Table of Contents | LRB Reports |
Issue One: Client/Staff Ratios
The first issued listed in H.C.R. No. 157, HD1 is "A comparison of the client/staff ratio for
blind services in comparison to deaf services." The Vocational Rehabilitation and Services for the
Blind Division (DVR) is the only body that has data relevant to this issue. This chapter provides
that data. However, to better understand what these ratios may mean, it is important to know what
services are being provided by the DVR to blind and deaf or hard of hearing clients. Therefore, this
chapter begins with a listing of all direct vocational rehabilitation services currently provided by the
DVR. The DVR was asked to list all direct services (excluding administrative or clerical services)
provided to (1) both disability subgroups; (2) to blind clients only; and (3) to deaf or hard of hearing
clients only. Unless otherwise indicated, all data in this chapter are derived from the DVR's original
and follow-up survey responses.(1) Additional information or clarification of original or follow-up data
are indicated as such and derive from further follow-up questions, interviews, or both.
Direct Vocational Rehabilitation Services: According to 348-2(4), Hawaii Revised Statutes,
vocational rehabilitation services consist of thirteen specifically listed services as well as ". . .
diagnostic and related services (including transportation) incidental to the determination of whether
an individual is a handicapped individual, and if so, the individual's eligibility for, and the nature and
scope of other vocational rehabilitation services to be provided." However, as can be seen in Table
2-1 (A) below, DVR services are not limited to those defined by statute. Additional services are
required by the Hawaii Administrative Rules. Table 2-1 (A) breaks down all DVR-provided direct
services available to both disability subgroups by type of mandate -- statutory or rule. Table
2-1 (B) lists services provided exclusively to blind clients while Table 2-1 (C) lists services provided
exclusively to deaf or hard of hearing clients.
A review of the type and number of direct vocational rehabilitation services provided to the
two disability subgroups may shed light on service imbalances of a different sort that client/staff
ratios do not address. A review of client/staff ratios assumes that there is no lack of necessary
services and that any inadequacy lies only in having too many clients, not enough staff, or both.
A look at actual services being provided may indicate that some needed services are lacking,
regardless of client/staff ratios. However, it appears the two may be interrelated: certain services
are lacking at the same time that there is no staff to provide them. What is unclear is whether
needed services are lacking because there is not enough staff or whether staff is adequate but
policy, or lack thereof, has resulted in the status quo where service is provided disproportionately
to one disability subgroup. The answer probably lies somewhere in between -- much as the
resolution seems to imply.
A separate deaf branch would address policy imbalances and undoubtedly spur additional staffing -- something that the Department of Human Services is to consider. An examination of client/staff ratios tends to support changes in policy and organizational restructuring. On the other hand, examination of specific service issues may help to shed light on what the service inadequacies are, regardless of whether they are caused by or exacerbated by a lack of staff.
"HRS" or "HAR" indicates a service is specifically mentioned in the Hawaii Revised Statutes or the Hawaii Administrative Rules,
respectively.
| Services for Both
Blind & Deaf Persons |
Description of Service | HRS | HAR |
| Counseling and guidance | Assists in:
determination of vocational potential understanding and relating health, disability, personal, and social problems to clients' vocational adjustment understanding capacities and limitations in selecting occupational goal assuring client commitment, participation, and cooperation achieving a job objective adjustment in a suitable job |
||
| Restoration | Corrects or modifies a physical or mental impairment which is stable or slowly progressive and results in a substantial impediment to employment | ||
| Training (vocational & other) | Restores clients to gainful occupation as part of a planned program to meet clients' needs | ||
| Post employment services | Maintains, through VR services, the employment of an individual whose case has recently been closed | ||
| Services to families of persons with disabilities | Enables client to benefit from the VR program and during extended evaluation for VR services | ||
| Maintenance services | Monetary support for living expenses (food, shelter, clothing, subsistence) authorized in individual client plan | ||
| Occupational licenses, tools, equipment, initial stocks and supplies | For employment or self-employment | ||
| Transportation services | Travel and subsistence costs for disabled persons and their attendants or escorts for diagnostic or VR services | ||
| Rehabilitation technology services | Systematic application of technologies, engineering, methodologies, or scientific principles to meet needs of and address barriers confronted by persons with disabilities in education, rehabilitation, employment, transportation, independent living, and recreation | Note | |
| Transition services | Promotes movement from school to post-school activities through coordinated set of activities for students with outcome-oriented process | ||
| Personal assistance services | Assists in performance of activities of daily living on or off the job | ||
| Supported employment services | Supports and maintains, with ongoing services, the most severely disabled persons in supported employment | ||
| Work-related placement services | Includes job search & placement assistance, job retention services, follow-up & follow-along for minimum 60 days after placement | ||
| Assessment for determination of eligibility | Determines eligibility and priority for services when the DVR is under an Order of Selection for services | ||
| Assessment for determination of VR needs | Provided for eligible persons under extended evaluation or if the DVR is under an Order of Selection | ||
| Referral and other services | As necessary to obtain services from other agencies and advice about the Client Assistance Program | ||
| Other goods and services | As necessary to achieve an employment outcome |
Note: "Rehabilitation technology services" as reported by the DVR is covered in 17-401-18(f), Hawaii Administrative
Rules (Department of Human Services) under "telecommunications, sensory, and other technological aids and
devices," and possibly 17-401-4(a)(1)(G), HAR "rehabilitation engineering services" under "scope of vocational
rehabilitation services," and 17-401-17, HAR "reader, rehabilitation teaching, and orientation and mobility
services for the blind."
| Services (Blind Only) | Description of Service | HRS | HAR |
| Reader notetaker services | Oral reading of printed material and notetaking of spoken material not available in braille or on tape | ||
| Orientation and mobility services | Sensory development; use of sighted guide; use of hands, arms, body in protective way; grip and use of canes; orientation to environment; use of transportation; travel in residential & business areas; travel with mobility aids; travel with low vision aids & guide dog | ||
| Occupational therapy services | Maximizes capacity for independent living and vocational readiness through development of basic skills, sensory-motor and psychosocial functioning and vocational activities |
Note |
|
| Manual arts services | Woodwork, household mechanics, gardening, weaving, etc. | ||
| Communication skills | Braille reading, writing techniques, typing, math computation, use of recording and electronic devices | ||
| Social services | Social casework for individuals and families; cooperative planning with other agencies to expand social and recreational resources in the community | ||
| Home teaching services | Instills confidence & independence resuming routine home activities after loss of sight: personal, home management, communication, leisure, etc. | ||
| Low vision clinic services | Examines, prescribes, fits, appropriate optical aids and devices | ||
| Personal and home management services | Teaches adaptive & alternative techniques in hygiene, grooming, eating, selecting clothes, money identification, housekeeping, shopping, cooking, etc. | ||
| Social group work services | Group counseling & activities, interest classes, education programs | ||
| Work evaluation and work adjustment training | Reviews work history & performance, testing, work sampling, situational placement, recommendations for jobs, extended pre-vocational exploration and development, vocational adjustment and training | ||
| Vending facility program | Comprehensive evaluation and training, certification for blind vendors; announcement of vending vacancies & placement; follow-up | ||
| Sheltered workshop services | Long-term job opportunities for persons with limited abilities unable to compete in labor market; pre-vocational exploration for clients who need a period of evaluation and training in a regular work setting | ||
| Work activities center program | Therapeutic activities for workers whose physical or mental impairment is so severe as to make their productive capacity inconsequential; includes skills of daily living, self-sufficient activities |
Note: "Occupational therapy" appears in 348-2(10), HRS, as one of five services provided by a "rehabilitation facility.
[See previous section entitled "Question Group One -- Services."]
| Services (Deaf Only) | Description of Service | HRS | HAR |
| Interpreter and notetaker services for deaf, hard of hearing and deaf-blind persons | Sign language/English and interpreting to facilitate communication between deaf, hard of hearing, deaf-blind, and hearing persons. Notetaking of spoken material not available in written form to enable the individual to benefit from VR services under an approved individual plan |
Client/Staff Ratios: The Bureau asked the DVR to list the number and distribution of filled,
full-time equivalent (FTE) positions providing direct services to all vocational rehabilitation clients;
to blind clients only; and to deaf or hard of hearing clients only. The DVR was also asked to supply
the number of blind and deaf or hard of hearing DVR clients who actually received services (data
were reported for FY 1994 through FY 1996).(2)
| Position Name | All Services | Blind Only | Deaf Only |
| Social Worker | 1.0 | 1.0 | 0.0 |
| Vocational Rehabilitation Counselor | 1.0 | 1.0 | 0.0 |
| Vocational Rehabilitation Counselor | 1.0 | 1.0 | 0.0 |
| Vocational Rehabilitation Counselor | 1.0 | 0.5 | 0.0 |
| Rehabilitation Teacher | 1.0 | 1.0 | 0.0 |
| Social Service Assistant | 1.0 | 1.0 | 0.0 |
| Social Service Assistant | 1.0 | 0.5 | 0.0 |
| Occupational Therapist | 1.0 | 1.0 | 0.0 |
| Occupational Therapist | 1.0 | 1.0 | 0.0 |
| Orientation & Mobility Specialist | 1.0 | 1.0 | 0.0 |
| Orientation & Mobility Specialist | 1.0 | 1.0 | 0.0 |
| Rehabilitation Teacher | 1.0 | 1.0 | 0.0 |
| Rehabilitation Teacher | 1.0 | 1.0 | 0.0 |
| Group Worker | 1.0 | 1.0 | 0.0 |
| Vending Specialist | 1.0 | 1.0 | 0.0 |
| Vending Specialist | 1.0 | 1.0 | 0.0 |
| Social Service Assistant | 1.0 | 0.5 | 0.0 |
| Rehabilitation Counselor with the Deaf | 1.0 | 0.0 | 1.0 |
| Social Service Assistant | 1.0 | 0.0 | 1.0 |
| Social Service Assistant | 0.5 | 0.0 | 0.5 |
The full-time vocational rehabilitation counselor and social service assistants also provide services to deaf-blind
individuals. Thus they are listed at only 0.5 FTE for direct services to the blind and 0.0 FTE for deaf clients.
A total of 14.5 FTE positions were available to provide direct services to 243, 287, and 265
visually-impaired clients, respectively, in the three fiscal years covered. Expressed as client-to-staff
ratios, they were 16.8-to-1, 19.8-to-1, and 18.3-to-1 for fiscal years 1994, 1995, and 1996,
respectively.
For the same three fiscal years, 194, 232, and 239 deaf or hard of hearing clients actually
received direct vocational rehabilitation services from the DVR. Only 2.5 FTE positions were
available to provide direct services to the deaf and hard of hearing. Expressed as client-to-staff
ratios, they were 77.6-to-1, 92.8-to-1, and 92.5-to-1 for fiscal years 1994, 1995, and 1996,
respectively. It is clear that the ratios are unbalanced, especially in light of the fact that the number
of deaf and hard of hearing clients receiving services were only slightly lower than that for visually-impaired clients. Proportionally, the number of deaf or hard of hearing clients were almost equal
to that of visually-impaired clients -- at about 80%, 81%, and 90% -- for the three fiscal years,
respectively.
As is obvious, there is only one service provided exclusively for deaf and hard of hearing
persons. On the other hand, the DVR reports 14 services provided exclusively for the visually-impaired. An additional 17 services are provided to both blind and deaf or hard of hearing clients.
That an imbalance in available services exists is clear. However, it is only fair to note that the DVR
is tasked to serve not only blind and deaf or hard of hearing persons but also "severely
handicapped individuals" who suffer from a variety of illnesses and conditions. [See material in
chapter 1 under the subheading "Vocational Rehabilitation and Services for the Blind Division."]
Nonetheless, the deaf and the hard of hearing constitute a major service population.
Furthermore, it would only be logical to provide more services to this population, if only because
of their large numbers.(3) Certainly, no one would advocate duplicating for the deaf or hard of
hearing, all services currently available exclusively to the blind. Even so, some additional services
could be extended to the deaf or hard of hearing (e.g. social services, communication skills, work
evaluation and work adjustment training). However, the blind and the deaf populations are
sufficiently different so that certain other services remain appropriate for only one population (e.g.
non-braille reader services, low vision clinic services, orientation and mobility services).
The perceived gap in services for the deaf or hard of hearing population in general may not
lie so much in a lack of services as in the inadequate delivery of existing services. A 1995 report
by the Pacific Basin Research and Training Center of the University of Hawaii concluded, in
general, that improvements were needed in access to, and delivery of, vocational rehabilitation
services for the deaf or hard of hearing. To address this issue, the Department of Human Services
has been requested to consider the creation of a separate branch in addition to the existing branch
that serves the blind to centralize the provision of services to the deaf or hard of hearing.
1. The DVR's original written response was received on July 15, 1996; its response to follow-up questions were received on August 19, 1996.
2. This number is the smaller number actually receiving services, and not the larger number of total referrals or the number that applied for eligibility determination. For purposes of the survey, the DVR agreed not to include those clients who were both deaf and blind.
3. H.C.R. No. 157 claims that Hawaii is home to 73,200 hearing-impaired persons, of which 9,700 are profoundly deaf (of which 6,499 are of work age): p. 1, lines 12 - 18.
|
Table of Contents | LRB Reports |