The Central Blind Rehabilitation Center at Edward Hines Jr. VA Hospital celebrated a milestone in 2018.

70 Years of Serving Veterans

Central Blind Rehabilitation Center Annual Perspective 2018

MISSION:

To provide high-quality blind rehabili-tation through the provision of a broad range of rehabilita-tion, education, and research/technology programs.

Feature Articles

Message from the Chief

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Accomplishments 3

Foundation Blind Rehabilitation

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Single Area Special Programs

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Supplemental Services

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Performance Improvement; Whole Health

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Performance Improvement

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Outreach 10

VIST Central Area Region

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Denise Van Koevering, COMS, CLVT, Chief, Blind Rehabilitation Center Chuck Brancheau, CVRT, Assistant Chief, Blind Rehabilitation Center Central Blind Rehabilitation Center Edward Hines Jr. VA Hospital 5000 S. 5th Ave Hines, IL 60141 (708)202-2273 E-mail: HINESCENTRALBRC@VA.GOV Web: http://www.hines.va.gov/services/blindrehab.asp Electronic or braille copies of this publication may be requested through our e-mail.

To our Stakeholders and Supporters-A milestone year it was!

There were a number of events marking 2018 as a significant year in the history of the Blind Rehabilitation Center at Hines VA.

First, we celebrated 70 years of existence. The Blind Rehabilitation Center at Hines VA was the first, and the largest, blind centers in VA Healthcare. Blind rehabilitation services has grown from that humble nine bed unit, with nine original staff here at Hines VA in 1948, to over 500 staff, 13 blind centers and multiple clinics and programs across the United States. The celebration in June provided an opportunity to reflect with many of you, including Western Michigan University (WMU), who presented the Blind Rehabilitation Center with a commenda-tion commemorating the partnership and affiliation established in 1961, today known as the De-partment of Blindness and Low Vision Studies at WMU. We are grateful for the support of many over those 70 years, and look forward to future years of providing world class blind reha-bilitation to our nation’s Veterans.

Additionally this year, the Blinded Veterans Association (BVA) awarded the Hines Blind Rehabili-tation Center the 2018 Award of Excellence for Blind Rehabilitation Services. This was in con-junction with a biennial review of our Center and Program, which proved successful.

In addition to the BVA Review, the Commission for the Accreditation of Rehabilitation Facilities, (CARF) also performed a review which was equally as successful. We continue to maintain the CARF Accreditation for another 3 years.

Time marches on and with it often comes change. A noteworthy addition to the Blind Center Program Staff included a Technology Specialist Position. The first of its kind in VA Blind Reha-bilitation Services, this position will support technology specific research, evaluation, and imple-mentation processes on new, up and coming, devices that continue to be developed in today’s technological world.

Our Annual Perspective this year provides a look into our history, an explanation of our current programs and services, to include additional support services and the ‘Whole Health ’ concept, as it applies to blind rehabilitation. Annual statistics provides a numbers view and an updated resource list of our field staff, the Visual Impairment Services Team, for the Central Area Re-gion. We look forward to continued success in 2019, working with our stakeholders, advocates, and of course, our Veterans, and perhaps more history making.

Sincerely,

Denise Van Koevering

Chief, Central Blind Rehabilitation Center, Edward Hines Jr. VA Hospital

Message from the Chief

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The Hines VA Blind Rehabilitation Center, established on July 4, 1948, has a proud history of providing quality blind rehabilitation to our Veterans. Since its founding, thousands of Veterans and their families have benefitted from the blind rehabilitation program and services. Here we look back at 70 years of accomplishments.

1948- VA celebrated the establishment of the first Blind Rehabilitation Center at Edward Hines Jr. VA Hospital.

1951 - The Korean War warranted an increase in beds at the Hines Blind Cen ter, the humble nine bed unit increased to 27 beds.

1953 - VA, in cooperation with the Department of Agriculture, produce the film entitled, “The Long Cane.”

1961 - The first University Training Program was developed in cooperation with Western Michigan University.

1970 - Program expansion led to the relocation of the Blind Rehabilitation Cen ter to a three-story building, centrally located on Hines VA campus.

1980 - The National VA Blind Rehabilitation logo was created by a Hines Blind Center patient.

1998- Hines Blind Rehabilitation Center celebrated 50 years.

2001 - CARF Accreditation status was achieved at the Hines Blind Center.

2005 - Activation of a new state-of-the-art, 2-story, residential blind rehabilita tion facility on Hines VA Campus.

2006 - The first Polytrauma BROS Specialist was established at Hines VA Blind Center.

2008 - Hines Blind Rehabilitation Center was the first Blind Center to offer Ap ple iOS technology training as part of the blind rehabilitation program.

2009 - Hines BRC hired its first full time permanent Recreation Therapist to support the rehabilitation process.

2018- Hines Blind Rehabilitation Center celebrated 70 years.

PROUD MOMENTS IN HISTORY

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Foundation Blind Rehabilitation Training The Central Blind Rehabilitation Center (CBRC), established in 1948, continues as a Center of excellence, meeting the needs of visually-impaired and blind Veter-ans in the Midwest Central Area Region through foundational blind rehabilitation training, and the appropriate application of Technology, in all blind rehabilitation training areas. Foundational blind rehabilitation, also known as basic core reha-bilitation, and often referred to as our Regular Program, supports the develop-ment of rudimentary skills for which today, technology can be added, to enhance independence and quality of life. At its inception, blind rehabilitation training consisted of three core areas; orien-tation and mobility (teaching travel skills with the long cane) activities of daily living (which included cooking, personal care, and communications) and manual arts, (consisting of shop class type activities, woodworking, leather work, loom work to name a few). Rehabilitation also included emotional adjustment thera-py, provided in a limited fashion through Psychologist assisted sessions, including personal counseling and teaching coping skills. Today, blind rehabilitation has expanded in those areas to include not only technology applications to Living Skills, Orientation & Mobility, and Manual Skills, but, additional skill areas, such as Visual Skills, and Access Computer Technology (CATs), enhanced by a variety of supplemental support programs, including Recreation, Group Therapy, and a Family Program, that supports the education of family support systems on the home front. Dual Program Blind Rehabilitation Training The Dual Program consists of a combination of both basic core rehabilitation training, and Computer Access Technology training. The Dual Program makes up the largest percentage of our program referrals, and typically introduces ‘adaptive access software’ and its application, while establishing basic core skills of blind rehabilitation. This program greatly enhances the communications meth-ods typically taught in the Regular Program. With the incorporation of com-puter use, it is beneficial for participants to be familiar with a keyboard, typically learned in the Regular Program Living Skills Communications training.

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BLIND REHABILITATION AT HINES VA BLIND CENTER

Single Area Special Programs Computer Access Training Training in the use and application of adaptive access software is the main focus of this program. With the advancement of Technology, adaptive software pro-grams continue to be developed at lightning speed. Programs that enlarge print, change speech to text, or devices that are physically wearable* are taught in this program area. *Wearable Technology The Central Blind Rehabilitation Center remains on the forefront of wearable low vision technology. Wearable technology has the capability to provide magnifica-tion and text-to-speech options to visually impaired users. Some newer devices currently featured in our Single Area Special Programs include BrainPort, Orcam and Aira. Additional devices have been evaluated for inclusion into our Program Offerings, including; NuEyes, Iris Vision, eSight, Jordy, and Patriot View Point. While single area special programs make up the second largest referral program, it is important to note that not every device is suitable for every individual. Low vision, capabilities with technology, and need, all play a part in determining which device works best for each individual. This is the basis for the individualized pro-gram that Hines Blind Rehabilitation Center offers. Additionally, core blind reha-bilitation is always the foundation on which these special programs are sustained. Explanations on some of these programs follows below: Brainport; the Brainport is an FDA approved device for profoundly blind indi-

viduals. The device sends electro-tactile stimulation to the users tongue onto the intra-oral device from a camera, mounted to the user’s glasses. Users are able to interpret shape, size, location, and position of objects in their environ-ment.

Orcam; Orcam is a small camera that attaches to the frame of the user’s glasses. The camera has the capability to scan and read text, identify up to 150 prestored products, currency identification, and facial recognition of pre-stored pictures of friends and family members.

Aira; is a camera device a visually impaired user mounts on a pair of glasses that communicates with a trained, sighted agent remotely. Common uses in-clude assistance with print identification, cooking, cleaning, layout of a room, or description of an unfamiliar environment. It is recommended participants complete a Regular Program first before participating in Aira training.

BLIND REHABILITATION PROGRAM UPDATES S

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The integration of several classes and programs offered at the Blind Rehabilita-tion Center are key to foster and promote independence by the Veteran upon their return home. This series of classes provides psycho educational support to the program participant, family, and supports many facets of the whole rehabili-tation process. The Transitions Class is a group class is geared toward group discussion sur-rounding adjustment to vision loss and self-advocacy. The 2-3 session program is led by one of our blind rehabilitation specialists, staff psychologist, and social worker where Veterans (both new and returning) discuss life experiences in cop-ing with visual impairment and strategies for assertive communication. The Family Program has played a key role in the reintegration of blinded Vet-erans back into the community. This program provides an opportunity to discuss the many adjustments that are made following sight loss, and to answer any questions or concerns that the family may have. An individualized training schedule is designed to provide in-depth information about all aspects of the Vet-eran’s Blind Rehabilitation program. Experience has proven that when the ex-pectations and needs of the family are addressed, the Veteran is more likely to make a smoother transition to the home environment and to use the skills that have been obtained during training.

The Healthy Eating Initiative is a new addition to the Central Blind Rehabilita-tion Center. Beginning in 2017, this group class, led by dietetic interns, aimed towards educating Veterans on healthier food choices is offered strategically dur-ing the year. It is facilitated during Adaptive Kitchen Skills training. Topics in-clude portion control, healthy substitutes, diabetic friendly meals, benefits to eat-ing a well- balanced diet, and healthy eating on a budget.

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SUPPLEMENTAL SUPPORT PROGRAMS AND SERVICES

In the last year we have revamped our Resource Class. Resources has been em-phasized in the Veteran training program for many years. In 2018, we moved back to a classroom format with emphasis on having Veterans understand and be able to access and use resources in order for them to locate programs and services that can serve to foster their independence and continual growth outside of the blind rehabilitation program. Veterans are encouraged to set discharge goals for them-selves. They often share their goals which include regular use of skills and equip-ment to enhance their independence and to gain confidence in the skills they learned while in the program. Our Recreation Program continues to be a Veteran favorite while participating in the program. Veterans are able to participate in activities during the day such as; golf, swimming, archery, Braveheart Horseback Riding , and many others. These activities are geared toward allowing the Veterans to practice independence skills gained during training. Learn, or re-learn new activities that they may be able to pursue when they return home, and gain confidence in using their skills and adjust-ing to their vision loss in a variety of settings. Many activities are sponsored by vol-unteers and Veteran Service Organizations, without their support, the Recreation Program would not exist as it does today. Our Gym class is now entering its fourth year as part of our curriculum. This class is led by a blind rehabilitation specialist and the class is no larger than 3 partici-pants at a time. The focus of the class is to work with Veterans that have lower stamina. The exercises are all done in the seated position to ensure safety. Veter-ans are encouraged to continue the same regimen when they return home. For those Veterans that are more accelerated in their exercise goals, we are able to help them get started whether in our gym or assisting them in making contact with a local gym or fitness club. Blind center staff continue to educate Veterans on the importance of Computer Security And Identity Protection. Veterans participate in a one hour group class on the importance of remaining vigilant when sharing information and surfing the web. Topics discussed include phone scams, email scams, types of hacking in-cluding phishing, spyware and trojans, and ways to identify if someone is trying to successfully scam. Staff also provide veterans with resources on how to remain safe when sharing information including using strong passwords, never sharing your passwords in messages, not opening links that are not familiar, logging out of sites and only allowing remote support from trusted sources. Veterans are provid-ed with security software and are trained on this software as part of their computer access training program.

SUPPLEMENTAL SUPPORT PROGRAMS AND SERVICES CONT.

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As the VA transforms from the traditional medical model to a more patient-driven (Whole Health) model for Veterans and their families, the Hines Blind Center continues to integrate these programs that have long been a part of the blind rehabilita-tion curriculum. In 2017, the Department of Vet-eran’ s Affairs initiated the Whole Health for Life Program and identifies the Veteran as the cen-tral figure in optimizing his and her quality of life, physically, and mentally. Living life fully and op-timizing health and wellness goes beyond just treating illness. It means understanding what mat-ters to the Veteran, and consider-ing all aspects in life that contrib-ute to his and her achievement of well-being. The model urges providers to en-gage the Veteran in discussions centered on what is most important to the him or her, including personal values, religious preferences and cultural beliefs. One objective of the model is to encourage the Veteran to be an active partner in the health care team. The model illustrates the Veteran as the central figure, em-phasizing self-care, professional care, and community integration. In 2018, the Blind Rehabilitation Center psychologist and social worker modified the existing psychoeducational series of classes (often referred to as ‘Group Class’) to increase alignment with the Whole Health principles. The eight-week curriculum emphasizes the mind - body connection in relation to the broader low vision and blind rehabilitation experience. Topics covered include, mindfulness meditation, the science of happiness, resilience and strength, the practice of self-compassion, healthy aging, health promoting behaviors and living congruently with one’s values and priorities. Through 2019, programming for this class series will be reviewed with other blind rehabilitation professionals to promote contin-ues improvement, and new ways to implement a whole health experience.

Whole Health Initiative

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2018 PROGRAM GOAL HIGHLIGHTS Access to care continues to be a priority locally and nationally. National VA mandates require 50% of approved applications result in a first offer date for admission ≤60 days of application receipt.

We remain committed to Veteran satisfaction and continue to allow for Veteran choice on admission dates, which often exceeds the less than 60-day target. Providing care in a timely fashion is remains an ongoing goal for Blind Rehabili-tation as well as VA.  SATISFACTION Hines Central Blind Rehabilitation Center remained in the upper 90 percentiles for three years running, and scored an average of 96.2% overall satisfaction rat-ing for 2018. Consumer satisfaction scores remained high in 2018 with the addi-tion of a National Mandate concerning Preferred Media*. *PREFERRED MEDIA Section 504 of the Americans with Disabilities Act of 1990, was amended to state that blinded Veterans should be queried about their preferred mode of re-ceiving information, e.g., large print, braille, electronic speech output. Blind Re-habilitation personnel at all phases of the continuum of care engaged in this goal including VIST and/or BROS during the application process, the Hines BRC Ad-missions Coordinator during the scheduling phone call, Blind Center Staff on completion of admission paperwork, during the initial 1st week new Vets Meet-ing, and the initial Team Coordinator meeting. The Preferred Media goal was another way to support Veteran Satisfaction by allowing personal choice to be a part of their rehabilitation experience. This is now standard practice in the blind rehabilitation process.

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Access to Care - ≤60 day Admission (Target 50%)

**STANDARD FOR VA BLIND REHAB ESTABLISHED FY17** # Admissions in 2018 312 Admissions ≤60 days 133

Percent Offered 59.2% Percent Admitted 43%

Community Relations efforts continue to be a priority in the Central Blind Reha-bilitation Center’s operational processes. Educating the community, stakeholders, and other professionals with whom we work, is a part of our culture and an on-going initiative that we feel passionately about. Community members often in-clude non-VA state and local agencies that provide support to the Blind and Visu-ally Impaired individuals, local community organizations, allied health students, Blind Rehabilitation Family Program Participants, co-workers and colleagues from other hospital services within the facility where our Center is located. All of these community members make up our Visitor Program. In 2018, this program sup-ported 1104 educational hours and 144 visitors to our program. Midwest Region outreach initiatives in 2018 included: University of Illinois Chicago Ophthalmology Grand Rounds

National Disability Employment Awareness Month Workshop, Edward Hines Jr. VA Hospital; Accessibility Needs for Individuals with TBI, SCI or Blindness

White Cane Day Informational Table - Edward Hines Jr. VA

Elderwerks Education & Resource Senior Fair, Crystal Lake, IL

Presentations on Occupational Therapy and Blind Rehabilitation Services, Chicago State University

Illinois Assembly of the American Council of the Blind Conference, Lisle, IL

Presentation on Night Mobility Lessons at the North Central Orientation & Mobility Conference, Milwaukee, WI

Additionally, the staff is active through membership in Professional Organizations that support and advocate on behalf of the blind and visually impaired communi-ty. These organizations provide an environment for Blind Rehabilitation profes-sionals to network on program developments, initiatives, and progress at the Lo-cal, Regional, and National levels.

Professional Organizations include:

Commission for the Certification of Rehabilitation Counselors (CRCC)

Choroideremia Research Foundation

Illinois Talking Book and Braille Advisory Committee

Illinois Association of Education & Rehabilitation (IAER)

Illinois Association of Orientation & Mobility Specialists (IOMS)

Community Relations

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Visual Impairment Services Team Coordinators (VIST) Central Area Region

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NAME LOCATION PHONE

Gregory Manuel Lexington, KY (859) 281-3916

Julie Kennedy Louisville, KY (502) 287-4000 x55049

Brian Joos Cincinnati, OH (513) 559-3567

Karla Riste Dayton, OH (937) 268-6511 X3514

Natalie Duarte DeEscalante Chillicothe, OH (740) 773-1141 x7855

Matthew Page Columbus, OH (614) 257-5325

Beth Levine Youngstown, OH (330)740-9200 X1580

Marianne Ryan Cleveland, OH (216) 791-3800 X2108

Jennifer Troyer Detroit, MI (313) 576-4888

Bill Bernhard Battle Creek, MI (269) 223-6607

Richard Alden Ann Arbor, MI (734) 845-3064

Deanna Austin Indianapolis, IN (317) 988-2576

NovaLea Welch Ft Wayne, IN (260) 426-5431 x72650

Leland Lewis Saginaw, MI (989) 497-2500 X11852

Jeff Stroud Danville, IL (217) 554-5406

Helen Witt North Chicago, IL (224) 610-7168

Pat Zeinstra Hines, IL (708) 202-2351

Melinda Dunlap Jesse Brown (Chicago, IL) (312) 569-7531

Daniel Snyder Milwaukee, WI (414) 384-2000 X41832

Kurt Brunner Madison, WI (608) 256-1901 x11960

Debora Pate Iron Mountain, MI (906) 774-3300 X31378

Kari Arch Tomah, WI (608) 372-3971 x61831

Jennifer Bach St. Louis, MO (314) 652-4100

Paul Clary-Archuleta Kansas City, MO (816) 861-4700 x56294

Erin Shaw Poplar Bluff, MO 573-686-9784

Dawn M. Clouse Leavenworth/Topeka, KS (913) 682-2000 x53825

Betty Howerton Marion, IL (618) 997-5311 X54815

Bob Hamilton Wichita, KS (316) 651-3682

Lauren Swift Columbia, MO (573) 814-6458

Anna Perry Sioux Falls, SD (605) 333-6891 Jennifer Points/ Meghan Michelotti Minneapolis, MN (612) 467-1814/(612) 629-7009

Lois Thesing St Cloud, MN (320) 255-6480 X7802

Wesley Hodgson Des Moines, IA (515) 699-5410

Ronita Bland Omaha, NE (402) 995-3188

Keith Queen Iowa City, IA (319) 338-0581 x6889

Jody Schommer Fargo, ND (701) 232-3241 X3056

Paul T. Cotton Black Hills, SD (605) 745-2000 x2727

*While the average age of Veterans in Blind Rehabilitation is 68, we have served Veterans from age 20 100.

*Orientation & Mobility, Living Skills, Manual Skills, Visual Skills, Computer Access Technology.

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The 2018 Annual Perspective is published for VA Blind Rehabilitation stakeholders. Contributors for this issue include: Chief, Denise Van Koevering,; Assistant Chief, Charles Brancheau Supervisory Staff-J. Molodecki, D. Smith, A. Cleveland, M. Elgersma Blind Center Staff– M. Wilt, LCSW; Clinical Psychologist, J. Kiebles, PhD; VIST, P. Zeinstra; Admissions Coordinator, K. Dahlheimer, Communications Specialist, A. Suchie. Hines VA does not endorse the use of, or purchase of, any prosthetic devices cited in this publication.

DISCHARGES AVERAGE WAIT TIME LENGTH OF STAY

306 Veterans* 52 Days 22 Days

Operating a 34 bed unit, serving 14 states.

With four distinct programs, wait times can vary from 46-55 days.

Type of program, goals, and skill levels all impact length of stay which can vary from 16-46 days.

TYPE OF PROGRAM PROGRAM EXPLANATION

NUMBER OF DISCHARGES

Single Area (iOS™, Orcam™, AIRA™, Brain-port™, etc.)

Refresher programs or technology specific

74

CATS Training in the use of adaptive access software.

73

Regular Consists of a basic core rehabilitation in 5 skill areas*

59

Dual Combination of both basic core rehabilitation and Computer Access Technology

100

Common Visual Diagnoses 2018

Diagnosis Admissions with Diagnoses Macular Degeneration 68

Glaucoma 86

Optic Atrophy 23

Diabetic Retinopathy 32

Retinitis Pigmentosa 29

Other-(Stroke, Optic Nerve disease, retinal detachment, etc.) 53

Pre-existing Medical Diagnoses Admissions with Pre-existing Conditions 2017

Diabetes 113

Psychological 100

Cardiac 74

Pulmonary 61

Other -(CVA) Neuropathy, cognitive, Neurological, Rheumatology, Renal, Amputee

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