Navigating the Early Stages of Adjustment

Jennifer Ottowitz: Welcome to OIB-TAC’s monthly webinars, where our presenters share valuable information and helpful resources to support professionals working with older adults who are blind or vision impaired. Let’s check out this month’s webinar.

Hello and welcome to Navigating the Early Stages of Adjustment. I'm Jennifer Ottowitz, Certified Vision Rehabilitation Therapist and Older Blind Specialist with the Older Individuals Who Are Blind Technical Assistance Center. As vision rehabilitation professionals, we recognize that when someone has a new diagnosis of vision impairment, they often experience feelings of sadness, fear, anger, frustration, and even stubbornness that can have an impact on their ability to seek out or accept help.

Today I want to share some supportive strategies to help guide you in your work with individuals as they navigate from the initial emotional reactions along the challenging journey to find and move along the path to adjustment. I want to share that I am not a licensed counselor. I base information I'm going to share on what I've learned through my education and training and over 30 years of experience working as a vision rehabilitation therapist with people who are blind or visually impaired.

I also draw on my own personal experience as I went through adjustment as my vision changed throughout the years. Now, as vision rehabilitation professionals, we don't do professional counseling, adjustment counseling with a capital A and capital C, unless we have that specific training. But we do adjustment counseling with a lowercase a and a lowercase c.

Because when we work with an individual, we work with the whole individual. And that psychosocial adjustment can have a tremendous impact on their ability to be successful as they try to maintain or regain independence and as they strive to build their self confidence and increase in their self esteem.

So let's talk about a couple of terms. Adjustment and acceptance. So adjustment is the process of changing to meet the demands of life. And these changes could be minor, like changing your plans, if you were planning to garden and it's raining outside. So now you, you need to decide what else you're gonna do with your time.

Or they could be very dramatic, like having to find transportation options because you're no longer able to drive. And when a person loses vision, they find themselves having to make both minor and dramatic adjustments. Acceptance is an internal consent to living with a vision impairment. Now that does not mean that a person has to always like being visually impaired or like the fact that they've lost vision or even enjoy it, but they have accepted that it is a part of their life that they have to make changes because of it.

And that although being visually impaired is part of who they are, it does not define who they are. And I would often share with clients and individuals that I worked with that you're more than just an eyeball with feet. Who you are as a person is so much more than an eyeball that does or does not work properly.

So who goes through adjustment? If we think about having to make changes because of vision loss, we often think of someone who suddenly loses vision. Maybe due to an accident or injury, or someone who suddenly wakes up one morning and they have lost a significant amount of vision. It could also be someone with a gradual vision loss or a condition where their vision slowly worsens over time.

It could be someone who was born with a vision impairment or born blind. We may not think of these folks as having to adjust, needing to adjust, or being in a situation where they are adjusting, but they also go through an adjustment process.

And of course, anyone who acquires visual loss at any age. Also people who are functionally visually impaired go through adjustment. And what this means is that on paper, their vision looks really good that they may not even be eligible for your services because their visual acuity may be 20/30, 20/40, 20/50. But they're having difficulty with everyday tasks because of vision issues. And for them, they are visually impaired, even though clinically that those acuities and the tests don't show a significant amount of vision loss.

And then also, it's important to remember that family members and members of the support network go through their own adjustment process. Now they can be very helpful to the individual experiencing vision loss as that individual goes through their own adjustment, but family members are also adjusting as well.

Now I like to think about adjustment or the adjustment process as a path. The process is really a journey along that adjustment path, and that path can be and is different for each individual person and can take on many different forms.

For some people, that path may be like the iconic Route 66, and on this slide I have a picture of a map of the U.S. with a line drawn denoting that popular Route 66, which originally connected Chicago, Illinois, to Santa Monica, California. It was originally 2,400 miles long and went through eight different states, and it's a fairly straightforward path.

So this does remind us that at times the adjustment path may not be short, but it could be fairly straight. And I would imagine that although most of the roads were quite smooth along the route, that there may have been some bumps and potholes along the way, and that can be true about the adjustment path as well.

For others, the path may be a little bit more like the Hana Highway. And on this slide, I have a picture of the road to Hana, the Hana Highway in Maui, Hawaii. And this route is a little bit different. It winds through a mountain. It's approximately 52 miles long, has 56 bridges, and 617 curves. I had the chance to travel this route on one of the Road to Hana tours.

And I can tell you that there are also some steep inclines involved. And this just reminds us that the adjustment path may often have twists and turns. It may circle back around on to itself. And it can often feel like you're going uphill, which feels like a lot more work.

Some considerations to think about as people move along their adjustment path. First, we need to meet people where they are. As professionals, it can be tempting to project where we think someone is or should be in their adjustment. A lot of times this can be done unintentionally, but we never want to tell people how they should be feeling.

And the story I want to share, although not specifically, about someone living with vision impairment, I think you can imagine how it relates and how this can also happen when somebody is visually impaired. A good friend of mine shared that she was in a serious car accident and was in the hospital. She was pretty banged up, bruised, sore.

She had done some extensive and significant damage to her knee and her leg. And as she was in the hospital, a well intentioned social worker came in and was talking to her about the accident, what had happened, and said to my friend, you must be depressed. And my friend said to me later that she really was not feeling depressed at all, that she was coming to terms with what happened.

She was processing through everything and was thinking about how she could move forward and what to do next. And it wasn't until the professional said those words that she thought maybe she was supposed to be or needed to be depressed. So we always want to listen, observe, and meet people where they are on the path.

It's also important to note that each person is going to move along their path at their own pace, and there are no set time frames for moving through the different stages or even getting to the end of the path. And an individual may move forward one day and backward the next. Another consideration is that the amount of vision lost is not always equal to the amount of challenges someone may have with adjustment. You may think, well, with somebody loses all their vision, they're going to have a harder time because the loss is greater, but my experience has been that this is not always true, that someone with a mild vision loss can often have a much harder time adjusting.

They're often in this in between world, not fully sighted and not totally blind. And they're trying to figure out where they fit in, in addition to the other aspects of adjusting.

Some factors that influence people as they move along that adjustment path. These factors can be both internal and external. Internal factors include personality characteristics. So if you think about whether a person is generally more optimistic, more easygoing, they may have a different experience along their path than someone who does not have those traits.

Age of onset can have an impact. Imagine the concerns of life will be different for someone in their thirties versus someone who's 55. And for someone who's 80 compared to someone who's 55, I think often we, we kind of lump the 55 and over population as one homogenous group, but there really are a lot of differences, even within that large age group to consider. Gender can play a role.

Men, women, people who are nonbinary or transgender all have maybe different issues that are impacted because of their vision. Culture can play a role. The stability of their vision. So is their vision a condition that is or expected to progressively get worse? That kind of anticipation. Sometimes anxiety about wondering when will more vision be lost?

What's going to happen tomorrow? How soon is it going to happen? Prior coping skills with other life traumas can have an impact. And then, of course, whether or not the person has additional health complications. If a person is dealing with many other physical or mental issues, it can sometimes impact just their energy level, to deal with an additional trauma.

But also having to deal with additional complications can compound feelings of depression. External factors include the level of support that a person has from family or an additional support network. It may not always be immediate family. It could be friends. It could be members of their religious community, and resources and services.

So how available these resources and services are can play a role in the whether or not the person is moving along well. And then role models. Does the person have a role model or role models who are blind or visually impaired? And if so, you know, what are they learning from those role models?

Sometimes role models are positive and negative, but these role models may be actual people or people from books, movies, TV.

So we talked earlier about who goes through the adjustment process, but now let's talk about who experiences these early stages in the process or along the journey. It could be somebody newly diagnosed that that's kind of the initial focus of this webinar. But that is a somewhat relative term because it could be the day of the diagnosis.

But also people can be in these early stages months or years after receiving that diagnosis. So when you kind of think of the term newly visually impaired, we try to put a time frame to it, right, within the first three months after their diagnosis, within the first six months or year after their diagnosis. But know also that, you know, people can still be in these early stages even longer after that initial diagnosis.

People can go through these early stages when they experience further vision loss. So maybe they got their diagnosis years ago. They've been living life well. They've gone through the adjustment process. Again, it's gotten to a level of acceptance, but now vision has gotten worse and they may, like we said, that path can sometimes twist and turn and circle back, they go back to the early stages and have to work through things all over again.

Someone experiencing fluctuating vision can also be in these early stages. You have good eye days, you have bad eye days, and again, you know, it's not knowing what today is going to bring and is tomorrow going to get worse and so, but that fluctuating vision can cause people to be doing well and then take some steps back and come back to these early stages, those experiencing setbacks as they learn new skills.

So, when people get to the later stages along the path, they're doing well, they're excited to learn new skills to try things in new ways, but sometimes when things go wrong, it can be a trigger. You burn the pizza in the oven. You're not able to find what you're looking for.

Things don't go as well as they did. During the lesson with your instructor, you're out on a walk that you traveled with your orientation mobility instructor, but you get lost. These can be triggers and set people back emotionally into some of these earlier stages. And people were also influenced by comments and actions of others.

So again, you know, you're doing very well and then you're out in the community and you hear someone talk about you using your white cane. Or the way that people interact with you makes you feel less of a person because they're talking to the people that you're with, asking, "Would she like anything else?"

"What would she like to have for her meal?" All these things can contribute.

So what are some ways that we can help? We want to look at three main areas: thoughts, emotions, and behaviors. So we want to help individuals reframe their thinking. We want to help identify emotions and validate those emotions, and I'll talk more about these in a little bit. And then we also want to introduce techniques that will help them change behavior and promote positive action.

We also want to be aware of psychological defense mechanisms. Now, defense mechanisms can be positive or negative. They're positive because we often use them to help protect us from the full impact of trauma. And when we use them, they can also give us time to develop other more effective coping strategies.

But they're negative when we overuse them or stay stuck in using them. Defense mechanisms can include things like denial, withdrawal, regression, and intellectualization. Now this one can happen when a person decides that the best thing they can do is really to learn everything they can about their vision loss, their visual condition.

And you may say, well, isn't that a good thing? Don't we want people to know about their eye condition? Absolutely. I think educating yourself about what's happening in your eye, what's happening with your eye condition, how it affects your vision and your daily functioning is a really good thing. But in this case, people are really into researching all of the many intricate details, and they are very forthright in sharing that information.

So, not only to family and friends, to the grocery store clerk, to just about anybody, and they will go into a deep, very detailed explanation. It is important to recognize when these defense mechanisms are being used appropriately or when someone is stuck in them, and it's also important to recognize when they're part of the adjustment process and when they may just be someone's personality, too.

Now let's talk about some models and stages of adjustment. There are several models that describe the adjustment process, but today we're going to focus on two of them. The Adjusting with Vision Loss model, identified by Dean Tuttle, and the Unified Model of Adjustment to Vision Loss, identified by Livneh.

Now, we're not going to get into a lot of detail about all of the stages within each of these models, but at the end of the webinar, I will share some resources where you can find more detailed information about each of the models and how they impact adjustment. In Tuttle's model, he identified seven stages of adjustment, while Livneh identified five.

And you can group the first four stages of Tuttle's model and the first four stages of Livneh's model into a category called the Reaction stages. The remaining three stages of Tuttle's model and the final stage of Livneh's model can be grouped into a category called the Rebuilding stages. And today, we're going to focus on learning more about those early stages, those reaction stages.

The first stage in Livneh's model is the initial impact, while the Tuttle model refers to this as the trauma stage. And in this stage, the person may feel numbness and experience inactivity. They're just trying to absorb what's happened. Tuttle refers to this as the what hit me stage. And it can be influenced by a person's age, their life experience, how they perceive themselves, and the strength of their self-esteem.

So how can we help someone in this stage? As professionals, we may not actually see people in this stage because they are not readily seeking out our services. They're just trying to absorb everything that's happening. We might get called in, though, by a hospital, if someone was in an accident, by an assisted living center, by a family member immediately after a diagnosis or traumatic experience that results in vision loss.

And sometimes the best we can do in this situation is to just plant the seed. We can share information about our services and about what may be possible. But honestly, if we're starting to give a litany of here's all of our services and all the many things that we can do to help and everything's going to be okay, don't worry, the person may not even hear what we're saying.

They're still processing through everything. But it can be important to share information and leave information and resources with the individual and their family so that they can contact you whenever they're ready. And I call this planting the seed. We're gonna talk more about that a little later on for now. I want you to think about asparagus and we'll come back to that.

Also, in this initial stage, you can begin to build the trust relationship. And although your contact may be minimal, with the person in this stage, it's still a good time to begin building a relationship.

And I think that's truly one of the key elements of what we do, because when we can develop the kind of relationship where we get to know more about the individual, about their life experience, their interests, what they like to do in their spare time, what makes them happy, what makes them laugh, how do they handle when things don't go as expected? What motivates them?

These are all things that we can use to help make their learning more meaningful and to help provide better support. We can also begin to build that relationship where they can recognize us as someone who will be open and honest, yet kind and gentle as well.

And we're going to talk more about that trust relationship throughout the other stages, but this is a good time to really start just by listening to the person, truly listening and again, sharing a little bit about yourself and your services, but it's important to keep it simple. You do want to verify vision loss with kind and gentle understanding. And as I just said, provide direct and simple frankness without pity or condescension.

 Next stage is the defense mobilization, according to Livneh, or the shock and denial stage, according to Tuttle. And one thing is when you recognize that people move from one of the earlier stages into the next, it's a really good thing because it does show that they are moving forward along the adjustment path.

But this particular stage Livneh describes as that I don't need you. Everything's fine. I'm okay. I'm really, my vision really isn't that bad. It's just the lighting in the restaurants aren't good enough. That print is just too small. So those might be statements that you hear. The person can be actually somewhat upbeat and hopeful in this stage.

And they can also begin to use those psychological defense mechanisms, such as denial. Tuttle describes this as the, this isn't happening to me stage. And during this stage, sometimes people search for a cure, a miracle cure. They're holding out and trying to find that medical breakthrough, that scientific discovery.

Anytime they hear about a news story of some kind of piece of technology or medical treatment that helps people see, they automatically want to jump on board. And even though it may be for a completely different eye condition, completely different functional implications from what they're having. They really want to find peace in, in restoring vision, right?

They also may go what I call doctor hopping. So, you know, that doctor didn't help me. He's no good. He didn't help me. And it may not be because the doctor was a terrible doctor, but it may be more because the doctor did not restore their vision. And so they, they tend to go from doctor to doctor to find someone who will give them hope.

But also possibly help, again, cure or restore their vision. And in this stage, people may engage in risky behavior, like driving, continuing to drive, crossing a street when their vision is not adequate for them to do that safely.

How can we help someone in this stage? Well, again, we want to meet them where they're at. Do not become an adversary. So you want to again, listen to where they're coming from, listen to what they're saying. We may know as professionals, but the reality is they're not quite as safe as they think they are.

They need to help start preparing for the future. But if we start to go into the conversation, becoming an adversary, it can really turn them off and that trust relationship does not get further developed and everything can fall apart. So remember again, meet people where they are.

You also want to use and in your statements instead of the word but. So, for example, you may say, well, I hear you say that you feel very comfortable with cooking in the kitchen. That's wonderful. If anything changes and you begin to feel unsafe, let us know and we can sign you up for training. So you're using that and instead of but. But would start to create that adversarial positioning.

So, and is a good way to tag onto what they're feeling and a good way to begin planting the seed. You want to use future planning to table things, table ideas, table thoughts of further training until a later date. So you may say, well, you know, we do offer braille.

And if they say they're not interested, you could ask other questions to find out, you know, what problems they're having and talk about how braille could solve those problems. But you might also say, if you get the feeling that they're just saying, Nope, everything's fine. I'm okay. I don't need it. Okay. Well, let's come back to it. You know, we can always revisit the idea in a couple of months.

We'll check in and see how you're doing and see what you think. And I mentioned earlier the idea of asparagus. And whenever you plant the seed, I think a lot of times in vision rehab, it's like planting asparagus. When you plant asparagus, it can take up to three years from the time that the seed is planted until you have a vegetable on your plate.

So it takes patience and nurturing. You can get that vegetable, so, just be patient and again, realize that sometimes it just takes time. Another thing to think about is that for some people, you may just need to pause their services or even close their case until they're ready. Because sometimes it's just not the right time and you can come back later on when they're more ready, and they'll be more successful.

So more ways we can help. We want to listen patiently. We also want to provide comfort, support, and understanding. Again, if you think of someone in a state of shock, you definitely want to provide that comfort and support. And you want to provide factual information that's easy to understand.

The next stage is what Livneh calls Initial Realization. And Tuttle, this kind of crosses two of Tuttle's domains, the mourning and withdrawal and succumbing and depression stages. Livneh describes this as the I can't stage, where people are experiencing sadness and withdrawal. They have feeling of being sorry for perceived loss of adequacy, self-esteem, equality, belongingness, or control.

And all of these can be experienced with vision loss. Tuttle explains this as the poor me stage as well, and says that some individuals describe this as giving in because of their real or perceived loss of personal freedom or independence. And the losses they experience do vary, but they can include things like a loss of income, loss of the ability to travel, especially when they lose the ability to drive and lose that spontaneity.

It's being able to pick up and do things when you want to without having to pre plan. Loss of the ability to do recreational activities or even maintain social interactions. They may experience depression along with other D's. And the other D's can be described as despair, discouragement, disinterest, despondency, distrust, and disenchantment.

So how can we help in this stage? Well, it's important to remember that some amount of depression can be normal. But when depression becomes serious and prolonged, then it can be harmful. It's important to know that often with support of family, friends, and professionals, depressive states can become less intense and less frequent.

It's important as professionals to be aware of the signs of clinical depression. If a person shares that they've been feeling, bitter, have feelings of self loathing, if they're feeling intense sadness, listlessness, or having significant trouble sleeping for more than two weeks, it's time to refer them to a mental health professional.

And as you're building that trust relationship with the individual, it will hopefully open the door to have the conversation with them so that you can find out how they're feeling and how long they've been experiencing these feelings.

Other ways we can help are to continue to build that trust relationship. Again, listen to the individual, find out how they're doing and what, again, what's happening with them, what interests them. You want to give them permission to grieve. Validate what they are feeling, let them know that it's okay to be sad, to be angry, to be frustrated.

The trick is that you don't want them to stay in those emotions too long, but it is okay for them to experience them. And they need to know that that's okay. You can establish a schedule for activities. This helps build some routine in their lives, gives them things to do so they're not spending their time dwelling on all the negative.

And you may even, as one of the activities, schedule a 10 minute session for a pity party so that the person can take time to let out the emotions of what's frustrating them, what they're feeling they're missing because of their vision loss, what they wish they could still be able to do.

Give them time to let that out, but set a time limit and then change the focus to behaviors that will promote more positive action and just reframing thinking onto more positive thoughts. And you can help break the cycle too. That cycle of withdrawal and sadness, you can help break it by suggesting changes in diet and exercise and by helping them find other positive ways to reduce stress during times like this.

Sometimes people will engage in some less than positive ways to reduce stress, including alcohol and other drug abuse. And so you want to help them focus on positive ways to reduce that stress.

Some additional ways we can help, as I just mentioned, is to redirect thoughts to more positive thinking, whether it's part of an activity or just, to help give suggestions as a person's going about their day, just to help redirect those thoughts. You also want to redirect their mental energies to help set realistic goals and to develop social contacts.

And suggesting peer support groups at this stage can be very helpful for so many reasons. It can create those social contacts. It can give role models that people may not have ever had. It can give a chance to learn how people are mastering everyday problems and addressing those problems with success, and how they've worked through when things have not been successful.

So peer support groups in this stage can be very helpful. And you do want to provide easily mastered practical solutions to everyday problems, both functional and social that a person may have. And some of the things I think about, just some simple introductory things- if the person uses an iPhone, teaching them how to use Siri if they're not already familiar with that. But Siri can be used to check the time, check the weather, make a phone call to someone in their contact list.

You might teach them how to use the digital talking book player from the talking book service so that they can have the ability to read. And that can open up so much for them. Just having even a bit of escape with fantasy books, nonfiction or fiction books.

Nonfiction books can actually help just increase their knowledge, and there are lots of books related to living with vision loss that can also be very helpful as well. Another great thing about listening to audiobooks is again, it's an activity that will fill their time so they have less time to dwell on all the negative.

And, at this stage, can provide insight to their family members about the adjustment process. Because, as mentioned earlier, family members also go through their adjustment. And information about the process can be both helpful to them in their journey as well as helping them support their loved one.

The next stage, Livneh identifies as the retaliation stage. And Tuttle, again, this kind of crosses the mourning and withdrawal and succumbing and depression stages. Livneh describes it as the I won't stage. I won't do that. And people can be feisty in this stage. They can exhibit a lot of anger and resentment. And it might be something such as "why did you let me fall off that curb," if they're on an orientation and mobility lesson.

I can speak to this. This happened to me when I was going through my O&M training. My cane missed the curb, and I fell into the street onto my knees. And I was frustrated. I was honestly more embarrassed than anything, but I was angry at my O&M instructor. Why did they let me fall? Aren't they there to protect me?

And I mentioned it to them. I kind of took it out on them. And the good news is that I did have a trusting relationship with my O&M instructor. And we were able to work through it, move past it, and go on. Another story was a client that came to the agency I was working at. It was about her third day with us, and she had additional health issues.

She had diabetes, she had neuropathy in her feet to the point where she was no longer able to always tell if her shoes were on the correct feet. And she was on a lesson learning the route from where the transit van dropped her off into our building to get to the reception desk. And unfortunately, her foot got caught on the legs of one of the benches on the pathway, and she tripped and fell.

Now, she did not have a trusting relationship with her O&M instructor, and she at that point decided, she was not going to continue with orientation and mobility. I won't, I won't put myself in that situation again. You wanna be aware that at times the resentment can be taken out on whoever may be closest to the person, and it could be a very well-intentioned comment by someone, a friend, a family member, a professional, even encouragement can be misconstrued.

A client once told me that she was birdwatching with her friend. She loved to go birdwatching, and she expressed feeling sad because she was no longer able to see the birds. And her friend, trying to help, said what I think most of us would say, "but at least you can hear them!"

And this individual shared with me that that just made her very angry. That was not what she wanted to hear. And she, she did not appreciate the comment. So, in this stage, people can exhibit retaliation either as a sudden outburst or even as constant irritability.

So how can we help someone in this stage? Well, apologize. Apologize and validate their feelings. At this point, again, we don't want to become an adversary with them. If we had a trust relationship with them and felt that at some point, it was okay to say, "well, but think about if I wasn't here, what would happen?

You're going to need to learn how to do this on your own." You know, saying that can be okay if you have that true trust relationship with someone. But in most cases, you know, let them feel what they're feeling, and continue to build that trust relationship with them, so you can get to that point where you can have those direct conversations.

Now, it seems a little strange to kind of stop here on the path, but we didn't want to devote this webinar just to the early stages. What happens next, hopefully, will be that the person moves along the path into the rebuilding stages.

And these rebuilding stages include reintegration, as identified by Livneh, as well as reassessment and reaffirmation, coping and mobilization, and self-acceptance and self esteem, the stages identified by Tuttle. In these stages, the person moves to saying, I can. They're interested, willing, and excited to try new things.

And they're really striving to find that new normal.

When someone begins these rebuilding stages, it's like coming to a turning point. They move from the earlier, darker stages of adjustment to more positive thoughts, emotions, and behaviors. And isn't that what we hope for? We hope that the individuals we work with can get to that turning point and continue on their path to adjustment, to building more confidence, increasing their self-esteem, and being successful in whatever their life brings.

Now, we may be with them all the way along their journey, or we may be with them only part way. And at some point, they begin to outpace us and go far beyond the point where we stop working with them. But if there's anything we can do to help them get to that turning point and continue on their path, it's a very valuable thing.

Now, I wanted to share the resources I mentioned earlier that provide more detailed information about the Tuttle and Livneh Models of Adjustment. OIB-TAC has a free online continuing education course called Adjustment and Acceptance of Blindness and Low Vision.

And I put the link in the PowerPoint, but you can also access it by going to OIB-TAC.org. Click on Continuing Education, then click on Courses. And you can access our full catalog of courses, including this one. We also have a past webinar called the Unified Model of Adjustment to Vision Loss, and you can find this on our webinar page. Go to OIB-TAC.org. Click on Continuing Education, then Webinars, and scroll through the past webinars to find it.

The link is also included in the PowerPoint. I hope that the information I shared today has given you insights into the adjustment process, as well as some supportive strategies that you can use as you're working with individuals as they navigate a challenging journey to find their way both to and on their path to adjustment.

Thank you.

Funding statement: The Older Individuals who are Blind Technical Assistance Center (OIB-TAC) is a development of the National Research & Training Center on Blindness and Low Vision (NRTC) at Mississippi State University, focused on agencies serving older individuals who are blind. This grant, H177Z200001, is funded by the Rehabilitation Services Administration (RSA) under the U.S. Department of Education. 

Contact us: To contact the presenter, Jennifer Ottowitz, email jottowitz@colled.msstate.edu. For more information about OIB-TAC, please visit our website, www.oib-tac.org. Also, visit our other NRTC websites, www.blind.msstate.edu and www.ntac.blind.msstate.edu. Visit NRTC on Facebook at www.facebook.com/theNRTC and on X/Twitter at www.twitter.com/MSU_NRTC. Our mailing address is P.O. Box 6189, 205 Morgan Avenue, Mississippi State, MS 39762. Our phone number is 662.352.2001.

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