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

RSA-7-OB for Delaware Division for the Visually Impaired - DHHS Campus - H177B110008 report through September 30, 2011

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year225,000
Other federal grant award for reported fiscal year0
Title VII-Chapter 2 carryover from previous year53,739
Other federal grant carryover from previous year0
A. Funding Sources for Expenditures in Reported FY
A1. Title VII-Chapter 2245,521
A2. Total other federal1,682
(a) Title VII-Chapter 1-Part B0
(b) SSA reimbursement0
(c) Title XX - Social Security Act0
(d) Older Americans Act0
(e) Other1,682
A3. State (excluding in-kind)210,251
A4. Third party0
A5. In-kind12,210
A6. Total Matching Funds222,461
A7. Total All Funds Expended469,664
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs126,663
C. Total expenditures and encumbrances for direct program services343,001

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 0.8000 2.4000 3.2000
2. FTE Contractors 0.0000 0.0000 0.0000
3. Total FTE 0.8000 2.4000 3.2000

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 2 0.8000
2. Employees with Blindness Age 55 and Older 0 0.0000
3. Employees who are Racial/Ethnic Minorities 4 1.5000
4. Employees who are Women 7 2.8000
5. Employees Age 55 and Older 3 3.0000

C. Volunteers


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 FY173
2. Number of individuals who began receiving services in the reported FY240
3. Total individuals served during the reported fiscal year (A1 + A2) 413

B. Age

1. 55-5938
2. 60-6440
3. 65-6929
4. 70-7440
5. 75-7942
6. 80-8464
7. 85-8980
8. 90-9457
9. 95-9922
10. 100 & over1
11. Total (must agree with A3)413

C. Gender

1. Female271
2. Male142
3. Total (must agree with A3)413

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race11
2. American Indian or Alaska Native1
3. Asian4
4. Black or African American73
5. Native Hawaiian or Other Pacific Islander1
6. White315
7. Two or more races8
8. Race and ethnicity unknown (only if consumer refuses to identify)0
9. Total (must agree with A3)413

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)17
2. Legally Blind (excluding totally blind)294
3. Severe Visual Impairment102
4. Total (must agree with A3)413

F. Major Cause of Visual Impairment

1. Macular Degeneration218
2. Diabetic Retinopathy39
3. Glaucoma46
4. Cataracts3
5. Other107
6. Total (must agree with A3)413

G. Other Age-Related Impairments

1. Hearing Impairment29
2. Diabetes68
3. Cardiovascular Disease and Strokes74
4. Cancer7
5. Bone, Muscle, Skin, Joint, and Movement Disorders30
6. Alzheimer's Disease/Cognitive Impairment6
7. Depression/Mood Disorder7
8. Other Major Geriatric Concerns31

H. Type of Residence

1. Private residence (house or apartment)367
2. Senior Living/Retirement Community10
3. Assisted Living Facility21
4. Nursing Home/Long-term Care facility15
5. Homeless0
6. Total (must agree with A3)413

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)112
2. Physician/medical provider19
3. State VR agency31
4. Government or Social Service Agency1
5. Veterans Administration2
6. Senior Center2
7. Assisted Living Facility0
8. Nursing Home/Long-term Care facility0
9. Faith-based organization0
10. Independent Living center0
11. Family member or friend64
12. Self-referral133
13. Other49
14. Total (must agree with A3)413

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 6,558
1b. Total Cost from other funds 713
2. Vision screening / vision examination / low vision evaluation 345
3. Surgical or therapeutic treatment to prevent, correct, or modify disabling eye conditions 3

B. Assistive technology devices and services

Cost Persons Served
1a. Total Cost from VII-2 funds 23,648
1b. Total Cost from other funds 13,583
2. Provision of assistive technology devices and aids 225
3. Provision of assistive technology services 305

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 107,862
1b. Total Cost from other funds 177,506
2. Orientation and Mobility training 93
3. Communication skills 269
4. Daily living skills 169
5. Supportive services (reader services, transportation, personal 6
6. Advocacy training and support networks 0
7. Counseling (peer, individual and group) 29
8. Information, referral and community integration 175
. Other IL services 6

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 5,517
1b. Total Cost from other funds 7,614
2. Information and Referral 237
3. Community Awareness: Events/Activities 25 750

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) 380,834 343,001 -37,833
2. Number of Individuals Served 378 413 35
3. Number of Minority Individuals Served 75 98 23
4. Number of Community Awareness Activities 93 47 -46
5. Number of Collaborating agencies and organizations 21 25 4
6. Number of Sub-grantees 6 6

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 305 100.00%
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) 189 61.97%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 2 0.66%
B1. Number of individuals who received orientation and mobility (O & M) services 93 100.00%
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) 79 84.95%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 14 15.05%
C1. Number of individuals who received communication skills training 269 100.00%
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) 246 91.45%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 19 7.06%
D1. Number of individuals who received daily living skills training 169 100.00%
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) 131 77.51%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 19 11.24%
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) 200 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) 0 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) 32 n/a
E4. Number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only) 32 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) 7 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.

Delaware Division for the Visually Impaired provides services directly to the consumers in the state. Five Senior Rehabilitation Instructors provide independent living skills training in areas such as activities of daily living, self-advocacy, low vision and communication. Information and referrals are made to other agency direct service providers such as Orientation and Mobility Specialists, Technology Trainers, Vocational Rehabilitation Counselors and community service personnel. The Division contracts with six providers for provision of Low vision services and Peer Support. Peer support is provided by Delaware Association of the Blind for peer support services. Delaware Association for the Blind employs a visually impaired coordinator that oversees the peer support volunteer pool and administrative specialist. The service is provided via telephone to newly visually impaired consumers. The contract is monitored monthly with the submission of reports. Communication with DAB personnel occurs during case assignment, goal setting meetings, and closure meetings. In addition, the Executive Director, Program Coordinator, Peer Support Representatives and the Program Manager meet quarterly to discuss the previous quarter’s performance, trends, comparisons, and issues that arise. There are five Low Vision Specialists that DVI contracts with for Low Vision evaluations and follow-up services. The Low Vision Specialists are: 1) Eye 2 Eye Optometry, 2) Simon Eye Associates, 3)Low Vision Specialists, Inc., 4) Vision Plus of DE, and 5) Kaplan and Epstein. These providers examine the consumers’ ocular health, prescribe aides, and consult with DVI personnel and the patient’s medical professional. The contracts are monitored throughout the year via reports, communication, correspondence, invoices, and consumer feedback.

The program continued the tradition this year of strategic planning for DVI’s IL program. The team brainstormed strengths, challenges, opportunities, and threats. In addition, the team discussed new initiatives and our vision for the program. This document is reviewed at our monthly meetings and adhoc committees have been formed for accomplishing the tasks. OUTREACH During FY’11 efforts continued to identify and provide services to populations that might be underserved and/or unserved. DVI participated in numerous health fairs, wellness programs and presentations throughout the state such as: •India Fest •St Catherine of Siena Martin Center Health Fair •Sherwood Park Human Service Fair •THE 2010 Governors Committee on Employing Persons with Disabilities Event •Delaware Park Annual Benefits and Health Fair •Life 50+ Expo •9th Annual Delaware Diabetes Coalition Expo •First Choice Chiropractic "Girl’s Saturday Out •Life Conference •Chelton Apartments Health Fair •10th Annual 55 Plus Expo •Forward Manor Health Fair and Lunchtime DEMO •Windsor Apartments Health Fair •Main Tower Apartments Health Fair •Georgetown Public Library Community Fair •Griswold Special Care Multi-Agency Overview •Methodist Country House Retirement Community Health Fair •Community Market Square Community Fair •Christiana Park 2011 Senior Health & Fitness Day •Resource Expo II •Rodney Court Apartments Mini Health Fair •Annual Trap Pond Fall Festival •Delaware Direct Support Professionals Day •Mini Health Fair •Red Clay Family Resource Fair

DVI also placed advertisements in several statewide publications, media outlets and special population newsletters to solicit referrals. Examples include: •WPVI (6-ABC Philadelphia) running DVI Public Service Announcements; •Director Robert Doyle appeared on WITN- Channel 22 program “Window on Wilmington” to discuss DVI programs and services.

• WYUS Radio LaExitosa ads run for a series of 10 sixty second ads per month in Spanish •Vital! magazine for April, May and June advertising. •Advertising campaign with the Wilmington News Journal

•Advertising on Delaware Agency for Regional Transportation (DART) bus panels •Advertisement with Comcast Spotlight for 6 month campaign consisting of banner ads with links to the DVI Homepage; a 15 second video “pre-roll” (a testimonial from DVI consumer) which precedes video segments on Comcast online; and also a DVI “tag line” on the “Health Matters” segments on Comcast Cable TV channels. • Ad campaign was extended to billboards in all three counties

•Mailing was sent to 21 Delaware Radio stations requesting a 15 second public service announcement on the agency

•Poster board ads at the Christiana and Dover Malls.

The DVI Views: Agency Newsletter continues to be produced in Large Print, Braille, Audio, PDF and text versions. This year the agency developed and distributed a large print agency brochure.

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.

This period DVI sponsored the first ever Technology Fair. The event drew vendors and consumers to the State’s capitol to enjoy the latest in technology. DVI displayed all of their services and also those of other community organizations. The event took place on October 15 which is significant due to the White Cane Day observance. The event was evaluated as successful by the vendors and consumers. There were forty-three attendees. The consumers are anxious for DVI to sponsor another event of this type in the near future. As indicated in our SPIL, we continued group training sessions this fiscal year. Our agency supported our Skills Center with additional adaptive equipment and high end Assistive Technology to complement our program. Our team developed a schedule for the workshops according to the evaluations. The curriculum included an overview of our services, community resources, Diabetes Management, Sensory Gardening, Apple Products, Labeling and Organizing, Fire Safety, AT Options, Self-Defense, Guide Dogs, Kitchen Skills, Recreation, and Self-Care. DVI worked with several consumers in these areas and the workshops were co-facilitated. The consumers talked openly during breaks and meals and commented on the value of the program. Consumers were contacted to evaluate the effectiveness of the workshops. All responses were positive. The feedback will be used to schedule additional workshops and follow-up with those who are in need of additional services.

Visual Impairment Sensitivity Training - DVI Senior Rehabilitation Instructors (SRIs) provide training on the specific aspects of working with the visually impaired population in order to familiarize new or existing DVI employees, family members, and local organizations who are interested in establishing and/or maintaining opportunities for this population. There are two Training Centers in the state, one located in Sussex County and the other in New Castle County, that are fully equipped with the necessary adaptive devices. We discovered that our external customers find it beneficial to learn additional skills in sighted guide technique, white cane use, as well as the wide variety of assistive technology; we invited colleagues from other programs to assist with this endeavor. During FY’11, 24 individuals were trained in sensitivity awareness for the visually impaired population. All of the training evaluations have been positive. The Sensitivity Training Centers at both sites include many appliances and items for daily living.

Diabetes - The Division for the Visually Impaired continued collaborating with the Diabetes Prevention and Control Program. The Center for Disease Control reports that every 24 hours nearly 50 adults go blind due to diabetes complications. Statistics show that one in twenty Delawareans have been diagnosed with diabetes. Diabetes is a costly disease associated with serious complications and premature death. The DSU Liaison is an active member of the Diabetes Coalition. This team is comprised of representatives from health insurance companies, physicians, pharmacists, diabetes educators, and other public and private agencies. The Coalition meets quarterly to discuss issues such as education, strategic plans, and health care issues. The DVI and the Diabetes Prevention and Control Program provide information to Delawareans about their respective programs to ensure awareness at various levels. The DVI and the Diabetes Prevention and Control Program also inform members of each organization about outreach opportunities, diabetes information, and access to community services. The Diabetes Prevention and Control Team also facilitated two series of workshops this period to assist our consumers with complications related to Diabetes. The sessions included topics regarding nutrition and management. DVI also assisted in the planning of all of the Diabetes Wellness Expos. This collaboration will continue to be enhanced as we strive to reduce the prevalence of diabetes and support effective management.

DVI partnered with the Delaware Association for the Blind to present a Teen Transition Weekend. There were 8 participants. The activities for the weekend incorporated skills such as Independent living skills, career exploration, nature exploration, and assistive technology. This is the seventh year that we have partnered with the local association for the blind for this activity. The Independent Living Advisory Committee is comprised of consumers appointed by the Director of DVI. Their primary function is to provide feedback to the independent living program. The committee frequently discussed their difficulty with transportation. As a result, DVI’s liaison to the Elderly Disabled Transportation Advisory Committee reports at the meetings and works with key representatives from Delaware’s Transportation Authority (DART) to address concerns. The DVI Vocational Rehabilitation (VR) program continues to employ full-time employees whose major responsibility is to seek employment opportunities statewide for the visually impaired population. During the fiscal year, they promoted employment opportunities for the visually impaired to several employers and businesses. Notably, DVI’s Vocational Rehabilitation Team’s Fiscal year 2011 employment outcomes have increased 23% over 2010. The majority of the placements have received Independent Living Services or Evaluations. One of DVI’s Orientation and Mobility Specialist serves on our Elderly and Disabled Transit Advisory Committee and WILMAPCO. She continues to work with a variety of stakeholders to discuss transportation and mobility services for the visually impaired. She serves as DVI’s liaison for consumers and DVI team members and DTC. In addition, the group determines the need of Auditory Pedestrian Signals (APS). With consumer assistance, areas continue to be identified and evaluated for APS installation. Both the Division for the Visually Impaired and the Division of Substance Abuse and Mental Health(DSAMH) are divisions within Delaware’s Department of Health of Social Services. DVI is a member of the DSAMH’s stakeholder group. The group is comprised of faith based organizations, community activists, and state and local government agencies. Information is shared at the meetings about services for Delawareans with substance abuse and mental health problems. DVI’s Administrative Specialist Teams participated in Braille Transcription training to continue expansion of our ability to produce Braille.

DVI is a member of the Advisory Committee for Emergency Preparedness for Individuals with Disabilities. This committee is charged with providing training and resources for family centered and inclusive emergency planning and preparedness in Delaware, and training for emergency responders and planners.

ARRA Activities The primary use of DVI’s ARRA funds was for expansion of consumers’ access to Assistive Technology. The Division for the Visually Impaired has procured assistive technology and computers for a computer lab at both office locations to increase access to specialized Assistive Technology for the visually impaired. The labs were opened in March of 2011. A Memorandum of Understanding has also been implemented with the Modern Maturity Center in Dover, Delaware, to also expand opportunities for the visually impaired to access Assistive Technology. Equipment has been placed at this location to allow consumers the opportunity to enjoy the AT in Kent County, the middle of the state since our offices are in the other two counties. DVI was also invited to their Open House to discuss our services and the appropriate use of the equipment. A Memorandum of Understanding has also been implemented with Easter Seals of Delaware- Maryland Eastern Shore to expand opportunities for the visually impaired to access Assistive Technology. A Memorandum of Understanding has also been entered with two Rehabilitation Facilities in Sussex County to expand opportunities for the visually impaired to access AT. Each location received a Close Circuit Television (Video Magnifier) to allow consumers to read documents. Another activity that is included in our ARRA (American Recovery and Reinvestment Act) project is Elearning. The American Foundation for the Blind is a nationally renowned organization and since its founding in 1921, has been a defining leader, advocate, and resource for people who are blind and visually impaired and service providers. AFB has developed E-learning to provide a comprehensive web-based learning center for vision rehabilitation professionals. It features 21 mini courses that are divided into four modules. Each module includes several courses. Each course is a stand alone course that includes references and resources. DVI employees (the e-learners) will receive progress reports on the courses they are enrolled. DVI will receive periodic electronic reports of usage, completed courses, access to the electronic bookshelf of AFB e-books that relate to the courses and the Journal of Visual Impairment and Blindness.

Training Examples of trainings and conferences that DVI has participated are: Braille Translation training, Downloading Library Books, Attracting Senior Drivers to Public Transportation, Apple for Business, IPOD, ITunes, Social Media for Business, Imovie, Iphoto, Finder, Getting Started with Apple Products, First Aide/CPR, Everything I, The Law related to People with Disabilities and Emergency Preparedness, Emergency Discharge Planning, and Learning from Catastrophe from 2011 Tohuku Earthquake. During this reporting period DVI also conducted agency-wide quarterly training. This initiative provides multiple program training and team-building opportunities. Topics covered were Low vision, Vocational Rehabilitation, Stress management, Independent Living Skills, and Interpersonal Interactions. DVI uses the employee evaluations and training needs assessments to determine the agenda for upcoming Quarterly Trainings. One of our CVRTs has an on-going Braille Group. There are a variety of concepts taught including: a) the alphabet, b) numbers, c) labeling, d) greeting cards, e)games and d) reading recipes. This group continues to progress well and enjoys the peer support aspect of this class.

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.

Comparison for the Division for the Visually Impaired The total number of DVI consumers served by the Independent Living Services unit for FY ’11 was 572. During the same period, DVI served 159 consumers aged 18-54, compared to 114 consumers in FY ’10. FY 2011 FY 2010 FY 2009 Low Vision Services (Number Served) 133 212 120 IL Goals Completed (Total Individual) 3698 3617 4053

Consumer Satisfaction Consumers Called/Surveys Mailed: 427 Surveys Completed:115 Percent Returned: 27% More confident in their abilities:83% Independence Increased as a result of services: 91% Better manage tasks:83% Better enjoy reading material:76% More in control of decision making: 83%

Rating of DVI IL Services: Excellent: 44% Good: 49% Average: 6% Poor: 1% Comments: •I can now use my washer and microwave. •I enjoy books on tape •I now have a better understanding •I am able to adjust better •Knowing there are resources out there •I am more confident •I am more confident and independent •I am able to go back to work and be more independent •I didn’t know about the coins with different edges and how to fold money until I was shown •Being able to handle my finances on my own and seeing the time without assistance •I now do not have to rely on others to conduct my business •I can still do things that I was afraid to do and to talk to others who have similar eye conditions •I was able to find a job •The service was helpful and fast •The magnifiers and markings allowed me to read directions, look at TV, that I could not do previously •I use my calendar and watch daily •Books on Tape is great •Able to read my prescription bottles with the stronger magnifier •Seeing the TV and being able to read •Ability to read •I am doing things that I thought I couldn’t do anymore. I am also more confident •Services have given me the ability to stay independent especially help with appliances and lighting •I am more motivated to do things •Being able to get around independently •I can go out and walk with my cane, see TV, and tell time again •Showed me other ways to do things without vision •Changed my opinion of someone working with a visual impairment •I can get to my destinations on the bus •Going back 37 years, I am more independent •Made me aware of things that I never thought about •I better understand my eye condition •Able to handle everyday tasks around the house •Definitely made me more confident •The workers understood my needs •Being able to read the paper again •I can now read the sports •DART training has made me more independent and costs less •The calendar helps me to keep track of appointments •Peer Support and lighting was helpful •Being able to read my Bible •Just being able to do simple things like signing my name on checks and seeing faces clearly makes a big difference.

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).

Mr. I is a 62 year old diagnosed with glaucoma and diabetes. When initially referred he lived with his father in a single family home. He was not motivated and was being taken care of by his father. He would not do anything for himself. He also was not managing his diabetes and spent a lot of time in the hospital. The family was looking to get him a home health nurse. At the onset of services Mr. I was comfortable with his family taking care of him. He had given up all hope and only wanted his sight back. Once he found out about the abilities of blind people and the services available- he said he was willing to try to do things for himself. His family continued to try to get him to be more independent. The family knew their father that was currently taking care of him was terminally ill. He initially set goals such as communication, daily living, self- care, time management, personal resource management, orientation and mobility and peer support. The worker set up a training schedule with him. Mr. I canceled several sessions. After a while, he was ready to continue with his training. The family continued to encourage him to work towards adjustment . Unfortunately, his father’s illness has progressed and his house was due to be foreclosed. We referred him to community resources for assistance. He is now living alone and frequently comes to our facility to attend workshops and other skills training such as Braille.

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

There are currently not any problematic areas or concerns related to the Delaware Older Blind program.

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 byElisha Jenkins
TitleProgram Manager
Date signed12/22/2011