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WORKING COPY
NOT To BE QUOTED
SOCIAL CONTEXTS OF HUMAN REHABILITATION:
PAST, PRESENT, AND FUTURE
Technology Assessment: Human Rehabilitation Techniques
Project
Department
Research and Training
of
Center
Industrial Engineering
in Mental Retardation
TEXAS TECH UNIVERSITY
Lubbock, Texas
Prepared for:
CONSEQUENCE ANALYSIS WORK SESSION
July 6 - 9, 1976
WORKING PAPER NUMBER 2
LIST OF WORKING PAPERS
Conceptual Framework/Program Thrusts
1
Social Contexts of Human Rehabilitation: Past,
Present and Future
2
Scope of the Problem of Disability: Life Functions
3
Rehabilitation Technologies
4
Abstracts of Papers Concerning Special Problem
Dimensions
5
Related Data
6
Possible Related Issues
7
NOTE
Please make all your comments (review comments, raise questions,
raise arguments, provide supplemental material and references,
etc.) within this booklet. Please use the margins and opposite
page. These will be used to assist the team in producing the
Work Session report and final report.
i
TABLE OF CONTENTS
Issues, Problems, Policies and Solution Within
Society
4
A Perspective on the Issues of the Disabled
Population
10
The Past - A Prologue to the Future
19
Development of Scenarios
26
Scenario Group I
35
Scenario Group II
37
Scenario Group III
39
Tables
1
Views of the Problem
13
2
State of Society Variables
42
Figures
1
General Relationship of Issues, Problems,
Policies and Solutions Within Society
4
2
Classification Hierarchy of the Members of
Society
10
3
Hierarchical Arrangements of Elements Appearing
in Scenarios
30
4
Net National Product
43
5
Society's Capability of Addressing Problems
44
6
Range of Government Expenditures
45
7
Range of Society's Willingness to be Taxed
46
8
Disabled Population.
47
9
Range of Government Expenditures for Social
Needs
48
ii
SOCIAL CONTEXTS OF HUMAN REHABILITATION:
PAST, PRESENT AND FUTURE
This technology assessment (TA) examines the impacts
and consequences upon society of techniques used in support
of the disabled in American society. All of the techniques
have a primary objective of effectively reducing the size
of our disabled population through assimilation of rehabilitated
individuals into the community and if possible into the work-
force, and thus, making their lives fuller and happier. The
primary objective of the various rehabilitation programs fit
into three basic classifications according to the technology
they employ, each with various "program thrusts," including
rehabilitation techniques based on environmental change,
on training and counseling, on physical intervention. A fourth
related technology is that of rehabilitation-service delivery
systems.
As various programs are used to achieve objectives in
reducing the number of disabled persons through rehabilitation,
they concurrently produce impacts on society as a whole. In
general, the programs require resources from the entire society;
thus "impact" on and have "consequences" for nondisabled per-
sons by reducing the resources available to meet other objec-
tives within society. Likewise, some programs impact or have
consequences which improve societies general well being.
Similarly, programs for meeting social objectives outside the
rehabilitation domain limit resources available for rehabili-
the Growth
2
tation programs. Such interaction between the disabled popu-
lation and the entire society is both an extremely important
and an extremely complex relationship which must be accounted
for in assessing future impacts and consequences of rehabilita-
tion technology.
To permit ordered examination of possible roles that
rehabilitation technology may play in the future of American
society, the interactive relationships must be carefully
observed and described. The "rails of inference" leading into
the future include concretely observable trends from the past
and present. Moreover, they also include a mechanism for
recognizing social characteristics and events which may occur
or develop in the future despite our lack of inference with
which to project them from the past. Economic boom or
depression, war, technological breakthrough, and rapid politi-
cal change are among many other social characteristics and
events which may also shape the role of rehabilitation techno-
logy within society in the future.
The complex disposition of American society is, in this
TA, accounted for by descriptive "scenarios" literally, "plot
outlines' - of the future. A most probable scenario group des-
cribes certain events and characteristics likely to occur accord-
ing to projections from the past. Two other scenario groups estab-
lish plausible limits of possibility in the future of American
events and characteristics with respect to the primary objec-
tive of rehabilitation; the first describes an accelerated
3
growth in funding for social needs and effectiveness of
foreseeable rehabilitation programs, and the second describes
a reduced growth in funding for social needs and effectiveness
of rehabilitation programs. Within these three scenario groups,
various possibilities for the future of rehabilitation techno-
logy will be analyzed.
4
Issues, Problems, Policies and Solutions Within Society
This problem oriented TA deals specifically with the pro-
blems and policies related to the area of human rehabilitation.
In order to provide a common understanding of terms for use in
the project work sessions and to highlight various concepts
which will have an influence on the consequence analysis of
programs thrusts, the following brief discussion relative to
issues within a society is presented. A general relationship
is presented in Figure 1 indicating that the problem emanates
Issue
Question to
be decided
Solution
Problem
Act, Method on
Issue Proposed
Process of
for Solution,
Solving Problem
Objective Defined
[Need]
Y
Policy
General Course
of Action
Alternatives
Options
[Means]
[Methods]
Figure 1
5
from an issue. Consideration of the problem leads to a defined
objective which in turn leads to an adopted policy after various
options or methods of approach are considered. Upon the
consideration of alternative means a solution is obtained. It
should be noted that an issue may surface in various ways; in
fact, a certain solution selected at one point in time may be-
come an issue at a later point in time.
A problem may be defined as one or more "needs" that are
considered for solution while each "need" is identified as
the difference or gap between "what is" and "what could be" or
"what should be." Although defining a specific problem in these
terms may appear to be a relatively easy task, experience
teaches that this is generally not the case.
Several questions are encountered in defining problems.
The first question may occur in obtaining agreement in identi-
fying the "what is" of a current situation in that the present
is not always perceived with unanimity. The second question
may be encountered in defining the "what could be" or "what
should be."
It should be noted here that even if agreement is reached
on the "what could be" or "what should be," this does not
require that those agreeing are doing SO for the same reasons.
It is very possible that agreement can be reached due to very
different or even opposite reasons.
Given that an agreement can be reached on the "what is"
and the "what could be" or "what should be," a third question
6
may arise. This question deals with establishing the relative
priority any one "need" should have in relation to various
other "needs." It may be safe to say that many individuals
have had to answer these questions when attempting to identify
personal "needs" and subsequently establishing the relative
priorities of the needs that they may have identified.
It is assumed here that, at least on the individual level,
decisions are generally based on some value judgements either
rational or emotional. Initially the value judgement may be
used in defining the "what is" only if in terms as something
that should not be. Actions taken under these conditions often
result in adversity. If the "what should be" is measurably
identified, again based on some value judgement, the individual
has at least established some direction and the progress in
achieving an objective can be measured. Due to the fact that
often times an individual is faced with problems competing
for action, the individual may find it necessary to establish
priorities among the various problems.
As the number of individuals involved in this process
increases thereby forming a society, it is very likely that the
magnitude of the difficulty in answering the above questions
increases also. If the numerical size of the population is
relatively small, i.e., a family, the difficulty in establishing
a value judgement upon which to base a decision may be minor.
As the society in question increases from family size to include
neighborhood, to the community, to the entire population of the
nation, the difficulties encountered differ only in complexity
7
and magnitude. The value judgements made at these various
levels are referred to here as "common" value judgements.
This designation, i.e., "common," does not mean that the value
judgement represents the value judgement of all the individuals
involved or even the majority of those individuals.
For the purposes here it is assumed that "common" value
judgements affecting society are established within two interre-
lated and interdependent subsystems within the social system.
The first of these two subsystems is the cultural subsystem.
The "common" value judgements influencing the decisions and
thus the actions of the members of society within the cultural
subsystem usually take an unwritten form and are generally
referred to as customs and courtesies. It should be recognized
that in any large society there may exist many subcultures
each with its own set of customs and courtesies. The second
of these two subsystems is the political subsystem. The "common"
value judgements within a political subsystem generally take
a written form commonly referred to as laws, statutes or policies.
The set of common value judgements established within a
subculture within the cultural subsystem may be no less binding
on the individual than the set established within the political
subsystem. On many occasions a violation of the subcultural
values of a group may be dealt with more harshly than a violation
of the politically established values of society.
Many common value judgements that originated within the
cultural subsystem may find their way into the set of political
common value judgements. Thus, a review of the political
8
subsystem of a society within a specific area, may possibly
be used to establish trends relating to society's formalized
identification of "needs" and the priority given to providing
solutions to the various problems in relationship to the other
problems of society.
If a problem has, in fact, been identified as the measurable
difference or gap between "what is" and "what should be," then
a solution can be generally defined as a measurable reduction
in or the elimination of a problem. This definition requires
action concerning not only the identification of those methods
available that can measurably reduce or eliminate a problem
but also the selection and implementation of the means capable
of achieving the solution.
As used here, the consideration of "method" leads to the
establishment of policy and procedure which may be employed
in obtaining a solution whereas the consideration of "means"
specifies the resources used in obtaining a solution. A
method in obtaining a solution may consist of altering the
constraints upon a problem. For example, in the definition
of a problem, the "what should be" can be set equal to the
"what is," thereby eliminating the problem. It may also be
possible to change the common value judgements, i.e., rules
or laws pertaining to the problem. In defining the "means"
in terms of the resources utilized in obtaining a solution,
the reference here is to those factors which are commonly
referred to as economic resources.
9
Just as in the case of the cultural and political subsystems,
the actual distribution of the economic resources and the
relative authority exercised within this subsystem do not
necessarily express the desire of the majority of society.
As individual or societal value judgements shift; whether due
to changes in customs, growth, or special interest groups
influence; new problems are identified. The utilization of means
in providing solutions to these problems often requires various
shifts in the distribution of allocatable resources. It may be
considered sufficient to many to simply state that society in
general is faced with a myraid of needs both public and private.
Further it is generally acknowledged that the allocatable re-
sources available to solve these many problems are limited in
one form or another.
10
A Perspective on the Issues of the Disabled Population
The questions in defining the problems associated with
the issues of a population of physically or mentally disabled
or disadvantaged individuals are quite similar to those
encountered in defining most other complex social problems.
The general "what is" of the issues is that within the American
society consisting of approximately 215 million individuals,
there exists a group of people that for some physical and/or
mental reason, cannot perform a minimum of normal human functions
with a minimum normal degree of ease. This group of people
form a subpopulation which can be further divided into two subgroups.
This division may well be to distinguish between those who
cannot perform a minimum of normal human functions and those
that can, however, not with a minimum normal degree of ease.
The latter subgroup is referred to here as the handicapped
population whereas the former is referred to as the disabled
population. Figure 2 depicts a classification hierarchy of
the members of society based on the qualitative characteristic
of human functions and ease as quantified by some nebulous
measure of normality.
Members of
American Society
Physically or Mentally
Able Members
Disabled or Disadvantaged
Normal
Disabled
Handicapped
Figure 2
11
This general connotation would appear to be supported by
some of the various definitions of disability as found in the
literature. For example, James Garrett 1 states that "
disability
is defined as the inability to perform a certain role. " The
distinction between disabled and handicapped was made here to
allow for those individuals who are able "to perform a certain
role" but with difficulty. This TA deals with the issues and
problems of both the disabled and the handicapped. For ease
of reference this subpopulation will be referred to as the
disabled population.
It could be argued at least in general terms, that the
"what should be" of this issue could be stated in terms that
there would be no disabled population. Sufficient empirical
evidence exists that would tend to support the position that a
subpopulation of this type will continue to exist at least within
the 50 year time frame used in this TA.
Any given set of criteria used in defining normal activities
may be considered aribtrary depending on individually held view-
points. Even if agreement could be reached in defining normality,
thereby establishing a common "what is" concerning the issues, it
may be possible that perhaps some fatalistically oriented members
of society would consider that the "what should be" is equal
to the "what is. " To these members of society, the disabled
population would pose no problems within society. However,
the remainder of society apparently considers that the existence
of a disabled population does pose many problems within society.
1
Garrett, James F., "Handicapped Americans--Overview," American
Rehabilitation, May/June, 1976.
12
In viewing the problems connected with the existence
of a disabled population it may be helpful to at least estimate
not only the total size of this population but also the size of
the various groupings that could be formed based on the normal
activities affected through the disability or handicapped.
Table 1 outlines a few of the affected activities along with
some general parameter of the individual problems.
It is assumed here that, due to the technicalities of the
terms used in defining the disabled and handicapped, many indivi-
duals included within this total subpopulation will continue
to remainso indifinitely. If one were to address a single
characteristic of the disabled population in order to define a
specific objective of rehabilitation the characteristic could
well be its size. The objective of rehabilitation could then
be stated as the measurable reduction or elimination of the
size of the disabled population. One method of achieving this
overall objective would be to assimilate the disabled into society
as functioning members and if possible, into the workforce.
This could be accomplished through the identification and
achievement of many subobjectives, such as: restoration of
skills, secondary prevention, etc., as represented by the
program thrusts.
Once the present size of the disabled population is identi-
fied under current definitions, its future size will be deter-
mined by the number of individuals entering this population in
relation to the number leaving this population.
Table 1
Views of the Problem: Normal Activities Affected
Numbers affected
Issue
Problem
Dimensions: "what is" and "what should be"
Community and
Lack of access to
"Almost totally neglected by all federal agencies are the transportation
extended locomo-
mass transportation
problems of persons with multiple and severe disabilities."
tion
facilities
"Federal programs for meeting transportation needs of persons with
disabilities are piecemeal, fragmented, incomplete, and inadequate."
13.4 million
"Federal support of training programs must be increased if persons
with disabilities are to increase their ability to effectively use
transportation modes."
2.4 million
"
have difficulty with some or all of the following functions related
to reaching, handling, and grasping, passing through turnstile, opening
vehicle doors, lifting baggages, grasping overhead supports, using
hand rails, and handling small change."
5.2 million
by 1985
"
citizens will be unable to change levels under their own
strength.'
13
"The major problems
are costs of obtaining services, availability
of services, physical demands made on passengers by the design of
transportation facilities and equipment, and comprehension and under-
standing as to when
services are appropriate and adequate.'
"The availability of accessible transportation affects directly the
quality of life"
"There are too many loopholes, too many ways local government can
cite their commonly shared fiscal shortfalls and not do justice to the
intent of these proposed rules."
"UMTA is reluctant to encourage manufacturers and require transit
authorities to immediately utilize exciting technology to solve trans-
portation problems of the disabled."
Numbers affected
Issue
Problem
Dimensions: "what is" and "what should be"
"The FAA underlying assumption is 'that handicapped persons will cause
most, if not all, of the difficulties in an emergency evacuation of an
airline'
"
Litigation
"
constitutional principles guaranteeing freedom of movement and
equal protection, require federal and local transit authorities se-
curing federal funds to provide accessible services."
"
the legislation in question is nothing more than a broad, non
operative statement of national policy, requiring little more than the
present research and demonstration programs
There is no constitu-
tionally guaranteed right to accessible transportation and that whatever
services disabled persons receive will be entirely at the discretion
of America's transit policy makers. "
Education**
lack of development
"A recent survey by Metz
estimated that
ten percent of the
due to lack of access
children were handicapped.
only 63 percent of these received one or
to proper Education.
more specialized services ranging from separate classrooms to individual
instruction."
14
8.7 million
"Using an incidence estimate of ten percent handicapped, a total of
handicapped children would need and have a right to publicly supported
educational services by 1980. This would be a sizeable increase over
4.7 million
the
school age handicapped children in 1970 needing special services
2.9 million
and a quantum leap over the estimated 62 percent of
who were re-
ceiving them in 1970.
"A recent report from BEH indicated that only 25 percent of the handi-
capped graduating from school will get adequate employment. Another
40 percent will be significantly underemployed and 35 percent will be
under the care of social services without employment."
"One well known conservative contender for the presidential post has
suggested cutting Federal spending in the area of special education by
$6.9 billion. "
Numbers affected
Issue
Problem
Dimensions: "what is" and "what should be"
"Governor Edward Brown, Jr., of California stated we are entering
an era of limits
It's now a question of reordering priorities and
choosing one program over another, based on a vigorous standard of
equity and common sense'.
"Other steps should be taken in order to effectively utilize the budget
and to satisfy the two important objectives of (1) assuring equal
access to programs and (2) achieving maximum efficiency in use of
resources.
Litigation
"Predominantly class-action in nature, the litigation has focused on
three major issues: the right to education; the right to treatment,
and the use of inappropriate procedures for the classification and
placement of children with special needs."
"
the court declared that insufficient funds were not an excuse for
noncompliance when
stated, 'the inadequacies of the District of
Columbia public school system, whether occasioned by insufficient
funding or administrative inefficiency, certainly cannot be permitted
15
to bear more heavily on the exceptional or handicapped child than on
the normal child'.
"
By stating that such programs must be made available to all
children,
no matter how seriously or extensively they are re-
tarded', the court eliminated the severity of a child's disability
as justification for non delivery of services."
Litigation
All Handicapped Children Act (PL 94-142)
"The act establishes a formula in which the Federal governments makes
a commitment to pay a gradually - escalating percentage of the national
average expenditure per public school
This percentage escalates
to a 40 percent level in 1982 and remains through subsequent years.
Numbers affected
Issue
Problem
Dimensions: "what is" and "what should be"
"This law has far reaching implications not only for education of the
handicapped but also for shifting balances of powers among Federal,
state, and local levels. Such rearrangements could result in a
backlog. This would leave the school district without the monies
and the Federal government without impact in this much needed area.
Heated debates on issues raised by this Act are likely to continue
for some time to come.
Employment***
Lack of opportu-
possible factors
nity to become
self-supporting
right to work
discrimination in hiring practices
safety of employment environment
6-7 million
lower productivity
more costly
Independent
Lack of freedom
possible factors
living
from financially
related living
right to quality life
conditions.
independent of costs
16
excessive costs
disincentive to be rehabilitated
Barrier free
Lack of proper
possible factors
housing
design in general
housing
right to living location
right to all types of dwellings costs
costs
All quoted material came from the following papers written for this T.A.
*Transportation Problems of Persons with Disabilities: The Federal Response. Researched and prepared by
E. Clark Ross, March 1, 1976.
**The Futures of Public Education and the Handicapped. Ron Wiegernik and Vincent J. Feudo.
***The Employment, Independent Living and Barrier Free Housing are presented as examples of other issues and
problems. Additional papers are being written in various areas and will be available before the work sessions.
17
Individuals may enter this population as a result of
various natural and social causes. They may also enter
through an expansion of the definitions of disabilities. Many
also leave this population for various reasons. Some individuals
depart the American society either through death or emigration,
others may be rehabilitated with or without public social assist-
ance. At some time in the future others may leave due to a
restriction in the definitions of disabilities.
Society's success in its rehabilitation efforts in reducing
the size of the disabled population is related to society's
capabilities and willingness to provide solutions to identified
problems. Success also depends on the capability and willing-
ness of the members of the disabled population to cooperate
in these efforts. Thus, even though society may have the
necessary capabilities and willingness to provide solutions to
these problems through rehabilitating techniques, success is not
automatic.
Despite any rules or regulations prohibiting various forms
of discriminatory practices, difficulties do arise in assimi-
lating the rehabilitated. Individual attitudes are very diffi-
cult to change. Factors such as the disabled individual's
age, sex, race, education and economic levels and the visibility
of disability all play very important roles [see the Life
Function report] in solving the problem even when the physical
capabilities to provide a solution are present. These factors
influence whether or not the rehabilitated individual will
18
be able to function in the environment. Other factors may
adversely influence the disabled individual and hinder
rehabilitation. For example, the loss of attention previously
received from family, friends, etc., the loss of current
economic benefits, i.e., income supplement or income maintenance.
Addressing the problem of the currently defined disabled
population poses many subproblems. If both society and the
disabled population were to achieve "tremendous" success in
reducing the size of the disabled population through assorted
combinations of human rehabilitation techniques, various impacts
may be felt. For example, these consequences could be in the
areas of employment and unemployment in general and specifically
within the rehabilitation field.
Success in reducing the size of the currently defined
disabled population may allow anexpansion of the definition
of the disabled in keeping with society's capability and will-
ingness to address additional disabilities in relationship
to society's other problems.
(
19
The Past - A Prologue to the Future
The American social system has a history relating to
problem solving activities. From its inception, its economic
resources, including not only money and material but also human
resources, have continued to grow. The increase in growth is
generally believed to have been brought about by the continual
change in the objectives and goals established by society and
improvements in the method and means used in solving problems.
On many occasions resources had to be developed, modified or
designed before the means to solve a particular problem became
available. For example, education has assisted in developing
human resources, new technologies had to be designed for man to
reach the moon.
The economic strength of society has, on occasion, been
measured through indicators dealing with the society's gross
national product (GNP). With an occasional exception, the
American society's GNP has continued to grow both in absolute
terms and in relationship to the total population. The GNP
has also continued to grow relative to the human resources
whose production is reflected in GNP. Thus, it may be possible
to consider that the productivity of society has increased
not only due to technological development in materials re-
sources, i.e., machines, electronics, etc. but also due to the
development of the human resources.
Although the size of the GNP has been used as a reflection
of society's standard of living, other factors must be considered
20
when reference is made to that group of problems dealing with
the concept of the quality of life or the social well being
of society. Efforts to develop more effective methods and means
of solving this group of problems began to gain momentum after
the turn of the century.
As the American society entered the Twentieth Century,
attempts were being made to solve many of its problems. The
amount of authority exercised by the public sector within the
economic subsystem was comparatively limited. One of these
problems dealt with status of the "less fortunate" members
of society. Activities of organized labor that began prior to
World War I had identified the problem of retraining those
workers who had been injured in industrial accidents. By the
time the legislation was enacted in 1921 the problem had been
enlarged to include other than those injured within industry.
This act was termed the Vocational Rehabilitation Act. [For
more detailed discussion of the legal environment surrounding
the disabled and rehabilitation, see Bubany. Thus, a shift
in attitude had taken place; whereas previously problems associ-
ated with disabilities had been handled almost exclusively
within the private sector, they were now addressed in the public
sector.
During the depression years that followed the crash of 1929,
the Social Security Act was passed. This act, passed in 1935,
generally addressed the problems of unemployment and old age.
Survivor insurance was added to the Social Security Act in
1939. The Railroad Retirement Act of 1937 was established to
21
provide disability and old age benefits to railroad workers.
Society gradually increased its capability to provide
economic resources in an attempt to reduce or eliminate pro-
blems in those areas. Yet many segments of society still
faced severe problems.
World War II brought about a period of rapid growth in
the GNP. A common cause provided the impetus needed to ac-
celerate the growth in many areas of technology. During the
middle of the war (1943) the Vocational Rehabilitation Act
was amended to permit the extension of publicly supported
rehabilitation service to the mentally retarded (MR) and the
mentally ill (MI). This one stroke formally added hundreds of
thousands to the rolls of the disabled by way of a change in
policy and the resulting solution--a change in definition of
eligibility. These hundreds of thousands did not just appear
on the horizon. Until 1943, at least on the federal level,
neglect was the former value judgement. Care for, or rehabili-
tation of, these individuals had been generally dealt with at
the state or local level or in the private sector.
Since that time the number of programs dealing with society's
problems have continued to increase. The federal, state, and
local governments have increased the exercise of their authority
within the economic subsystem considerably. For example, during
the 20 year period from 1950 to 1970, total government expendi-
tures increased from 21.34 percent of the GNP to 32.04 percent.
If capital consumption values were removed from the GNP, thereby
leaving what is termed the net national product (NNP), the
22
relative exercise of economic authority during this same period
shows that government expenditures have increased from 22.82
percent to 35.07 percent. It may be well to note that the
bulk of the monies used by the federal, state and local govern-
ments in this exercise of the public's authority within the
economic subsystem is derived from the members of society
through various forms of taxes. The taxes over the years have
continued to increase as evidenced by government's increased
contribution to the GNP. It may be possible that at some
level of taxation, the productive members of the private sector
may become dissatisfied with its share of authority within the
economic subsystem. History states that taxes were a major
issue in the founding of this nation. The dissatisfaction,
of course, may not be aimed at any specific issue, problem,
policy or solution.
Other political events dealing with humanitarian problems
occured during the 1960's. Civil rights issues came to the
forefront. Various cultural minorities characterized by ethnic
background, socioeconomic levels, or sex began articulating
their interests within the political, economic and cultural
subsystems. For example, these groups identified the "what
should be" of the problems in such a manner that the resultant
legislation not only made it illegal to use discriminatory
practices in hiring but also stipulated positive employment
practices that were to be followed. Specific employers were
required to have a certain percentage of their employees come
from within these groups. Additionally, regulations required
23
that many of these employees could not be hired into dead-end,
low-level positions.
Although the military forces of the country were involved
in an unpopular conflict in Vietnam, the federal government
launched the "War on Poverty. One subgroup of the target
population of this "War on Poverty," the welfare population,
became visible and vocal in expressing the opinion that welfare
benefits should be increased. Many of the "benefits" described
in the "what should be" were considered as rights and were
granted.
The tenor of the 60's and early to mid 70's has been one
showing concern for equity issues. These issues are referred to
here as equity issues in that they dealt with inequalities
resulting from past actions. For example, the affirmative
actions legislation designed to ensure employment of members
of minority groups in various occupations. It was felt that
due to past discrimination practices members of the minority
groups had received unequal treatment. Some members of society
viewed these actions as preferrential treatment for minorities,
especially those people adversely affected because they were
not members of any minority group.
The economic recession that began in 1973 and extended
well into 1975 initiated a shift in eligibility requirements
for receiving unemployment. The length of eligibility was
eventually extended from 13 weeks to 65 weeks in order to
assist those members of society that had been adversely effected
by the recession.
24
Regulations dealing with civil rights issues, the "War
on Poverty," affirmative actions in the employment field and
unemployment benefits are primarily the results of the
actions of or concern for "special interest" groups. Unlike
some regulations, most of these regulations detail the rights
of the individuals with little if any delineation of responsi-
bilities that these rights carry. Some regulations, however,
do specify rights and responsibilities. For example, one such
regulation states the members of the society have the "right"
to earn a living by working or investing in order to receive
income, the IRS rules and regulations deal with the responsi-
bilities to pay taxes on this income.
All in all, it can be said that the American society has
continually increased its total capability to address the
various problems of society. It would appear logical to state
that historically society is willing to address its problems.
Throughout its history, society has chosen to either
measurably reduce or to eliminate many problems. Of course,
others have been considered infeasible for solution and still
others may appear to some as having been ignored. The solution
of the specific problems selected required coordinated joint
activity in the use of many resources. The success of the
solution was dependent upon the extent of the compatibility of
societies capability and willingness to solve the specific
problem. For example, the present state of space technology
has resulted from past decisions to develop this technology
25
wherein the decisions were based on some value judgements
either "commonly held or individually held." Sufficient
empirical evidence exists to demonstrate that the current
level of technological development within a specific area
is reflective of past compatibility of society's capability
and willingness to pursue a specific technological problem,
e.g., the moon landing.
The review of the past as presented here highlights the
various shifts in attitudes toward human problems dealing with
the disabled population and other "less fortunate" groups.
Detailed discussion of various aspects of problems related
to the disabled population is presented in the supplemental
reports. Concepts of rights and equity, relating to the
quality of life or social well being, have been discussed
within the context of society's general capability and willing-
ness to provide the methods and means of solving its problems.
26
Development of Scenarios
Introduction
Scenarios provide useful vehicles for the impact- or
consequence-analysis step of technology assessment. They pro-
vide an outline of some conceivable future state (s) of affairs
given certain assumptions about the present and a consideration
of the occurrences leading to the future period. Vlachos
states that "Scenarios or future histories are narrative des-
criptions of potential courses of development which may describe
some expected or desired future state." Scenarios should develop
alternative possible futures- "to demonstrate the range of
developments, those likely to occur, those reasonably expected,
and even those that are conceivable or plausible as well as
desirable." They are developed in order to illustrate the
future, to stimulate thought about the future, and to provide
a background against which an understanding of the impacts
and consequences of special issues or program thrusts can be
determined. Usually TA studies use scenarios to represent
"high" or "good", "average," and "low" or "bad" situations.
These are usually expressed by a limited number of scenario
theme dimensions that are selected to be basic characteristics
which are representative of potential futures.
Assumptions Relative to Human Rehabilitation
In order to develop the future states to provide for the
assessment of long-range effects from various program thrusts
applied to the problem of rehabilitation, the following general
27
assumptions underlie the function of human rehabilitation in
the future.
1. Concepts of humanitarianism and equity influencing the
rehabilitation of the disabled will continue to prevail within
society.
2. Public funding for social welfare programs will con-
tinue and will receive increasing consideration in relation to
the total needs of society.
3. Increased consideration will be given to establishing
responsibilities required of those receiving the benefits.
4. For society to continue present levels or increased
levels of funding for social programs, increasing productivity
is a necessity.
5. Governmental expenditures will continue to be funded
primarily through taxation.
6. The present goals of rehabilitation- to improve the
social well being of the disabled by assimilating them into
society and if possible into the workforce--will continue,
at least for the immediate future.
7. As the general level of technology increases, there
will be greater improvement in rehabilitation techniques.
Basic Scenario Themes and Dimensions
Based upon past trends, present consideration and emerging
policies three broad potential futures emerge within which the
problem of human rehabilitation can be assessed. These are
the following:
28
Scenario Group I
MGFS: Moderate Growth in Funding for Social Needs, No
Limit on Willingness to be Taxed.
MGFS-C: Moderage Growth in Funding for Social Needs,
Constraints on Willingness to be Taxed.
Scenario Group II
AGFS: Accelerated Growth in Funding for Social Needs,
No Limit on Willingness to be Taxed.
AGFS-C: Accelerated Growth in Funding for Social Needs,
Constraints on Willingness to be Taxed.
Scenario Group III
RGFS: Reduced Growth in Funding for Social Needs, No
Limit on Willingness to be Taxed.
RGFS-C: Reduced Growth in Funding for Social Needs,
Constraints on Willingness to be Taxed.
These three represent a continuum of possible alternatives
from minimal to rapid growth as well as redistribution of
funds among programs and a host of other conditions which will
be discussed later.
Society's decision to continue addressing social problems
and especially those of the disabled population will be pre-
dicated on both its capability and willingness to do SO. These
two major dimensions are selected, in that for any problem
involving humans the mere existence of the capability to act
a certain way under a given set of circumstances does not in and
of itself state that humans will act that way. Thus, although
29
society may possess the capabilities to provide the means,
it may not be willing to provide the means. Conversely, even
if society were eager to provide the means, it could not do
so without the capabilities. A general conceptual hierarchy
of these basic variables and rehabilitation program thrusts
is depicted in Figure 3.
The capability of society to address any of its needs
and problems is a function of multiple factors, the main contri-
butors being financial, technological, organizational, and
social attitudes. Based on a consideration of the problem
at hand and society's operation in the past, it appears valid
to assume that capability can be represented and measured best
by the financial and technological factors. Society has been
able to develop proper organizational structures and change
social attitudes when the finances and technologies are avail-
able. Further, it is assumed that government spending (funding
of programs) is a valid representation of society's considera-
tion of handling public problems and/or issues which it faces.
A general measure of society's financial capability to
address the problems of the disabled is defined as per capita
net national product (NNP = GNP - Capital Consumption) obtained
by dividing the NNP by the size of the population (NNP/Pop.).
The financial capabilities alone cannot directly produce
rehabilitation. Thus, society's technological capabilities
are also important.
A measure for society's overall technological capability
could be employed; e.g., in terms of the difference over time
30
LEVEL I
/CAPABILITY/
LEVEL II
WILLINGNESS TO BE TAXED
/
/ STANDARD OF LIVING /
LEVEL III
TOTAL GOVERNMENT SPENDING
LEVEL IV
/ FUNDS FOR SOCIETAL NEEDS
/
FUNDS FOR SECURITY NEEDS /
LEVEL V
/ SOCIETAL FUNDING FOR REHABILITATION
/
/ OTHER SOCIETAL FUNDING
/
FIGURE 3. Hierarchical Arrangement of Elements Appearing in Scenarios
31
in the NNP contribution per individual in the employed
workforce; i.e., [NNP, T n /Size Employed Workforce - NNP T n-1 /Size
n
Employed Workforce, T ], where ᵀₙ is the latest period being
n-1
considered and T n-1 is a prior period and assuming productive
hours remain constant. The difference (increase) in each
worker's contribution to NNP can be viewed as the contribution
of increased technology available to society. This measure,
however, considers technological contributions and advances
in all areas of need or endeavor and what is required to
consider the problem under study--human rehabilitation techni-
ques--is a measure of the technological capability in addressing
only this problem. Therefore, when the cumulative effects of
applying technological advances are felt, the rate of rehabila-
tation will increase, thereby reducing the population of dis-
abled. Thus, society's technological capability in addressing
the human rehabilitation problem will be reflected in the size
of "disabled population," as other factors remain constant
in this study.
The general willingness of society to address any of its
problems is also a function of multiple factors, such as:
private funds and foundations; society funds and programs at
federal, state and local levels; attitudinal positions; etc.
Here, based on the problem under consideration, it appears
valid to assume that society's willingness to be taxed to
provide governmental funds for federal spending is representa-
32
tive of this dimension. Therefore, the general measure of
society's willingness to address public problems is defined
in terms of the total federal dollars applied to security
needs, social needs and other needs relative to the net national
2
product
That is:
Willingness =
Σ (Security needs) + Σ (Social needs) + Other needs
NNP
Security Needs
Social Needs
Other Needs
i.e., national defense,
i.e., education and
i.e., general
international affairs,
social security, health,
government,
science and technology,
income security, veterans
interest.
natural resources and
benefits, revenue sharing,
environment, agriculture,
community and regional
commerce and transportation,
development.
law enforcement and justice.
This measure also permits the consideration of the rehabilita-
tion problem within the total needs of society. Based on some
of the discussion presently taking place in current literature
this measure appears to have an upper limit.
Within this general structure of society as defined by
the measures of capability and willingness the problem of
rehabilitation of the disabled is embedded as one of the social
needs requiring and receiving consideration and support.
The problem of human rehabilitation is a function of
multiple factors, for example size of the disabled population,
funds and other resources required, visibility, political
power, etc. The significance of a problem and/or the sub-
population affected varies considerably and is usually related
to its visibility. It is not the intention here to determine
2
The United States Budget in Brief--Fiscal Year 1977, Executive Office
of the President of the United States, Office of Management and Budget,
Washington, DC (January, 1976).
33
the significance, visibility, etc., but rather to accept
that human rehabilitation is a problem as indicated by the
extent of attention and funding provided both by legislation
enacted and by private and governmental agencies. Thus, the
problem must be dimensioned. The general scope of this pro-
blem is best defined by the size of the problem, both from the
aspect of financial support provided for it and by the number
of individuals included in the disabled population. The disabled
population is defined here as including those disabled indivi-
duals not assimilated into the community or the workforce. The
measures selected to represent the general problem are therefore
the funds made available to rehabilitation expressed as the
funds allocated to rehabilitation relative to the funding for
all social needs, and the size of the disabled population, both
severely and moderately disabled, which also reflects the
technological capability of society to address this problem.
It is with these four basic variables 3 reflecting the
general dimensions of the state of society and the size of
the problem being assessed that the themes for the scenarios
utilized in the TA are formulated. With these scenarios and
utilization of the hierarchial model described in Figure 3, it
is possible to perform the consequence analysis of various
program thrusts considered for adoption in rehabilitation.
Further, the scenarios as basically described in terms of
funds available for social needs are depictive of many potential
futures. For example, should a major war or famine involve our
3
capability, willingness, disabled population, and funds
for social needs
34
society, or should society decide on a major accelerated pro-
gram for the development of energy technologies in the future,
funds for security needs would increase thus having a decreasing
affect on funds for social needs. Even though willingness
to be taxed under these conditions would most likely increase
there would be reduced growth in funding for social needs as
represented by Scenario Group III, RGFS and RGFS-C. Likewise,
should a major breakthrough in technology as applied to the
disabled take place in the future, this would have the same
effect as that of an increase in capability with no increase
in security needs, thus providing accelerated growth in funding
for social needs. This future would be represented by Scenario
Group II, AGFS and AGFS-C.
The MGFS scenario reflecting moderate growth in funding
for social needs with no limit on the willingness to be taxed
is discussed first.
35
Scenario Group I
MGFS: Moderate Growth in Funding for Social Needs, No
Limit on the Willingness. to be Taxed.
No major new funding for rehabilitation occurs though
moderate growth is experienced, the maintenance of programs
initiated in the 70's continues, and some minor reallocations
among programs are made.
The disabled population grows at a moderate rate (main-
taining approximately the same percentage of total population)
to about the year 2000. At this time, due to continuing
research programs of the 60's and 70's, technological develop-
ment for rehabilitation needs begins to have marked effect
and the disabled population stabilizes growth.
Due to increased technological development in related areas,
by the year 2000 the moderately disabled and handicapped are
being better assimilated into society. For example, new trans-
portation systems are capable of handling the disabled; public
buildings are designed or remodeled to permit the disabled to
use them; industry has positive programs for their employment,
etc.
The United States continues to improve its productivity
at a moderately increasing rate and the NNP grows at an
average annual rate of 3.4 percent. [Prediction from Energy,
the Economy and Mass Transit, United States Congress, Office
of Technology Assessment, 1975].
The population grows moderately at an average annual
rate of .685 percent. [Predictions based on Statistical
36
Abstract of the United States, 1975].
The capability and the willingness of society to address
its public needs grows moderately along with the economy.
Due to legislation of Congress in the 60's and 70's, a
sizable amount of future tax funding is committed both for
the natural growth of committed programs and for the retirement
of debt. Thus, the tax rate rises at a moderate rate and this
coupled with a continuing moderate inflation rate has the
effect of lowering the standard of living or "lifestyle."
Unemployment rates continue at approximately the 6-7
percent level. For this reason and the fact that the work
ethic grows no major changes occur in work schedules, the work
week remains much as it is today.
The telecommunications industry contributes technology
that permits some work to be performed in the home. This
makes more jobs available to the disabled population but at
the same time they are competing for the work with the non-
disabled unemployed.
The problem of energy continues through the year 2025,
thus any energy intensive program thrusts are not highly
favored.
MGFS-C: Moderate Growth in Funding for Social Needs,
Constraints on Willingness to be Taxed.
Under this scenario, all factors are as depicted above
except that as the tax rate rises beyond a certain point
society reacts by opposing any new or additional funds for
governmental programs. This has an affect on funds available
for rehabilitation.
37
Scenario Group II
AGFS: Accelerated Growth in Funding for Social Needs,
No Limit on Willingness to be Taxed.
With an increasing growth of the economy, funding for
social programs grows and this has the effect of increasing
funds available for rehabilitation.
The disabled population grows at a moderate rate (main-
taining approximately the same percentage of total population)
to about the year 2000. At this time, due to continuing re-
search programs of the 60's and 70's, as well as additional
funding through the 80's and 90's, technology development for
rehabilitation needs begins to have marked affect and the
effective disabled population begins to reduce at a rate of
about 3 percent per year. New funding for rehabilitation
occurs as well as the maintenance of funding trends of the
70's and some major reallocations among programs occurs.
Due to increased technological development in related
areas, by the year 1995 the moderately disabled and handi-
capped are being better assimilated into society. For
example, new transportation systems are capable of handling
the disabled; public buildings are designed or remodeled to
permit the disabled to use them; and industry has positive
programs for employment of the disabled, etc.
The United States improves its productivity at an increas-
ing rate and the NNP grows at an average annual rate of 4.5
percent from now to 2025. [Predictions based on Technology
Assessment of Portable Energy, RDT & P Center for Energy
Studies, The University of Texas at Austin].
38
The population grows moderately at a annual rate of
.682 percent until 1985. From 1985 to 2020 the annual rate
is reduced to 2014 percent. From 2020 to 2025 the population
declines by an annual rate of .255 percent. [Predictions
based on Statistical Abstract of the United States, 1975].
The capability and the willingness of society to address
its public needs increases along with the economy.
Due to legislation of Congress in the 60's and 70's, a
sizable amount of future tax funding is committed both for
the natural growth of programs committed and for the retirement
of debt. The tax rate arises at a very moderate rate since
taxable income is increasing and a moderate inflation rate
continues.
Unemployment rates decrease to approximately the 4-5
percent level. For this reason and the relative prosperity
of society and their desire for leisure time in larger
amounts than provided by the two-day weekend, experimentation
with different work scheduling procedures occurs. By the
turn of the century, people are permitted to "bid" on work
time and with the use of computers, individualized worker
schedules are a reality. The basic 1920 working hours per
year is maintained, however.
The telecommunications industry contributes technology
that permits considerable work to be performed in the home.
This makes more jobs available to the disabled population and
many are gainfully employed because of the general prosperity
and the increasing productivity taking place.
39
The service and information industry continues to grow
as society continues to utilize more services. This trend
also provides a greater job market for the disabled. Some
programs of rehabilitation are required to permit the dis-
abled to take advantage of this opportunity.
Due to increased programs of energy technology, the
energy problem begins to subside around the turn of the
century.
AGFS-C: Accelerated Growth in Funding for Social Needs,
Constrained a Willingness to be Taxed.
Under this scenario all factors are as depicted above
except that as the tax rate rises beyond a certain point
society reacts by opposing any new or additional funds for
governmental programs. Because of the prosperity and the
increasing standard of living, this threshold limit is
somewhat higher than under Scenario Group I. Also, due to
the prosperity, national debt has been decreased and govern-
mental interest is reduced, thus permitting more funds for
other programs. This has a beneficial affect on funds for
rehabilitation.
Scenario Group III
RGFS: Reduced Growth in Funding for Social Needs, No
Limit on Willingness to be Taxed.
As the economy declines thus producing a decline in
society's capability to address public problems and also in
their willingness, funds for social programs experience
reduced growth. This has an affect on funds for rehabilitation,
40
in fact, some programs initiated in the 60's and 70's experi-
ence curtailment.
The disabled population grows at a moderate rate (main-
taining approximately the same percentage of total population).
Due to reduction of research programs of the late 70's and 80's,
technology development for rehabilitation is less effective and
the disabled population continues the moderate growth rate.
Technological development in related areas is slowed,
thus affecting the rate at which the moderately disabled and
handicapped can be assimilated into society.
Due to legislation of Congress in the 60's and 70's, a
sizable amount of future tax funding is committed both for
the natural growth of programs committed and for the retire-
ment of debt. Thus, the tax rate rises at an accelerated rate
and this coupled with a continuing moderate inflation rate and
reduced productivity has the effect of lowering the standard
of living or "lifestyle." Government funding programs are all
subjected to review.
The United States experiences reduced productivity after
1985 and the NNP stabilizes to grow at an annual rate of only
an estimated 1.33 percent.
The population growth rate is higher due to reduction in
emphasis on population control and grows at an average annual
rate of 1.125 percent. [Prediction based on Statistical
Abstract of the United States, 1975].
Unemployment rates rise to approximately the 9-11 percent
level. Thus, social needs for the unemployed increase. This
41
factor affects the disabled and handicapped considerably,
both in that jobs for them are not readily available and in
that funds for rehabilitation programs are reduced.
RGFS-C: Reduced Growth in Funding for Social Needs,
Constrained on Willingness to be Taxed.
Under this scenario, all factors are as depicted above
except that as the tax rate rises above a certain point
society reacts by opposing any new or additional funds for
governmental programs. Because of the reduced standard of
living, this threshold limit is somewhat lower than under
Scenario Group I.
Data Base
To accompany these scenarios considerable data concerning
various variables will be provided. Foremost among these
will be the four theme variables (see Figure ;4 to 9) which will be
reported from the past to the present and projected into the
future.
Other data being accumulated will include information
about the variables indicated in Table 2. Some of these will
be presented only with data from the past to the present;
however, a few critical ones will also be projected into the
future.
The general time frame will include data obtained from as
far into the past as necessary to establish trends. Projections
into the future will not be made past the year 2025.
42
Table 2
State of Society Variables
TA: Human Rehabilitation
Report
Report
Variable
Dimension
Variable
Dimension
Population
Economics
Size
Source of funds for DA
Taxes, etc.
Demographics (DEM) *
Total No.
Distribution of funds
% by Life
Sex
% total pop.
Research
functions
Age Groups
Rehabilitation
by employ.
Race
Institutional Based
direct
Disabled pop. (DA)
% total by DEM
Community Based
indirect
Severe
Transfer funds
Moderate
Employment
"Probable" work-
% Total pop.
Social Attitudinal
force
18-64 years
View of DA
Available work-
% Probable WF
by Able pop.
Degree acceptance
force
laws
Employed
% WF by DA and
by DA pop.
Self-image
Able
Willingness to
Goods
enter WF and
Services
community
Information
Unemployed
% WF by DA-A
Benefits to society
Income Earned
by A-DA pop.
Disbenefits to society
Median
Less than $3000
Quintile
*Age groups: 0-5, 6-18, 19-30, 31-45, 46-64, 65 up.
Race: Balck, white, other
7200
Growth rate of 4.5%
43
6900
6600
6300
6000
5700
Note: Growth rates based on predictions
made for GNP in "Energy, the Economy
5400
and Mass Transit," United States Congress,
Office of Technology Assessment, 1975, and
"Technology Assessment of Portable Energy
Growth rate of
5100
RDT & P," Center for Energy Studies, The
3.35%
University of Texas at Austin, 1975.
4800
4500
4200
3900
Dollars in Billions
3600
3300
3000
2700
2400
2100
Growth rate of 1.33%
1800
1500
1200
900
600
300
0
1940
1950
1960
1970
1980
1990
2000
2010
2020
2025
Year
Figure 4. Net National Product (Projected in
Constant '69 Dollars)
44
60000
57000
Capability under Scenario Group II
54000
Note: Population projections for each scenario
group taken from "Statistical Abstract of
-51000
the United States," 1975.
48000
45000
42000
-39000
36000
33000
Dollars per Capita
-30000
27000
24000
-21000
Capability under
Scenario Group I
18000
15000
-12000
9000
Capability under
Scenario Group III
6000
3000
1940
1950
1960
1970
1980
1990
2000
2010
2020
2025
Year
Figure 5. Society's Capability of Addressing Problems
Capability = Net National Product ('69$)
Total Population
45
6000
Growth rate of 5.6%
5700
5400
5100
4800
Note: Work session may consider selecting a
4500
probable projection of government expendi-
tures or establish a probable projection
on the willingness factor.
4300
4000
3700
3300
3000
n
2700
2400
2100
Growth rate of 3.0%
1800
1500
1200
900
Growth rate of 1.3%
600
300
0
1940
1950
1960
1970
1980
1990
2000
2010
2020
2025
Year
Figure 6. Range of Government Expenditures (Projected
in Constant '69 Dollars).
I
46
III
Legend: Range of Willingness for
Scenario I
Scenario II
Scenario III
Government Expenditure as Percent of NNP
II
III
I
Willingness
Total Government Spending ('69$)
=
NNP ('69$)
II
1940
1950
1960
1970
1980
1990
2000
2010
2020
2025
Years
Figure 7. Range of Society's Willingness to
be Taxed
47
Note: Population figures for disabled
population are very sparse. Past data
70
available are individual estimates of
total disabled population for years
1966 and 1973 only.
65
Scenario I
60
Scenario II
III
55
Scenario III
50
Population (Millions of Disabled All Ages)
45
40
I
35
II
30
25
20
15
10
5
1940
1950
1960
1970
1980
1990
2000
2010
2020 2025
Years
Figure 8. Disabled Population
Growth rate 3.5%
2200
2100
Note: Work session will select
probable growth rate as function
2000
of willingness factor.
1900
1800
1700
Growth rate
3.0%
1600
1500
1400
1300
1200
1100
1000
[...art
Growth rate 7.9%
900
800
700
600
500
400
300
200
Growth rate - 9%
100
Growth rate
Growth rate .9%
1.3%
1940
1950
1960
1970
1980
1990
2000
2010
2020 2025
Years
Figure 9. Range of Government Expenditures
for Social Needs
(projected in constant '69 dollars)