals of color with disabilitiesneed to be addressed too. Efforts to deal with employ-ers’ attitudes and concerns about hiring minorities withdisabilities, including explaining the tax benefits and fi-nancial incentives available to employers, could helpminimize some of the concerns. Finally, although wedid not find specific services having a salient role on therehabilitation outcomes of the participants, the combi-nations of services and number of services did play acritical role in increasing the likelihood of successfulrehabilitation. Vocational rehabilitation guidance andinformation and referral were among the most com-monly used services.

Conclusions

The results confirmed the differences in referrals, el-igibility, and rehabilitation outcomes between Whiteand African American consumers. These differencesappear insidious and difficult to change. Policies de-signed to increase the awareness and understanding ofrehabilitation for minority and/or marginalized popula-tions at the onset of the process could be beneficial. Ouranalyses of the variables that predict rehabilitation out-comes for African Americans indicate that other thanage and disability type, demographic variables are notgood predictors of rehabilitation success. Types of ser-vices were not good predictors either, although thenumber of services and the amount spent in each casewere. Once a consumer receives from $5,000 to $8,000in services (around 6 to 8 types), his or her chances ofsuccessful rehabilitation increase to 80%. For stateagencies, there is a need for up-to-date data that can betranslated into information and knowledge to initiatemanagement directives. The agencies’ development ofmeaningful service improvements depends on theirability to have timely access to data and information, so

administrators can make informed decisions and buildcapacity. The partnership with the university was valu-able because it provided access to information that wasneeded to address service gaps and evaluate staff per-formance. VR agencies need to maximize collective as-sets and improve services while expanding communityand business partnerships.

Bruyère and Houtenville (2006) argued that in timesof increasing fiscal pressures at the federal, state, andlocal levels, the need to make the case for public sup-port of rehabilitation services is increasingly important.Understanding the characteristics, economic status, andsocial participation of those who use rehabilitation ser-vices is crucial to evaluating the need for and impact ofrehabilitation services. Data analyses like the one weconducted can be used in rehabilitation science to testhypotheses, evaluate needs, assess the performance ofrehabilitation counselors, and clarify expectations andchallenge practices that may need to be changed.Knowledge of these data sets and their utility for reha-bilitation service program planning and evaluation, andadvocacy at the local, state, and federal levels should bean integral part of rehabilitation counselor pre- andpost-service training and ultimately of rehabilitationpractice, management, public policy, and research.

Similar to previous research findings on race/ethnic-ity and VR outcomes disparities (e.g., Alston, Gayles,Rucker, & Hobson, 2007; Baker & Taylor, 1995; Olney& Kennedy, 2002: Wilson, Harley, & Alston, 2001),the results also suggest the need for cultural compe-tence training (CCT) for VR counselors. CCT is in-tended to improve counselors’ awareness about the im-pact of their behaviors, attitudes, knowledge, and skillsin cross-cultural interactions with consumers andco-workers (Leung, Flowers, Talley, & Sanderson,2007; Sue & Sue, 2008). Middleton and colleagues(2000) suggest that CCT should include content onsocio-political perspectives and the VR history of ser-vice disparities. Research funded by the National Insti-tute on Disability and Rehabilitation Research(NIDRR) reiterates the benefits of CCT for rehabilita-tion professionals (Taylor-Ritzler et al., 2008). Addi-tional research is needed to explore the effects of cul-tural competence on VR outcomes.

The study has a few limitations. First, we identifieddata entry errors that rendered several cases unusable.Most of these errors are easily corrected with softwarethat alerts counselors of the mistakes. The agency is al-



ready implementing changes in the database to mini-mize data entry errors like the ones we identified. Sec-ond, we did not collect any data from counselors and/orconsumers themselves, since that was not the intent ofthe study. However, additional data particularly fromqualitative interviews could add more texture to thefindings and clarify some of the reasons behind thefindings. Last, additional minority groups could also becompared. We are in effect planning to replicate this re-search with other racial groups (i.e., Latinos, AsianAmericans), in order to determine if the findings areconsistent across groups or differ in any significantways.

Finally, Alston, Harley, and Middleton (2006) arguethat social justice will likely be the context in which fu-ture debates surrounding race and rehabilitation will beframed. Expanding the discussion beyond multicultur-alism and diversity allows greater exploration of soci-ety’s moral shortcomings such as oppression and dis-crimination. The philosophical concept of social justiceforces one to contemplate the contradictions of fairnessinherent to American society, as manifested in the in-equalities that exist in this country. More importantly,Alston and his colleagues argue that consideration ofjustice, equality, and access would invariably lead oneto contrast idealism with realism for persons with dis-abilities in general and minorities with disabilities inparticular. The authors also propose that racism has al-ways been implicit to the debate on social justice in re-habilitation, but rarely discussed openly. Numerous au-thors have suggested that racism in the form of coun-selor bias, indifference, or incompetence is central tothe disparity in rehabilitation success between minorityand White clients. There is a lot of work left to do.

References

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Balcazar, F., Suarez-Balcazar, Y., Willis, C. &Alvarado, F. (2010). Cultural competence: A re-view of conceptual frameworks. In F. Balcazar, Y.Suarez-Balcazar, T. Taylor-Ritzler, & C. B. Keys

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Balcazar, F. E., Hayes-Kelly, E., Keys, C. B., &Belfanz-Vertiz, C. (2011). Using peer mentoring tosupport the rehabilitation of individuals with violentlyacquired spinal cord injuries. Journal of Applied Reha-bilitation Counseling, 42(4), 3–11.

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Endnotes1 The logistic regression analyses used in this reportgenerated odds ratios that state how much more or lesslikely it is for an outcome variable (i.e., successful em-ployment) to occur when the predictor variable is pres-ent, controlling for all the other variables in the model.The size of any relationship is measured by the differ-ence in either direction from 1, (1 indicates equal oddsfor the predictor vs. the reference group for the outcometo be 1). The greater the departures of the odds rationfrom 1, the stronger the relationship between the pre-dictor and the outcome variable.2 The category used as the reference group is bolded forall categorical variables.3 For more information on the variable selection criteriafor the model, please contact the first author.4 Chi-square with Yates correction was done to controlfor large sample sizes.



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