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A Distance Orientation to Vision Loss: A Pilot Project for Outreach & Services in Rural Areas

A Distance Orientation to Vision Loss: A Pilot Project for Outreach & Services in Rural Areas. Julia J. Kleinschmidt, PhD, LCSW John A. Moran Eye Center University of Utah Salt Lake City, Utah USA. The Moran Eye Center’s Orientation to Vision Loss (OVL). Established December 1992

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A Distance Orientation to Vision Loss: A Pilot Project for Outreach & Services in Rural Areas

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  1. A Distance Orientation to Vision Loss:A Pilot Project for Outreach & Services in Rural Areas

    Julia J. Kleinschmidt, PhD, LCSW John A. Moran Eye Center University of Utah Salt Lake City, Utah USA
  2. The Moran Eye Center’sOrientation to Vision Loss (OVL) Established December 1992 Held at the Moran Eye Center-Salt Lake City 2 hour program Families & friends encouraged to attend Scheduled one Saturday per month to accommodate working family members Open to all-not just Moran patients No charge
  3. OVL Components Display of LV aids and adaptive equipment Group meeting (Teaching/discussion): How to use remaining vision optimally Using other senses Extensive use of examples, stories Video- From Us to You: Adjusting to Vision Loss Packet-brochures, application forms for services Peer counselor(s)
  4. OVL- A Success! Kleinschmidt, J. (1996). An orientation to vision loss program: Meeting the needs of newly visually impaired older adults. The Gerontologist, 36, 534-538. Evaluations from 22 OVLs from 1992 to 1995 indicating “helpful” or “very helpful”: Discussion-92% VI/96% family members Video-90% VI & family members Information Packets-94% VI/96% family members
  5. Success, cont. Evaluation open-ended questions: “I hadn’t realized that there’s so much to help me.” “I think my family understands me better now.” “I had thought I was alone. How wonderful to find out that I’m not.” “It was great to get my questions answered.” Those ladies (peer counselors) were wonderful. It makes me think I can do it too!”
  6. However….. Attendance overwhelmingly from the Wasatch Front urban area We were obviously missing and not serving Utah’s rural areas
  7. Health Care/Informationin Rural Areas Rural areas are vastly underserved: Rural America constitutes approximately 20% of the population Only 10% of doctors practice in rural areas National Rural Health Association Rural residents tend to be poorer, older, less educated, and uninsured Isolation and lack of proximity are barriers to health care Economic Research Service U.S. Department of Agriculture August 2009
  8. Barriers to Serving Utah Rural ResidentsInterviews-Utah Key Informants Bill Gibson-Director, Utah Division of Services for the Blind and Visually Impaired (DSBVI) Dr. Milo Waddoups, Voc Rehab Counselor, St. George, UT Office of DSBVI 4 SLC OVL participants interviewed following an OVL-all resided along the Wasatch front
  9. Barriers Identified: Identifying those in rural areas who need services Distances: Getting to SLC for services Getting rehab professionals to the rural areas (In Utah 50 professionals serve 85,000 square miles) Funding-in the past 2 ½ years funding to DSBVI has been cut $850,000 affecting travel reimbursements for professionals in rural areas All 4 OVL participants confirmed that their attendance would have been unlikely if they lived outside of the Wasatch front
  10. Challenges in Getting Rural Residents to OVL Effectively disseminating program information Transportation issues Cost of staying overnight in SLC
  11. Our Reality in the World of Rehab and Education for Individuals with VI Too often eye care providers are not referring patients for services Are we, professionals in the field of rehab and education, being sufficiently pro-active in reaching those who are not referred?
  12. So what to do? Consider the success of using interactive teleconferencing technology in medical diagnosis, consulting, education-telemedicine Consider the Ed Net system- readily available in universities provide information and education to rural areas Question: Could this technology be utilized to take the OVL to rural areas?
  13. Enter Keriann Lynch Masters student-Communications Research interest-dissemination of health information Knowledge and experience with marketing techniques
  14. Distance OVL Pilot Project-Research Questions: Could interactive video be used to successfully replicate the OVL experience for a rural population? Could basic marketing techniques be used to disseminate OVL information and recruit participants? Would the Distance OVL increase the accessing of vision rehab services? Would the Distance OVL improve the ability of participants to access services ant to cope with vision loss?
  15. Project Development Met with DSBVI Director, Bill Gibson Offered full support Offered use of DSBVI’s video teleconference equipment-generally used for staff training Suggested St. George, UT for the pilot project
  16. St. George, UT 300 miles south of SLC; 119 miles north of Las Vegas Small DSBVI office in St. George 2 DSBVI staff serve the VI in 9 counties-the entire SW portion of Utah Area includes 30,000 miles of roads Constant challenge is getting information on services to rural areas Funding cuts have resulted in cuts in services reaching the rural areas A retirement community
  17. Distance OVL Pilot Project: Use of interactive video to connect the DSBVI office in SLC with the office in St. George In SLC-a panel of providers: Bill Gibson, DSBVI Director Dr. Hank Bogen, LVS consultant with DSBVI Lisa Nelson, Director, Utah State Library for the Blind Chris Edwards, Director, DSBVI’s Elder Blind Program Dr. Julia Kleinschmidt
  18. Project, cont. In St. George: 3 St. George staff members Dr. Milo Waddoups (VR) Ceil Stevenson, Older Blind Specialist Ellen Owens, Assistant, Driver, etc. Keriann Lynch -- OVL Participants
  19. Program Content Similar to SLC OVL (except for display of LV devices) In St. George-½ hour for greeting, refreshments, completing questionnaires Video Interactions: 45 minutes-panelists sharing information DSBVI services, LVS, Elder Blind Program, Talking Books 45 minutes-basic ADL information, how to use remaining vision optimally, environmental modifications After signing off from SLC, post-questionnaires, completing forms to access services
  20. Distance OVL Evaluations Prior to the OVL: Self-designed pre-session questionnaire Demographics Areas of daily life impacted by vision loss Number of services accessed Impact of vision loss on daily life How well coping with VL Level of general happiness in daily life Adaptation to Vision Loss Scale (AVL) (Horowitz, Reinhardt & Raykov, 2007) 12 Items Measures adjustment to vision loss in older adults

  21. Evaluations, cont.

    Post-Session Self-designed questionnaire 5 Likert Scale Items Feedback on the session-Enjoyed? Valuable? Usable? What stands out? What would have made it better? Telephone follow-up one month later Adaptation to Vision Loss Scale Follow-up Survey-changes since the Distance OVL Areas of life affected by vision loss Impact of VL on daily life Services accessed Coping Happiness
  22. Marketing the Program Campaign aimed at traditional media outlets and community gathering places Press releases created and distributed via email to daily and weekly newspapers in the St. George area PSAs were written and distributed to radio stations in the St. George area Informational fliers were designed for LV readers and distributed in St. George gathering places-senior centers, churches, doctors’ offices, and the public library
  23. Basic Marketing Tips(What I learned from Keriann) A good news release will have a newsworthy angle-timeliness, local interest, new information, unique nature Most editors skim submitted materials-write the piece to catch the editor’s eye Submit your news release to appropriate organizations-Ex. St. George’s Senior Sampler, a weekly news pamphlet aimed at St. George’s large retirement community
  24. Tips, cont. Check an organization’s website to determine the correct person for submission Submit the news release in a variety of lengths and formats-an editor or radio/TV stations will most likely use a submission that fits a time or space available. Examples: For radio/TV-submit 2 PSAs-one 15 seconds long and another 30 seconds long For newspapers-submit a full story, a news brief of 175 words, and an event listing for the paper’s activities calendar
  25. Results Participants 29 17 with VI 12 family/friends 15 surveyed at 1 mo f/u Final data set 15 subjects Ages 14-95 age range Discounting teen outlier 61-95 age range M=78 Eye Conditions macular degeneration 8 diabetic retinopathy 2 injury 1 multiple conditions 4 Length of time with VI Average 1-5 years 5 with 10+ years
  26. Post OVL Self-designed QuestionnaireResults N=17 Likert scale 1-5 Negative to Positive How much enjoyed? Average 5 How valuable? Average 4.8 How usable? Average 4.7 What stands out for you? “Great program. Thanks!” “Really helpful! Thank you!” What would have made it better? –One response- ”enhanced volume for my hearing loss.”
  27. Self-designed QuestionnairePre and Post-tests Matched sample t-tests Areas of life affected by VL Average change for better .2 Fewer negative effects, but not statistically significant t(14)=.587;p >.05) Affect of VL on daily life Not a statistically significant difference t(14)=2.824;p >.05 Number of services accessed Average increase in services= 1.8 services change for better was statistically significant t(14)=4.447; p<.05
  28. Self-designed Questionnaire Pre and Post Test Results, Cont. How well coping with VL? Statistically significant results t(14)=2.824; p<.05 Happiness levels .2 average increase in happiness level But not statistically significant t(14)=1.146;p>.05
  29. Adjustment to Vision Loss ScalePre and Post Mean respondent scores Pre-test 22.7 SD 4.6 Post-test 25.8 SD 3.6 Increase in levels of adjustment 3.13 points Matched sample t-tests Statistically significant improvements in adjustment to VL t(14)=3.662; p< .05
  30. Limitations Small sample size The SLC OVL affords more opportunity for connection among participants. Personal sharing and support were less available. Perhaps the above resulted in a leadership impression that fewer questions were asked and fewer stories shared. Perhaps more time should be allowed for the initial greeting, and time for introductions should have been allowed. More attention should have been given to the room setups In SLC the panel congregated at one end of a conference table with the camera at the other end. This resulted in a stiff, interrogation-like appearance of the professional panel In St. George the monitor was situated to a side resulting in participants needing to turn at an angle to view it The marketing aspect of this project was time-consuming and could pose issues for others attempting it.
  31. Future Distance OVL Programs Allow more time for introductions and interactions among participants Include a display of low vision aids/devices Develop a workbook of the program contents and the marketing strategies to aid in replication. Consider online versions of this program. There may be a question of online access in rural areas, but it would be helpful to provide this option.
  32. Summary This distance Orientation to Vision Loss pilot proved successful in bringing information and in initiating services for individuals with vision loss who live in a rural area. It was an excellent example of the benefits of 1. using current technology to serve and support this population 2. using basic marketing tools to reach difficult-to-access individuals in need. 3. implementing a group-model program. St. George professionals were pleased that, in 2 ½ hours, they were able to meet with and initiate services for 17 individuals with VI. This is a number that is usually served by their agency over three months!

  33. Thank you!

    Keriann Lynch Strickland Bill Gibson, Director, DSBVI Dr. Milo Waddoups, Director DSBVI Office, St. George, UT DSBVI-SLC-Dr. Hank Bogen, Chris Edwards, Lisa Nelson DSBVI St. George-Ceil Stevenson, Ellen Owens Henry W. and Leslie W. Eskuche Foundation
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