VRT and OT Professionals Working Together

1. VRT and OT Professionals Working Together Kendra Farrow, CVRT

2. What is a VRT? • VRTs address the physical, emotional, and social implications of vision loss • Provides counseling and training in NEW skills and adaptive techniques • Success is based on level of independence and emotional adjustment • Work to enhance vocational opportunities, independent living, and educational development

3. What is an OT? • OTs address physical, cognitive, psychosocial and sensory performance • Provides activities with an aim towards improving health, well-being, and quality of life • Success is based on increasing participation and performance • Engagement in daily life activities (occupations) that support health and participation in home, school, the workplace, and community life (AOTA, 2008)

4. Differences In Services OT • Work with all impairments as well as states of wellness • If billing insurance, • Treatment is defined in the Plan of Care (POC) written by the OT & authorized by the physician • OT must perform an evaluation to identify medical necessity of services • Anyone can refer. • If utilizing medical insurance requires physician involvement VRT • Focuses on blindness and vision impairment • Has community B/VI connections • Free services, generally • Flexibility in service hours • Anyone can refer

5. Two OT approaches 1. OTs with training to work with Low Vision and may also work in the Blindness Stream. • Services are directed at LV patients 2. OTs who work in other settings and may occasionally have a patient who is also experiencing vision loss. • OTs in hospitals and nursing homes without LV training frequently provide vision services to clients with field limitations and loss secondary to brain injury

6. Why is language important? • If we don’t use the same words with the same meanings, it leads to; misunderstandings, confusion, and frustration. • If we can’t communicate, we can’t work together.

7. International Classification of Functioning Disability and Health (ICF) • Developed by the World Health Organization to help communication • Offers specific terminology and definitions to describe disability and functioning • OTs use this language

8. Differences in Language OT • Patient • SNF (skilled nursing facility) • MCB • Physician Prescription or Orders • Plan of Care (POC) • Training, Participation • Eccentric Viewing Training (EVT) Using Preferred retinal locus (PRL) VRT • Client • Nursing Home • Medicare part B • Referral • Individualized service plan • Teaching • Eccentric viewing

9. Confusing Terminology • Low Vision – OT uses this phrase to describe vision rehabilitation, including legal blindness. • Low Vision – VRT uses this phrase to describe specific training

10. New Terminology for (some) OTs Terms • Blindism • Acuity • Photophobic • Charles Bonnet Syndrome • Lumens • Diopter Concepts • Perceived brightness • Color perception • Contrast sensitivity • Focal distance • Color temperature • Principles of task lighting

11. New Skills for (some) OTs • Reading an eye report • Measuring low vision using near and distance charts • Knowledge of low vision aids and appliances

12. Services specific to VRTs • Braille instruction • Transition services • Advocacy skills • Concept development • Training under blindfold • Adjustment to vision loss counseling • Link to vocational services • Sighted guide and protective technique

13. One way to divide the work • OT referrals must have: • Visual acuity of 20/70 or worse • Must have doctors’ orders and use medical codes, CPT and ICD9 • VRT referrals are for clients who: • Want to learn Braille • Are not eligible for OT services • Need only one appointment

14. Low Vision Rehabilitation Delivery Model http://www.mdsupport.org/deliverymodel/deliverymodel.html • Model developed 2007 by a group of professionals representing: • Ophthalmology • Low Vision, optometry • Vision Rehabilitation • Occupational Therapy • The Consumer

15. OT & Vision Impairment • In 2002, Medicare issued transmittal AB-02-78: Medicare Coverage of Rehabilitation Services for Beneficiaries With Vision Impairment • All licensed rehabilitative therapists eligible to provide and bill services provided to those with vision impairment • “Medicare beneficiaries who are blind or visually impaired are eligible for physician-prescribed rehabilitation services from approved health care professionals on the same basis as beneficiaries with other medical conditions that result in reduced physical functioning.” (Centers for Medicare & Medicaid Services, 2002)

17. Flow of Services

18. Tips for interacting with OTs • Keep a positive attitude • Respect the OT • Offer training • Offer shadowing opportunities • Give resources • Keep the door open for further communication

19. Things I have learned from OTs • Using a hand squeeze to detect tremors and strength • Exercises for hand-eye coordination improvement • Awareness of tripping hazards like throw rugs

20. The Numbers Occupational Therapists • Over 100,000 OTs Vision Rehabilitation Therapists • Approximately 600 CVRTs • Up to 2,500 working in the field

21. Training for (General) Ots • Overview of types of vision loss • Causes • Different patterns of vision loss • LV devices are not one size fits all

22. Training for OTs • What is a Low Vision Exam? • The importance of LV exam • LV doctors in your area • Stress the importance of using the correct device for each task

23. Training for OTs • Blindness Services • Your services and how to make a referral • Funding for LV devices • Courtesy rules for blindness • Other specialized services • NLS, Newsline • O&M services • Support groups

24. How can OTs inform VRTs • Introduction to Functional vision impairment assessments & screens • Consideration of co-morbidities • Centralized OT domain articulating occupational roles, participation & performance • Treatment, progress & discharge notes

25. What do OTs have to share with VRTs • Introduction to functional and acuity assessment tools • Implications of other disabling conditions • Scope of work of the OT • Documentation

26. Continuing Education Opportunities • AFB eLearning • The Carroll Center • Lighthouse • University of Alabama at Birmingham • Hadley School • The NRTC on Blindness and Low Vision

27. Books • Low Vision Rehabilitation: A Practical Guide for Occupational Therapists, Second Edition • Occupational Therapy Interventions for Adults with Low Vision

28. Final Thoughts for VRTs • Be proud of what you do • Keep up your certification • Educate yourself about medical terminology • Take opportunities to talk with OTs • Provide education when appropriate

29. Final Thoughts for OTs • Your role is valuable and needed • VRTs can be a great resource • Referring your patient to the VRT does not mean your services are unnecessary • Keep learning, you can never learn everything about vision loss

30. Thoughts for Administrators • Communicate with your staff • Have specific expectations and goals • Support the VRT staff • Require LV qualifications from OT staff • Debrief and assess service delivery • Communicate with staff

31. Thank You Carmen Garcia-Hommel, OTL Occupational Therapist VisionCorps 244 N. Queen Street Lancaster, PA 17603 717.205.4145 717.291.9183 fax www.visioncorps.net

32. References Number of OTs • http://www.bls.gov/ooh/healthcare/occupational-therapists.htm AOTA overview of LV Certification • https://www.aota.org/-/media/Corporate/Files/EducationCareers/CE/SCLV%20Overview.pdf VRT Scope of Practice • www.acvrep.org OT Scope of Practice • www.aota.org International Classification of Functioning • http://www.who.int/classifications/icf/en/

33. Contact Information kfarrow@colled.msstate.edu 662-325-8694 The National Research and Training Center on Blindness and Low Vision at Mississippi State University www.blind.msstate.edu