Complete and accurate data on the average cost per case for rehabilitation have not been compiled, but the figure usually given is approximately $300. This amount is obtained by dividing the total number of persons rehabilitated during the year into the total expenditures for the year from both Federal and State funds. An approximate figure may also be derived by dividing the total number of cases rehabilitated since the beginning of the program, 98,690 (See Table 4), into the total expenditures for vocational rehabilitation during the same period, which gives and average of $291. Obviously such figures are only rough estimates. Some significance attaches to them, however, when they are compared with the continuing cost of providing institutional care for a dependent person, which is reported as ranging from $300 to $500 a year.1

Need for an Adequate Program

The rehabilitation problem as measured by the number of persons in need of the service is not being adequately met. It is estimated that only 20 percent of the persons who are disabled annually in the United States and who are eligible for and feasible of vocational rehabilitation for usual types of employment are receiving help, but the exact situation is not known with respect to the number of disabled persons, the types of disabilities, and the service required to effect rehabilitation. Moreover, rehabilitation costs have not been analyzed sufficiently to indicate how much money would be needed to help a given number of persons with certain types of disabilities. The rehabilitation program has grown in the same way as other public services; it has been given appropriations, depending as a rule on the funds available or the amounts which pressure groups could force legislative bodies to grant, rather than upon the amounts required to meet public needs, and the program has then been developed on the basis of available funds.

There is no reason to believe that the demands for additional rehabilitation service will cease. On the contrary,

1 Vocational Rehabilitation of the Physically Handicapped, U. S. Office of Education Vocational Education Bulletin No. 190 (Washington: U. S. Government Printing Office, 1936), p. 27.

there is increasing pressure for extended activities, such as providing assistance for persons who can be rehabilitated for sheltered occupations and for homebound persons who can engage in certain types of work. The time has come, therefore, when a comprehensive program of vocational rehabilitation should be outlined for the Nation, which should be based upon objective studies made by competent investigators. These considerations support the suggestion made in the preceding chapter that a study should be made with a view to planning an adequate national program of vocational rehabilitation.

CHAPTER VI

STATE ORGANIZATION AND ADMINISTRATION

The Vocational Rehabilitation Act makes certain requirements with respect to organization and administration which the States must meet. The general nature of the organization and administration of the service is prescribed by Federal law, but the States have considerable latitude in organizing and carrying on their programs of vocational rehabilitation.

Requirements Made of States

In order to benefit from the provisions of Federal legislation for vocational rehabilitation a State must take certain legislative action. It must (1) accept the provisions of the Federal Act, (2) empower and direct the State board for vocational education to conduct the vocational rehabilitation service and cooperate with the United States Office of Education, (3) provide a plan of cooperation between the State board and the State workmen's compensation commission or agency, where such commission or agency exists, the plan to become effective when approved by the governor of the State, (4) provide for the supervision and support of vocational rehabilitation service, and (5) appoint the State treasurer custodian of Federal funds paid to the State for vocational rehabilitation.

Certain requirements are also made regarding administration. The State board must submit annually to the United States Office of Education a State plan showing (1) the plan of administration and supervision of the work, (2) the qualifications of directors, supervisors, and other employees, and (3) the policies and methods of carrying on the work. State plans follow an outline which has been prepared by the Office of Education and covers seven items: (1) Acceptance of provisions of the Federal Act, (2) administrative organization, (3) supervision of the program, (4) qualifications of

personnel, (5) training of personnel, (6) administrative policies, and (7) record system.

The State board is required to make a report annually, before September 1, to the United States Office of Education, on the receipts and expenditures of money under the provisions of the Federal legislation. The board is also required, by the Office of Education, to report to it not later than December 15 of each year what portion of its allotment it cannot use, or what amount of Federal funds it is prepared, through available State funds, to expend in addition to its regular allotment. This is necessary in order that the Office of Education may utilize the monies which would not be spent by some States to make the additional allotments requested by other States.

The Office of Education holds that the State board for vocational education may not relinquish its responsibility for vocational rehabilitation to any other agency. According to the standards of the Office of Education supervision under the National Rehabilitation Act requires at least the following activities: (1) Planning definite programs of rehabilitation for individuals, (2) supervising all steps in their rehabilitation, (3) inspecting facilities of agencies for training and other forms of preparation for employment, (4) contracting to pay the cost of rehabilitation for individuals, (5) setting up cooperative agreements, (6) supervising the operation of the program, and (7) auditing expenditures by agencies.

The Vocational Rehabilitation Act requires that all vocational rehabilitation service under the supervision and control of the State board shall be available, under such rules and regulations as the Office of Education shall prescribe, to any civil employee of the United States disabled while in the performance of his duty. In general, a State is required to take care of civil employees of the United States if they are legal residents of the State. The Office of Education reserves the right, however, to request any State to accept any civil employee of the Federal Government regardless of residence. Such requests may be necessary because of lack of rehabilitation facilities in the State of residence.

Organization in the States

The Vocational Rehabilitation Act stipulates that the State agency of administration shall be the board designated or created as the State board for vocational education to cooperate in the administration of the Smith-Hughes Act. In most of the States the State board of education has been designated as the board for vocational education; in a few States some other board has been so designated; and in other instances a special State board has been created.

Pennsylvania and New Jersey are the only States cooperating with the Federal Government in which the operation of the rehabilitation program is not directly under the State board for vocational education. In Pennsylvania the program is conducted by the bureau of rehabilitation in the department of labor and industry, but a cooperative relationship has been established with the State board for vocational education in so far as relations with the Federal Government are concerned. In New Jersey the program is conducted by the rehabilitation commission in cooperation with the State board for vocational education, the board being responsible to the Federal Government for carrying out the provisions of the Vocational Rehabilitation Act.

The composition of the State boards varies greatly. When membership is representative, the fields usually included are education, agriculture, commerce, industry, and labor. The State superintendent of public instruction is usually the executive officer of the board.

The State board employs a technical staff for the administration of the rehabilitation service. (See Table 13.) The head of the staff is generally designated as director or supervisor of vocational rehabilitation. Case work is usually carried on by assistants who are known as assistant supervisors in some States and as field agents in others. The need for a sizable staff in large States is apparent from the fact that the service is carried out on a case work basis and that one supervisor or field agent can handle at one time only from 75 to 100 clients in process of rehabilitation. From 30 to 50 percent of the total cost of rehabilitation of a disabled person is spent for administration, which includes the salaries of case workers.