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INFORMATION TO USERS This manuscript has been reproduced from the microfilm master. UMI films the text directly from the original or copy submitted. Thus, some thesis and dissertation copies are in typewriter face, while others may be from any type ofcomputer printer. The quality ofthis reproduction is dependent upon the quality ofthe copy submitted. Broken or indistinct print, colored or poor quality illustrations and photographs, print bleedthrough, substandard margins, and improper alignment can adversely affect reproduction. In the unlikely event that the author did not send UMI a complete manuscript and there are missing pages, these will be noted. Also, if unauthorized copyright material had to be removed, a note will indicate the deletion. Oversize materials (e.g., maps, drawings, charts) are reproduced by sectioning the original, beginning at the upper left-hand comer and continuing from left to right in equal sections with small overlaps. Each original is also photographed in one exposure and is included in reduced form at the back ofthe book. Photographs included in the original manuscript have been reproduced xerographically in this copy. Higher quality 6" x 9" black and white photographic prints are available for any photographs or illustrations appearing in this copy for an additional charge. Contact UMI directly to order. UMI A Bell & Howell Information Company 300 North Zeeb Road, Ann AIbor MI 48106-1346 USA 313n61-4700 8001521-0600 ='n..7!!TI!I!:l~.•.,-.....,.'~_,_,_ - _ _ _._ - .._----- THE FUTURE OF WORK AND DISABILITY: POLICY AND SCENARIOS A DISSERTATION SUBMITTED TO THE GRADUATE DIVISION OF THE UNIVERSITY OF HAWAI'I IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN POLITICAL SCIENCE MAY 1996 By: Robin L. Brandt Dissertation Committee: James Dator, Chairperson Douglas Bwy Neal Milner Deane Neubauer Gunnar Thompson Daniel Wedemeyer UMI Number: 9629811 UMI Microform 9629811 Copyright 1996, by UMI Company. All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code. UMI 300 North Zeeb Road Ann Arbor, MI 48103 ACKNOWLEDGEMENTS Aloha kakou! Mahalo nui loa to so many beings who made the completion of this project possible. Most of all, I want to say thank you to all the persons with disabilities, their parents, siblings, friends and advocates who have shared their lives, knowledge, wisdom, criticisms, humor and accomplishments with me. Without them, I would have never dared to start this journey. There are also some special thanks to my co-workers and former co­ workers who supported me through this process, especially Clara, Debbie, Kim and Joakim. Thanks go to the Department of Political Science at the University of Hawai'j at Manoa and East-West Center for funds to study here and participate in research elsewhere as well. Aloha pumehana to my family and 'ohana who have tolerantly watched and supported me. I thank my mother and grandmother who prayed endlessly for my success. Elizabeth and Vee, thank you for all the positive thoughts and perpetual enthusiasm. Janice and Leolani, my hula sisters, deserve thanks for sharing my journey. I am thankful to participate in hula and have learned to focus. Mahalo to my Kumu and his Kumu for sharing. Finally, I thank John for holding me capable. Aloha ·oe. iii ABSTRACT Tremendous change is occurring in the United States. Societal support for individuals who cannot work or do not display the capacity to participate as working members in our communities has diminished rapidly in the last decade. No longer are there guarantees of extended financial assistance, long term benefit programs, monies for training, or even goodwill for those who do not work and live independently. The future of vocational rehabilitation, disability and work can be approached in many ways. At one extreme policy, social programs, public perspectives and the economy could be seen as "fated," interacting and producing a situation beyond the control of anyone. Conversely, from a futures research perspective, the future can be approached as a creative process. Relationships between vocational rehabilitation, disability and work can be examined with a purpose, dedicated to fostering choice, and empowering individuals to strategically direct their efforts to meet a dynamic design of what they would prefer. This dissertation is dedicated to assisting people to consider alternative futures so that they might have an impact on the future to come, by acting in the present. This dissertation is a futures research study of vocational rehabilitation, disability and work, concluding with the creation of many scenarios. Initially current models, definitions and measures of disability are examined. A review of rehabilitation history describes how disability has been constituted in the past iv and how vocational rehabilitation services have measured efforts to serve persons with disabilities. Conventional expectations for the future of disability follow. Probable and possible alternate images of society and how work and disability could be constituted in the future are examined. The project concludes with a discussion of scenarios and their place in the process of planning. Suggestions for their subsequent use are also made. v - ----_ .._-_.__.---_.._--------~~-~~. _.. _--~_._---- TABLE OF CONTENTS ACKNOWLEDGEMENTS iii ABSTRACT iv LIST OF TABLES x LIST OF FIGURES xiii CHAPTER 1 SOCIETY, DISABILITY, AND WORK: FIRST IMPRESSIONS .................................... .. 1 1.1 Dissertation Focus ............................. .. 1 1.2 Overview .................................... .. 3 1.3 The Dilemma of Distribution 4 1.4 Public Concepts of Disability ...................... .. 8 1.5 Conclusion. ................................. .. 9 CHAPTER 2 MODELS OF REHABILITATION:THEORY, POLICY AND FUTURES IMAGES ................................ .. 11 2.1 Theories, Maps and the Future ................... .. 11 2.2 No Single Theory, No Single Path. ................ .. 15 2.3 Rehabilitation Professional Theory Abounds. ......... .. 16 2.3.1 Theory and the Future 20 2.4 Rehabilitation Program Evaluation and Effectiveness 21 2.4.1 Historical Measures: Successful Rehabs 22 2.4.2 Public Perspectives, Government Response . .. 23 2.4.3 Accountability and Quality .............. .. 26 2.4.4 Unclear Relationships and Developments. .. .. 32 2.4.5 Effectiveness, Discrimination and the ADA .. .. 36 2.4.6 Rehab: Is It Worth It? ................. .. 41 2.5 Recent Medical Rehabilitation Models .............. .. 42 2.5.1 The Process ofDisability ............... .. 46 2.5.2 Medical Rehabilitation Research and Disability .......................... .. 47 2.5.3 The Quest for Healthy People ........... .. 52 2.5.4 Futurists Drawn to Health Care Broadly .... .. 56 2.6 Issues of Interest and Innovation 59 2.7 Rehabilitation Questions 63 2.7.1 Building Maps for the Future in Rehabilitation.. 64 vi CHAPTER 3 PREVALENCE OF DISABILlTY:DEFINITIONS, NUMBERS, AND WORK 67 3.1 What's in a Name: Definitions as Resolution . 67 3.2 Assumptions . 72 3.2.1 Possible Room for Error . 74 3.3 Work, a Primary Concern . 75 3.3.1 Incidence of Disability . 76 3.3.2 Factors Influencing Ability to Work and Disability 79 3.3.3 Socioeconomic Factors and Disability 80 3.3.4 Cultural Factors and Disability ........... .. 83 3.3.5 Summary: Cross Impact ofFactors and Disability .. ........................ .. 90 3.4 Disability in the Context of Seeking Assistance 91 3.4.1 Benefits for Disabled Who are Unemployed and Unemployable . 95 3.5 Vocational Rehabilitation . 103 3.5.1 Program History . 104 3.5.2 Vocational Rehabilitation Definitions . 107 3.5.3 Measures of Service . 111 3.5.4 Financial Resources . 116 3.6 Do Definitions Assist in Finding Solutions? . 119 3.7 Conclusion . 121 CHAPTER 4 A BRIEF HISTORY OF REHABILITATION 122 4.1 Overview 122 4.2 The Medical Profession and the Emergence of Vocational Rehabilitation 124 4.2.1 Impacts of Industrialization, World Wars, and Volunteer Agencies 126 4.2.2 Creating a Market and Vying for a Share 131 4.2.3 Technology and New Frontiers 139 4.2.4 Visions that Transformed 143 4.2.5 Political Prescriptions and Legislation 152 4.2.6 Summary ............................ 156 4.3 The Continuing Evolution of Vocational Rehabilitation ..... 157 4.3.1 Continuing Legislative Mandates ........... 159 4.3.2 Educationallnfluences 161 4.4 Conclusion.. ................................. 162 vii CHAPTER 5 CONVENTIONAL VIEWS OF THE FUTURE 164 5.1 Introduction. ................................ .. 164 5.2 Conventional VR Images of the Future 164 5.2.1 The Official Future ofRehab and Work 165 5.2.2 Visions from Experience ................. 168 5.3 The Reemergence of the Consumer ................. 174 5.3.1 Evolution ofa New Constituency? 180 5.3.2 Warning from an Elder .................. 185 5.4 The Future Economy, Work and Disability 188 5.4.1 Incidence ofDisability ................... 189 5.4.2 Economic Outlook 198 5.4.3 Ability to Serve VR Clients 201 5.5 Government Funds and the ADA: Contradictions and Spin 205 5.5.1 Promise and Possibilities: Legislation ........ 206 5.5.2 Into the Abyss of Scarcity ................ 209 5.5.3 The ADA Spin on Scarce Services 212 5.5.4 Philosophical Outlook on Legislation 216 5.6 Technology: Promise and Threats ................... 223 5.6.1 Professionals See Opportunities and Advances. ........................... 224 5.6.2 Technology: Stalemate, Solution or Genocide? 229 5.7 Conclusion..... .............................. 232 CHAPTER
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