The National Association for Rehabilitation Leadership

A Professional Division of the National Rehabilitation Association

The National Association for Rehabilitation Leadership

It is widely accepted that the practices and skills of leadership, supervision, and administration of rehabilitation process are vitally related to that process.  The National Association for Rehabilitation Leadership has been organized to develop, improve and strengthen practices and skills in both public and private rehabilitation organizations.  

Leadership Articles, and Information
A Professional Division of the National Rehabilitation Associaition
NARL Leadership Exchange

The "NARL Leadership Exchange" is an initiative of the NARL Board to facilitate learning, information sharing, and discussion regarding leadership.  This section of the NARL website www.NARL.us will be a place to organize, archive, share this information and in the future discuss Leadership. This effort is a work in progress and as such new leadership articles will be published when they have been submitted by NARL Leaders.

This article was submitted by Russ Thelin, former NARL President and currently Commissioner of the Utah VR Agency.  It has to do with leadership development particularly in light of the upcoming wave of retirements in the Vocational Rehabilitation Profession
As leadership content becomes available for this web site section it will be organized and listed here.....Please check back often for updates.
Using Leadership Development To Boost Return-on-Investment

Friday, June 15, 2012 - by Linda Olivia Nichols, Debra Van Voorst,Kathy E Burnham, Patricia Finch, Nancy C Smith, Barbara Hall

Waves of retiring leaders plus budget uncertainties make finding new federal leaders a tough task. Six veterans' hospitals developed an internal leadership program, and found that for every $1 spent, $2.20 was returned.

Federal agencies may soon be facing an unprecedented need for internal leadership development. Training in succession planning and renewal can keep people in the organization and build commitment to the organization's culture and values.
As many Baby Boomer leaders become eligible for retirement, there is a need for new leaders to fill the gaps left by retirement. However, ongoing proposals from Congress to downsize the federal workforce may thwart agencies' ability to hire new leaders from the outside. Additionally, a declining or stagnant federal budget may force cutbacks in external training and consulting budgets for developing leaders.
One solution is leadership development sponsored and run internally by the agency. The Department of Veterans Affairs (VA) has had excellent internal leadership development, from entry level upward. While there are standards and commonalities mandated by the department, each individual facility has extraordinary leeway to tailor the program to meet its specific mission, vision, and values. These internal programs have many advantages to the agency and can provide a significant return-on-investment, through the innovative use of internal resources and talent.
VISN 9 Leadership Institute
Since 2000, the Midsouth Health Care Network (Veterans Integrated Service Network, or VISN 9) has provided leadership development training for employees of its six sister facilities who are competitively selected as “high-potential†employees. These high-potential employees have the desire to learn, work hard, and move into a leadership role; they are high performers in their current position. Plus, they show evidence of mastery of the eight core competencies (personal mastery, technical skills, interpersonal effectiveness, customer service, flexibility and adaptability, creative thinking, systems thinking, organizational stewardship), which are expected of all VA employees.
For its first 10 years (2000-2009), the Leadership Institute (LI) was internally driven, from curriculum development to implementation of curriculum. Each facility in VISN 9 sent five or six participants and a coach each year. A total of 379 participants and coaches attended over these 10 years. In addition to three intense, off-station one-week sessions over some six months, the LI program required participants to devote additional personal time to complete reading, assessments, personal action plans, and leadership shadowing assignments between sessions. They also had to participate in a workplace initiative selected by facility leadership with other LI participants from their facility. In 2010, a new generation of faculty took responsibility of the program. This educational endeavor remains internally driven, although the new team made some curricular changes.
Continuity and Common Values
LI was developed and implemented in a time of federal fiscal austerity much like the current climate. Consequently, facility managers decided to minimize costs as much as possible and to share costs with all stakeholders. Using internal expertise was one important strategy to minimize costs. The VA has long had policies of providing training in cutting-edge educational programs for its own staff to serve as internal trainers and leaders coaching leaders; this helps to reinforce common organizational values.
For example, two VISN 9 leadership faculty were certified Franklin Covey trainers and VA professional clinical staff were brought in to administer and teach the Myers-Briggs Type Inventory. Internal subject matter experts in areas such as generational relationships, quality improvement, and stress management ensured that examples were relevant to the participants. Coaches and mentors, who were higher mid-level and senior-level leaders from the sister hospitals, attended all sessions and therefore received refresher leadership training as they provided a strong organizational context for the participants mentored.
Because the core faculty remained the same and was responsible for LI from year-to-year, efficiency savings were possible. Each of the three-week off-station training sessions was held at the same location and off-season, which enabled discounts in room rates. This stability enabled quantity discounts for larger orders for program materials such as books that would be used over several years.
Leadership Institute Evaluation
In 2004, the VA's VISN 9 Learning Council conducted an evaluation of LI. The council was responsible for the Institute and the VA Employee Education System (EES) and included all Kirkpatrick levels of evaluation (reaction and planned action, learning, job applications, business results, and return-on-investment). The council placed special emphasis on job applications, business impact (the extent to which LI training impacted medical center/VISN/VHA operations) and return-on-investment (ROI) benefits—whether LI provided sufficient benefits to offset the cost of the program.
The Jack Phillips Center for Research, a division of Franklin Covey, provided training for how to conduct the ROI analysis and assisted with the evaluation strategy. The EES provided the funding.
The ROI Process
The ROI process is conservative and guided by strict and proven data collection and analysis standards. It can provide both financial and nonfinancial results. There are several key steps involved to develop ROI. The most important step is collecting data both before and after a program has been conducted. Select data collection methods based on clear indicators of success, credibility, cost, and ease of implementation. Collect data on costs, tangible and intangible benefits, savings, and the portion of savings due to the program.
Finally, the costs and benefits come together in an equation for the ROI. Net benefits (the program benefits minus costs) are divided by costs to get the total investment in the training program. This provides an ROI formula comparable to ROI calculations for other investments, which typically show the net earnings, divided by the average investment.
Collectively, this process provides a framework to measure the business impact and return-on-investment for any type of training or educational program.
Cost. An essential component of ROI is to tabulate the program costs to determine the specific investment, including all fully loaded costs that are related directly or indirectly to the educational program. LI 2004 costs included faculty and participant salaries and travel costs, room rental, materials, and audiovisual equipment. In addition, salaries and travel for initial planning (pro-rated across the four years of LI that had occurred to date), yearly planning, preparation and logistics, and evaluation were included. The fully loaded cost for the 2004 LI was $382,336.
Benefits. The tangible benefits for LI were derived from workplace initiatives, specific business accomplishments and improvements, and internal promotions.
Workplace Initiatives
Participants from each medical center developed and implemented one or more workplace initiatives during LI, often at the request of the facility director. The initiatives were designed to result in organizational improvement in one or more of the following areas: customer service, work climate, work habits, work output, quality, cost, and time. These soft and hard data are typically used in ROI analysis as measures of performance, according to Jack J. Phillips in the Handbook of Training Evaluation and Measurement Methods (1997).
Participants implemented seven initiatives that met the organizational improvement areas and had a measurable economic benefit. Examples of initiatives included reducing outpatient fee services provided outside VA; reducing patient waiting times; and reorganizing an ophthalmology clinic, which resulted in the sharing eye equipment, reduced wait times, and restoration of a residency program that resulted in not hiring full-time staff. Change in economic parameters was measured pre- and post-initiative implementation.
One of the most important steps in the process focused on isolating the effects of training. In every organizational situation, a number of factors influence the output measures of organizational or business impact. Training is only one of many influences that will drive a particular measure. As an ROI-accepted method of isolating the effects of training, leaders asked participants to estimate the effect of training, its monetary amounts, and their level of confidence in their estimates. These were discussed with the faculty to ensure participants understood the process and were conservative in their estimates.
After isolation, there was a total of $164,776 in benefits. Because most of the initiatives were not completed by the end of the 2004 LI sessions, each monetary value was pro-rated by the percentage completion, for a total of $120,889.
Business Improvements
Each participant also identified specific business-related accomplishments and improvements (for example, increased revenue, improved customer satisfaction, improved employee satisfaction, decreased costs, time saved) related to participation in LI. Only five met the ROI standards for inclusion as tangible, measurable benefits. Examples of accomplishments included increasing contract compliance for ordering medication, and standardization of immunochemistry, coagulation, and hematology processes for lab services for the six LI participating sister hospitals. Monetary value was calculated in the same manner as for workplace initiatives. Total business accomplishments benefit was $60,734.
Internal Promotions
The third set of monetary benefits was savings generated by promoting from within. One purpose of LI was to create a candidate readiness pool, so it was appropriate to capture the efficiency benefits of promotion from within as compared to hiring at the middle manager (GS-12) level externally. This is the essence of succession planning and is one way it pays for itself. For the 2004 class, there were a total of 12 promotions within the VISN and three in the VA that were included in this ROI.
Internal promotion is a standardized part of ROI with internal hiring probabilities, hiring cascade assumptions as employees are promoted up, and turnover replacement costs all pre-specified. As internal candidates fill a middle level manager position and the positions below it, eventually an external candidate is hired for a lower position and the benefit from hiring from the LI readiness pool is the difference between the external replacement cost of a the lower level employee versus a middle level manager.
Using the standardized, pre-specified ROI calculations and the most conservative salary estimates (lower level of each salary range), savings for each LI graduate moving up from the readiness pool was $55,000, for a total of $825,000. However, to ensure that all costs were captured, a pre-specified cost to cover any additional human resources services for the 15 promotions was included ($165,515) for an LI benefit of $659,485. (See sidebar.)
Intangible Benefits
Participants also listed intangible benefits that were important. These included such activities as initiating coaching or mentoring relationships and providing recognition to employees at their worksite. Participants estimated impacts on cost, work output, work habits, customer service, customer and employee satisfaction, turnover, time savings, quality improvement, and response time, but these were not translated into monetary values for the program benefits or included in the ROI.
ROI Calculations
Total Leadership Institute benefit was $841,473, including seven facility initiatives ($120,889), five business accomplishments ($60,734) and promotion of 15 LI graduates ($659,850). The ROI calculation for Leadership Institute was:

An ROI value of 120 percent means that for $1 spent on LI, the return-on-investment was $2.20.
LI Becomes a Brand
The ROI standard for training programs suggests at least a 25 percent return for the first year ($1.25 return for each $1 spent). This internally driven and staffed training program well exceeded this return, with a $2.20 return for each $1 spent. Participants from 10 years of LI had more than 130 promotions.
Word-of-mouth recruitment by each successive class and a growing internal organizational awareness bolstered the program's success. Leadership Institute has become a recognizable entity (“brandâ€) with a sense of continuity and an understanding of what participants could expect. The program also gave participants opportunities to provide service to their home facilities, which helped increase buy-in from those home facilities.
Intangible benefits that were not captured, but very apparent were the tight bonds that came from three intense weeks spent off site with other participants, coaches, and faculty. Opportunities for informal networking were built into the program through meals and planned social events. Participants made friendships within their facilities and across the VISN; these relationships were tapped later when colleagues ask for assistance and support in developing new projects and exploring job opportunities.
While most evaluations of training programs move past participant reaction to learning and job behaviors, many do not make the leap to measure organizational results. However, in a time of austerity and increased fiscal scrutiny of public sector, the return-on-investment process is relatively straightforward and simple to implement. Careful data collection and recognition that training affects organizational results can inform and promote viable leadership development, particularly when internal talent and resources are used.

Multicultural persons with disabilities encounter different barriers that affect their employment as well as their transition back into society.   As an African American woman, rehabilitation counseling is a field of study that I am very passionate about.  I believe that it is important for professionals of different ethnic backgrounds to be seen and recognized in this field, due to the challenges that multicultural persons with disabilities face.   “Multicultural initiatives still frequently omit disability, despite the fact that over one billion human beings worldwide have disabilities and 200 million have severe disabilities.”(Brown, 2002, p.157) Being a person of a different race with a disability is a double whammy.  Not only am I an individual with a disability, I am a black woman which causes me to face discrimination and places me into the triple whammy category.
On July 30, 2008 I was involved in a serious car accident. Not only were my goals almost taken from me but I almost lost my life. While being in the hospital for four months I lost my focus and things I took for granted I could no longer accomplish.  I was diagnosed with Traumatic Brain Injury.  I had to learn how to walk again, talk again, and take care of myself. After being discharged from the hospital, I had to go to a rehabilitation facility.  While at the rehabilitation center, I felt like a outcast because I did not see anyone that looked like me nor did I feel like anyone could relate to the barriers that I began to face.  I had reached a point in my life where I was angry and agitated. I felt like giving up.  There were days when I did not feel like going to physical therapy and instead of being encouraged or empowered to go, I was left in my room laying in the bed feeling depressed and alone.
I never will forget the day one of my occupational therapists walked into my room and demanded that I get out of bed and into my wheelchair without any assistance.  I had never completed this task on my own before and I still lacked the confidence of knowing that I could do it.  As I struggled to try and complete this task, I ended up in a position on the edge of my bed that I could not get out of.  Instead of my occupational therapist helping me, she just walked out of my room.  Luckily my mother and my nurse came back into my room at the right time and helped me get back into bed.  “When abuse occurs, a disabled person’s personal health, safety and emotional well-being may be at risk, along with their ability to engage in daily life activities.” (“Recognizing and Interrupting Abuse of Adults with Disabilities,” 1999).
Being culturally competent in this working field is extremely important.  “Cultural competency is one the main ingredients in closing the disparities gap in health care.  It’s the way patients and doctors can come together and talk about health concerns without cultural differences hindering the conversation, but enhancing it.” (“What Is Cultural Competency,”1989).  Both the consumer and the professional bring different beliefs, values, and morals throughout this rehabilitation process.  It is crucial that the professional as well as the consumer respect each other’s differences, but at the same time continue to work together in order to strengthen the healing process.  I think that it is beneficial for the counseling world to have organizations such as NAMRC. “NAMRC is dedicated to promoting cultural diversity and disability through advocacy for excellence and equity in rehabilitation research, education, and practice.”  (“National Association of Multicultural Rehabilitation Concerns,” 2007).
In April 2013, I became employed at a substance abuse counseling agency. When I first started working here I struggled with showing empathy to the consumers that I case manage.  I had a hard time seeing substance abuse as a disability because it is something that I have never experienced.  Making the decision to further my education to obtain a masters degree in vocational rehabilitation counseling, my thoughts on substance abuse have changed. I now have a better understanding and come to realize that substance abuse dependency can become a disability. Because I attend a HBCU I have the benefits of learning from professors who look like me, as well as collaborating with students who look like me. We are able to come together and address issues that individuals with disabilities from different backgrounds are likely to be faced with.
My professors in this program challenge and encourage me to not only think about African Americans with disabilities but also people from other cultures with disabilities. It is powerful and uplifting for me to hear this type of discussion from individuals who knows what it is like to be in the minority.   This educational experience has taught me that it is important to see an individual as the unique person that they are.  No matter if two people have the same type of disability, they should be looked at as an individual because every situation is different and what might work for person might not work for the other.  It is important that I learn that not every person that I work with is going to have the same views and concepts as me when it comes to addressing the situation.
A few weeks ago I applied for a paid internship at the Department of Rehabilitation Services.  While at my interview I was told that the location of the current opening is at an office in my hometown.  My first thought was how ironic.  There was a time when I decided to seek help with school and employment while dealing with TBI.  I went to this location for assistance. I was not treated as though I had rehab potential.  I was told that the best thing for me to do was to stay at home and continue to collect Social Security Disability.  I started out with a very knowledgeable person who also had a disability.  We talked about all the ways DRS could help me achieve my goals.  As we began the process of filling out my paperwork, I began to feel like I was on the right track.  I had to have multiple evaluations and assessments; upon competition of everything I was told to do I received a letter stating that I qualified for assistance.  I went to my next appointment only to find out that the person who was helping me was no longer there and I was reassigned to another counselor.  Upon meeting with this person, I was told that none of my information was entered into the system.  Due to the fact that I was dealing with the affects of TBI, I got frustrated and upset and decided to leave.  This office never contacted me again. I took it upon myself to push through school and search for competitive employment. My first job after my accident was at the substance abuse counseling agency. 
I was recently offered a job with DRS at the same location that I attempted to go to for services.  I accepted this job knowing that I am going to be the one who is going to make a difference at this location.  Having been on both sides of the table, I am fully aware of how important how it is to make an individual with a disability feel as though their goals are important and obtainable.  I am determined to go above and beyond to ensure that their needs are being met, even if that means stepping out of my comfort zone and putting myself into their shoes.  It is important for people to be treated with dignity and respect.  Instead of focusing and dwelling on how I was not treated fairly at this location as a consumer, I can help to make a difference. With hard work and dedication I can help to break barriers that once existed at this location.
In my opinion the biggest setback that a person with disabilities face when it comes to accomplishing their goals is lack of support and lack of motivation . Throughout my journey in the rehabilitation counseling field, I want to open the gateway for multicultural persons with disabilities.  I plan to empower these individuals and show them that their disability does not define who they are.  The road ahead may not be a smooth ride, but nothing is impossible.  My personal struggle has shown me that the word impossible itself says I’m Possible.

Independent Living Institute Newsletter: Editorial-What Is Disability Culture?; Steven E. Brown; 2001-2002
National Association of Multicultural Rehabilitation Concerns. (2007).
Retrieved from http://www.namrc.org
Recognizing and Interrupting Abuse of Adults with Disabilities.  (1999).
Retrieved from http://www.wid.org
What Is Cultural Competency? (1989).
Retrieved from http:/www./minorityhealth.hhs.gov/templates/browse.aspx

Keyeonna Gray a Rehabilitation Student recently wrote an article and presented at the Oklahoma Rehabilitation Association on Multicultural persons with disabilities and Traumatic Brain Injury.  Her article appears below and the related PowerPoint can be viewed and downloaded by clicking to the right.