Briefing to the Federal Advisory Committee on Prosthetics and Special Disabilities April 11, 2006

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Central Office Staff Gale Watson, Director, VACO
Mike Williams, Data Analyst, VACO Wanda
Washington, Program Analyst, VACO Lucille Beck,
PhD, Chief Consultant, Rehabilitation
Services David Chandler PhD, Deputy Chief
Consultant

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• The VA Blind Rehabilitation program
• supports blind and low vision veterans and active
  duty service members in regaining their
  independence and quality of life to enable their
  successful integration into family and community
  life.
• supports family and significant others to foster
  understanding of visual impairment and foster
  provision of appropriate support, to assist in
  enhancing home environments and to reduce
  caregiver burden.

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BRS Program Components

• VACO BRS National Program Office
• 5 National Program Consultants (field-based)
• 112 full-time Visual Impairment Services Team
  (VIST) Coordinators, additional 45 part-time VIST
  Coordinators
• 11 new full-time VIST position being deployed
• 10 Inpatient Blind Rehabilitation Centers
• 77 Blind Rehab Outpatient Specialists (BROS)
  positions 11 positions to be filled
• Inpatient/Outpatient Computer Access Training
  (CAT)
• 2 Visual Impairment Services Outpatient Rehab
  Programs Lebanon, PA W. Haven, CT
• 55 new Continuum of Care outpatient clinics, a
  3-tiered level of vision rehab care provided

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Continuum of Care Clinical Training Components
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Continuum of Care Implementation
Three levels of service have been funded through
2010 for which BRS has oversight
Intermediate Low Vision Care (eye care, LVT,
support) Advanced Ambulatory Low Vision
Care (eye care, low LVT, OM, support)
Outpatient Hoptel Blind Rehabilitation (eye
care, low vision therapy, OM, VRT, support) Each
VISN is required to implement a plan for the
provision of the services consistent with the
Continuum of Care recommendations provided by
VACO. 55 new clinics are coming online, totaling
232 unique positions
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Intermediate LV Clinics
White River Junction, White River Junct,
VT Samuel S. Stratton, Albany NY Franklin Delano,
Montrose, NY VA Pittsburgh HCS, Pittsburgh,
PA Martinsburg VAMC, Martinsburg, WV Hampton
VAMC, Hampton, VA William Jennings Bryan Dorn,
Columbia, SC Ocala CBOC, Ocala, FL Veterans
Affairs, Medical Ctr, Memphis, TN Cincinnati
VAMC, Cincinnati, OH John D. Dingell, Detroit,
MI William S. Middleton Mem Vet Hosp, Madison,
WI St. Louis VAMC, St. Louis, MO Oklahoma City
VAMC, Oklahoma, OK Central Texas Veterans HCS,
Temple, TX New Mexico VA HCS, Albuquerque, NM VA
Montana HCS, Fort Harrison, MT Spokane VAMC,
Spokane, WA VA Ukiah CBOC, Ukia, CA VA Loma Linda
HCS, Loma Linda, CA VA Southern Nevada HCS, Las
Vegas, NV Sioux Falls VAMC, Sioux Fall, SD
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Adv. Low Vision Clinics
VA Boston HCS, Jamaica Plains, Jamaica,
MA Syracuse VAMC, NY New York Harbor, Brooklyn,
NY Philadelphia VAMC, Philadelphia, PA Baltimore
VAMC, VA Maryland HCS, Baltimore, MD Salisbury
W.G. Bill Hefner VAMC, Salisbury, NC Atlanta
VAMC, Decatur, GA James Haley Veterans Hospital,
Tampa, FL Tennessee Valley HCS, Nashville,
TN Dayton VAMC, Dayton, OH Aleda E. Lutz VAMC,
Saginaw, MI Clement J. Zablocki VAMC, Milwaukee,
WI Robert J. Dole DVAMC, Wichita, KS Central
Arkansas Veterans HCS, Little Rock, AR VA North
Texas HCS, Dallas, TX Carl T. Hayden VAMC,
Phoenix, AZ VA Salt Lake City HCS, Salt Lake
City, UT Portland VAMC, Portland, OR Martinez
Outpt Clinic, Martinez, CA VA Greater Las Angeles
HCS, Greater LA, CA VA San Diego HCS, San Diego,
CA VA Central Iowa, Des Moines, IA
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Outpatient BRCs VISOR
VA Western HCS, Buffalo, NY East Orange Campus of
New Jersey HCS, East Orange NJ Washington,
D.C. Hunter Holmes McGuire, VAMC, Richmond,
VA Lexington VAMC, Lexington, KY Louis Stokes
VAMC, Cleveland, OH Battle Creek VAMC, Battle
Creek, Michigan Kansas City VAMC, Kansas City,
MO Michael E. Debakey VAMC, Houston, TX VA
Eastern Colorado HCS, Denver, CO Minneapolis, MN
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Outpatient Program new staff

• 232 Positions provided in the rollout
• Remaining unfilled positions are
• 1.5 FTEE eye care specialists
• 7 FTEE blind rehabilitation professionals
• 6 FTEE support staff

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BRS Outpatient Care
Source VSSC / KLF
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Legally blind veterans and those with excess
disability

• Excess Disability - Problems and task
  performance difficulties related to vision loss
  that have a substantial impact on the person's
  functional independence or personal safety, and
  that are out of proportion to the degree of
  visual impairment as measured by visual acuities
  or visual fields.  Veterans whose vision is
  better than legal blindness may have excess
  disability due to (i) sudden and/or traumatic
  visual disorder (especially related to military
  service), (ii) disabling co-morbidities (e.g.,
  hearing impairment, mobility impairment, etc.),
  (iii) systemic diseases that cause fluctuating
  visual impairment, (iv) combined losses of other
  vision functions (e.g. contrast sensitivity,
  stereopsis, etc), (v) sudden changes in caregiver
  status, or (vi) other reasons.

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VIST Visual Impairment Services Team
A team of professionals who ensure that blinded
veterans are identified, evaluated, and provided
health and rehabilitation services to maximize
adjustment to sight loss. Representatives may
include but are not limited to social work,
ophthalmology, optometry, prosthetics, primary
care, vocational rehabilitation, nursing,
audiology, physical medicine and rehabilitation,
Veterans Benefits Administration, and blinded
veterans consumer organizations.
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Visual Impairment Services Team Coordinator
The VIST Coordinator is a case manager who has
major responsibility for the coordination of
services for visually impaired veterans, service
members, and their families. The VIST
Coordinator is often the entry point into the
continuum of care for visually impaired veterans.
Duties include providing and/or arranging for
the provision of appropriate rehabilitation
services and devices (referrals to BRC, BROS,
Continuum of Care clinics and/or community-based
services). Other duties include identifying new
cases of blindness and severe visual impairment,
providing professional counseling, arranging VIST
Reviews, and conducting educational programs
relating to VIST and blindness.
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VIST Rosters
FY08 Total eligible veterans 46,888 OEF/OIF
vets/active duty 668 VIST Referrals Community-bas
ed training 1,259 Community-based CATS 1,299
Source VIST annual reports BR 5.0
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Inpatient Blind Rehabilitation Centers 10
Centers Nationwide
Comprehensive, interdisciplinary, residential
inpatient blind rehabilitation services 2,085
patients discharged in FY08. Five specialized
areas of training orientation and mobility,
living skills, manual skills, visual skills and
computer skills. Veterans also receive
specialized healthcare, wellness education, and
adjustment counseling support. The average
Length of Stay is 5 weeks. All Blind Rehab
Centers are CARF accredited.
Source VSSC / AMIS Workload Cube
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Blind Rehabilitation Centers 10 Centers
Nationwide
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Proposed Inpatient BRCs

• Cleveland BRC
• Planned 15 inpatient beds
• ground-breaking ceremony
• planned for operation in 2011
• Biloxi BRC (CARES initiative)
• planned 26 inpatient beds, recommending start-up
  of 15 beds
• planned for operation in 2011
• Long Beach BRC (CARES initiative)
• planned 24 beds
• planned for operation in 2011

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BROS Blind Rehabilitation Outpatient Specialist
Program Implemented in 199677 positions
nationally

• Local blind rehabilitation assessment and
  training designed to
• decrease the time needed for inpatient
  rehabilitation
• obviate the need for the inpatient program, or
• meet the needs of those veterans who are unable
  to attend BRC.

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BROS Blind Rehabilitation Outpatient Specialist
BROS provided rehabilitation care for 4,764
veterans and active duty service members in FY08
Source VSSC / KLF
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National Program Consultants
5 Positions Nationwide
National Program Consultants provide support,
review, and evaluation of field based Blind
Rehabilitation Services. They are actively
involved in program development and staff
training.
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Operation Enduring Freedom Operation Iraqi
Freedom (OEF/OIF)
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BRS Services and OEF/OIF

• All Blind Rehabilitation Service program
  components actively support veterans and active
  duty service members of OEF/OIF.
• Visual Impairment Service Team (VIST)
  Coordinators
• Involvement with Military Treatment Facilities
  through liaisons and FRC
• Case management in support of Polytrauma
  Rehabilitation programs
• Ongoing case management at local medical centers
• Blind Rehabilitation Outpatient Specialists
  (BROS)
• BROS assigned to Walter Reed Army Medical Center
  and Bethesda
• BROS assigned to all Polytrauma Rehabilitation
  Centers and Sites
• Treat patients in homes, communities, and local
  VAMCs and CBOCs
• BR Liaison for the VA/DoD Vision Center of
  Excellence on Eye Injuries

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BRS Services and OEF/OIF

• Blind Rehabilitation Centers
• Provide comprehensive, individualized, inpatient
  blind rehabilitation.
• Full clinical support services.
• Continuity of care at admission through
  discharge.
• 112 OEF/OIF veterans or service members attended
  inpatient BRC programs (9/24/09)
• 943 OEF/OIF Vets/ADSMs are being followed by VIST
  and/or BROS or are in the BR Database as having
  low vision (9/24/09).

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Description of OEF/OIF

• Of the 112
• 52 were active duty at time of treatment
• 59 were veterans at time of treatment
• 1 was active duty foreign soldier
• 83 were legally blind (18 totally blind)
• 29 visually impaired, greater than legal blindness

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BRS Strategic Planning

• Four goals that do not change
• Improve Access and Outreach
• Enhance Service Quality
• Utilize Resources Effectively
• Develop Workforce and Plan for Succession

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Strategic Doing

• Improve Access and Outreach
• Continuum of Care rollout
• BROS rollout
• Moved closer to MTF liaisons and FRC programs
• Specified basis for adding veterans and ADSMs to
  VIST/LV rosters in database
• Partnership with DoD for the Vision Center of
  Excellence

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Strategic Doing

• Enhance Service Quality
• Provided psychologists and recreational
  therapists positions for BRCs
• Developed/revised CARF standards for all clinical
  programs
• Developed revised format for clinical practice
  standards evidence-based and outcomes-driven
  implemented in workgroups for LVT and OM
• Partnering with Social Work Service to develop
  strategies for coordination of care for
  individuals with low vision
• Partnering with VA VRE, state, public and
  private agencies to foster careers and meaningful
  occupations for Veterans and ADSMs

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Strategic Doing

• Utilize Resources Effectively
• Streamline processes for workload capture (DSS
  data sources, Event Capture, Encounters) across
  the Continuum
• Provided equipment and training dollars to all
  services in BRS
• Provided equipment dollars for basic low vision
  services in Optometry and Ophthalmology

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Strategic Doing

• Develop Workforce and
• Plan for Succession
• Hybrid Title 38 qualification standard
• Staff Training programs
• Technical Career Field program 66 TCF
  internships awarded
• Recruitment brochure - HRRO
• Recruitment booth HRRO

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