A Distance Orientation to Vision Loss:

A Pilot Project for Outreach & Services in Rural Areas

Julia J. Kleinschmidt, PhD, LCSWJohn A. Moran Eye CenterUniversity of UtahSalt Lake City, UtahUSA

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

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)

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

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!”

However…..

• Attendance overwhelmingly from the Wasatch Front urban area

• We were obviously missing and not serving Utah’s rural areas

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 ServiceU.S. Department of AgricultureAugust 2009

Barriers to Serving Utah Rural Residents

Interviews-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

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

Challenges in Getting Rural Residents to OVL

• Effectively disseminating program information • Transportation issues• Cost of staying overnight in SLC

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?

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?

Enter Keriann Lynch

• Masters student-Communications• Research interest-dissemination of health

information• Knowledge and experience with marketing

techniques

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?

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

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

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

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

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

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

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

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

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

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

Results

Participants 2917 with VI12 family/friends15 surveyed at 1 mo f/u

Final data set 15 subjectsAges 14-95 age range Discounting teen outlier 61-95 age range M=78 Eye Conditions macular degeneration 8

diabetic retinopathy 2injury 1multiple conditions 4

Length of time with VI Average 1-5 years5 with 10+ years

Post OVL Self-designed QuestionnaireResults

• N=17Likert 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.”

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 lifeNot a statistically significant differencet(14)=2.824;p >.05

• Number of services accessedAverage increase in services= 1.8 serviceschange for better was statistically significantt(14)=4.447; p<.05

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 levelBut not statistically significant t(14)=1.146;p>.05

Adjustment to Vision Loss ScalePre and Post

• Mean respondent scoresPre-test 22.7 SD 4.6Post-test 25.8 SD 3.6Increase in levels of adjustment 3.13 points

• Matched sample t-testsStatistically significant improvements in adjustment to VLt(14)=3.662; p< .05

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.

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.

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!

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