by
MelindaMaryDuggan
in partial fulfilmentof therequirem entsforthedegreeof
MemorialUniversityofNewfoundland
InNewfoundlandand Labradorthere arc over 15,000people thatscifidcn tifyas
livingwithvisionloss(Stat isticsCanada,2(06)andone incightpeoplecan expecttolive withsignilicantv isionlossaticrl hcagen f7 5(C1Il.200S}.Given thaithe proportion ofthepopulat ion over the age of65isgrowing faster inNcwfoundlandand Labrador thananywhereelsein Canada age-relatedvision losswillhave asignificantimp act.
Dcspilcthisprcdictionand lhcdocumcntcdbcnclilsof vision rehabilitationscrviccs, undcrutilizat ionisa conccrn.Thepurposc ofthisresearchwastoidentifytheneeds, barricrs,and palhw aysloaccc ssingandusingvision rehabilitationservicesin the province.!\qualitativeresearchapproachwas usedto explore the topic and individual interviewswereconductedwithsixteen participants.Theresear ch informsthe expansion andimprovementofvisionheal th andrehabilitation programsand thc workofthcCNIU
It isapleasure to tha nkthosethathavemadethisthcsispossiblc
IowcIllydeep est gratitude toIlly supe rvisor,Dr. GailWideman, whosccncouragcm cnt, guidance,support,expertise.and mostimportantlypaticncehavebeen invalu ablet o me
Rch ab ilitation Conuni ttcc for the irguidance andfcedbac kduri ngthcresearchprocess
lam also ingratitudeto thccmpl oyeeso fCNI13for thcir assistancc throughoutthis venture.AspecialthankyoutoDuaneMorganforhisongoing suppor t andded ication to cnsuringthis rescarch bccamc a rcality
Finally,tha nkyou tomyfami lyandfriend sthat haveprovidedthcirsuppor t incountless
Chaptcr I IntroJ uction 1
Significancco f thc Rcscarchfo rSoc iaIWork..
Psych ologi calandemotionalsupport LI
Assistivclcchnologyfundingandt raining LO
Inaccessibilityofassistivctechno logydemonstrati on ccntrcsand
UnequaIacccsstovision rchabilitationscrviccs..
Inadequatepromotion ofvision rehab ilitationcentres
Concurrenthealthproblem .ro
IdentifiedPathwaysto Vision Rehabilitat ion Services..
Other providersof vision rehabilitat ionservices
Partnershipsand coll aboration 39
Presentation o ft heF indings 49
Assistivetechnologytr aining 50
Psychological andemotionalsupport...
Increaseinpublicandprofessionalinfonnation...
Changingneedslhroughollt lhelifespan...
Improvedaccesstovisionrehabilitationservices . Accesstoassistivetechnologydemocentres andstores
Costof assistivetechnology ...
Perceptionofindividualvisionloss and postponem entinaccessing
Personal expe riences ofCNIB
PathwaystoVision RehabilitationServices...
Olherprovidcrsofvisionrchabilitationservices ...
Partnershipsandcollaboration
Adjustmenttovisionloss groups
Changingneedsthro ughoutthe lifcspan andcontinued contact
Sourccofrefc rra ltoC NIBand increaseinpublicand pro fessional
Publicand professional education OL
Pcrception of individu al vision lossand postpon ementin accessing
Improved access10visionrehab ilitat ionservices,assistivetcchnology,
Psychological andemotionalsupport o~
Assistivct echno logydcmocentresandstoresandassistivcteehnology
Cost ofassistiv cIcehnology Limitationsof thcStudy...
Recommenda tionsforSoc ial \VorkPractice.Policyand Research
AppclldixALcttcrofEth icalApproval
AppendixBProtectionof Parlieipants IU
AppendixC Scriptfor TelephoneContact with IndividualIntcrvicw
AppendixDCandidatcInformation List . 119
AppcndixELctlcrt oCandidatc s....
AppcndixFProjccl lnformationShcct...
Appendix G ConsentFonn. Appcndixll lnterview Guide....
Appendix I ParticipantProfiles....
AppcndixfCodingCbart....
Cha p te r I
Thepurposeof this study wasto exp lore theneed s.barriers and path waysto acce ssin gand usingvisionrehabilitation services intheprovinccofewfoundlandand Labrador.Thisthesi sisa reportof the resultsof a qualitati ve studycarriedou twitha smallsample o fclients o fCNIIlinNewfound landand Labrador. Thisfirstchapterof the thesisoutlinesthepurpose ofthestudy.presentstheresea rchqucstion.nndprovidcs infoTmation on thc contcxt o f thcp roblcm andi ts signifi can cc tosocia I workpractice and policy.Thcchaptcr con cludcswith a discussion ofthcth corcticalfram cw a rk.
Purposeof theStudy
The purpose ofthisqualit ative resear chstudyisto assistthe CNIBNcw fo und land and LabradorVisionReh ab ilitau on Commi uccin thedevelopm ent ofa provincialvision hcalthslratcgybyidcnlifyin glhcnccds,harricrsandp athwaysto accessin gand us ing
thisresear ch willbe uscdtoaidthe commi ttee. comprisedof comm unitymcmb er s and groupswithaninterest in the areaof visionloss,inthedevelopment ofavis ion health strategy forNewfound land andLabrador. The goalsof thestrategy arctofa cilitatethe bestquality oflifefor peopl elivingwith visionlo ssin theprovince o fNew fo undlanda nd
Labradorand redu ce theincidcnccofvisionlossand blind ncssthrough publiceducat ion and earlydetection (CNI13,201O).Thereisnationaland internationaldatasupporting the importanceof vision rehabilitationservices and the uscof assistivctcchnologyforpeoplc withvisionloss(CNIB,2010;Gold&Zuvcla,2005;i\Iuzychka,2009)butthcrci s limitcd rescarch about thcavailability and lltiliza tion o f thcsc scrviccsinNew found land
TheResearch Question
Thceffectsof visionlossarcpro foundandcostly,with direct andindircct implicalionsforind ividlials andgo vcrnm cllt.Manyind ividualsliving withvisionloss arclIl1cmployedorunderemployed, sociallyisolatcd,livingbelowthcpovcrtylinc,and faccthrectimcsthcriskfordeprcssionth an lhc gcncralpoplilation(Burh rnann,Fielden,
&lIodgc ,2007).For govcmmc nts.fhcimpact ofvisionlossmeansincreasedcostsin socialassi stance.socialsupports and programs,andearlyrclianceonhorneand com munitycare aswellas socialwelfaresystems (AccessEconomicsPtyLim ited, 2009)
For thepurpose of this study the definitionofvis ion lossasprovide dbyth eCNI13 hasbeenuscd:··...anychronicvi sualdclicitthatimpairs cveryda yfun ctioning and isnot corrcctableby ordinaryeyeglasscs.conta cllensesorsurgery.Visualirnpairmcntcan
2007,p.6).Vision losscanbc a rcs;ult of cycproblcrnsth atarcp,rCscnllfromb irthas a
KccITc,2003)
(LighthouseIntemational,20 10;Muzychka,2009;Pollard et aI.,20(3 )
200S) Visionrehabilitatio nenables thedevelopmentofskillsandstratcgicsnccdcd to
International,20 10). Vision rehahilitati onscrvices considcrcdinthis studyincludclow
concess ions.'Assistivercchnologyreferstothedevicesthat'aim tohclp a pcrson acbicvc
asa fe,independent.and productivelife,Itisimportantforallpersonsliving withvision
tcchn ology.
maximi zcsaperson' sindependcnceandimp rovcsth ed evclopmentof ncwandm odi ficd lifeskills(Pollardctal.,2003).AccordingtoThe Chicago Lighthousc( 20 11)itisll1os1 bene ticialforapcrsont oa cccss vision rchabilitationscrviccsb cforcth cir vision rcachcs 20/60.2Nevertheless, research hasd cmonstratcdthatpcrsonswithmildto modcrate levelsofvisionlossarclesslikelythanthosewithseverevision iosstobcawarcofvision rehabilitationservices {Mwi lambwc,\Vittich ,&Frceman, 2009).3Ithasalsobeen documentedthat evenwhenthepop ulation withmildtomoderate vision loss areawareof vision rehabilitationservicestheymay chooscnotto availofthembecausetheybelieve suchservicesarc for peoplethat arctotallyblind(Gold&Zuvcla,2005;Matti,Pcsudovs, Daly,Brown,&Chen, 20 10; Pollardct ul., 2003)
rehabilitationscrviccstobe ani ssllc.It isreportedthatonlya smallamountof those that
2Apcrsonwith20/60visio nwould ncl.'d to standtwcnty fcctawayfroma tellcrlhalsomconc wilh
3ThcWorldHealthOrgani zation (2003)definesmildvision loss asbeing between20/30and
ofthese servicesislow(Mwilambwe,Wiltich,&Freeman, 2009)
undcnuilizationofvision rehabilitationservices (CNIB, 200S)
Theobjectivesofthisresear charc
services in theprovince;
usingvisionrehabilitationservicesin theprovince;and
servicesin theprovince
Basedontheoutlinedobjectivesthe researchquestionis
visionre habi litationservices.p<tthw<tystolearningabout.<tccessing .and using vision rehabi litationservices. and about what morccan be done to pro motc thesc scrviccs in thc gcncralpublic.
Research ers. eye care professionals. andservice providersbelieve Canadnis on the brink ofancpidemicof age-related eyediseuse.duelargely to theagingof the population.Thenumber ofpeoplewith vision lossin Canadahasincreased37%inthe last10years and isproj ectedto doublebetween2006 and2031 (Muzycbka ,2009). No othe r province inCanada islikelyto cxperienccthe impactof populat ion aginga s significantlyasNewfou ndlandand Labrador.Asaresultof outmigration and lower fertilityratestheproportion ofthepopulation ofNewfoundlandand Labrad or ovcr the ageof65has expanded more quicklythananyother province,This isa trend that is expec tedtocontinue forthe next seve ral dccudcsfUcpartmcntufHcalth and Community Serviccs. 20( 7).Population aging willalsohavean impactonthenumberofpersonsin theprovincewho willexperiencevisionloss.Thereareoverl5.000pcoplein Newf(llll1dland and Labrador thatsc lf-iden tify as havi nga "s eeing disabilit y"(Statistics Canada.2006).In addition to this. one in eightpeople in theprovince canexpect to live withsignificant visionloss after theage of75 (CNI13.2008).lt isanticipat edthe demographi c shift will resultinadram aticincreasein visionhealt hdiseascsin
Newfoundlandand Labradorleadingtoa potentialcrisisin visionhealth and rehab ilitationresource s (Muzychku.2009).\Vithout the dcve lopment of vision rclated policiesthe province will not be able toadequately respondto theissuc.
Government ofNewfoundland and Labr ador strategiesand policies arc not void of attention tov ision health issucs.The ProvincialIlcalthyAgingPolicy Frame work isa document aimedat improvingthe independence,health.and vvell- bcingof sen iorsin the province.Despitc itsfocusonscniorsthcframcwork takcsa lifc1ongapproach tohealthy aging.includinga lifetimeapproach to visionhcalth.One of thegoals of thisframework is "increas edsupport fora lifelongapproachtoprotect oralhealth,visionh caringand spccch"(Dcpartmcnt ofHealth andCommunityScrvices.2007.p.18)
The governme nt hasalso begun developin g a StrategyforthelnclusionofPcrsons with Disabiliti es.Aseries of public consultationswcrc hcldto informthisnew strategy . Thcconsultationswcrcin response to theGovernmcntof NcwfoundlandandLabrador's (200 7)documen t Our Blueprint / or theFuture.TheGovernmentofNewfoundlandand Labradorhas statcd theyarccommittcdtocnhancingthcinclusionofpcrsonswith disabilitiesin allaspects ofsoc iety.Theconsultation swereheldtoengagcpeoplewith disabilitiesin developingrecomm endati ons andstrategies toaddrcssbarricrsto public scrviccs.education. and cmploy mcnto pportunitics for pcoplc \vith disabilitics (lIuman Resource s.Labour andEmployme nt.20 10).
These gove rnme ntinitiativesarcnecessarybut notsufficient inaddrcssingthc growingnumberofpcopleliving withvis ion lossinthe provin ceofNewfoundlanda nd Labrador.Thereisa needfor aprovincial vision healthstra tcgy andassociated policies toaddrcssthclln iquea sp ccts of vision loss suchasth eprevenl ionofvisionloss, acccss to affordableassisti vctechnology.anduniversalaccess tovision rehabilitationprogram s
Signilic:lIIccof thcl{cscarchfor Soci :.tl\ Vork
practiccwi thintheareasofvision lossandvis ion rehabilitation.Howeversocial wor kers havea lon ghistoryof working within thcbroaderficldof disabiliticsadvoc ating withandon bcbalfofpcoplewith disabilitiesandwor kingtoeliminatcthc soc ictal barriers exp eriencedbythcpoplllalion(Ma ckelprang & Salsgi vcr,1996)
Peoplelivi ngwithvision lossmay expe riencesign ifican t psychosocialprobl em s dueto thcirdisahility.Losingallorpartofone'ssightcan have aprofound effec tona person' squalityoflife and hasthepotential toaffectallaspcctso f theirlifeincludin g employ me nt,personalrelationships,daily activities.andcommunityparticip ation.The expe rienceof livingwithvis ionlosscanmeantheloss ofopportunities, access,and independence.Thus, socialwor k invol vem entin thefieldofvision rehabilitationmay
occurat all levelsof practice:macro: social work at thesocietallevel:mezzo: socialwork at the communitylevel;and micro: socialwork with individualsandfamilies
At themacrolevelsocial workerscanheinvolvedinthedevelopment and amendm ent of national and provincialpoliciesand pract icesthataffectpeoplelivingwith vision loss,Atthe mezzolevelsocialworkerswork withcommunities.agencies.
organizations. andgroups to ensuretheir programsandservicesareavailableand
accessible topeople with visionloss.Finall y.at themicrolevel social workersprovid e directservicetoindividualsand familiesaffectedbyvision Ioss.
Alongwiththisconceptualizationof thelevelsofsocial workpractice.a ffamcwork of socialwo rkro lesdcvelopedby Stevcnllick(199X)ish elpfu ltoconsidcr
Edllcato r:Social work crsmaybc involvedinp rovidingpeoplewithin form ation related to vision health,living withvision loss.and programsandserviccs. Social workersmayalsohavea rolein teachingindividuals.families. communirics.and organizationsa varietyofskillsrangingfrompract icalvision rchabilitationskills
Ad\'ocatl':Social workcrsmay advocatcon behalfofindividuals.familics.
gro ups. or communities on issue srelated tovision loss suchastherightstoequal
cmploymcmopport unitics.fundingfor assistivedevices,orissues relatedto accessibility
Arml)"st/E\'a lua tor:Socialwor kershavestronganalytical and evaluationskills thatcan beusedtodetcrmine the effectivenessof available programsandservices for peoplewith visionloss.
Brok er: Social workersmaylinkindividuals,groups.organiz..ations. nr communit ieswithresource s,programs.andservices forpeoplelivingwith vision
F:lcilit ator:Social workersl11ayplaythe rolc o f groupfacilitatorina nul11ber o f settings:client groups,communitygroups,or advocacygroups
Counsellor:A socia lworker mayhelp individualsand familiesdevel op waysof copingw ilhv isionloss.Thcyca n help pco plcrccog nizcand ma n:lgcfcclings, idcnti fyandsupportstrengths,breakdown pro blemsinto manageable pieces, and assistpeop leinfocusingongoals andwaysofachicvingthc m.
Morespecifi cally. theNew found landand LabradorSoc ial \VorkersAct(2010)
individuals,families, groupsandcomm unitiesby:
Providin gdirect counsellingand therap y serv ices toac1icnt,
thosedoneinassociationwith otherprofessions,
(2010cS-17.2 s2)
blindncssth rollghpllblic cdllcation and carlyd ctcction(C NI13, 2010)
suitableforaMasterofSoc ialWork thesi s researchtopi c
Thc thcorct ical framcwor kguidcsthc rcscarchandthcd ata an alysis.Itisaway ofcx plaining.prcdict ing.and undcrstandingthc phcnomcnabc ingstudicd(Rub in&
Babbic. 2007).Asocialin clusion framc\..:ork \\fasuscd inthis study bccausc"ision rehabilitation program sandservices arc anessentialcomponent in thesocial inclusion of peopl e with visionloss.Indevelopingap rovincialvisionh calthstrategyitisimportant
Labrador facilitatestheinclusion of'pcoplcwithvisionlossor ifpcop lc arc expcricncing barriersto accessing vision rehabilitation program sandservices.It is also beneficialto identifyindividualpathwaystovision rehabilitationscrvicesto understandhowpeopl e lindandaccessthese scrviccs and ifthcre arcpotentialpathwaysthatmaybccxplorcd
People livingwithvisionlossarcat an incrcascdrisk ofcxpcricncings ocial exclusion duc tothe nature of thedisability."Seemingly ordinary,cvc l)'day activities sllchas travc lingto familiar and llnfamiliar placcs.caring for a childor anailing parent , rcadin g anewspaperandsucceedingatworkcanall prcscnt cxtraordinary challcngcs.
Familyrelationshipsmaybecomestrained.Andwithoutassistanccinadjustingto vision loss.manypeople (particularlyseniors)maylivein isolati on and fcar" (CNIB.201I a.
Howdocsvision lossaffcctpeoplc'ljI)
Manypeoplewithvision losslive withoutthe protect ive factorsthathelp decrease thc risk ofsocialexclusion. Protect ive factorsarctraits.situations.orcircu mstancesthat
contributeto aperson's socialincl usionand includ ehavingadcquatc incomcand housing.satisfyingpersonalrelationships.asocia lsupportnctwork.uccessto hcalth services, access10transportat ion.skillsandresour cesto lind and obtain nccdcdscrvices , and higher levclsofcducation( FedcraI/Provincialn'crritoriaI MinislcrsResponsible for Seniors,2007).Protective factorsalsoinclude beingingood health,feelingsafein one's nc igh bourhood,fccling conncctcd and valucd byothcrs,and cxpcricncingmcaningflll rolesinsocicty (p. II ). Visionrchabilitaliontrain ingcnhanccsthcindcpcndcnccof people withvision loss andassiststhemindcvcloping andm aintainingt hcscprotcctivc
Thc conccpto f socialexclusion cmcrgcdin thel 970s and 80s as a rcsponsc10the grow ingsoc ialdividesin Europcansocicty(Frazcc,2003; Saloojcc,20( 1).These soc ial dividesevolvedfromnewlabour market conditions and thcinudcquacyofcxisting social wclfllrc provisionio rncct thcc hangingnccds o f lllorc divcrsc poplilations( Frazcc,2003).
Morcr cccntly.Stanlcy( 2007)d cscribcssocial cxcllision asth c cxistcncc o fh arricrs which makeit diffic ultor impossibleforpeopletoparticip atefullyinsociety orobtainan acceptablestandardofliving.Thcconditiono fv isionlossrcslIIts in barriers suchasthe nccd for alternative formatsoft cxt, sa femobility training.andacccssto assistivc Icchnology for cd ucation.cmp loymcnt and homc.
Socialexclusionhasbeen associatedwith an increasedchance ofprematuredeath.
depression,increaseddisabilityfromchronic discascs.fncntalhcalth problcms,incrcascd
determ inantof health(WorldHealt h Organi zation, 20I0)Accordi ng 10 thcWorld Ilealth Organization(2010) soc ialexclusionconsistsof:
tohealth incqualiticsrvn
Asoc ial inclusion frameworkisa respon setosoc ialexclus ion
rcspcctcd,andcontributingm cmbcrso fsocicty( Frazcc,2003)Itaimsto 0l,cnsystems
of diver sityandof people ' slived exper iences (Frazee,2003 )
barriers separating people(Frazee, 2003;lIutehinson&Lee, 2004)
RespcctfoTd iffercn cesnccdsto occurandbarricr sr cmo vcdto cn sur c that evcryonci s ablctoc ffcctivclyandc quitablyparticipa teinallarcas o fs ociety (Saloojcc.Rnnl:The RocherInstitute,2( 03)
Therearcmanydimensions of soc ial inclusio n (Shookner, 20(2 ).Severalarc relevant10thoselivingwithvision loss. Econom icinclu sionrequiresthat people have adcqllatcincomcst omcctlheirbasicn ccdsandto participatcinsoc icly.ltinvolvcsthc climinat ion ofpovc rtyand thc rcductionof disparitics amollgstva riousgroups(p.5) Thisis an importan tcompone ntof inclusionfor peoplewithvision lossbecauseonly 25%ofworking-age people withvisio olossarc employed(CNIU,20Il a).Thisis despite thefactthat themajor ityof peoplewithvisionlossarchighly educated an d quali fied .Thishighratco funcmploymcntis contributedto outdated cmploycrattitudcs aboutthcabilitiesof people withvision loss.Manypeople withvision lossli vein povcrt ya sarcsultofd iscrimi nalio n(CNIB, 201la)
Funct ional inclusionenablespeopleto beactivelyinvolvedinsocictyvalucs theirsocialroles,and reco gni zestheirco mpetencewhileprovidingopportunitic sfor personaldevelopmen t(Shookncr,2002). Thcfunctional ab iliticso f pco plewi thv ision loss arcoftenoverlookedinfavoUTofoutdated ster cotypcsthatminimizethcubilitics and indcp cnden ceo fpcopl e withvisionloss
Participatoryinclusion involves empowe rme ntandthefreedom0fchoi ce.It providespcoplewi ththeopportunitytocontribute tothcir community andaccess
general population
soc iety in healthy andsuppo rtiveenvi ronme nts (Shookncr , 2002)
availab le toprovidetransport ation
resou rces(Shookn cr,2002 ) Pcopl<, w ithvisiOlll oss o ftcnfccl ,,,,thou ghthcyarc on thc outskirtsofsoc iety Thcrci sliltl cr cspcctfolcandrccogni tion oftheir abilities.
havelilllitedaccesstorcsourccsdllcto highratcsofunc mploymcnta ndanoften inaccessiblesociety
Finally.struc turalinclusionfocuseson communit ycapacitybuilding andoptions forchange.It includcsintcr-dc partmcntalandinlcr-goVcnllllcnt allinks.aceountabi lity.
andopen channelsof communicati on(Shookncr,2002).
Visionlosshasprof ound impactsfor indivi du alsandsociety thc rcforc individ uals.organizations.andgovernmentmustcometogethe r to bringaboutsocictal changclo prom otcthe incl usionofpeople withvisionloss.Theyrnu stw ork togethcr to changethestructuresthat exclu de people withvisionlossand mak esociety convivialand
l'hcFederallProvincialfferri torialMinislersRcsponsiblcforScniors(20()7) developedaguide toassist organizationsandgove rnmentsinthe screeningofexisting and plan nedprogra msand practices todetcrminc their impactonsocialisolation.Th is gu idc wasprcparcdin rcsponsctothcrccognitionlhatsocial isolation isa sign ificu nt risk forolderadultswithseriousconseq ue ncesontbcirqualityoflife.People withvisionloss have asimilarrisk ofsocialisolation.there fore theguide can be applied to thecx pcric ncc ofinclusion for person swithvisionloss
Usingtheguideasastartingpoint,itcanbe seen thattherearewaysfor organizationsthatoffervision reh abilit ationprogramsandse rviccs,topromotethe inclusionofpeoplewithvisionlossin thcirprogramsand policics
invo lvepeopl ewithvis ion lossin plann ing,imp lement ing,andcvaluating theprogramsand policiesthataffectthem;
conductingalocalscanof resourcesavailab le topeoplewithvisionloss;
identifyin glocalresources thatcanbeutilizedin programdeliver y
Accordi ng10the guidcorgan izationscanalsoidcnti fyandaddressrcaland potentialbarr ierstoparticip ation by
usingllexibleappro achcsthat addressthepsychological, soc iaI,and physicalasp ects ofliving withvision loss;
making effo rts toapproachthose withvision lossthatarcisolalcd oral riskof becomi ngisolated;
increasing accessibi litytoservicesbyprovidinginformationandeducation topeopl ewithvision lossusingavarictyo f mcthods tha tarc sensitivc to potcnlial barr icrs(i.c.litcracy.commu nicati on, ctc.};
addressingthe transporta tionneeds ofpeoplewithvis ionloss;and ensuring theirstuffa ndvoluntee rsarc supportedand providedwith
ongoingtrainingopportunities(FcdcrallProvincialrr crritorialtVlinistcrs Responsiblefor Seniors,2( 07 )
SuIIIiliaQ
Theeffectsof visionlosshavedirect and indirectimp licationsfor individualsand gove rnment andarcagrow ing conccm incwfoundlandandLabradorductopopu lation agin g.Individ ualslivingwithvisionloss1~lccmanybarricrsandarcatagrcat crriskof becomi ng sociallyisolat ed.Thepredictedgrowth inservice needswillhave a profound impact ongovernme nt poli ciesand programsandforsocialwork practicc int hcprov incc.
Vision reh abilitation serv iceshelpenab lepeopl e withvision 1osslivc indc pc ndc nta nd fulli llinglivcsandt oparti cipa tc full yinsocicty. llo\Vcvcr,not allpeopl earc accessing and usin g thesespec ializedservices,Thisrcscm ch ailll st ocxplorclh en ccds.bar ricrs.
and palhwaysassocialcdw ithacccssingandu lilizing visionrc hab ilitationservicesin
Itisan ticip alcd lh isresearch will facilit:ltcandin fo m l the expansion and illlprovclllcnlof programsand scrviccsailll cdalvision hcalthand rchabilitationandthe
alsoadd to existingknowledgeabout the experien ceof visionrchabilitation in this
provin ce andaboutsocialwork practicein that context.Mostimpor tan tlyit willgive voice to thoselivi ng withvision lossinNew foundland andLabrador
Chapter2
Thepurposeof theliterature review istodetermin e what isknown about atopic.
Aprim ary goalof thisresearchwastounderstand accessandutilizationofvision rehab ilitationservicesinNewfo undlan dand Labr ad or.Issuesthat emergedin the literaturereviewwerecons ide redin term s of theirrclationshiptothcscrviccuscr und the irrelevan ceasneeds,barrier s,orpathways.In addition to areview ofthe literatur e, theliesDisability Suppo rts Project(Goss Gilroy,20(7)and theEnv ironmentalSeem of Vi,\';OI1Health and ViS;OI1Loss;n thcl'ro \'il1c esond Tl'rritoriesolCanada (Muzychka, 20(9)providediuforrnationabo ut program sandservicesspecifictoNewfoundland and Lab rad or.This chapterwillprovide an overview ofvision rehabilit at ion nccds and servicesand thebarriersand pathwaystotheiracc essand utilization asidcntificdina
Inorderto understandthe needs.barriers.and pathwa ysrclatcd to accessingand usin gvisionreha bi litatio nservicesitisim porta nt10gainanunder standin g of vision rch abilitalionserviceswhi charc ak cy suppo rtfo rpcopleli vingwilh vision loss.While
visionrehabilitatio ntrainingcannotrestorelost sight itcan hclpa pcrsonmaximize cxisting vision and to dcvclop tcchniqucs to mainta in an indcpcndent lifcs tylc.Vision rehabilitation servicescan cnablcapersontoadj ust emotionall ytolivingwith visionloss.
travcl safcl y.takccareofthcirh omc.m cctth circarecr goals.andcnjoyl eisurc activities (Lighthousclnlemational ,2010 j
C IB isthemain provider of visionrehabilitationservices inNcwfoundlandand Labrador with other professionalsprovidingSOI1lCbasicvisionrchabilitation program s andservices.For example.Itinerant Teacherswork withCNIB to provide vision rehabi litatio nservices to childrenandschoolagedyouthin the areasof independe nt livingskillsandassistivetechn ology.Inaddition toltincrantTcachcrs;ulimitednumber ofoptome tristsprovidelow visionassessments10theirpatients.Thisrescarch foclIsed on thc expericllccs ofcli entso f C NIB.
Vision rehabilitation servicesprovided byCNIBinc lude
information andtrainingin the useoflow visiondevices,andinstruction
•orientationand mobilit ytraining:instruction on howtomovesafcl y aroundthehol11c.orwhcntmvcllingoutsidc;
•assistivetechn ologyservices:infonn ation about the availability. selccti on, use. andpurchaseofdcviccsbcstsuitcdtoindividualnecd s.Thisi s
accompl ishcdt hro ughdcmonstratio n,asscssm cnt,training,t cchnical suppor t, andinstruction on how tousccurrcnt computcrprogramsto accessinformation andcom municate indepe ndently:
•independcnt living ski llstraini ng:lifc-ski llstrainingto hclpmanagc thc esscntials o fdailyliving , withanemphasi sonmainta in ingindepcndcncc- including sa fe andeffective methodsofcookingand doingbouschold tasks suc haslaundry,bank ing , writing, and personalcare;
•career andemployme ntservices:emp loy mentassessments,helping individuals explorecareerinterests,develop ing employ mentplans, mar ketingtopotentialemployers,and investigationofjobopportun itics
•ch ildandfamilyservices:supportivcc ounsc lling,servicecoo rdinat ion, informa t i on,advocacy ,andprogramm ingforchild rcnand thc ir t~un ilics Earlyinterventionspec ialists workwithchildrenfrombirthtoschoo lagc andtheirfamiliesto assessdevelopmentalneeds associatcd withvision loss,takinginto conside rationadd itionaldisabilit ies, andcnv ironmcn tul needstohclpschoolsaccommodatestude ntswithvisionloss;
•adj ustmcnt tovision loss collnsclling : supportto peoplca sth cyadjustto visionloss.This can bcaccolllpl ishcd throlighindividllal,f1l1nily,or group counselling. Clientgroup programsprovideavenuetodiscu ss
work.hol11clife.activ itiesofdaily living.orleisurcandco mmunity particip ation; and
•supportservices: inform ationand advocacysupportforresour cesavailablc fromCNIBaswellasresourc esavailablefromcommunitypartners focusingonsocial issue s such asconcessions.housing,finances.nnd leisurepursuits.
Ilealth care providcrs.cye carep rofessionals.and individualswith visionlossrely onorganizations like CNIB todeli ver visionrehabilitationservicesbecauseoften no otheralternativeexists(Muzychka ,2009).However, alack ofsustainable fundingand increaseddifficulti eswithfundraisingismakin git difficultfor CNI B to provide a
consistcn tscrviceevc nwithinsmall regions(CNIB.2008).Accord ingt o CNIB,the cost ofproviding vision rchabilitationservices forpeople withvisionlossinCanadawas S32.8million in2007.Inadditionto this.the costofspeciallibrary services forpeople withvision lossin Canadawas$7.4million.Only23%of thcsefundsarcprovided by government.The balanceisprovided by supportfromthepublic(AccessEconomics,
For the purposeof thisresearch .thetcnn need refers10thesupportsandservices needed to enablea persontoaccess and uscvisionrehabilitationservices. Unless
indicated.theneedsidentifi edbelowarcnotspecificlo on cvision reh ab ilitati onservice but tovision rehabilitati onservicesingeneral
vision rehabilitationservicesamongst allprofessiona ls.Inastudy byPnllardct al (200 3)on ly46%ofparticipants,adultswitha visual impa irment whowere current patientsat theRoyalVictorian Eyeand EarHospital.Iiad been referredtovision rehabilitat ionservicesbyaneye care practitioner.Otherresearchind icatesthatthe majorityof thoseliving withvisionlossthatarcawareofvision rehabilitationservices havebeentoldabou ttheserv icesbyfamilymembersand friendsnotthcireye care specialist(Ovcrburyctal.,2008).Thesefindi ngsarcparticularlyproblematicasithas beendem onstratedthatpeoplearcmorelikelyto accessthe servicesif theircyecare specialist discussesthe services withthem(Pollardct al.,2003)
Thereisacommon misconception amongprofessionalsandthe generalpublic thatvisionrehabilitationservicesareintendedfor peoplewithnovisionand notfor or neededbythose withvario uslevelsofvisionloss(Gold&Zuvela,20(5).Eye care specialistsarc likely10onlyin fo rmthosewith moreseverevisionlossaboutvision rehabilitationservices(Ovcrburyct al., 200 S;Pollardct al.,2003).In manycases eye carespec ialistssubstantiallyunderestimatetheeffectof visionlussonaperson'squality oflife andpeopicarclcftt ofindand acccss visionrehabilitationservices on their own (Ovcrburyct al.,2008)
Thcrci salso anccd for carlyr cfcrral asitisimportant forpcoplc withvisionloss to availofvision rehabilitat iontrainingatthc onsetof thcirv isionl oss.ltisrecognizcd tha ithe earlieraperson withvision lossbegins vision rchabi litationtrainingthchighcr thcirlikclihoodofasucccssfuloutcome(Pollardetal.,2003).Withearly utilizationa personbecomes accustomedto using new tools,lcchniqucs, and adapt ivc dcviccs,This maymakeiteasicrforthem to acceplthcn ccdforlll orc advan ccdirainingandassistivc dcviccsifthcir vision loss advanccs(Mu zychka,2009) .Dcspitcthc bencfits of early access10visionrehabi litationtrainingpeoplewithvision losshavcrcporlcdthatrcferrals 10vision rehabilitationservicesoftenoccurat the veryendofthctreatment process (Pollardet al.,2003). Eye carespecialists must beaware of thefullspectrumof services availab lc, cffcctivelyinlcraclwithorganizat ionsthat provideth c scrvices, andb c knowlcdgeablcinmakingreferralstotheseorganizations(MlIzychka, 2009 ;O verbury el al., 200S)
ThcN ationaIEyelnstilutc (201O)in theUnitcdS tatcshasrccognized thcneed for increased referralsandisdevelopinga programwith ihc goalofcducating cyc carc spec ialists aboutvisionrehab ilitationservices.Theprogramwillbedesignedtoincrease patientreferrals,develop,test, andevaluatemeasurablestrategics, idcntifyo pportunities andbarriers.and provideinfo rmation tohcalthcare professionalsandthcir paticntsaboul visionrehabilitationservices.Thisprogram is still in thedevelopment stage.
l)s)'ch olnJ:ical and cm nli on al suppn rt.Thedebilitatingpsychologicaland emotiona laffects of visionlossarc an importantissue that isoft cn overlookedin the CUfTentmodelsofvisionrehabili tation services.Rcsearchshowsapproximately 31%o f peoplewithvision losshave depressive symptoms (Tcmisjian etal.,2008).Manypeople mayfcclal oss ofindependence and autonom yandattcmptt oc oncealtheir vision lossto protect theirpridc(Pollardat al.,2003).This canleadtoanincrease insocialisolaricn and make it difficultforpco pletoinitiatcor he rcceptivcofvisionrehabilitationserv iccs Thisiswhyit isimportant for individualandgroupcounsellingprogramsto beincluded aspart ofallvisionrehabilitationmodels.Accessingcounsellingattheonsetof vision losswill increasetheIikclihoodof'aperson acce ptingand availingof other essential vision rehabilitationservices.Itis know nthatthcrcisanem otionaltransitionalperiodin which itlakeslimeforpeopletofeelcomfortableaccessingand using vision rehabilitationscrviccs(Soothallctal.,2(08).
Assist ivctcchnolouy. Peoplewithvisionlossare in need ofaccessto assistive technologydevices.Assistivctcchnologyrcfers to dcviccsthatcna blcpeoplclivingwith visionlosstoimprovethe irqualityoflite and perform taskstheywouldotbcrwisc havc dillicohyaccomplishing(CNIB, 20 1Ib).Itenab lespeopletopart icipatemore fullyat home.work.andintheircommuni ties.Devic es canrangefromlow tech items such as
talkingcloc ks,handmagnifiers,and largebuttonphonestohightcchitcms suchas CCTVs4,adap tive computersoftw are.and highpoweredelectronicmagnifier s
Asslst ivetech nologyfuud lngaud training.Pcoplcwi thvision lossarcin nccd offundi ngforassistivc tcchnologytoimprovcac ccsst odcviccsandintumthcirquality of lifc.Inasludycondll ctcd byGold, Zuvcla,&lI odgc(2006 ) ovcrSm/o ofrcspondcnts indcntilicdhi ghpriccsasth cr cason thcy collld notpurchascrcqui rcdassistivcdcviccs Muzychka( 2009)alsorcportsthatmanypco plcw ithvision lossareunablctopurc hasc assistivetechno logyorhavetosettleforcheape ralternat ivesthatdo not mcctt hcir ncc ds
Providersofvisionreh ab ilitationservicesindicatethcrisin g cost o f assistive tech nol ogyinprovinces witho utsubsidyisaseriousburdenandSignificantly affccts thc abilityo fpco plcw ith lowo r fixcd incomcstobcncfitfromvision rch abilitationscrvi ccs (Goldctul.,2006). AccordingtoMuzychka(2009)Canad ianswhoarcin nccdof assistivclcchno logyarcpayingthcmajorit yofcostsolltofthciro wnpockets with governme nt and thehealthcaresyste ms providin gminimalsubsidies.Whilcprovincia l govcm mc nts ofTergc ncralsupports tothosewith disabili tiesfcwprovinccsputforward programs specifica lly forpcopl c withvision loss.Asurvcyo fprovincial and tcrritor ial programs showcdno orlimiteddetails in most jurisd ictio ns rcgardingthc inadcquatc
~CCTVsarcvideo magnificrscons istingof'uvideocameraconnectedtoamonitor.Matenalscun
funding availableforassistivctechnology.a finding whichwas confirmedbythe Assistive Techn ologyLinksprogram o flndllstry Canada (lndll stry Canada.2010 ).
Anexception isOntario.\..'hicholTersan AssistiveDevicesProgram (ADP) that coversoptica laids such asmagni fiers.telescopes.specia lizedglasscs. jeadingand writing systems.incl udingaudio-book machin es and Braillers.Thisprogramisavailab le toany Ontarioresidentwhohas a valid OntarioHealth cardissued intheir nam e and has hada physicaldisabilityforaminimumofsix months.Thcprogram stipulatesthatthc equipmentmustbeneededon a daily basisboth insideandouts idcofthch omc and cannot berequiredexclusivel yforsports.work.orschool(Govcrnm cnt of Ontario, 2010).ThcADPdoe snot payforequipment availablefrom otherfundingsourecs.
There are specificeligibilitycriteria whichapplyto eachdevicccatcgory but thcsc critcriaarc not puhlicknowledge(GossGilroy.20()7).TheADP isa costshare program with theamoun tofsubsidyprovided dependentonfactors suchasthe device required.
applicantage.and the availability ofothcr sour cesoffunding (GovernmentofOntario.
Saskatchewan isanother exceptionoffering aservice called theA idstothe Blind Program.Thisisoperated by CNIBSaskatchewan underagovernment contr actandis availableto consumerswho meet certain med ical criteria.The Saskatchewa n program loan sBraillers, audio-boo k machines,and magnifiers.Theprogram alsohe lps subsidize thc costof watchcs.talking calclliators. andl ow-vision eyewear (Muzyehk a. 2009).
InNewfo undland andLabrador,ther eis110universalsubsidy forIhosclooking to acquirefund ingforassisti vetechno logy. Someassistivetechnologyisprovidedby governme nt andcommunity fundingtoeligib lestude nts, thenewly cmploye d,andthose lookingtoretainemploy me nt.Asin Ontar io, eligibilityreq uirem ents varywide lyand arcnotpublicknowled ge(Goss Gilroy,2007 ).Althoughthis assistan cc isbenefi cial, manypeoplcinNewfo und land andLabrador maynotmeet the cligibility criteriaand havenoguarantee theirneeds willbemetthroughthcpatch work oforganizationsand progra msthat haveattemptedtofill the gaps(GossGilroy, 2007 )
Assi stivc technologysubs idiesarcimperativetoens urepeople withvision loss havca eeesstot hcdevicesth eyr cqu irc(C NIB, 2008).Therei saneedto coordinatcthe nlimcrousagen eiesin New foundland an dL ahrad or thatarc currcnlIyprovidin gfundi ng forassistivet cchno logyinorde r10create atimcly, efTective,andstreaml inedprocessfor acquiringdevices(GossGilroy, 2(07)
Onceaperson hasa ccesstoassistivct cchnologylhcrcis an eed for incrca scd training opportunities.Ittakes timefo rapersoll withvis ion losstofcclprepar edand com fortable usingassistivctechno logy(Southa llcia 1., 200 8). A study byGold, Zuvcla,
&Hodge(2006)revcalcdthat on lyasmall nllmbcro f participantsweretrained inthe usc ofassistivcdcviccs.Thosc who d idrcccivetrainingrcp ortcdreccivin gonly on e ortw0 bricfsess ions pcrassistivc dcvi cc.Furthermore,in most cases thelim itednumber s of train ing sessionswereusedtoteachind ividualshowto uscmorethanonedevice.In
additiontoimprovingtheconfidcn ce ofuscrs.re sc<lTchh asd cmon stratedthat aslittleas five training sessionscan increa secomplian cewith assistivctechnologyusc (Gold&
Zuvcla.2005)
For thepurposeof thisresearch.thet cnn barrierrefersto the factorsthatprcvent apcrsonfrom acce ssingor using vision rehabilit ationservices.Barrierscanbe external tothe individualor they can be personal chal lengesthatpreventapersonfromacccssing and usingvisio nrehabi litationservices
Imll: cessihilit yofa ssisti vc1 l'chn ology d l'monstrafioll ccntrc s and s1orcs. The
lack of accessto assistivetechnologydemonstration centresandstores scllingassistive technologyis ubarrier tha tcan prevcn tp coplcfrom using ncccssarydeviccs.A ssistive technologyisoftcnlimited to trainingfacilities. whichare inshortsupply.wherethe availabil ityofdcvice smaybcinadcqllatc{Mu zychka. 20(9).
InNcwfoundland and Labrador.for example, there isan assistivetechnol ogy centrelocatedin the St.John'sCNI13centreshowcasing many of thclatcsthightccb assistivc dcvi ccs.Thcrc is alsoastorco nsitc whcrc many low tech itcmscanbcsamplcd and purchased.However,theCNIB centr esinCornerBrookand GrandFalls-Windsor havc averylimitedselection ofhighand 10\\'techassistivcdcvicesavailablc for
demonstrati onand nodevi cesarc availableforsale.Whcn assistivctcchno logyisno t availab lein thelocaloftice clicnt shave theoptions ofwaiting forapieceof assislivc techn olo gytobe couricrcd from the SL John' s officeinorde r10try itororderinga dcvice not knowin gifitwill beappropriatetomcettheirneeds , Goldctal.(2006)foundthatin manyinstan ccs apersonwillchoose toorder aIess effectivedevice simplybecause itis availablefor demonstration orc hoosc nottoordcran y assistivc tcchnology
l'ranspnrt ation.The challengeof Canada'sclimate andgeography mean s lim itedaccesstoserv iceswhere peoplelive.Peopl eresid ingin rural areasmaynced to traveloutsidetheirco mmunity to receive the services theyrequire. Even in urban areas, pcoplema yb clicvcth at visionr chabilitationcentresar ct oofar away frolll whcreth ey
liveand that thcyarcdifli cultto gctto (Ovc rburyctal..2008; Poll ard ct al..2( 03).
Transpor tati onisfrequentl ynotedasa barriertovisionrehab ilitat ion services,espec ially in ruralarea swherepublictran sp ortati on can belimitedor non-existcn t (CNIB2005;
Gold, Zuvc la,& Shaw,2008; Muzychk a,2009; Ovcrbu ry ctal.,2008;Pollard ctal., 2003). Tran sportation canalsobe anissuefor vis ion reh abilit arionspec ialistsbecause tilllc spcnttravellingt oruralar eas top rovidc visionr chabilitationservicescanbe subs tantial(Gold ctal.. 2( 08)
Evenw hc n publictran sportati onisavailablepeopl emaybc anxious abo ut usin git as aresult oftheonset oflow vision.Goldetal.(200 8)reportthatbasedon thc 2001 ParticipationandActivity Limitation Survcy ( PA LS) peopl e withvisionloss arcmore
likelythan those withother disabili tiesto experienc e diffi cult yusingpubl ic
transporta tion.Over 80%o fPALS responde ntswith vision lossreportedhavin g difficulty getting on andotTpublic transportation;40%haddifficulty getting to bus stops (Goldctal..2008)
UIH.'q llalaccessto\'isionreha h ilitationsl'r\'icl's.AccordingtoManiet al.
(2010)theunequaldistribut ion ofservices in ruralandurbanareasmay be a barrier to visionrehabilitationservices forsome people. cwfoundla ndand Labradorisalarge provincewith manypeoplelivingoutsideof thecapitalregionofSI.John' s,The majority ofCNI13services are housedin the St.John'scentrewithvisionrcbabi litation spccialists regularlytravelling to otherareas of theprovincetoprovideserviccs Muzychka( 2009)recognizcd that CNIBservicc sll1aynotbcliniversalIy availablcan d cquallyucccssiblctoul!people withvision lossduetostaffingandgeog raphical challenges
Inadequat epromoti onofvisionrch abllttat ion centres. Thelack of public knowlcdgc o f vision rehabilitation programsandservices and thosetheymay bene fitisa barric r to pcopicwil halllcve lsofvisioniossacccssingthesc services.According10 Muzychk a (2009)thepublie hasIinlc knowledgeofavailablevisionrehabilitation scrvices ( t\.1uzychka. 2009).Peop lewithvisionlosshave expressed conccmthat publicityof visionrehabilitationcentresisdirectedatpcoplethatare blind andnotthose withmildto moderatelevelsof visionloss.~l uchoftheadvcrtisingdepietspcoplewith
whitecan es and guidcdogsandpeoplcwithlowvisionlindthescilll agcsdifli cultto rc1atct o(Poll ard ct al. , 200 3) .lnordcrt oh clpclilllinat cthis barri cr ad vcrti s ingn cedst o
Concernshave been raised bypeopl e withvision lossth at organi zation sprovidin g visionrehab ilitationservicesself-pro mo te to raisefund srather thanmise awarenessof Ihcp rogram s and scrvicestheyp rovid c (P oli ardct al. . 200 3 ).Thismay be ductothcfuct that many of thcs corganiza tio nsarc non-profitand rely on privat cdonor stoassi stin fundingth cprovisionofvi sionrehabilitati on servi ces.ltisanticipatedthatifthcse organi".ationsrcccivcdmorc govcTlllllcntfund ingthcy couldfocusonpubli c cducati on effortsto miseawar enessofthcvisionrehabilitat ion programs andservices theyprovid e.
P:ltil'lIt prrn'p tion.Pcopl e' spcrccptions o f thenaturc oftheirvisionl ossalld/or thcirnccdl"or vi sionrchabilitationscrviccsca nb e a barricr to accessin g and usingthese services. Theymay choosenot to availofvision rchabilitat ionscrvic cs ducto miscol1ccp tionsabout thescrviccs,inadcq llatclll1dcrstandingo f thcir eycconditio n,lack of knowledgco f the availablcscrv iccs,waitingforeyetrea tm ent stobcfinishcd . tmnsporta tio n issucs.and notc o nsidc ringthcmsc lves to havclowv ision (l\lattic t al., 20 10;Ovcr bu ry et al.. 2008)
Researchhasrep ortedconflict inginform ation abou ttheuptakeIcvcls fo rvision rehabil itation services. Ovc rbu ry etal.(2008)rep ort ed tha tonly58.2%oflhci r participant s availedofvision rehabilitati on services.wh ile Mattictal.(20 10) rep ort ed a
97%uptakeof visionrehabilitationservicesamongparticipants.Thcresearch byMatt i and his colleaguesappears to bcthc exceptionas researchfromCanada,Australia , and Britain hasreportedthatlownumbers ofpco plcarcaccessingany typcofvision rchabililation scrvicc (Gold& Zuvcla.2005;O vcrbury.ct aL.2008;Pollard ctal.,2003).
Mattie etal.attributethe highrare ofuptakein theirstudy tothescrvicedeliverymodel used.Allparticipantswerecontactedbythe vision rehab ilitationprovidcr within onc weekof thereferralbeingreceived withinterpreters andvoluntcerdriversalsobcing madca vailablc( p.185).
Mattictal.(20 10) found thebiggestbarrierto uptakeof visionrehabilitation serviceswaspatientperception.Of thoseparticipat ingin the study,initially 27%didnot hc1icvcthcynccdcdvisionrehabilitationservicesandafurlhcr l O%did not hclicvcthat
vision rehabil itationserviceswouldbenefitthem.Thiswas supported in astudy hy l' ollardctal.(2003)wherealmost50%ofparticipantsdidnot considerthemselvesto havelowvisionand of theparticipantslhald id,manythlselyhclieved thatvision rehabilitationscrvicescollldnotassistthcmbc callsethcircyeca repraclitionerloldthcm thai"nothingmore can bedone"(Pollardetal.,2 0(3)
Asprcviollslydiscusscd.pcople otienhave thc misconcepti on thatlow-vision serviccs arclorpeoplewith severevision lossandarc unaware that thereisa range of visio n rehabilitationservicesthatmay bcncfitpeople withvaryinglcvclsofvisionrGold
&Zuvcla,2005;Mauicla L.20 10;Pollardct al.,2003).Related to thebarriercreatedby
amispcrccp tion of thevalueof visionrehabilitationservices. isalack ofunderstanding aboutthclongtemlconsequenccsof cycconditionsthatcauscSJleOJllcto delayaccessing visionrehabilitationservices (Southall et al.,200S)
People mayalsochoosenot to uscvisionrehabilitation servicesbccause they arc scared andconfused at the timeof their diagnosis and may gothrough a period ofdenial Itmaybe difficult fortheperson to consideravailing of visionrehabilitation services if theyarcconccmcdaboutbeinglabelled as 'blind ' (Southallet al..2008).Thisharricr maybepart icularlypromin ent amongolderadultswhoassume that vision lossisa natural partof agingandonlyseckservices when theirvisionloss significantly interferes withtheir ability to completeeveryday activiticsorwhcn theyrcalizc thcirvisionlossis incrcasing(Gold ct al.,2006)
Concu r rcnt hcnlthprohl cm s. Mattictal.(2010)citethepresenceofconcurrent majorbcalthproblcrns as afurther barriertovisionrchabilitationservices.Pcoplc with concurre nt healthproblem smaychoosenotto availof visionrehabilitationservices becausetheyarc hesitant aboutcommittingtothelow visionassessmcnt duc tothc fcar ofmultiplcap pointmcntsundadd itiona l tcsting(p .IX5).Concurrenthealth problems maybe aparticular barrier for olderadults.
IdcntilicdPathw ays to VisionH.ch a hili hltion Scr viccs
For the purposeof thisrcscarch,thc term pathwayrefersto factor sthatmotivate orenableapersonwithvis ionlossto accessandusc vision reh abilitationscrviccs
Init hll co n hlct. People report initiallycontactingandacccssing vision rehabilitation centrestolearn newsk ills andwaysofmanagin gtaskso f ev erydaylife (Scheiman,Scheiman,&Whittaker , 2007).Thismayincludelearningnewwaysto completechores, select cloth es,cook,and walkin thecommunity.Peoplemayalsowant 10learnwaysto maximizetheirvision and improvetheir readingability withdevi cesor training(p.62)
Atterinitialco ntac tvision rc habi litation train ingoften incl udesaccessingand lIsingassistivetechnology.CNIB providesinfon n ation aholilthcavailability, selcction, use,andpurchaseof assistivctechn ology.Theyarcabletoassisl peoplein findingthe best devices10meettheirindividualneeds ,throughdcmonstraticnusscssmc nt.fraining.
and technical support(C NIB , 20 10)
Othcrprovid er s of visio nrch a bll itat ion services. Itinerant Teachersarc cmployc dinschoolsthroughoulNewfoundlandand Labr ad or and providci mpo rtunt pathwaysforchildren andschool agedyouthwithvision lossandtheirparents.Access10 ltincran tT each crsisregulatcdbythc Go vcrnm cl1tof Newfo lindland and Labrad or.In order10recei ve supportserviccs froman ItinerantTcnchcr':uchiId musthaveavisual
acuityof 20170orless in thcbetter eyc withcorrectivelenses, or a child musthavea visualfield restrictionof 20°or less"(Govcmmcntof Newfoundland and Labrador, 200I,p.2.2).In additiont oth esupport providcd to familics,ltincrant Teachersalso provide supporttoclassroomteach ersthat\\'orkwithchildrcnwithvisionloss.They encourage a realisticunderstandin gof the child'sneedsand ab iliticswith the aimof helpingthechildreachthcir highest potential(GovernmentofNcwfbundlnnd and
InpartnershipwithCNI13.Itinerant Teachersprovidetrainingtostudentsinthe areasofBraille,orientationand mobility,language, socialskills,indepenJentliving skills.usc oflow visionaids.listening skills,kcyboardingskills.assertivenesstraining.
organizationalskills,v isualefficiency andpost-secondarycolll1selling(Govcrnmcntuf Ncwfol1ndlanda ndLabrador,20(1). Thcya lso ass ists tlldcnts in acccss ing assistivc devices,teachthem howtousc and maintainthedevices, andmonitor thedevicesto ensurethat theyarcworking properly(p.5.20)
TheHadleySchoolfortheBlind ishelpingto make visionrehabi litationscrvices moreaccessibletopeople byofferingdistanceeducation programsfocusingon assistiv e tcchnology,Braillc,indcpendent living skills,andotherimportantareas.Theschoo l was foundedin 1920 and todayit isthelargesteducator in the worldofpeoplewithvision lossand the largesteducator of Braille.Eachyear theyhave more than10,000 students locatcdinIOOcollntrics(Thcllad lcySchllolforthclllind.2011).
Thc m issiono f Thclladlcy School fort hcBlind isto"pro motcindcpcnden!
livingthrough lifclong,d istancc cd ucation programsfi:}r individuals who arcblindor visuallyim paired,lheirfamilicsandblindncss scrvicc prov idcrs"(ThcHadleySchoolfor the B1ind,201I,',1).Thc sch oolprovid esdistance educa tion programsfreeofcha rgcto individual sliving withvisionlossandtheirfamilies,They also offe rafforda b letuition coursestopro fessionals working within thcficldo fvisionloss. Thcschoolrclieson assistancefrom individuals,found ations,and corpora tionstofund itsprograms(Thc Hadley Schoolfor theI3lind, 2011)
l' a r tuc r shjp s andcollabnra tlen.Partnership sbetweenvision health profession alsand related organizationsarccited inthcliteraturcashavingthcpotential to improvcpathwaysto vision rchabi litationscrviccsforpcoplcli vingwithvisionlossif theyunitcaroundcommongoals(C NIB, 200S). This could includeimprovedrefer ral processcsby eye carc specialists,incrcascdawarcncssof availabl cscr viccso ffcrcdby CNIB andother vision rcbabilitutionprofessionals,and initialreferralsbeingmade at curlierstages ofvision loss(Gold&Zuvcla,2005; Muzych ka. 2009 )
Public ed ucation.Alackofpublicknowlcdgcof vision rehabilit ationprograms
incducation.uwarcncss. and healthpromotioncam paignsarcpotcntialp athwaysto the acce ssand utilization ofvision rehabil itationservices(Muzychka,2 009).An incrcasc in pub liccdu cation focu singonthc tcrm ino logyuscdwhc nd isCllssing visiolliossand thc
rolcand function ofvis ion rehab ilitationservices in thelivesofpeoplewithvision loss hasthepotentia l toincreasepublic awa renessandirn provcpublicattitudesaboutvision loss(Po llardetal.,20(3). An increasein publicawareness couldresult inanincreased uptakeofvision rehabilitation servicesas wellas an increasein the socialinclusionof thoselivin g withvision lossducto anincreasedunderstand ing0ftheabilitiesofpeople
Summa ry
barriers,and pathwaysrelated tothe acce ssib ilityand utilizationofvisionrehabilitati on servicesforpeopl ewithvis ion lossthatcan be gene ralized topeepIeinNew foundland andLabrad or.Thesearctheidentifi edneed sofpro fessionalawarcncssand rcfcrral , psychologicalandcmotiona lsuppor t,assistivercchnol ogy,andassistivctcchno logy fundingandtraini ng.Thcbarrier sidcnt ificd wcrcinacccssihili tyo f assistivctcchnology democentresandstores, inadequa tepromotionofvisionrchabi liunioncentres.
transportationu nequalaccessto visionreh ab ilitationscrvices.patientpercepti on, and concurr cnt hcalth pro hlcm s.Thepathways identifie dwereinitial contact,othe rproviders ofvisionreha bilitationscrviccs,partllcrships andcollaboration, and pub lic educatio n
Thegoalofthisresearch wasto explore theexperiencesofaccessingandusing visionrehab ilitationscrviccso fpcrsons living withvision 10SSinNev..foundlandand Labrad or. Thenext chapter discussestheprocessusedto carry outthcrescarch.
Chapter 3
Th ischa pterdescribesthemeth odsused10explorethe expc ricncc o fsixtccn indi vidu alsinaccessingand using vision rehabili tationscrv iccsinNcwfo und land and Lab rador.Thecha ptcrbcginswitha descriptionofthestudydesignandthesampling methodsused10select par ticipants.Thechapter then goeson to discu ssmethodsof data collect ion,theinstrum en tsused,anddataana lysis
StudyDcsi~n
The purposeof thisresearch wastoexplore anddescribethe need s,barricrs,and pathwaysto accessingandusingvision rehabi litat ionservicesin thcprov incc o f
Explora tionofatopicisbestaccomplishedusinga qua litativercscarchapproach asameansof open ingdialoguein whichtoexam ine issuesbecause theprimaryaim of qual itat iveresearch isnot to disco verorverifycom monalitiesacross experiences but ratherto explore eachperson' suniquelylivedexperiences (Piantanidu ee Garma n,1999) Furtherm ore.aqual itat ive approac h isbetter su itedthan quantitativemcthodsto cxamin c issuestha tarcpoor lyunderstood andresear ch questionsthatconsidcr thcqualityof
experiences rathcr thanmagnitude(Creswell2007)Thistypeofapproachgenerates richdataallowing fordcpthofundcrstanding(lIutc hinson&Lee. 2004 ).Theusc ofa scmi-structllreu q ualitativcintcrview inthis studycapturcd thcIivcdcxpc ricnccs o f people withvisionloss.This willpro videtheVision Rehab ilitation Committeewithan in-depthllnderstanding ofp articipants ' cxpcricnccsandpcrspcctivcso fvision rehabililationscrviccsinthcp rovince
Theresearchquestion asked:whatarcthcneeds,barriers.andpathwaysto
Samp ling
for thepurposeofstatisticalinference (Luborsky&Rubcn stcin,1995)
saturation ill qualitativeresearch (Guest,Bunce,and Johnson,2006)
sixtee n participan ts wereselec tedforind ividual intervie wsusingacomb inationof availability and purpos ive sampling
Availabilitysamp ling isasampling methodthatselec tselcmcn tsbccauscthcy are rcadil y availablc and con vcnicnt. This salllplinglll cthodis collllllonl yu scdinsocial
work resear ch becauseitisusuallyless expens ive andmorefcasiblctbauothcrmcthods of samp ling(Rubin&llabbie,2007).
Purposive sam pling is commoninqualitative researchandinvol ves selccting participantsbasedonvariables that arc ana lytically andthcorctically linkcd to thc researchquestion(Rubi n&Babbie, 2007).Usingthe C NIB clicnt lista sthe sampling framc, apurposivc stratcgy wa sundertakcnto con sidcr spccifi c catcgo ricsof cxpcricllcc ofvis ionrehabilitatio nservices. Purp osi ve samplingwasused toselect participants bascdon thc cxperienccsof thcfollowing grollps
Group I: Parent s orguardi ansofchildre nwithvisio nloss(ChildrenagcslS
GroupZ \Vorkinga gcadults withvisionloss(aged19-(5)
Group3 Olderadults withvisionloss(agcd66+)
Thcscc xpcr icntia lcatego riesrepresent thcma in visionrehabilitati on consurner groupsinNcwfoundland andLabrador
There cruitmentprotocol wasreview edandapproved byMemorialUniversity's Interd isciplin aryCommi tteeonEth ics inlIuman Research (ICEIIR)(sec Appendix Afor Lettcrof EthicalA pprovalandAppendi xBfor inton nation abouttheProtecti on of Partic ipants)
Parti cipantswererecruitedusin gthe CNIB clientlist. ACNIBrcprcsc ntative contac ted potent ialinterviewparticipantsfromcachcategorytoi nfon n thcm ofthe research andask iftheywouldagree toreceiveadd itiona l infon nationabout theresearch incilidingafoll owlipphone callfromth c rcsearcher.A recruitmentscriptwasusedto ensurethatpeopleunderstoodthat theirparticipationwasC0111pIctely voluntary and wouldhave noimpacton theireligib ilityf(lrCNIBprogramsandservices(secAppe ndix CforScript for Telepho ne Contac twithIndividua l IntcrvicwCandidntcs).Alistol individual sthat agreedtorece ivemoreinformationabout theprojcctwas compiled usin g astandard ized form (secAppend ixDfo r CandidatcIn fon nation List)and turned over10 thcrcscarchcr.Thekeyinform an t fromCNIB didnot knowwh ichpot ent ial parti eipants agrccd to bcintcrviewed.A Part icipant Pro fileslist providesmoredetailabo utthe participantsandcan be found in Appendi xI
Ind ividua lswho agreed toreceivemoreinformationwere sentalcttcr and proj cct informa tion shee t whichintrod uced theresear che r. iden tified the purp ose of thcresea rch.
andinformedthC111tha t theresearcher wouldfollowup with aphone callto answe r
question sand provide moreinformation asnecessary(secAppendixEforLcltcrto Candidates and AppendixFforProjectlnformation Shcct),Thispackagealso conta ined aconscntfonnoutliningth crc scarch condition s( sccAppcndi xGforCon selltF onn ).
All materials sent toparticipantswerede\'clopcdfollowin gthc guidelin csforplain language and wereavailabl ein alternativeformats.
Data wascollected usingtelephoneinterviews.Theinterview guidewascreated
Rchabilitation Commi ttccllsingthc framcwork o fn ccds,barriers,andp alh ways describedinChaptcrl.Thc commilt cc wasprovidcd with adratt cop y o f ap rclimin ary intcrvicw gllideand askedtoprovidcfccdba ck.Feedbackwascollected andutilizedin the development of thefinaldraft ofthe interview guide(SeeAppcndixllforthe Interview Guide)
Individual intervicws\,,"crc rccordcd and conductcd via tclephoncoTheconscnt form wasrcadatthe beginningof thc interview andparticipants wereaskedtoprovide verbal consent10proceedbeforcthc interview commenced.The verbal permis sion of each participantwasrecorded and the researche r signed the conscnt formiudicatingthat vcrbalpcnnissionhadbccn grantcd .Thcint crvicw guidcconsistcdof open cndcd qucstionsd csigncdtoencouragcafull.mcanin gfulanswcrusingthcparticipant' sown
knowlcdgcandfcelingsrclatcdto accc ssingandusin gvi sionrchabilitation servic cs Thcu scof asemi-structurcd intcrview gu idcallO\v cdforindividuali zeddiscu ssionand qllcstionin gb ascdonparticipants 'answ crstotheprclimin aryqucsti on s
nataAnulysis
In qualitat iveresearchanalysisa codingprocedureisusedtodiscernand organi ze patternswithindata.The processof codinginvolvesmovingfrom raw data to a thcorctical narrat iveinsmallstcps.cachncwstcp bllildingupo n thc previou sone (Auerbac h&Silve rste in.2003).
Aspa rtof thc initialcodingprocessthe textfro m thci nd ivid ualintcrv icwswas reviewed and organizedinthc contextoftheresearchconce rnsof nccds.barr iers.und path ways.For eachinterviewanyreferencemade toneeds.barriers,and pathwayswas identifiedasrelevanttextandcopiedintoan elect ronic chart. Otherinformation provided byparticipan tsthatdid not titthesecategorie sbutseemed to bc relevanttothe research wasplaccdinthc "othcr "catcgo ry( sccAppendixJforthcCodingChart).Thismadethe text eas ierto work with.Therelevanttextwasthen exam ined for repeatin gide as across individualinterviews.Repeatingideasarc the sameorsim ilar words and phrasesusedby particip ant stocxprc ssthe sam cid ca(Aucrbach& Silvcr stcin. 2003 ).Ancwel cctroni c document wascreatedto compilethcrepeatin gideasinto theme s.The them eswerethen
organized intocategoriesbased on the concepts of needs,barriers,andpathways. The
Summary
This researchutilized aqualitativeresearch approach to expIoretheneeds, barr iersandpa thwaystoa ccessingandusing visionre habilitatio nservicesintheprovince ofNewfoundlandand Labrador. Acombinationof availability and purposive sampling wasused to selectparticipantsfromthree experientialeategoricsrepresentingthemain consumergroupsofvisionrehabilitationservicesinNewfoundland andLnbrador .Data wascollectedfrom individualphoneinterviewsandrecordedtoensurea ccuracy.Data obtainedfromtheinterviews wascodedand organizedaccording to their relevanceas needs.barriers,and pathways.Theresultantcategoriesarcdescribed inthefollowing chapter
Chaptcr d
This study aimcdto cxplorca samplc ofilldi viduals' cxpcricnccs of vision rehabilitation services:the irneedsregardin g accesstoscrviccs,theva riablcs that can compoundor complicatc thcproccss.anJthc pathwaysthatfacilitateaccessand uulization ofvisionrehab ilitatio nservices.Theresultsofthis studyarcorganized accordingtothisframewo rk usingneeds.barriers. andpath waystovision rehab ilitation services asthethreemainheadings.Each headin gcontainsapresentation of thefindings asit relatesto thatspecific concept
Pr cscututjunof thcFiud ings
Individualintervie ws werecond uctedwithsixteenparticipan tsifour parcn ts or guardiansof childrenwithvision loss,eightworkingageadu ltswith visionloss.and four olde r adults with visionloss.Thetindingsofthc researcharepresentedastheyrefuteto theorganizingframework of needs.barriers.anti pathways.lnsomc cascsthc findings corresponded with issuesidentified in thcliterature review, However.participant intervi ewsalso revealed subthemes thatwere unique tothisrescarch.
In th isrcscarchIuscdthct crm 'nccd'to referto thesupportsandservices need ed locnab lcaperson to accessand usc vision rehabi litationservices. Needswereidentified hy cxamininglhc cxpc ricnccsofpcopl c withvi sionlossinrclation10us ing and acccssing
Assistivetech no logytraining, Participant sidentifiedassistivc technology train ingasaneed and reportedavailing oftrainingfrom a numbcrof sourccs Partic ipantsrcportcdhavingreceivcdtrainin ginschool,froll1 C NIB,and bein g self taught.Mostparticipant s saidthatthcassistivctechnologytruiningpTOvid cdby C NIBis relevant,ben efi cial,accurate, and relativelyup to date.lIowcvcr,Joy saidwhilcthc assisti vcl cchnologytraining shcreceivcdfroll1 C NIBhasb ccnbcneficial itwas "not alwaysin depthasIwould havc likedit." Shcwasoften unsatisfiedwiththe assistancc providedby C NIBandwouldconiactthe manufacturerfor furtherhelp
Threcparticipantsreccivcd assistivetechno logytrainingfro mC NIBvia telephonebutsaid thisform of trainingwasnot helpful.Corey,a partiall y sighted man in Labrador, said heneed ed "hands on"trainingbutC NIBwasnot ab Ieto providci t. CNIB attempt edtoprovidetrainingto hiIIIoverthephonebut virwas n' t bcnetici a l."He went on tosay"thehandsont hing is theth ingw ith the techno logy for peoplewithvisionloss becau sethey can'tseeto operateit."He said heca lled forassistaneebut "[CN IB
Specialist,Assi stiveTechnolo gy]justcouldn't leave andCOIllcup hcrctohelpmc workit
Ps)'chnlo gir:l1:md cmoti on al supp o rt.Themajorityofparticipantsdiscussed theneedforprofessionalcounse llingservicesasapartofthc visionrehab ilitation servicesof fercdbyCNIU. Participan ts saidpro fcssionalcolln scllin gandemoti onal support is very impor tan t becausepeoplemust adjusttotheir visionlossemo tionally
bcfor e thcyar e opcn toa cccssingothcrvision rchabilit at ionscrviccs.Parti cipan tsin each age catcgory agrccd thaicounselling ishelpfulthroughoutthelifc spannot justforthem bUltC)ftheirfam ilym cmb crs who alsolivc with anda reaffcctcdbyvisionloss
Andrcwspokcatlcngthabolltthcncc dfor apro fcssionalcounsc lloratCNIB.He said"thai'swhereyourcon nection isb etwccn CNI13andtheclient. it' sthe counsellor."
Andrewwent on10say"eve ryoneofthose,fromkidsright intothe cldcrs ,theyneed SOIllCollctotalk and it nccds to bca pro fess ionalcounscIlor."Participants pointedout thatco unsclling scrviccsn ccdtobcprovidcd bya profcssionalcounscllor,notsolllconc thatp rovidcsothcrvisionrchabilitati onscrviccs.Participan ts said coullscllinglctspcopl c knowthaiCNIBcaresin addition toprovidin gpeopl ewith aconncc tiontothe
Theneedfor emotionalsupportwasiden tified asparticularl yimpor tan tby wor kingageparticipants astheybelievedemotionalsupportwasnolavailablctoC NI13 c1icntsbctwcen thea gcsof20to65.Andrew said"j usttheide a of dcalingwithvision
lossandthcchangcithasinyo urlifc you needaIittlc support."Franksaid counselling services arcneeded andarcveryimportantfor thosein theworkforcethat bcgin los ing thcirvisiono rcxpcricnccchangcsint hcir vision.Whcn spcakingabout counsclling he says...it isall intertwined.Issucs comcup allthc timcandhow doyo udealwith these things'!Evenformcandl'vebeenvisuallyimpairedforallmylife."
SOIl1Cwor king ag c participant s stated thatCNIB docsnot provid eanytypco f support to them,Brcndasaid working agepcoplcwithvisionloss"have nothing."Four of theworkingageparticipants spec ifically expressed theneed ofso mc fon n o f pccr support.Thcybclicvcthis wouldprovide CNIB client swithanopportunitytoshare information.provide support tocach other,and interact soc ially.I3rcndanolcdthatoldcr adultsandch ildrcn canha vcth cirpcc r suppo rlnccd sm ctout sidcof C NIBbutworking agcc1icnts arc forgott enabout.Ingcncral workinga gcparticipantsindicat edtheyarc fe clingisolatcdandbclievethcynccda groupspccificallyfor workinga gcpcople bccauscthcyha vcdiffcrcnt nccdsandissuesthanoldcradults
l'bcCanadian Councilforthe13lind(CCB) isan organi zati onthat addressesthe ongoing cffcctso f b lindnesswith programsdcsigncdtocncouragc activc participatio n o f peoplelivingwith visionlossinloca lcommunities, education, sports andrecreation, and employm ent.Theyhave sixty-tivcc haptcrs acro ss Canada, includin gtwoin Newfo undland and Labrador.SOll1eparticipan tsb elicvcthatthisorganizationismceting thc cmotionalneed sof peoplewithvisionloss.ThcybclicvcCCBisprovidin gthcpccr
support that CNIB is not. Andrewsaid the organizationprovidesanopportunity for peopleto getto knowthemsel ves and becomecomfortablelivingwithvision loss.He says vjusttodcalwith the idea of having vision lossandthe chan gc in your lifc.you do nccdalittlc bit of'cxtra help."He believesthis extrahclp isbcingprovidcdbyCf'B.
Ilowcver. Brcnda. a working agc person fromEastern Icwfolindland.believcsCCBis for older peopl e with vision loss.She describedattend ingCCBoutingsandfcclingthey didnot have anythingto offer to workingagepeople.Oncc ugaiuhighlightingthe expressedneedfor apeersupportgroupspecificallydesignedfor workingagepeople
Thc need forprofessionalcounscllingwasalso notedin relation tothe emotional
discussingthelossofhisDriver'sLicense.Eugene.anolderadultinCentral Newfollndland.said"thatwas thewo rslthinglfound ahollt it.thelossofIllylicense.I wasdrivingsinceIwas 17"
Ongoing accessto counsclhng\"..ashighlightedbyparticipantstodeal with fe ars ofincreased vision lossand thepossiblyof beingblind.Erin.anolderadult in Western cwfouudlun dthat recent lystartedexperienc ingvision loss. saidshc isworried about
"whathappenswhen Igoin total darknessbecausel'm tcrrifi ed ofthcdark.Counselling
Emot iona lsupportwasdescribedasimportanttoparent s ofchild renexperi encing vision loss.Amysaid "it'smo re than justthesupport of thechild it' sthe whole emotional support aswell"for her aswellasher child.Parents sa idC NIBisab lc to providerccommendationswhentheyfeel"stuck.v providc dircction. and makcreferrals to otherserv ices when necessary .Parentsalso said that the support provid edby C NIBat children'sappointmentswith theeyecare speciali stisveryimportant.Parents saidCNI13 spc:cialists as k appropriatc qucstions and ass ist d uring the appo intmc:nt when it bccomcs ovcrwhclm ingfor thcm
lncr ea scln publi cand pr ufcssien ulinfo rma ti on,Participan tsbelieved thereis anecd fori nc rcasc d publicand pro fessionalin forma tio na bo utt heprogra lllsandservi ces offc red hyCN I13.thc be nefitsofassistive tcc hl1ology .andt hec ffcctsofv is ion loss.A nlllllberofparticipant sb clievc C NIBshouldbcpll blishin g n: gllla rn ewslc:ltcrs to kccp clicl1ts. pro fcss iona ls, and thegc ncralpub lici nfor lllcd abo lit thc prog ra lllsa ndserv ices olTcrc:d by lhc organiza tiona nd h igh lighl newassistivc lechno logyasitbecomes available.Par ticip an ts suggestedthatthesenewslettcrs sho uld beshared withdoctors, nurses, socialworkers ,andother pro fessionals.notingthatfront linc workcrs. cspcci ally those visitingpcopl c ·shom cs.need to bc:ed llcated:lbolltvision lossandC NIU
Elcvcn of the participants saidCNIIJshouldincrease thenumberof public informationsessio ns theyofTer.Theybcli cvcthcscinfonnation scssionss hould be used to increaseawarenessof visionloss.whatit islikctoli vewith visionloss.fhcprogram s
andservicesprovidedby CNIB,andnvai lablcassisrivctechnology.Participants also pointcd out thc ill1portancc o f promoting allpublicinfonnationscssionslocnsure awarcncssall1on gstthc general pub lica ndthccli cntpopulalion .Franksuggested there bcatrained volunteerin each coll1ll1unityth at canfacilitatc these sessionson aregular
Partic ipa ntsbelieveassistivc technology should bc animportantpart ofallpublic inforll1ationscssions andl ow and hightcchitcll1s should bcavailablefor dcmonstratiol1.
rhcy said thiswouldprovidcan opport llnityforh andsoncxpcricncc wilh assistivc devices.Brandonsaidthere isaneedtohavc anassistivctccbnologytourevery6-12 ll1ollthsb ccallsclhcsctoursarc vcl)'b cncficialandprov idcclicntswilhanopportunity to secitemsandtrythemfirsth and.Thisis vel)'importantbecauseaspreviously I1lcntiollcdp coplcolitsidcof SLJ ohn'sdonoth avcr cgular acccssto assistivctcchllology demo items.Particip ants alsosaidit maybebeneficialtohaveinformationsessionsfor workingagepeople thatbeginlosingtheir vision toinformthem about assistivc techn ologyandletthe m knowtherearc waysforthemto continuetheiremployme nt.
Participan ts sugges tcd twospecificgroups.employersandsmdcntsctowhich puhlicinfonnation scssions shouldbetargeted.\Vorkingage andoidcr adllltp articipants suggestcdi nfonnationscssionforc mploycrsto incrcaseopportunities fllf peoplc with visionlossin thc workplace.Joy suggestedCNIB bring apersonwithvisionlossthatis currcntlycmploycd to thcscss ionasa mca ns o f promoting thc hiringof a personwith
vision loss.Participants said busincsscsnccd to bcmorc accessiblctopeopIc withvision loss.Daniellonotedthatit ishard as a personwithadisabilityto find employrnentina smallcommunity.
A numberofpart icipantsalsoexpressedaneed for informationand issuesrelated tovision loss to bctaught inschoolsatalllcvcls.Thcybclic\'c thatin additiontoa lInivers itycourscaimcdat tcac hing profcssiona lsab out thccauscsofvisionloss.whatit isIikc tolive withvisionloss.and howtointeract withthoselivingwithvision loss, CNIBshouldconductinformationsess ionsaboutvisionlosswithstudcnts at alllcvclsof the educationsystem
Ch.lI1l!.illl!.IICl·dsthrolll!.holltl hc lifcs p:tn.Participantsdiscussedtheneed for ongoingopport unitiesforvisionrehabili tationtraiuingthroughoutthcli fcspanbcyoud initialcontact or referral. Thisissuehad notbeenrcvcalcdth roughthc course oft hc litcraturcrevicw.Eight pa rticipants statedt hatasthcirvision change dsodidthcirnecd forvisionrehabilitationserviccsandncwa ssistivctcchnology
Carla isnowblindbuthad partialvisionasa child.Sherecentlybegan indcpcndcntliving skillstrainingto improvcand rcdcvclopskills she lcam cd whcnshc still rctaincd partialvision.\Vhcns peakingabolltthcchanging nccd forv ision rchahilitationscrvicesthrougho litt hclifcspan.Carlasaid"itcha ngcsforsure becauseI meanyo ulearn thingsasachildthatyouwant toimprovcasunndu h."Frank.a resident of Labrado rwho isnow blindbuthadpartialvision in the past.reinforccdCurlnsvicw
