Annual Report - Independent Living Services For Older Individuals Who Are Blind

RSA-7-OB for California Department of Rehabilitation - H177B110005 report through September 30, 2011

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year3,379,345
Other federal grant award for reported fiscal year0
Title VII-Chapter 2 carryover from previous year0
Other federal grant carryover from previous year0
A. Funding Sources for Expenditures in Reported FY
A1. Title VII-Chapter 23,495,477
A2. Total other federal2,482,514
(a) Title VII-Chapter 1-Part B0
(b) SSA reimbursement0
(c) Title XX - Social Security Act0
(d) Older Americans Act0
(e) Other2,482,514
A3. State (excluding in-kind)34,562
A4. Third party0
A5. In-kind624,587
A6. Total Matching Funds659,149
A7. Total All Funds Expended6,637,140
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs2,776,787
C. Total expenditures and encumbrances for direct program services3,860,353

Part II: Staffing

FTE (full time equivalent) is based upon a 40-hour workweek or 2080 hours per year.

A. Full-time Equivalent (FTE)

Program Staff a) Administrative and Support b) Direct Service c) Total
1. FTE State Agency 1.9100 0.0000 1.9100
2. FTE Contractors 20.8700 60.1300 81.0000
3. Total FTE 22.7800 60.1300 82.9100

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 44 20.4800
2. Employees with Blindness Age 55 and Older 29 12.6000
3. Employees who are Racial/Ethnic Minorities 65 27.3900
4. Employees who are Women 163 74.8700
5. Employees Age 55 and Older 64 29.4800

C. Volunteers

27.00

Part III: Data on Individuals Served

Provide data in each of the categories below related to the number of individuals for whom one or more services were provided during the reported fiscal year.

A. Individuals Served

1. Number of individuals who began receiving services in the previous FY and continued to receive services in the reported FY2,365
2. Number of individuals who began receiving services in the reported FY3,509
3. Total individuals served during the reported fiscal year (A1 + A2) 5,874

B. Age

1. 55-59636
2. 60-64624
3. 65-69512
4. 70-74494
5. 75-79642
6. 80-84953
7. 85-891,132
8. 90-94680
9. 95-99176
10. 100 & over25
11. Total (must agree with A3)5,874

C. Gender

1. Female4,009
2. Male1,865
3. Total (must agree with A3)5,874

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race756
2. American Indian or Alaska Native37
3. Asian326
4. Black or African American490
5. Native Hawaiian or Other Pacific Islander95
6. White3,956
7. Two or more races46
8. Race and ethnicity unknown (only if consumer refuses to identify)168
9. Total (must agree with A3)5,874

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)466
2. Legally Blind (excluding totally blind)3,022
3. Severe Visual Impairment2,386
4. Total (must agree with A3)5,874

F. Major Cause of Visual Impairment

1. Macular Degeneration2,748
2. Diabetic Retinopathy585
3. Glaucoma776
4. Cataracts237
5. Other1,528
6. Total (must agree with A3)5,874

G. Other Age-Related Impairments

1. Hearing Impairment1,376
2. Diabetes1,225
3. Cardiovascular Disease and Strokes1,885
4. Cancer328
5. Bone, Muscle, Skin, Joint, and Movement Disorders1,590
6. Alzheimer's Disease/Cognitive Impairment333
7. Depression/Mood Disorder319
8. Other Major Geriatric Concerns1,591

H. Type of Residence

1. Private residence (house or apartment)4,782
2. Senior Living/Retirement Community763
3. Assisted Living Facility213
4. Nursing Home/Long-term Care facility100
5. Homeless16
6. Total (must agree with A3)5,874

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)1,365
2. Physician/medical provider255
3. State VR agency381
4. Government or Social Service Agency538
5. Veterans Administration17
6. Senior Center694
7. Assisted Living Facility0
8. Nursing Home/Long-term Care facility0
9. Faith-based organization6
10. Independent Living center79
11. Family member or friend1,074
12. Self-referral961
13. Other504
14. Total (must agree with A3)5,874

Part IV: Types of Services Provided and Resources Allocated

Provide data related to the number of older individuals who are blind receiving each type of service and resources committed to each type of service.

A. Clinical/functional vision assessments and services

Cost Persons Served
1a. Total Cost from VII-2 funds 489,002
1b. Total Cost from other funds 3,680
2. Vision screening / vision examination / low vision evaluation 1,585
3. Surgical or therapeutic treatment to prevent, correct, or modify disabling eye conditions 563

B. Assistive technology devices and services

Cost Persons Served
1a. Total Cost from VII-2 funds 784,139
1b. Total Cost from other funds 7,243
2. Provision of assistive technology devices and aids 1,881
3. Provision of assistive technology services 1,803

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 2,081,556
1b. Total Cost from other funds 32,059
2. Orientation and Mobility training 1,295
3. Communication skills 1,240
4. Daily living skills 2,328
5. Supportive services (reader services, transportation, personal 1,984
6. Advocacy training and support networks 987
7. Counseling (peer, individual and group) 2,788
8. Information, referral and community integration 2,359
. Other IL services 1,123

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 460,002
1b. Total Cost from other funds 2,673
2. Information and Referral 1,964
3. Community Awareness: Events/Activities 681 27,488

Part V: Comparison of Prior Year Activities to Current Reported Year

A. Activity

a) Prior Year b) Reported FY c) Change ( + / - )
1. Program Cost (all sources) 4,971,701 6,637,140 1,665,439
2. Number of Individuals Served 5,509 5,874 365
3. Number of Minority Individuals Served 1,524 1,918 394
4. Number of Community Awareness Activities 649 681 32
5. Number of Collaborating agencies and organizations 0 0 0
6. Number of Sub-grantees 17 17

Part VI: Program Outcomes/Performance Measures

Provide the following data for each of the performance measures below. This will assist RSA in reporting results and outcomes related to the program.

Number of persons Percent of persons
A1. Number of individuals receiving AT (assistive technology) services and training 1,803 100.00%
A2. Number of individuals receiving AT (assistive technology) services and training who maintained or improved functional abilities that were previously lost or diminished as a result of vision loss. (closed/inactive cases only) 1,376 76.32%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 427 23.68%
B1. Number of individuals who received orientation and mobility (O & M) services 1,295 100.00%
B2. Of those receiving orientation and mobility (O & M) services, the number of individuals who experienced functional gains or maintained their ability to travel safely and independently in their residence and/or community environment as a result of services. (closed/inactive cases only) 878 67.80%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 417 32.20%
C1. Number of individuals who received communication skills training 1,240 100.00%
C2. Of those receiving communication skills training, the number of individuals who gained or maintained their functional abilities as a result of services they received. (Closed/inactive cases only) 0 0.00%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 0 0.00%
D1. Number of individuals who received daily living skills training 2,328 100.00%
D2. Number of individuals that experienced functional gains or successfully restored or maintained their functional ability to engage in their customary daily life activities as a result of services or training in personal management and daily living skills. (closed/inactive cases only) 0 0.00%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 0 0.00%
E1. Number of individuals served who reported feeling that they are in greater control and are more confident in their ability to maintain their current living situation as a result of services they received. (closed/inactive cases only) 4,486 n/a
E2. Number of individuals served who reported feeling that they have less control and confidence in their ability to maintain their current living situation as a result of services they received. (closed/inactive cases only) 98 n/a
E3. Number of individuals served who reported no change in their feelings of control and confidence in their ability to maintain their current living situation as a result of services they received. (closed/inactive cases only) 283 n/a
E4. Number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only) 209 n/a
E5. Number of individuals served who died before achieving functional gain or experiencing changes in lifestyle as a result of services they received. (closed/inactive cases only) 0 n/a

Part VII: Narrative

A. Briefly describe the agency's method of implementation for the Title VII-Chapter 2 program (i.e. in-house, through sub-grantees/contractors, or a combination) incorporating outreach efforts to reach underserved and/or unserved populations. Please list all sub-grantees/contractors.

The Department of Rehabilitation (DOR) provides comprehensive independent living services to individuals age 55 years and older throughout California. The Department, through its seventeen sub-grantees, provides the majority of its services in the consumer’s every day surroundings be it home or community centers.

The program is implemented through sub-grant agreements with private, nonprofit community-based organizations, independent living centers and other service agencies that have expertise in providing effective services to individuals who are blind or visually impaired. The grant is advertised statewide and opened to non-profit eligible agencies providing core Independent Living Services (ILS). For purposes of providing Title VII, Chapter 2 services throughout the state, DOR divided the state into 14 separate geographical areas with a goal to award at least one grant in each of the 14 designated geographical areas.

The applications of successful sub-grantees were assessed, scored and three-year funding recommendations were based upon the following components: • demonstrated ability to effectively provide ILS in a specified designated geographical area; • proven expertise in providing core ILS to older individuals who are blind or visually impaired; • effective service provision to enhance consumers’ participation and integration in their communities; • establishment of innovative tools to identify, target and reach, underserved, unserved and ethnically diverse population groups; • provision of culturally sensitive and linguistically appropriate ILS services; • development of a comprehensive plan of operation for delivery of services including referral processes; • service delivery collaboration with local DOR offices of Blind Field Services (BFS) for DOR consumers and non-DOR consumers;

Outreach Efforts to Unserved and Underserved Populations Title VII, Chapter 2 sub-grantees are required to meet SPIL outreach challenges by utilizing methodologies that help ensure that eligible consumers are aware of services and to focus upon unserved and underserved population groups. The outreach challenges of the 17 sub-grantees to identify local needs of sub-population groups within their geographic area have been met with innovative and effective strategies that included: • hiring culturally sensitive and knowledgeable Outreach Workers; • encouraging inclusiveness of consumer involvement in impacted, underserved and unserved communities by coordinating peer-to-peer volunteer services and utilizing senior support groups to promote and advertise services; • providing translation services for non-English speaking populations; • incorporating gender and ethnic appropriate ILS promotional information via various media: specialty publications, ethnic-specific print, television, radio and public service announcements; • partnering with senior advocacy organizations to disseminate information on the availability of ILS services; • conducting ILS training information to eye care medical specialists and physicians serving targeted population groups in underserved and unserved communities to increase referrals for services; • conducting presentations at adult day health centers and health/social services businesses located in unserved and underserved communities; • ensuring that allied organizations promote services and are oriented to the ILS referral process; • providing ILS services information to organizations, agencies and businesses serving target population sub-groups; • utilizing ‘senior mentors’ to orient and demonstrate non-visual skills to members of targeted population sub-groups living in residential facilities, attending health and disability fairs and participating in cultural based social activities and support groups; • recruiting volunteers representative of various cultures and languages of diverse population groups to identify and respond to barriers to services (i.e., transportation, geography, cultural sensitivity, translations services etc.); • identifying underserved and unserved communities with high demand for ILS services and finite resources to help fill in service gaps; • distributing ILS information at faith-based organizations and establishments located in underserved and unserved diverse communities:

One of our sub-grantees, the San Francisco LightHouse for the Blind, has always questioned who isn’t underserved, especially when transportation is a constant issue. So, in all locations, the LightHouse has identified community centers and partners that they communicate regularly via email blast about upcoming programs, trainings etc. that each location is hosting. Each location also host monthly program orientations for seniors with vision loss, and their family and friends. In San Francisco the LightHouse has community partners that primarily provide services to seniors who are Spanish, Chinese, Russian and Tagalog speaking, and have done specific outreach to the GLBT community. In Marin the senior center, where the LightHouse classroom and office is located, houses the multicultural senior hub of Marin County (Seniors who are Spanish, Vietnamese, German and Farsi speaking). In Oakland, the primary outreach is to deaf and severely hard of hearing seniors and in the North Coast, the primary outreach has been to the following Native American Tribes at: Big Lagoon Rancheria; Blue Lake Rancheria; Hoopa Valley Indian Reservation; and, Yurok Indian Reservation — these are long and ongoing relationship-building outreach activities that are continual and develop slowly over time. The LightHouse Specialist in Humboldt County finds that attending family oriented opportunities to the public and community agencies like the LightHouse, provides more opportunity for trust.

The LightHouse also participates in annual senior and disability fairs that specifically attract low vision seniors, there is at least one in each area per year. Specifically in Oakland, the LightHouse participated in two fairs, one sponsored by Deaf Counseling, Advocacy Referral Agency (DCARA) and the other by a senior center in Fremont that has a larger deaf population. In San Francisco, staff specifically participates in three fairs, two of which are culturally based (in Spanish and Chinese). In the north coast, staff serve two remote counties, Humboldt and Del Norte, each has a fair, and in Marin the primary senior fair is in the heart of Marin County.

The San Francisco LightHouse strategies for outreach is a preference to engage, teach and educate. With the increase of senior residences (HUD, continuum of care, faith based etc.) LightHouse has been reconnecting with the larger residences to ensure they know of the ILS services. In Marin and San Francisco specifically they have hosted 2-3 hour seminars on introductions to lighting, magnification, home safety and technology. They see these as opportunities to bring out those “who are not blind, but they can’t see” — hoping the carrot works! In all presentations to seniors they also bring out the Assistive Listening Devices so that those with both hearing and vision loss participate. Each presentation, even if it is for one hour, their philosophy is to leave each person with a skill. The LightHouse “Lessons in a Zip Lock” have provided the opportunity for persons to learn money identification and folding techniques; Junk Drawer Braille; and medication management. These quick lessons are engaging, simple and let folks know that there are simple solutions, if they are willing to learn.

While the LightHouse has many collaborative community partners, their paid contractors provide some of the unique services that the LightHouse is able to provide, they include: • UC Berkeley School of Optometry — Low Vision Clinic (San Francisco only) • Blind and Vision Impaired of Marin (adjustment to vision loss groups in Marin County) • Interpreters (sign language, tele-interpreters and various language interpreters) • Helen Keller National Center • Hearing/Communication/Technology

The above Efforts by the San Francisco LightHouse is reflected in their serving 817 individuals in the 2011 Federal fiscal year which was a 19.6% increase from the 2010 reporting year. Of this total, 34% were of various ethnic groups.

Another sub-grantee, The Center for the Partially Sighted (CPS), provides comprehensive low vision rehabilitation services with the goals of enhancing any remaining sight, providing emotional support, and training in independent living strategies. The Center offers optometric care, the latest in computer and assistive technology, individual and group counseling sessions, independent living skills training, Orientation and Mobility (O&M) instruction, a low vision store, as well as a variety of other services. Optometric evaluations are conducted on-site. Counseling is offered face-to-face or by telephone. O&M and rehabilitation services are provided in clients’ homes. The Center conducts outreach to low-income clinics, ophthalmology and optometric offices, and maintains a website.

The Center for the Partially Sighted should also be congratulated for serving 946 older individuals who are blind or visually impaired for the 2011 Federal fiscal year, and of that total 46.6% were from various ethnic groups.

Of all consumers served during the 2010-11 Federal fiscal year, sub-grantees averaged serving 32.7% non-white consumers. This was an increase of 25.9% from the prior reporting year. The primary reason for the consistent services to underserved/unserved populations is sub-grantees’ recruitment of 65 volunteers and staff representative of California’s diverse population groups. Below is a breakdown of the diversity of the consumers served by sub-grantees:

Sub-grantee Non-white percentage Blind and Visually Impaired Center 34.5% Blindness Support Services, Inc 60.1% The Center for the Partially Sighted 46.6% Community Access Center 45.4% Dayle McIntosh Center for the Disabled 34.1% Earle Baum Center of the Blind 4.9% El Dorado Center for the Visually Impaired 2% Independent Living Services of Northern California 4.9% LightHouse for the Blind 34% Lions Blind Center of Oakland 59.6% Lions Center for the Visually Impaired 13.5% San Diego Center for the Blind 30% Santa Clara Valley Center for the Blind 35% Society for the Blind 31.9% Valley Center for the Blind 34.1% Vista Center for the Blind 24.6% VTC Enterprises 22.2%

FFY 2010-11 Sub-Grantees Agency ARRA Location Counties Served Blind and Visually Impaired Center of Monterey County Monterey Monterey Blindness Support Services, Inc. X Riverside Riverside, San Bernardino Community Access Center X Riverside Riverside The Center for the Partially Sighted X Culver City Los Angeles, Santa Barbara, Ventura, Van Nuys, Foothill Dayle McIntosh Center for the Disabled X Garden Grove Orange Earle Baum Center of the Blind X Santa Rosa Sonoma, Napa, Lake, Mendocino El Dorado Center for the Visually Impaired El Dorado El Dorado Independent Living Services of Northern California X Chico Butte, Shasta, Tehama, Plumas LightHouse for the Blind, San Francisco X San Francisco Marin, San Francisco, Solano, Humboldt, Del Norte Lions Center for the Blind of Oakland X Oakland Contra Costa, Alameda Lions Blind Center of Diablo Valley X Pittsburg Contra Costa San Diego Center for the Blind X San Diego San Diego Santa Clara Valley Blind Center San Jose Santa Clara, San Mateo Society for the Blind X Sacramento Butte, Sacramento, Solano, San Joaquin, Yolo, Yuba Valley Center for the Blind Fresno Fresno, Kern, Merced, Madera, Tulare, Kings, Mariposa Vista Center for the Blind and Visually Impaired X Palo Alto Santa Clara, San Benito, Santa Cruz, Monterey VTC Enterprises X Santa Maria Santa Barbara, San Luis Obispo

American Recovery and Reinvestment Act (ARRA) OIB Highlights

During Federal fiscal year 2010-11, the 13 sub-grantees that had previously been awarded additional funds under the American Recovery and Reinvestment Act has complemented the core services by both expanding and enhancing services to the Older Individuals Who Are Blind (OIB) population in their respective geographic areas. Expanded services included increased vision screenings at senior centers and assisted living centers, additional independent living skills development, a summer camp immersion training program, and targeting of underrepresented groups whose native language is other than English. Some sub-grantees have been able to purchase wheel chair accessible vehicles to provide more transportation support for the OIB population.

Enhanced services included website development to better address the needs of the OIB population and public relations efforts such as introducing assistive technology, optical solutions and other rehabilitation services. Additionally, the ARRA OIB funding has helped allow outreach to ophthalmologists in an effort to increase referral services.

Most of the Older Blind programs in California face funding issues, lack of resources and a shortage of trained professionals in vision loss. To address these issues many of the agencies have entered into collaborations with other agencies. In southern California the Center for the Partially Sighted, the San Diego Center for the Blind, and the Dayle McIntosh Center hold regular teleconference meetings. The San Francisco Lighthouse also has a long-standing partnership with the Vista Center for the Blind. The Lighthouse also shares resources with the Earle Baum Center for the Blind in Santa Rosa. Because of its expertise in serving deaf-blind consumers the Lighthouse expanded these services in the east and south San Francisco Bay areas.

Since each of the 13 awarded agencies operates with its own unique service model, disposition of ARRA funds varied with the more center-based agencies such as the San Diego Center and The Center for the Partially Sighted using additional funds to build internal resources while the more field-oriented agencies focused on travel costs and portability. Both the Society for the Blind and the LightHouse have used ARRA funds to support immersion training whereby they bring together a group of older visually impaired individuals in a group setting for several days. This represents one way to maximize training effectiveness. It also serves the purpose of enabling consumers to network with others who are also dealing with changing vision.

Each of the 13 grantees has drawn upon ARRA funds to purchase both high and low tech assistive technology. Access to quality low vision assessment is critical for older individuals to maintain their independence. A need for many OIB consumers is a thorough low vision evaluation. Recognizing this crucial need the Earle Baum center used ARRA funds to start a low vision clinic while VTC Enterprises in Santa Maria used ARRA funds to purchase low vision exams from outside sources. Visual aids were purchased by all of the thirteen grantees. Additionally, all of the OIB agencies report an increased number of consumers are interested in seeking or maintaining employment. Conversely, agencies are increasingly reporting that they are serving an aging clientele with the average client age now being in the 70s.

Strategic Planning and Training Summit

The OIB team members hosted the OIB Summit over three days at The Citizen Hotel in Sacramento. Attendees included representatives from 14 Title VII funded organizations that provide services to OIB consumers, one non-Title VII funded organization and various DOR staff. In addition, the Director of the Department of Aging and Executive Director of the California Commission on Aging, attended a portion of the Summit.

On a scale of 5 points, attendees gave the Summit an overall rating of 4.2. By far, the biggest value to the attending service organizations was the networking, information sharing and general interaction between one another. Attendees travelled from as far north as Humboldt County to as far south as Riverside and San Bernardino. DOR used ARRA funding to finance the travel and lodging for up to two attendees from each of the Title VII funded organizations.

Highlights of the Strategic Planning and Training Summit included presentations from ARRA OIB sub-grantees on accomplishments with the stimulus funding, a lively dialogue on determining service areas, common findings and grant management tips from DOR’s Chief Auditor, an educational presentation on the Implications of Aging and Vision Loss, and training on establishing performance measures.

ARRA sub-grantee agencies are noted with an X in the ARRA column of Table 2: FFY 2010-11 Sub-Grantees.

B. Briefly describe any activities designed to expand or improve services including collaborative activities or community awareness; and efforts to incorporate new methods and approaches developed by the program into the State Plan for Independent Living (SPIL) under Section 704.

Collaborative Activities:

Community Access Center (CAC) schedules and attends events on an ongoing basis that allows them to present information on the Older Blind Program. CAC staff participated in the following events: • A one-day workshop at the village in Hemet • Attended a meeting of sight seekers in Corona — conducted needs assessment for the Older Blind Program • Sky Valley — 3 large gated senior communities • California Retired State Workers Association • Menifee Sun City Senior Expo Day • Perris Senior Center - Outreach and Assistive Technology demonstration for seniors • Mass Care II Facilitation with the American Red Cross • Evacuation Study for People with Disabilities’ tabletop exercises — Seniors and People with Access and Functional Needs

In addition, the CAC provided a retirement apartment complex in Hemet with a presentation on the Dolphin GUIDE program as well as the Kindle. The demonstration showed the benefits to the visually impaired residents to see how they may be able to read their mail and other correspondence. The room was at capacity and a good overview was given explaining how to use the program. Also for visually impaired individuals who can no longer read a newspaper but wished they could, CAC demonstrated a Kindle which comes with text to speech capabilities. We explained that subscriptions to newspapers, books, and magazines are available, and with some training and using just a few keys, the Kindle would read with speech without assistance.

The CAC continues to operate the Accessible Mail Program (AMP). AMP provides free reader services to older individuals who are blind through the use of fax machines and toll free telephone lines. The objective is to assist the consumer with identifying what they have received in the mail. A consumer will fax their mail to the reading service coordinator at a scheduled time, and then call on a toll free line to have their mail read to them. The AMP has been expanded to offer assistive technology that will allow consumers to read mail and other documents with out assistance. The technology includes the following: 1. a very easy to use computer based screen reading and scan and read program; 2. a stand alone scan and read system; and 3. the use of a Kindle which comes with a text to speech feature. The OIB consumers are finding the Kindle a very desirable reading device. Consumers do not need any experience using a computer to operate a Kindle in the text to speech mode. The Kindle is very light and portable. Also consumers do not need to subscribe to an expensive internet access service. The CAC continues to offer the fax machine service, however there is a stronger focus on providing the consumers with the assistive technology that allows them to use equipment to independently read hard copy documents.

The goal of California’s Title VII program is to prolong the independence of older individuals who are severely visually impaired. The sub-grantees participated in the following collaborative and community oriented activities: • developed and implement initiatives that strengthen existing relationships with public and private health agencies; • expanded partnerships with multi-cultural, ethnic, and senior organizations to help close the gap to access to services among the state’s diverse population subgroups; • participated on social marketing campaigns with other agencies serving seniors and the diverse senior communities; • referred appropriate related services such as mental health services and public assistance programs; • established networks of care systems with various providers, medical providers, agencies, associations and organizations that emphasize ILS to improve access and ensure cost-effective use of resources;

The DOR continues to provide technical assistance and consultation to sub-grantees on strategic planning of delivery of comprehensive ILS.

Community Awareness: In addition, sub-grantees participated in the following community awareness activities: • health forums sponsored by cities’ parks and recreation departments; • public awareness campaigns; • annual health/social services events and seminars sponsored by organizations that target seniors (i.e., Arthritis Foundation, Diabetes Association, American Stroke Foundation, etc.); • presentations at adult education schools; • coordinating public events with various foundations and organizations that specifically serve the visually impaired; • demonstrations in English as a Second Language classes; and • distribution of cultural and ethnical sensitive agency information at various events conducted by or provided to individuals of ethnicities who are unserved or underserved.

C. Briefly summarize results from any of the most recent evaluations or satisfaction surveys conducted for your program and attach a copy of applicable reports.

Currently, sub-grantees report quarterly on the outcomes of their ILS-OIB programs. The evaluation of the reporting requirements for the ILS-OIB is an in-house program evaluation activity. Careful documentation of service provision and consumer outcomes help measure sub-grantees’ effectiveness and identify technical assistance needs. Moreover, the evaluations increase accountability, strengthen quality assurance and identify where program policy revisions are needed.

The evaluation process includes all components of the data collection requirements established by RSA.

Below are a few examples of sub-grantees narrative reports on their evaluations.

In order for the Center for the Partially Sighted (CPS) to assess optometric services, post-hoc phone interviews are conducted. Clients are questioned about the quality, helpfulness, and timeliness of the services provided by the Center. Overall, clients are pleased with the services provided. Each question had a mean rating over “4.4” indicating satisfaction with the services. At the end of each interview, clients are given the opportunity to provide their own feedback. Clients have commented on more than one occasion that they liked that the optometrists took time to explain things to them in a way that they could understand, explained their visual conditions, and demonstrated visual aids. One client remarked, "The doctor was very personable. I felt like he concentrated only on me. I had his full attention." Recent satisfaction surveys conducted for Blindness Support Services Inc. concluded that the program is satisfying the client’s needs. People are recommending activities which would help them in their blind rehabilitation. One consumer mentioned that he would like to come to our peer support meetings. However, he is a Spanish speaker. This is a great recommendation and something we would like to develop into next year’s Title VII program.

Since January 2011, individuals receiving ILS services met 79% of personal objectives; this represents 367 tasks that can now be performed independently. This year, 50 of 53 people who responded to our satisfaction survey for the Low Vision Program were satisfied with services; 50 are still using the equipment that they received; 46 are using the training that they received; and 50 felt that services improved their Quality of Life.

The Santa Clara Valley Center for the Blind (SCVBC) conducts ongoing 30 day and 90 day evaluations with their clients. 30 day evaluations are collected from new clients and serve as a satisfaction survey. 90 day evaluations help SCVBC tailor effective ISP segments to promote confidence and independence.

Based on the 30 day evaluations: • 26 Title VII individuals began receiving services in 3rd and 4th quarter. • 17 clients were evaluated. • 17 were pleased with the responsiveness and attention of the agency to their needs. • 13 were currently enrolled in activities or courses at the agency at the time of the evaluation. • 4 who were not enrolled in activities or courses at the time of the evaluation had completed their goals. • 17 believed that the course materials were clear and effective for them. As a result, 100% were pleased with SCVBC services and find them effective.

Based on the 90 day evaluation: • 26 clients were evaluated • 22 responded that they are more confident in their activities • 0 responded that they are less confident in their activities • 4 responded that they feel the same confidence in their activities as before. • Of the 4 response to “same,” 4 said it was due to reasons other than their vision loss. As a result, 85% felt more confidence since receiving rehabilitative services at SCVBC.

The Lions Center for the Blind in Oakland has implemented a Closure Form for instructors to complete with their clients when a service has ended. The form asks consumers to rate their satisfaction in the service area in which they received instruction. In O&M, there were 23 Closure Forms completed. Of the 23 clients completing O&M services, 74% felt very satisfied with their services and 26% felt satisfied. In Independent Living Skills, of the 9 forms completed, 67% felt very satisfied with their services and 33% felt satisfied. In Employment, 2 forms were completed, both having ratings of "Very Satisfied".

D. Briefly describe the impact of the Title VII-Chapter 2 program, citing examples from individual cases (without identifying information) in which services contributed significantly to increasing independence and quality of life for the individual(s).

A testament to the success of services is when a consumer is confident enough to give back to the community. An older gentleman with serious medical conditions as well as being visually impaired received low vision assessment, optical aids and orientation and mobility instruction from the Blind and Visually Impaired Center of Monterey. We are proud that the Salinas client, a former health professional, now serves as a Spanish speaking interpreter for the BVIC receiving a modest stipend.

Another individual was a 91 year old lady who was provided a CCTV from CAC in Riverside. This lady had lived through some of the most interesting discoveries of recent times. Among her accomplishments was that while working for Lockheed, she worked on the arm that was used to scoop up the soil on the lunar surface that was then returned to earth to be analyzed. Recently she has been organizing all of her paperwork and she has been using magnifying glasses. This was a slow and time consuming task. Another advocate from the CAC office on a previous meeting had noted that she was in need of a CCTV. She was provided one that we had on hand and installed it. It was put through the paces and she marveled at the speed and ease over what she had been doing. She could not be happier. Years ago she had owned a CCTV, so she was familiar with them. However, she had given it away to someone she thought needed it more. It is just, that after donating her CCTV previously, she would now receive one that was donated by someone else. She did say that the local flea markets would not be happy. Each week she would go to them trying to find magnifiers that would work better than what she had. She was sure they would miss her business.

Mr. P is a recently retired Engineer who is deaf and has been losing vision due to macular degeneration (over the past two years). He found out about the LightHouse through an outreach visit to the Deaf Counseling, Advocacy Referral Agency (DCARA) where the LightHouse had an information booth. Increasingly in denial about his low vision, Mr. P was finding communication (ASL) increasingly difficult to understand, and print even more difficult to read. Connecting with the LightHouse Deaf-Blind Specialist was both scary and beneficial. Acknowledging he was unable to communicate in the way he’d been doing all his life was profound, and the change to learning close-up and some tactile signing even more scary — what would his friends think? Starting with small steps he had a low vision evaluation, then recognized how much hand held magnification and lighting (especially a hand held beam for night time mobility) would be helpful. After participating at the Confident Living Program at Enchanted Hills Camp, he practice each day using close up and tactile ASL skills, feeling less anxious and more confident, he even found himself teaching some of the hard of hearing participants some emergency signs and print on palm. Mr. P has agreed to become a speaker to other groups of older adults who are deaf to let them know that losing vision is scary but reaching out for help is better than sitting at home than being afraid.

Glenna is age 83 and has lost her vision due to advanced stages of Glaucoma. She spent her career days as a nurse and has always been a caring person. Determined not to let a loss of vision get in her way, Glenna attended the San Diego Center for the Blind and availed herself of all the classes. While at the Center, she mentored and looked after those new individuals who came in a little nervous and uncertain if this was the right course of action for them. She was a great role model. Following graduation from her program, she was determined not to let her life slip into inactivity. She found an opportunity to volunteer at a continuation school for juvenile ex-offenders. She became a tutor and surrogate grandmother. To bridge the generation gap, she started coming up with rap songs and is currently known around the school as the "Rapping Grandma." Glenna is a wonderful success story of someone who has moved past her loss of vision and is giving back to the community.

Lemma is currently age 60. He immigrated from Ethiopia in 2004 and resettled as a refugee. He lost his vision totally from glaucoma and attended the San Diego Center for the Blind to adjust to his loss of vision and new life in the United States. After fully participating in all aspects of vision rehabilitation, including assistive technology, Lemma studied and was successful in obtaining his U.S. citizenship. Following that success, he attended Community College and earned his AA degree, but he did not stop there. He is currently enrolled at San Diego State University in the Sociology Dept., and has plans to begin a Master’s program in Rehabilitation Counseling. During his studies, he has returned to the Center as a student intern and is putting into practice his desire to help others who have found themselves in similar situations as a new immigrant with a loss of vision.

E. Finally, note any problematic areas or concerns related to implementing the Title VII-Chapter 2 program in your state.

LightHouse for the Blind San Francisco/Marin/North Coast/Oakland

This past year was a huge pleasure as well as a challenge in implementing the Title VII-Chapter 2 Program, as it had the added bonus of ARRA funding to try out different outreach and training strategies to implement for the future. If anything, this past year was the opportunity to see where the program can go. While we continue in all areas to be challenged with closing supportive community programs that have dually supported many of the clients we see, we have had to be even more vigorous in instilling independent living, O&M, technology skills and advocacy skills so that those persons who are new to vision loss do not become isolated and not in control of their lives. This situation has also given the LightHouse pause to re-educate those service providers in the community about what we do and how we can provide those with vision loss support and training.

Moving into the future we will implement several of the program modalities explored this past year, including group training over the phone in several languages, internet/conference call workshops; training on Apple products (iMac and iPad etc.); expanding use of internet training and practices and providing pointed training with persons who have both hearing and vision loss.

We will constantly be challenged by transportation (especially in the North Coast and Marin areas) and encouraging those to make a regular commitment to training, even when it rains. It is our experience that group related training, even if started on the phone, is motivating and brings folks together with a constant bond. Finally our overall challenge, like many agencies is to bring together multicultural groups. While we have had success, the challenges lies in finding professionals who also speak the same language. Interpreters are a stop gap, but true connection and learning deserves more connectedness. At this time we are incorporating mentors who can provide some teaching assistance, this is something we will continue to do to help bridge the cultural gap of culture and blindness.

Lions Center for the Blind, Oakland

The ongoing challenge is to serve all clients in need of rehabilitation services with minimal financial resources. Due to cuts in Adult Day Health Centers and mental health facilities, we are being called upon to serve clients who are not legally blind but have other disabilities that are causing difficulties in their life. Since funding for In Home Support Services has been reduced there is more confusion as to what our instructors’ jobs entail. For Lions Center to continue to expand geographically and increase the number and type of services offered we must have more financial support.

Vista Center for the Blind

The challenges remain the same on transportation, other disabilities and cultural barriers. Although we are itinerant and we collaborate with senior centers and other agencies throughout our service area, we have office locations in only two of the four counties we serve. One challenge that we’ve encountered with our consumers is in the area of transportation. For some seniors, even the relative low cost of para-transit makes attending support groups and counseling sessions or low vision evaluations too expensive. It would be helpful to be able to cover the cost of transportation for seniors who need it. Hearing loss is another problem for many of the clients we serve along with multiple disabilities. Staff training is essential to ensure our consumers receive the best care and variety of services, however time and expense of trainings are a challenge.

The Center for the Partially Sighted

The association of vision loss with the development of other health care issues is not widely recognized. Falls, medication mismanagement, poor diet, reduced exercise and isolation/depression resulting from impaired vision can be alleviated by comprehensive low vision services, but access is limited. The elimination of optical devices from Medicaid coverage and the delays in payment creates an added burden for Medicare/Medicaid beneficiaries. Medicare coverage also does not include rehabilitation services by rehabilitation specialists, O&M specialists or low vision therapists, nor do they include optical and electronic devices under covered durable medical equipment. As a result, older adults with limited resources have only OIB funding to rely on. The need will only continue to outpace the availability with the aging of the population and the increase in diabetes-related vision loss, especially in areas with large populations of Latinos and African Americans and others with limited access to healthcare.

Society for the Blind

One challenge Society for the Blind faces in serving Sacramento, Chico and Mount Diablo is the large geographic area these regions encompass. There are many blind and low vision seniors within this area who are either unserved or underserved as a result of their residing far from available services. Society for the Blind works to address the needs of these individuals by extending outreach efforts to far flung communities and attempting to organize training event that serve groups of seniors large enough to justify the time and resources necessary to serve communities many hours driving distance from Sacramento.

Linguistic and cultural differences also present challenges to serving blind and low vision seniors from ethnic minority groups. Outreach efforts to these seniors require engaging the services of translators to facilitate communications between service providers and potential clients. Also, time and effort must be given to establishing relationships that engender trust in service providers and willingness among blind and low vision seniors from ethnic minority groups to step outside the familiarity of their communities to receive beneficial services. Overcoming cultural beliefs that discourage full participation of blind and low vision seniors in many activities is one of the greater challenges faced in providing services to these individuals.

VTC Enterprises

Title VII funds alone are not sufficient to provide services to all who need it in all three counties, so we must continue to look for alternative funding for both support staff and direct services. The ARRA grant increased the number of therapists available to provide services. But the loss of one DOR counselor in the largely-populated expansion area has caused all referrals to be funneled through one counselor. In the past two months, we have not received any ILS or O&M authorizations from DOR in the southern area. The lull in services causes the risk of losing the six providers that we trained.

Part VIII: Signature

As the authorized signatory, I will sign, date and retain in the state agency's files a copy of this 7-OB Report and the separate Certification of Lobbying form ED-80-0013 (available in MS Word and PDF formats.

Signed byJoe Xavier
TitleDeputy Director, Specialized Services Division
Telephone(916) 558-5822
Date signed12/30/2011