Find sample forms and resources to support quality services.
After eligibility has been determined, intake captures demographic information and client history.
Information required to be collected at time of application/intake, per the 7-OB, includes:
● New consumer in the current federal fiscal year vs. returning consumer
● Age at application
● Degree of visual impairment
● Major cause of visual impairment
● Other age-related impairments
● Type of residence
● Source of referral
The following items are not required to be included in the intake, but are recommended:
● A recent eye report from a qualified medical professional
● Other agencies the person accesses for services (past or present)
● Timeline of processing a referral, completing an intake, and providing services
● Waitlist procedures
● Additional questions regarding safety, especially if staff will be providing services in the consumer’s home. Sample questions may include “Do you or anyone else in your household smoke?” and “Are there any dogs in your home?”
Other forms may be completed during intake such as release of information.
Some states have a registration list for every resident with blindness or low vision.
General or Initial Assessment
A general assessment interview with a consumer gathers background information that informs what services will be provided.
Engage the consumer in a conversation, rather than reading items off a checklist for detailed information gathering. Encourage interviewers to ask open-ended as well as follow-up questions.
General Assessments will identify
- red flags for health and safety concerns
- state of emotional readiness to participate in services/training for independence
- areas of difficulty in daily living due to vision impairment
Goals are generally not set until discipline-specific assessment have been completed by the direct service professionals.
A well-conducted interview builds rapport and sets a positive tone for the consumer's future with the agency.
Assessment Checklist for Consumers with Diabetes
If you are a vision rehabilitation professional providing service to a person with diabetes, here is a checklist of skills and tasks related to setting diabetes management goals.
___Had diabetic education by a healthcare professional in the past year
___Has received counselling from a dietician
___Keeps phone numbers for doctor/pharmacy in accessible format
___Keeps log of glucose, body weight, blood pressure if requested by doctor
Checking Blood Glucose
___Results can be accessed and recorded
___Identifies symptoms of high and low blood glucose
___Has an emergency plan for sick days
Manages Diet and Exercise
___Access information on food labels
___Determines correct serving size
___Can explain the impact of carbohydrates on blood sugar levels
___Can explain the role of protein and fiber in a diabetic diet
___Follows an exercise plan
___Weighs self (accessible scale)
___Measures blood pressure
___Takes body temperature
___Keeps feet clean and dry
___Wears recommended or proper footwear
___Can describe symptoms of potential foot problems and the consequences of not paying attention.
___Knows name, dosage, and directions for all medications
___Obtains refills for prescriptions
___Disposes of lancets appropriately
___Finds transportation to all medical appointments
Case Closure Begins at Intake
- Discuss/estimate a date for completion of goals at the first appointment. Introduce case closure as a positive event.
- Establish a relationship as a professional service provider, not as a peer or a friend.
- Arrive at appointments on time; wearing your name badge.
- Avoid excessive general chit chat.
- Do not disclose personal information about yourself or your family.
- Do not give out your personal contact information.
- Refer to each appointment as a lesson or session. Do not use "visit".
Focus on Projected Outcomes During the Functional Assessment
- Explain the purpose of training and explain the sequence of the services or skill areas to be addressed.
- Direct the conversation towards what consumers can accomplish at completion of training--remember, the person who is new to vision loss may not realize that services include discrete skills that can be learned to accomplish daily living independently.
- When starting the functional assessment, explain that their answers will determine training needs and that goals will be set after a review of the assessment.
- Estimate length of training and share this with the consumer. Then set a date for the first lesson.
- Explicitly state that the consumer's case will be closed when all training goals have been met.
Lesson Preparation / Training Suggestions
- At the first lesson, ask the consumer to sign and individualized training plan.
- Review the responsibilities of the consumer and the service provider.
- Review the scope of practice of the service provider to ensure the consumer understands the area of expertise.
- Early in the training, teach the consumer an accessible means for independently keeping track of appointments. Practice first with OIB services and current appointments. Later this skill can transition to the consumer booking and planning their own activities.
- Use lesson time wisely by keeping a focus on skills that relate to documented goals.
- At the beginning of each lesson, review training goals that have been accomplished and list the goals that remain.
- Review accomplishments at the end of each lesson. Give homework for the next lesson.
- Encourage the consumer to make recordings of lessons to emphasize that they are receiving training that should be reviewed.
Facilitating Consumer Connections in the Community
Consumers who have connection in the community, especially within the blindness community, will have less of a sense of loss when services come to an end.
- Encourage and actively facilitate participation in activities outside of training that will promote blindness skills and increase social connections.
- Vision Loss Support Groups
- Hadley discussion groups
- Promote and offer group classes to consumers
- If the consumer is a veteran, refer them to the Veteran's Administration (VA). VA services are for a lifetime.
At the Last Lesson
- Review all the training goals that have been accomplished.
- Ask if they are satisfied with the quantity and quality of training received (or have another staff call to survey).
- Explain how to reopen a case. Give examples of when this might be necessary such as a change in vision.
- Revisit the option to pursue employment and, if appropriate, describe vocational rehabilitation services.
- Consider using the term "graduation" and providing the consumer with a certificate of completion.