blind rehabilitation service state of the program – 8/18/09 central office staff: gale watson,...

Blind Rehabilitation Service STATE OF THE PROGRAM – 8/18/09

Central Office Staff:

Gale Watson, Director, VACO

Mike Williams, Data Analyst, VACO

Wanda Washington, Program Analyst, VACO

Lucille Beck, PhD, Chief Consultant, Rehabilitation Services

David Chandler PhD, Deputy Chief Consultant

The VA Blind Rehabilitation program:

•supports blind and low vision veterans and active duty service members in regaining their independence and quality of life to enable their successful integration into family and community life.

• supports family and significant others to foster understanding of visual impairment and foster provision of appropriate support, to assist in enhancing home environments and to reduce caregiver burden.

Blind Rehabilitation Service

Department of Veterans Affairs

BRS Program Components



• VACO BRS National Program Office • 5 National Program Consultants (field-based)• 112 full-time Visual Impairment Services Team (VIST)

Coordinators, additional 45 part-time VIST Coordinators• 11 new full-time VIST position being deployed• 10 Inpatient Blind Rehabilitation Centers• 77 Blind Rehab Outpatient Specialists (BROS) positions; 11

positions to be filled• Inpatient/Outpatient Computer Access Training (CAT) • 2 Visual Impairment Services Outpatient Rehab Programs

Lebanon, PA & W. Haven, CT • 55 new Continuum of Care outpatient clinics, a 3-tiered level

of vision rehab care provided



Continuum of Care:Clinical Training Components

Continuum of Care

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ADL/

Comm.Optical Devices

LVT/VisualSkills

O&M Audiology Manual Skills

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Adjust GeneralMedical

CAT

Basic

Intermediate

Advanced

OutpatientBlind Rehab

InpatientBlind Rehab

Three levels of service have been funded through 2010 for which BRS has oversight:

Intermediate Low Vision Care

(eye care, LVT, support)

Advanced Ambulatory Low Vision Care

(eye care, low LVT, O&M, support)

Outpatient Hoptel Blind Rehabilitation

(eye care, low vision therapy, O&M, VRT, support)

Each VISN is required to implement a plan for the provision of the services consistent with the Continuum of Care recommendations provided by VACO.

55 new clinics are coming online, totaling 232 unique positions

Continuum of Care: Implementation



Intermediate LV Clinics



White River Junction, White River Junct, VT

Samuel S. Stratton, Albany NY

Franklin Delano, Montrose, NY

VA Pittsburgh HCS, Pittsburgh, PA

Martinsburg VAMC, Martinsburg, WV

Hampton VAMC, Hampton, VA

William Jennings Bryan Dorn, Columbia, SC

Ocala CBOC, Ocala, FL

Veterans Affairs, Medical Ctr, Memphis, TN

Cincinnati VAMC, Cincinnati, OH

John D. Dingell, Detroit, MI

William S. Middleton Mem Vet Hosp, Madison, WI

St. Louis VAMC, St. Louis, MO

Oklahoma City VAMC, Oklahoma, OK

Central Texas Veterans HCS, Temple, TX

New Mexico VA HCS, Albuquerque, NM

VA Montana HCS, Fort Harrison, MT

Spokane VAMC, Spokane, WA

VA Ukiah CBOC, Ukia, CA

VA Loma Linda HCS, Loma Linda, CA

VA Southern Nevada HCS, Las Vegas, NV

Sioux Falls VAMC, Sioux Fall, SD

Adv. Low Vision Clinics



VA Boston HCS, Jamaica Plains, Jamaica, MA

Syracuse VAMC, NY

New York Harbor, Brooklyn, NY

Philadelphia VAMC, Philadelphia, PA

Baltimore VAMC, VA Maryland HCS, Baltimore, MD

Salisbury W.G. Bill Hefner VAMC, Salisbury, NC

Atlanta VAMC, Decatur, GA

James Haley Veterans Hospital, Tampa, FL

Tennessee Valley HCS, Nashville, TN

Dayton VAMC, Dayton, OH

Aleda E. Lutz VAMC, Saginaw, MI

Clement J. Zablocki VAMC, Milwaukee, WI

Robert J. Dole DVAMC, Wichita, KS

Central Arkansas Veterans HCS, Little Rock, AR

VA North Texas HCS, Dallas, TX

Carl T. Hayden VAMC, Phoenix, AZ

VA Salt Lake City HCS, Salt Lake City, UT

Portland VAMC, Portland, OR

Martinez Outpt Clinic, Martinez, CA

VA Greater Las Angeles HCS, Greater LA, CA

VA San Diego HCS, San Diego, CA

VA Central Iowa, Des Moines, IA

Outpatient BRCs “VISOR”



VA Western HCS, Buffalo, NY

East Orange Campus of New Jersey HCS, East Orange NJ

Washington, D.C.

Hunter Holmes McGuire, VAMC, Richmond, VA

Lexington VAMC, Lexington, KY

Louis Stokes VAMC, Cleveland, OH

Battle Creek VAMC, Battle Creek, Michigan

Kansas City VAMC, Kansas City, MO

Michael E. Debakey VAMC, Houston, TX

VA Eastern Colorado HCS, Denver, CO

Minneapolis, MN

Outpatient Program – new staff

• 232 Positions provided in the rollout

• Remaining unfilled positions are – – 1.5 FTEE eye care specialists– 7 FTEE blind rehabilitation professionals– 6 FTEE support staff



BRS Outpatient Care

Clinic Identifier

Unduplicated Clinic Stop

Count Cumulative

Uniques

Clinic Stops per Uniques

(220) Visor 7,405 2,747 2.7 (437) Advanced Low Vision 7,868 3,753 2.1 (438) Intermed Low Vision 5,422 3,075 1.76

20,695 9,575 2.17



Source: VSSC / KLF

Legally blind veterans and those with “excess disability”

• Excess Disability - Problems and task performance difficulties related to vision loss that have a substantial impact on the person's functional independence or personal safety, and that are out of proportion to the degree of visual impairment as measured by visual acuities or visual fields. Veterans whose vision is better than legal blindness may have excess disability due to: (i) sudden and/or traumatic visual disorder (especially related to military service), (ii) disabling co-morbidities (e.g., hearing impairment, mobility impairment, etc.), (iii) systemic diseases that cause fluctuating visual impairment, (iv) combined losses of other vision functions (e.g. contrast sensitivity, stereopsis, etc), (v) sudden changes in caregiver status, or (vi) other reasons.

A team of professionals who ensure that blinded veterans are identified, evaluated, and provided health and rehabilitation services to maximize adjustment to sight loss. Representatives may include but are not limited to: social work, ophthalmology, optometry, prosthetics, primary care, vocational rehabilitation, nursing, audiology, physical medicine and rehabilitation, Veterans Benefits Administration, and blinded veterans’ consumer organizations.

VIST: Visual Impairment Services Team



Visual Impairment Services Team Coordinator



The VIST Coordinator is a case manager who has major responsibility for the coordination of services for visually impaired veterans, service members, and their families.

The VIST Coordinator is often the entry point into the continuum of care for visually impaired veterans.

Duties include providing and/or arranging for the provision of appropriate rehabilitation services and devices (referrals to BRC, BROS, Continuum of Care clinics and/or community-based services).

Other duties include identifying new cases of blindness and severe visual impairment, providing professional counseling, arranging VIST Reviews, and conducting educational programs relating to VIST and blindness.



VIST Rosters

Source: VIST annual reports; BR 5.0

FY08

Total eligible veterans 46,888

OEF/OIF vets/active duty 668

VIST Referrals

Community-based training 1,259

Community-based CATS 1,299

Inpatient Blind Rehabilitation Centers

10 Centers Nationwide

Comprehensive, interdisciplinary, residential inpatient blind rehabilitation services: 2,085 patients discharged in FY08.

Five specialized areas of training: orientation and mobility, living skills, manual skills, visual skills and computer skills.

Veterans also receive specialized healthcare, wellness education, and adjustment counseling support.

The average Length of Stay is 5 weeks.

All Blind Rehab Centers are CARF accredited.



Source: VSSC / AMIS Workload Cube

Blind Rehabilitation Centers

10 Centers Nationwide



Proposed Inpatient BRCs

• Cleveland BRC:– Planned 15 inpatient beds – ground-breaking ceremony– planned for operation in 2011

• Biloxi BRC (CARES initiative): – planned 26 inpatient beds,

recommending start-up of 15 beds – planned for operation in 2011

• Long Beach BRC (CARES initiative): – planned 24 beds – planned for operation in 2011



BROS: Blind Rehabilitation Outpatient Specialist

Program Implemented in 199677 positions nationally



Local blind rehabilitation assessment and training designed to:- decrease the time needed for inpatient rehabilitation - obviate the need for the inpatient program, or- meet the needs of those veterans who are unable to attend BRC.



BROS provided rehabilitation care for 4,764 veterans and active duty service members in FY08

Source: VSSC / KLF

BROS: Blind Rehabilitation Outpatient Specialist

National Program Consultants

National Program Consultants provide support, review, and evaluation of field based Blind Rehabilitation Services. They are actively involved in program development and staff training.



5 Positions Nationwide

Operation Enduring Freedom – Operation Iraqi Freedom (OEF/OIF)

BRS Services and OEF/OIF



All Blind Rehabilitation Service program components actively support veterans and active duty service members of OEF/OIF.

Visual Impairment Service Team (VIST) Coordinators• Involvement with Military Treatment Facilities through liaisons and

FRC• Case management in support of Polytrauma Rehabilitation programs• Ongoing case management at local medical centers

Blind Rehabilitation Outpatient Specialists (BROS)• BROS assigned to Walter Reed Army Medical Center and Bethesda• BROS assigned to all Polytrauma Rehabilitation Centers and Sites• Treat patients in homes, communities, and local VAMCs and CBOCs

• BR Liaison for the VA/DoD Vision Center of Excellence on Eye Injuries

BRS Services and OEF/OIF



Blind Rehabilitation Centers• Provide comprehensive, individualized,

inpatient blind rehabilitation.• Full clinical support services.• Continuity of care at admission through

discharge.

112 OEF/OIF veterans or service members attended inpatient BRC programs (9/24/09)

943 OEF/OIF Vets/ADSMs are being followed by VIST and/or BROS or are in the BR Database as having low vision (9/24/09).

Description of OEF/OIF

• Of the 112:– 52 were active duty at time of treatment– 59 were veterans at time of treatment– 1 was active duty foreign soldier

– 83 were legally blind (18 totally blind)– 29 visually impaired, greater than legal

blindness

BRS Strategic Planning

Four goals that do not change:

• Improve Access and Outreach

• Enhance Service Quality

• Utilize Resources Effectively

• Develop Workforce and Plan for Succession



Strategic “Doing”

Improve Access and Outreach• Continuum of Care rollout• BROS rollout• Moved closer to MTF liaisons and FRC

programs • Specified basis for adding veterans and

ADSMs to VIST/LV rosters in database• Partnership with DoD for the Vision

Center of Excellence



Enhance Service Quality• Provided psychologists’ and recreational therapists’

positions for BRCs• Developed/revised CARF standards for all clinical

programs• Developed revised format for clinical practice

standards: evidence-based and outcomes-driven; implemented in workgroups for LVT and O&M

• Partnering with Social Work Service to develop strategies for coordination of care for individuals with low vision

• Partnering with VA VR&E, state, public and private agencies to foster careers and meaningful occupations for Veterans and ADSMs





Utilize Resources Effectively• Streamline processes for workload capture

(DSS data sources, Event Capture, Encounters) across the Continuum

• Provided equipment and training dollars to all services in BRS

• Provided equipment dollars for basic low vision services in Optometry and Ophthalmology




Develop Workforce and Plan for Succession

• Hybrid Title 38 qualification standard• Staff Training programs• Technical Career Field program – 66

TCF internships awarded• Recruitment brochure - HRRO• Recruitment booth – HRRO



blind rehabilitation service state of the program – 8/18/09 central office staff: gale watson,...

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