Rural Contracted Services

Job placement and development activities are important predictors of Vocational Rehabilitation (VR) employment outcome, and the bulk of these services are provided through purchasing agreements with external vendors. When these services are not available for purchase, VR counselors provide them. This can cause significant delay for rural consumers because many counselors are unable to provide timely services due to their large service areas.

One explanation for provider scarcity is the VR system’s movement away from fee-for-service (FFS) towards results-based funding (RBF) for purchasing job placement and development services.  FFS arrangements generally require pre-authorization from the VR agency to pay for a specified number of consumer contact hours.  RBF payments are contingent on achieving specified milestones linked to consumer outcomes.  RBF has some noted advantages, including greater incentive to secure consumer employment outcomes; faster service delivery; reduced provider paperwork requirements; and greater flexibility in how providers deliver services.  Studies have highlighted improved outcomes using RBF including higher rates of person centered planning and employment retention rates for consumers.

However, the system has limitations. For instance, because RBF payments are contingent on meeting specific milestones, there is an inherent disincentive to serve cases who might be harder to place.  RBF also shifts risk away from the payer of services towards the provider because there is no payment unless a milestone is achieved.  There is a need for adequate compensation to overcome disincentive and risk to entice providers to serve consumers in most need.

RBF payment mechanisms also have not adequately accommodated geographic “risk” or disincentives linked to serving consumers in or near towns with small economies. Qualitative research conducted by RTC:Rural showed that RBF resulted in fewer providers in rural locations because consumers were harder to reach, experienced transportation barriers, and had fewer employment options—all factors that delay case progression and make it more difficult to  achieve required milestones.

The Rural Contracted Services project explores state VR agency access to job development services provided by vendors in rural communities.

  • Study 1 uses qualitative interviews with VR informants to examine current VR agency purchasing practices for job placement and development services, current provider availability within each state and region, and agency strategies for delivering services when providers are not present.
  • Study 2 is informed by study one to examine how different payment methods affect competitive employment outcomes using RSA 911 data.
  • Study 3 examines vendor decision-making regarding service delivery to rural areas, including the advantages and disadvantages of different payment arrangements such as fee-for-service or milestone payments to overcome geographic risk. We will conduct qualitative interviews with both small and large vendors operating under a variety of payment arrangements.

Results from these three studies will serve as a basis for developing VR practice recommendations. The recommendations will outline effective third-party payment arrangements that promote access for rural consumers. These findings are important because third party providers often provide the bulk of job placement and development services.  When these services are not available for purchase, VR counselors provide them. For rural consumers, this can significantly delay case progression because many counselors visit out-locations infrequently and are unable to provide timely services (Rigles, Ipsen, Arnold, & Seekins, 2011). Additionally, VR offices indicate that lack of access to community rehabilitation programs “impedes positive consumer outcomes” (U.S. Department of Education, 2005, p. 35).

What the Research Says…

Quick Links: Employment & Vocational Rehabilitation

Current Projects

  • Rural Self-Employment Opportunities
    Self-employment is an important option for rural consumers of Vocational Rehabilitation services. The goal of this project is to develop and evaluate a state Vocational Rehabilitation self-employment process.
    • Rural Self Employment
      Self-employment is an important option for people with disabilities, especially in rural areas where job opportunities are limited. Previously, RTC:Rural developed the Vocational Rehabilitation Self-Employment Guide. This project will pilot and evaluate this website, as well as create, pilot, and evaluate a new culturally appropriate translation for use within the tribal vocational rehabilitation system on American Indian reservations.

Completed Projects

COMPLETED PROJECTS | 2013 - 2018

 
  • Rural Contracted Services
    Vocational Rehabilitation agencies purchase job development services from vendors. How vendors are paid influences service reach, delivery outcomes, and pacing. The goal of this project is to increase the quality and number of vendors that provide job placement and development services in rural communities.
  • Use of Social Media for Employment
    In keeping with current job-search methods, Vocational Rehabilitation counselors should have capacity to guide consumers on the use of social media for a wide range of job-search and related tasks. This project will develop a recommended state Vocational Rehabilitation policy to guide use of social media and develop and evaluate training for VR counselors.

    • COMPLETED PROJECTS | 2008 - 2013

     
    • Comparing Rural/Urban Vocational Rehabilitation Service Delivery
      We compiled 2008 and 2009 RSA-911 data with zip and county code information from 47 VR agencies and used these data to compare rural and urban caseloads and outcomes. As compared to urban, rural caseloads had a higher rate of transition aged students and a lower rate of consumers with mental health disability. Outcomes were different in terms of closure rates to self-employment, supported employment in integrated settings, and time to IPE plan development. Rural and urban data comparisons provide the basis for more targeted evaluation of VR delivery practices.
    • Health Plans to Employment
      People with disabilities often experience health problems such as pain, weight gain, or high blood pressure. These problems can make it difficult to hold a job. Participation in health promotion programs can have positive effects on health but services are often limited in rural areas. Health Plans to Employment is a virtual health promotion program that consumers can access from their homes.
    • Premature Exit from VR Services
      Consumers leave VR services for a number of reasons. Some leave because services are too slow, they are unable to find a job, or they have problems connecting with the VR counselor. Sometimes consumers are frustrated because promised services are not forthcoming. Finding solutions to these problems will save valuable VR funding as well as improve outcomes for VR consumers.
    • VR Agencies' Use of Telecommunications to Deliver Services
      People in rural areas have trouble getting to in-person meetings with VR counselors because of transportation barriers. Telecommunication may be one way to increase services to these consumers. Research on this topic led to the development of the Telecom Toolbox, an online service designed to educate VR counselors about using telecommunications to serve consumers.

    COMPLETED PROJECTS | prior to 2008

     
    • Community and Economic Development
      This project developed a process for people with disabilities and agencies that provide disability services to assist with economic development in rural areas. One outcome of the project was a grant that supported low-income entrepreneurs and led to the development of 79 small businesses.
    • Vocational Rehabilitation Agency Self-Employment: Rural/Urban Use
      This project identified differences in rural and urban counselor attitudes and their use of self-employment as an employment outcome. Rural counselors used self-employment at higher rates than urban counselors, but both desired additional training in how to support consumers in business development.
    • State Vocational Rehabilitation Agency Self-Employment Policies and Procedures
      This project collected and analyzed state Vocational Rehabilitation agency policies and procedures on self-employment to develop a model policy for adoption.
    • National Study of People with Disabilities who are Self-Employed
      People with disabilities are self-employed at higher rates than the general population. This study surveyed entrepreneurs with disabilities to learn more about their successes and challenges as business owners.
    • Steps for Vocational Rehabilitation Counselors: Helping a Consumer Start a Business
      VR counselors are trained as employment counselors, not business developers. In order to provide services to consumers who want to start their own businesses, counselors need information and training. To address this gap, we developed a training designed for VR counselors to help them provide better services to people who want to be self-employed.
    • Vocational Rehabilitation Linkages with Small Business Development Centers
      This project focused on encouraging VR agencies to work with Small Business Development Centers. This collaboration is sometimes hard because each agency has different responsibilities. RTC: Rural looked at the ways in which the services provided by each agency overlapped and developed a process for collaboration.
    • Action on Self Employment
      The RTC: Rural and the Abilities Fund hosted a national conference to advance the cause of self-employment for people with disabilities. The conference focused on consumer access to capital.
    • Worker Cooperatives
      Worker cooperatives have a long history in rural America. Members of the cooperative co-own and manage the business and share costs and responsibilities. This project researched and described ways for people to organize and manage worker-owned businesses.
    • Working Well with a Disability
      Working Well with a Disability (WWD) is a program that was developed to help people with disabilities find and maintain employment by setting goals and improving their health. It was adapted from the RTC: Rural’s health promotion program, Living Well with a Disability (LWD). Researchers who developed LWD found that the healthier people are, the more they are able to do. The WWD program builds on LWD but focuses on consumers who are employed or seeking employment.

    Products & Training

    • American Indian Disability Technical Assistance Center
      The American Indian Disability Technical Assistance Center (AIDTAC) was a national center providing information, training, and technical assistance to vocational rehabilitation and employment-related services assisting American Indians and Alaska Natives with disabilities.
    • Self-Employment Online Curriculum
      This is an online, self-employment training program for vocational rehabilitation counselors, counselors working in Section 121 programs and students pursuing a degree in vocational rehabilitation.
    • Telecom Toolbox
      Telecom Toolbox is an online resource for Vocational Rehabilitation counselors to help build their capacity to use online communication methods while providing services to consumers.
    • Working Well with a Disability
      Working Well with a Disability is a peer-led health promotion workshop that focuses on creating a healthy and balanced lifestyle that supports employment. Training is available.

    External Resources