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Microsoft Word 60 Prototype

By Susan Ford,2014-06-28 13:16
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Microsoft Word 60 Prototype ...

A. Intermediate Low Vision Clinic

In the Intermediate Low Vision Service, a moderate breadth and level of

    complexity of low vision services are provided. The moderate spectrum of low

    vision devices available for prescribing include, but are not limited to, spectacle prescriptive considerations such as height of bifocal segment, frame size and

    shape to allow use of the preferred retinal locus, tints for contrast and glare,

    specialized coatings, etc., specialty contact lenses for low vision, etc., spectacle microscopes, handheld and stand magnifiers, handheld and simple spectacle-

    mounted telescopes, absorptive lenses to control glare and photophobia and

    enhance vision and various non-optical aids (large print, illumination controls,

    etc) as well as other emerging technologies that may be evaluated and

    prescribed. An eye care specialist (MD or OD) who has been trained in vision

    rehabilitation will provide this service, or the trained eye care specialist may

    directly supervise allied health professionals in some aspects of the clinical low vision examination and prescription of devices.

Low vision therapy begins with a functional low vision evaluation that identifies

    visual impediments related to:

    ? performance of developmentally appropriate activities of daily living by the

    veteran with low vision including dressing appropriately, personal health care

    and grooming, safe movement, care of orthotic, prosthetic and other health

    care devices,

    ? performance of instrumental activities of daily living by the person with low

    vision including care of self and family, effective literacy and communication,

    health management, home management, meal preparation, safety awareness

    training, and shopping,

    ? performance of educational pursuits including life-long learning, ? performance of vocational pursuits including job, retirement and volunteerism, ? performance of leisure and social activities and

    ? community involvement.

Moderate level LVT uses functional vision evaluation instruments to assess the

    use of vision for everyday tasks such as reading (critical print size, rate,

    comprehension, endurance) writing (legibility, speed, endurance, spatial

    awareness), health related skills (diabetic management, taking/organizing

    medications, care of medical, orthotic and prosthetic devices, etc.) and other

    tasks that require the use of vision. Moderate level LVT provides an evaluation

    of work history, educational and vocational performance, use of technology,

    quality of life, and screens aspects of cognitive function such as intelligence and cognition as they relate to vision impairment, disability and rehabilitation. The LVT will also conduct a depression screening for adequate referral.

    Moderate level LVT provides training in the use of specific visual motor skills such as the identification and use of preferred retinal locus for fixation, accurate saccades, smooth pursuits, etc. Therapy is provided in the use of vision in both static and dynamic viewing conditions. Therapy is provided in the appropriate and safe use of low vision devices such as magnifiers, spectacle microscopes, and telescopes and other devices that includes component skills such as establishing and maintaining focal distance, compensation for reduced field of view and/or depth of focus, development of necessary manual and ocular dexterity, and implementation of appropriate ergonomic strategies for effective and efficient positioning and management of fatigue. This can include use of large print, reading stands, lamps and other illumination control, writing implements, software, electronic devices, etc. Therapy is also provided in the use of appropriate environmental modifications such as ergonomic positioning, organization, illumination control, marking, etc and in the use of environmental cues such as signage, shadow, contrast, form, pattern, etc. for safe and effective management of the environment. Therapy is provided in efficient functioning to manage energy and to organize space and objects to enable goal achievement. Moderate LVT provides knowledge of local, regional and national resources and encourages consumerism.

    Basic low vision activities of daily living and communication (ADL/Comm): This will include an assessment of function and appropriate intervention for the impact of vision loss on instrumental activities of daily living related to preparing meals (“survival” cooking level, e.g. heating prepared food in microwave, making sandwiches, preparing beverages, using toaster oven and microwave, organization strategies in kitchen), managing money and paying bills, shopping for groceries or personal items performing housework (light housekeeping and laundry), using a telephone, time management and grooming and health care (such as shaving, organizing and managing medications, issues related to diabetic management such as glucose monitoring, wound inspection and bandaging, etc.). Communication activities include both receptive and expressive forms and include written communication such as writing legibly, accessing radio and television, hobbies, volunteer and leisure activities that are done in isolation as well as a social milieu.

    Space for low vision services should be in or near the eye clinic and primary care. Windows are not required, but if present, they should have darkening shades.

SPACE REQUIREMENTS: INTERMEDIATE LOW VISION

     Sq. FEET

    CLINICAL EXAM ROOM 12X16 192

    CLERICAL SPACE 0 0 THERAPY ROOM (and office): ADL, LVDs, VISUAL SKILLS 20X20 400 Hoptel beds (two beds, shared room) 15X20 300

     TOTAL 892 Note: The budget does not include any funds for facility construction costs.

     Table 1

    INITIAL INTERMEDIATE LOW VISION FTEE AND COSTS 0.5 FTEE Support Staff: GS 8-Step 5 $29,528 1.0 FTEE LV Therapist GS11-Step 5 $78, 919 0.5 FTEE EYE CARE SPECIALIST (Staff) GS14-Step 5 $66,457 EMPLOYEE TRAVEL $2,000 OFFICE SUPPLIES $500 MEDICAL EQUIPMENT $25,626 MEDICAL SUPPLIES $1,400 OFFICE FURNITURE $6,840 TOTAL: $211,270

    Note: This budget reflects year 1 (startup) costs. *IT costs will be absorbed by Office of Information Technology, and the costs are not calculated into this budget breakout. The Office of Information and Technology staff

    will meet with facility based managers of programs serving visually impaired veterans

    and ensure their computing requirements are met.

B. Advanced (Ambulatory) Low Vision Clinic

An eye care specialist (MD or OD) who has been trained in vision rehabilitation

    will oversee the clinical low vision examination and prescribe optical and/or

    electronic devices, or the trained eye care specialist may directly supervise

    allied health professionals in some aspects of the clinical low vision examination

    and prescription of devices. The full spectrum of low vision devices available for

    prescribing include, but are not limited to, spectacle Rx special considerations

    such as height of bifocal segment, frame size and shape to allow use of PRL,

    tints for contrast and glare, specialized coatings, etc., specialty contact lenses

    for low vision, spectacle microscopes, handheld and stand magnifiers, handheld

    and spectacle mounted telescopes, bioptic-mounted telescopes, electronic aids

    (CCTV, portable CCTV, head-mounted video magnifier, etc), absorptive lenses

    to control glare and photophobia and enhance vision and various non-optical

    aids (large print, illumination controls, etc), ergonomic positioning devices for

    using low vision devices, as well as other emerging technologies that may be

    evaluated and prescribed.

A low vision therapist (LVT) will provide rehabilitation assessment and

    intervention. This process begins with a functional low vision evaluation that

    identifies visual impediments related to:

    ? performance of developmentally appropriate activities of daily living by the

    veteran with low vision including dressing appropriately, personal health care

    and grooming, safe movement, care of orthotic, prosthetic and other health

    care devices,

    ? performance of instrumental activities of daily living by the person with low

    vision including care of self and family, effective literacy and communication,

    health management, home management, meal preparation, safety awareness

    training, and shopping,

    ? performance of educational pursuits including life-long learning, ? performance of vocational pursuits including job, retirement and volunteerism, ? performance of leisure and social activities and

    ? community involvement.

    Full spectrum LVT uses functional vision evaluation instruments to assess the use of vision for everyday tasks such as reading (critical print size, rate,

    comprehension, endurance) writing (legibility, speed, endurance, spatial

    awareness), health related skills (diabetic management, taking/organizing

    medications, care of medical devices, etc.) and other tasks that require the use of vision. Full spectrum LVT provides an evaluation of work history, educational and vocational performance, use of technology, quality of life, and aspects of cognitive function such as intelligence and cognition as they relate to vision impairment, disability and rehabilitation.

    Full spectrum LVT provides training in the use of specific visual motor skills such as the identification and use of preferred retinal locus for fixation, accurate saccades, smooth pursuits, etc. Therapy is provided in the use of vision in both static and dynamic viewing conditions. Therapy is provided in the use of visual perceptual and visual motor skills in relation to overall perceptual and motor skills and coordination and the use of specific visual perceptual skills such as visual closure, part-to-whole relationships, figure-ground, etc. Therapy is

    provided in the appropriate and safe use of low vision devices such as

    magnifiers, spectacle microscopes, CCTVs, mounted telelupes and telescopes

    and other devices that includes component skills such as establishing and

    maintaining focal distance, compensation for reduced field of view and/or depth of focus, development of necessary manual and ocular dexterity, and

    implementation of appropriate ergonomic strategies for effective and efficient positioning and management of fatigue. Full spectrum LVT provides instruction in the use of adaptive equipment that enhance visual function and/or

    compensate for loss of vision through tactual and/or auditory means: This can include use of large print, reading stands, lamps and other illumination control, writing implements, software, electronic devices, etc. Therapy is also provided in the use of appropriate environmental modifications such as positioning,

    organization, illumination control, marking, etc and in the use of environmental cues such as signage, shadow, contrast, form, pattern, and use of non-visual

    techniques for safe and effective management of the environment such as audio or tactile markings, etc. Therapy is provided in efficient functioning to manage energy and to organize space and objects to enable goal achievement. Full spectrum LVT provides knowledge of local, regional and national resources and encourages consumerism.

    Basic low vision activities of daily living and communication (ADL/Comm) intervention includes an assessment of function and appropriate intervention for the impact of vision loss on instrumental activities of daily living related to preparing meals (“survival” cooking level, e.g. heating prepared food in microwave, making sandwiches, preparing beverages, using toaster oven and microwave, organization strategies in kitchen), managing money and paying bills, shopping for groceries or personal items, housework (light housekeeping and laundry), using a telephone, time management and grooming and health care (such as shaving, organizing and managing medications, issues related to diabetic management such as glucose monitoring, wound inspection and bandaging, etc.). Communication activities include both receptive and expressive forms and include written communication such as writing legibly, accessing radio and television, hobbies, volunteer and leisure activities that are done in isolation as well as a social milieu. ADL/Comm includes assisting veterans with understanding when using vision is not safe and/or effective, and includes introduction and basic training in other modalities such as speech output and basic Braille when needed.

    An orientation and mobility (O&M) therapist will provide basic orientation and mobility services. This will includes a functional assessment of the O&M problems such as changing lighting conditions and glare, changes in terrain and depth, unwanted contacts, ability to judge distance and speed of cars and other important moving targets, identification of street signs and traffic signals, crosswalk lines, identification of the opposite corner of the street and judging traffic patterns. Basic O&M includes assessment of critical incidents such as bumps, stumbles and falls, the environment the veteran moves in, and the development of a functional O&M plan. O&M therapy will be provided in the use of optical and non-optical devices and interventions for distance tasks such as field enhancement devices, bioptic telescopes, absorptive lenses, etc, sighted guide technique and basic safety techniques, orientation to the environment, use of maps, and use of the long cane to enhance the use of vision. The long cane, when used appropriately to detect drop-offs, curbs, terrain changes, etc., frees the veteran’s use of vision for viewing ahead and also provides identification of

    the veteran as visually impaired. Training in the use of the long cane such as diagonal technique or verification technique is often required. Basic O&M also includes teaming with audiology for veterans with hearing loss to assure that veterans are able to use auditory devices and auditory skills (especially the detection and localization of traffic sounds) to facilitate orientation and safe travel.

Every vision-impaired veteran will be questioned regarding hearing loss. If a

    positive response is elicited, the veteran will undergo audiological evaluation to

    determine the extent of the hearing loss and whether amplification would be of

    benefit. If necessary, assistive listening devices will be evaluated and

    dispensed, and the veteran will be trained in their use, care and maintenance.

    Service agreements between the low vision service and audiology service are

    recommended.

Falls for older veterans often have devastating consequences. Older veterans

    are at higher risk of falling due to vision problems related to contrast sensitivity

    loss, loss of stereopsis, loss of acuity and loss of visual field. Falls risk is

    exacerbated by co-morbidities and/or medications that affect balance; they

    contribute to further destabilization. Service agreements between the low vision

    service and Physical Medicine and Rehabilitation are recommended.

All low vision team members assist the veteran and family in adjustment to

    changing vision and the life changes that accompany this process. Adjustment

    counseling such as bridge counseling, family counseling and/or supportive

    group counseling and discussion when required should be offered. The VIST

    Coordinator, low vision eye care specialist and therapists, who are educated in

    the psycho-social dynamics of low vision and blindness, will integrate

    appropriate adjustment strategies into their examination and therapeutic

    approaches and they will support counseling if the veteran is referred to

    counseling professionals.

Space for low vision services should be in or near the eye clinic and primary

    care. Windows are not required, but if present, they should have darkening

    shades.

    SPACE RECOMMENDATIONS: ADVANCED LOW VISION CLINIC

     Sq. FEET CLINICAL EXAM ROOM 12X16 192 CLERICAL SPACE 0 0 SOCIAL WORK/INTAKE/ADJUSTMENT COUNSELING (office) 10x14 140 THERAPY ROOM 1 (office): ADL, NEAR AND INTER. LVDs, VISUAL SKILLS 20X20 400 THERAPY ROOM 2 (office): DISTANCE LVDs, O&M, VISUAL SKILLS 20X20 400 Hoptel beds (two beds, shared room) 15X20 300

     TOTAL 1432 Note: The budget does not include any funds for facility construction costs.

Table 2

    INITIAL ADVANCED LOW VISION FTEE AND COSTS 0.5 FTEE Support Staff: GS 8- Step 5 $29,528 2.0 FTEE Therapists LVT and O&M GS11-Step 5 $157,838 0.5 FTEE EYE CARE SPECIALIST GS14-Step 5 $66,457 EMPLOYEE TRAVEL $4,000.00 OFFICE SUPPLIES $1,000.00 MEDICAL EQUIPMENT $31,713.00 MEDICAL SUPPLIES $1,400.00 OFFICE FURNITURE $14,960 TOTAL: $306,896

    Note: This budget reflects year 1 (startup) costs *IT costs will be absorbed by Office of Information Technology, and

    the costs are not calculated into this budget breakout. The Office of

    Information and Technology staff will meet with facility based

    managers of programs serving visually impaired veterans and

     ensure their computing requirements are met.

C. Advanced (Hoptel) Outpatient Blind Rehabilitation ).

A full-time Service Chief is provided in the budget to oversee this intensive

    rehabilitation program. In existing outpatient blind rehabilitation programs,

    patients are provided day-long regimens for one week or more through the

    hoptel program, and are followed for a period of time in their homes to assure

    good transition of independent function and coping skills. We recommend the

    service chief have a background in blind/vision rehabilitation practice as well as

    administrative experience.

In the Outpatient Hoptel Blind Rehabilitation program, a full spectrum of low

    vision devices will be available for prescribing include, but are not limited to,

    spectacle Rx special considerations such as height of bifocal segment, frame

    size and shape to allow use of PRL, tints for contrast and glare, specialized

    coatings, etc., specialty contact lenses for low vision, spectacle microscopes,

    handheld and stand magnifiers, handheld and spectacle mounted telescopes,

    bioptic-mounted telescopes, electronic aids (CCTV, portable CCTV, head-

    mounted video magnifier, etc), absorptive lenses to control glare and

    photophobia and enhance vision and various non-optical aids (large print,

    illumination controls, etc), ergonomic positioning devices for using low vision

    devices, as well as other emerging technologies that may be evaluated and

    prescribed. An eye care specialist (MD or OD) who has been trained in vision

    rehabilitation will provide this service, or the trained eye care specialist may

    directly supervise allied health professionals in some aspects of the clinical low

    vision examination and prescription of devices.

Full spectrum low vision therapy (LVT) is recommended at this facility. Low

    vision therapy begins with a functional low vision evaluation that identifies visual impediments related to:

    ? performance of developmentally appropriate activities of daily living by the

    veteran with low vision including dressing appropriately, personal health care

    and grooming, safe movement, care of orthotic, prosthetic and other health

    care devices,

    ? performance of instrumental activities of daily living by the person with low

    vision including care of self and family, effective literacy and communication,

    health management, home management, meal preparation, safety awareness

    training, and shopping,

    ? performance of educational pursuits including life-long learning, ? performance of vocational pursuits including job, retirement and volunteerism, ? performance of leisure and social activities and

    ? community involvement.

    Full spectrum LVT uses functional vision evaluation instruments to assess the use of vision for everyday tasks such as reading (critical print size, rate,

    comprehension, endurance) writing (legibility, speed, endurance, spatial

    awareness), health related skills (diabetic management, taking/organizing

    medications, care of medical devices, etc.) and other tasks that require the use of vision. Full spectrum LVT provides an evaluation of work history, educational and vocational performance, use of technology, quality of life, and aspects of cognitive function such as intelligence and cognition as they relate to vision impairment, disability and rehabilitation.

    Full spectrum LVT provides training in the use of specific visual motor skills such as the identification and use of preferred retinal locus for fixation, accurate saccades, smooth pursuits, etc. Therapy is provided in the use of vision in both static and dynamic viewing conditions. Therapy is provided in the use of visual perceptual and visual motor skills in relation to overall perceptual and motor skills and coordination and the use of specific visual perceptual skills such as visual closure, part-to-whole relationships, figure-ground, etc. Therapy is

    provided in the appropriate and safe use of low vision devices such as

    magnifiers, spectacle microscopes, CCTVs, mounted telelupes and telescopes

    and other devices that includes component skills such as establishing and

    maintaining focal distance, compensation for reduced field of view and/or depth of focus, development of necessary manual and ocular dexterity, and

    implementation of appropriate ergonomic strategies for effective and efficient positioning and management of fatigue. Full spectrum LVT provides instruction in the use of adaptive equipment that enhance visual function and/or

    compensate for loss of vision through tactual and/or auditory means: This can include use of large print, reading stands, lamps and other illumination control, writing implements, software, electronic devices, etc. Therapy is also provided

    in the use of appropriate environmental modifications such as positioning, organization, illumination control, marking, etc and in the use of environmental cues such as signage, shadow, contrast, form, pattern, and use of non-visual techniques for safe and effective management of the environment such as audio or tactile markings, etc. Therapy is provided in efficient functioning to manage energy and to organize space and objects to enable goal achievement. Full spectrum LVT provides knowledge of local, regional and national resources and encourages consumerism. Two low vision therapists are provided in the resource budget for these services.

    A moderate level of Activities of Daily Living and Communication Training (ADL/Comm) is recommended at this facility. Moderate level ADL/Comm intervention includes an assessment of function and appropriate intervention for the impact of vision loss on instrumental activities of daily living related to preparing meals, managing money and paying bills, shopping for groceries or personal items (teaming with COMS), performing housework (full housekeeping and laundry), using a telephone, time management and grooming and health care (such as shaving, organizing and managing medications, issues related to diabetic management such as glucose monitoring, wound inspection and bandaging, etc.). Communication activities include both receptive and expressive forms and include written communication such as writing legibly using visual and/or non-visual techniques, accessing radio and television, hobbies, volunteer and leisure activities that are done in isolation as well as a social milieu. ADL/Comm includes assisting veterans with understanding when using vision is not safe and/or effective, and includes introduction and training in other modalities such as speech output and basic Braille when needed. Salary for a vision rehabilitation therapist (formerly known as a rehabilitation teacher for the blind) is provided in the resources to provide this service.

    A moderate level of orientation and mobility training (O&M) is recommended at this facility. Moderate level O&M includes a functional assessment of the O&M problems such as changing lighting conditions and glare, changes in terrain and depth, unwanted contacts, ability to judge distance and speed of cars and other important moving targets, identification of street signs and traffic signals, crosswalk lines, identification of the opposite corner of the street and judging traffic patterns. Moderate level O&M includes assessment of critical incidents, the environment the veteran moves in, and the development of a functional O&M plan. O&M therapy will be provided in the use of optical and non-optical devices and interventions for distance tasks such as field enhancement devices, bioptic telescopes, absorptive lenses, etc, sighted guide technique and basic safety techniques, orientation to the environment, use of maps, and use of the long cane to enhance the use of vision. The long cane, when used appropriately to detect drop-offs, curbs, terrain changes, etc., frees the veteran’s use of vision for

    viewing ahead and also provides identification of the veteran as visually impaired. Long cane techniques will also be taught for veterans whose vision is

    not useful for traveling. Training in the use of the long cane such as diagonal technique or verification technique is often required. Moderate level O&M also includes teaming with audiology for veterans with hearing loss to assure that veterans are able to use auditory devices and auditory skills (especially the detection and localization of traffic sounds) to facilitate orientation and safe travel. Salary for an Orientation and Mobility Specialist is included in the resources to provide this service.

    Every vision-impaired veteran will be questioned regarding hearing loss. If a positive response is elicited, the veteran will undergo audiological evaluation to determine the extent of the hearing loss and whether amplification would be of benefit. If necessary, assistive listening devices will be evaluated and dispensed, and the veteran will be trained in their use, care and maintenance. Vision Rehabilitation staff will work closely with audiology and speech pathology staff to assure that veterans gain maximum audiological input and that audiology and blind rehabilitation staff work as an interdisciplinary team. A service agreement should be developed between the outpatient blind rehabilitation service and the audiology department to assure that patient appointments are available in a timely way so that veterans who require audiological services may be served while in the blind rehabilitation program.

    Falls for older veterans often have devastating consequences. Older veterans are at higher risk of falling due to vision problems related to contrast sensitivity loss, loss of stereopsis, loss of acuity and loss of visual field. Falls risk is exacerbated by co-morbidities and/or medications that affect balance; they contribute to further destabilization. A service agreement should be developed between the outpatient blind rehabilitation service and physical medicine and rehabilitation to assure that timely patient appointments are available. Veterans who require intervention for falls and balance problems may then be assessed and a rehabilitation plan developed while in the blind rehabilitation program.

    All low vision team members assist the veteran and family in adjustment to changing vision and the life changes that accompany this process. Adjustment counseling such as bridge counseling, family counseling and/or supportive group counseling and discussion when required should be offered. The VIST Coordinator, low vision eye care specialist and therapists, who are educated in the psycho-social dynamics of low vision and blindness, will integrate appropriate adjustment strategies into their examination and therapeutic approaches and they will support counseling if the veteran is referred to counseling professionals.

    Computer Access training will be provided for visually impaired veterans who wish to use the computer for basic internet and email access and word processing. The Vision Rehabilitation Therapist or Low Vision Therapist will be cross-trained to provide Computer Access Training when necessary.

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