The Road to Success
The Rehabilitation Services Bureau
September 2006

Recently students in graduate programs reported that IVRS will no longer be hiring Master's level counselors. Since this is not at all consistent with the message that has been communicated to managers and staff during office visits it was determined that perhaps this article would clarify just exactly what the reasons were for restructuring and plan for hiring. Readers interested in the full text concerning how these decisions were made and the strategic planning involved in the process should refer to the full text of this article found at the end of the newsletter.

Four critical elements contributed to the need to re-organize and restructure:

1. Budget issues led to increasing waiting lists;
   a. Caseloads began to decrease with the implementation of the waiting lists thereby providing counselors with more time for counseling and placement activities;
   b. Counselors continued to voice inability to do placement due to paperwork demands
2. Case management activities reduce the amount of time counselors can spend performing their core function;
3. RSA standards are a minimum level to achieve and should be exceeded regularly when serving individuals to achieve their employment outcomes.

The salary for a senior counselor at the top of the pay grade is $59,051.20 to perform work at a professional level pay grade 28, which validates the need to ensure that clients receive services from a qualified rehabilitation counselor. However there are a number of functions that counseling staff currently perform that are not considered counseling activities nor do they require a master's degree to perform them. Paying a rehabilitation counselor salary to a person who performs work that can and should be performed by a person whose skills fall in a case management position is not an effective nor an efficient use of resources.

IVRS will continue to hire rehabilitation counselors when the job being filled demands it. In addition IVRS will continue to analyze what job is most appropriate for the caseload structure of the office, and the needs of the clientele, so that staff maintain regular and consistent contact as is positively correlated with successful outcomes. There will always be a need to hire rehabilitation counselors when it is feasible and appropriate to work force planning. However rehabilitation associates and assistants will also be hired so that counselors will no longer spend their time doing things that do not contribute to the client outcomes, but only serve the case service reporting requirements.

The efficiency and effectiveness of rehabilitation in general has been called into question by many detractors of the rehabilitation program. The statistics of the public program demonstrate an "adequate" program according to the federal accountability standards but fails to support VR as a high quality program. IVRS is dedicated to changing that by minimizing the number of cases closed due to "loss of contact" or other less than positive closures. This change in structure will enhance IVRS' ability to transform into a high performing organization dedicated to quality and timely services.

Success Story

By: Monty South

An IVRS client's file was reassigned to me, upon another counselor retiring from our agency. This individual's name just came to the top of our waiting list. When she applied for services about one year ago, all she wanted was funding for a new power wheelchair.

Counselor contacted client and asked her if she still wanted VR services. She informed me that she still only wanted help with funding a new power wheelchair. Client currently works a permanent, full time position at Principal Financial Corp. She has muscular dystrophy and receives SSDI. She has full benefits with her employer. Co asked Client to find out how much her private insurance would cover for the wheelchair. I also asked her to find out how much her Medicare Part B would cover. I also provided client with information about the Muscular Dystrophy Association at www.mdusa.org or at 319-393-8905 to find out if they would cover some of the cost. Client was also provided another funding resource through the Wheelchair Project at www.lifenets.org/wheelchair/ or at 888-821-0095 to see if they too could provide any funding.

About two weeks after I provided client with the comparable assistive technology funding resources, she contacted me to inform that she will be getting 100% of her new power chair funded and to go ahead and close her file. She thanked me for providing her with other funding resources. In the past, client had utilized VR funding for any assistive technology needs. I closed her file in status 38-0. Applicants and clients on our waiting list can definitely benefit if they are provided with assistive technology, housing, transportation and employment resources at intake time.

A New Paradigm

Iowa Vocational Rehabilitation Services (IVRS) has done an amazing job of assisting individuals with disabilities in achieving the vocational goal as identified in the Individual Plan for Employment. Since 2002 the management team in the Rehabilitation Services Bureau (RSB) began to focus upon the guiding principles and core function of the agency to make decisions, design service delivery, and enhance the experience that the clients have in working with IVRS. Critical to this analysis included various factors: restricted fiscal resources, the RSA Longitudinal Study, outcome measures, increasing case service costs, increasing case load sizes, time demands, work load, and the value added activities reported by clients that contributed to their satisfaction.

First and foremost clients reported that while the financial assistance provided by the agency to participate in training opportunities was appreciated, the encouragement and support that the counselors provided made the difference in their achieving their vocational goal. This was certainly validated by the RSA Longitudinal study that demonstrated a positive correlation between the counselor/client relationship and outcomes. Frequency of relevant and meaningful contact was highlighted as the most significant impact on an individual's ability to obtain employment.

In addition to ever increasing costs and decreasing fiscal resources, partnerships that were dependent upon IVRS funding rather than quality collaboration, required significant evaluation of the services that IVRS purchased and provided. As costs increased regularly fewer and fewer clients were able to be served due to the pressure it created upon the budget. In addition as recently as three years ago IVRS outcome data demonstrated that there was a 50% recidivism rate for individuals who received supported employment purchased services, causing an ever revolving door and duplicative service provision straining an already depleted budget. IVRS in the late 1990s became more of a case management purchased service organization so that counseling staff could handle more cases with fewer staff. Staff who desired to provide quality counseling services could not perform at the level they expected of themselves. The outcry concerning work load demands shouted for either more and more staff or restricted case loads so clients could be served. As such the staff capacity issues and budgetary difficulties forced IVRS into a waiting list.

In response to the intersection of all of these pressures the RSB Management Team set out to solve the IVRS version of what Thomas Friedman describes in his book The World is Flat as the "Triple Convergence". When a triple convergence type process occurs, various forces intersect and create momentum thereby changing the structure and the processes which can either be planned for and developed or simply reacted to as things arise. Therefore the RSB Management team reviewed various indicators and information to make an informed decision on how to best structure the organization to meet the expectations of the clients we serve.

In considering our core values and core function the RSB Management team determined that some specific areas required attention:

1. Responding to clients in a timely manner;
2. Providing high quality and effective customer service delivery;
3. Increasing the number of clients the agency serves;
4. Balancing the staff/case load ratio;
5. Training staff to meet the changing demands of service delivery;
6. Utilizing talents and skills of staff to their optimal level;
7. Reducing case service costs that detract from outcomes; and
8. Increasing outcomes and developing relationships with business and industry.

Allowing the clients' expectations to drive the decision-making process on agency structure, service delivery, and resource usage it quickly became evident that the structure established in 1920 was no longer an effective or efficient manner of operation. The 1920 model of rehabilitation in which one counselor worked with one client, placing that individual on a job was a very inefficient method when considering outcomes, financial resources, and staff capacity issues. The team considered that there are three primary ways to increase capacity that the agency actually has control over:

1. Hire more staff;
2. Change processes, access comparable services and streamline operations; and
3. Restructure the organization in terms of job function.

1. Hire more staff: In the past the answer to staff capacity issues so that more clients could be served was resolved by hiring additional staff. However this option was not a possibility at the time because resources were dwindling and IVRS only is allocated a specific number of positions to staff within state government. Since many of the services that IVRS provided were purchased services there were very few opportunities to hire additional staff. In addition the costs for the services continued to spiral to a point where the return on investment was questionable. (You might recall that we had a 50% recidivism rate when we paid for supported employment services.) Finally hiring more staff, doing the work in the same inefficient way, was not a solution but rather a band aid until there was a need for more staff again thus creating a cyclical problem/solution process that did not solve the core issue: limited resources and high demand.
2. Change processes, etc: In 2002 management began asking the questions - What can we do differently? What adds value to the client? What processes, etc., are barriers to outcomes? Staff was asked to consider processes and operations to identify a better way to perform the work. Systemic changes were options as long as the change was legal, ethical, and served the client. As a result data was reviewed concerning closures that resulted in discussions and plans for development of an Orientation module, Referral module, and an Eligibilty SD revision. The Eligibility revision still awaits RSA's approval, and then next will require the SRC to approve it. The other two modules have been completed. In addition other changes actually impacted the timeliness and quality of service delivery:
   a. Testing could be completed for any individual placed on the waiting list for whom the information was necessary to determine the placement on the waiting list.
   b. Developing relationships with employers became the primary core function as management recognized it was much more efficient to develop business relationships that may result in multiple placements than placing one individual at a time.
   c. Focusing upon the identity of IVRS enhanced better referrals seeking employment. Those requiring social services could be referred to other more qualified organizations to provide those services. d. Training staff on the regulatory requirements so that staff could be more creative as they understood that the regulations are not restrictive but guiding principles.
3. Restructure the organization: While continued review of processes decreases barriers that clients experience when they interact with IVRS, that still does not address the staff capacity issue that grew to be the primary pressure upon the service delivery system. Through the workforce planning model (in which the work is better defined according to the function to be completed and the assignment not on past classification) the most efficient and effective resource to perform the function is recruited. This provides the RSB Management a staffing model to capitalize upon staff talents. The model incorporates the talents of all staff and places rehabilitation counselors in a position of using a more advanced skill level than had been used previously simply because of the workload demands. Removing those functions from the counselors work load that are more case management and do not required a master's degree provides counselors with more time to perform the critical functions so essential to quality rehabilitation.
   a. Rehabilitation Counselors are mandated by Federal Regulations to perform specific functions in the rehabilitation process. The function described in the law include: determination of eligibility, signing an Individual Plan for Employment, and a determination to close the record of services of an individual who has achieved an employment outcome in accordance with the IPE. However IVRS determined the need for a Qualified Rehabilitation Counselor extended far beyond those functions. Indeed the reason counselors are necessary is not only to make an accurate determination of eligibility and placement on the waiting list but also to:
   
   i. Provide quality counseling to enhance: the client's understanding of his/her disability; the client's understanding not only of his/her informed choices but also how to exercise those choices; the client's understanding of the world of work and how to be a contributing member of his/her community; and develop the client's self advocacy skills related to the world of work.
   ii. Develop quality Individualized Plans for employment. The rehabilitation counselor synthesizes all of the research and information to assist the client in understanding the employment possibilities that compliment his/her strengths, resources, priorities, concerns, abilities, capabilities, interests and informed choice. Extensive knowledge of the business community and implications of disability issues is critical for a Rehabilitation Counselor to develop a quality plan with a client that focuses upon the individual's optimal level of employment. The technical work is time intensive, immensely satisfying, and requires a master's degree to perform the critical function of the job.
   iii. Develop relationships with business and industry. The negotiation skills required to develop these relationships are the very same skills a counselor demonstrates everyday in working with clients. Advising business and industry of the advantages of partnering with IVRS, negotiating customized training plans to enhance the employer's bottom line and the client's job match, and negotiating reasonable accommodations to create a successful work environment requires specialized training and expertise that only a Rehabilitation Counselor can provide.
   
   b. Rehabilitation Associates, on the other hand, have assumed a para professional role in which they: spend 90% of their time managing cases; working one on one with clients under the direction of the counselors; assisting the client in developing self advocacy skills so that the client is prepared for the world of work and interacting with the counselor; researching information and assisting the client in understanding that information so the client is prepared to meet with the counselor; completing assessment needs; following up with the client on specific requests identified by the counselors; and managing supported employment or other cases where case management needs are the primary focus once the counseling has been completed.
   c. Rehabilitation Assistants have assumed the role of orienting the client to IVRS; providing job search assistance direction; completing intakes; researching information for counselors; maintaining relevant contact with the client prior to a decision of eligibility; and accompanying clients to purchase items for various service needs.

While recent budgetary issues prevented full implementation of the model the plan remains in effect and will be used to consider appropriate staffing needs. Staff still struggle with the vision of the model Rumors continue to abound with staff instilling fear that jobs are being phased out or territorial issues prevent some staff from embracing the team concept that is designed to increase professionalism and timeliness of services. Staff continues to struggle with the entire concept of change. But in order for IVRS to be a viable organization we must work smarter.

RSB Management is committed to working through these issues and realizing a more efficient and effective system so that one day the retention rate for all populations achieving status 26 is at 80%, (currently non diversity populations are at 49% and diversity populations are 38%). Iowan's with disabilities deserve the best possible service, equal access to those services, and a team of professionals committed to helping them realize their goals. The vision the RSB Management team has always had is that when people think of who the best organization is to serve individuals with disabilities the answer immediately comes to mind: Iowa Vocational Rehabilitation Services.