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·	From Theory To Practice

• Introduction
• Profile
• General Lessons Learned
• Specific Lessons Learned: Employment
• Specific Lessons Learned: Barrier Removal Legislation
• Specific Lessons Learned: Disability Income Programs
• Specific Lessons Learned: Independent Living and Community Support Services
• Specific Lessons Learned: Implications for Future Evaluations

Introduction

This study is part of the Lessons Learned series, produced by Human Resources Development Canada (HRDC). It uses previous evaluations and research findings to identify what works and what does not in the development of public policies and programs.

This particular study summarises and updates information about disability policies and programs, covering the period from 1980 to 1997.

Profile

There are many reasons why the issues related to persons with disabilities constitute a major public policy component in Canada. One reason is the size of the population with disabilities. Statistics Canada reported that there were 4.2 million Canadians with disabilities in 1991, up from 3.3 million in 1986 -- this increase being associated with an ageing population. These individuals represent 15.5% of Canada's total population. Furthermore, surveys indicate that disabled individuals are more likely to be affiliated with poverty than adults without disabilities.

In addition, since the 1980s disability has been officially recognised as a citizenship and human rights issue in Canada. Section 15 of the Canadian Charter of Rights and Freedoms grants people with mental or physical disabilities the right to equality under the constitution.

Some studies have found that a co-ordinated government vision and action can play an important role in removing barriers that prevent people with disabilities from exercising their rights and participating fully in the activities of their societies. As well, these programs must be cost effective because today's current fiscal and social environment demands that any publicly-funded program or service be as cost-effective as possible.

In light of these considerations, it would be advantageous to build future policies or programs upon lessons learned from evaluations completed in Canada or abroad.

General Lessons Learned

Without some form of co-ordination amongst various government departments, the resulting disability policy is frequently a fragmented effort, with inconsistencies, overlaps, and gaps within and across jurisdictions. For example, the all-or-nothing approach inherent in eligibility requirements of some income programs, which label people as fully employable or unemployable, acts as a major disincentive to employment and reinforces the welfare trap for people with disabilities.

2. Environmental barriers are a greater impediment to participation in society and to employment than are functional limitations.

For people with disabilities, the ability to function in society is limited, as much by the openness of the society in which they live, as by the specific functional limitations that identify them as having a disability.

3. People with disabilities vary in their characteristics and needs.

The barriers faced by persons with disabilities are as varied as the disabilities themselves. As such, personalised approaches that feature services adapted to the particular needs of the individual are most likely to be successful.

4. Many approaches to permit participation of people with disabilities can be low-cost but require involvement of different sectors in society, frequently on a partnership basis.

This report identifies a number of approaches that have facilitated participation of people with disabilities in employment and in independent living. These approaches have proven to be cost-effective in reducing the direct and indirect costs of disability. It has been found, for example, that costs are minimal when accessibility is built into the design of facilities and generic programs, as opposed to retrofitting.

5. Direct involvement of individuals with disabilities with programs, services, and policies that affect them increases their satisfaction and support, produces higher levels of functioning, and greater success at community integration.

A greater integration of persons with disabilities in the decision-making process for issues that affect them directly usually leads to more effective decisions being made.

Specific Lessons Learned: Employment

When it comes to the placement of people with disabilities within the labour market, there are many misconceptions about their potential to work. However, there is strong evidence that a substantial proportion of people with disabilities who are not currently in the labour force are capable of being employed in some way, given proper supports and removal of barriers. Unfortunately, many past programs and policies have held to an all-or-nothing view of employability that has resulted in disincentives to work. A more supportive approach would choose to see employability along a continuum as opposed to an either/or situation.

As for workplace barriers, they can largely be classified as either physical or attitudinal. With regards to physical barriers, job accommodations, usually of nominal cost, can enable many people with disabilities to be fully employed. Employers who have provided such accommodations say that the savings they have achieved average 27 times the cost of providing the accommodations.

In regard to attitudinal barriers, misperceptions and lack of information on the part of employers do play a role in keeping people with disabilities out of the workforce. One attempt to overcome this barrier has been through the provision of wage subsidies that are designed to encourage the private sector to increase the training and employment opportunities for persons with disabilities. However, the effectiveness of these subsidies has been mixed. For example, while subsidies can help people who have little or no experience gain entry to the labour market, it is not certain that they lead to long-term employment once the subsidy is over.

Another consideration is the effectiveness of interventions. Evaluations of return-to-work programs from a variety of settings emphasise the importance of early intervention and active case management. It has been estimated that up to 10% of CPP beneficiaries have potential for rehabilitation and return to the workforce. One program that has potential to enable people with disabilities to participate in the labour force is the vocational rehabilitational programs. Unfortunately, the biggest limitation to the effectiveness of such return-to-work programs has been the lack of access.

Another issue is the assistance provided to people with disabilities to assist them in getting into the labour force. In this area, supported employment has proven a better and more cost-effective alternative to sheltered work.

The supported employment model provides opportunities to work in regular employment settings and it results in a higher degree of satisfaction than that found among individuals participating in sheltered workshop placements.

Whichever approach is chosen to assist people with disabilities to find employment, evidence from the data gathered in this study suggests that a co-ordinated approach is the most effective. This approach takes into consideration the varied needs of the people searching for work; the varied needs of the employers and the position in the labour market of people with disabilities find themselves.

Specific Lessons Learned: Barrier Removal Legislation

Despite the importance of proper supports, barriers remain the major stumbling block to full participation for many people with disabilities. In order to accelerate the necessary changes, legislation is needed. In fact, barrier removal legislation has proven to be much more effective than awareness campaigns and public relations campaigns when it comes to enabling people with disabilities to participate more fully in society. Legislation that has clear and precise standards has been identified as being far more effective in removing barriers than legislation with generalised criteria. Consequently, Canadian human rights commissions and employment equity legislation have been limited in their effectiveness in addressing the barriers faced by people with disabilities. Since their standards have been unclear, they have had to rely upon litigation for enforcement and the resulting costs have been high. Conversely, the Americans with Disabilities Act (ADA) has been successful in enabling access for people with disabilities in a number of different areas. However, in the case of the ADA it should be noted, that support from the business community came after its implementation, not before. This shows that changes in attitudes can follow changes in behaviour.

In the area of barrier removal legislation and employment, “redistributive” or “grant-levy” approaches can permit stable participation of the significant minority of individuals with severe disabilities whose labour market attachment is marginal. By providing incentives for employers to hire individuals with disabilities, or by levying taxes on those who do not, these models place some responsibility for employment of people with disabilities on employers while providing options for how this is to be done. While the overall effectiveness of this particular method is presently unclear, it is thought to be an improvement over the direct quota system that socially stigmatises the participants and is considered ineffective.

Specific Lessons Learned: Disability Income Programs

A major issue of contention has been the definition of disability for the purpose of eligibility to income assistance programs. The fact that different programs “define disability” differently sometimes leads to inconsistencies. The crucial point here is that the relationships between programs need to be taken into account and any contemplated changes should be examined from a systemic rather than program perspective. In this way, one is more likely to be aware of unintended impacts and effects within each program, as well as possible unintended outcomes when program changes are considered.

As mentioned under the employment heading, 10% of CPP disability beneficiaries have the potential to return to work given the appropriate vocational rehabilitation services. However, if there is to be a successful return-to-work, early intervention has been identified as a crucial factor. Yet such intervention would require greater cohesion across program lines than currently exists. To encourage increased co-operation across program lines, one must remember that even limited success in enabling people to return to work can result in very significant cost savings.

Overall, there is no a priori reason to suggest that a unified system would be more effective than what now exists. Consequently, consideration of a more co-ordinated system might be a more meaningful intermediate step towards reform.

Specific Lessons Learned: Independent Living and Community Support Services

Most people with disabilities, if they have the supports they need, can live independently and participate in the community. In fact, people with disabilities strongly favour community living, in particular, the independent living model gives them control over their lives.

The principal reason for the success of community living is the level of individual control it provides to people with disabilities. From the perspective of the service provider, services based upon independent living principles are more effective than traditional, professionally driven services.

Another approach that has been documented as an effective model for the provision of services is direct funding. Also referred to as “individualised funding”, “service brokerage”, or “self-managed attendant care”, direct funding allows individual customers to hire and direct their own staff. Evaluations have documented the effectiveness of direct funding in terms of improvements in customer satisfaction, dignity and well-being, control over their own lives, and positive impacts on family members.

While the “open house” vision is increasingly accepted in principle, many services are slow in adapting to the new philosophy. While one of the core values of the independent living movement is empowerment, many agencies are slow to adopt this principle and they continue to offer services based upon the medical/ rehabilitation model.

Specific Lessons Learned: Implications for Future Evaluations

1. Evaluation paradigms and approaches have been evolving.

There is a strong trend in the evaluation field towards participatory and empowerment evaluation, with greater involvement of consumers in the process.

2. There is insufficient information about the full costs of disability, and the fiscal relationships among disability programs are unclear.

The fact that benefits from program measures and expenditures may accrue in different cost centres is one of the biggest obstacles to systemic change.

3. Greater consensus is needed on appropriate outcome measures for evaluating disability policy.

Without agreement on at least the general goals of policies, it can be difficult or impossible to focus evaluation efforts. Consequently, evaluation findings may not be considered meaningful or acceptable. There is particular potential for using the concept of quality of life as a primary outcome indicator, all the while considering the degree of cost-effectiveness.