Closing the Gap: A Comparative Study of Majority and Minority Rehabilitation Outcomes

1. Closing the Gap: A Comparative Study of Majority and Minority Rehabilitation Outcomes A Study Conducted by: Rocky Mountain Technical Assistance and Consulting Center (RMTACC) In collaboration with Ari Mwachofi, Ph.D. Consultant

2. 1998 Amendments to Section 21 of the Act The 1998 amendments state: “…compared to white Americans, a larger percentage of African-American applicants to the vocational rehabilitation system is denied acceptance. Of applicants accepted for service, a larger percentage of African-American cases is closed without being rehabilitated. Minorities are provided less training than their white counterparts. Consistently, less money is spent on minorities than on their white counterparts...”

3. Study Objectives • The Study tested the hypotheses that after the provisions of 1998 amendments to Section 21 of the Act took effect there was no difference between white and minorities in: • Waiting and intervention access periods for White and for ethnic minority consumers; • Per capita expenditures on services rendered to White and to ethnic minority consumers; • Quality of services rendered to White and to ethnic minority consumers; • Rehabilitation services intervention outcomes of White and of ethnic minority consumers; • Closure types for White and for ethnic minority consumers; • Reasons for closure of White and of ethnic minority consumers.

4. Study Methods • The study compared VR access and intervention outcomes before and after the 1998 amendments using 1997 and 2007 RSA-911 data • T-tests and Chi-square tests were used to analyze significant differences in access and outcomes of white and minority consumers • Multivariate analysis was used to test if minority status was a significant predictor of VR outcomes

5. Study Sample by Race

6. Hypothesis 1 1: After the provisions of the 1998 amendments to Section 21 of the Act took effect there was no difference in waiting and intervention access period for Whites and for ethnic minority consumers. The Study found significant differences between minority and white consumers waiting and service periods. African American and American Indian consumers waited for shorter periods of time for determination of eligibility and for their IPE but they were served for significantly shorter periods. For Asian and Hawaiian consumers the changes in access and outcomes between 1997 and 2007 seem to have worked in their favor. Asian consumers accessed VR services for longer time periods. Hypothesis 1 is rejected – especially for African American and American Indian consumers.

7. T-tests of the mean differences in number of days consumers were served ** Statistically significant (p<0.001)

8. Hypothesis 2 2. After the provisions of the 1998 amendments to Section 21 of the Act took effect there was no difference in per capita expenditures on services rendered to Whites and to ethnic minority consumers. The expenditure patterns depicted by the 1997 data were also present in the 2007 data. VR spent more per capita on white consumers than on: African Americans by $625.67; American Indians by $825.79; non-white Hispanics by $396.34; and less for Hawaiian consumers than for Whites by $141.12. VR spent more on Asian consumers than on white consumers by $516.26. These results suggest that the expenditure patterns did not change after the provisions of the 1998 amendments to Section 21 of the Act Hypothesis 2 is rejected.

9. Per capita expenditure differences ** Statistically significant (p<0.01)

10. Hypothesis 3 3. After the provisions of 1998 amendments to Section 21 of the Act took effect there was no difference in quality of services rendered to Whites and to ethnic minority consumers. African American and American Indian access to higher quality services seems worse in 2007 than in 1997 They received proportionately less of the high-end training than Whites, including: college/university training, vocational training, and disability argumentative skills training They also received proportionately less diagnosis and treatment, job search, on-the-job supports, rehabilitation technology and technical assistance However, they receive proportionately more transportation and maintenance Hypothesis 3 is rejected.

11. Hypothesis 4 • The study measured differences before and after receiving VR services using 1997 and 2007 data • The study measured outcomes in several ways including: • consumer weekly hours worked • employment earnings • dependence on public support • health insurance coverage

12. Differences in Weekly Earnings at Closure ** Statistically significant (p<0.001)

13. Differences in Weekly Work Hours at Closure ** Statistically significant (p<0.001)

14. Hypothesis 5 • 5. After the provisions of 1998 amendments to Section 21 of the Act took effect there was no difference in closure types of Whites and those of ethnic minority consumers. • Larger proportions of minority consumers were closed as applicants • Asian closure types were similar those of Whites and their employment outcomes were slightly better than those of white consumers • Statistical tests indicate that differences in closure types for White and minority consumers are statistically significant • Multivariate analysis of the likelihood of successful closures indicated that minority status negatively and significantly effects such likelihood • Given these findings, hypothesis 5 is rejected.

16. Test of difference in closure types 1997 Data ** Statistically significant (p<0.001

18. Test of difference in closure types 2007 Data

19. Hypothesis 6 • 6. After the provisions of 1998 amendments to Section 21 of the Act took effect there was no difference in reasons for case closures for Whites and for ethnic minority consumers. • The 2007 & 1997 data indicate that only 25% - 36% of all consumers closed with an employment outcome • Proportionately more minority consumers closed for “failure to cooperate” and “unable to locate” • A higher percentage of Asian consumers closed with an employment outcome • The groups with the smallest proportion of employment outcomes at closure were American Indian and African Americans • Hypothesis 6 is rejected.

22. Test of difference in closure reasons- ** Statistically significant (p<0.001)

23. Conclusion • Given these findings, the study concludes that even after the implementation of section 21 of the Act, there are still differences in service delivery and outcomes between majority and minority consumers. • The differences are especially pronounced for American Indian and African American consumers.

24. Recommendations • Identify population demographics for State and for office catchment areas. • If possible, outline disability prevalence in area. • Develop collaborative working agreements with community based agencies. Including: • Local Schools • Community based agencies serving specific population groups such as, LULAC, Asian Pacific Community Centers, local churches, Urban League, etc.

25. Recommendations (Cont.) • Develop MOUs for sharing space. • Engage community residents in outreach efforts. • Include outcomes achieved in staff evaluations.

26. MISSOURI’S OUTREACH TO UNDERSERVED POPULATIONS

27. Who we are in Missouri Has been in an order of selection status since October 1, 2003 MO is a state of about 6 million people (12% African American, 2.8% Hispanic/Latino, 3% Asian, American Indian/Native Hawaiian/Pacific Islander) Two major urban centers, the rest of the state is mostly rural Large number of Hispanic /Latinos in the state that is not being tapped.

28. “What drove Missouri to look at diversity seriously?” Meet federal standards Tap into the number of Hispanic/Latinos in the state who were not being served In-service training grant Serving these unserved and underserved populations is just the right thing to do Dan’s study also motivated us to do more

29. Service delivery concerns in culturally diverse communities • Developing Productive Referral Sources • Office Décor • Poverty and Lack of Resources • Lack of Support Groups & Role Models • Education Deficits • Documentation Issues • Lack of Cultural Competency (VR Staff) • Mistrust & Lack of Faith

30. This is what Missouri is doing Hired a diversity consultant Conducted training on culturally competent service delivery Convened a diversity team Continue to do ongoing studies to determine how well we are doing There is an ongoing effort to hire persons from culturally diverse backgrounds Bilingual Rehab Techs (three in the state) Developed a Diversity Resource Guide Customer Satisfaction Survey

31. MOVING FORWARD Develop referral sources in diverse communities Work with VR offices at the local level Culturally competent service delivery Take a closer look at our performance evaluation processes

32. Contact Information Richard L. Presberry, Sr., Ph.D. Diversity Consultant Vocational Rehabilitation Services 3024 Dupont Circle Jefferson City, MO 65109 (573) 526-4953 (573) 230-3792 - Cell richard.presberry@vr.dese.mo.gov

33. New Americans ProjectMinnesota Vocational Rehabilitation Services February 28, 2011

34. Musse Salah M.S. CRC, Project Coordinator, Lead Counselor

35. Community LiaisonsWarsam Osman, B.A., ArtAways Mohamed, B.S., Business

36. Origins of the New Americans Project • Since the early 1990’s, Minnesota has seen new immigrant waves, primarily from East Africa. • Discussions & focus groups initiated in 2006 verified gaps in outreach to underserved populations. • In 2007, Minnesota VRS initiated New Americans Project.

37. Refugee populations served… • Burma • Somalia • Ethiopia • Jamaica • Turkey • Congo • Iraq • Guyana • Cameroon • Nigeria • Egypt • Pakistan • Sudan • Eritrea Top 3 Populations Served: Somali Burmese Ethiopia/Oromo

38. Community Outreach • Health Clinics/Community Organizations serving immigrant populations • Center for Victims of Torture • Schools with high enrollment of new immigrant populations • Adult Basic Education (ABE) programs • High Rises • Coffee Houses • Places of Worship • Community Gatherings

40. It’s about Relationship • Build relationship with communities New Americans team serves. • Understand disclosure of personal feelings, disability especially mental health disorders is difficult. • Power point presentations, formal meetings relating to VRS services, is not a successful recruitment tool. • Touch point must be personal, 1:1, often building trust over the course of multiple meetings

41. New Refugee Run CRP • Musse Salah understood need to identify community agencies which provide ABE, socialization and social services for VRS outreach. • Recruited community based refugee run agencies which became Community Rehabilitation Providers. • Provided disability awareness training and technical expertise to newly recruited refugee agencies.

42. Predominant disabilities in New American VRS applicants • Depression • Post Traumatic Stress Disorder • Physical Disability due to civil war injuries such as gun shot wounds. • Physical Disability due to heavy labor with insufficient work place safety training as a result of limited cultural/language skills.

43. Challenges • Some clients concerned about losing public assistance income if they go to work. • Family members encourage clients to remain on benefits and discourage possibility of work. • People with disabilities are not expected to work in their original cultures. • Systematic disincentives for people on public housing and SSI to work. • Difficult to convince some clients that their capabilities are greater than they perceive.

44. Strategies & Solutions • Good outreach strategy is the driving element in serving New Americans. • Meet clients in their comfortable community environment as opposed to the traditional method of VRS intake process. • While outreach to New American is time consuming, result is more engaged, active VRS clients focused on job search & employment. • New American team identifies self employment and small business as a viable option for some VRS consumers. • New Americans team conducts 1:1 extensive meeting with VRS clients, family members and community elders to encourage them to work and long term economic self sufficiency.

45. Earnings Summary & Employment Rate

47. Contact Information: • Musse Salah, M.S., CRC Project Coordinator, Lead Counselor • (651)642-0736 • Musse.Salah@state.mn.us • Chris McVey, M.S.,CRC • MN VRS Deputy Field Director • (651)259-7357 • Chris.McVey@state.mn.us