KSBVI ADVISORY COMMITTEE MARCH MEETING

By Ann Byington

On Saturday, March 11, 2006,the Kansas Services for the Blind and Visually Impaired Advisory Committee. Chairman Sanford Alexander called the meeting to order at 9:30 a.m. in the conference room at the Kansas Rehabilitation Center for the Blind and Visually Impaired (RCBVI). All organization representatives, or their alternate delegates, were present with the exception of Susie Stanzel, National Federation of the Blind of Kansas (NFBK) President, who attended via conference call. No appointee had been named to represent older blind consumers. It was later determined that no representative of the KRCBVI Client Council was at the table. Shawn Klein as the councils secretary was asked to fill that slot. Fourteen guests were present. Betsy Thompson, Acting Director, Kansas Rehabilitation Services was also in attendance.

Minutes: Because of frequent recording equipment breakdowns and the committee’s extreme dissatisfaction with the quality and tone of minutes for the past August meeting, Nancy Johnson volunteered to do the minutes for the March meeting. After further discussion, a motion passed to have Connie Dagget, who does minutes for the State Rehabilitation Council, re-do the minutes from the August 27, 2006 meeting, as well as those of subsequent meetings.

Reconstruction of December Minutes: The remainder of the morning portion of the meeting dealt with reconstructing minutes for the December, 2005 KSBVI Advisory Committee meeting.

KABVI Delegate Status: Ms. Thompson declined to appoint a delegate for KABVI, stating that she preferred to leave this duty to whomever was hired as the new director.

Election of chair and vice chair: According to the current committee by-laws, all committee positions will expire December 31, 2006. Beginning in 2007, one third of the committee would be appointed for 1 year, one third for two years, and one third for three years to create staggered terms. Because of the vacancy in the vice-Chair’s position created by Michael Byington’s resignation, and since this was the regular election meeting for electing a chairperson as well, Sanford Alexander was re-elected as committee Chairman and John Kitchens received the post of Vice-Chair.

New director for KRS: During her presentation, Betsy Thompson stated she is reluctant to make decisions regarding board members or other decisions of importance to the committee. These should, she indicated, be left for the new director to make. The search for a new KRS director has taken longer than planned. It was hoped a new director would be available to attend this meeting. A national posting was done. A field of about 50 applicants was narrowed to 10 or 12. Interviews have begun. It was hoped that two or three candidates could be given an opportunity to interact with groups such as the Disability Rights Council, the State Rehab Council, independent living centers, this committee, etc. It is hoped the position will be filled in April.

Report of Interim Director: Order of SelectionAbout 350 names with application dates of September, 2005, were removed from the waiting list in January. It was hoped about the same number could be removed in March. About 1200 names remained on the waiting list.

State Rehabilitation Council (SRC) An employer forum, consumer forum, and meeting of the SRC were held March 2-3. Attendance was small. Additional forums are scheduled for Liberal in June; the Wichita area in September; and in the Kansas City area in December. The relationship between the Disability Rights Center (DRC) and SRC relative to the Client Assistance (CAP) Program is going well. DRC staff is being included in new counselor training.

Federal Review The 107 review of casework policies and procedures was recently completed. Outcomes were positive. A result of the review was the presumed eligibility of persons receiving SSI and SSDI. We are awaiting the report on corrective actions.

Pilot Project This project in Western Kansas would develop improved access for field rehab counselors. They would have laptop computers, which would provide them access to the information they need to process cases on the spot. This should improve customer satisfaction and staff efficiency. If this pilot succeeds it will help other SRS programs.

SRS Budget The budget has been worked through both the House and the Senate. Funding for KRCBVI is included for 2007 and 2008. The budget needs to go to the conference committee yet. Results are expected in late April or May.

The Prairie Band Pottawatomie received a grant of $1.8 million, which will allow expansion of services to all of Northeast Kansas.

Rehab Act Reauthorization This has been held up at the federal level. Its passage is questionable at this time. Concerns delaying passage appear to be some unrelated marriage issues.

A Transition Summit is planned April 18-19 in Topeka. The focus will be on local community teams and how they work together to improve outcomes for younger persons with disabilities.

Increase of field staff in KSBVI programs A pilot project is being developed in the Kansas City area. The persons hired will undergo intensive sleep shade training at KRCBVI to determine what impact such training has on referrals to the Center as well as on the employment outcomes of clients. As has happened quite frequently at the past several KSBVI Advisory Committee meetings, discussion of this pilot program shifted to the inherent flawed conclusions built into reliance on structured discovery learning as an outcome predictor. Dianne Hemphill, KSBVI administrator, noted that only 10 to 20% of current VR counselors have had blindness training and that most counselors serve “blended” caseloads of people with a variety of disabilities. Measurements for program improvement via the pilot project will include a reduction in homemaker closures and increased earnings of KRCBVI graduates. Dianne alluded to the process used to decide that the Center would adopt the SDL or empowerment approach as well as the standards and indicators used by the Rehab Services Administration to reflect outcomes. Centers (Iowa, Nebraska, and New Mexico as the top three over the past five years) using the SDL approach have superior outcomes. Sanford pointed out that one of the statements made by the Iowa presenters in August (and audible on the tape) was that half of the people in Iowa do not attend the center and thus do not receive SDL training. The number of closures includes both groups. The conclusion, therefore, that Iowas high closure rate is linked to SDL training is flawed.

Additional SDL-Related Issues: Discussion then shifted to concerns, expressed by Dr. Welsh in December, regarding the subcommittee on training of individuals with low vision and the policy it took over a year to develop. That policy appears to have no place in a program of SDL training. Dianne reported that the majority of closed cases who received RCBVI training had received low vision evaluation prior to coming to the center. Low vision devices are available, and clients may bring their low vision devices when they come for training. But that training is placed at the end of their programs. Ann Byington reported that, in reality, clients receive training with low vision devices only if they remind staff that they are nearing the end of the program and need low vision training. Dianne stated that at each staffing, a projected completion date is determined, which would allow planning for low vision training. Ann Byington further commented that, whereas use of low-vision aids and techniques for communication were once taught, clients must now perform all of these activities using braille. There is no plan for integrating low vision into the program at this time. Dianne responded that a new braille instructor has been hired. She is taking back responsibility for teaching basic communication skills, which does include the use of low-vision aids and techniques. There are now two formal classes per week in basic communications.

Shawn Klein indicated the projected completion date, for a variety of reasons, may not be reached. He stated he was one of the six who was impacted by Order of Selection. Had he not fought to get back in, he would not have been able to finish his program. And, had he had low vision, he would have received no low vision training. Family, medical, or other issues may interrupt training. Shawn Klein suggested a compromise program with 25% low vision training and 75% blind training. Dianne responded that lesson plans show staff incorporate low vision training when they believe it is appropriate.

Dr. David Lewerenz, alternate for the Kansas Optometric Association, commented that, in his memory, a program of integrating low vision care has never been a part of RCBVI training. Many people with low vision havent the financial resources to pay for the time or equipment needed for them to become independent. A low vision optometrist has never been employed by RCB and, though some have had low vision evaluations before they enter the program, it has never been incorporated into the plan of care. It seems that the prescribed treatment is unrelated to the diagnosis or prognosis. He asked if anyone present would go to a hospital where everyone got the same treatment regardless of the diagnosis. This seems to be what is happening at RCBVI. He read from an article by Ann Corn, a professor of special education at Vanderbilt. She said that a functional visual assessment, a clinical low vision assessment, and an O&M assessment are needed to project the degree to which a person can use vision for literacy and orientation and mobility. Without these assessments it is inappropriate to say that everyone needs a specific treatment to become rehabilitated. Blindfolding should not be the response when people receive poor quality or no low vision services.

Several committee members and guests in attendance reported on their receipt of low vision training as past RCBVI clients and its favorable impact on their independent living and job retension.

Dr. Lewerenz commented that some of the experiences shared support the idea that the diagnosis and prognosis of the individual should be taken into account. A person who can expect to go blind should receive appropriate training as they choose. He asked if the studies supporting SDL were done under scientific conditions and published in peer reviewed journals. If they are, he would like to see them.

Dr. Abio Sokari commented he would like to see individuals have the best of both worlds. If, after adequate assessment as described by Dr. Lewerenz, a person is determined to be able to benefit from both blindfold and low vision training, then they should receive it at the center. He suggested a scientific comparison of the effectiveness of the two types of training would be appropriate.

Efficacy of the advisory committee: Sanford reported that every state has a legally mandated rehab council. The last Rehab Act gave the SRC a more active role in developing the states rehab plan; in developing the annual report to RSA; in monitoring what’s going on within programs; and in participation in making suggestions to improve the plan. Kansas SRC is very active.

Some states opt to file their rehab plan in two parts, one for general services and one for blind services. In those states they will have a mandated council representing services for the blind, which files a separate report like that of the SRC. In some other states there is an umbrella agency that has a break-off of services for the blind and an SRC. In still other states there is no break within the umbrella agency for services to the blind. In both circumstances where there is an umbrella agency, they may establish an advisory committee. An advisory committee has neither the teeth of the legislation, the responsibility for input into the states rehab plan nor the requirement to file a report. A history of this advisory committee was reviewed.

The current questions are: Is this committee being taken seriously; does its input carry the weight it has historically carried; has it become an exercise in futility; and, does it provide input that will be totally disregarded? The committee needs clarification of where it stands; assurance that its complete input is being considered. Should the committee consider recommending to the director of rehab services that blindness issues need to be more fully incorporated into the overall structure? We could ask that appointments be made to the SRC, as Dr. Sokari suggested earlier, who would specifically represent issues involving the blind community. Or we could ask that the state go back to a dual filing plan so the advisory committee would assume a mandatory role and know that its input would be heard. Another alternative would be to ask the governor to redouble efforts to establish a separate agency or commission for the blind.

After considerable discussion of the options, Susie Stanzel made a motion that the committee recommends to management that Kansas file a separate plan for services to blind people. Sanford Alexander summarized the impact of adopting this recommendation: Kansas would file a rehab plan for general services and one for blind services. Consequentially the services for the blind advisory committee would become the services for the blind council. Although there would be two plans and two bodies, they would have to interact because there are many overlapping issues. The primary difference would be that when we spent a year on developing a policy and then implementing it as we did with the low vision policy, what is now just advice would become input that would have to be considered. It would give this body some authority because it would have to sign off on the state rehab report. The motion passed with one abstention.

Change in leadership of KRCBVI: The committee has reached a point that it has a lack of confidence in leadership and needs to see a change in direction or a change in leadership. Betsy Thompson indicated that a public meeting such as this is not an appropriate setting for such a discussion. Written or one-on-one Input would be acceptable. It can be sent to her by email, bat@srskansas.org. The mailing address is Kansas Rehabilitation Services, 3640 SW Topeka Blvd. Suite 150, Topeka, KS 66611.

Next meeting: Dates will be forthcoming. Following this discussion, the meeting was adjourn