A Review of the Research on Outcomes for Blind and Visually Impaired Consumers Served in Separate vs. Combined Agencies
Research Takeaway: Across multiple studies, separate agencies were found to serve a higher proportion of socially disadvantaged individuals but scored as well as, if not better than, combined agencies on key outcome measures, such as competitive employment rates.
Reprinted from the Mississippi State University National Rehabilitation and Training Center blog.
In 1920, legislation was signed into law creating the first civilian Vocational Rehabilitation (VR) agencies. These early VR agencies served very few blind consumers. Instead, most individuals with blindness or visual impairments (BVI) sought services from separate, non-governmental organizations. As service delivery for individuals with BVI evolved, more states created VR agencies focused specifically on serving individuals with BVI (referred to as “separate” or “blind” agencies). As of 2011, there were 24 separate agencies serving individuals with BVI. Instead of maintaining separate agencies, many states operate “combined” agencies that serve consumers of all disability types.
Separate and combined agencies can take on many different forms. In general, separate agencies are those that have their own administrator, budget, spending authority, and plan for provision of services. Some separate agencies restrict services to consumers with the most severe BVI; in those cases, consumers with less severe impairments are served by the state’s general VR agency. Combined agencies may have a division dedicated to consumers with BVI, or they may take a more general approach to service delivery (for example, consumers with B/VI may be served by the same personnel that serve consumers with all other disabilities).
The existence of separate agencies has been a source of controversy. Opponents of separate agencies consider them to be expensive, duplicative, and potentially unfair to individuals with other disabilities. Instead of maintaining separate agencies, opponents suggest that separate agencies be absorbed into combined agencies. On the other hand, many consumer groups, advocates, and professionals in the field of blindness promote the maintenance of separate blind agencies. They believe that individuals with BVI have unique needs that can best be served by dedicated agencies.
Several research studies from the NRTC have examined services provided by separate and combined agencies. In general, our findings support the maintenance of separate agencies for individuals with BVI. Research-based answers to frequently asked questions can be found below.
- Do separate and combined agencies serve different consumer populations?
Multiple studies have found that, in general, separate agencies serve consumers who are more socially and economically disadvantaged. Overall, consumers of separate agencies are more likely to:
- Have more severe vision loss
- Be Hispanic
- Have less than a high school diploma
- Have a secondary disability
- Be female
- Receive public assistance
In general, the population served by separate agencies contains a higher percentage of consumers who would be considered at higher risk for unemployment due to their sociodemographic characteristics, such as lower levels of education and the presence of secondary disabilities.
- How does service provision differ between separate and combined agencies?
When served by a separate agency, legally blind consumers typically receive more services and spend more time in VR. This finding is not surprising, given that separate agency consumers are more likely to be economically disadvantaged, have less education, or have a secondary disability. Separate agencies are more likely than combined agencies to provide their consumers with adjustment services, on-the-job training, and counseling/guidance services.
Costs in separate agencies are slightly higher than costs in combined agencies, and this may be due to a number of factors: separate agencies tend to serve a more at-risk population who may require more services; separate agencies deliver more services per consumer; and separate agencies’ consumers tend to spend a longer time in VR. It is also important to note that, although separate agencies may have greater expenditures, this does not speak to the question of cost-effectiveness, which also takes outcomes into consideration. It may be that, given the more at-risk population they serve, separate agencies are just as, or more, cost-effective than their combined agency peers.
- Do consumers served in separate and combined agencies have different outcomes?
Consumers served in separate agencies are more likely to:
- Achieve competitive employment
- Have higher levels of weekly earnings at closure
- Report that income/earnings at closure are their primary source of support (rather than public assistance)
Separate agencies close more clients in competitive employment and self-employment, and close fewer clients as homemakers or unpaid family workers.
When Social Security Disability Insurance (SSDI) recipients are served by separate agencies, they are more likely to achieve employment than those served in combined agencies. The positive impact of separate agencies was especially evident for older SSDI recipients. Rates of employment in combined agencies dropped off sharply for consumers over age 60. In contrast, consumers of a similar age served in separate agencies were more likely to achieve competitive employment, and this higher employment rate did not diminish as consumers grew older.
- Should separate agencies be maintained?
Findings from multiple research sources support the continued existence of separate agencies for the following reasons:
- Separate agencies serve a consumer population that is more economically and socially at risk for poor employment outcomes (e.g., individuals who are the most significantly disabled). Consumers of separate agencies are more likely to have lower levels of education and higher levels of secondary disabilities and public assistance receipt.
- When compared with combined agencies, separate agencies provide more services at only a slightly higher cost.
- Consumers served in separate agencies are more likely to achieve competitive employment.
- Learn More
Cavenaugh, B.S. (1999). Relationship of agency structure and client characteristics to rehabilitation services and outcomes for consumers who are blind. Available for download: https://www.blind.msstate.edu/research/publications/reports
Cavenaugh, B.S. (2010). An update on services and outcomes of blind and visually impaired consumers served in separate and general/combined VR agencies. Available for download: https://www.blind.msstate.edu/research/publications/reports
Cavenaugh, B.S., Giesen, J.M., & Pierce, S.J. (2000). Rehabilitation of visually impaired persons in separate and general agencies. Journal of Visual Impairment & Blindness, 94(3), 133-145.
Giesen, J.M., & Cavenaugh, B.S. (2013). Disability Insurance beneficiaries with visual impairments in Vocational Rehabilitation: Socio-demographic influences on employment. Journal of Visual Impairment & Blindness, 107(6), 453-467. Available for download: https://www.blind.msstate.edu/research/publications/citations