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

RSA-7-OB for Delaware Division for the Visually Impaired - DHHS Campus - H177B130008 report through September 30, 2013

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 year28,843
Other federal grant carryover from previous year0
A. Funding Sources for Expenditures in Reported FY
A1. Title VII-Chapter 2253,843
A2. Total other federal0
(a) Title VII-Chapter 1-Part B0
(b) SSA reimbursement0
(c) Title XX - Social Security Act0
(d) Older Americans Act0
(e) Other0
A3. State (excluding in-kind)177,439
A4. Third party1,420
A5. In-kind25,151
A6. Total Matching Funds204,010
A7. Total All Funds Expended457,853
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs166,050
C. Total expenditures and encumbrances for direct program services291,803

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

2.00

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 FY101
2. Number of individuals who began receiving services in the reported FY193
3. Total individuals served during the reported fiscal year (A1 + A2) 294

B. Age

1. 55-5926
2. 60-6424
3. 65-6923
4. 70-7432
5. 75-7931
6. 80-8443
7. 85-8955
8. 90-9445
9. 95-9910
10. 100 & over5
11. Total (must agree with A3)294

C. Gender

1. Female199
2. Male95
3. Total (must agree with A3)294

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race6
2. American Indian or Alaska Native0
3. Asian1
4. Black or African American57
5. Native Hawaiian or Other Pacific Islander1
6. White222
7. Two or more races7
8. Race and ethnicity unknown (only if consumer refuses to identify)0
9. Total (must agree with A3)294

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)14
2. Legally Blind (excluding totally blind)218
3. Severe Visual Impairment62
4. Total (must agree with A3)294

F. Major Cause of Visual Impairment

1. Macular Degeneration138
2. Diabetic Retinopathy35
3. Glaucoma44
4. Cataracts0
5. Other77
6. Total (must agree with A3)294

G. Other Age-Related Impairments

1. Hearing Impairment22
2. Diabetes64
3. Cardiovascular Disease and Strokes82
4. Cancer13
5. Bone, Muscle, Skin, Joint, and Movement Disorders45
6. Alzheimer's Disease/Cognitive Impairment23
7. Depression/Mood Disorder7
8. Other Major Geriatric Concerns53

H. Type of Residence

1. Private residence (house or apartment)266
2. Senior Living/Retirement Community2
3. Assisted Living Facility14
4. Nursing Home/Long-term Care facility12
5. Homeless0
6. Total (must agree with A3)294

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)98
2. Physician/medical provider8
3. State VR agency29
4. Government or Social Service Agency2
5. Veterans Administration2
6. Senior Center0
7. Assisted Living Facility0
8. Nursing Home/Long-term Care facility8
9. Faith-based organization0
10. Independent Living center0
11. Family member or friend43
12. Self-referral80
13. Other24
14. Total (must agree with A3)294

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 6,693
1b. Total Cost from other funds 8,142
2. Vision screening / vision examination / low vision evaluation 257
3. Surgical or therapeutic treatment to prevent, correct, or modify disabling eye conditions 2

B. Assistive technology devices and services

Cost Persons Served
1a. Total Cost from VII-2 funds 6,742
1b. Total Cost from other funds 9,255
2. Provision of assistive technology devices and aids 176
3. Provision of assistive technology services 260

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 175,051
1b. Total Cost from other funds 145,370
2. Orientation and Mobility training 64
3. Communication skills 190
4. Daily living skills 135
5. Supportive services (reader services, transportation, personal 2
6. Advocacy training and support networks 0
7. Counseling (peer, individual and group) 22
8. Information, referral and community integration 112
. Other IL services 3

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 495
1b. Total Cost from other funds 1,914
2. Information and Referral 155
3. Community Awareness: Events/Activities 51 652

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) 310,127 457,853 147,726
2. Number of Individuals Served 338 294 -44
3. Number of Minority Individuals Served 90 72 -18
4. Number of Community Awareness Activities 49 51 2
5. Number of Collaborating agencies and organizations 27 27 0
6. Number of Sub-grantees 6 5

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 260 100.00%
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) 246 94.62%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 14 5.38%
B1. Number of individuals who received orientation and mobility (O & M) services 64 100.00%
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) 62 96.88%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 2 3.13%
C1. Number of individuals who received communication skills training 190 100.00%
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) 171 90.00%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 12 6.32%
D1. Number of individuals who received daily living skills training 135 100.00%
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) 110 81.48%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 4 2.96%
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) 150 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) 27 n/a
E4. Number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only) 5 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) 1 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 Vision Rehabilitation Therapists 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 five providers for provision of Low Vision services and Peer Support. Peer support is provided by Delaware Association of the Blind. Delaware Association for the Blind employs two visually impaired coordinators that oversee the peer support volunteer pool and administrative duties. 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 Coordinators, Peer Support Representatives and the Program Manager meet quarterly to discuss the previous quarter’s performance, trends, comparisons, and issues that arise. There are four 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., and 4) Vision Plus of DE. 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.

DVI OUTREACH During FY’13 efforts continued to identify and provide services to populations that might be underserved and/or unserved. DVI advertised with Vital! Magazine, News Journal and the Central Delaware Chamber of Commerce, and at local mall kiosks with Clear Channel Communications, on Paratransit, rail stations, and fixed route buses via Gateway Communications. DVI has two appearances on Window on Wilmington, TV. DVI established Social Media accounts this period to increase awareness as well. DVI also worked with IN-Focus with Martin Sheen to develop a documentary and commercial. The documentary was aired in the summer of 2013 and is available on our website. DVI also partnered with Screen Vision, Inc. for a twelve week advertising campaign at the Dover Mall Carmike Theaters; two thirty second ads highlighted services before every movie.

Presentations about services provided include:

•Employees of Delaware Park •Board of Examiners in Optometry Meeting in Dover •The Annual Winter Thaw meeting of the Delaware Optometric and Para-Optometric Association in Newark •Coalition for the Organization for Delaware Entrepreneurship Centers held at the Chase Center in Wilmington •Millsboro Lion Club •Support Groups DVI participated in numerous health fairs, wellness programs and presentations throughout the state such as: •Delaware Industries for the Blind Open House •Delaware Diabetes Coalition Tenth Annual "Delaware Diabetes Wellness EXPO" •Life Conference •Heritage Shores Wellness Fair •Homelife Milton Century Club Annual Meeting 684-5277 •55+ Expo •Brain Injury •NFB State Conference •Woodlea Apt. Independence Health Fair •AstraZeneca •Methodist Country House •Cape Henlopen Senior Center •Statewide Advisory Network of DE •42nd Annual Summer Institute "Trauma Across the Lifespan" •Wesley College Disabilities Coordinator Sensitivity Training •Health Fair Long Neck Cheer Center •Employer Conference at the White Clay Conference Center in Christiana. •Blue Rocks Father’s Day Game in Wilmington • Workforce Opportunities Conference at the Chase Center in Wilmington.

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.

DVI’s Partnerships: Visual Impairment Sensitivity Training - DVI Vision Rehabilitation Therapists (VRTs) 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 FFY’13, 16 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. 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. During Fiscal Year 2013 partnerships were established with Capital One, J P Morgan Chase, Christiana Care, Delaware Department of Transportation, Integrity Staffing, and Nemours.

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. 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 mental health professionals, substance abuse professionals, 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.

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, Sensory Gardening, Technology, Kitchen Skills, Financial Literacy, Apple Products, Holiday Baking, Downloading Books, Fitness and You. 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. Sensory Garden The DVI sensory gardening project continues to provide agency consumers, employees and visitors the opportunity to experience the many benefits of gardening in a manner through which all can enjoy, regardless of their abilities. One of the focal points of the garden area is a raised bed planting table, primarily used for edible vegetation and planting demonstrations. The table incorporates barrier free design in a way that recognizes the needs of all potential users. It is located in a high profile area that is aesthetically pleasing and accessible. The garden provides DVI with an additional programmatic location through which consumers can learn to garden, fostering another aspect of independence and self-sufficiency. They have the opportunity to reap the benefits of gardening, including: • Recreation and Socialization • Stress Relief • Horticultural Therapy • Exercise • Sensory Stimulation DVI continues to expand consumers’ access to Assistive Technology. The Division for the Visually Impaired procured assistive technology for consumers in the community throughout the state. The locations report the equipment is beneficial and positive feedback. 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.

Consumer Satisfaction Division for the Visually Impaired Summary of IL Consumer Satisfaction Survey FY ‘13 Consumers Called/Surveys Mailed: 251 Surveys Completed: 71 Percent Returned: 28 % More confident in their abilities: 92% Satisfaction with goals and instruction received: 87% Better manage tasks: 88% Better enjoy reading material: 59% More in control of decision making: 84% Ease of Accessing Services: 77% Rating of DVI IL Services: Excellent:59 % Good:27 % Average:14% Poor: 0% Greatest Difference this program made(Consumer Quotes): Able to regain some sight Enjoy reading more and the reading guides have really helped Having access to more reading materials Enjoyed Ms. Williams company I don’t feel like giving up as much anymore More confident Can now read bills on own, read newspapers, prescriptions, and small print Magnification so can see better and watch tv better Able to tell time now I can do more things around the house Taught how to id money Enjoy listening to tapes Quite a bit Can read now Provided tips to make life better, talking books, more independent Adapt as a visually impaired person Satisfied to know he has eyesight left First was scared to do basic things, now he has the tools to accomplish things See the microwave better Gave the ability to be independent Learning to use the computer Helped to read Enjoy television more with glasses received Meeting people like myself is enjoyable Cope with blindness better Positively wonderful with all help for work purposes. Great employees, very helpful in all aspects. More able to cope than in the beginning Read mail and audio books have been great. People are very kind. Not Satisfied More able to get around better and able to listen to books and really enjoy what I like. The TV and the people have been extremely kind and caring. Every aspect has improved Has learned a lot from the program Gave confidence in doing simple daily tasks. Kind people to help. Audio Books None Audio Books gave eyes a rest More Confidence Entered the program in 1976, moved for 20+ years Yes-lives with family, great to her. More confidence, know- how, positivity Mobility, knowing about others Allowed him to do more things independently Reading machines helpful; Something to look forward to Way to look for employment; new avenues to explore Happy there was some out there to help Can watch TV now; great adjustments and so helpful and very pleased Showing how to do more adaptive things on my own More confidence in myself and ability to do things for myself Manage on my own now Better glasses to see Helping me with everyday tasks Provided some assistive technology tools Marked numbers on her stove and difference in change in money being able to get around to different stores Helped her to get mobility and teach her to be independent and be able to do almost everything a sited person can Has been helpful because they gave sunglasses and a magnifier Knows that she is able to do more; got stencils and labels so she can be more independent Shows that people care and are willing and able to teach people regardless of age Helped to accept disability and be happy with it Helped with working and helping others to help her. Teaching her about calling 411 Helped with mobility and labeling Ability to read Visual aids for seeing/reading Computer skills to job hunt Access Services from DVI: Easy: 77% Difficult: 11% No Response: 22% Improve services(Consumer Quotes): Cannot say Just a suggestion, have more places like lawyer offices, with those plastic reading guides. It really helped and the lawyer said she had other clients who could use them. Can’t think of anything Nothing I can think of It’s great! Stay the same No, loved everyone I met. Cannot say Needs to visit more often, concentrate on helping to see better. More follow-ups Excellent job Nothing wrong Not sure; excellent job; needs an apartment with room for wheelchair/big walker. Not sure; excellent Get people to call once in a while. Don’t see anything wrong No complaints; excellent services. Informal sessions to tell what services are needed No idea I don’t know- give me a new pair of eyes We’re doing everything we can do None at this point More equipment for lower charge Excellent services No ways Not needed New Castle and Kent have more group activities than in Sussex. Sussex County needs to have more activities to keep in contact with blind communities. More meetings offered in Millsboro area, not much offered. Housing options for blind? Curious about opportunities for the blind. Only uses audio books Finding jobs/services for the blind Client needs to make calls to counselor (Jean May) put Braille up Help with walking No input-satisfied No improvements No improvements he can think of; faster delivery for Braille templates Unaware of all the things that DVI does-has been a big help! Improve on delivery to consumers, faster delivery Adding more help to services Keep on doing what you’re doing Remind of appointments and keep updates on case I think they do a great job I honestly don’t know Don’t know Just keep everything coming Need to have a follow-up system and repeat help over time-easier to access help No idea-everyone was very friendly and helpful Don’t have any suggestions Keep doing what DVI is doing Do not know Said there is nothing else that can be done Be more willing to buy more devices Doesn’t know it was good all around. Communication skills are great Business cards. Had trouble finding phone number Have people show No idea-great service already Nothing More resources for other disabilities for under 65

Recommended Changes to the Program(Consumer Quotes): Very satisfied, no changes Can’t think of any None Can’t say; excellent People check in on you every once in a while Don’t see anything wrong. Satisfied More assistance to the consumer Reading in larger letters Have someday call to check up on clients I don’t know None at this point, still able to do a lot Have more gatherings in Sussex County. More steady meetings instead of sporadic Housing Help with finding a job Not much else she can do Not that she knows of Increase response time Contact us more often; home visits Did not want to answer Same as above; seems overloaded/understaffed Check in with clients more More programs for the blind No answer, everything is excellent I think it’s fine the way it is Establish a follow-up system to keep in contact-check-in Everything was great-no change necessary Transportation services None! She loves the program and knows she can count on the DVI when she needs it. Can’t think of anything Very satisfied with the way things are Hire more blind people (50:50 things) and more employees (case workers, etc.) Improve communications. People need to be open and honest Make people more accountable for their actions. Tie people together so that different departments understand what is going on in the other ones. Looking for jobs-require computer skills-need help with that. Make more affordable

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. S. is a 64 year old whose vision loss is due to diabetic retinopathy. Mr. S. is originally from Egypt and speaks very little English. His daughter, a local optometrist, was very supportive to motivate him to receive services. Mr. S. had difficulty preparing meals; therefore his diet included a lot of prepared frozen meals which ultimately was not managing his diabetes well. Mr. S. established goals in kitchen skills, cooking, using appliances, communication skills, time management, transportation, recreation, and management of secondary disabilities. After receiving training in these areas, Mr. S. decided he was longing to be able to read his mail and the liturgy at church along with writing checks. He lives with his wife who works full time. Resources were sought to acquire technology that would assist him with this goal while his family members were away from the home. Mr. S. was provided with a video magnifier that allows him to accomplish the tasks and live independently while home alone.

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

There are not any problematic areas or concerns related to implementing the program in Delaware.

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
TitleDeputy Director
Telephone302-255-9813
Date signed12/27/2013