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Publications: CRPs Redefined
An NCARF position paper on the role of Community Rehabilitation Programs in community-based service delivery to people with disabilities.
In response to the de-institutionalization movement, community-based day program options were developed for individuals being discharged from the state mental retardation centers and mental health institutions. Known as ‘sheltered workshops for the disabled,’ these programs offered vocational training, paid work, and employment opportunities using work contracted from local business and industry. During the 1960’s and 1970’s organizations incorporated in nearly every county in North Carolina, most as private not-for-profits while others operated through the emerging public mental health and developmental disability services system. Families, physicians, and other human service professionals were choosing (not consumers---not yet, at least) services offered by Community Rehabilitation Programs (CRPs) based in their home communities, rather than services offered by regional institutions.
Until the early-1980’s North Carolina’s primary service delivery model was CRP-based sheltered employment. As rehabilitation staff learned about the Supported Employment models utilized in other states, the perceived employment limits of people with disabilities were re-evaluated and facilities began to create opportunities for consumers to participate in community-based employment. In the mid-1980’s, NCARF, the NC Division of Vocational Rehabilitation Services, and the Developmental Disabilities Services Section of the NC Division of MH/DD/SA, collaborated to fund eight supported employment pilot sites. Of the eight projects, seven were hosted by CRPs that developed mobile work crews, enclaves in industry, and models based on individual job coaching. By the end of the decade, supported employment models and service delivery options had been enthusiastically embraced by many CRP’s, and additional supported employment programs began operation with the support of the two state agencies.
The funding systems in the developmental disabilities services sector, however, did not keep pace with the needed expansion of these programs, as funding was and continues to be based on a subsidy that provides only a 60-65% reimbursement of service costs to CRPs. Consequently, most CRPs remain heavily dependant on the revenues generated by their production components and must continue to provide services in the most cost-effective manner (work groups of 8-10 persons in a facility-based model), as opposed to the acknowledged ‘best practice’ models which are not only community-based but more individualized.
While CRPs in metropolitan areas of North Carolina had many opportunities to help people with disabilities find work in the community, the rural areas of the state were met with some very real challenges. Often, CRPs in these areas were (and still are) the largest employers in their community. This meant there were very few community-based jobs in which to place individuals with disabilities. Therefore, some facilities began to explore the benefits of reverse integration----employing people without disabilities as model workers in sufficient numbers that their programs began to resemble the other work places in their communities. No longer were these facilities a specialized place of employment for people with disabilities----they were one of their community’s main employers for all persons. These CRPs provide living wages and benefits to all employees and---like any other successful business---have become quite sophisticated in their product development, marketing, and manufacturing techniques.
In short, the development of service delivery to people with disabilities has been an evolutionary process. Forty years ago, the regional hospitalization of a person with a developmental disability was the accepted ‘best practice’ service model. A decade later, that ‘best practice’ became the de-institutionalization of citizens with disabilities into community-based congregate living and work programs. And so it has evolved, where we now know and accept best practice as including the movement of people with disabilities into community-based living and working, in places and careers of their choosing, no matter the severity of their disability.
Community Rehabilitation Programs wish to promote those practices and strategies which will support the inclusion of people with disabilities in their communities---they are only limited by the lack of available funds and reimbursement systems which will support more individualized service models. There have been few---if any---incentives beside the intrinsic knowledge that it was ‘the right thing to do’ for and with people with disabilities. Most programs continue to believe that it is important to maintain a full array of service options, and that there are people who cannot or will not accept community placement. We recognize that the availability of newer community-based service options, presented to young men and women as they exit the school system, will be more frequently selected by them (and their families) through earlier education and an increasing awareness of the success of others who pioneered these models.
Since 1964, the member agencies of the North Carolina Association of Rehabilitation Facilities have played a unique role in providing community-based training and employment to persons with disabilities. These agencies---over 70 in all---continue to provide a broad range of services each day to over 10,000 North Carolinians with disabilities. As the trade association for these agencies, the North Carolina Association of Rehabilitation Facilities will continue---through its membership and leadership---to collaborate with State funding agencies and sponsors in an effort to create individualized models of service delivery which will result in our consumer’s full community ownership and participation.
Adopted January 29, 2003 by the NCARF Board of Directors
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