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					                                       Table of Contents

Executive Summary                                                                            3–19

Chapter 1      SNAP 2009 Overview
               1.1  Introduction                                                                  20
               1.2  Purpose and Objectives                                                        20
               1.3  Research Approach and Methodology                                             21

Chapter 2      Framework for Understanding
               2.1  Overview of AZRSA VR and IL Services                                          25
               2.2  Core Definitions and Terms                                                    26
               2.3  Definitions and Terms: SNAP 2009 Reporting                                    31

Chapter 3      Prevalence of Disability
               3.1   Prevalence of Disability in the U.S. and Arizona.                            35
               3.2   A Comparative Look: U.S., Arizona, & AZRSA-served                            42
               3.3   At a Glance: Population Served by AZRSA FFY07                                52

Chapter 4      Voice of the Consumer
               4.1   Primary and Secondary Data Sources                                           59
               4.2   Demographics of Survey Respondents                                           60
               4.3   Significance of Disability                                                   64
               4.4   Barriers to Employment and Independence                                      73
               4.5   Consumer Self-Identified Service Needs                                       75
               4.6   Consumer Satisfaction with AZRSA Services                                    81
               4.7   Benefits and Assistance Received                                             84

Chapter 5      Voice of the Provider
               5.1   Primary Data Sources                                                      88
               5.2   Attributes of Survey Respondents                                          89
               5.3   Disability Groups Served                                                  91
               5.4   Assessing Prevalence of Unmet Needs                                       91
               5.5   Barriers to Employment and Independence                                   92
               5.6   Gaps in the Service Delivery Systems                                      97
               5.7   Service Needs of Individuals with Disabilities                            99
                     5.7.1      VR Service Needs                                               99
                     5.7.2      IL Service Needs                                              101
               5.8   Examination of Unserved and Underserved Populations                      103
                     5.8.1      VR Populations                                                103
                     5.8.2      IL Populations                                                103
                     5.8.3      Special Populations                                           104
               5.9   Effectiveness of CRP Services                                            106




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report    1
               5.10   Perceived Importance & Effectiveness of AZRSA Services                 109
                      5.10.1    Menu of VR Services                                          109
                      5.10.2    Menu of IL Services                                          112
               5.11   Factors Impacting Service Delivery                                     113
               5.12   Youth in Transition                                                    120

Chapter 6      Voice of the Employer
               6.1   Purpose and Objectives of SNAP 2009 Survey                              124
               6.2   Demographic Data – Employer Survey Respondents                          125
               6.3   The Employer Experience: Insights and Perspectives                      125
               6.4   Information, Resource, and Service Needs of Employers                   128
               6.5   AZRSA Engagement Strategies                                             131

Chapter 7      Looking to the Future: Emerging Issues of Strategic Importance
               7.1   Voice of the Provider                                    132
               7.2   Voice of the Employer                                    135
               7.3   Economic Outlook for Arizona                             139

Notes and References                                                                         142




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   2
            Statewide Needs Assessment Program – SNAP 2009
                              Final Report
                           Executive Summary



Overview
The Arizona Rehabilitation Services Administration (AZRSA) provides vocational
rehabilitation (VR) and independent living (IL) services to eligible individuals with
disabilities. AZRSA is required, under the federal Rehabilitation Services Act, Title I, as
amended in Section 361.29, to conduct a comprehensive statewide needs assessment
(referred to as SNAP) of the service requirements of individuals with disabilities residing
in the state. As required in the Act, AZRSA works in partnership with the Arizona State
Rehabilitation Council (SRC) to conduct the SNAP on a triennial basis. The last SNAP
was conducted in 2006.

AZRSA commissioned the research firm Partners In Brainstorms, Inc. to conduct the
SNAP 2009 study in September 2008. The study was conducted over a three-month
period concluding in December 2008 and was designed to address multiple purposes in
addition to fulfilling the requirements of the statewide needs assessment. These
additional purposes included AZRSA 2009 strategic planning and the development of
baseline data to support ongoing evaluation and process improvement efforts.

Purpose of Research Study
The purpose and objectives of SNAP 2009 were to:

   f Identify the vocational rehabilitation needs of individuals with disabilities and
     those with the most significant disabilities, including their need for supported
     employment services.

   f Identify the vocational rehabilitation needs of individuals with disabilities who are
     minorities and those who have been unserved and underserved by AZRSA
     vocational rehabilitation services.

   f Assess the vocational rehabilitation needs of individuals with disabilities served
     through other components of the statewide workforce investment system, as
     identified by those individuals and personnel assisting those individuals through
     the components of the system.

   f Assess perceptions of the capacity and quality of the existing community
     rehabilitation provider (CPR) network that AZRSA contracts with for the delivery
     of services supporting consumer self-sufficiency through work and/or
     independent living.


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   3
In addition, the study was designed to aid and inform AZRSA 2009 strategic planning
discussions, providing insight into prevalence, barriers to employment, service needs,
and system improvements.

Research Approach
Data collection, evaluation, and assessment of needs related to employment and
independent living for individuals with disabilities were conducted from a number of
perspectives. The framework for this analysis was as follows:

   f Secondary research and data collection that included: (1) a review of prior SNAP
     research conducted in Arizona and other key states; (2) statistics on prevalence
     of disability on national and state levels; (3) an analysis of AZRSA VR client
     satisfaction survey data from 1,423 survey respondents; and (4) an analysis of
     aggregate data provided by AZRSA on VR and IL individuals served and data
     reported to federal Rehabilitation Services Administration (RSA) on FFY2007
     service activity and outcomes.

   f Primary research and data collection that elicited input from consumers
     (individuals with disabilities), community services providers, employers, and other
     key informants through three audience-specific online surveys. In addition, a print
     version of the consumer survey was available for those not having access to the
     online medium or who preferred a direct-mail format. The print survey was
     available in English and Spanish and was distributed through the provider
     network.

       The e-mail invitation to participate in the statewide needs assessment was
       distributed on November 24, 2008, to 526 individuals. The completion date for
       the online response was December 19, 2008 (later extended to December 21,
       2008). The total response to SNAP 2009 was 600 survey participants, as follows:
           ƒ   346 community providers who completed the online provider survey
           ƒ   33 employers who completed the online employer survey
           ƒ   170 consumers (persons with disabilities) who completed the online
               consumer survey. In addition, 51 responses to the print version of the
               consumer survey were secured, resulting in a total of 221 responses from
               individuals with disabilities.

Primary Research: Survey Response
As noted, the SNAP study elicited response from 221 consumers and 346 service
providers within a four-week period. Feedback and input from these 346 service
providers provided AZRSA with invaluable information on the needs of individuals with
disabilities, gaps in the service delivery system, unserved or underserved populations,
areas where VR and IL services are needed, the effectiveness of services provided by
community services providers, and the perceived importance and effectiveness of
AZRSA services (as well as a host of other related information to support federally
mandated requirements of the statewide needs assessment).
Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   4
The inclusion of 346 service providers in SNAP 2009 enhances RSA’s efforts to obtain
feedback and amplifies the “voice of the consumer” for the following reasons:

   a) Providers who participated in the online survey represented a diverse and
      relevant group of providers throughout the state that included: government
      agencies, community rehabilitation providers, and other organizations providing
      direct support and services to persons with disabilities.

   b) The providers demonstrated their extensive “first-hand” knowledge of the current
      needs of persons with disabilities in Arizona, providing a true and accurate voice
      for these individuals (as demonstrated through the consistency in
      response/feedback among both consumers and providers on key barriers to
      employment and independence, difficulties in MLAs, service needs, and issues
      impacting delivery of service, etc.)

   c) Based on the profiles of the 346 SNAP provider respondents, if one were to
      assume that each provider only had contact with one individual (person with
      disability) per week this would result in contact with 17,992 persons with
      disabilities over the course of a year, which is roughly 60% of the RSA “client
      served” count for FFY07 (30,051).

One other factor to consider is when including consumers and providers in the
SNAP2009 “sample size”, the total sample is 567. In order to achieve a 95% confidence
level, when taken against the universe of 455,000 individuals ages 16 to 64 reporting a
disability in Arizona in 2007 (ACS), the needed sample size for SNAP2009 is 384.
When applying the worst case percentage (50%) to determine the general level of
accuracy for this sample, the confidence interval is 4.11, within the 5% confidence
interval driving a 95% confidence level for the survey.

Research Findings
The following findings are reported according to the research objectives that guided this
study.


Research Objective 1                  Status: Met
Identify the vocational rehabilitation needs of individuals with the most
significant disabilities, including their need for supported employment services.

Data specific to the vocational rehabilitation needs of individuals with most significant
disabilities was obtained from primary and secondary research that included: (1) an
analysis of AZRSA data regarding individuals served during the study period of federal
fiscal year 2007 (October 1, 2006 through September 30, 2007) and (2) feedback from
clients participating in AZRSA VR client satisfaction surveys and consumer response to
SNAP 2009 surveys.



Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   5
Finding 1.1 – AZRSA is serving individuals with most significant disabilities.

The two primary indicators of significance of disability are Order of Selection (OOS)
priority status and SSI/SSDI beneficiary status.

   •   (OOS) priority status identifies and prioritizes services to individuals based on the
       significance of their disability.

   •   Client limitations, current accommodations, and unmet service needs are
       assessed in seven major life areas (MLAs) that include: mobility, communication,
       interpersonal skills, self-care, self-direction, work skills, and work tolerance.

   •   The need for services in three or more MLAs and over an extended period of
       time (six months or more) are the criteria for a Priority 1 (Most Significantly
       Disabled) ranking. Priority 2 (Significantly Disabled) is defined by limitations in
       two to three MLAs) and Priority 3 (Disabled) as limitations in zero to one MLA.

   •   In FFY07, AZRSA served a total of 30,051 individuals through its VR and IL
       programs.

   •   52% of the 24,592 individuals receiving VR services during FFY07 were most
       significantly disabled, 32% were significantly disabled, and 4% were disabled.
       (priority status for 12% of individuals was unknown).

   •   55% of the 1,505 individuals receiving post-employment services (PES) and
       extended supported employment (ESE) services were most significantly
       disabled.

   •   Significance of disability for individuals receiving independent living (IL) services
       (3,954) is not captured or reported through the AZRSA data management
       system.

   •   Individuals receiving SSI/SSDI (Supplemental Security Income and Social
       Security Disability Insurance) are presumed to be most significantly disabled for
       OOS priority ranking.

   •   45% of all individuals served by AZRSA in FFY07 were SSI/SSDI recipients: VR
       (47% of clients), ESE and PES (68%), and IL (21%).

           o SSI/SSDI beneficiary status is unknown for 70% of IL clients, as
             individuals are not required to provide this information.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   6
Finding 1.2 – The findings of the SNAP 2009 study are consistent with and reflect
the vocational rehabilitation and independent living service needs of individuals
with most significant disabilities.
Respondents: VR Client Satisfaction Surveys
   •   56% of the 1,423 clients responding to VR client satisfaction surveys conducted
       over the past two-year period were identified as OOS Priority 1 (Most
       Significantly Disabled), 40% as OOS Priority 2 (Significantly Disabled), and 4%
       as OOS Priority 3 (Disabled).

   •   In addition, 52% of survey respondents were SSI/SSDI recipients.

Respondents: SNAP 2009 Consumer Surveys
   •   86% of online (n=170) and 62% (n=51) of print survey respondents reported
       difficulties or limitations in three or more major life areas (MLAs), which is a key
       determinant of OOS Priority 1 (Most Significantly Disabled) assignment.

   •   In addition, 67% (n=221) of all consumers participating in the study reported
       receiving SSI/SSDI benefits.


Finding 1.3

VR Service Needs – The vocational rehabilitation service needs of individuals
with most significant disabilities are: (1) transportation, (2) services to prepare for
and find employment, and (3) initial work exploration services (to learn about
work options).

IL Service Needs – In addition to transportation, the IL service needs of
individuals with most significant disabilities include: (1) social and recreational
activities/outlets, (2) services to help individuals adjust to their disability, and (3)
skills training to facilitate independent living.

SNAP 2009 Survey Respondents
Consumers were asked to identify services needed to help them secure employment
and/or live independently. The question was framed around four service needs
categories that included: (1) services to help me learn about my work option,
(2) services to help me get the job that I want, (3) services to get the things I need for
work, and (4) services to help me to live independently. (n=221)

   Services related to learning about work options (VR)
      ƒ 33% – Identify my job interests and skills
      ƒ 31% – Decide on a job goal
      ƒ 31% – Learn how I can work and find a job
      ƒ 23% – Learn how going to work will affect my Social Security benefits


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   7
       Services related to securing employment (VR)
        ƒ 38% – Find the job that I want
        ƒ 35% – Learn new skills to get the job I want
        ƒ 33% – Take classes or go to school to prepare for the job that I want
        ƒ 29% – Get on-the-job coaching help
        ƒ 16% – Go from high school to work or college
        ƒ 16% – Learn about starting my own business

   Services related to obtaining resources, restorative aids (VR)
      ƒ 37% – Find transportation to and from work
      ƒ 21% – Learn about and get assistive technology
      ƒ 16% – Eyeglasses, hearing aids, and/or prosthetics
      ƒ 10% – Wheelchair, walker, white cane, or other aids
      ƒ 03% – Sign language interpreter services

   Services related to living independently (IL)
      ƒ 39% – Get involved in social and recreational activities
      ƒ 34% – Adjust to my disability and learn about the things I can do
      ƒ 33% – Skills training to live more independently
      ƒ 20% – Help to care for myself (Personal Assistant)
      ƒ 17% – Medical care so I can work and be more independent
      ƒ 11% – Make my car or house accessible

VR Client Satisfaction Survey Respondents
In response to the open-ended question, “How could Vocational Rehabilitation have
improved services to you?” clients cited a number of service needs that are consistent
with study findings.

   •    Transportation, employment services, and basic life skills training that include
        money management and access to general assistance, child care, and medical
        care emerged as service needs.


Finding 1.4 – AZRSA VR service provision is directly aligned with consumer-
identified needs that include transportation, job search assistance, education and
training, and assessment services.

   •    A total of 23,020 purchased services had been authorized for the 1,423 VR
        clients who had participated in client satisfaction surveys conducted in SFY07
        and SFY08.

   •    If equally distributed, each client would have been authorized, on average, to
        receive 16.2 services. Care should be taken when interpreting this data, as we
        do not know the spread of services by client.


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   8
   •   As a percentage of total services authorized, transportation constituted 20% of
       authorized and purchased services; job search assistance was 15%, education
       was 11%; vocational rehabilitation training and job readiness were 5% each; and
       assessment services constituted 9%.

   •   The system-wide effort to provide services aligned with the needs of individuals
       with most significant disabilities appears to be consistent with where these
       system-identified needs exist.


Finding 1.5 – Supported Employment Services

Consumer Perspective
   •   29% (n=221) of consumers participating in the study identified on-the-job
       coaching as an important service to help them maintain employment.

AZRSA Individuals Served
   •   AZRSA provides supported employment services to eligible clients through short-
       term supported employment services and/or extended supported employment
       (ESE) services.

   •   Short-term supported employment services provided through AZRSA assist
       clients to reach job stabilization and are usually provided at or between job
       placement and stabilization. While we have data on the number of individuals
       receiving VR services in FFY07, we do not have exact numbers on how many of
       these individuals received supported employment services as part of their service
       plan.

   •   ESE services are provided to clients who have achieved an employment
       outcome, require extended services, and qualify for funding through either the
       Arizona Department of Health Services, Division of Behavioral Health Services
       (DBHS); the Department of Economic Security, Division of Developmental
       Disabilities (DDD); or AZRSA funding.

   •   18% (4,474) of the 24,592 individuals receiving VR services in FFY07 (pre- and
       post-IPE implementation) were identified as being eligible for ESE services.

   •   Of the 2,095 clients who achieved an employment outcome in FFY07, 147 (7%)
       went on to receive ESE services in FFY07.

   •   In total, AZRSA provided ESE services to 879 clients in FFY07.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   9
Provider Perspective
   •   Approximately 20% (n=194) of providers responding to an open-ended question
       about gaps in the service needs of individuals with disabilities identified job
       coaching, job shadowing, and ready access to extended supports on an as
       needed basis as important to helping clients to maintain employment.

   •   The target populations identified as most likely to benefit from these services
       included: (1) youth-in-transition, (2) individuals with autism spectrum disorders,
       and (3) individuals with cognitive or developmental disabilities, traumatic and/or
       acquired brain injury, or mental or psychosocial disabilities.

   •   While 98% of VR providers rated “job coaching and supported employment
       services” as important, less than half (46%) rated these services as effective,
       which points to needed improvements in service delivery. (15% rated level of
       services as ineffective, 24% rated them as neither effective nor ineffective, and
       15% said they were unable to assess effectiveness).

Employer Perspective
Employers participating in the SNAP 2009 survey were asked to identify their
information needs regarding services and resources available to them through AZRSA.

   •   30% of employers cited an interest in learning more about the on-the-job training
       services and supports (defined as onsite job trainer or coach) available to them
       through AZRSA.

   •   In addition, 52% expressed interest in learning more about job specific training
       and retraining services available to employers (identified as employee retention
       services offered by RSA).

   •   While training and retraining may not technically fall under the domain of
       supported employment services, this feedback reinforces the value of services
       targeted at helping individuals with disabilities to maintain employment and
       providing employers with access to resources and services to support retention.


Research Objective 2               Status: Met
Assess the vocational rehabilitation needs of individuals with disabilities who are
minorities.

Finding 2.1 – There appear to be no perceptible differences in the self-reported
vocational rehabilitation or independent living service needs of individuals with
disabilities across race or ethnicity.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   10
   •   When examining AZRSA data on individuals served, we find that:
       o Minority populations comprised 28% of individuals receiving VR services
         (from the point of IPE implementation) in FFY07, and 27% of individuals who
         achieved an employment outcome.
       o Non-minority populations comprised 72% of individuals receiving VR services
         (from the point of IPE implementation) in FFY07, and 73% of individuals who
         achieved an employment outcome.

   •   When examining rehabilitation rates, we find that the rehabilitation rate for
       individuals receiving VR services in FFY07 was 52.7%; that is, 2,095 of the 3,973
       cases closed in FFY07 closed with an employment outcome.

   •   Overall, the rehabilitation rate for minorities was 51.3% and the rate for non-
       minorities was 53.3%.

   •   Minority groups that were below the agency-wide rate of 52.7% included Asians
       (47.2%), Blacks-African Americans (42.5%), and Hawaiians/Other Pacific
       Islanders (42.9%). Note that total case closures for Hawaiian/ Pacific Islander
       totaled only 7.

   •   Minority groups that exceeded the agency-wide rate of 52.7% included American
       Indians (56.0%), Hispanics/Latinos (54.9%), and Whites (53.3%).


Research Objective 3            Status: Met
Assess the vocational rehabilitation needs of individuals with disabilities who
have been unserved or underserved by the vocational rehabilitation program.


Finding 3.1 – VR Unserved or Underserved Populations

To identify individuals or populations unserved or underserved by VR or IL programs,
providers were asked, “Are you aware of any specific disability groups or populations of
individuals that are either not currently being served or are underserved by RSA (VR or
IL) programs?” A “yes” response then resulted in the provider being asked to identify
these populations and their service needs (open-ended question).

The terms unserved and underserved were loosely defined as: (1) persons with
disabilities who are not receiving vocational rehabilitation services and are perceived as
being capable of working; (2) individuals who are in need of but not receiving
independent living services; and/or (3) individuals who, from the provider’s perspective,
are not receiving adequate services.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   11
Feedback from VR Providers (Providers completing the VR portion of the survey)
   • 39% (n=264) of VR providers identified unserved or underserved populations in
     terms of individuals with specific types of disabilities, population groups, and
     individuals residing in rural areas.

       Individuals with specific types of disabilities
       Chronic health problems, autism spectrum disorders and severe learning
       disabilities, TBI and spinal cord injuries, and those with a dual diagnosis of
       developmental disabilities and mental illness.

       Population groups
       Veterans, homeless, ex-felons, transition age youth, and individuals who tend to
       “fall through the cracks” (don’t qualify for Title 19)

       Individuals residing in rural areas of the state
       Limited access to services and resources, limited job opportunities, and
       transportation issues

   •   Identified VR service needs included:
       o Systemic improvements: expedited processing of applications, eligibility
         determinations, and access to comprehensive system navigation services
       o Improved access to VR counseling, job training, post-employment and
         extended supported employment services
       o Services targeted to the special needs of groups such as youth-in-transition
         and veterans, etc.


Finding 3.2 – IL Unserved or Underserved Populations

Feedback from IL Providers (Providers completing the IL portion of the survey)
   • 26% (n=185) of IL providers identified unserved or underserved populations in
     much the same terms as VR providers (individuals residing in rural areas,
     veterans, etc.).

   •   Other populations identified included:
       o Younger populations of individuals living in nursing centers
       o Elderly individuals with disabilities
       o Minority groups that included American Indian, Black/African-American,
         Hispanic/Latino, and non-traditional cultures
   •   Identified IL service needs included
       o An integrated care and service delivery model (medical and mental health
         care services

Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   12
       o Multi-lingual and multi-cultural services
       o Support and outreach programs for consumers, family members, and
         caregivers/attendants

Finding 3.3 – Provider Feedback: Factors Impacting Service Utilization

Although the majority of the 346 providers participating in the study were not aware of
any specific groups of unserved or underserved individuals with disabilities, there does
appear to be a shared perception that consumers are not tapping into the AZRSA
service system for a number of reasons directly tied to factors that prevent or hinder
individuals from “taking the next step” to employment and independence.

   •   59% indicated that lack of awareness and/or information about services available
       to persons with disabilities prevents or hinders them from accessing services to
       assist them in gaining or maintaining employment and independence.

   •   59% indicated that service system issues related to lack of qualified providers,
       specialized care resources, and/or targeted coordination of services are barriers.

   •   32% indicated that cultural barriers and/or resistance to seeking assistance from
       government agencies are barriers (another 35% identified these as “somewhat of
       a barrier”).

   •   22% felt that current service delivery systems were ineffective in meeting the
       needs of individuals with disabilities (health care, direct care services,
       employment support service systems, etc.).

   •   In rating AZRSA services:
       o Only 35% of VR and 33% of IL providers felt that AZRSA outreach and
         marketing services were effective.
       o Only 39% of VR and 51% of IL providers felt that AZRSA information and
         referral services were effective.


Finding 3.4 – Who is AZRSA Serving?

Under the administrative code for rehabilitation services, unserved and underserved
individuals with disabilities are defined as groups or populations of individuals in the
state with severe disabilities, including but not limited to those groups that: (1) have
cognitive or sensory impairments, (2) are members of racial or ethnic minority groups,
(3) live in rural areas, and (4) are identified by Department of Human Services or a local
CIL (Center for Independent Living) as being unserved or underserved.



Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   13
Using this framework to examine individuals served by AZRSA VR and IL programs in
FFY07, we find that:

   •   A total of 30,051 individuals received AZRSA VR and IL services.

   •   By significance of disability, AZRSA is serving individuals who have significant
       and most significant disabilities.

   •   As noted earlier, 45% of individuals were most significantly disabled (OOS
       Priority 1), 27% were significantly disabled (OOS Priority 2), and 4% were
       disabled (OOS Priority 3). Information was unknown on 24% (IL clients).

   •   By disability type, according to federal RSA reporting categories:
       o 13% of individuals served had visual disabilities.
       o 7% of individuals served had communicative disabilities (deafness and
         hearing-related disabilities and communicative impairments).
       o 18% of individuals served had physical disabilities.
       o 22% of individuals served had cognitive disabilities.
       o 27% of individuals served had mental/emotional disabilities.
       o Information on 13% of individuals was unknown.

   •   By ethnicity
       o 69% of individuals served were non-minorities, 27% were minorities, and
         information on 5% of the population served was unknown.
       o Overall, the proportion between minority and non-minority individuals served
         is consistent with secondary research indicating that non-Whites comprise
         more than one-quarter of individuals in the U.S. reporting a disability.
       o However, in looking at rates for individual groups, it appears that AZRSA is
         underserving Whites, Hispanics, and American Indians and overserving
         Blacks/ African-Americans (see Prevalence Table).
               ƒ   Whites represent 76.5% of individuals in Arizona, ages 16 to 64, with a
                   disability, and 68.5% of individuals receiving AZRSA services.
               ƒ   Hispanics represent 20.9% of individuals in Arizona, ages 16 to 64,
                   with a disability, and 15.1% of individuals receiving AZRSA services.
               ƒ   American Indians represent 6.8% of individuals with a disability, and
                   3.5% of individuals receiving AZRSA services.
               ƒ   Blacks/African-Americans represent 4.4% of individuals with a
                   disability and 6.9% of individuals receiving AZRSA services.



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   •   By geographic location
       o 51% of individuals served reside in Maricopa County and 22% of individuals
         served reside in Pima County, the most densely populated counties in the
         state. (Per U.S. Census Bureau March 2007 figures, Maricopa County gained
         696,000 residents between 2000 and 2006, the largest numerical increase of
         the nation’s 3,141 counties.)
       o 5% reside in Yavapai and 4% in Yuma Counties.
       o 3% reside in each of Cochise, Coconino, Mohave, and Pinal Counties, and
         2% in Navajo County.
       o The remainder resides in Apache (0.4%), Gila (1%), Greenlee (0.1%),
         Graham (0.8%), La Paz (0.6%), and Santa Cruz (0.4%) Counties.

   •   Individuals with disabilities appear to be served in relative proportion to their
       representation in state estimates of persons with disabilities except for a few
       counties such as Apache. In the cases of Maricopa and Pima Counties, more
       research is needed in light of projected continued growth in population. The
       source for this data is the 2005-2007 American Community Survey 3-Year
       Estimates (providing county level data). Also referenced as an indicator of
       population growth is the U.S. Census Bureau’s State and County QuickFacts,
       last revised February 20, 2009.
       2005-2007 ACS 3-Year Estimates
           o Apache County: Individuals with disabilities, ages 5 and over, represent
             1.7% of the state population of individuals ages 5 and over with
             disabilities. Individuals ages 16 to 64 with disabilities represent 1.9% of
             the state population of individuals 16 to 64 with disabilities and .41% of
             those served by AZRSA in FFY07.
           o Pima County: Individuals with disabilities, ages 5 and over, represent
             17.6% of the state population of individuals ages 5 and over with
             disabilities. Individuals ages 16 to 64 with disabilities represent 17.3% of
             the state population of individuals 16 to 64 with disabilities and 21.7% of
             those served by AZRSA in FFY07.
           o Maricopa County: Individuals with disabilities, ages 5 and over, represent
             53.7% of the state population of individuals ages 5 and over with
             disabilities (Census 2007 estimate, 55.97%). Individuals ages 16 to 64
             with disabilities represent 55.3% of the state population of individuals 16 to
             64 with disabilities and 51.3% of those served by AZRSA in FFY07.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   15
Research Objective 4               Status: Met
Assess the vocational rehabilitation needs of individuals with disabilities served
through other components of the statewide workforce investment system as
identified by those individuals and personnel assisting those individuals through
the components of the system.

Data on the vocational rehabilitation needs and services provided to individuals with
disabilities through the WIA One-Stop delivery system were obtained from sources that
included: (1) stakeholder feedback, (2) a review of AZRSA data on individuals served in
FFY07, and (3) data contained in the Arizona’s Governor’s Council on Workforce Policy,
Workforce Investment Act Title1B Annual Report for Program Year 2006.


Finding 4.1 – Provider Feedback

   •   The service needs of individuals with disabilities served through other
       components of the statewide workforce investment system are consistent with
       earlier findings that identified primary service needs as: (1) transportation, (2)
       education and training, and (3) services to help individuals adjust to their
       disability.

   •   Providers also offered suggestions on how to further improve and enhance the
       working relationship between AZRSA and the WIA One-Stop system to better
       meet the needs of individuals with disabilities, as follows:
       o Increased marketing and outreach by community agencies that offer referral
         services to consumers
       o Targeted coordination of services between AZRS and the One-Stops to meet
         anticipated demand (influx of youth with special needs, etc.)
       o Job training that equips individuals to take advantage of opportunities in the
         health care field


Finding 4.2 – Secondary Data Review: WIA Referrals to AZRSA

An analysis of AZRSA FFY07 data on number of individuals served shows that in
FFY07, AZRSA provided services to 633 individuals whose referral source was listed as
a One Stop Center.

   •   These 633 referrals represent 2.1% of all individuals served by AZRSA in FFY07.

   •   The rehabilitation rate for One-Stop referrals was 66.0%, with 46 out of 70 cases
       closing with an employment outcome (Status 26). This exceeds the VR
       rehabilitation rate of 52.7%.

Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   16
Finding 4.3 – Secondary Data Review: WIA Annual Report

As reported in the Arizona’s Governor’s Council on Workforce Policy, Workforce
Investment Act Title1B Annual Report for Program Year 2006 (July 1, 2006 through
June 30, 2007), outcomes for individuals with disabilities are as follows:

   •   78.9% (75) of individuals exiting the Adult program entered into employment.

   •   80.0% (20) of individuals exiting the Dislocated Worker program entered into
       employment.

   •   68.4% (13) of young adults ages 19 to 21 exiting the Youth program entered into
       employment.

   •   This resulted in an overall employment rate of 77.7% for individuals with
       disabilities, with 108 out of 139 individuals having entered into employment.


Research Objective 5              Status: Met
Assess the need to establish, develop, or improve community rehabilitation
programs (CRP) within the state.

Insights on the need to establish, develop, or improve community rehabilitation
programs within the state were elicited through consumer, provider, and employer
responses to SNAP 2009 surveys, and indirectly through feedback obtained from clients
who had participated in VR client satisfaction surveys.


Finding 5.1 – Client Feedback

   •   Approximately 78% of the 1,423 clients responding to AZRSA VR Client
       Satisfaction surveys conducted over the course of the past two years indicated
       that they were satisfied with services received.

   •   While these surveys do not distinguish between direct services provided by
       AZRSA VR staff and purchased employment services provided through CRPs, it
       is presumed that client satisfaction ratings reflect the client’s collective
       impression of his/her VR experience.


Finding 5.2 – Consumer Feedback

   •   44% (n=170) of consumers responding to the online survey indicated that they
       had, at some point in time, received VR services to help them prepare for or find
       a job, with 57% reporting that services had been helpful.


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   17
   •   When asked about IL services, 21% (n=170) of consumers indicated that they
       had received IL services, with 74% reporting that services had been helpful.

   •   Where concerns were expressed, they focused on quality of service delivery.
       This included policy and procedural and customer service concerns as well as
       staff training on specific types of disabilities.

       o Policy and procedural concerns focused on: a) service authorizations
         (insufficient number of approved hours to effect substantial improvement in
         client’s progress); b) frequent reassignment of cases among VR staff; c) slow
         intake and eligibility process that causes individuals to become frustrated and
         lose interest in the VR program, and d) concern that IL services are too time-
         limited and not intensive enough

       o Customer service concerns focused on the need for VR to: a) communicate
         more frequently with clients; b) follow-up on a timely basis; and c) provide
         more personalized service that is tailored to the specific needs of the client.

       o Additional concerns focused on the need for more IL centers and the need to
         have qualified and trained staff that is knowledgeable and familiar with
         specific types of disabilities such as autism, TBI, and cognitive disabilities.


Finding 5.3 – Provider Feedback

   •   47% (n=346) of community services providers feel that the VR and IL services
       provided through CRPs are effective in meeting the needs of persons with
       disabilities, while 14% do not. (Balance is neutral in response or unable to judge).

   •   Suggestions for improving services delivered through CRPs (open-ended
       question) included:
       o Marketing and outreach to consumers and employers
       o Increased emphasis on an integrated and coordinated VR and IL service
         model that builds upon inter-agency partnerships and collaborations
       o Capacity-building to address the needs of individuals residing in rural areas


Finding 5.5 – Employer Feedback

   •   Approximately 50% of the 33 employers participating in the study reported that
       they are aware or very aware of AZRSA VR.

   •   24% reported that they had utilized or accepted job applicant referrals from
       community providers specializing in employment services for individuals with
       disabilities.
Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   18
           o 88% of these employers reported that they were satisfied with the services
             they had received.

           o 42% of employers indicated that they would likely utilize or accept referrals
             from CRPs in the future.

Conclusion – Based on the findings presented, AZRSA has met the objectives of
the Statewide Needs Assessment and has effectively identified the vocational
rehabilitation (and independent living) needs of individuals with most significant
disabilities.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   19
Chapter 1: SNAP 2009 Overview

1.1 Introduction
The Arizona Rehabilitation Services Administration (AZRSA) provides vocational
rehabilitation (VR) and independent living (IL) services to eligible individuals with
disabilities. AZRSA is required, under the federal Rehabilitation Services Act, Title I, as
amended in Section 361.29, to conduct a comprehensive statewide needs assessment
(referred to as SNAP) of the service requirements of individuals with disabilities residing
in the state. As required in the Act, AZRSA works in partnership with the Arizona State
Rehabilitation Council (SRC) to conduct the SNAP on a triennial basis. The last SNAP
was conducted in 2006.

AZRSA commissioned the research firm Partners In Brainstorms, Inc. to conduct the
SNAP 2009 study in September 2008. The study was conducted over a three-month
period concluding in December 2008 and was designed to address multiple purposes in
addition to fulfilling the requirements of the statewide needs assessment. These
additional purposes included AZRSA 2009 strategic planning and the development of
baseline data to support ongoing evaluation and process improvement efforts.

1.2 Purpose and Objectives
The purpose and objectives of the SNAP 2009 study are to:

   •   Identify the vocational rehabilitation needs of individuals with disabilities and
       those with the most significant disabilities, including their need for supported
       employment services.

   •   Identify the vocational rehabilitation needs of individuals with disabilities who are
       minorities and those who have been unserved and underserved by AZRSA
       vocational rehabilitation services.

   •   Assess the vocational rehabilitation needs of individuals with disabilities served
       through other components of the statewide workforce investment system as
       identified by those individuals and personnel assisting those individuals through
       the components of the system.

   •   Assess perceptions of the capacity and quality of the existing community
       rehabilitation provider (CPR) network that AZRSA contracts with for the delivery
       of services supporting consumer self-sufficiency through work and/or
       independent living.

In addition, the study was designed to aid and inform AZRSA 2009 strategic planning
discussions, providing insight into prevalence, barriers to employment, service needs,
and system improvements



Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   20
1.3 Research Approach and Methodology
The overarching principles guiding the SNAP 2009 study were to use a process and
methodology aimed at:
   •   Eliciting the input and involvement of both external and internal AZRSA
       stakeholders.
   •   Building upon existing knowledge and leveraging invested resources so that
       SNAP 2009 serves a broad range of purposes and audiences.
   •   Ensuring the relevancy and usefulness of research findings and results for
       multiple stakeholders.
   •   Building a framework for replication and ongoing data surveillance.

Research Approach
Data collection, evaluation, and assessment of needs related to employment and
independent living for individuals with disabilities were conducted from a number of
perspectives. The framework for this analysis was as follows:

   •   Secondary research and data collection that included: (1) a review of prior SNAP
       research conducted in Arizona and other key states; (2) statistics on prevalence
       of disability on national and state levels and information on attributes and
       demographics of individuals with disabilities; (3) a review of AZRSA VR client
       satisfaction survey data; (4) an intra- and inter-agency look at systemic supports
       available to individuals with disabilities in Arizona; and (5) data culled from
       AZRSA data management systems and information reported to the federal
       Rehabilitation Services Administration (RSA).

   •   Primary research and data collection that elicited input from consumers
       (individuals with disabilities), community services providers, employers, and other
       key stakeholders or informants.

Primary research strategies focused on:

   •   Facilitated meetings with internal and external AZRSA stakeholders, including
       community stakeholders, members of the AZSRC (State Rehabilitation Council),
       and AZRSA supervisory personnel to assist and aid in the design of survey
       instruments.

   •   Design and implementation of three audience-specific online survey(s), one
       targeted to community services providers, one to employers, and one to
       consumers.

   •   In addition to the three online surveys, a print version of the consumer survey
       was available to those individuals who did not have access to the Internet or who
       preferred a mail-in survey format. The print survey was also available in English

Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   21
       and Spanish and was distributed through the network of providers and advocacy
       groups participating in SNAP 2009.

Recruitment efforts were focused on driving potential respondents to the online surveys
in order to leverage the many advantages of web-based surveys:
   •   Immediacy of response and logic flow that customizes the survey in accordance
       with respondent answer choices (branch or skip capabilities)
   •   Real-time edit and correction capabilities
   •   Ease of use and convenience resulting from programming that allows
       respondents to start and return to the survey at will
   •   Ability to meet the needs of individuals with blindness or visual impairments (501
       compliant, AT compatible, and AZRSA tested survey tools)
   •   Technical assistance capabilities
   •   Real-time tracking and monitoring of response rates
   •   Viral distribution capabilities (snowball recruitment strategies)

An initial distribution list containing over 500 e-mail addresses, including those of
collaborative stakeholders, was constructed by the researchers and used to elicit
response to SNAP 2009. These resources included: AZSRC (Arizona State
Rehabilitation Council), Arizona Healthcare Cost Containment System (AHCCCS),
Arizona Employment and Disability Partnership (Arizona Medicaid Infrastructure Grant),
each of the various Governor’s councils serving the needs of individuals with disabilities,
including the Governor’s Council on Developmental Disabilities and the State
Independent Living Council, Tribal council members, Workforce Investment Act (WIA)
personnel, and other AZRSA intra-agency and DES inter-agency personnel.

Participation in SNAP 2009 was promoted via:

   •   E-mail invitation and reminder notifications to stakeholders (500 plus e-mail
       recipients)

   •   Distribution of printed announcement cards (postcard format) containing the links
       to the SNAP 2009 online survey(s)

   •   Grass-roots viral marketing campaign to stakeholders that included status
       updates on SNAP 2009 recruitment efforts and a call-to-action for pass-along or
       snowball distribution of e-mail and reminder notifications in addition to personal
       calls

   •   Web-posting announcement and access to SNAP 2009 via the Governor’s
       Council on Developmental Disabilities website.


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   22
It should be noted that the invitation list did not include e-mail addresses for AZRSA
employees or VR clients; that is, Partners In Brainstorms was not provided access to
consumer e-mail or direct mail lists. In addition, we were not able to secure access to a
list of individuals with disabilities receiving Social Security Disability Insurance (SSDI) or
Social Security Supplemental Income (SSI) benefits. Thus, direct contact with
consumers whether through e-mail or direct mail was not a recruitment option.

Survey Distribution and Response
The initial e-mail invite to participate in the statewide needs assessment was distributed
on November 24, 2008 to 526 individuals. Recipients were encouraged to complete the
survey by accessing the appropriate online link (Provider, Employer, or Consumer) that
was embedded in the invite and to pass the e-mail/ link along to their circle of
professional and personal contacts.

The completion date for the online surveys was December 19, 2008 (later extended to
December 21, 2008). Given the extremely tight window for response, two e-mail
reminder notifications were sent to recipients (including an additional group of 50
recipients) on December 8, 2008 and again on December 17, 2008. Within this 3½
week period allotted for survey distribution and receipt (November 24, 2008- December
21, 2008), Partners In Brainstorms effectively reached-out and garnered response from:

           ƒ   346 community providers who completed the online Provider survey

           ƒ   33 employers who completed the online Employer survey

           ƒ   170 individuals with disabilities who completed the Consumer online
               survey.

           ƒ   Total online response: 549 completed surveys.

           ƒ   In addition, 51 responses to the print version of the consumer survey were
               secured, resulting in a total of 221 responses from individuals with
               disabilities.

           ƒ   This increased the total response to SNAP 2009 to 600 survey
               participants.

Instrument Design
The three online surveys developed by Partners In Brainstorms sought to elicit feedback
from that population of individuals with disabilities interested in seeking or maintaining
self-sufficiency through employment and/or independent living. From the perspective of
the consumer, the provider, and the employer, input on the issues and dynamics
impacting the vocational and independent living aspirations of persons with disabilities
was explored. This included perceived barriers to employment, service needs,
perceived gaps in the systems supporting service delivery, and the identification of
unserved and underserved populations likely to benefit from VR and IL services.

Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   23
Survey instruments were designed in consultation with the AZRSA SNAP 2009 Steering
Committee, input derived from meetings with SRC, internal and external AZRSA
stakeholders, and a review of Arizona and other state implemented SNAP surveys.
Partners In Brainstorms developed each survey to meet the specific objectives of a
comprehensive statewide needs assessment and to address the key strategic planning
questions outlined earlier in this report.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   24
Chapter 2: A Framework for Understanding

2.1 Overview of AZRSA VR and IL Services

Vocational Rehabilitation Services
The State Vocational Rehabilitation (VR) Services Program is a state-federal program
that has been established to assist individuals with disabilities, particularly those with
significant disabilities, to achieve high quality employment outcomes in integrated
settings. The federal Rehabilitation Services Administration (RSA), which is housed
under the U.S. Department of Education, is charged with overseeing that each state
complies with the provisions of its state plan and with the standards and indicators
established under the Rehabilitation Act of 1973 (the Act). Under the Act, each state is
afforded the flexibility to have either one general (combined) VR agency or two state VR
agencies (one to serve the blind and one for individuals with other types disabilities).
The Arizona Rehabilitation Services Administration (AZRSA), which is housed under the
Arizona Department of Economic Security (AZDES), is a combined agency that serves
individuals with all types of disabilities.

Under Title I of the Act, AZRSA receives federal grants to operate a comprehensive VR
program. This state-operated program is designed to assess, plan, develop, and
provide VR services to eligible individuals with disabilities, consistent with their
strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed
choice. By providing services in this way, the VR program enables individuals with
disabilities to prepare for and engage in employment. Services include but are not
limited to: (1) assessment, (2) vocational counseling, guidance and referral services; (3)
physical and mental restoration; (4) vocational and other training; (5) services to assist
students with disabilities to transition from school to work; (6) assistive aids and
devices; (7) supported employment; and (8) job placement.


Independent Living Services – AZRSA Service Delivery through Centers for
Independent Living
Part of the funding provided to states through the Department of Education,
Rehabilitation Services Administration (RSA) is aimed at supporting and enhancing
independent living services. The AZRSA statewide IL program provides core services to
individuals with disabilities and partners with local IL resources for the purchase of
goods, services, or assistive technology. Any individual with a significant disability is
eligible for IL services under the Arizona Statewide Independent Living Council (SILC)
and the Centers for Independent Living (CIL) programs authorized under Chapter 1 of
Title VIII of the Act. The overall goals and mission of the Statewide Independent Living
Services (SILS) and Centers for Independent Living (CIL) programs are to offer
programs and services that assist people with significant disabilities to maximize
independence and community participation and to advocate for their independent living
needs. Any individual may seek information about IL services under these programs
and request referral to other services and programs for individuals with significant
disabilities (as deemed appropriate.
Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   25
The minimum core services that an organization must provide to be considered a
Center for Independent Living includes: a) information and referral services; b)
independent living skills training; c) peer support, and d) individual system advocacy.
Additional services such as counseling, mobility training, supported living,
transportation, rehabilitation services, housing, education and social and recreational
services are typically supported through RSA funding. 1


2.2 Core Definitions and Terms
Prior to presenting data on the VR and IL needs of persons with disabilities in Arizona, it
is important that the following points be noted to aid one’s understanding of the
information and data presented in this report.

Definition of Disability
Legal definitions of disability vary between entities providing benefits and services to
individuals with disabilities (e.g., state vocational rehabilitation administrations, Centers
for Independent Living, Social Security Administration, etc.). Under the Rehabilitation
Act of 1973, as amended in 1992 and 1998, and the Americans with Disabilities Act of
1990, both of which are civil rights laws that protect individuals with disabilities from
discrimination, the definitions of disability are somewhat consistent. However, it is in the
definition of disability as it relates to eligibility criteria for vocational rehabilitation
services that one finds references to assumed employability (that individuals, even
those with most severe difficulties and disabilities, can work unless proven otherwise).

ADA
Under the Americans with Disabilities Act that was passed in 1990 an individual with a
disability is defined as a person who has a physical or mental impairment that
substantially limits one or more major life activities, a person who has a history or record
of such an impairment, or a person who is perceived by others as having such an
impairment. 2

Centers for Independent Living
Under the guidelines governing Centers for Independent Living (CIL) an individual with
a disability is defined as an individual who: a) has a physical, mental, cognitive or
sensory impairment that substantially limits one or more of the individuals major life
activities; b) has as a record of having such an impairment; or c) Is regarded as having
such an impairment. 3

Vocational Rehabilitation
While closely aligned with the ADA definition of disability, the Rehabilitation Act of 1973
Title V uses the term "disabled individual" to mean "any person who (1) has a physical
or mental impairment which substantially limits one or more of such person's major life
activities, (2) has a record of such impairment, or (3) is regarded as having such an
impairment." 4


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   26
When describing eligibility for VR services (section 102(a) of the Rehabilitation Act of
1973), in order to be eligible for VR services, an individual must be an “individual with a
disability, “meaning a person who (1) has a physical or mental impairment which
constitutes or results in a substantial impediment to employment for the individual; and
(2) can benefit from VR services to achieve an employment outcome; and require VR
services to prepare for, secure, retain, or regain employment. In addition, individuals
who receive Supplemental Security Income (SSI) and/or Social Security Disability
Insurance (SSDI) benefits are presumed to be eligible for VR services leading to
employment, unless there is clear and convincing evidence that they are too
significantly disabled to benefit from VR services.

Workforce Investment Act (WIA)
Under the Workforce Investment Act of 1998 (WIA), which became effective July 1,
2000, establishes a national workforce preparation and employment system (America’s
Workforce Network) to meet the needs of businesses, job seekers and those who want
to further their careers. The act mandates that customers with disabilities must be
served alongside customers without disabilities and have easy access to information
and services through the One-Stop Career Center system. The One-Stop approach
provides a single point where customers can access a wide array of job training,
education and employment services. It also provides a single point of contact for
employers to provide information about current and future skills needed by their
workers, and to list job openings. WIA requires the participation of relevant programs
administered by the Department of Labor (DOL) and the Departments of Agriculture,
Education (including Vocational Rehabilitation), Health and Human Services and
Housing and Urban Development. The goal of the One-Stop is to provide a streamlined
and simplified process for accessing services that support and promote employment.

Under WIA regulations, people with disabilities are defined using the ADA definition
which means that the One-Stop Centers are likely to serve individuals with disabilities
who are ADA-defined disabled but not eligible for services from Vocational
Rehabilitation as a One-Stop partner. 5

Social Security Administration
The delimitation of disability for SSA determination is the inability to engage in any
substantial gainful activity by reason of any medically determinable physical or mental
disabilities which can be expected to result in death or which has lasted or can be
expected to last for a continuous period of not less than 12 months.


Definition of Disability: Implications of the Americans With Disabilities Act (ADA)
Amendments Act of 2008 (ADA and Section 503 of the Rehabilitation Act)

The Americans with Disabilities Act Amendments Act of 2008 (ADA Amendments Act)
was signed into law by the President on September 25, 2008 and became effective
January 1, 2009. It is intended to overturn a series of Supreme Court decisions that
interpreted the Americans with Disabilities Act of 1990 in a way that made it difficult to

Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   27
prove that impairment is a disability. The ADAAA makes significant changes to the
ADA's definition of "disability" that broadens the scope of coverage under both the ADA
and Section 503 of the Rehabilitation Act.

Major Changes/Definition of Disability
The ADAAA retains the basic definition of "disability" as an impairment that substantially
limits one or more major life activities, a record of such an impairment, or being
regarded as having such an impairment. However, the ADAAA broadens the definition
of 'disability' by modifying key terms of that definition by:
   •   Expanding the definition of 'major life activities;'
   •   Redefining who is 'regarded as' having a disability;
   •   Modifying the regulatory definition of 'substantially limits;
   •   Specifying that "disability" includes any impairment that is episodic or in
       remission if it would substantially limit a major life activity when active; and
   •   Prohibiting consideration of the ameliorative effects of "mitigating measures"
       when assessing whether an impairment substantially limits a person's major life
       activities, with one exception.

Under the ADAAA, 'major life activities' is expanded to include "major bodily functions."
The statute contains a non-exhaustive list of "major life activities" that adds additional
activities to those currently listed in the ADA and Section 503 regulations, and a non-
exhaustive list of "major bodily functions." Specifically, the ADAAA provides that:

   •   Major life activities include, but are not limited to, caring for oneself, performing
       manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting,
       bending, speaking, breathing, learning, reading, concentrating, thinking,
       communicating, and working.
   •   Major Bodily Functions include, but are not limited to, functions of the immune
       system, normal cell growth, digestive, bowel, bladder, neurological, brain,
       respiratory, circulatory, endocrine, and reproductive functions.

Significant Disability
One of the objectives of the SNAP 2009 study is to identify the vocational rehabilitation
needs of individuals with most significant disabilities. Under RSA guidelines, an
individual with a significant disability is defined as an individual with a severe physical,
mental, cognitive, or sensory impairment whose ability to function independently in the
family or community or whose ability to obtain, maintain, or advance in employment is
substantially limited and for whom the delivery of independent living services will
improve the ability to function, continue to function, or move toward functioning
independently in the family or community or to continue employment.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   28
Order of Selection

AZRSA Determination of Priority Status and Significance of Disability
A state VR agency must implement an order of selection when it does not have enough
fiscal and/or personnel resources to fully serve all eligible individuals. While there is no
single legal definition of Order of Selection for Services (OOS), Section 101(a)(5) of the
Rehabilitation Act states:

(5) Order of Selection for Vocational Rehabilitation Services—In the event that
vocational rehabilitation services cannot be provided to all eligible individuals with
disabilities in the state who apply for the services, the State Plan shall
    (a) show the order to be followed in selecting eligible individuals to be provided
        vocational rehabilitation services;
    (b) provide the justification for the order of selection;
    (c) include an assurance that, in accordance with criteria established by the state for
        the order of selection, individuals with the most significant disabilities will be
        selected first for the provision of vocational rehabilitation services; and
    (d) provide that eligible individuals, who do not meet the order of selection criteria
        shall have access to service provided through he information and referral system
        implemented under paragraph (20)

An order of selection (OOS), then, is a list of priority categories from which eligible
individuals are selected for services based on the significance of their disability with first
priority for services given to those deemed to have the most significant disabilities. Of
80 State VR agencies nationwide, approximately half have established an OSS, and
about 28 are actually implementing it. AZRSA is currently on an order of selection and
as of September 30, 2007 had no individuals on the OOS waiting list.

The AZRSA “Health Appraisal and Order of Selection Worksheet” is the primary tool
used by AZRSA for: (1) finalizing VR disability codes (codes for impairment s and codes
for the causes or sources of impairments); (2) assigning priority status in the Order of
Selection (OOS); and (3) IPE (Individualized Plan for Employment) planning and
development. The Worksheet incorporates information obtained from the client, from
formal evaluations, from existing documents (medical/psychological reports, school
Individual Education Plan, etc.) and from counselor/client interactions. The form is
completed by the vocational rehabilitation counselor (VRC) after client eligibility for
vocational rehabilitation services has been established but prior to completing the IPE.

The Health Appraisal and Order of Selection Worksheet contains documentation of:
   •   The significant limitations that result from the client’s disability related
       impairment(s);
   •   The services/goods that are currently available to the client for accommodating
       or managing his/her impairments


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   29
   •   The disability related service needs which need to be addressed via IPE planning
       and which determine an individual’s priority in the Order of selection; and
   •   Other service needs (disability and non-disability related) which need to be
       addressed in the IPE but which are not included in OOS priority determinations.

As noted, priority status for OOS is based on a review of client limitations, current
accommodations, and unmet service needs in seven major life areas (MLAs) or
functional domains that include: (a) mobility, (b) communication, (c) interpersonal skills,
(d) self-care, (e) self-direction, (f) work skills, and (g) work tolerance. The total number
of service needs across MLA categories is a critical determinant of OOS priority
designations as well as the need for services over an extended period of time, defined
as six months or more. AZRSA uses three priority status designations: (a) Priority 1 –
Most significantly disabled (defined as limitations with 3 or more MLAs); (b) Priority 2 –
Significantly disabled (limitations with 2–3 MLAs); and (c) Priority 3 – Disabled
(limitations with zero or 1 MLA).


AZRSA Overview of Supported Employment Services
As noted in the AZRSA State Plan for FY 2008, supported employment services are
provided to all clients of the VR program who have the need for such services, are
eligible for such services, and for whom extended employment supports are necessary
for the individual to maintain employment. AZRSA supported employment services are
provided to: (a) individuals with developmental disabilities; (b) those with serious mental
illnesses; and (c) other individuals with significant disabilities. Services include:
development of and placement in jobs; time-limited, on-going support, such as on-the­
job training, job coaching, supportive intervention and guidance counseling; follow-up
services; and post-employment services following transition from VR to extended
supported employment services. The use of existing resources, including Plan to
Achieve Self Sufficiency/Impairment Work Related Expense (PASS/IRWEs) is explored
for every individual and, if available, is used to pay for extended supported employment.
If other resources are not available, funds for long-term supports are identified before
proceeding with a VR Individualized Plan of Employment.
While time-limited VR supported employment services are the responsibility of AZRSA,
ongoing employment support service needs are provided through AZRSA’s
collaboration with Community Rehabilitation Program (CRP) providers. This
collaboration ensures AZRSA’s capacity to serve VR clients with available in-community
services. AZRSA collaborates with the Arizona Department of Health Services
(ADHS)/Division of Behavioral Health Services (DBHS), the DES Division of
Developmental Disabilities (DDD), and the Councils of Government (COG) to make
ongoing employment supports available to successfully rehabilitated clients of the VR
program who need them.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   30
Arizona Department of Health Services/Division of Behavioral Health Services
(BHS)
AZRSA has an ongoing intergovernmental agreement (IGA) with the ADHS/ DBHS to
serve individuals with serious mental illnesses (SMI). One provision of this IGA is that
assigns the responsibility to provide extended support services to the RBHA (Regional
Behavioral Health Authority) in each area of the state. The current IGA strengthens the
commitment of the ADHS/DBHS to fund extended support services following transition
from VR services.

DES Division of Developmental Disabilities (DDD)
For over 20 years, AZRSA and the DDD have worked collaboratively to meet the
employment needs of individuals with developmental disabilities. In 1993, the
responsibility for all employment related programming for the DDD population shifted to
AZRSA. However, responsibility for ongoing employment support service needs for
individuals with developmental disabilities was reassigned back to the DDD. The
coordination of employment related services are handled at the local VR counselor/DDD
support coordinator level.

Councils of Government (COG)
AZRSA works within the Department of Economic Security (DES) and with the COGs in
planning for the use of Social Security Block Grant (SSBG) (Title XX) resources. The
AZRSA assists the DES and the COGs with planning how to best use their portions of
the SSBG resources. AZRSA has managed such resources to pay for the extended
employment support services needed by VR consumers with the most significant
disabilities who are successfully rehabilitated in the VR program. AZRSA contracts
these monies directly with private, non-profit community rehabilitation programs.


2.3 Definitions and Terms: SNAP 2009 Reporting
Following is a list of definitions and terms that are used throughout this report to
reference state and federal reporting periods and the manner in which data is
summarized and reported according to AZRSA and RSA guidelines.

State and Federal Reporting Periods
AZRSA utilizes a state fiscal year (SFY) calendar that begins on July 1 and ends on
June 30 of each year, whereas the federal Rehabilitation Services Administration (RSA)
utilizes a federal fiscal year (FFY) calendar that begins on October 1 and ends on
September 30. The two major reports issued by RSA under the U.S. Department of
Education, Office of Special Education and Rehabilitative Services, and referenced in
SNAP 2009 include: (a) the Annual Review Report for Arizona Rehabilitation Services
Administration for FY 2007 (beginning on October 1, 2006 and ending on September
30, 2007; noted as the ARR for FFY 2007) which is based on data submitted to RSA by
AZRSA as of December 8, 2008, and (b) the Fiscal Year 2008 Monitoring Report on the
Vocational Rehabilitation and Independent Living Programs in the State of Arizona
dated September 12, 2008 and containing data through FFY 2007 (beginning October
1, 2006 and ending September 30, 2007).

Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   31
Reporting of Disability Types
RSA federal reporting collapses reporting on the nineteen disability codes used to
identify the primary and secondary disabilities of individuals seeking services into five
categories: a) Visual impairments, b) Communicative impairments, c) Physical
disorders, d) Cognitive impairments, and e) Mental and emotional (psychosocial)
disabilities. To remain consistent with data cited from various RSA reports, we have
reported on disabilities in this same manner but have, for reference, included a detailed
breakout of disabilities by each of the nineteen codes. What is significant to note is that
in contrast to the federal reporting, AZRSA’s internal reporting keeps as separate and
distinct deafness and hearing related impairments (included under RSA communicative
disabilities) and psychosocial (SMI or severe mental) impairments (included under RSA
mental and emotional (psychosocial) disabilities).

References to Unserved or Underserved Populations
One of the primary research objectives of SNAP 2009 is to report on the vocational
rehabilitation needs of unserved and underserved populations. While these terms are
used rather loosely, under the administrative code governing rehabilitation services,
unserved or underserved populations are defined as groups or populations of
individuals with severe disabilities in the State, including but not limited to those groups
that:
    1. Have cognitive or sensory impairments
    2. Are members of racial or ethnic minority groups
    3. Live in rural areas
    4. (for the purposes of independent living) Are identified by DHS (Department of
       Human Services) or a local CIL (Center for Independent Living) as being
       unserved or underserved

Reporting on Number of Individuals Served by AZRSA
Data on the number and demographic attributes of individuals served by AZRSA is
critical to “painting the picture” and creating the context within which to examine SNAP
2009 research findings. Data from a number of secondary data sources, including the
RSA Annual Review Report for Arizona Rehabilitation Services Administration (ARR) for
FFY2007, which includes AZRSA data submitted as of December 8, 2008 and the
Fiscal Year 2008 Monitoring Report on the Vocational Rehabilitation and Independent
Living Programs in the State of Arizona issued by RSA on September 12, 2008, provide
a baseline for gathering data on individuals served. In addition, AZRSA provided the
researchers with additional data from its internal data management system (IRIS) that
provided insight on individuals served at various stages in service delivery.

In FFY07, AZRSA provided services to 30,051 individuals. Five data files containing
aggregate data on individuals served was analyzed and included data on:
   •   13,092 individuals who as of September 30, 2007 were in the early stages of VR
       application, eligibility, and trial work status




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   32
   •   11,530 individuals whose IPE (Individualized Plan for Employment) had been
       implemented and were receiving VR services during the course of FFY 2007
       (ending September 30, 2007)
   •   879 individuals receiving extended supported employment services (ESE)
   •   626 individuals receiving VR post-employment services (PES)
   •   3,954 individuals receiving IL services (housed on two separate databases; one
       contains 1,170 clients and the other contains 2,784).

In reviewing this snapshot of service delivery in FFY2007, it is important to bear in mind
that: (1) there may be some duplication (although believed to be minimal) in the
number of clients housed on each of the IL databases as there is no ability to cross-
reference these files; and (2) the total number of clients receiving PES and ESE
services (1,505) includes 250 individuals who appear in the count of individuals who
received VR services and whose cases closed with an employment outcome in FFY07.

RSA Definition of Special Populations
As defined by RSA, two population groups require particular attention: transition age
youth (defined as between the ages of 14 to 24) and individuals age 65 and older. For
the purposes of this study, we have reported on these populations using age categories
that are consistent with findings from the 2007 American Community Survey as reported
by Cornell University Disability and Employment Institute, online resource for U.S.
Disability Statistics. The age categories used to define the AZRSA youth populations
are individuals under the age of 16 and those between the ages 16 to 20 and for older
populations, individuals ages 65 to 74 and those ages 75 and older.

Reporting of Services Provided to AZRSA Clients
Reporting on services authorized and purchased by AZRSA for the 1,423 clients
participating in VR Client Satisfaction surveys conducted in SFY2007 and SFY2008 are
summarized according to the AZRSA list (containing 20 or more services purchased
codes) and not the consolidated list of reported services referenced by RSA in its
Annual Review Report for Arizona (containing 10 service codes). The reason for this is
that the AZRSA services referenced in this report pertain to authorizations for
“purchased only” services and are not reflective of the full scope of services provided
through AZRSA (e.g. direct services delivered by VRC and other AZRSA personnel).
Thus, we can only comment on authorized purchased services using AZRSA reporting
categories.

In addition, whereas federal reporting details services provided to individuals served
(defined as those receiving services from the point at which their Individualized Plan for
Employment (IPE) has been implemented), the AZRSA data examines services as an
aggregate number within each category of purchased services and as authorized for
individuals receiving services at both the early and later stages of the process; that is,
pre and post IPE. This analysis also reports on authorized and purchased services as a
percentage of the total number of authorized services for that population. Reporting
reflects services as a percentage of total authorized services, as opposed to federal
Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   33
reporting that looks at the percentage of clients that received services at IPE
implementation or post-IPE.

A Framework for Understanding
As noted, the definition of disability varies widely in use and application, from its legal
definition, to its defined use and application in federal and state program eligibility
determinations, to its varied meanings in surveys and studies focusing on individuals
with disabilities. Add to this, gaps in the availability of data on individuals with
disabilities, the frequency with which research is updated, and the numerous
inconsistencies in how data is captured and reported within and between agencies, and
one can readily surmise the difficulties in attempting to draw “apples to apples”
comparisons that cut across multiple data sources.

These issues, coupled with concerns regarding the limitations of existing data to provide
a “holistic representation of the lives of people with disabilities,” led to the Government
Accountability Office, in cooperation with the National Academies, to begin work on the
Key National Indicators Initiative (KNII) in 2003. The purpose of this initiative was to
develop a comprehensive indicator system for the country as a whole. On April 21, 2008
the National Council on Disabilities released Keeping Track: National Disability Status
and Program Performance Indicators. 6 The report is a year-long effort by NCD to
identify valid federal data and to describe the status of the U.S. population of Americans
with disabilities. It includes 18 indicators determined by key stakeholders (via focus
group studies with individuals with disabilities) to measure “quality of life” using both
objective and subjective measures. The indicators span a variety of life domains,
including employment, education, health status and health care, financial status and
security, leisure and recreation, personal relationships, and crime and safety. NCD
believes that collectively, these indicators will create a holistic representation of the lives
of people with disabilities.

The NCD report is rich with information that includes an extensive review of existing
data sources, gaps and limitations in available data, and how the term “disability” is
defined within each survey/study tool. The report is an invaluable aid to anyone seeking
to learn more about existing research and what is known about individuals with
disabilities.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   34
Chapter 3: Prevalence of Disability
A review of secondary data on prevalence of disability on national and state levels
provides a framework for examining individuals served by AZRSA during FFY07. The
overview that follows is based on a review of three widely acknowledged sources:
disability statistics from the 2007 Disability Status Report on Arizona published by the
Employment and Disability Institute at Cornell University, data from the Census
Bureau’s 2007 American Community Survey (ACS), and findings from the 2007
National Health Interview Survey.

Based on Census 2000 and ACS definition, there are six types of disabilities. An
affirmative response to any one of these three questions identifies the individual as
having reported a disability.

   ƒ   Does this person have any of the following long-lasting conditions: (a) blindness,
       deafness, or a severe vision or hearing impairment? (Sensory Disability); (b) a
       condition that substantially limits one or more basic physical activities such as
       walking, climbing stairs reaching, lifting, or carrying? (Physical Disability)

   ƒ   Because of a physical, mental, or emotional condition lasting 6 months or more,
       does this person have any difficulty in doing any of the following activities:
       (a) learning, remembering, or concentrating? (Mental Disability); (b) dressing,
       bathing, or getting around inside the home? (Self-care Disability)

   ƒ   (Asked of persons ages 16 and older) Because of a physical, mental, or
       emotional condition lasting 6 months or more, does this person have any
       difficulty (a) going outside the home alone to shop or visit a doctor’s office? (Go-
       outside-home Disability); (b) working at a job or business? (Employment
       Disability)


3.1 Prevalence of Disability in Arizona and the United States

Individuals Reporting Disabilities in 2007
Prevalence of disability can be reported in two ways:
   1. As a percentage of all individuals (those with and without disability) ages 5 and
      older, with specific attention to those ages16 to 64
   2. As a percentage of individuals within the target population of individuals ages 16
      to 64 with a reported disability in 2007.

These perspectives provide insight on current and future service populations as it
pertains to prevalence of disability within the larger context of the population as a whole
and within the context of individuals with disabilities.


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   35
Table 1 presents data from the 2007 American Community Survey on prevalence of
disability as reported among individuals ages 5 and older, with a focus on individuals
ages 16 to 64. In addition, it highlights the demographic attributes of the 30,051
individuals served by AZRSA in FFY07. Prior to reviewing this data, it may be helpful to
answer two key questions: (1) What is the prevalence of disability in the U.S. and
Arizona by each of the perspectives outlined above? (2) Why focus on individuals with
disabilities ages 16 to 64?

What is the prevalence of disability in the U.S. and Arizona?

   Individuals Ages 5 and Older

   U.S.
   • The prevalence rate or overall percentage of people with disabilities (any type of
      disability) ages 5 and older in the U.S. is 14.9%.

   •   Out the total U.S. population of 301,621,159, there are 276,758,000 ages 5 and
       older (base population of individuals with and without disabilities)

   •   Of the 276,758,000 individuals ages 5 and older, 14.9% (41,306,000) reported a
       disability in 2007

   Arizona
   • The prevalence rate or overall percentage of people with disabilities (any type of
       disability) ages 5 and older in Arizona is 14.3%.

   •   Out of a total state population of 6,338,755 there are 5,779,000 people ages 5
       and older (base population of individuals with and without disabilities).

   •   Of the 5,779,000 individuals ages 5 and older, 14.3% (828,000) reported a
       disability in 2007


   Individuals Ages 5 to 15

   U.S.
   • The prevalence rate or overall percentage of people with disabilities (any type of
      disability) ages 5 to 15 in the U.S. is 6.3%.

   •   Of the 44,429,000 individuals ages 5 to 15, 6.3% (2,786,000) reported a disability
       in 2007

   Arizona
   • The prevalence rate or overall percentage of people with disabilities (any type of
       disability) ages 5 to 15 in AZ. is 5.5%.

Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   36
   •   Of the 984,000 individuals ages 5 to 15, 5.5% (54,000) reported a disability in
       2007

   Individuals Ages 16 to 20 (Transition-Age Youth)

   U.S.
   • The prevalence rate or overall percentage of people with disabilities (any type of
      disability) ages 16 to 20 in the U.S. is 6.8%.

   •   Of the 21,897,000 individuals ages 16 to 20, 6.8% (1,496,000) reported a
       disability in 2007

   Arizona
   • The prevalence rate or overall percentage of people with disabilities (any type of
       disability) ages 16 to 20 in AZ. is 6.4%.

   •   Of the 433,000 individuals ages 16 to 20, 6.4% (28,000) reported a disability in
       2007

   Individuals Ages 21 to 64 (Working Age)

   U.S.
   • The prevalence rate or overall percentage of people with disabilities (any type of
      disability) ages 21 to 64 in the U.S. is 12.8%.

   •   Of the 174,206,000 individuals ages 21 to 64, 12.8% (22,295,000) reported a
       disability in 2007

   Arizona
   • The prevalence rate or overall percentage of people with disabilities (any type of
       disability) ages 21 to 64 in AZ. is 12%.

   •   Of the 3,547,000 individuals ages 21 to 64, 12% (427,000) reported a disability in
       2007

   Individuals Ages 65 to 74

   U.S.
   • The prevalence rate or overall percentage of people with disabilities (any type of
      disability) ages 65 to 74 in the U.S. is 29.7%.

   •   Of the 19,104,000 individuals ages 65 to 74, 29.7% (5,667,000) reported a
       disability in 2007




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   37
   Arizona
   • The prevalence rate or overall percentage of people with disabilities (any type of
       disability) ages 65 to 74 in AZ. is 27.8%.

   •   Of the 422,000 individuals ages 65 to 74, 27.8% (118,000) reported a disability in
       2007

   Individuals 75 and Older

   U.S.
   • The prevalence rate or overall percentage of people with disabilities (any type of
      disability) ages 75 and older in the U.S. is 52.9%.

   •   Of the 17,122,000 individuals ages 75 and Older, 52.9% (9,063,000) reported a
       disability in 2007

   Arizona
   • The prevalence rate or overall percentage of people with disabilities (any type of
       disability) ages 75 and older in AZ. is 51.5%.

   •   Of the 393,000 individuals ages 75 and Older, 51.5% (203,000) reported a
       disability in 2007


Why focus on individuals ages 16 to 64?

For the purposes of this study, the target population of individuals identified as most
likely to seek assistance from and utilize VR services is individuals with disabilities
between the ages of 16 to 64.

The reasons for targeting this age group are that individuals ages 16 to 64 represent:

   •   63% of Arizona’s population (or 3,980,000 out of 6,338,755 people).

   •   55% (455,000) of the 828,000 individuals ages 5 and older reporting a disability
       in 2007.

   •   Of the 455,000 individuals ages 16 to 64 that reported a disability in 2007, 60%
       (272,000) reported an employment disability—one that makes it hard for them to
       work at a job or business.

   •   Of the 272,000 individuals reporting an employment disability, 261,000 are
       between the ages of 21 to 64. Within this group, 22% (59,000 of 261,000)
       reported receiving SSI benefits. When examined within the context of the total
       number of individuals in Arizona receiving SSI benefits (100,996 as of December
       2007), these individuals account for 58% of all SSI recipients.
Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   38
   •   In a recent initiative undertaken by Arizona’s Medicaid Infrastructure Grant and
       the Arizona Social Security Administration, SSDI beneficiaries between the ages
       of 18 to 64 who had an employment history within the past five years were
       targeted for a direct mail campaign highlighting SSA work options. It was felt that
       this population would likely be most predisposed to returning to work.

   •   Individuals ages 16 to 64, represent 94% of individuals receiving AZRSA VR
       services in FFY07 and 87% agency-wide (VR and IL). This agency-wide figure
       jumps to 92% when counts of individuals with unknown age data are removed.

These points support the decision to identify individuals ages 16 to 64 reporting a
disability in 2007 as most closely aligned with the AZRSA VR target population. The
issue of whether one prefers to examine AZRSA data on individuals served in FFY07
within the framework of the 455,000 individuals ages 16 to 64 who reported a disability
in 2007 or the subgroup of 272,000 who specifically reported an employment disability
is up to the reader as Table 1 presents data from each perspective.

Prevalence of disability among the study population of individuals ages 16 to 64 is as
follows:

   •   12.1% or 23,791,000 of the 196,103,000 individuals between the ages of 16 to
       64 in the U.S. reported a disability in 2007

   •   11.4% or 455,000 of the 3,980,000 individuals between the ages of 16 to 64 in
       AZ reported a disability in 2007. Within this group, 60% (272,000) reported an
       employment disability.

A Closer Look at Prevalence by Disability Type – U.S. and Arizona Populations
The American Community Survey reports: a) Sensory, b) Physical, c) Mental, d) Self-
care, e) Go-Outside-Home, and f) Employment disabilities. Data on individuals ages 5
and Older in the U.S. and Arizona is presented to provide a “big picture” view of
prevalence of disability along with data on the target group, individuals 16 to 64
reporting “any” type of disability (as well as those reporting an “employment disability”).
To address questions specific to prevalence of disability among other age groups, Table
2 has been included. (Note: Reporting of disability in 2007 ACS is not mutually
exclusive; individuals can report more than one type of disability.)

Sensory Disability
(Defined by Census/ACS as blindness, deafness, or severe vision or hearing
impairment).

   Ages 5 and Older

   •   U.S. – 28.3% of individuals reporting a disability reported a sensory disability
       (11,696,000 out of 41,306,000)

Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   39
   •   AZ – 30.6% of individuals reporting a disability reported a sensory disability
       (253,000 out of 828,000)

   Ages 16 to 64

   •   U.S. – 22.3% of individuals reporting a disability reported a sensory disability
       (5,315,000 out of 23,791,000)

   •   AZ – 23.3% of individuals reporting a disability reported a sensory disability
       (106,000 out of 455,000)


Physical Disability
(Defined by Census/ACS as a condition that substantially limits one or more basic
physical activities such as walking, climbing stairs reaching, lifting, or carrying)

   Ages 5 and Older

   •   U.S. – 62.8% of individuals reporting a disability reported a physical disability
       (25,930,000 out of 41,306,000)

   •   AZ – 63.4% of individuals reporting a disability reported a physical disability
       (525,000 out of 828,000)

   Ages 16 to 64

   •   U.S. – 59.4% of individuals reporting a disability reported a physical disability
       (14,138,000 out of 23,791,000)

   •   AZ – 59.8% of individuals reporting a disability reported a physical disability
       (272,000 out of 455,000)


Mental Disability
(Defined by Census/ACS as a condition that because of a physical, mental, or
emotional condition lasting 6 months or more, the person has difficulty learning,
remembering or concentrating).

   Ages 5 and Older

   •   U.S. – 38.8% of individuals reporting a disability reported a mental disability
       (16,021,000 out of 41,306,000)

   •   AZ – 38.3% of individuals reporting a disability reported a mental disability
       (317,000 out of 828,000)
Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   40
   Ages 16 to 64

   •   U.S. – 39.1% of individuals reporting a disability reported a mental disability
       (9,291,000 out of 23,791,000)

   •   AZ – 38.9% of individuals reporting a disability reported a mental disability
       (177,000 out of 455,000)


Self-Care Disability
(Defined by Census/ACS as a condition that because of a physical, mental or emotional
condition lasting 6 months or more, the person has difficulty dressing, bathing, or getting
around inside the home).

   Ages 5 and Older

   •   U.S. – 20.3% of individuals reporting a disability reported a self-care disability
       (8,382,000 out of 41,306,000)

   •   AZ – 19.9% of individuals reporting a disability reported a self-care disability
       (165,000 out of 828,000)

   Ages 16 to 64

   •   U.S. – 17.7% of individuals reporting a disability reported a self-care disability
       (4,213,000 out of 23,791,000)

   •   AZ – 18.2% of individuals reporting a disability reported a self-care disability
       (83,000 out of 455,000)

   •   Note on ages 65 and older: What may prove to be of strategic significance to
       AZRSA, specifically with regard to IL services, is that 16.9% of individuals ages
       65 to 74 who reported a disability reported a Self-care disability (20,000 out of
       118,000), and among those ages 75 and older, this figure was 27.1% (55,000 out
       of 203,000),

Go-outside-home Disability
(Question only asked of those 16 and older)
(Defined by Census/ACS as a condition that because of a physical, mental, or
emotional condition lasting 6 months or more, the person has difficulty going outside the
home alone to shop or visit a Dr’s office).




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   41
   Ages 16 to 64

   •   U.S. – 26.4% of individuals ages 16 to 64 reporting a disability reported a self-
       care disability (6,276,000 out of 23,791,000)
   •   AZ – 27.9% of individuals ages 16 to 64 reporting a disability reported a self-care
       disability (127,000 out of 455,000)

   •   Note on ages 65 and Older: What may prove to be of strategic significance to
       AZRSA, specifically with regard to IL services, is that 26.3% of individuals ages
       65 to 74 who reported a disability reported a Go-outside-home disability (31,000
       out of 118,000), and among those ages 75 and older, this figure was 48.8%
       (99,000 out of 203,000).


Employment Disability
(Question only asked of those 16 and older)
(Defined by Census/ACS as a condition that because of a physical, mental, or
emotional condition lasting 6 months or more, the person has difficulty working at a job
or business).

   Ages 16 to 64

   •   U.S. – 58.1% of individuals ages 16 to 64 reporting a disability reported an
       employment disability (13,826,000 out of 23,791,000)

   •   AZ – 59.8% of individuals ages 16 to 64 reporting a disability reported an
       employment disability (272,000 out of 455,000)

   •   Note on ages 65 and Older: What may prove to be of strategic significance to
       AZRSA, specifically with regard to VR and/or IL services for individuals looking to
       return to the workforce, is that 58.5% of individuals ages 65 to 74 who reported a
       disability reported an Employment disability (69,000 out of 118,000), and among
       those ages 75 and older, this figure was 70.9% (144,000 out of 203,000).


3.2 A Comparative Look: U.S., Arizona, and Individuals Served by AZRSA

Efforts to correlate data between individuals ages 16 to 64 in Arizona who reported a
disability in 2007 (ACS) and the 30,051 individuals who received AZRSA VR and IL
services in FFY07 provide a framework that helps to “paint the picture” of who AZRSA
serves. As noted, Table 1 provides a quick comparative reference, with the key
findings listed in this next section providing an in-depth look at individuals receiving
AZRSA services in FFY07. (Note: The limitation of this comparative look includes the
fact that ACS reporting of disability is not mutually exclusive. Individuals can report
more than one type of disability vs. AZRSA reporting by primary disability.)


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   42
 TABLE 1
                       2007                      U.S.                                                  Arizona                                                 AZRSA
          U.S. and Arizona Populations:       Population     5 & Older    16-64         16-64         Population   5 & Older      16-64         16-64         FFY2007
             Prevalence of Disability                        Reporting    Reporting     Reporting                  Reporting    Reporting     Reporting       Individuals
                                                                                                                                             Employmen
                                              ALL AGES         ANY        ANY           Employment                   ANY          ANY            t
                                                             Disability   Disability    Disability                 Disability   Disability    Disability
                                                                                                                                                           Served


 Total Population Est. in Age Group           301,621,159   276,758,000   196,103,000                  6,338,755    5,779,000   3,980,000                           30,051



 Number Reporting Disability (in age group)                 41,306,000     23,791,000    13,826,000                   828,000   455,000       272,000
 Percentage: Indiv Reporting a Disability                     14.9%          12.1%         58.1%                    14.3%        11.4%         59.8%
 Gender
 Male                                           49.3%         46.9%          49.2%         48.0%        50.1%       47.5%        48.8%         47.4%            51.4%
 Female                                         50.7%         53.1%          50.8%         52.0%        49.9%       52.5%        51.2%         52.6%            48.6%


 Ethnicity
 White                                          73.9%         76.3%          73.2%         73.1%        76.4%       76.4%        76.5%         77.6%            68.5%
 Black                                          12.4%         13.8%          15.7%         16.6%        3.5%         3.6%         4.4%          4.8%            6.9%
 American Indian/Alaska Native                  0.8%           1.1%           1.4%          1.3%        4.4%         5.6%         6.8%          6.6%            3.5%
 Asian                                          4.4%           2.6%           2.4%          2.2%        2.4%         1.3%         1.1%          1.1%            1.0%
 Native Hawaiian/Other Pacific Islander         0.1%           0.1%           0.1%          0.1%        0.1%         0.1%         0.2%          0.0%            0.2%
 Other (includes 2 or more races)               8.4%           6.1%           7.2%          6.5%        13.1%        9.3%        11.0%          9.9%                NA
 Unknown (AZRSA/IRIS data)                                                                                                                                      4.8%
 Hispanic/Latino Origin                                       10.3%          11.4%         10.3%                    19.1%        20.9%         19.5%            15.1%


 SSI/SSDI Recipients                                                                                                                                            44.6%
 SSDI Recipients                                2.2%                                                    2.0%                                                        *
 SSI Recipients                                 2.4%                                                    1.6%                                                        *
 AZRSA reports SSDI/SSI as 1 figure




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report             43
TABLE 1
2007                                              U.S.                                                   Arizona                                             AZRSA
U.S. and Arizona Populations:                     Population    5 & Older     16-64         16-64        Population   5 & Older    16-64        16-64        FFY2007
Prevalence of Disability                                        Reporting     Reporting     Reporting                 Reporting    Reporting    Reporting    Individuals
                                                  ALL AGES      ANY           ANY           Employment                ANY          ANY          Employment   Served
                                                                Disability    Disability    Disability                Disability   Disability   Disability


Total Population Est. in Age Group                301,621,159   276,758,000   196,103,000                6,338,755    5,779,000    3,980,000                 30,051


Number Reporting Disability (in age group)                      41,306,000    23,791,000    13,826,000                828,000      455,000      272,000
Percentage: Indiv Reporting a Disability                        14.9%         12.1%         58.1%                     14.3%        11.4%        59.8%
Age
(% of indiv. (Ages X-Y) reporting a Disability)
% population Ages 5 and Older                     14.9%                                     NA           14.3%                     NA           NA           NA
Ages 5 to 15                                      6.3%          6.7%          NA            NA           5.5%         6.5%         NA           NA           0.5%
Ages 16 to 20                                     6.8%          3.6%          6.7%          3.8%         6.4%         3.4%         6.2%         4.0%         21.8%
Ages 21 to 64                                     12.8%         54.0%         93.7%         96.2%        12.0%        51.6%        93.8%        96.0%        64.9%
Ages 65-74                                        29.7%         13.7%         NA            NA           27.8%        14.3%        NA           NA           2.4%
Ages 75 and older                                 52.9%         21.9%
                                                                NA            NA            NA           51.5%        24.5%        NA           NA           5.6%
Unknown (AZRSA data)                                                                                                                                         5.0%


Disability Type(s) Reported
Reporting ANY type of disability                  14.9%                                     NA           14.3%                                  NA
Sensory (% disabilities reported)                 4.2%          28.3%         22.3%         NA           4.4%         30.6%        23.3%        NA           19.7%
Physical                                          9.4%          62.8%         59.4%         NA           9.1%         63.4%        59.8%        NA           18.3%
Mental                                            5.8%          38.8%         39.1%         NA           5.5%         38.3%        38.9%        NA           49.5%
Self-care                                         3.0%          20.3%         17.7%         NA           2.9%         19.9%        18.2%        NA           NA
Go-outside-home                                   5.4%          30.6%         26.4%         NA           5.4%         31.0%        27.9%        NA           NA
Employment disability                             10.5%         59.0%         58.1%         100.0%       10.1%        58.6%        59.8%        100.0%       NA
Unknown AZRSA/IRIS data)                                                                                                                                     12.5%




   Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report            44
Notes:
1) NA: Not Applicable
2) Ethnicity: Does not total to 100%; those reporting Hispanic/Latino origin included in Census defined race categories
3) Disability by Age: number of individuals reporting any disability against base population of individuals with and without
disabilities in specified age range)
Base Population Counts                                     US                              AZ
Count: All individuals Ages 5 and Older               276,758,000                       5,779,000
Count: All individuals ages 5 to 15                    44,429,000                        984,000
Count: All individuals ages 16 to 20                   21,897,000                        433,000
Count: All individuals ages 21 to 64                  174,206,000                       3,547,000
Count: All individuals ages 65 to 74                   19,104,000                        422,000


Count: All individuals ages 75 and Older               17122000                          393,000
Focus of study: Ages 16 to 64                         196,103,000                       3,980,000
3) Chart by Age and Disability presents data specific to Arizona populations. Note: Go-Outside-Home and Employment Disability
only asked of individuals ages 16 and older (16 to 75+ years).
4) Focus of comparison between numbers reporting a disability and those served by AZRSA is on individuals ages 16 to 64 who
reported a disability and those reporting employment disabilities in 2007.
5) Employment disability (defined by Census/ACS): Individual reports difficulty working at a job or business because of
a physical, mental, or emotional condition lasting 6 months or longer. Breakout within Employment Disability by type
(sensory, physical, mental, self-care, etc. is not available)
6) U.S.--Out of a total population of 301,621,159 there are 196,103,000 people between the ages of 16 to 64.
13,826,000 (7.1%) of these individuals reported an Employment Disability in 2007.
7) AZ: Out of a total population of 6,338,755 there are 3,980,000 people between the ages of 16 to 64.
272,000 (6.8%) of these individuals reported an Employment Disability in 2007.
8) AZRSA Population Served in FFY2007 (October 1, 2006 - September 30, 2007) includes individuals receiving VR
services (pre/post IPE implementation), ESE (extended supported employment) and PES (post-employment) services,
and IL services.
9) AZRSA data presented within the global context of the 16-64 population with disabilities. While no direct
correlations can be made, this does provide insight on the VR "target market" and AZRSA service delivery in FFY2007.
Source Data:
Bjelland, M.J., Erickson, W. A., Lee, C. G. (2008, November 8). Disability Statistics from the American Community Survey (ACS).
Ithaca, NY:
Cornell University Rehabilitation Research and Training Center on Disability Demographics and Statistics
(StatsRRTC)


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report                          45
TABLE 2 Prevalence of Disability/Type of Disability
ACS 2007 Summarized Report / Cornell University

Prevalence of disability: Non-institutionalized persons with disabilities, by age, by disability type
                                                                                                                                               Go-
US and Arizona                                           Reporting                                                              Disability   Outside     Employment   Employment
                                                                                                                                  Type                                  AZRSA
                                                            ANY             Sensory          Physical    Mental     Self-Care   and/or       Ages16+      Ages 16+     Target
                                                                                                                                Self-Care
                                                          Disability                                                              (*1)                                16-64 Only


U.S. Population: Ages 5 and Older                           14.9%            4.2%              9.4%       5.8%        3.0%       13.9%         5.4%        10.50%       7.10%
AZ Population: Ages 5 and Older                             14.3%            4.4%              9.1%       5.5%        2.9%       13.4%         5.4%        10.1%         6.8%
AZ 2007 number people reporting disability                 828,000          253,000          525,000    317,000     165,000     775,000      257,000      485,000      272,000
Total AZ base population-with& w/o disabilities           5,779,000        5,779,000        5,779,000   5,779,000   5,779,000   5,779,000    4,795,000    4,795,000    3,980,000
Type of disability as a % of all disabilities reported                       30.6%            63.4%      38.3%       19.9%                    31.0%        58.6%        32.9%
                                                                                                                                                *2           *3
U.S. Population: Ages 5 to 15                               6.3%             1.2%              1.1%       5.1%        0.9%        6.3%          NA           NA
AZ Population: Ages 5 to 15                                 5.5%             1.1%              1.1%       4.3%        0.8%        5.5%          NA           NA
AZ 2007 number people reporting disability                 54,000            11,000           11,000     42,000      8,000       54,000
AZ base population-with & w/o disabilities age group       984,000          984,000          984,000    984,000     984,000     984,000
Type of disability as a % of all disabilities reported                       20.4%            20.4%      77.8%       14.8%       100.0%


U.S. Population: Ages 16 to 20                              6.8%             1.3%              1.6%       4.6%        0.7%        6.3%         1.6%         2.4%
AZ Population: Ages 16 to 20                                6.4%             1.6%              1.7%       3.9%        0.8%        5.8%         1.6%         2.4%
AZ 2007 number people reporting disability                 28,000            7,000             7,000     17,000      3,000       25,000       7,000        11,000
AZ base population-with & w/o disabilities age group       433,000          433,000          433,000    433,000     433,000     433,000      433,000      433,000
Type of disability as a % of all disabilities reported                       25.0%            25.0%      60.7%       10.7%       89.3%        25.0%        39.3%


U.S. Population: Ages 21 to 64                              12.8%            2.9%              7.9%       4.7%        2.3%       11.5%         7.6%         7.6%
AZ Population: Ages 21 to 64                                12.0%            2.8%              7.4%       4.5%        2.2%       10.8%         3.4%         7.4%
AZ 2007 number people reporting disability                 427,000           99,000          264,000    160,000      79,000     383,000      120,000      261,000
AZ base population-with & w/o disabilities age group      3,547,000        3,547,000        3,547,000   3,547,000   3,547,000   3,547,000    3,547,000    3,547,000
Type of disability as a % of all disabilities reported                       23.2%            61.8%      37.5%       18.5%       89.7%        28.1%        61.1%


U.S. Population: Ages 65 to 74                              29.7%            9.7%             23.0%       7.5%        6.0%       29.0%         9.1%        19.4%
AZ Population: Ages 65 to 74                                27.8%            9.1%             20.9%       6.8%        4.7%       27.4%         7.3%        16.4%
AZ 2007 number people reporting disability                 118,000           38,000           88,000     29,000      20,000     116,000       31,000       69,000
AZ base population-with & w/o disabilities age group       422,000          422,000          422,000    422,000     422,000     422,000      422,000      422,000

      Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report                     46
Type of disability as a % of all disabilities reported              32.2%          74.6%          24.6%          16.9%         98.3%            26.3%            58.5%


U.S. Population: Ages 75 and Older                       52.9%      23.6%          40.3%          17.8%          15.4%         51.1%            27.0%            40.2%
AZ Population: Ages 75 and Older                         51.5%      24.8%          39.1%          17.5%          14.0%         50.2%            25.3%            36.5%
AZ 2007 number people reporting disability               203,000    98,000        154,000         69,000        55,000        197,000           99,000          144,000
AZ base population-with & w/o disabilities age group     393,000   393,000        393,000        393,000        393,000       393,000           393,000         393,000
Type of disability as a % of all disabilities reported              93.1%          75.9%          34.0%          27.1%         97.0%            48.8%            70.9%


       Notes:

       1) Individual reported a sensory, physical, mental and/or self-care disability. Note: Breakout by disability types will not total 100% (e.g. multiple disabilities)
       2) Go-Outside-Home disability question only asked of individuals ages 16 to 75+; Base population of those 16 to 75+ is 4,795,000
       3) Employment disability only asked of those ages 16 and older; AZRSA VR "target" population is ages 16 to 64 (AZ base population 16-64 = 3,980,000)
       4) Percentages based on +/minus 95% Confidence Index (%).
       The confidence interval is a measurement of the accuracy of the statistic. Statistics sourced from ACS2007, Cornell University Disability Statistics

       Disability Types Defined: ACS and Census Questions
       Q15: Does this person have any of the following long-lasting conditions: a) blindness, deafness, or a severe vision or hearing impairment (Sensory);
       a condition that substantially limits one or more basic physical activities such as walking, climbing stairs, reaching, lifting or carrying? (Physical Disability)?

       Q16: Because of a physical, mental, or emotional condition lasting six months or more, does this person have any difficulty in doing any of the following
       activities: a) learning, remembering, or concentrating? (Mental Disability); b) dressing, bathing, or getting around inside of the home (Self-Care Disability)?

       Q17: Because of a physical, mental, or emotional condition lasting six months or more, does this person have any difficulty in doing any of the following
       activities: a) going outside the home alone to shop or visit a doctor's office (Go-Outside-Home Disability); b) working at a job or business? (Employment
       Disability)?

       Statistics Summarized
       Source Data:
       Bjelland, M.J., Erickson, W. A., Lee, C. G. (2008, November 8). Disability Statistics from the American Community Survey (ACS). Ithaca, NY:
       Cornell University Rehabilitation Research and Training Center on Disability Demographics and Statistics (StatsRRTC)
       Retrieved February 8, 2009 from www.disabilitystatistics.org




      Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report                 47
Highlighted Findings from Secondary Data Source: U.S. Department of Labor,
Bureau of Labor Statistics – Recently Released Monthly Reporting Feature
The first release of the new monthly data series from the U.S. Department of Labor on
employment and unemployment data on people with disabilities shows that in February
2009:
   •   The percentage of people with disabilities in the labor force was 23%
   •   The unemployment rate of persons with a disability was 14.0 percent, compared
       with 8.7 percent for persons with no disability, not seasonally adjusted

This data is derived from the Current Population Survey (CPS), which provides
comprehensive information on the employment status of the civilian, non-institutional
population 16 years of age and older.

CPS uses six disability questions to measure the employment status of people with
disabilities on a timely basis. A response of “yes” to any one of the questions indicates
that the person in question has a disability. The disability questions appear in the CPS
in the following format:
   •   Is anyone deaf or does anyone have serious difficulty hearing?
   •   Is anyone blind or does anyone have serious difficulty seeing even when wearing
       glasses?
   •   Because of a physical, mental, or emotional condition, does anyone have serious
       difficulty concentrating, remembering, or making decisions?
   •   Does anyone have serious difficulty walking or climbing stairs?
   •   Does anyone have difficulty dressing or bathing?
   •   Because of a physical, mental, or emotional condition, does anyone have
       difficulty doing errands alone such as visiting a doctor’s office or shopping?

The following chart, taken directly from the Bureau of Labor Statistics website, recaps
data for January and February 2009. The website should be referenced for a better
understanding of the differences in data reported through the CPS and ACS. The fact
that monthly updates will now be available on the employment status of individuals with
disabilities (only on the national level) will assist AZRSA in taking a real-time pulse of
employment activity.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   48
 Table 1. Employment status of the civilian noninstitutional population by sex, age, and
              disability status, not seasonally adjusted (Numbers in thousands)

                                                        Persons with a
                                                                          Persons with no disability
                                                          disability
           Employment status, sex, and age
                                                       Jan.        Feb.       Jan.           Feb.
                                                       2009        2009       2009           2009
               TOTAL, 16 years and over
          Civilian noninstitutional population         26,804    26,738     207,934       208,175
                   Civilian labor force                 6,184     6,141     147,261       147,663
          Percent of population in labor force           23.1      23.0       70.8          70.9
                        Employed                        5,368     5,282     135,068       134,823
             Employment-population ratio                 20.0      19.8       65.0          64.8
                      Unemployed                         816       859       12,193       12,840
                  Unemployment rate                      13.2      14.0        8.3          8.7
                    Not in labor force                 20,620    20,596      60,673       60,512

                  Men, 16 to 64 years
                  Civilian labor force                 2,824      2,865      75,343       75,581
          Percent of population in labor force          38.5       39.1       83.7          83.9
                       Employed                        2,345      2,362      68,086       67,833
             Employment-population ratio                32.0       32.2       75.7          75.3
                     Unemployed                         479        503        7,257        7,748
                 Unemployment rate                      17.0       17.6        9.6          10.3
                   Not in labor force                  4,510      4,468      14,658       14,495

                Women, 16 to 64 years
                  Civilian labor force                 2,500      2,470      66,276       66,488
          Percent of population in labor force          33.0       32.7       71.9          72.1
                       Employed                        2,197      2,172      61,678       61,772
             Employment-population ratio                29.0       28.7       66.9          67.0
                     Unemployed                         303        299        4,598        4,716
                 Unemployment rate                      12.1       12.1        6.9          7.1
                   Not in labor force                  5,065      5,092      25,884       25,743

            Both sexes, 65 years and over
                  Civilian labor force                  860        806       5,643           5,594
          Percent of population in labor force          7.2        6.8       21.9            21.6
                       Employed                         826        748       5,304           5,218
             Employment-population ratio                6.9        6.3        20.6            20.2
                     Unemployed                          34         57        339             376
                 Unemployment rate                      3.9        7.1         6.0            6.7

                   Not in labor force                  11,044    11,036      20,130       20,274




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report           49
Highlighted Findings from Secondary Data Source: 2008 Progress Report on the
Economic Well-Being of Working-Age People with Disabilities 7
This progress report on the prevalence rate, employment, poverty, and household
income of working-age people with disabilities (ages 21 to 64) uses data from the 2008
and earlier Current Population Surveys—Annual Social and Economic Supplement
(CPS-ASEC). The report provides information on the CPS, the definition of disability
used in the survey, and a brief overview of the strengths and weaknesses of CPS data.

CPS-ASEC uses the work limitation question: “Does anyone in this household have a
health problem or disability which prevents them from working or which limits the kind or
amount of work they can do?

Many researchers argue that CPS does not capture the actual population with
disabilities or its employment trends, while others have shown that while the levels of
employment found in CPS data are significantly lower than those found in datasets with
better measures of the working-age population of individuals with disabilities, the
employment trends are not significantly different. Thus, this data is presented as
another view of prevalence rates.

Key Findings: Working-Age Adults Ages 21 to 64 (nationwide statistics based on
CPS-ASEC data)

2008 and 2007 Comparative Data
   • The disability prevalence rate in March 2008 was 7.9%, down slightly from 8.0%
      in 2007.

   •   The employment rate of people with disabilities was 17.7% in March 2008, down
       slightly from 18.7% in 2007.

   •   The employment rate of people without disabilities was 79.7% in March 2008,
       down slightly from 80.3% in 2007.

   •   In March 2008, working-age people with disabilities were only 22% as likely to be
       employed as individuals without disabilities.

2007 Data
   • In 2007, the full-time/full-year employment rate of working-age people with
      disabilities was 8.0% and 63.4% among people without disabilities.

   •   Working-age people with disabilities were 13% as likely to be employed as a
       working –age person without disabilities.

   •   The poverty rate of working-age people with disabilities was 28.6% and 8.6%
       among people without disabilities.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   50
   •   Working-age people with disabilities were 3.31 times more likely to be in poverty
       when compared to people without disabilities.

   •   The median household income of working-age people with disabilities was
       $30,607 (less than $30,875 in 2006); for people without disabilities, $60,009.

   •   The median household income of working-age people with disabilities was 51%
       of the median household income of working-age people without disabilities.


Highlighted Findings from Secondary Data Sources: 2007 National Health
Interview Survey
According to data published in the National Health Interview Survey 2007, a household,
multi-stage probability sample survey conducted annually by interviewers of the U.S.
Census Bureau for the Centers for Disease Control and Prevention’s National Center
for Health Statistics:

   •   Approximately 12.2 million (8%) of adults aged 18-69 reported being unable to
       work due to chronic health problems.

   •   6.2 million (3%) were limited in the kind or amount of work they could do because
       of their health.

   •   Persons aged 45-64 and 65-69 years were about three to four times as likely to
       be unable to work due to health reasons as persons aged 18-44 years.

   •   About 3% of Asian adults aged 18-69 years were unable to work for health
       reasons compared with 6% of white adults and 9% of black adults.

   •   Persons with the least education and the lowest incomes were the most likely to
       be able to work due to health problems.

   •   Persons under age 65 years who had private health insurance were less likely to
       be limited in their work activity than persons who had Medicaid or other types of
       health insurance.

   •   Poor non-Hispanic white persons (24%) and poor non-Hispanic black persons
       (22%) were more likely than poor Hispanic persons (12%) to be unable to work.

Urban Institute
     • Many low-income adults live with disabilities. Of the 30 million people in low-
         income families, 24 percent (7.3 million) report a work limitation. Over 32
         percent of adults living below the poverty level report such limits to work, and
         they are about half as likely to have worked during the past year as those
         without work limitations



Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   51
National Council on Disability (NCOD)
      • In 2000, employed people age 18–64 with disabilities were less likely to report
         that their jobs required their full talents and abilities than those without
         disabilities (40 percent of workers with disabilities and 48 percent of workers
         without disabilities said their jobs required their full talents and abilities.)
         (Harris Interactive 2000).

       •   In 2004, 22 percent of adults 18–64 with disabilities said they had
           experienced some type of employment-related discrimination (Harris
           Interactive 2004).


3.3 At a Glance: Individuals Served by AZRSA FFY07

Total served by VR and IL Programs: 30,051

AZRSA FFY07 By Order of Selection
                                 AZRSA Individuals Served FFY 2007
                                 Total AZRSA: by OOS Priority Rating
                                             N = 30,051




                                               4%

                                                                      24%

                           27%




                                                        45%

              UNKNOWN     Priority 1/Most Significant   Priority 2/Significant   Priority 3/Disabled




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report             52
AZRSA FFY07 By Disability Type
                                      AZRSA Individuals Served FFY 2007
                                     Total AZRSA: by RSA Disability Types
                                                  N = 30,051
                                                                    12%

                                                                            0%
                                   28%

                                                                                 12%




                                                                                  7%




                                     23%
                                                                      18%

              Unknow n   No Impairment   Visual     Communicative   Physical     Cognitive   Mental/Emotional




AZRSA FFY07 By ESE Eligibility (Extended Supported Employment)

                                    AZRSA Individuals Served FFY 2007
                                Total AZRSA: by Eligibility for ESE Services
                                                N = 30,051

                                           18%




                                                                          82%


                                                  Not Eligible   Eligible




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report                      53
AZRSA FFY07 By SSI/SSDI Recipient Status

                              AZRSA Individuals Served FFY 2007
                           Total AZRSA: by SSI/SSDI Recipient Status
                                          N = 30,051


                                                      9%




                          45%




                                                                  46%




                                Unknown    Non-Recipient   Recipient




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   54
AZRSA FFY07 By Referral Source
                                AZRSA Individuals Served FFY 2007
                                 Total AZRSA: by Referral Source
                                            N = 30,051

       50%

       45%
       40%

       35%
                                                            30%
       30%                                                        28%

       25%
       20%

       15%    13%
                                         10%
       10%
                    4%     5%
                                   4%
        5%                                            2%                1%           1%
                                                1%                            0%
        0%
               01    02    03      04     05    06    07    08    09     10    11    99


       01 Educational Inst (Elem/Secondary)          07 One Stop Employment/Training Center
       02 Education Inst (Post Secondary)            08 Self-Referral
       03 Physician/Medical (Public/Private)         09 Other Sources
       04 Welfare Agency                             10 Fast Track BHS (Behavioral Health Svcs)
       (State/Local Government)                      11 Work Exploration BHS
       05 Community Rehab Program (CRP)              99 Other Sources
       06 SSA



AZRSA FFY07 By Veteran Status
                          AZRSA Individuals Served FFY 2007
                            Total AZRSA: by Veteran Status
                                      N = 30,051
                                           0%
                                                     14%


                                                            5%




                                81%
         UNKNOWN       VETERAN          NON-VETERAN      VET/SERVICE DISABILITY
Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report        55
AZRSA FFY07 By Ethnicity

                        AZRSA Individuals Served FFY 2007
                           Total AZRSA: by ETHNICITY
                                    N = 30,051

                                            5% 1%
                                                      7%




                                                                15%




                                                                 3%
                                                                 0%
                      69%



                         UNKNOWN
                         ASIAN
                         BLACK/AFRICAN AMERICAN
                         HISPANIC/LATINO
                         AMERICAN INDIAN/ALASKAN NATIVE
                         PACIFIC ISLANDER/HAWAIIAN
                         WHITE


AZRSA FFY07 By Minority and Non-Minority Groups
                         AZRSA Individuals Served FFY 2007
                      VR& IL Program: by Minority vs Non-Minority
                                      N = 30,051


                                            5%




                                                                27%




                     68%




                            Unknown   Minority   Non-Minority




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   56
AZRSA FFY07 By County of Residence and District


                                     AZRSA Individuals Se r ve d FFY 2007
                                    Total AZRSA: by County of Re s ide nce
                                                 N = 30,051

           U N KN O W N      0.0%

                Y UM A             4.0%

             Y A V A PA I               5.3%

        SA N T A C R U Z     0.4%

                 PIN A L           3.2%

                  PIM A                                  21.6%

       OU T OF ST A T E          0.8%

              N A V A JO          2.0%

             M O HA V E           2.7%

          M A R IC OPA                                                                    50.9%

               LA P A Z      0.1%

             G R A HA M          0.8%

           G R E E N LE E    0.1%

                   G I LA        1.3%

           C OC ON IN O            3.3%

             C O C HI S E          3.1%

              A P A C HE     0.4%

                            0%            10 %     20%           30%         40%   50 %           60%




                            AZRSA Individuals Served FFY 2007
                                Total AZRSA: by District
                                        N = 30,051
               6A                4%
               5A                4%
               4A                 5%
               3A                   9%
               2A                                20%
               1A                                                      48%
       (blank)                        9%

                    0%                    20%             40%            60%              80%




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report              57
AZRSA FFY07 By Gender

                              AZRSA Individuals Served FFY 2007
                                  Total AZRSA: by Gender
                                           N = 30,051




                                                                   49%
                        51%




                                          Female    Male



AZRSA FFY07 By Age Range (at application)


                            AZRSA Individuals Served FFY 2007
                               Total AZRSA: by Age Range
                                        N = 30,051

            75 & up          5.5%

            65 to 74        2.4%

            21 to 64                                             64.9%

            16 to 20                  21.8%

          Under 16      0.5%

              Blank          5.0%

                       0%           20%       40%          60%       80%     100%



Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   58
CHAPTER 4: Voice of the Consumer

4.1 Primary and Secondary Data Sources

Information on the vocational rehabilitation and independent living needs of individuals
with disabilities was obtained from AZRSA VR client satisfaction surveys and SNAP
2009 consumer surveys. In total, feedback from 1,644 consumers was reviewed and
analyzed.

AZRSA VR Client Satisfaction Survey
Survey respondents: 1,423
Data from VR client satisfaction surveys conducted over the course of SFY 2007–2008
(July 2006 through June 2008) provide insight on the needs of individuals with most
significant disabilities. The client satisfaction survey includes a series of questions
related to the quality of service received from VRC (Vocational Rehabilitation
Counselor) personnel, satisfaction with employment outcomes, and open-ended
questions related to unmet service needs. Surveys are sent to clients at the point of
case closure, targeting both clients who had achieved an employment outcome (Status
26 successful rehabilitation) and those who had not (Status 28 unsuccessful
rehabilitation).

SNAP 2009 Consumer Surveys
Survey respondents: 221
Data from the SNAP 2009 online survey (170 respondents) and print survey (51
respondents) answer key questions related to the vocational rehabilitation and
independent living service needs of individuals with most significant disabilities.

The survey was designed to elicit feedback on:
   ƒ   Demographics of survey respondents (county of residence, gender, age,
       education, ethnicity, veteran status, benefits received, etc.)
   ƒ   Disabilities, both primary and secondary
   ƒ   Perceptions of barriers to employment and increased self-sufficiency
   ƒ   Extent to which the consumer’s disability affects everyday life at home, at work,
       and when out in the community
   ƒ   Current employment status, experience with AZRSA vocational rehabilitation and
       independent living services, helpfulness of services received, and/or barriers to
       seeking assistance
   ƒ   Need for employment-related supports or independent living services
   ƒ   Service needs of individuals with disabilities




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   59
4.2 Demographics of Survey Respondents

AZRSA VR Client Satisfaction Survey
Survey respondents: 1,423
   • Gender: 51% male and 49% female
   • Veteran status: 7% were veterans (includes those with service-related disability)
   • SSA: 48% were SSI/SSDI recipients
   • Ethnicity
       o 77% were non-minorities (defined as White) and 23% minorities.
       o Among the 362 minority respondents, 58% were Hispanic/Latino, 25%
         Black/African-American, 9% American Indian, 7% Asian, and less than one-
         half percent were Hawaiian/Pacific Islander.
                                       VR Client Satisfaction Survey
                                                  Ethnicity
                                                 N = 1,423


                    Haw aiian        0%

            American Indian            2%

                         Asian         2%

                         Black            6%

                     Hispanic                  14%

                         W hite                                                 77%

                                  0%           20%         40%         60%     80%    100%


   •   Education level
                                          VR Client Satisfaction Survey
                                                 Education Level
                                                    N = 1,423


                  M as te r or PHd             4%
                  Colle ge 4 ye ar                     11%
                  Colle ge 2 ye ar                    9%
              Colle ge No De gre e                               16%
                       HS or GED                                               28%
                    Spe cial CERT              5%
                           9 to 12                                       23%
                           1 to 8           3%
                       No Form0%
                              al

                                     0%     5%       10%   15%    20%    25%   30%



Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   60
   •   County of residence

                             AZ RSA SYF 07/08 Clie nt Satis faction Surve y Re s ponde nts
                                                     By County


              Y UM A             3%
           Y A V A PA I               6%
        SA NTA CRUZ        0%
               PINA L           3%
                PIM A                                                24%
       OUT OF STA TE        1%
            NA V A JO           2%
           M OHA V E                  5%
         M A RICOPA                                                                                 45%
             LA PA Z       0%
           GRA HA M         1%
          GREENLEE        0%
                 GILA        1%
          COCONINO                   5%
            COCHISE             2%
            A PA CHE       0%

                      0%                   10%            20%               30%             40%           50%
                                                                N = 1423



   •   Age

                                                 VR Client Satisfaction Survey Respondents
                                                                   By Age
                                                                  N = 1,423


                     65 And Up                        6.3%


                          55 to 64                                                       19.3%


                          45 to 54                                                                        28.0%


                          35 to 44                                               16.4%

                          23 to 34                                                       19.3%


                          18 to 22                                 10.8%


                                     0%          5%          10%           15%       20%          25%      30%




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report                        61
SNAP 2009 Consumer Survey
Survey respondents: 221
   • Person completing the survey: (a) Individual with a disability – 54%; (b) Family
      member/guardian/caregiver – 35%; (c) other (e.g., friend, advocate) – 1%
   • Gender: 51% male and 49% female.
   • Veteran status: 6% were veterans
   • SSA: 67% were SSI/SSDI recipients
   • Ethnicity

                      SNAP 2009 Online + Print Consumer Survey
                                      Ethnicity
                                       N =221


            Ame rican Indian          3%
                    Hawaiian          0%
                        Asian         0%
                        Black          5%
                    Hispanic           6%
                       White                                                   86%

                                 0%         20%       40%         60%    80%    100%


   •   Education level

                      SNAP 2009 Online + Print Consume r Surve y
                                  Educa tion Le ve l
                                       N =221

               Master or PhD                         7%
                 College 4 YR                                      15%
                 College 2 YR                             10%
            College No Degree                                                  22%
                   HS or GED                                                   21%
                      Special                   5%
                      9 to 12                               11%
                        1 to 8             4%
                   No Formal                5%

                                 0%         5%        10%         15%    20%         25%




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   62
   •       Age at application
                    SNAP 2009 Online + Print Consumer Survey
                                   Age Range
                                    N = 221
                                   5%        14%
                          15%
                                                               Under 18
                                                   8%
                                                               19 to 22
                                                               23 to 34
                                                               35 to 44
                                                               45 to 54
                       23%
                                                   22%         55 to 64
                                                               65 and Up

                                    13%


   •       County of residence

                    SNAP2009 Online & Print Consumer Survey
                           by County of Residence
                                    N = 221


       1

    0.8

    0.6                                   54%

    0.4

                                                        18%
    0.2
                    5%                                                7%
            1% 0%        1% 1% 0% 0%            3% 3%         3% 0%        1% 1%
       0
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         a c och con         ah een La aric oh Na    P   P a C av       Yu ot S
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                C                                         Sa




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   63
4.3 Significance of Disability

Significance of disability was obtained by analyzing aggregate data on the primary
disabilities and Order of Selection (OOS) priority status of VR Client Satisfaction
respondents. For consumers participating in SNAP 2009 surveys, self-reported data on
disabilities and limitations in major life areas (MLAs) were used to gain insight into
significance of disability.


AZRSA VR Client Satisfaction Survey
Survey respondents: 1,423

Client Satisfaction Survey Respondents by Primary Disability Type (RSA
Reporting Category)

                     AZRSA SYF 07/08 Clie nt Satis faction Surve y Re s ponde nts
                                   By Prim ary Dis ability Type
                                              N = 1423


                                                5%

                                                              13%

                    32%
                                                                             V isual
                                                                             Communicative
                                                                             Physical
                                                                             Cognitive
                                                                             Mental/Emotional


                                                                     26%




                               24%


   •   32% of all client respondents, and 34% of minority respondents, had mental or
       emotional disabilities (AZRSA disability codes 18 and 19).

   •   26% of all client respondents, and 24% of minority respondents, had physical
       impairments (AZRSA disability codes 10-16).

   •   24% of all client respondents, and 26% of minority respondents, had cognitive
       impairments (AZRSA disability code 17).




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report      64
    •    13% of all client respondents, and 10% of minority respondents, had
         communicative impairments (AZRSA disability codes 03-07, 09).

    •    5% of all respondents, and the same percentage of minority respondents, had
         visual impairments (AZRSA disability codes 01, 02, 08).

    A closer look at disabilities reported under RSA categories (vs. AZRSA categories),
    shows that:

    •    The RSA category of mental and emotional disabilities included individuals with
         SMI (psychosocial or severe mental impairments) (22.3%) and individuals with
         other mental impairments (9.6%).

    •    The RSA category of communicative impairments included individuals with
         hearing loss/auditory impairments (6.1%).


Client Satisfaction Survey Respondents by Order of Selection (OOS)
(Significance of Disability)
As noted earlier, OOS priority status indicates significance of disability and is based on
an assessment of limitations in major life areas (MLAs) that include mobility,
communication, interpersonal skills, self-care, self-direction, work skills, and work
tolerance.


                AZRSA SFY 07/08 Client Satisfaction Survey Respondents
                            By Order of Selection Priority


    70%

    60%             56%

    50%
                                            40%
    40%

    30%

    20%

    10%                                                             4%
        0%
.                 Priority 1              Priority 2             Priority 3
                                          N = 1423



    •    56% of clients were Most Significantly Disabled (Priority 1), defined as difficulties
         in three or more MLAs.



Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   65
   •   40% of clients were Significantly Disabled (Priority 2), defined as limitations or
       difficulties in 2 to 3 MLAs.

   •   4% of clients were Disabled (Priority 3), defined as limitations or difficulties in 0 to
       1 MLA.


SNAP 2009 Consumer Survey
Survey respondents: 221

Primary and Secondary Disabilities

SNAP 2009 Survey Respondents’ Primary Disabilities

                 SNAP2009 Consumer: Online & Print Survey Respondents:
                                Primary Disabilities
                                        N=221


           100%

              80%
              60%

              40%                        28%
                                                15%            21%      17%
              20%       4%   4%                         7%
                                   1%                                            2%
               0%
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   •   The majority of consumers reported physical (28%), psychiatric (21%), and
       developmental disabilities (15%).

   •   “Other” primary disabilities reported included: autism spectrum disorders,
       Asperger’s syndrome, Albright’s syndrome, spinal cord injuries and paralysis,
       TBI, fetal alcohol syndrome, Down syndrome, bipolar disorders, and other ADD-
       related disabilities.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   66
SNAP 2009 Survey Respondents’ Secondary Disabilities
Consumers were asked if they had any other disabilities that make it difficult or hard for
them to work. 61% (135) of the 221 respondents indicated that they did.

                         SNAP2009 Consumer: Online & Print Survey
                            Respondents: Secondary Disabilities
                                           N=135


            100%
               80%
               60%
                                          34%
               40%                                 24%   28%    24%     22%
               20%       8%   8%    2%                                           4%
                0%




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   •   Secondary disabilities included: physical disabilities (34%), learning disabilities
       (28%), developmental disabilities (24%), and psychiatric disabilities (24%).

   •   The “Other” category included a number of self-reported chronic conditions and
       disabilities that would be categorized under the disability types presented. For
       example, physical conditions that included spinal cord injuries, arthritis, lupus and
       fibromyalgia, and chemical sensitivities; learning disabilities that included ADD
       and ADHD, etc.

Significance of Disability: Limitations in Major Life Areas
To better understand how consumer-reported disabilities might correlate to AZRSA
Order of Selection (OOS) priority rankings, consumers were asked a series of questions
on how their disability affects their everyday life. Questions were framed around the
major life areas (MLA) used to assess OOS priority status: mobility, communication,
interpersonal skills, self-care, self-direction, work skills, and work tolerance.

Analysis of responses across MLAs revealed that the majority of survey respondents
reported limitations in 3 or more MLAs, a key indicator for OOS Priority 1, Most
Significantly Disabled ranking.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   67
SNAP 2009 Online Survey Respondents Reporting Difficulties, by Number of
MLAs
  • 86% of consumers reported problems/difficulties in 3 or more MLAs.

                          SNAP 2009 Online Consumer Survey
                   % Reporting Problems By Number of MLA Limitations
                                          N = 170
                                              3% 2%
                                 18%                      9%
                                                                        No Problem
                                                                        1 MLA
                                                                11%
                                                                        2 MLAs
                                                                        3 MLAs
                          14%
                                                                        4 MLAs

                                                                13%     5 MLAs
                                                                        6 MLAs
                                                                        7 MLAs

                                         30%




SNAP 2009 Print Survey Respondents Reporting Difficulties, by Number of MLAs
  • 62% of consumers reported problems/limitations in 3 or more MLAs.

                            SNAP 2009 Print Consumer Survey
                   % Reporting Problems by Number of MLA Limitations
                                           N = 51
                                   12%              12%
                                                                      No Problem
                                                                      1 MLA
                                                                      2 MLA
                          16%
                                                                20%   3 MLA
                                                                      4 MLA
                                                                      5 MLA
                                                                      6 MLA
                           12%                                        7 MLA
                                                           8%

                                   6%
                                                16%




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   68
Correlating Consumer Self-Reported Limitations with AZRSA OOS Priority
To identify the percentage of survey respondents likely to be considered Most
Significantly Disabled, and to address the “fine line” between Significantly Disabled
(limitations in 2–3 MLAs) and Most Significantly Disabled (limitations in 3 or more
MLAs), the researchers opted to classify consumers reporting limitations in 4 or more
MLAs as Priority 1 – Most Significantly Disabled.

                        SNAP 2009 Online + Print Consumer Survey
                           Percentage By AZRSA OOS Priority
                                            N=221

                                  11%




                       20%                                         Priority 1 (4+)
                                                                   Priority 2 (2-3)
                                                                   Priority 3 (0-1)



                                                             69%




   •   Using the criterion of difficulty in 4 or more MLAs, 69% of consumers (includes
       online and print survey respondents) would likely be ranked as OOS Priority 1,
       Most Significantly Disabled.


Significance of Disability: Where Do Consumers Experience Problems?
The 170 consumers responding to the online survey were asked to report whether their
disability presented problems for them when at home, at work, or out in the community.
Using a very simple scale (“not a problem,” “little problem,” or “big problem”),
consumers answered questions about each MLA. The data highlight the significance of
disability and provide further insight into vocational rehabilitation and independent living
service needs as they relate to assistance with mobility, communication, interpersonal,
self-care, self-direction, and work-related supports.

It should be noted that the 51 print survey respondents were asked about the general
impact of their disability on daily life activities (by MLA). These questions did not,
however, distinguish between impact “at home,” “at work,” or when “out in the
community.”




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   69
MLA: Mobility
How does your disability affect your ability to move around from place to place on your
own? Percentage reporting either a “little problem” or “big problem” with mobility (N =
170).

                                           Mobility
          100%
           80%                                                          65%
                                                 55%
           60%            44%
           40%
           20%
            0%
                        At Home                At W ork           Out In Community




MLA: Communication
How does your disability affect your ability to communicate (with other people, your
ability to read, write, or listen, etc.)? Percentage reporting either a “little problem” or “big
problem” with communication (N = 170).

                                       Communication

          100%
           80%                                   63%                    65%
           60%            47%
           40%
           20%
            0%
                        At Home                 At W ork          Out In Community



MLA: Interpersonal Skills
How does your disability affect your ability to get along with other people? Percentage
reporting either a “little problem” or “big problem” with interpersonal skills (N = 170).


                          Interpersonal/Get along with others

        100%
         80%                                   58%                    58%
         60%            44%
         40%
         20%
          0%
                      At Home                 At W ork          Out In Community




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   70
MLA: Self-care
How does your disability affect your ability to care for yourself and perform daily tasks
(eating, dressing, toileting, and house-related tasks)? Percentage reporting either a
“little problem” or “big problem” with self-care (N = 170).


                                          Self-Care

        100%
                        68%                     68%                    71%
         80%
         60%
         40%
         20%
          0%
                      At Home                 At W ork           Out In Community



MLA: Self-direction
How does your disability affect your ability to set goals, plan, and make responsible
choices? Percentage reporting either a “little problem” or “big problem” with self-
direction (N = 170).

                                          Self Direction

        100%             69%                      71%                         70%
         80%
         60%
         40%
         20%
          0%
                       At Home                  At W ork            Out In Community




MLA: Work Skills and Work Tolerance
(1) How does your disability affect your ability to learn and perform new job skills or
tasks? (2) How does your disability affect your ability to work your scheduled number of
hours each day or week? Respondents were instructed that the questions applied to
current or past jobs. Percentage reporting either a “little problem” or “big problem” (N =
170).

                                     Work Related Issues

        100%
         80%                   64%
                                                                 51%
         60%
         40%
         20%
          0%
                           W ork Skills                     W ork Tolerance

Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   71
Implications of MLA Findings

   Online Respondents
   • Close to 70% of consumers participating in the online survey reported difficulties
     or limitations “at home,” ”at work,” and “out in the community” in the major life
     areas of self-care and self-direction.

   •   It can be surmised that “at home” supports (whether natural supports, caregiver
       or attendant services, or technology aids) likely contribute to the less than 50% of
       consumers reporting problems with mobility, communication, and interpersonal
       skills in their home environments.

   •   Consumers reporting problems when “out in the community” most frequently
       report problems with self-care, self-direction, mobility, and communication
       (including interpersonal skills).

   •   The impact of one’s disability “at work” is evidenced in soft skill areas (MLAs) that
       include self-direction, communication, and interpersonal skills as well as physical
       well-being (mobility, self-care, and work tolerance).

   Print Survey Respondents
   • Over half of the 51 print survey respondents reported problems with self-care
      (53%), self-direction (51%), and mobility (55%). As noted, these individuals were
      not asked to report on difficulties “at home,” “at work,” or when “out in the
      community.”




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   72
4.4 Barriers to Employment and Independence
Consumers were asked, “What things make it hard for you to find a job, keep a job, or
look for a better job?” and instructed to select all that apply.


                               S NAP 2009 O n l i n e + P ri n t Co n su m e r S u rve y
                                        Ba rri e rs to Em ploym e nt
                                                     N = 221
           60%



           40%         35%        35%
                                              32%        30%         28%
                                                                                 25%        24%          23%       24%
                                                                                                                               19%
           20%



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                              SN AP 2009 On lin e + Pr in t C o n s u me r Su r v e y
                                  B a rrie r s t o Emplo yme nt ( C o n t inu e d )
      60%                                            N = 221


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Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report                                             73
   •   Consumers identified transportation, personal health concerns and problems,
       and fear of losing SSI or SSDI benefits as major barriers.

   •   These barriers reflect problems in major life areas that include mobility, self-care,
       and work tolerance.

   •   Consumers who selected the ”Other” answer option typically used this comment
       field to describe their specific health condition or disability. In a few instances,
       consumers cited service needs that included help to keep a job, learn new skills,
       or help with interviewing as well as the need for work-from-home options and
       accommodations.

   •   The 19% of consumers reporting age as a barrier to employment likely represent
       consumers under the age of 18 (31 survey respondents) and/or those over 65
       years of age (10 survey respondents).

   •   It is interesting to note that only 5% of consumers cited not wanting to work as a
       barrier to employment.


Highlighted Findings from Secondary Data Sources

Why Adults with Disabilities Have Difficulty Finding Jobs
Source: "Barriers and Supports for Work among Adults with Disabilities: Results from
the NHIS-D”; Pamela Loprest, Elaine Maag, January 2001, The Urban Institute,
Washington DC

The Urban Institute used information from the Disability Supplement of the National
Interview Survey (NHIS-D) to look at barriers to employment for adults with disabilities.
Sixteen thousand persons with disabilities were asked about their disability, their work,
and their need for accommodation. The researchers used respondents' self-reports of
specific activity limitations to define disability. By this definition, the researchers
calculated that there were 11.3 million working-age adults (18 to 64) with disabilities, of
whom 37 percent were working in 1994–1995.

The researchers separated the sample into two categories: "high likelihood" to work,
defined as those for whom accommodations would enable work or who reported their
disabilities were not work limiting, and "low likelihood," defined as those who reported
they were retired from work or could not work even with accommodations.

Some of the key findings regarding the "high likelihood" group are outlined below.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   74
Looking for Work
More than half the non-working adults with disabilities who were studied encountered
difficulties. The most frequently cited reasons for being discouraged from looking for
work were:

   •   No appropriate jobs available – 52%
   •   Family responsibilities – 34%
   •   Lack of transportation – 29%
   •   No appropriate information about jobs – 23%
   •   Inadequate training – 21.6%
   •   Fear of losing health insurance or Medicaid – 20.1%
   •   Discouraged from working by family and friends – 14%


4.5 Consumer Self-Identified Service Needs

VR Client Satisfaction Survey Respondents
Survey Respondents: 1,423

Clients were asked, “How could Vocational Rehabilitation have improved services to
you?” Responses centered on service needs, quality of services provided, and system
improvements.

Services and supports included:
   • Employment supports to help clients find employment and/or a better job
   • Access to transportation services
   • Basic life skills training (money management, etc.)
   • Support services to ensure that clients don’t feel “forgotten and lost in the
      system”

Quality of VR services included:
  • More communication and follow-up from VR counselors
  • Continuity in care/service (stability of working with the same counselor)
  • Focus on results and outcomes to help clients secure employment

VR service and system improvements included:
  • Policy and procedural improvements (takes too long to be approved for service
      and to actually start receiving services, too much red tape, lengthy process to
      obtain AT equipment and restorative aids, etc.)
  • Improved referral and system navigation to help clients access other services
      (e.g., general assistance, childcare, etc.)




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   75
SNAP 2009 Consumer Survey Feedback
Survey respondents: 221

Consumers were asked to identify services needed to help them find or maintain
employment and/or live more independently. Questions were framed around four
service needs categories that included: (1) services to help me learn about my work
options; (2) services to help me get the job that I want; (3) services to get the things I
need for work; and (4) services to help me to live independently.

Services to help me learn about my work options
   • Identify my job interests and skills (33%)
   • Decide on a job goal (31%)
   • Learn how I can work and find a job (31%)
   • Learn how going to work will affect my Social Security benefits (23%)

                           SNAP 2009 Online + Print Consum er Survey
                       Services To Help Me: Learn About My Work Options
                                             N=221
            100%


             80%

             60%


             40%        33%                31%           31%
                                                                          23%
             20%


              0%
                        Identify       Decide on Job   Employment   SSA Counseling
                    Interests/Skills      Goals          Options




Services to help me get the job I want
   • Find the job that I want (38%)
   • Learn new skills to get the job I want (35%)
   • Take classes or go to school to prepare for the job that I want (33%)
   • Get on-the-job coaching help (29%)
   • Go from high school to work or college (16%)
   • Learn about starting my own business (16%)




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   76
                                   SNAP 2009 Online + Print Consumer Survey
                                    Services To Help Me: Get the Job I Want
                                                     N=221
          100%

           80%

           60%
                       38%             35%            33%
           40%                                                         29%
                                                                                        16%               16%
           20%

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Services to help me get the things I need for work                                     Se
   • Find transportation to and from work (37%)
   • Learn about and get assistive technology (21%)
   • Get eyeglasses, hearing aids, and/or prosthetics (16%)
   • Get a wheelchair, walker, white cane, or other aids (10%)
   • Get sign language interpreter services (3%)


                                   SNAP 2009 Online + Print Consum er Survey
                               Services To Help Me: Get the Things I need for Work
                                                     N=221
            100%
             80%
             60%
                           37%
             40%
                                             21%                  16%
             20%                                                                       10%
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Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report                          77
Services to help me live independently
   • Get involved in social and recreational activities (39%)
   • Adjust to my disability and learn about the things I can do (34%)
   • Skills training to live more independently (33%)
   • Help to care for myself (Personal Assistant) (20%)
   • Medical care so I can work and be more independent (17%)
   • Make my car or house accessible (modifications to home/vehicle) (11%)

                                    SNAP 2009 Online + Print Cons um e r Surve y
                                     Se rvice s To He lp M e : Live Inde pe nde ntly
                                                         N=221

            100%

             80%

             60%
                        39%              34%
             40%                                       33%
                                                                         20%         17%
             20%                                                                                       11%
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Summary
  VR Service Needs
  The vocational rehabilitation service needs of individuals with most significant
  disabilities are: (1) transportation, (2) services to prepare for and find employment,
  and (3) initial work exploration services (to learn about work options).

   IL Service Needs
   In addition to transportation, the IL service needs of individuals with most significant
   disabilities include: (1) social and recreational activities/outlets, (2) services to help
   individuals adjust to their disability, and (3) skills training to facilitate independent
   living.

Additional Service Needs
Consumers were then asked, “Do you need other services to assist you to find or keep
a job and become more self-sufficient?”

   Online survey respondents
   • 26% of consumers (44 of 170) answered in the affirmative and cited a number of
     services that are currently included in AZRSA VR and IL programs.


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report                   78
   •   Services already offered by AZRSA included: (a) information and referral
       services, (b) system navigation, (c) access to assistive technology or restorative
       aids, and (d) on-the-job supports such as job coaching.

   •   Other services included: (a) respite care, (b) substance abuse outpatient services
       (including services for fetal alcohol syndrome), (c) affordable psychiatric care,
       and (d) advocacy services to educate employers about the advantages of hiring
       individuals with disabilities.

   Print survey respondents
   • 18% of consumers (9 of 51) also cited a number of services that are currently
      included in AZRSA VR and IL programs. These services included: (a) adjustment
      to disability, (b) assistance with healthcare and legal issues, (c) supported
      employment services, internships, and job coaching, and (d) employment
      services.


AZRSA VR and IL Service Provision

VR Service Provision: Alignment with Consumer-Identified Needs

Secondary Data
To determine alignment of AZRSA service provision with client and consumer-identified
VR service needs, an analysis of authorized and purchased services provided to the
1,423 clients who had participated in VR client satisfaction surveys was conducted.

Service Delivery: Authorized and Purchased VR Services


                    VR Clie nt Sa tisfa ction Surve y SFY2007-2008
                      Author ize d Se r vice s (5% plus of total s e r vice s )

        25%
                20%
        20%
                         15%
        15%
                                   11%
        10%                                   9%
                                                         7%
                                                                   6%        5%   5%
         5%


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Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   79
   •   A total of 23,020 purchased services had been authorized for the 1,423 VR
       clients who had participated in client satisfaction surveys conducted in SFY07
       and SFY08.

   •   If equally distributed, each client would have been authorized to receive, on
       average, 16.2 services. Care should be taken when interpreting this data, as we
       do not know the spread of services by client.

   •   As a percentage of total services authorized, transportation constituted 20% of
       authorized and purchased services, job search assistance was 15%, education
       was 11%, vocational rehabilitation training and job readiness were 5% each, and
       assessment services constituted 9%.

   •   It is clear that VR service provision is directly aligned with consumer-identified
       needs that include transportation, job search assistance, education and training,
       and assessment services.


VR Service Provision: Supported Employment Services

Secondary Data
29% of consumers (along with a number of community services providers and
employers) participating in SNAP 2009 surveys spoke to the value and importance of
supported employment services to assist individuals with disabilities in maintaining
employment. While supported employment services can refer to a number of different
services, for the purposes of presenting data on the 24,592 clients receiving VR
services in FFY07, the focus is on:
   (a) Short-term supported employment services provided to clients as part of their
       service plan, prior to Status 26 Successful Rehabilitation case closure
   (b) Short-term post-employment (PES) services provided to clients after they have
       achieved an employment outcome (successful rehabilitation)
   (c) Extended supported employment (ESE) services provided to clients after they
       have achieved an employment outcome (successful rehabilitation)

Short-term supported employment services (pre- and post-employment) are time-limited
and provided through AZRSA. Long-term extended services (ESE) can be funded
through and provided by AZRSA VR, although most services are provided through the
Arizona Department of Health Services, Division of Behavioral Health Services (DBHS),
or the Department of Economic Security, Division of Developmental Disabilities (DDD).

AZRSA VR Individuals Served
24,592 individuals received VR services in FFY07 (non-inclusive of individuals receiving
PES and ESE services).



Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   80
Supported Employment
Short-term supported employment services provided through AZRSA are usually
provided at or between job placement and stabilization. While we have data on the
number of individuals receiving VR services in FFY07, we did not have access to the
numbers of individuals who received these services as part of their service plan.

   PES Services (Post-employment)
   • 626 clients received post-employment services in FFY07.

   •   22% (138) of these clients had achieved an employment outcome in FFY07,
       representing roughly 7% of the 2,095 Status 26 case closures in FFY07.

   •   As of September 30, 2007 (end of FFY07), 43% (271) of individuals receiving
       PES services had their cases closed. This included the 138 individuals cited
       above.

   ESE Services
   Eligibility for funding for ESE services is determined early on in the VR eligibility
   process.

   •   18% (4,474) of the 24,592 individuals receiving VR services in FFY07 were
       identified as being eligible for ESE services.

   •   879 clients received ESE services from AZRSA in FFY07.

   ƒ   17% (147) of these clients had achieved an employment outcome in FFY07,
       representing roughly 7% of the 2,095 Status 26 case closures in FFY07.

   ƒ   As of September 30, 2007 (end of FFY07), 13% (115) of individuals receiving
       ESE services had their cases closed. Of these 115 clients, 9 (8%) had achieved
       an employment outcome in FFY07.


4.6 Consumer Satisfaction with AZRSA Services

VR Client Satisfaction Survey Respondents
78% of the 1,423 clients participating in SFY07 and SFY08 VR client satisfaction
surveys were “satisfied” or “very satisfied” with VR services. In addition, the percentage
of clients reporting satisfaction with services and outcomes achieved increased from
SFY07 to SFY08.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   81
         VR Client Satisfaction – Clients Reporting                  SFY07 SFY08
   Work preparedness (felt prepared for work)                         63%   66%
   Satisfaction with last job obtained (via VR assistance)            53%   64%
   Currently employed                                                 64%   69%
   Satisfaction with current job                                      60%   77%
   Employed in the same job (as obtained via VR)                      41%   58%


SNAP 2009 Consumer Survey Feedback

VR Services
  • 44% of online respondents (74 of 170) reported that they had received VR
     services to prepare for or find a job, with 57% reporting that VR services were
     helpful, 28% reporting “not helpful,” and15% were “not sure”.

   •   Concerns raised by the 28% (21) of consumers reporting that VR services were
       not helpful included:

       o Effectiveness of the VR system (cases reassigned, slow service delivery
         process, and inappropriate job placements)

       o Quality of service received from VRC personnel (failure to communicate and
         follow up with clients, non-personalized service, etc.)

       o VRC lack of knowledge about specific disabilities such as autism, TBI, and
         cognitive disabilities.

IL Services
   • 21% of online respondents (35 of 170) reported that they had received IL
      services, with 74% (26 of 35) reporting that IL services were helpful, 9% reporting
      “not helpful,” and 17% were “not sure.”

   •   Concerns raised by the 9% of consumers (3) reporting that IL services were not
       helpful included:

       o Capacity (not enough centers/facilities to meet demand)
       o Quality (too limited, not intensive enough)
       o Policy-related issues (number of approved service hours was not enough to
         make a substantial impact on client’s progress).

   •   In addition, the 35 consumers who reported having received IL services were
       asked to identify who they had received IL services from.

       o AZRSA – 26%


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   82
       o CILs (Centers for Independent Living – 26%
       o Other independent living services agencies or organizations – 43%
       o Not sure – 22%

Reasons for Not Accessing VR Services
  • The 56% of online respondents (96 of 170) who reported that they had either not
     used or were not sure if they had used VR services were asked why they had not
     applied for or received VR services. Consumers were instructed to select all
     reasons that apply.

                          SNAP 2009 Online Consumer Survey
                     Reasons for Not Seeking VR Assistance/Services
                                          N=96
      100%

       80%

       60%
                                                                            40%
       40%     29%
                         24%                              25%
       20%                        11%      8%
                                                  3%                2%
        0%
               Didn't    Don't    Don't   Don't   Don't   Health   Family   Other
               Know     Qualify   Like    need    want    Issues
                                  Ask              Job



   The primary reasons for not seeking assistance from VR (aside from “other”
   comment responses) included:
       o Lack of awareness about AZRSA services – 29%
       o Health concerns (e.g., “My health isn’t good enough for me to work”) – 25%
       o Program eligibility (e.g., “I don’t think I qualify for services”) – 24%

   Additional reasons included:
       o Do not like to ask for help – 11%
       o Don’t need VR services – 0.8%
       o Not interested in working – 0.3%
       o My family doesn’t want me to work – 0.2%




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   83
   The 40% of consumers who chose “Other” listed the following reasons for not
   accessing or utilizing VR services:
       o Currently working, in school, or has applied for service
       o Not sure how VR could be of benefit to them (often couched in terms of
         impact on their SSA and other benefits as well as severity of health issues)
       o Issues/concerns with transportation and employer attitudes
       o Most consumers used the “other” category to describe their health
         condition(s) in more detail


4.7 Benefits and Assistance Received
Consumers were asked to identify the types of benefits that they currently receive. The
purpose of this question was to learn more about the service needs of individuals with
most significant disabilities and the programs and services most widely accessed.
Answer choices included benefits offered through: (a) SSA (Social Security
Administration), (b) AHCCCS (Arizona Health Care Cost Containment System), (c) DES
(Department of Economic Security), (d) Department of Veteran’s Affairs, and (e) other
state agencies and programs.


                            SNAP 2009 Online + Print Consumer Survey
                           Percentage of Consumers Receiving Benefits
                                                N=221


          100%

           80%

           60%
                  40% 35%
           40%            31%
                                       24%
                                               17% 17% 14%
           20%                                                      7%
                                                                          1%       0%    0%
            0%
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Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report    84
Benefit Program Descriptions

AHCCCS
  • AHCCCS is the state’s Medicaid program. Consumers who are blind, aged, or
    disabled and who receive Supplemental Security Income (SSI) typically enter the
    system through the Social Security Administration, while access for pregnant
    women, families, and children typically occurs through the Department of
    Economic Security (DES). AHCCCS directly handles eligibility for other health
    insurance programs such as Kids Care, long-term care, and Medicare Cost
    Sharing.

   •   AHCCCS also administers the Arizona Freedom to Work AHCCCS Medicaid
       Buy-In program, which allows individuals who are disabled and working to "buy
       in" to AHCCCS Medicaid health insurance coverage for a premium that is based
       on "countable income." The program offers individuals receiving SSDI/SSI an
       explanation of their benefits, how those benefits will be impacted by earnings,
       how to use Social Security Work Incentives, and an explanation of the SSA
       Ticket to Work program.

ALTCS
  • ALTCS, a program administered by AHCCCS, is designed for individuals ages
     65 and over, blind, or disabled who need ongoing services at a nursing facility
     level of care. However, individuals do not have to reside in a nursing home
     (many live in their own homes or an assisted living facility and receive needed in-
     home services). ALTCS participants are also covered for medical care, including
     office visits to doctors, hospitalization, prescriptions, lab work, and behavioral
     health services.

Food Stamps
  • DES Nutrition Assistance Program (Arizona's title for the Federal Supplemental
     Nutrition Assistance Program or SNAP) was formerly known as the food stamps
     program. This program also serves as an application point for cash assistance
     and AHCCCS medical insurance. In addition, adults in families who qualify for
     cash assistance are referred to the DES employment and training program to get
     help with preparing for or finding a job.

   •   Another DES program that supports the nutritional needs of families is the
       Coordinated Hunger Program, which coordinates with various federal, state, and
       local organizations that provide food assistance to the hungry. This program also
       contracts with various hunger organizations to maximize resources. In addition to
       food bank coordination and other related services, the program provides food
       stamp outreach services.

TANF
  • No consumers reported receiving TANF (Temporary Assistance for Needy
     Families) benefits. Like the Nutrition Assistance program, TANF is administered


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   85
       through DES, Family Assistance Administration. Through its Cash Assistance
       Program, TANF provides cash assistance to eligible families with at least one
       dependent child.

   •   In addition, the grant diversion program provides one-time temporary financial
       assistance to eligible families to assist them to keep or get a job so they will not
       require ongoing assistance.

   •   Interestingly, in a recent TANF study, 48% (476 of the 988) families surveyed
       reported a documented disability or personal medical issue. In addition, 79% of
       those who were disabled felt that their disability kept them from working.
       (Families at risk of reaching their sixty month lifetime benefit limit for TANF cash
       assistance between 10/01/07 and 9/30/08.)

Other Benefits and Assistance Received
While it is not surprising to find that 35% of consumers are SSDI (Social Security
Disability Insurance) recipients and 31% SSI (Supplemental Security Income)
recipients, it is interesting to note that 17% of consumers indicated that they receive no
benefits.

In addition, 17% of consumers also reported that they receive “Other” benefits, which
included:
   •   Section 8 Housing Vouchers
   •   DES/DDD benefits
   •   Private pension or disability insurance
   •   Adoption subsidies
   •   Unemployment benefits
   •   AZRSA vocational rehabilitation

Secondary Data Findings
Secondary data supports these findings and speaks to reliance on public programs with
health insurance benefits and the underlying fear of losing these safety-net benefits.

   •   Recently released 2008 Arizona Health Survey statistics on health insurance
       coverage for 227,400 individuals with disabilities shows that 53.6% are covered
       through Medicare, 52.8% AHCCCS, 21% employer provided insurance, 1.1%
       direct purchase health insurance, and .8% have no insurance.

   •   A study of individuals who were working, had first enrolled in a Medicaid Buy-in
       program in 2003–2004, and had received SSDI benefits in the month before they
       enrolled (approximately 47,000 people) 8 revealed that many SSDI beneficiaries
       may be deterred from working or from earning above the substantial gainful
       activity level (SGA) for fear of losing their benefits.

Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   86
   •   This same study found that age and the receipt of federal disability benefits are
       related to employment. Older participants were five percent less likely to be
       employed than younger participants, for each one-year difference in age.
       Participants who were neither SSDI nor SSI beneficiaries were more than two
       times as likely as an SSI recipient to be employed.

   •   Nationally, the number of disabled workers on SSDI more than doubled from
       1990 (3 million) to 2006 (6.8 million). A reported 28% of SSDI beneficiaries
       depend on these benefits for 100% of their income. Among SSI recipients, 47%
       of working-age adults depend solely on their income from SSI.

   •   The Office of Disability, Aging, and Long-Term Care Policy (DALTCP) reports
       that:
       (a) Once disabled people begin receiving SSI or SSDI, the probability of their
           becoming employed is greatly reduced (Rosenheck et al., 2006; Resnick et
           al., 2003).
       (b) The work disincentives of SSI and SSDI are well documented (Stapleton &
           Burkhauser, 2003). 9
       (c) There also is widespread fear among recipients of both SSI and SSDI that, by
           becoming employed and earning too much money, they risk losing eligibility
           for continued benefits, including health insurance.
       (d) In addition, findings from a 1999 study support the belief that the potential
           lack of adequate health care coverage prevents some people with disabilities
           from working or working as much as they would like. 10

   •   As of December 2006, the reported number of SSDI beneficiaries in Arizona was
       125,727, and the number of SSI beneficiaries (as of December 2007) was
       100,996. Forty-five percent of individuals receiving services from AZRSA in
       FFY07 were SSA recipients (data is not broken out between SSI/DI recipients).

It appears that, despite the strides made by the Social Security Administration through
its “back to work” incentives 11 and Ticket to Work 12 program, the fear of losing benefits
is a critical concern to individuals with disabilities.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   87
Chapter 5: Voice of the Provider

5.1 Primary Data Sources
Information on the vocational rehabilitation and independent living needs of individuals
with disabilities was secured from 346 community services providers that responded to
the online Provider survey.

SNAP 2009 Provider Survey
The online Provider survey was designed to elicit feedback on:

   •   Communities served or represented (county level); age, ethnicity and
       demographics of disability groups served.

   •   Barriers to employment and independence.

   •   Perceived gaps in the service delivery systems that assist persons with
       disabilities and those with most significant disabilities to overcome barriers to
       employment and/or independence.

   •   Overall effectiveness of the current service delivery systems designed to meet
       the needs of persons with disabilities.

   •   Prevalence of unmet needs in populations served according to functional or MLA
       categories (mobility, communications, interpersonal skills, self-care and home
       care, self direction, work skills and work tolerance).

   •   Unserved or underserved populations of individuals with disabilities; service
       needs and suggestions for outreach and engagement.

   •   Perceived importance and effectiveness of services provided by AZRSA; gaps in
       AZRSA services (VR and/or IL) and areas where services are most needed.

   •   Effectiveness of community providers in meeting needs of persons with
       disabilities (VR and/or IL); suggestions for system improvements for services
       offered through community providers.

   •   Emerging issues or challenges likely to impact the service needs of individuals
       with disabilities.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   88
5.2 Attributes of Survey Respondents

SNAP 2009 Provider Survey
346 community services providers completed the online SNAP 2009 Provider survey.
Providers consisted of: (a) CRP (community rehabilitation provider), (b) advocacy, faith-
based, and other organizations providing services, equipment, or support to persons
with disabilities; (c) state, regional, tribal or other council members; (d) RSA employees
or employees of other state/government agencies; (e) educator or healthcare
professional; (f) interested citizen; or (g) a member of one of the groups listed and a
person with a disability.

                                       SNAP 2009 Provider Respondents
                                                                   N=346
        100%

         80%

         60%

         40%                                                                    31%
                                                   19%
         20% 14%                                                                                     12%                                     7%
                        5%             1%                       2%        4%                                    0%        5%
           0%




                                                                                                                          Indiv/Disability
                        Advocacy Org




                                                                                Employee/State/Gov




                                                                                                                                             Other
                                                                                                     Educator
                                                    Other Org




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                                                                Council
                 CRP




                                        Reglious




                                                                          RSA




Respondents by Type of Provider and Services Offered
  • The majority of respondents were employees of state or government agencies
     (31%); members of other organizations providing services, equipment, or support
     to individuals with disabilities (19%); community rehabilitation providers (14%);
     and educators or healthcare providers (12%)

   •   38% of providers reported offering VR and IL services

   •   36% reported offering VR services only and 26% reported offering IL services
       only

   •   17% of these providers also reported offering other types of services that
       included: (a) benefits counseling, (b) in-home services, (c) healthcare related
       services, (d) social justice and legal services, and (e) general support/
       coordinator services.



Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report                                                           89
   Age Groups Served
   • Over 80% of providers reported serving individuals with disabilities between the
     ages 19 to 64.
   • 53% reported that they also serve youth between the ages of 14 to 18 and 32%
     reported serving youth under the age of 14.

   Ethnicity of Individuals Served
   • Providers reported serving a diverse client base that included White, Black or
      African-American, Hispanic or Latino, and American Indian individuals with
      disabilities. A slightly lower percentage of providers reported serving Asians or
      Native Hawaiians or Other Pacific Islanders.

   Service Areas

                                  SNAP 2009 Provider Survey
                                      Counties Served


          100%

           80%

           60%                                   54%

           40%                                                   28%
                                                                       17%         16% 14%
           20% 10% 14% 12% 13% 11% 10% 10%             14% 12%               11%

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   •   Maricopa and Pima counties are major service areas (highest population and
       density counts).

   •   There is a relatively even spread of providers offering services throughout the
       state.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   90
5.3 Disability Groups Served

                                  SNAP 2009 Provider Survey
                         Percentage of Providers Serving Disability Types
                                                    N=346


        100%
                                                    75%        77%          77%
         80%
                    51%        55%
         60%                              44%
         40%
         20%                                                                           9%
                                                                                                 2%
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   •   Over 75% of providers reported serving individuals with developmental (DD),
       psychiatric or mental health (SMI), and physical disabilities.

   •   Approximately 50%-55% reported serving individuals with sensory and
       communicative disabilities, with slightly less serving the needs of those with
       deafness and blindness.

   •   “Other” disabilities reported included: a) TBI and spinal cord injuries, b)
       environmental illness, c) learning disabilities, d) dual diagnosis, e) autism, f)
       substance abuse, and f) HIV.


5.4 Assessing Prevalence of Unmet Needs
To better understand the service needs of the individuals with disabilities served,
providers were asked to indicate the frequency with which consumers reported unmet
needs in each of the major life areas (MLAs). For example, providers were asked if the
need for assistance with mobility (whether “at home”, “at work”, or when “out in the
community”) was: a) almost always cited as a prevalent or unmet need, b) very
frequently cited, c) occasionally cited, d) rarely cited, or e) very rarely cited.

The following chart summarizes response by MLA and by the percentage of providers
reporting that the need for assistance is “almost always” or “very frequently” presented
as an unmet service need.



Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report            91
                                           SNAP 2009 Pr ovide r Surve y
                       % Pr ovide rs Re por ting Cons um e rs ALWAYS/V ERY FREQUENTLY
                                      Cite Ne e ds for As s is tance /By M LAs
                                                       N=346
       100%

       80%
                   60%
       60%                             53%     52%          48%        45%
                                                                                        38%               37%
       40%

       20%

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   •   60% of providers reported that the need for assistance with work skills was
       “almost always” or “very frequently” cited by consumers as a prevalent or unmet
       need (defined as the ability to learn and perform new job skills or tasks, plan and
       organize job tasks or complete job tasks).

   •   53% of providers reported that the need for assistance with self-direction was
       “almost always” or “very frequently” cited by consumers as a prevalent or unmet
       need (defined as the ability to set goals, plan and make responsible choices at
       home, at work, or out in the community).

   •   52% reported the need for assistance with work tolerance was “almost always” or
       “very frequently” cited by consumers as a prevalent or unmet need (defined as
       the ability to work scheduled number of hours each day/week, getting or using
       assistive devices at work or training, and /or access to other aids).

   •   48% reported that self-care was “almost always” or “very frequently” cited by
       consumers as a prevalent or unmet need (defined as the ability to care for one’s
       self and perform daily living tasks at home, at work, or out in the community).

   •   This feedback is aligned with consumer-reported problems and limitations in MLA
       categories; most notably self-direction, self-care, and work-related areas.

5.5 Barriers to Employment and Independence
Using a four-point scale, providers were asked to rate the extent to which various
factors prevent or hinder the persons with disabilities that they serve from gaining and


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report                      92
maintaining employment and/or independence. (Scale: Major barrier, Barrier, Somewhat
of a barrier, or Not a barrier).

Charts only report the percentage of providers selecting the “Barrier” and “Major Barrier”
answer choice; “Somewhat of a Barrier” is not included.

                                          S NAP 2009 P rovi de r S urve y
                                   Ma j or Ba rri e rs (% P rovi de rs Re porti ng)


          100%

              80%

              60%                       38%
                           45%                                  34%                     29%          29%
                                                    36%                    32%
              40%

              20%                      37%                      37%                    40%           38%
                        28%                         29%                    29%
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                                                     Barrier     Major Barrier




                                   SNAP 2009 Provi de r Surve y-Conti nue d
                                   Ma jor Ba rrie rs (% Provide rs Re porting)


         70%
         60%
         50%                                  21%
                       27%         23%
         40%                                                        15%
                                                                              14%          12%
         30%                                                                                             7%
                                                          17%
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                       32%                                          33%                    30%
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                                                    Barrier     Major Barriers



   The list of answer choices presented to providers included three specific items that
   were not included on the consumer survey:


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report                     93
   •   Lack of employment opportunities and slow down in the job market: 45% of
       providers rated this a major barrier (charted as “employment opportunities”);

   •   Service system issues related to lack of qualified providers, specialized care
       resources, and/or targeted coordination of services: 27% of providers rated this a
       major barrier (charted as “service system”). Open-text comments referenced the
       following system issues and service needs:

       o System issues: (a) bureaucracy of systems and lengthy processing times
         from application to service delivery; (b) lack of inter-agency and intra-agency
         communications; and (c) VR staff turn-over, reassignment of caseloads, and
         difficulty contacting or accessing VRC resources.

       o Service needs: (a) access to qualified and trained ASL interpreters; (b) a
         number of IL services such as socialization programs, family counseling,
         respite services for caregivers, and day programs; and (c) a number of VR
         services that included benefits counseling, post-employment services, and job
         training programs.

   •   Lack of awareness and/or information about services available to persons with
       disabilities: 21% of providers rated this a major barrier (charted as “unaware of
       services”).

   •   “Other” answer option was selected by 34% of providers. Open-text comments
       describing other barriers to employment and independence included references
       to: a) geographic location (rural areas); b) budget issues and cutbacks in funding
       for programs and services; c) personal motivation of client and support of family
       members; d) lack of awareness among healthcare professionals as to services
       and programs for individuals with disabilities; and e) inadequate provision of
       basic need services (housing, financial assistance, food and utilities, etc.)


Perceptions Regarding Barriers to Employment and Independence – Alignment of
Provider and Consumer Response
The following two charts show provider and consumer response when asked to identify
barriers to employment and independence. The charts present total consumer response
and only that portion of providers indicating “Major Barrier” (versus “Barrier” or
“Somewhat of a Barrier”).




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   94
                               Barrie rs to Em ploym e nt & Inde pe nde nce
              M ajor Barrie rs Cite d by Cons um e rs and Provide rs (SNAP2009 Surve ys )



            Loss Health                                                        32%
            Ins/Benefits                                         24%

            Lack                                                         29%
      Education/Training                                           25%

                                                                                     36%
      Loss SSA benefits
                                                                               32%

                                                                                 34%
        Health Problems
                                                                                  35%

                                                                                     38%
         Transportation
                                                                                  35%

                           0%    5%        10%   15%    20%     25%     30%      35%   40%    45%   50%

                                                       Consumer       Provider


                                  Bar r ie r s to Em ploym e nt & Inde pe nde nce
              M ajor Bar r ie r s Cite d by Cons um e r s and Pr ovide r s (SNAP2009 Sur ve ys )



                                                       17%
         Criminal Record
                                      5%


                                                    15%
        Need AT Devices
                                      5%


                                                 12%
                     Age
                                                          19%


                                                                23%
      Employer Attitudes
                                                                 24%


             Lack W ork                                                   29%
             Experience                                         23%

                           0%     5%       10%   15%    20%     25%      30%     35%    40%   45%   50%

                                                        Consumer      Provider




Findings
There is a high degree of consistency in the top three provider and consumer responses
regarding major barriers to employment and/or self-sufficiency:
   • Transportation


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report                95
   •   Personal health issues or problems
   •   Fear of losing benefits

There is also consistency in perceived obstacles and challenges to attaining job goals:
   • Lack of education and training
   • Lack of work experience
   • Employer attitudes


Secondary Research: Supporting Key Findings
In a briefing, Earnings and Work Expectations of Social Security Disability Beneficiaries
(2006), from Mathematica Policy, it was noted that: 13

   •   While 40% indicate an interest in working, only 9% are actually working at any
       given time. 11% of those not working at the time of interview reported fear of
       losing cash or health insurance benefits as a reason for not working.
       o 39% are age 55 and older.
       o 43% report having poor health; 41% report deteriorating health and difficulty
         performing activities such as getting around outside of the home (46%),
         concentrating (55%), or coping with stress (58%).
       o 53% of beneficiaries have been on the rolls 10 years or longer.

   •   Other challenges to successful employment are evidenced in the following
       characteristics:
       o 42% have less than a high school level education.
       o 49% are living in poverty.
       o 18% report obstacles such as reliable transportation.
       o 28% report inaccessible workplaces.
       o 27% report being discouraged from working by others.
       o 30% report that their own experiences have discouraged them from working.

   •   While a large portion report an interest in employment, far fewer (15% overall)
       see themselves working and earning enough to leave the SSI or SSDI disability
       rolls in the next five years. Expectations are higher among concurrent (18%) and
       SSI-only (19%) beneficiaries than among SSDI-only (12%).

           o Overall, 43% demonstrated an interest in employment; among SSI-only
             beneficiaries, 48%; among concurrent beneficiaries, 49%; and among
             SSDI-only beneficiaries, 39%.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   96
5.6 Gaps in the Service Delivery Systems
Providers were asked, “Do you see any gaps in the service delivery systems that assist
persons with disabilities and those with most significant disabilities to overcome barriers
to employment and/or independence? And, if so, please identify these gaps in services
or programs.” (open-ended question).

   •   56% of providers (194 of 346) responded that there are gaps in the service
       delivery systems.

   •   Transportation was consistently identified as a major gap and critical service
       need of individuals with disabilities and was referenced throughout the survey
       (answer choice selections, comments, and responses to open-ended questions).

   •   Other feedback focused on gaps in: (a) access to services and resources, (b)
       system-related policy and procedural guidelines that exclude individuals in need,
       (c) unmet service needs, and (d) issues impacting AZRSA service delivery.
       Among the key points raised were the following:

       o Gaps in the level of assistance offered to individuals who do not meet
         eligibility criteria but are in need of services and support

       o “Assistance for people who have worked all their lives and who cannot afford
         the medical insurance offered by the government or afford medications . . . All
         of those who are in need and do not qualify for Title 19.”

       o Lack of a comprehensive and coordinated service system to ensure that basic
         needs (housing, nutrition, financial assistance) are provided. Gaps in
         communications between agencies that result in the failure to identify,
         leverage, and coordinate needed services.

       o Gaps in the provision of needed services such as: (a) psychiatric and
         recovery services, (b) general counseling services at mental health clinics,
         and (c) early intervention services at pre-school and elementary grades.

       o Gaps in training services that specifically included job training, supported
         employment or extended employment services to individuals requiring such
         services, specifically young adults and survivors of traumatic and/or acquired
         brain injury.

       o Services for individuals with specific types of disabilities (DD, autism, mental
         disabilities, traumatic brain injury, deaf, etc.) and needs of special population
         such as transition-age youth.

       o Issues identified in the AZRSA system included: (a) lengthy processing time
         at early application, eligibility, and start of service; (b) delays in purchasing AT



Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   97
           aids; and (c) provision of services to individuals residing in rural areas of the
           state where transportation is an issue.

                 Gaps in the Service Delivery Systems
                   For Individuals w ith Disabilities
                               1%
                              1%     3% 3%
                     14%
                                                   13%




                                                               #1- Funding
                                                         19%
                                                               #2- Rura A rea

             30%                                               #3- Disability
                                                               #4- Special Population
                                                               #5 System issues
                                                               #6 Training Services
                                           16%                 #7 Transportation
                                                               #8 Employer
                                                               #9 Other



“Navigating the web of various social services programs and agencies. Lack of communication
between agencies and coordination, lack of knowledge of resources available, some services or
agencies provide unnecessary duplication of similar services, lack of funding for many programs
and those in need, often put on wait list.”

“Some people with disabilities access some community services, but don't even know that other
services exist. There's a lack of communication between agencies in terms of client needs. And
people with mild disabilities and less serious cognitive disorders fall through the gaps – not
keeping employment, not accessing needed services.”

“It is increasingly difficult to find appropriate services for all groups, including those with
disabilities. These include access to behavioral health, transportation, and educational and
other services. Transportation and service coordination continue to be the most difficult needs to
meet.”

"Gaps in services and / or supports for youth with a diagnosis within the autistic spectrum – not
a specific diagnosis of "autism." These families do not qualify for DDD services, and often needs
are not met through behavioral health services."




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   98
                                           Gaps in Service Delivery System
                                       Counties Where Services Are Most Needed
                                              SNAP 2009 Provider Survey
                                                       N = 194

                       100

                       80
                                                                60
          Percentage




                       60
                                                                               41
                                                                     34             36        35   34
                       40    30   32   31   31   31   30   29             31             29

                       20

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   •   The counties where services are most needed are Maricopa and Pima Counties,
       with a relatively even spread in the perceived need for services throughout the
       state.

   •   It is interesting to note that the relatively equal distribution of need across the
       state and among the 13 rural counties.

5.7 Service Needs of Individuals with Disabilities
After completing a series of general questions (asked of all 346 survey respondents),
providers were given the option to either complete the remainder of the survey in full
(remaining VR and IL sections) or to complete only that section of the survey that
pertained to their area of expertise.

   •   30% (103) of providers went on to complete the survey in full.
   •   46% (61) completed only the VR section.
   •   24% (82) completed only the IL section.
   •   In total, 264 providers offered input on VR-related questions and 185 on IL-
       related questions.


5.7.1 VR Service Needs
The 264 providers completing the VR section of the survey were asked if any additional
VR services or programs were needed to assist persons with disabilities to achieve their

Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report              99
employment goals. This question followed a series of queries in which providers were
asked to rate the perceived importance and effectiveness of 12 different VR services
provided by AZRSA (outreach and marketing, eligibility and intake, assessment related
services, employment services, technical assistance, and system navigation, etc.).

Additional Service Needs
  • 43% of providers (114 of 264) felt additional VR services were needed:

   •   A number of support services were identified, many of which are part of AZRSA’s
       current menu of services. These services included: (a) post-employment
       services, (b) transition services for youth, (c) assistance for individuals interested
       in self-employment, and (d) information and referral services.

   •   In a number of instances, providers voiced the need to expand the scope of
       services available to targeted populations such as TBI and ABI (and other brain-
       injury survivors) and youth in transition. Services identified for these groups
       included increased access to services, provision of supported employment
       services, and post-employment supports and follow-up.

   •   In addition, the need to provide additional supports or to modify current policy
       and procedural guidelines was referenced in relation to: (a) providing transitional
       employment services; (b) extended job coaching or intermittent job coaching to
       individuals when their job duties change or they experience problems on the job;
       (c) vocational assessments and evaluations for all VR clients (including, where
       appropriate, physical performance testing to ensure appropriate placements);
       and (d) referral services to ensure that social service needs are met (child care,
       money management, etc.).

   •   Other service needs identified included: (a) family education and counseling
       services; (b) support groups for clients; (c) services and training to assist clients
       in learning how to manage their behaviors in the work setting; and (d) integrated
       and coordinated training sessions for AZRSA employees, clients and their
       families, and employers (addressing topics on specific disability types, sensitivity
       training, etc.).




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   100
                               Where Are Additional VR Services Most Needed?
                                 SNAP 2009 Provider Survey Respondents
                                     (% providers citing need by county)
                                                  N = 114

                    100

                    80
                                                             67
       Percentage




                    60
                                                                            45
                               35        34   34                                 35             37
                    40              33             33                  31             32   32
                          28                            28        29

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   •      Providers were asked to identify those areas where additional VR services are
          most needed. In addition to the more densely populated counties (Maricopa and
          Pima), we, again, find that the perceived need for services is evenly spread
          throughout the state.


5.7.2 IL Service Needs
The 185 providers completing the IL section of the survey were asked if any additional
IL services or programs were needed to maximize independence and assist persons
with disabilities to achieve their independent living goals. This question followed a series
of queries in which providers were asked to rate the perceived importance and
effectiveness of 7 different IL services provided by AZRSA (outreach and marketing,
information and referral, core independent living services, and home/car modifications,
etc.)

Additional Service Needs
  • 38% of providers (71 of 185) cited a need for additional IL services.

   •      Access to adequate, affordable, and appropriate housing options surfaced as a
          critical need. Included was: (a) start-up financial assistance for people moving
          from institutions to independent living apartments in the community; (b) programs
          to support individuals residing in non-segregated settings in the community; and
          (c) assistance with residential placements.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report           101
   •   Similar to VR responses, a number of providers referenced existing services,
       focusing on access and expansion of services that included: (a) increased
       availability of home and vehicle modification services; (b) “better funded and
       more structured follow-up services”; and (c) self- and home-care services
       (weekly housekeeping, personal care, home-delivered meals, life safety alert
       systems, home health nurse services, etc.).

   •   Education and counseling services included: (a) peer support groups; (b) open
       community forums and support groups; (c) more classes available to family
       members and caregivers at ILCs, and (d) professional training and development
       for counselors and instructors.

   •   Quality assurance improvements included better monitoring and oversight of
       group and individual homes and increased emphasis on tools to measure client
       satisfaction (surveys, etc.).


                                  SNAP 2009 Provider Survey
                        W here are additional IL services most needed?
                    (% Providers Citing Need--by County)Percent Response
          100%


           80%


           60%                                     55%

                                                                   39% 37%
           40%                                                                         34%
                 30% 30% 30% 30% 31% 30%                 31% 32%             28% 28%
                                             25%
           20%


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   •   Providers were asked to identify those areas where additional IL services are
       most needed. In addition to the more densely populated counties (Maricopa and
       Pima), Pinal (37%) and Yuma (34%) were cited. However, similar to the
       response received from VR providers, there is a relatively even spread in the
       perceived need for additional services throughout the state.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   102
5.8 Examination of Unserved and Underserved Populations

5.8.1 Unserved and Underserved VR Populations
The 264 providers who completed the VR section of the survey were asked if they were
aware of any specific disability groups or populations of individuals with disabilities that
are either not currently being served or are underserved by RSA. The terms unserved
or underserved were loosely defined as: (a) persons with disabilities who are not
receiving vocational rehabilitation services and are perceived as being capable of
working; (b) individuals who are in need of but not receiving independent living services;
and/or (c) individuals who, from the provider’s perspective, are not receiving adequate
services.

Feedback from VR Providers
39% of VR providers identified unserved or underserved populations in terms of
individuals with specific types of disabilities, population groups, and individuals residing
in rural areas.

   Individuals with specific types of disabilities
   Chronic health problems, autism spectrum disorders and severe learning disabilities,
   TBI and spinal cord injuries, and those with a dual diagnoses of developmental
   disabilities and mental illness.

   Population groups
   Veterans, homeless, ex-felons, transition age youth, and individuals who tend to “fall
   through the cracks” (don’t qualify for Title 19)

   Individuals residing in rural areas of the state
   Limited access to services and resources, limited job opportunities, and
   transportation issues

   Identified VR service needs
       o Systemic improvements: expedited processing of applications, eligibility
         determinations, and access to comprehensive system navigation services
       o Improved access to VR counseling, job training, post-employment and
         extended supported employment services
       o Services targeted to the special needs of groups such as youth-in-transition
         and veterans, etc.


5.8.2 Unserved and Underserved IL Populations
The 185 providers who completed the IL section of the survey were asked if they were
aware of any specific disability groups or populations of individuals with disabilities that
are either not currently being served or are underserved by RSA. Unserved and
underserved populations were defined as persons with disabilities who are not receiving
independent living services as well as those who are receiving adequate services.


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   103
Feedback from IL Providers
26% of IL providers identified unserved or underserved populations in much the same
terms as VR providers (individuals residing in rural areas, veterans, etc.).

   Individuals with specific types of disabilities
   Many of the same disability types as those described by VR providers were
   identified, including: SMI, TBI and spinal cord injuries, those with blindness and
   deafness, adults with CP (non-ambulatory), blind and deaf, individuals with
   developmental disabilities, and those with environmental illnesses

   Population groups
     o Younger populations of individuals living in nursing centers
     o Elderly individuals with disabilities
     o Minority groups that included American Indian, Black/African-American,
        Hispanic/Latino, and “non-traditional” cultures
     o Quadriplegics and wheel chair bound populations
     o Obese persons
     o Juveniles with mental health issues
     o Veterans with PTSD
     o Ex-felons


   Individuals residing in rural areas of the state
   As with VR providers, this population was identified as unserved or underserved due
   to issues with access to and availability of services and resources

   Identified IL service needs
      o An integrated care and service delivery model (medical and mental health
          care services
      o Multi-lingual and multi-cultural services
      o Support and outreach programs for consumers, family members, and
          caregivers/attendants

5.8.3 Service Needs of Special Populations Identified as Unserved or
Underserved

Unserved and Underserved Populations (VR)
Identifying Service Needs

The following service needs were identified for specific populations of individuals with
disabilities considered to be unserved or underserved by community services providers.

   Individuals with Addictions
   Integrated approach for persons with addictions, supportive services for recovery co­
   occurring with employment services


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   104
    Individuals Needing General Mental Health Services
       o More comprehensive IPE planning for people in the general mental health
         system
       o Provision of extended job coaching services, flexibility to utilize these services
         on “an as needed” basis (transitional employment, etc.)

   Youth in Transition
       o Coordination of services provide VR services to youth during their last two
         years of school; earlier intervention; and provision of long-range planning
         services to students
       o Assignment of VR counselors at each school location
       o Job training sites specifically designed for youth transitioning to work
       o Various job training opportunities that include: a) volunteer opportunities (test
         out new skills); b) internships; c) availability of vocational training in high
         school; and d) enclave settings and other programs appropriate for young
         people transitioning to work
       o Counseling services, financial aid specialists and scholarship professionals to
         assist youth in transition

   Veterans
       o Provision of adequate medical care and services
       o Integrated service model that addresses psychological counseling needs,
         adjustment and reorientation skills training, linkages between RSA and VA to
         ensure seamless delivery of services

Provider Feedback: Factors Impacting Service Utilization
Although the majority of VR and IL providers were not aware of any specific groups of
unserved or underserved individuals with disabilities, there does appear to be a shared
perception that consumers are not tapping into the AZRSA service system for a number
of reasons that are directly tied to factors that prevent or hinder individuals from “taking
the next step” to employment and independence.

   •   59% of providers indicated that lack of awareness and/or information about
       services available to persons with disabilities prevents or hinders individuals with
       disabilities from accessing services to assist them in gaining or maintaining
       employment and independence.

   •   59% indicated that service system issues related to lack of qualified providers,
       specialized care resources, and/or targeted coordination of services is a barrier.

   •   32% indicated that cultural barriers and/or resistance to seeking assistance from


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   105
       government agencies are a barrier (another 35% “somewhat of a barrier”).

   •   22% felt that current service delivery systems were ineffective in meeting the
       needs of individuals with disabilities (health care, direct care services, and
       employment support service systems, etc.).

   •   When rating AZRSA services: a) only 35% of VR and 33% of IL providers felt
       that AZRSA outreach and marketing services were effective and b) only 39% of
       VR and 51% of IL providers felt that AZRSA information and referral services
       were effective.


5.9 Effectiveness of Services Delivered by Community Rehabilitation Services
    Providers (CRPs)

VR Providers
The 264 providers completing the VR section of the survey were asked, “Based on your
experiences and interactions with consumers, how effective are community providers in
meeting the vocational rehabilitation needs of persons with disabilities?”


                                          SNAP 2009 Provider Survey
                                       Effectiveness of CRP Services/VR
                                                      N=264

          100%

           80%

           60%          47%
           40%
                                               21%                                  18%
           20%                                                     14%

            0%
                    Ef f ective(1-2)          Neither(3)      Inef f ective(4-5)   Unable(6)




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report     106
IL Providers
The 185 providers completing the IL section of the survey were asked, “Based on your
experiences and interactions with consumers, how effective are community providers in
meeting the independent living needs of persons with disabilities?”

                                       SNAP 2009 Provider Survey
                                    Effectiveness of CRP Services/IL
                                                 N=185



       100%

        80%

        60%
                     43%
        40%
                                          23%
                                                             15%              18%
        20%

         0%
                 Ef f ective(1-2)       Neither(3)      Inef f ective(4-5)   Unable(6)




Effectiveness of VR and IL Services Provided through CRPs
   • Slightly less than 50% of providers felt that CRPs are effectively meeting the VR
       and IL needs of persons with disabilities, with roughly 20% reporting that services
       are “neither effective nor ineffective” and 15% rating services as “ineffective.”

   •   It is interesting to note the consistency in response between VR and IL providers.
       Except for a slightly higher percentage of VR providers rating services provided
       by CRPs as effective (47% of VR providers vs. 43% of IL providers), the balance
       of response between the two groups is almost identical.

Suggestions for System Improvements – VR Services/CRPs
System improvements for RSA VR services offered through community providers:
   •   Network supports to address the needs of individuals living in rural communities
       where access to resources are limited and transportation is a paramount problem
   •   Enhance core competencies of CRPs to address needs of specialized
       populations (autism spectrum disorders, TBI, etc.)
   •   Increase diversity in service offerings
   •   Focus on expanded utilization of qualified providers
   •   Identify coordinated care opportunities between/among providers



Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   107
   •   Have CRP programs address needs of individuals requiring supported
       employment
   •   Increase emphasis and focus of CRP programs on long-term support services
   •   CRPs to provide enhanced job development services
   •   Leverage relationships between AZRSA and One Stop or other WIA programs
   •   CRPs to provide more specialized services to better connect with businesses to
       ensure that their workforce needs are being met
   •   Evaluate feedback on needing more providers

Suggestions for System Improvements – IL Services/CRPs
System improvements for RSA IL services offered through community providers:
   •   Services are under-utilized due to public lack of awareness regarding services
       that are available, need to educate public on what independent living programs
       are, and make it easier for consumers to access these services.
   •   Increased and better coordination of service delivery between agencies
       supporting needs of individuals with disabilities.
   •   Address capacity issues (availability and access to services in rural areas;
       programs designed specifically for youth, etc.)
   •   Professional training and development programs for CRP providers and staff
   •   Higher standards for agencies (performance goals and outcomes) and increased
       monitoring

   “Get the word out more to let the people know these services are available and what
   needs to be done to receive these services. Also, assistance to help them apply.”

   “Communicate, communicate, communicate. The service you offer may be just the
   service my subscriber needs, but if I don’t know about you . . .”

   “To ensure that the State agencies supporting people with disabilities are aware of IL
   thru RSA. Work closer with DDD to help people have knowledge of these services.”

   “Coordination amongst all services to ensure follow-through. A comprehensive
   follow-up of those persons who either lose their job or quit their jobs. They need to
   be reintegrated into the system. Many give up.”

   “More focus on persons with serious mental illnesses including juveniles.”

   “Focus on hiring better trained workers, increase effectiveness of training programs,
   reduce employee turnover, connect workers to one another for motivation.”




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   108
   “More focus on persons with series mental illnesses, juveniles with mental health
   issues”

   “No choices, if any, in our area. There should be more agencies providing these
   services or more funding for the current agencies that provide these services to
   expand their current program.”


5.10 Perceived Importance and Effectiveness of AZRSA Services
Providers were asked to rate the perceived importance and effectiveness of AZRSA VR
and IL services. Using a 4-point scale for importance (Very important, Important,
Somewhat important, or Not important) and a 6-point scale for effectiveness of services
provided (Very effective, Effective, Neither effective nor ineffective, Ineffective, Very
Ineffective, or Unable to assess), providers rated a series of 12 core services offered by
VR and IL.

While over 90% of providers rated each of the services as important (except Technical
Assistance, which was rated by 77% as important), only a few services received an
“effective” rating from 50% or more of providers.


5.10.1 Menu of AZRSA VR Services: Importance and Effectiveness

VR Outreach and Marketing, Intake and Eligibility, and Benefits Counseling

                                     SNAP 2009 Provider Survey
                                           VR Services



                                                                                         95%
             Outreach and
                                                            45%
              Marketing
                                        21%



                                                                                         95%
      Intake and Eligibility                                    50%
                                    17%



                                                                                         96%
      Benefits Counseling                                       50%
                                       20%


                               0%       25%                  50%                 75%     100%

                                    Ineffective(4-5)   Effective(1-2)   Important(1-2)




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report      109
VR Assessment and Evaluation, Career Training and Education Services, and
AT Assessment

                                               SNAP 2009 Provider Survey
                                                      VR Services


                                                                                                                            99%
        Assessment and
                                                                                     51%
           Evaluation
                                            15%


                                                                                                                            98%
      Career Training and
                                                                                      52%
      Education Services
                                             16%


                                                                                                                          95%
         AT Assessment                                                          48%
                                           14%


                            0%       10%      20%        30%         40%        50%        60%        70%    80%    90%    100%

                                            Ineffective(4-5)        Effective(1-2)    Important(1-2)



VR Adjustment to Disability, Job Development and Placement, and Job
Coaching/Supported Employment Services

                                               SNAP 2009 Provider Survey
                                                      VR Services


                                                                                                                                97%
                Adjustm ent
                                                                              42%
                to Disability
                                              14%



                                                                                                                                 99%
          Job Developm ent
                                                                          39%
           and Placem ent
                                                        22%



        Job Coaching and                                                                                                        98%
           Supported                                                             46%
      Em ploym ent Services                    15%


                                0%    10%         20%         30%       40%          50%     60%       70%    80%    90%    100%

                                           Ineffective(4-5)     Effective(1-2)       Important(1-2)


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report                                             110
VR Information & Referral Services, Technical Assistance Services (TA), and
Workplace Accommodations

                                       SNAP 2009 Provider Survey
                                             VR Services


                                                                                                               96%
       Information and
                                                             39%
       Referral Services
                                        18%



                                                                                                   77%
    Technical Assistance
                                               24%
          Services
                                      14%



                                                                                                               97%
          Workplace
                                                                 43%
       Accommodations
                                 9%


                           0%   10%    20%       30%       40%      50%      60%      70%          80%   90%   100%

                                              Ineffective(4-5)   Effective(1-2)   Important(1-2)




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report                            111
5.10.2 Menu of AZRSA IL Services

IL Family/Caregiver Services, AT and Restorative Aids, Home Modification
Services

                                             SNAP 2009 Provider Survey
                                                    IL Services



                                                                                                                    92%
          Fam ily & Caregiver
                                                                              48%
                Services
                                                 17%



     Assistive technology,                                                                                           95%
    Restorative and Adaptive                                                   50%
              Aids                           15%


                                                                                                                     95%
          Hom e Modification
                                                                                    54%
              Services
                                            13%


                                0%   10%         20%   30%       40%       50%       60%     70%       80%    90%     100%
                                                                                                                          ment
                                       Ineffective(4-5)      Effective(1-2)    Important(1-2)




IL Vehicle Modification, Job Development and Placement, and Job Coaching and
Supported Employment Services

                                            SNAP 2009 Provider Survey
                                                   IL Services


                                                                                                               86%
       Vehicle Modification
                                                                     41%
            Services
                                           12%



                                                                                                                           98%
     Job Developm ent and
                                                                   39%
          Placem ent
                                                   22%



      Job Coaching and                                                                                                     98%
    Supported Em ploym ent                                                 46%
          Services                          15%


                              0%     10%     20%       30%       40%       50%        60%        70%    80%    90%        100%

                                       Ineffective(4-5)      Effective(1-2)     Important(1-2)
Arizona Reha                                                                                                                     112
IL Information and Referral, Self-employment Assistance (TA), Accommodations

                                             SNAP 2009 Provider Survey
                                                    IL Services


                                                                                                                 97%
               Workplace
                                                                       43%
            Accom m odations
                                        9%



                                                                                                     77%
         Technical Assistance
                                                     24%
              Services
                                             14%



                                                                                                                 96%
      Inform ation and Referral
                                                                   39%
              Services
                                               18%


                                  0%   10%    20%      30%       40%      50%      60%         70%   80%   90%   100%

                                         Ineffective(4-5)    Effective(1-2)   Important(1-2)




5.11 Factors Impacting Service Delivery
Feedback on systemic issues impacting service delivery to individuals with disabilities
was obtained from: (a) providers participating in the SNAP 2009 survey (findings noted
throughout the prior sections of this report) and (b) a review of secondary data that
included a literature review and highlighted findings from stakeholder interviews.

Primary Research: Community Services Providers

WIA One-Stop Delivery System
Providers offered insight on the systemic issues impacting the effectiveness of AZRSA
VR and the One-Stop delivery system to work hand-in-hand to meet the needs of
individuals with disabilities. Feedback focused on issues related to funding, coordination
of services, and the need to strengthen the working relationships between the two
agencies.

   “The One-Stop’s silo funding prevents persons with disabilities from being eligible for
   training funds for short-term, targeted skills training.”

   “A closer and more effective relationship between VR and the One-Stops is needed.”

   “One-Stop Centers are to provide access to services to persons with disabilities just
   as other persons without disabilities. Unless staff have formal training and work with


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report                              113
   individuals with a disability everyday, they are not necessarily confident in their
   abilities to provide appropriate services.”

   “Full-time on-site staff funded by RSA/Voc Rehab at One-Stop Centers is a must.”


Secondary Research: Highlights of Key Stakeholder Interviews
Early “first-phase” findings of a Strategic Systems Analysis project recently initiated by
Arizona’s Medicaid Infrastructure Grant (MIG) 14 proved helpful in demonstrating the
consistency between primary research (SNAP findings) and secondary data findings.
The purpose of the MIG project is to document or map existing employment, training
and health-related services and supports for individuals with disabilities for the purposes
of identifying what is working or could be working better within these systems. This
preliminary feedback proved useful in highlighting themes in service delivery, system
coordination, and identification of unnerved/underserved populations.

Issues and Factors Impacting Service Delivery

   Consumer access to services (consumers residing in rural communities)
     o Lack of transportation impedes consumer access to services (healthcare,
        independent living resources, VR, and other state administered programs)


   Funding issues and concerns
       o Lack of adequate funding to address capacity-building needs (given cutbacks
         in programs and services on state/federal level)
       o Concerns that state funding does not adequately address demand for specific
         services such as job coaching or other extended supported employment
         services
       o Concerns regarding the funding status of programs and services over the
         next 3–5 years

   Labor pool shortages/Professional personnel
       o Difficulties in finding, recruiting, hiring, and retaining credentialed and certified
         staff (CWICS, healthcare professionals, specialists for deaf and blind
         community, etc.)
       o Limited access to qualified and trained employment services personnel (job
         developers)
       o Distance, travel times, and transportation costs make it difficult for providers
         to meet the needs of individuals residing in rural and sparsely populated
         areas (ability to address “frequency of need,” timeliness and efficiency in
         service delivery, in-home visits, etc.)




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   114
       o Capacity concerns regarding WIPA's ability to serve the needs of SSI/SSDI
         beneficiaries (over 200,000 SSI/DI beneficiaries)

   System coordination needs
       o Better communications within/between agencies to identify service needs and
         coordinate service delivery options (e.g. co-enrollments, etc.)
       o Cross-agency collaborations and leveraged use of existing resources to
         promote service utilization (e.g. One-Stop System Navigators, etc.)
       o Comprehensive system navigation services delivered by well informed and
         trained personnel
       o Integration of benefits counseling into service plans for individuals with
         disabilities to ensure timely and accurate information is provided to
         consumers
       o Outreach and marketing (uniform and consistent messaging, cross-promote
         services, and extend outreach to the full spectrum of consumers, providers,
         and employers)
       o Address transportation and “basic needs” services for individuals with
         disabilities, especially individuals residing in rural or remote communities


Unserved or Underserved Populations
The following populations were identified as unserved or underserved populations. This
list replicates feedback from providers, except for the specific reference to the Black
deaf community (other feedback identified the deaf community as a whole).

   •   Black deaf community
   •   Wounded veterans (Wounded Warrior Project)
   •   Individuals living in rural areas outside of Phoenix and Tucson metro areas
   •   Homeless population
   •   Members of isolated ethnic communities
   •   Populations at risk for unemployment including individuals with felony
       backgrounds, disadvantaged youth, displaced homemakers, individuals with
       disabilities
   •   Cultural/ethnic groups that include: African-American, Latino, Native American,
       and Asian populations


Secondary Research

Evaluation of the Ticket to Work Program (May 2007)
Highlighted findings from the evaluation of the Ticket to Work program conducted by
Mathematica Policy Research. 15



Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   115
Beneficiary Demand for Employment Services
TTW participation remains low but continues to grow. As of December 2004 (the
last month for which we have complete data), the participation rate in Phase 1 states
had risen to 1.4 percent, up from the 1.1 percent for March 2004.

There is potential for growth in TTW participation. The survey data suggest that
demand for employment and employment-related services among Social Security
disability beneficiaries is much greater than early Ticket experience suggests.

The positive work expectations of many beneficiaries give TTW a basis on which to
build. A major goal of SSA’s proposed TTW program changes is to increase EN and
beneficiary participation. That is, if providers are more aggressive in addressing barriers
to employment as a result of the impending changes, it seems likely that more
beneficiaries will participate.

Outreach might substantially stimulate TTW participation, especially among
recently employed beneficiaries under age 55. Outreach is likely to be more effective
and efficient if it is targeted at those with work goals and expectations. We found that
such beneficiaries share two primary characteristics: they are under age 55, and they
have recently been employed.

Many beneficiaries, especially Ticket participants, already use services to support
employment efforts, including traditional employment supports and health-
related services. Data from the National Beneficiary Survey (NBS) indicate that 34
percent of all beneficiaries in Phase 1 states used employment-support services
(broadly defined) in 2003, a much larger share than the approximately 1 percent of
Phase 1 participants who had assigned their Ticket by the time of the survey. Services
used by beneficiaries included not only conventional work supports (e.g., training and
job search assistance) but also a large volume of health-related services (e.g.,
occupational therapy, counseling, and adaptive equipment), which are seen by
beneficiaries as enhancing their ability to work or live independently.

It appears that participants facing return-to-work challenges other than disability
are more likely than others to assign their Tickets to ENs rather than to SVRAs.
The likelihood that a participant’s Ticket is assigned to an EN is relatively high if the
participant has limited or no work experience, is relatively old, has limited education, is
Hispanic, is a single parent, or has preschool children. We also found that participants
from relatively high-income households (i.e., with household income of at least 300
percent of the federal poverty line) were much more likely than others to have assigned
their Ticket to an EN.

Participants who assigned their Tickets to ENs received fewer services than
those who assigned their Tickets to SVRAs and were generally less satisfied with
services received. Participants who assigned their Ticket to an EN were significantly
less likely than those who assigned their Ticket to an SVRA to report receiving any
services (including services from outside TTW). Moreover, even when participants using

Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   116
ENs reported receiving services, they tended to report fewer hours of services, on
average, than those who assigned Tickets to an SVRA. Similarly, EN participants who
used services were less likely to report using the services to find a job or a better job.
This does not bode well for ENs, which can generate full TTW payments only if
participants earn enough to leave the benefit rolls. We also found that participants who
assigned Tickets to an EN as opposed to an SVRA were less likely to report that the
services were useful; more likely to report unmet service needs; and more likely to
report problems with services and providers as the reason for the unmet needs. The
higher payment rates under the proposed regulations combined with more experience
with the performance-based payment system may address these problems.


Earnings and Work Expectations of Social Security Disability Beneficiaries 16
Brief on the extent to which SSI and SSDI beneficiaries are currently working and
engaging in efforts to return to work, interest in increasing earnings and self-sufficiency,
challenges they face. Based on 2004 National Beneficiary Survey (NBS), nationally
representative survey of 7,601 SSI and SSDI beneficiaries ages 18-64, August 2008.
Conducted as part of the SSA Ticket to Work program evaluation.

   •   18% of working-age beneficiaries had been employed or actively sought
       employment during the last year.

   •   Beneficiaries receiving concurrent benefits (SSDI and SSI) were most likely to be
       employed (11%), while SSI-only recipients were least likely (7%).

   •   One-third of all working-age beneficiaries reported using services during the
       previous year (2003) to improve their ability to work or to live independently, but
       less than half (12% overall) reported recent service use and training activities
       specific to employment.

   •   Overall, 40% of beneficiaries indicated that their personal goals include getting a
       job, moving up in a job, or learning new job skills, and/or saw themselves working
       for pay in the near future. This implies that large numbers of beneficiaries
       (approximately 4 million) are interested in employment (via their actions or
       expectations).

   •   While a large share report an interest in employment, far fewer see themselves
       working and earning enough to leave the SSI or SSDI disability rolls in the next 5
       years. Overall just 15%, expectations higher among concurrent (18%) and SSI-
       only (19%) beneficiaries than among SSDI-only (12%).

           o Overall: 43% of all demonstrated an interest in employment; SSI-only
             beneficiaries (48%), concurrent (49%), and SSDI-only (39%)

   •   Possible factors for why SSI-only interest is higher: (a) younger population, (b) in
       better general health, (c) lack of other sources of income. Also, SSI recipients are


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   117
       subject to a gradual loss of cash benefits as earnings rise, while SSDI
       beneficiaries have a total loss of cash benefits when earnings exceed the SGA
       level for more than 9 months (likely a greater deterrent).

   •   While 40% indicate an interest in working, only 9% are actually working at any
       given time. 11% of those not working at the time of interview reported fear of
       losing cash or health insurance benefits as a reason for not working.
       o 39% are age 55 and older.
       o 43% report having poor health; 41% report deteriorating health and difficulty
         performing activities such as getting around outside of the home (46%),
         concentrating (55%), or coping with stress (58%).
       o 53% of beneficiaries have been on the rolls 10 years or longer.

   •   Other challenges to successful employment are evidenced in the following
       characteristics:
       o 42% have less than a high school level education.
       o 49% are living in poverty.
       o 18% report obstacles such as reliable transportation.
       o 28% report inaccessible workplaces.
       o 27% report being discouraged from working by others.
       o 30% report that their own experiences have discouraged them from working.
   •   It may be that survey respondents exaggerate their interest in work. However,
       supports need to address obstacles to employment, low levels of education, and
       reliance on other public programs.


How Do Medicaid Buy-In Participants Who Collect Social Security Disability
Insurance Benefits Use SSA Work Incentive Programs? 17
Study population: Medicaid Buy-in participants who first enrolled in 2003-2004 and who
received SSDI benefits in the month before they enrolled (approximately 47,000
people). Examined participation in 4 SSA work incentive programs from January 1,
2000 through December 31, 2005.

   •   The majority of Medicaid Buy-in participants both collect SSDI benefits and are
       eligible for the work incentive programs that are part of SSDI program.

   •   Many SSDI beneficiaries may be deterred from working or from earning above
       the substantial gainful activity level (SGA) for fear of losing their benefits

   •   Percentage of Buy-In Participants Using SSDI Work Incentive Program
       o Approximately 23% use any work incentive.
       o Approximately 16% use the Trial Work Period.

Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   118
       o 7% use Extended Period of Eligibility
       o 6% use Ticket to Work.
       o 1% use Impairment-Related Work Expenses

   •   State buy-in program designs impact participation in SSDI Work Incentive
       Programs. Across the U.S. and the program overall, just 23% of Medicaid Buy-In
       participants who receive SSDI benefits use at least one of the work incentive
       programs, implying that 77% are not taking advantage of these programs.


Enrollment, Employment, and Earnings in the Medicaid Buy-In Program (2006) 18.
Key findings, demographics, most common disabling conditions/disabilities, relationship
of age and receipt of federal disability benefits to employment, etc.

   •   The Medicaid Buy-In program continues to be a popular coverage option for
       states, and enrollment nationwide is growing. In most buy-in programs,
       participants received Social Security Disability Insurance (SSDI) in the year
       before they enrolled in the program.

   •   The composition of the Medicaid Buy-In population in 2006 was weighted toward
       older white adults.

   •   The most common primary disabling condition was severe mental illness (25
       percent); an additional 7 percent had other mental disorders in 2006.

Employment

About 69 percent of Buy-In participants nationwide were employed and had
earnings in 2006.

Age and the receipt of federal disability benefits are related to employment. Older
participants were five percent less likely to be employed than younger participants, for
each one-year difference in age. Participants who were neither SSDI nor SSI
beneficiaries were more than two times as likely as an SSI recipient to be employed.

Employment varied by primary disabling condition. Participants with mental
retardation were almost three times as likely as participants with a musculoskeletal
disorder to be employed. Indeed, several groups of participants with other disabling
conditions were all more likely than participants with a musculoskeletal disorder to be
employed, including those with a severe mental illness (82 percent more likely), other
mental disorder (52 percent more likely), a sensory impairment (84 percent more likely),
or any other condition (8 percent more likely).

Participants in states with a work verification requirement were 27 percent more
likely to be employed relative to participants in states without any such
requirement.


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   119
Average annual earnings varied by primary disabling condition. While participants
with mental retardation were more likely than those with a musculoskeletal disorder to
be employed, they earned $1,003 less than employed participants with a
musculoskeletal disorder. Compared to participants with a musculoskeletal disorder,
those with a severe mental illness earned $379 less, those with a sensory impairment
earned $1,133 more, and those with any other condition earned $343 more.


5.12 Youth In Transition

Key Stakeholders: Youth-in-Transition Educators
Partners In Brainstorms developed a mini-questionnaire that was distributed to
educators and counselors who visited the AZRSA booth at the Eighth Annual Transition
Conference hosted by the Arizona Department of Education in September 2008. The
conference, “Addressing the Transition Needs of Youth and Young Adults with
Disabilities, Transforming Visions to Realities,” was designed to support the
commitment of Arizona stakeholders to provide effective transition opportunities for
youth and young adults with disabilities to help prepare them for productive and
independent adult life. During the first day of the conference, a representative from the
SNAP 2009 Steering Committee was present to hand out surveys to attendees and was
able to elicit response from thirteen educators.

The survey contained four brief questions that asked stakeholders to: (a) identify the
barriers impacting the success of young people with disabilities to become employed
and/or independent, (b) identify the major gaps in service impacting and affecting this
special population, (c) provide information regarding the quality and effectiveness of
services provided by RSA VR and IL programs to young people referred for services,
and (d) list other agencies or organizations to whom young people are referred for
employment services.

Key Findings
  • Major barriers to employment and independence in order of ranking, included: (a)
      transportation (cited by all 13 respondents), (b) social skills, (c) career training,
      (d) student not ready for work, (e) disability, and (f) behavioral issues.

   •   Other barriers included housing, unstable home life, assistive technology needs,
       concerns about benefits (SSA/other), other medical conditions, and low socio­
       economic status.

   •   Major gaps in services and service delivery issues included:
       o Funding barriers and economic downturn.
       o Lack of services that bridge the systems, allowing for continuity of care.
       o Coordination between and with other agencies (DDD and Magellan cited).



Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   120
       o Services delivered too late (waiting until Junior year for services).
       o Not knowing who to call or how to navigate the system.
       o Limitations in resources, training, and transportation in small towns and rural
         areas.
       o Home schooling (not preparing youth for transition to work).
       o Perception that vocational training sites are looking to weed out disabled
         students (focus on disability vs. ability).
       o Too much focus on group employment, students not receiving individualized
         services/plan.
       o Lack of behavioral and/or social supports to maintain employment.
       o Inadequate understanding of what young people need and the services that
         are available to them.
       o Need for job training/coaching for students with autism. Concern that
         relatively high functioning students on the spectrum need help finding jobs
         with the right fit. While they are efficient at doing the tasks they are trained for,
         their communication needs, social skills, and sensory needs are unique.
       o Funding issues between VR, school districts, and other agencies (DDD).
       o Unavailability of services (e.g., one respondent noted Prescott office indicated
         no services for students with disabilities were available).
       o Break in school year (summer) causes many students to not follow up with
         their counselor.
       o Concern about post-secondary support services (if student fails on first job,
         etc.).

   •   Of the 11 educators who had referred students to RSA VR or IL programs, 5 felt
       that the services had been helpful, 2 felt that they had not been helpful, 2 felt that
       it was a bit of a “mixed bag,” and 2 did not answer this question.

   •   Concerns raised:
       o Student needed on-the-job training and extended coaching support that was
         not provided
       o Number of hours authorized for services were too limited to successfully find
         employment
       o Not enough time expended in finding the right job fit (student considered by
         VR to be unemployable yet had successfully held a summer job and was
         currently working)
       o Need to have more VR follow-up (calling/meeting to check-in on students
         during course of the year)
       o No services available in geographical locations (Prescott area).


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   121
   •   Agencies or organizations that educators refer youth (and/or their families) to for
       employment services and supports included:
       o DDD (Division of Developmental Disabilities)
       o Community colleges and trade schools
       o Transition programming within the district
       o Workforce Development
       o DES
       o NACOG
       o AHCCCS
       o SSDI
       o Magellan
       o MARC Center
       o Direct referral to community rehabilitation provider agencies


Secondary Data
As noted in the High School-High Tech Program Manual (National Collaborative on
Workforce and Disability for Youth, 2003):
   •   Structured exposure to the world of work is especially important for students with
       disabilities. “Substantial evidence exists to support the value of work experience
       as a critical educational intervention effective in improving the post-secondary
       employment of youth with disabilities (Blackorby & Wagnor, 1996; Colley &
       Jamison, 1998; Kohler, 1993; Kohler & Rusch, 1995; Luecking & Fabian, 2000;
       Morningstar, 1997; Rogan, 1997; Wehman, 1996).”
   •   Since work-based learning experiences are often not available to youth with
       disabilities or are limited in scope, increasing those opportunities should have a
       positive effect on outcomes. Currently, only 27% of students in special education
       who complete high school are enrolled in post-secondary education compared to
       68% of the general student population. And, three to five years after exiting high
       school, only a little more than half are found to be employed compared to 69% of
       their peers (Fabian, Lent & Willis, 1998).
   •   In the United States, the number of individuals who never enter unsubsidized
       employment by moving from school into publicly funded income and health
       support programs remains stubbornly high. For example, the Social Security
       Administration records (2002) show that children who receive benefits are likely
       to continue receiving SSI for the rest of their lives.
   •   Correlates of unemployment and underemployment among individuals with
       disabilities include low educational attainment and lack of access to effective
       transition services. While there will always be a need for a range of disability

Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   122
       benefits for some, career preparation costs considerably less than disability
       benefit programs, particularly if done well during the initial preparation period.



Youth Leadership Activities Addressed in Workforce Investment Act
The Workforce Investment Act includes youth leadership activities in its list of required
youth program elements, i.e., “leadership development opportunities, which may include
community service and peer-centered activities encouraging responsibility and other
positive social behaviors.”

Several of the other program elements are directly related to working, learning,
connecting, and thriving:
   •   Tutoring, study skills training, and instruction, including dropout prevention
       strategies
   •   Summer employment opportunities that are directly linked to academic and
       occupational learning
   •   Paid and unpaid work experiences, including internships and job shadowing
   •   Occupational skill training, as appropriate
   •   Adult mentoring
   •   Comprehensive guidance and counseling, which may include drug and alcohol
       abuse counseling and referral

The level of youth development and youth leadership activities in a program depends on
the purpose of the program, the resources available to the program, and the program’s
ability to individualize its activities and services.

Most programs may not have the resources to provide the full spectrum of youth
leadership and development activities. Carefully planned partnerships are essential.
Schools need to be a key partner, and they can play several roles – primary provider of
one or more of the competency areas is but one. They can also serve as a “community
school” and bring in partners for after school programs to ensure that the youth
development and leadership needs of participants are met. Models for community
schools are available through the Coalition for Community Schools (CCS), which works
to improve education and help students learn and grow while supporting and
strengthening their families and communities. Community schools bring together many
partners to offer a range of supports and opportunities to children, youth, families, and
communities – before, during, and after school, seven days a week. CCS mobilizes the
resources and capacity of multiple sectors and institutions to create a united movement
for community schools by sharing information, building public support, informing public-
and private-sector policies, and developing sustainable sources of funding for
community schools.



Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   123
Chapter 6: Voice of the Employer

SNAP 2009 Employer Survey

Overview/Outreach to Employers
As noted in an earlier section of this report, recruitment efforts for survey participation in
SNAP 2009 were reliant on “pass-along” communications from key stakeholders that
had been identified by members of the SNAP 2009 Steering Committee, AZRSA, and
SRC. In addition, direct and indirect access to employers was secured through the
researcher’s efforts to compile an e-mail list of approximately one hundred statewide
Chamber of Commerce agencies, directors at each of the Workforce Investment Act
(WIA) One-Stop centers in Arizona, community services providers who employ
individuals with disabilities, tribal gaming entities, and members of a few Human
Resource associations. Participation in the Employer Survey was also highlighted in the
e-mail invite and reminder notifications that were sent to the entire list of 500 plus SNAP
2009 survey recipients.

Response
A total of 33 completed surveys were received during the 3-½ week response period
from November 25, 2008 through December 21, 2008. While response to the employer
survey was quite low, a number of stakeholders commented favorably on the number of
employer responses, noting: a) the difficulties in accessing an extensive e-mail list
containing the names of Human Resource personnel and/or business owners
throughout Arizona, b) a perception that employers may be somewhat reluctant to
participate in a survey about their employment experiences and practices regarding
individuals with disabilities, and c) to some extent, that SNAP 2009 was “going in cold”
without the benefit of a leveraged and strong working relationship between AZRSA VR
(agency-level) and the Arizona business community. There is no doubt that future
efforts to engage community employers would best be served by enhanced awareness
and outreach on the part of AZRSA, coupled with a personalized recruitment strategy
for eliciting participation in surveys of this nature.

While response to the SNAP 2009 Employer survey is statistically not significant, given
the slightly more than 100,000 businesses with employees in Arizona, there is still a
wealth of insight to be gleaned from this endeavor.


6.1 Purpose and Objectives of SNAP Employer Survey
As noted, the primary objectives of the survey were to obtain feedback on: a) the
employer’s experience; b) perceptions of services provided through the AZRSA network
of community providers specializing in employment and job placement services, c)
thoughts on Arizona’s emerging economy and the challenges and opportunities for
individuals with disabilities seeking employment, d) awareness and knowledge of
AZRSA vocational rehabilitation services and supports, e) support and service needs to
promote hiring, and f) suggestions to improve AZRSA outreach and marketing to the
business community.

Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   124
6.2 Demographic Data – Employer Survey Respondents
Roughly half (45%) of businesses were for profit, 36% were not-for-profit, and 18% were
government or academic institutions.

   Industry classifications
   ƒ Health care and human services       33% (11 of 33 employers)
   ƒ Unclassified                         24% (8)
   ƒ Retail trade                         12% (4)
   ƒ Educational services                 9% (3)
   ƒ Government                           9% (3)
   ƒ Utilities                            3% (1)
   ƒ Finance and Insurance                3% (1)
   ƒ Public administration                3% (1)
   ƒ Other services (except public admin) 3% (1)

   Unclassified included: (a) 2 domestic violence services agency, (b) a foster
   care/adoption agency and community center, and (c) employers in the field of non­
   medical home care, media, assessment and advisory services, and a tribal entity.

   The four counties in which employers had the highest presence (corporate offices or
   satellite business locations) included Maricopa (76%), Pima (33%), Gila (30%), and
   Coconino (24%).

   It is interesting to note that counties considered to be somewhat more rural were
   also home to a number of these businesses: 21% (7) reported locations in Cochise,
   Graham, Mohave, and Pinal counties and 15%-18% reported locations in Apache,
   Greenlee, La Paz, Navajo, and Yuma (15%) and Santa Cruz and Yavapai (18%).


6.3 The Employer Experience: Insights and Perspectives

Current Hiring Practices
58% of businesses responding to the survey currently employ individuals with
disabilities.

   •   59% (11) employ less than 20 individuals with disabilities, 16% (3) employ 20 to
       99; and 26% (5) employ over 100.

   •   When asked how many individuals with disabilities the business employed over
       the course of the past 1 to 3 years, 27% (9) indicated “none.”

   •   64% of smaller employers (7 of 11), businesses with a total Arizona workforce of
       less than 20 employees, reported they did not currently employ any individuals
       with disabilities nor had they employed any individuals with disabilities over the
       course of the past one to three years.



Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   125
Views on Hiring Individuals with Disabilities

       •    70% of employers are open to hiring individuals with disabilities if the
            opportunity presents itself.

       •    30% make a concerted effort to recruit and hire individuals with disabilities.

       •    Among smaller employers (less than 20 employees), the above figures were
            73% and 27%, respectively.


Employer Experiences
Based on information they are privy to, employers have hired individuals with physical
disabilities (52%), deafness or hearing impairments (48%), individuals with other types
of disabilities (45%), cognitive disabilities (36%), mental or psychiatric disabilities (33%),
and visual impairments (18%).


Workplace Accommodations
48% of employers reported that workspace modifications, assistive technology or
devices, and/or changes to the physical environment had been requested/required to
improve accessibility to/within the workplace (16 of 33 employers).

   •       Modifications typically identified as already being in place at the worksite(s)
           included: (a) physical or architectural accommodations (restrooms, automatic
           doors, elevators, accessible parking, etc.); (b) job design/structure
           accommodations (reduced or part-time work hours, break/rest periods, training
           supports); and (c) workspace accommodations.

   •       Accommodations identified as representing a relatively minor change or
           modification included: (a) assistive technology devices, (b) Braille, enlarged print,
           special lighting or audio, (c) a reader, oral or sign language interpreter, and (d)
           workstation adaptations.

   •       Other accommodation needs that were implemented included: (a) filtered
           lighting, accessible walkways and doorways; (b) special pagers and dictation
           software; (c) telecommuting; and (d) allowing time for sensitivity training.


WOTC and Other Tax Credit Incentives
88% of employers indicated that they either had not taken advantage of the Work
Opportunity Tax Credit (52%) or were “not sure” if they had (36%) (total responses: 29
of 33 employers).

   •       Reasons for not taking advantage of the WOTC or other tax credit programs
           available to employers hiring persons with disabilities included:


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   126
       o Lack of awareness/no knowledge of WOTC (05)
       o Opportunity has not presented itself (04))
       o Qualification--employees do not fall into eligible categories to qualify (01)
       o Non-profit enterprise (02)
       o No need or not that important to employer (02)
       o Other (not sure)


Hiring Experiences
When asked to rate their business’s overall experience with hiring individuals with
disabilities, 69% (23) rated their experience as positive. Nine were unable to judge, 1
stated neither positive nor negative, and none reported a negative experience.


Assessing Job Performance
Employers were asked to select the top three qualities or attributes that are most
important to them when determining satisfaction with an employee’s job performance.
Attitude, quality of work and communication / interpersonal skills top the list, regardless
of whether the worker has a disability.


                              SNAP 2009 Employer Survey
                           Top 3- Valued Employee Attributes
                              Asssessing Job Performance
      100%
               76%
       80%

       60%                      52% 52%

       40%
                     24%                    24%         27%
       20%                                        15%
                           9%                                 6%          6%      6%
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Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   127
Employer Awareness/Familiarity with AZRSA VR

   •   51% of employers are aware or very aware of AZRSA VR.
   •   27% were somewhat aware.
   •   21% were not aware and/or familiar.


AZRSA Community Rehabilitation Provider/Employment Services

   •   24% (8 of 33) employers had utilized or accepted referrals from community
       providers that specialize in employment and job placement services for persons
       with disabilities.

   •   of 8 employers were satisfied with the services they received and 1 was neutral.

   •   When asked if they plan to utilize or accept referrals from these agencies in the
       future (asked of all survey respondents):
       o 42% said yes
       o 55% were not sure
       o 3% said no


6.4 Information, Resource, and Service Needs of Employers

Information and Service Needs of AZRSA VR Employers
Employers were asked to identify the types of information, resources, and services
needed.

   Ongoing and updated information on:
       o Financial incentives available to employers hiring workers with disabilities
       o Technical assistance or referrals to appropriate resources for questions
         regarding the Americans with Disabilities Act (ADA)
       o Information on the Employer’s Disability Resource Network (EDRN: coalition
         of employment and rehabilitation organizations who can provide information
         and resources to employers)
       o Information on employment and disability related issues from RSA and
         employer support and recruitment information form the DES Employment
         Administration (formerly Job Services)




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   128
                              SNAP 2009 Employer Survey
                    Ongoing Needs for Updated Information from AZRSA

        100%

         80%

         60%
                   45%
         40%                    30%                                            33%
                                           24%                    27%
                                                      21%
         20%

          0%
                 Financial    TA/ADA      EDRN      RSA Info     DES     None of the
                incentives     Help      Network                Employer   above
                                                                 Asst



   Information on RSA resources and services available to employers
       o Referral of qualified and screened applicants
       o Job related training of applicants to meet employer’s needs
       o On-the-job training supports available to employers (on-site job trainer/coach)
       o Consultation regarding helping employees to be successful
       o Information, referral and training on assistive technology and adaptive aids


                            SNAP 2009 Employer Survey
                Need for AZRSA Resources/Info Available to Employers

      100%

       80%
                 61%
       60%                    55%


       40%                               30%
                                                                24%          21%
                                                    18%
       20%

        0%
               Applicant       Job      On-site    Success     Adaptive   None of the
               Referrals     Training   Coach       on Job      Aids        above




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   129
   Employer support and recruitment services
       o Job fairs, position postings, and labor market data
       o Veterans’ services
       o Information on unemployment insurance, rapid response services

                                              SNAP 2009 Em ploye r Surve y
                                 Ne e d for AZRSA Job Support/Re cruitm e nt Se rvice s
        100%


         80%


         60%
                            48%                 48%

         40%
                                                                                              30%
                                                                          27%                                                                            27%
                                                                                                                           21%
         20%


          0%
                       Job fairs           Position                   Labor                  Veterans                Unemploy                     None of the
                                           postings                   market                 services                   Ins                         above
                                                                       data




   Information on employee retention services offered by RSA
       o Vocational assessments and counseling
       o Job training and retraining
       o Assistive technology assessments
       o Assistance with assistive technology aids and devices (“undue hardship”
         under the ADA)

                                               SNAP 2009 Employer Survey
                                      Need fpr AZRSA Employee Retention Services

           100%
            80%
            60%                                                 52%
                                  45%
                                                                                        36%                          33%
            40%                                                                                                                                          27%
            20%
                 0%

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Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report                                                                      130
   Additional supports cited
       o Menu of services, contacts and/or networking meeting options
       o In-service technical assistance (for tribal departments and community)
       o Education to help employers keep individuals with disabilities employed


6.5 AZRSA Engagement Strategies

Suggestions for AZRSA to improve outreach and marketing to employers:

   •   Presence/participation in events where employers network (workshops, SHRM
       events, AZNDEPA, job fairs, etc.)

   •   Set up appointments with employers to inform and educate them on services
       available through VR (presentations on the benefits of hiring individuals with
       benefits and the incentives available to them).

   •   Communicate with employers via e-news blasts to HR directors and small
       business owners, mailings, person-to-person contact at job fairs, etc.

   •   Create a peer mentor program so that prospective employers can communicate
       with those who have successfully hired persons with disabilities.

   •   Develop a broad-based outreach program that targets all communities in Arizona
       (urban and rural), helping to educate employers, community leaders, and school
       personnel.

   •   Be proactive . . . “Make sure that RSA staff members don’t have that ‘sit on our
       hands’ and ‘wait to be approached by employers’ attitude that seems to pervade
       public job assistance agencies. If an employer shows an interest, jump on it!”




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   131
Chapter 7: Looking to the Future – Emerging Issues of
Strategic Importance

7.1 Voice of the Provider
Providers were asked, “Looking to the future, what do you envision as the emerging
issues or challenges that will impact the service needs of persons with disabilities
seeking to maximize their independence through employment and/or independent
living?”

The majority of respondents addressed:

   •   Issues with the economy and the impact of the economic downturn on:
       o Funding of services and programs to support individuals with disabilities
         (vocational rehabilitation, independent living services, medical and
         rehabilitative resource availability)
       o Reduction in employment opportunities due to cutbacks in overhead (staffing)
       o Increased competition among job applicants and dwindling employment
         options for individuals with disabilities

       “Unemployment and the economy. Funding for workforce investment for persons
       with disabilities.”

       “Decrease in job market and decrease in funds from the federal government due
       to the economy issues . . . and then a rising cost of health care needs compound
       to a very difficult environment for individuals with disabilities who are not making
       a full time competitive wage, much less even a part-time competitive wage.”

        “With the economy, jobs will be scarce. An emphasis on economic development
       and customized employment is going to be crucial.”

       “The current economy will hinder any and all prospective employees due to the
       magnitude and numbers of those applying for employment. Companies will have
       their choice of employees from a very large pool of candidates, making it very
       difficult for those with any type of disability or impairment.”

   •   Need for enhanced skills training that prepares individuals with disabilities for the
       increasingly competitive job market

   •   Increased emphasis on the need to educate and cultivate relationships with
       employers.

       “The current labor market has been flooded with qualified people who have been
       laid off and are now competing for jobs with our clientele, who are at an ever-


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   132
       growing disadvantage in this respect. This trend is not likely to change in the
       near future as the economy will take years to become healed and vital again.”

       “I think people with disabilities need a competitive edge in their areas of
       expertise. Thus, job experience, internships, and professional recommendations
       are paramount to success. I think people with disabilities should be technology
       savvy and masters of the technology they will use on the job. Intensive training
       and required mastery in technology use and job applications should be required
       as part of the VR continued eligibility.”

       “A need for current skills training. A person with a disability who has not worked
       for at least one year due to the disability needs current skills to be competitive in
       the job market. They need to show the employer that they may have a gap in
       employment but updated their skills meanwhile so that they could be more of an
       asset to the employer.”

       “Competitiveness will be an emerging issue for the next decade as the global
       economy changes, hence making it more difficult for persons with disabilities to
       compete for jobs, unless greater services are provided to both the employer and
       the job seeker.”

   •   Need to creatively explore work accommodation needs, leverage the power of
       technology, and remain attuned to the changing business environment.

       “I see an increasing ability for disabled persons to work from home, obtain
       services, and communicate effectively with others in their lives through the use of
       computers and other long-distance tools/applications.”

       “The current economy is impacting the job market and the growing
       telecommuting opportunities are not being taken advantage of.”

       “Job creation, job sharing, and job carving in the employment industry and to
       increase awareness and support for employers to hire persons with disabilities.”

       “Perhaps part-time disabled workers will be the “new workforce,” yet our health
       care delivery system is breaking down for these consumers because of a lack of
       funding and escalating health care cost.”

   •   Needs of specific populations (veterans, youth in transition, aging population,
       autism spectrum disabilities and impairments, etc.).

       “Increased number of veterans with disabilities; many returning vets have TBI
       and will require many services to get employed.”




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   133
       “Schools may be exiting cognitively lower students earlier than 22 years old in
       some circumstances, and adult agencies need to be prepared for those clients.
       More individuals are on the autism spectrum and need support for behavioral /
       social problems, and many agencies are not equipped to work them. Agencies
       need to provide more comprehensive supports rather than determining the
       individual ‘unemployable’ and closing their case.”

       “With the population in Arizona aging, there will be an increased demand for
       services. Additional resources are needed to keep pace with the demand.”

       “Aging population and resulting auditory and visual losses.”

       “Meaningful and purposeful activity for individuals with disabilities. People are
       becoming disabled at a young age. There is not enough structured and
       meaningful activity available to them to engage in. Hence, involvement in
       destructive activity continues to rise, for example, smoking and use of drugs and
       alcohol. This in turn increases health care costs. I believe more time, energy, and
       financial resources need to be devoted to prevention, by providing assistance to
       be productive for all people.”

   •   Access to benefits and reductions in benefits and compensation will impact how
       employment is viewed and pursued.

       “Medical insurance benefits for rehabilitation services continue to be trimmed to
       fewer days, less disciplines; therefore, the number of people applying for VR /
       ILRS services will likely increase earlier in the rehab process—many are starting
       to apply directly after acute rehab services in hospital due to decreased
       outpatient benefits. In addition, increased unemployment and economic situation
       will increase the number of people without medical insurance that will likely turn
       to RSA seeking rehab services.”

       “Need a more flexible system that recognizes the variable health status of some
       people with disabilities, allowing them to work without having to sacrifice their
       long-term benefits.”

       “Restriction of income for those wanting to work. Loss of benefits, health care,
       Social Security, and SSI payments being decrease. Coordination of benefits and
       qualifying factors for various state aid programs. Problem with loss of state aid
       benefits when they seek employment and extra income.”

       ”Maintaining benefits such as Social Security and food stamps as well as medical
       benefits. Unfortunately, people with disabilities many times will fall into the gap
       between making too much for assistance and not enough to be fully self-
       sufficient.”




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   134
   •   Need for a qualified workforce of trained professionals to meet the service needs
       of individuals with disabilities.

       “Lack of qualified employment-focused clinical staff.”

       “Lack of qualified caregivers and medical professionals.”

       “I think we are seeing more cases with emotional and mental disabilities. I think
       that counseling vs. medicating these individuals may become an issue due to the
       limited personnel in mental and emotional aid.”

       “Adequate staffing to meet growing needs for in-school youth and when they
       graduate.”


7.2 Voice of the Employer
Following are comments from employers regarding the emerging trends and anticipated
changes in the business and economic outlook for Arizona over the course of the next 3
to 5 years.

Impact of the Economy

       “I can only imagine that the unemployment rate is so high that employers are
       going to hire those that can do the job and not those they have to spend a lot of
       time with someone else. This is costly to companies.”

       “Able-bodied economic victims of the downturn will become a large component of
       the job-seeking pool, crowding out disabled job-seekers.”

       “The economy at the moment and for the next few years will definitely affect the
       workforce. Every business will be looking for people who are dependable and
       productive.”

       “In the current economic situation I feel sure the workforce will be limited and
       employers will be looking for dependable and productive employees.”

       “In Arizona the economy is tied to immigration, construction, and the house
       market. 2009 is going to be a tough year, but I think after 2009 things will
       improve.”

       “Economy may have negative effects on hiring disabled in the near term, but
       employee shortages will drive more hiring in the future.”




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   135
Changing Demographics: Impacting Needs and Opportunities

Aging Workforce

       “Due to being in the health care field, I see the impact that the baby boomers will
       have. The need for trained health care providers will be needed. In the next 3-5
       years, it is my opinion that workforce needs will increase while employment
       opportunities decrease and stagnate at current levels. I also believe that
       specialized training will become more important as there are fewer job
       opportunities, selection criteria will probably increase.”

       “Shortage of skilled labor force to meet the needs of baby boomers’ care needs.”


Job Skills Training

       “It's going to continue to be a challenge for both the jobseeker and the supporting
       coaches/counselors/employment specialists to get themselves and/or their
       respective clients ready to be competitive in the job search world. They have to
       stress abilities and not disability.”

       “Many job openings for those with specialized skills or backgrounds.”

       “Difficult to say what the trends may be – customer service a plus.”

Referrals and Job Placement

       “We need referrals to be better prepared to take on the responsibilities of a job.
       Only refer those clients ready to work, not every person on the list.”

       “Tight workforce requires that employees present with work-ready skills, and able
       to take direction.”

       “To hire more people with disabilities that could fit the job description they are
       qualified for. My reason is that when I’m out, I receive the best customer service
       from someone that is disabled.”

Secondary Research
How Employers Are Doing when It Comes to Hiring and Making Accommodations for
Workers with Disabilities

Cornell University conducted two research initiatives to examine employer practices in
response to the employment provisions of Title I of the American with Disabilities Act
(ADA) and related civil rights legislation. Cornell interviewed by phone a random sample


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   136
of human resource and equal employment opportunity personnel from the public and
private sectors. Key findings of those initiatives are discussed below.

Meeting Accommodation and Access Needs of Applicants and Employees with
Disabilities
Listed below are the 11 areas of accommodations and 5 access areas outlined in the
study and the percentage of employers who stated they had made accommodations in
these areas.


                     Accommodation                        Private Sector      Public Sector
                                                           Percentage          Percentage
    Made facilities accessible                                  82                 93
    Had flexible human resource policy                          79                 93
    Restructured jobs/work hours                                69                 87
    Made transportation accommodations                          67                 86
    Provided written job instructions                           64                 69
    Modified work environment                                   62                 93
    Modified equipment                                          59                 90
    Made reassignment to vacant position                        46                 58
    Provided readers and interpreters                           36                 79
    Changed supervisory methods                                 35                 55
    Modified training material                                  31                 49



                Types of Access Provided                  Private Sector      Public Sector
                                                           Percentage          Percentage
    Wheelchair access                                           82                 95
    Time flexibility in test taking                             45                 39
    Communication access for hearing impaired                   43                 91
    Communication access for visually impaired                  37                 77
    Removing volatile/scented substances                        32                 48




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report    137
Identifying Barriers to Employment and Advancement for People with Disabilities
Respondents were asked to rate seven possible barriers to employment and
advancement of people with disabilities. Lack of related experience was seen as the
biggest barrier by both the public and private sector employers. The results in this area
are outlined below.


                          Barriers                          Private Sector       Public Sector
                                                             Percentage           Percentage
    Lack of related experience                                    49                  53
    Lack of required skills/training                              39                  45
    Supervisor knowledge of accommodation                         31                  34
    Attitudes/stereotypes                                         22                  43
    Cost of accommodations                                        16                  19
    Cost of supervision                                           12                  10
    Cost of training                                               9                  11

Additional questions in this area were related to rating ways of reducing employment
and advancement barriers, changes made in the workplace to meet the needs of
employees with disabilities and the difficulty in making these changes. The results of the
respondents' replies are outlined below.

          Effective Reduction Strategies              Private Sector         Public Sector
                                                       Percentage             Percentage
    Visible top management commitment                       81                    90
    Staff training                                          32                    71
    Mentoring                                               59                    71
    On-site consultation/technical assistance               58                    71
    Short term outside assistance                           41                    43
    Employer tax incentives/special budgets                 26                    69



         Difficulty in Making Workplace          Private Sector        Public Sector
                      Change                      Percentage            Percentage
    Changing co-workers' & supervisors'
                                                       32                    33
    attitudes
    Modifying return to work policy                    17                    11
    Creating flexibility in performance
                                                       17                    15
    management system
    Change in leave policy                             10                    8
    Adjusting medical policies                          7                    9
    Ensuring equal pay and benefits                     2                    4




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report       138
These studies show that much still needs to be done to bring the unemployment rate for
persons with disabilities into line with that of the general public. Progress is being made.
More will need to be done by persons with disabilities, educators, rehabilitation
counselors, and the public and private employment communities if we are to achieve full
integration of persons with disabilities into the employment marketplace.

Key areas that need to be addressed are improvement in the education and training of
persons with disabilities, more outreach on the part of the employment community to
recruit persons with disabilities, a better understanding of reasonable accommodation,
and a concerted effort to break through the attitudinal barrier that is so detrimental to full
integration of people with disabilities into the employment arena.


7.3 Economic Outlook for Arizona

Disability and Employment Rates
It is well-documented that people with disabilities have a significantly lower rate of
employment than people without disabilities – 36% versus 74% nationally, according to
the U.S. Census Bureau’s 2006 American Community Survey (ACS). These figures
reflect a 1-point worsening from the ACS of 2005, when the national employment rate of
people with disabilities was 37% versus 74% for people without disabilities.

In analyzing the 2005 ACS data, U.S. Census Bureau researchers calculated the
correlation between employment rates for the working-age population – defined as non-
institutionalized people ages 16 to 64 – with and without disabilities across all states.
The results showed a moderate to strong relationship – that is, states with a high
employment rate for people without disabilities tended to also have a high employment
rate for people with disabilities, and vice versa.

Where is Arizona positioned within this context? The gap in employment rates between
people with and without disabilities ranged from a low of 24.2% in Utah to a high of
45.3% in Kentucky, with a national average of 37%. Arizona’s employment rates among
people with and without disabilities were 38% and 74% respectively, reflecting a gap of
36% that was comparable to the national average. 19

Disability and Occupation
As shown in the following chart, compiled from the 2006 ACS data, people with
disabilities constitute 6.5% of all working-age individuals who are employed in the
United States. Also shown in the chart is the prevalence of people with disabilities
across occupational groupings.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   139
The U.S. Department of Labor has projected that approximately 18.9 million new jobs
will be created nationally between 2004 and 2014. Of the occupations seen on Chart 1,
“production, transportation, and materials moving,” which presently has the highest
percentage of people with disabilities, is projected to have the lowest number of new
jobs (approximately 1 million). However, “service” and “professional and related”
occupations are projected to have the greatest increase in number of jobs nationally,
with over 5 million in each group, which could allow for increased opportunities for
people with disabilities to work in these areas.

Arizona’s Economic Outlook and Contributing Factors
With regard to the current economic situation, recession continues to grip Arizona, and
various economic forecasters predict little prospect for recovery in the near term. In
early October 2008, Arizona Department of Commerce’s Research Administration (RA)
projected a continued loss of nonfarm jobs for the calendar year 2008-09 with a
decrease of more than 47,000 jobs (−1.8%). 20 According to the U.S. Department of
Labor’s Bureau of Labor Statistics (BLS), Arizona also suffered the third largest over-
the-month (October 2008) percentage decrease in employment among all states, at
−0.7%.

The RA noted that it may be late 2009 and into 2010 before any steps toward recovery
occur in Arizona because of higher commodity prices – especially for food and energy –
stagnant incomes, and the effects of the crisis in finance and housing. Stagnant
incomes and rising prices have reduced the real spending power of the consumer and
damaged the Arizona industries dependent on consumer spending such as trade,
transportation, leisure, and hospitality.

Additionally, the reduction of credit availability has compounded the downturn in
housing by increasing the difficulty in securing home loans for many potential buyers.
Less money is available not only for home loans, but also for other consumer and
business purchases, which is expected to decrease output and employment.


Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   140
Arizona’s Occupational Outlook and Contributing Factors
Current demographics in Arizona and the nation are being influenced by the aging of
the baby boomers. The U.S. Census Bureau population projections forecast that the
median age of Arizona residents is expected to rise from 34.2 as measured by the 2000
census to 38.2 years of age by 2020, a shift that is expect to positively influence the
number of jobs in such areas as education and health services and leisure and
hospitality.

Additionally, Arizona’s overall population growth is expected to continue at a rapid rate,
with our current population more than doubling over the next 30 years. The Economic
and Business Research Center of the University of Arizona’s Eller College of
Management predicts a corresponding doubling of the number of jobs in Arizona,
boosting the total to 6.3 million. The Center also predicts that Arizona’s employment-to­
population ratio will rise to approximately 42% by 2040, closely approaching the 43%
peak it experienced in 2000. 21

For the short term, we turn to the Research Administration’s 2008-09 forecast period.
The largest job growth is projected to occur within the educational and health services
industry group, with a gain of 18,000 jobs (6.1%). The next largest gain is expected to
occur in the public sector, with an increase of 7,500 jobs (1.8%), followed by a gain of
2,700 jobs (1%) in the leisure and hospitality industry. These groups represent some of
the highest current employment rates among people with disabilities, bolstering the
potential for increased employment opportunities for these individuals.

On the other hand, these recent projections must be viewed in light of the fact that
Arizona is currently undergoing a significant change in its executive leadership,
accompanied by the strong possibility of budget cuts in such areas as education and
health services over the next few years.

Clearly, the current economic and financial crisis will continue to impact the country as a
whole – and the state of Arizona – over the next few years and decades. Only time will
tell how successful we will be in meeting these challenges, particularly employment
rates for people with and without disabilities.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report   141
                                                  Notes and References

1 SSS Part B: funding provided to states through the U.S. Department of Education—Rehabilitation Services Administration (RSA),
under the provisions of Title VII- Part B of the Rehabilitation Act of 1973, as amended (29 U.S.C.701-796i) to support and enhance
independent living services within a state;
Part C: funding provided directly to qualifying CILs through the U.S. Department of Education, Rehabilitation Services
Administration (RSA), under the provisions of Title VII- Part C of the Rehabilitation Act of 1973, as amended (29 U.S.C. 701-796i) to
establish new CILs and to support and enhance independent living


2 ADA definition of disability. This same definition is found under Section 886.20 definitions for Centers for Independent Living (Joint
Committee on Administrative Rules, Administrative Code, Title 89: Social Services, Chapter IV: Department of Human Services,
Part 886 Centers for Independent Living Section


3 This same definition is found under Section 886.20 definitions for Centers for Independent Living (Joint Committee on
Administrative Rules, Administrative Code, Title 89: Social Services, Chapter IV: Department of Human Services, Part 886 Centers
for Independent Living Section


4 VR definition of eligibility


5 WIA guidelines


6 http://www.ncd.gov/newsroom/publications/2008/pdf/Indicators_Report.pdf


7 Bjelland, Melissa J., Burkhauser, Richard V., Houtenvill, Andrew J. 2008, September. 2008 Progress Report on the Economic
Well-Being of Working Age People with Disabilities, Rehabilitation Research and Training Center on Employment Policy for Persons
with Disability, Cornell University, Ithaca, NY


8 How Do Medicaid Buy-In Participants Who collect Social Security Disability Insurance Benefits Use SSA Work Incentive
Programs? examined participation in 4 SSA work incentive programs from January 1, 2000 through December 31, 2005,
Mathematica Research

9 http://aspe.hhs.gov/hsp/homelessness/symposium07/long/#_ftn72


10 Exploratory Study of Health Care Coverage and the Employment of People with Disabilities


11 These incentives include the trial work period, extended period of eligibility, continued Medicaid eligibility (section 1619b), and a
host of tax advantage and saving benefits (Impairment Related Work Expenses (IRWE) and Plan to Achieve Self-Support (PASS)
etc.)


12 Ticket to Work and Self-Sufficiency Program (Ticket to Work) allows individuals with disabilities greater choices to seek the
services necessary to obtain/retain employment. As of September 2006, SSA had mailed almost 12 million Tickets to beneficiaries.
Individuals can assign their ticket to an EN (see below) to start receiving employment and related support (e.g. training) services.
Ticket to Work utilizes a performance-based compensation plan.

13 Center for Studying DISABILITY POLICY Number 08-01 • August 2008 Earnings and Work Expectations of Social Security
Disability Beneficiaries, Disability Policy Research Brief, Mathematica Policy Research, Inc.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report                                          142
14 The Arizona Employment and Disability Partnership is a Medicaid Infrastructure Grant (1QACMS300122) solely funded by the
U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services and administered by the Arizona
Health Care Cost Containment System.


15 Evaluation of the Ticket To Work Program, Assessment of Post-Rollout Implementation and Early Impacts, Executive Summary
May 2007, Mathematic Policy Research and Cornell University Institute for Policy Research

16 Center for Studying DISABILITY POLICY Number 08-01 • August 2008 Earnings and Work Expectations of Social Security
Disability Beneficiaries, Disability Policy Research Brief, Mathematica Policy Research, Inc.


17 How Do Medicaid Buy-In Participants Who Collect Social Security Disability Insurance Benefits Use SSA Work Incentive
Programs? Mathematica Policy Research Inc. www.mathematica-mpr.com.


18 The Three E's: Enrollment, Employment, and Earnings in the Medicaid Buy-In Program, 2006 Final Report (April 11, 2006),
Mathematica Policy Research Inc.


19 Employment Rates for People With and Without Disabilities. Smith, F. A. & Gilmore, D. S. Data Note No. 10, 2007. DataNote
Series, Institute for Community Inclusion. Boston, MA.


20 Arizona Workforce, Forecast Report. Arizona Department of Commerce, Research Administration, October 2, 2008. Phoenix,
AZ.


21Arizona’s Economy. The University of Arizona, Eller College of Management, Economic & Business Research Center, October
2008 – Fall Issue. Tucson, AZ.




Arizona Rehabilitation Services Administration 2009 Statewide Needs Assessment Full Report                                   143

				
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