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

RSA-7-OB for Massachusetts Commission for the Blind - H177B130021 report through September 30, 2013

Part I: Funding Sources And Expenditures

Title VII-Chapter 2 Federal grant award for reported fiscal year656,008
Other federal grant award for reported fiscal year0
Title VII-Chapter 2 carryover from previous year0
Other federal grant carryover from previous year186,673
A. Funding Sources for Expenditures in Reported FY
A1. Title VII-Chapter 2662,037
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)136,044
A4. Third party0
A5. In-kind0
A6. Total Matching Funds136,044
A7. Total All Funds Expended798,081
B. Total expenditures and encumbrances allocated to administrative, support staff, and general overhead costs306,698
C. Total expenditures and encumbrances for direct program services491,383

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 1.6000 3.4000 5.0000
2. FTE Contractors 0.0000 0.5000 0.5000
3. Total FTE 1.6000 3.9000 5.5000

B. Employed or advanced in employment

a) Number employed b) FTE
1. Employees with Disabilities 0 0.0000
2. Employees with Blindness Age 55 and Older 0 0.0000
3. Employees who are Racial/Ethnic Minorities 1 1.0000
4. Employees who are Women 5 4.5000
5. Employees Age 55 and Older 5 4.5000

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 FY738
2. Number of individuals who began receiving services in the reported FY268
3. Total individuals served during the reported fiscal year (A1 + A2) 1,006

B. Age

1. 55-5916
2. 60-6441
3. 65-6954
4. 70-7485
5. 75-79138
6. 80-84243
7. 85-89227
8. 90-94155
9. 95-9942
10. 100 & over5
11. Total (must agree with A3)1,006

C. Gender

1. Female733
2. Male273
3. Total (must agree with A3)1,006

D. Race/Ethnicity

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race18
2. American Indian or Alaska Native3
3. Asian4
4. Black or African American32
5. Native Hawaiian or Other Pacific Islander0
6. White928
7. Two or more races15
8. Race and ethnicity unknown (only if consumer refuses to identify)6
9. Total (must agree with A3)1,006

E. Degree of Visual Impairment

1. Totally Blind (LP only or NLP)24
2. Legally Blind (excluding totally blind)982
3. Severe Visual Impairment0
4. Total (must agree with A3)1,006

F. Major Cause of Visual Impairment

1. Macular Degeneration673
2. Diabetic Retinopathy88
3. Glaucoma96
4. Cataracts11
5. Other138
6. Total (must agree with A3)1,006

G. Other Age-Related Impairments

1. Hearing Impairment331
2. Diabetes199
3. Cardiovascular Disease and Strokes550
4. Cancer38
5. Bone, Muscle, Skin, Joint, and Movement Disorders434
6. Alzheimer's Disease/Cognitive Impairment45
7. Depression/Mood Disorder29
8. Other Major Geriatric Concerns197

H. Type of Residence

1. Private residence (house or apartment)842
2. Senior Living/Retirement Community89
3. Assisted Living Facility71
4. Nursing Home/Long-term Care facility4
5. Homeless0
6. Total (must agree with A3)1,006

I. Source of Referral

1. Eye care provider (ophthalmologist, optometrist)29
2. Physician/medical provider7
3. State VR agency758
4. Government or Social Service Agency75
5. Veterans Administration0
6. Senior Center34
7. Assisted Living Facility3
8. Nursing Home/Long-term Care facility0
9. Faith-based organization0
10. Independent Living center3
11. Family member or friend9
12. Self-referral77
13. Other11
14. Total (must agree with A3)1,006

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 68,636
1b. Total Cost from other funds 0
2. Vision screening / vision examination / low vision evaluation 121
3. Surgical or therapeutic treatment to prevent, correct, or modify disabling eye conditions 1

B. Assistive technology devices and services

Cost Persons Served
1a. Total Cost from VII-2 funds 155,883
1b. Total Cost from other funds 0
2. Provision of assistive technology devices and aids 499
3. Provision of assistive technology services 333

C. Independent living and adjustment training and services

Cost Persons Served
1a. Total Cost from VII-2 funds 170,624
1b. Total Cost from other funds 0
2. Orientation and Mobility training 22
3. Communication skills 377
4. Daily living skills 85
5. Supportive services (reader services, transportation, personal 52
6. Advocacy training and support networks 5
7. Counseling (peer, individual and group) 423
8. Information, referral and community integration 53
. Other IL services 27

D. Community Awareness: Events & Activities

Cost a. Events / Activities b. Persons Served
1a. Total Cost from VII-2 funds 96,240
1b. Total Cost from other funds 0
2. Information and Referral 56
3. Community Awareness: Events/Activities 138 3,208

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) 967,320 798,081 -169,239
2. Number of Individuals Served 1,197 1,006 -191
3. Number of Minority Individuals Served 79 72 -7
4. Number of Community Awareness Activities 159 138 -21
5. Number of Collaborating agencies and organizations 64 83 19
6. Number of Sub-grantees 5 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 333 100.00%
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) 333 100.00%
A3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 89 26.73%
B1. Number of individuals who received orientation and mobility (O & M) services 22 100.00%
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) 1 4.55%
B3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 19 86.36%
C1. Number of individuals who received communication skills training 377 100.00%
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) 108 28.65%
C3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 261 69.23%
D1. Number of individuals who received daily living skills training 85 100.00%
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) 10 11.76%
D3. Number of individuals for whom functional gains have not yet been determined at the close of the reporting period. 69 81.18%
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) 189 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) 4 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) 1 n/a
E4. Number of individuals served who experienced changes in lifestyle for reasons unrelated to vision loss. (closed/inactive cases only) 11 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) 22 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 Massachusetts Commission for the Blind’s (MCB) Title VII, Chapter 2 Program (the BRIDGE Program) utilizes a program design that includes both In-House and Sub-Grantee components. The In-House BRIDGE Program employs a full time Program Director and three Case Workers who provide direct independent living services to blind elders age 55+. The direct IL services include: case management, information and referral, adjustment to blindness counseling, advocacy, low vision services, low vision devices, assistive technology services and devices including the provision of magnifiers, cooking items, clocks and watches, communication devices, adaptive software, and assistive listening devices. The Sub-Grantee component includes contracting with a Public Education Consultant on Aging and Blindness to conduct outreach that targets under-represented populations as well as raising community awareness about benefits and services available to blind elders in Massachusetts. Outreach activities include presentations to low vision support groups, in-service training, speaking to groups of seniors, conference presentations and health fairs. During FY 13, the BRIDGE Public Education Consultant conducted 113 public education events with a combined audience of 3,151 individuals. Outreach to under-represented individuals included: In service training to 38 African American, Latino and Haitian nurses’ aides at Elder Service Plan in Cambridge, speaking engagements at the Elder Health Care Disparities Coalition at Twelfth Baptist Church, Boston, TOPS (Taking Off Pounds Sensibly) group meeting at the Reggie Lewis Center and the Health Care Revival Day at the Mattapan Community Health Center. The Public Education Consultant also spoke at the Living Well Adult Day Health Center in West Boylston to 50 Spanish speaking Seniors (an interpreter was provided), as well as a Spanish speaking engagement at the Chelsea Senior Center (an interpreter was provided). Outreach in the Asian community included and in-service presentation to 9 Activities Directors from several adult day activity centers run by Kit Clark Adult Day Health in Dorchester. The group included Chinese and Vietnamese directors. The Public Education Consultant’s outreach in FY 13 included new audiences, representing 35% of the outreach activity during the year. The new activities included speaking at an Occupational Therapist class at Tufts and setting up a table at the annual meeting for the MA Association of Occupational Therapists following the presentation, the Massachusetts Medicare Patrol, (an organization of “watch dog” activity for Medicare fraud), and an emergency preparedness educational presentation to a large group of state workers from various agencies. The consultant also targeted services to health care workers in the form of in-service training on aging and low vision. She delivered 14 presentations to a total of 261 workers. These included nursing homes, home care agencies, rest homes and day activity centers. Andrea was involved in an outreach collaborative with other agencies, participating in health and disability fairs which included 860 visitors. The Public Education Consultant also attended the 12th Annual Deaf Community Health Fair at Northeastern University in Boston. Thirty-two deaf blind consumers visited the MCB table. The Public Education Consultant also targeted rural areas of Massachusetts in FY 13 with 37 of her group presentations being held in the more rural communities of Massachusetts (populations under 25,000).The OIB BRIDGE Program continued to develop and present Community-Based Training in the areas of Essential Skills Training, Senior Low Vision Assessments and Diabetic Self-Management Training. During FY 13, and the 6 Week Community Based Essential Skills Program was conducted in Hingham, Amesbury and Middleboro, effectively helping 19 consumers with using other senses, personal care, kitchen organization, eating and microwave cooking, time and money, and recreational resources. In addition to the 19 blind consumers, there were also visually impaired consumers who paid to go through the programs. The sessions were held one day per week for seven weeks for four hours each day. The feedback from group participants has been extremely positive. There were two consumers who opted for the two week center based training at The Carroll Center in Newton.

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.

The Massachusetts SPIL states that, "The priority of the public education component of the OIB program is the provision of information that will enhance the capacity for independent living to consumers and opportunities for collaboration and community awareness to service providers, with a particular emphasis on outreach to under-represented populations."The SPIL further states that, "The BRIDGE Program contracts with a Public Education Consultant for approximately 1,000 hours/year to do outreach and in-service training. The contractor is selected through a competitive bidding process." During FY 13, the BRIDGE OIB Program contracted with a consultant for outreach and public education on the issues of aging and blindness. She spoke to a combined audience of 3,151 comprised of seniors in low vision support groups, assisted living facilities, housing developments, health fairs, etc. She provided in-service training to 261 staff at nursing homes, home health agencies, etc. She represented the OIB BRIDGE Program at 16 health fairs; she provided workshops and information tables at 14 conferences. The consultant has maintained a high level of provision of information, increasing the level of performance in outreach to African-American and Asian-American communities, in-service training, and involvement in relevant conferences. The lack of information about benefits, services, and assistive technology continues to be a barrier to independence for elder blind individuals however improvements have been made in the areas of collaboration with other agencies serving the elder blind and visually impaired as well as conducting more MCB outreach. Innovative programming included collaboration with Carroll Center for the Blind and Perkins School for the Blind to provide the third annual training for leaders of Low Vision Peer Support Groups unaffiliated with MAB Community Services or Sight Loss Services. The OIB BRIDGE Program continued to develop and present Community-Based Training in the areas of Essential Skills Training, Senior Low Vision Assessments and Diabetic Self-Management Training. During FY 13, and a 6 Week Community Based Essential Skills Programs were conducted in Hingham, Amesbury and Middleboro, effectively helping 19 consumers with using other senses, personal care, kitchen organization, eating and microwave cooking, time and money, and recreational resources. The sessions were held one day per week for seven weeks for four hours each day. The feedback from group participants has been extremely positive. There were two consumers who opted for the two week center based training at The Carroll Center, where they live there for 2 weeks to go through all independent living training and care in two fairly intensive weeks. Initially, the OIB Program used ARRA funds to develop the community-based model for Senior Vision Assessments, Diabetic Self-Management training and Community-Based Essential Skills Training. The expectation is to continue the community-based model for some of our programming and expand this model to other services which we provide i.e., adaptive software training. The community-based essential skills training has been well received by the elder blind, and the model facilitates collaboration with public and private agency partners and further expands the community’s awareness of the OIB program and services.

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.

The Massachusetts OIB (BRIDGE Program) contracts with the NRTS at Mississippi State University to conduct program evaluation and measure consumer satisfaction with OIB services, and specifically related to the Peer Led Support Groups. A Program Participant Survey was conducted in FY 2013 to determine the degree to which consumers are satisfied with the Peer Led Support Groups through the BRIDGE Program. In addition, the survey gathers outcome data from consumers related to their attendance and increased socialization as a result of participating in the support groups. Included in the survey were questions related to participant satisfaction with the manner in which the peer groups were conducted. This unique survey was designed to allow the administrative team to gather outcome data on Peer Led Support Groups to supplement reporting to RSA plus some additional data that would be useful in program analysis and planning. The survey was provided to a group of peer group participants who attended throughout the fiscal year 2013. The support group programs are contracted to the Massachusetts Association for the Blind (MAB) and Sight Loss Services. Questions for the survey were determined in part from previous satisfaction surveys conducted by MAB and a collaboration of the BRIDGE program staff and the project staff of the NRTC. The survey asked questions related to meeting location, group members, transportation, leadership, meeting structure and content, outcomes and gave opportunities for open ended responses. What follows is a brief summary of the demographics of the project and the general commendations and recommendations. One hundred and eight four individuals completed and returned the survey instrument. Demographics Respondents (N = 184, 77.8% women, 22.2% men) had an average age of 82 years old, and the majority were Caucasian (95.9%), with 1.8% of respondents indicating their race as African American, and 2.4% indicating another race/ethnicity. A variety of causes of vision loss were reported with 54.4% attributed to macular degeneration, 6.6% to glaucoma, 2.2% to diabetic retinopathy, 1.1% to cataracts, and 35.7% to another cause (including multiple causes). Slightly less than half of respondents (42.5%) reported having a hearing impairment. Participants were asked to indicate the year they began attending peer group meetings and how many meetings they attended in the past year. Participant responses ranged from 0-33 years in how long they have been attending meetings, with an average of 7 years. Participants reported attending an average of 9 peer support meetings last year. Commendations The BRIDGE program is to be commended for instituting an effective network of peer led support groups. This allows for on-going support for elders who are often at risk given their age, vision loss and health issues. Overall the program is well conceived, and well administrated by involving two community agencies for the day-to-day implementation. The basic principles of the peer-led support groups are sound and fundamental to the development of an effective peer group system. The peer-led support groups are run by and for group members. Professional providers from the BRIDGE program and other community agencies participate as advisors and speakers, with the sanction of the group. Each of the support groups includes guest speakers, discussion, sharing of information and experiences, and other activities that promote mutual support and empowerment. Support groups are open to all who have experienced the common concern of vision loss and aging (with the exception of one multi-age group) and to facilitate participation. The support group is free of charge and includes funding for transportation when necessary. This structure is commendable. The peer led concept has its challenges, but in large part it helps consumers be invested in their own on-going wellness and independence. It also brings a sense of empowerment to the group by setting examples of independent productive leaders. Leaders have personally experienced the challenges of vision loss and aging. The BRIDGE program is also to be commended for seeking feedback from consumers as to their thoughts and concerns about the program’s effectiveness and soliciting both satisfaction measures and suggestions for improvement. Recommendations The two separately administered programs have some different dynamics, however, there are also some things they seem to have in common. General recommendations for both groups include the following: Some individuals indicated that there are distractions that sometimes interfere with the function of the group. These distractions included talking during the speaker, coming and goings among group members, and difficulty hearing for some persons with hearing impairments. We are listing the difficulty hearing here as a distraction because people need to ask for things to be repeated or clarified and that causes distractions. It is recommended that leaders give verbal reminders to the group about distractions even when amplification systems are being utilized. The size of the groups may cause distractions as well. Some groups had over 20 members and this can increase the likelihood of distractions and difficulty hearing. It also makes it more difficult for members to participate in discussions and feel invested in the group. There were several negative comments about group size. It is our suggestion that groups be limited to 12 members. Larger groups might need to be divided into two groups. One question on the survey related to leaders reminding members of confidentiality at each meeting. Respondents indicated that this was often overlooked and since mutual trust and the assurance of confidentiality is essential to meeting effectiveness, it is recommended that leaders be urged to remind members of this critical issue at the start of each meeting. These specific issues might need to be addressed in upcoming discussions. Speakers from the Massachusetts Commission for the Blind or the BRIDGE Program might address these topics with the groups. A change in leadership periodically is a good thing. One idea is to change the role of the co-leader and leader for a period. People may be more apt to volunteer to be leaders if they do not see it as a life-long commitment. There may also need to be policies in place for interim leadership if a group leader is unable to serve for a while. The development of criteria may need to take place in order to assist in knowing when it is time for a leader to step down. This might include a vote of confidence from the group, a time limit, or some other criteria. A number of respondents from both agencies seemed to feel that the members of the group do not follow the guidelines or rules for discussion. These issues might need to be addressed with discussion from the groups. It is our suggestion that some of these results be shared with the members of the groups, and in the training sessions of the leaders. There was some interest in a newsletter or calendar of events that could be shared with group members to help them keep up on up-coming events. An accessible list of upcoming speakers and events might encourage members to invite a guest. Open-Ended Comments The vast majority of the comments were positive. Here are some comments to a few of the questions. When asked what they liked about the peer-group, some responded: The camaraderie. No one looks down on anyone, but always tries to help them. Great people with tons of info that cannot be found anywhere else. I meet others with my sight loss condition. I enjoy the social aspect of meeting others and sharing discussions with them. When asked for suggestions to improve the peer-groups, many of the comments focused on their need to understand their visual loss and to be more positive. Here are a few of their thoughtful suggestions: We like having cheerful people to help us understand sight loss. We need a brighter room. Would like to hear more from research doctors. Directors of the agencies could mail out agenda for upcoming meeting in ample time to make individual plans and not last minute phone calls. Create a special transportation plan if needed. Participants reported being pleased with the program and felt it was beneficial to them in their adjustment to vision loss. Overall, the peer-led support groups are a very effective way to maintain meaningful contact with seniors adjusting to vision loss and to provide on-going services when needed.

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).

1. Consumer is a 77-year-old single female who lives with her sister and brother-in-law in a single-family home located in a city north of Boston. She was born in India. Her native language is Gujarati. She is fluent in English too. Consumer has a visual diagnosis of myopic degeneration OU. Prior to experiencing significant vision loss, consumer had led an active, independent life. She earned a master’s degree in library science from Simmons College. She retired from her long-time position as librarian at a state agency in 2002. BRIDGE worker met with consumer for initial home visit in November 2010. At that time, she was extremely anxious about the functional losses triggered by her visual condition—especially her decreased reading ability. She was motivated to explore any rehabilitation service that might enable her to increase her independence level. To help consumer increase her functional capacity, her BRIDGE service plan included the following vision rehabilitation services: ILA 4x LED-illuminated pocket magnifier With this portable magnifier, consumer is able to complete short-term reading tasks—at home and in the community. Merlin flat panel color CCTV and CCTV training She can use her CCTV for long-term reading tasks (e.g., books, record keeping). Prior to receiving the CCTV, she was unable to read books. She is thrilled that she is able to read books on a regular basis again. Gooseneck reading floor lamp with full spectrum bulb This lamp provides good illumination for reading tasks. 20/20 pens and bold line writing paper. These aids make it easier for her to complete basic record keeping tasks. Liquid level indicator, color-coded measuring cups/spoons, and LP timer. These adaptive aids facilitate meal preparation tasks. Ambutech long folding cane with roller tip and training in sighted guide technique. With a white cane, she is able to travel more safely. Her sister is able to act as a sighted guide when necessary. Eschenbach 2.1x Max TV glasses. Consumer is able to see images on her television more clearly with these telescopic glasses. ZoomText Magnifier/Reader software and adaptive software training. With this adaptive software installed on her new all-in-one computer, she can use her computer more efficiently for email and web browsing. As a result of BRIDGE OIB IL services, consumer was able to achieve functional gains in reading, record keeping, meal preparation, independent travel, leisure time activities, and computer operation. At the completion of BRIDGE OIB IL services, consumer is much more confident and hopeful about her future as a visually impaired adult. She is extremely grateful for the vision rehabilitation services that she received from the MCB BRIDGE Program—in particular, her desktop CCTV.

2. Client had recently moved to Massachusetts from Florida. Her eye impairment is a result of Glaucoma and in addition, the client suffers from severe respiratory issues. Client’s son had set her up in an apartment after the move to MA to be close to one of her sons. Client was an English interpreter for the courts in her native country and is highly intelligent. The client was challenged with increased vision loss, loneliness, and social isolation when BRIDGE took over her case. Client was very motivated to become as independent as possible in her new environment. BRIDGE was able to provide the following plan of action: Senior Low Vision Assessment at the Carroll CenterEssential skills - 2 week on site IL program at the Carroll Center where Client was able to gain a great deal of confidence having learned ADL skills. CCTV- Perkins talking book library was able to provide client with machine. Perkins Talking Book Program — Worker assisted client to enroll in the program. O&M - Worker made sure client received mobility instruction to enable her to use the local resources. Client also had Safe Home Assessment conducted to help her stay safe in her apartment. LAB (Lowell Association for the Blind) - Client was introduced to their program and has attended many of their activities. Chelmsford Peer Support Group - Worker assisted client in connecting with the support group and the senior center in Chelmsford, which has been a big part in the client’s socialization progress. Zoom Text — Software was installed and training was conducted in the client’s home computer and she is using it to her advantage in continuing with computer use and connection to her family. Client communicated that due to the BRIDGE Program and the worker’s involvement in providing services to the client, she has dramatically increased her independence and confidence in all aspects of her life.

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

The lateness of the Grant Award and Continuing Resolution letters continues to be problematic often resulting in service delays for OIB Consumers.

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 byKaren Hatcher
TitleDirector, BRIDGE Program
Date signed12/31/2013