Fostering attitudes of separation History of O/M and TVI services Balancing the view of rehabilitation services

Rehabilitation

Introduction

Before we talk about vision rehabilitation services I want to give you some background on the network of services people who are visually impaired or blind receive in this country. I mentioned in one of my previous lectures that a lot of U.S. legislation was passed to provide the blind community with services.These services include a federal income tax credit for being blind along with additioal deductions which apply to Social Security, and expanded rehabilitative services. Blind people receive more services of better quality than any other disability group in the country.

In Massachusetts people who are legally blind don't pay to ride the public transportation system. People with other disabilities receive a reduced fare, but they have to pay something. Also in this state there is a Commission to administer services just too legally blind people. All other disabilities have their services administered by another agency. This is not true in all other states, but I believe there are some other states that have this same model.

To my knowledge people with visual impairments are also entitled to receive the same discounts and services that other disability groups receive. We are not restricted by our disability for receiving things like special seating in the Fleet Center. I bought a ticket for a concert there and got a very good seat in the tenth row of the lower stands. When the ticket agent found out I was disabled, my seat was moved from the stands to the eighth row center stage on the floor. After the concert I wanted to get the band's autographs and started out in the back of the line behind about two hundred people. Then I was moved up to the very front of the line and spoke to the band members first.

Supplemental Security Insurance

Many, many legally blind people live off of Supplemental Security Income which is about $600.00 a month and comes with a membership in Medicaid (a welfare health insurance plan). This is due partly to the fact that seventy percent of all blind people are under employed or unemployed. Many people are able to construct an adequate life living below the poverty line because it allows us to draw on all the public services available to us.

Some other features of how people with visual impairments lives are shaped by rehabilitative services are that I never have to wait in line at the security check in the airport. I am rarely asked to remove my shoes. When I travel overseas I have never spent more than ten minutes going through customs. I am always pulled out of line and dealt with separately.

Fostering attitudes of separation

Audible signals and tactile stripping on the edges of subway platforms are also a result of the presence of people with visual impairments in society. Tuttle referred to these as fostering attitudes of separation in the society. This is a position held by the National Federation of the Blind as well.

Another feature of the rehabilitative/cultural support for people with visual impairments is television programs which are described for blind people. There is also a reading service for the blind which broadcasts out of Marshfield, Massachusetts. All these different kinds of services and programs may not seem connected to rehabilitation, but they all are in some way. They are connected because they provide ways for blind people to either function or interact with mainstream society. A lot of these services have a charitable component to them since they offer reduced prices or are of no cost to blind people.

The Fleet Center is an interesting exception to the charitable rule since a person with a disability has to pay the same price for the ticket as everyone else even though they are provided with a better seat. I suspect there are several motives behind providing specific seating to members of the disability community. One is to make negotiating the Center easier. Another is to make it more enjoyable for the individual and I think the third one is that if there is some reason the Center has to be evacuated quickly it would be much easier for the staff to get people with disabilities out if they knew where they were sitting.

By the way, the Fleet Center will provide an American Sign Language interpreter for someone who is deaf as long as the staff knows a few weeks ahead and has time to hire someone. There is definitely a community service element to the provision of the seats.

Meaning of vision rehabilitation services

When we use the phrase, "vision rehabilitation" we usually mean the vocational/rehabilitative services provided by state and federal agencies. Most services are provided for those whose visual limitation falls into the definition of legal blindness we have already discussed.

There are some agencies which provide services for people who have low vision, but are not legally blind. Also the majority of services available are provided to U.S. citizens. What is often not known is that rehabilitation services are available to people from other countries who are not citizens. Unfortunately there are a lot of gaps in the service provision to those who are immigrants. Some of it is that case workers don't understand how someone from another culture feels about being visually impaired and many people who don't have green cards won't request the services because they have concerns about how their information will be used. There are often difficulties with service providers trying to communicate in a language they don't speak.

The way rehabilitation services are provided in this country is that a child is assigned to a teacher of children with visual impairments (TVI). This teacher works with the child and his or her family to support the child with schooling, mobility, social skills, learning Braille if that is appropriate, and assistance with other life issues.

A child works with a TVI until he or she is ready to graduate from high school. At that time the child has a case opened with a counselor who works with him or her to make decisions about secondary education and employment.

History of O/M and TVI services

Now, I want to go over a little bit of history for you. First of all both the disciplines of Orientation and Mobility and Teachers of Children with Visual Impairments are fairly new. They started developing in earnest around the nineteen forties. I entered elementary school in 1963 and I never worked with a TVI the entire time I was there. I had what was probably called a home teacher assisting me when I was in public school. Her name as Anne Howard and she was a wonderful woman, but did very little to help me go through my experience of losing vision. She taught me to touch type on a manual typewriter (boy I feel old!) and arranged for me to use large print books. She also got me signed up for talking books from the Library for the Blind and that was pretty much it for my entire public school education.

Please understand that this was the best level of service offered at the time to legally blind children. I was one of the first students to be mainstreamed into public school. If I had been a few years older I would have gone to the Overbrook School for the Blind which is Philadelphia's answer to Perkins. I didn't become fully ensconced in rehabilitation services until I was ready to go to college. I am getting ahead of myself, however. Before I launch into what voc/rehab. Services are today I want to tell you about an interesting development which has shaped how blind people feel about rehab. When blind people began to live in communities with other people (they were no longer placed in institutions) the seeds of O/M and TVI services began to flower. What happened is that blind people started visiting each other to help one another integrate into their surrounding communities. Blind people themselves were the very first instructors of people with visual impairments. These services were not formal or consistent. They were more about people helping other people.

When the fields of O/M and TVI started developing into a delivery system for services and masters programs were established it was determined that blind people could not provide these services. I am not sure that this was as true of the TVI services, but it was definitely true of O/M. For several decades no legally blind individual could be certified as an Orientation and Mobility instructor. I will check to find out if that was also true of the TVI, but as I said I am not quite sure of that. Having the services blind people had been providing to our community taken away from us caused a backlash within the blind population. It is one of the major reasons the political advocacy groups were started by blind people. The decision not to certify qualified blind people as O/M instructors was reversed in the nineteen seventies, but there is still a lot of concern in the O/M field about how well a blind person can teach another blind person mobility skills safely.

Blind communities view of service provision

This episode created an ambivalent relationship between clients with visual impairments and the sighted service providers which still exist in the background today even though service provision is much better now. State and federal agencies provide technological equipment, pay for higher education, offer orientation and mobility instruction, and other services depending on the determination of needs made by an individual's counselor. This is the main emphasis for decision-making by voc/rehab. Counselors are to support an individual in getting an education and/or getting a job. Many of the decisions made by counselors are based in their adherence to the laws surrounding service provision and how the client plan is to be executed.

From a psychosocial perspective blind people feel that their desires for education and employment are not always respected, but that they have to live with the decisions their counselors make because they need the services. Many blind people vacillate between wanting to do their own thing and feeling like they are trapped by the system. I am not saying this is right or wrong. I am just showing you the pattern which developed.

The Service providerís view of the blind consumers

On the other hand, many service providers feel like they get criticized for trying to do their best with the resources they have available to them. Providers sometimes have the attitude as well that blind people won't try to do anything on their own and expect to be given everything. There is a sense in our field and in the larger society that blind people are given more than their fair share.

Some service providers feel that many blind people have developed a sense of entitlement and that even blind children's parents feel entitled to ask for every possible support for their children. My personal opinion is that the attitudes developing on both sides are the residue from the time period when blind people themselves provided the services and then had them taken away. There is no right or wrong view here. Both the service providers and the clients have a right to their perspectives.

Balancing the view of rehabilitation services

Here is how we balance this situation. First, we recognize that there are underpinnings which influence how rehabilitative service provision is dispensed today. Several of the services are inter-connected with social security and income limits which are one of the many complicated reasons more blind people are not working. Once we set aside the background we can assist people with visual impairments to relieve the pressure of feeling dependent on the rehab system by suggesting that they advocate for themselves.

The best way a blind person can work with the local Commission for the Blind is by being clear about what they want out of life and then evaluating whether or not the rehab. System can assist them with their goals. Services are provided in very specific ways. Counselors want to say yes to their clients, but they have to do it within the rules they live by. Most people with visual impairments don't know what services are provided by their state agencies or how the decisions are made. This information is available to them if they ask.

An example of what I am talking about is that until recently I never knew that I could request O/M instruction to learn how to go to the movies. I thought that my Commission only provided O/M services for learning to travel in a new living community or for learning the route to a new job. I never knew that support for learning how to get to social activities can be requested. The mobility requests are prioritized. Someone going to a new job may get orientation and mobility before someone who wants to learn how to get to Fenway Park, but the requests are addressed eventually.

Clients also often don't know that they can hire an O/M counselor's services on a contract basis any time they want. Blind people don't do this often because they feel they can't afford it, but most people don't even know they could do this if they wanted to do so. They think the commission is the only source of services. The same self-advocacy is useful for making decisions on employment. My counselor may not agree that my choice to become an airline pilot is a good form of employment. She may refuse to authorize payment for flying lessons.

I have a choice to either feel angry that she won't pay for the lessons or I could find another way to pay for the lessons and go on with my career choice. Seeing all the services as tools is a very good way for people with visual impairments to view the voc/rehab. Services. Even the services available in the wider society can be viewed the same way.

I personally don't have an issue with tactile stripping along the trolley platforms. I learned how to travel before that was put there and I know what I can do safely. I don't take it as a personal statement of my disability. I think it assists many people and I am not so sure that the larger society sees it as a sign that blind people are not independent. Audible signals and tactile stripping are becoming part of the fabric of the society the same way the curb cuts are. Everybody uses them for different reasons and that improves the comfort level of all of the people around us.

The changing role of service provision and education

One thing I would like you to think about as I wrap up this week's lecture is whether or not TVIs are providing rehabilitation services or if they are doing something different from a socio/cultural perspective. TVIs work with children from birth until they are ready to graduate from high school. They provide the kinds of assistance a child needs to participate in public school. Is this truly rehabilitation or another form of teaching?

I have a friend who is a general educator and she likes working with the special ed. teacher in her classroom. My friend doesn't have a visually impaired child in her class, but she does have several children with learning disabilities who are on I.E.P.s. An I.E.P. is an Individualized Education Plan. It is the document which outlines what a child receives in the way of services throughout their public education. The special educator in my friend's class not only works with the children with I.E.P.s, but she also works with every other child as well. She is there to assist all the children and this creates a completely different feeling in the classroom. There has also been some talk about all children spending time in a resource room working on whatever they need assistance with for their learning. Some of this conversation has arisen because educators in visual impairment are finding that integrating a blind child into a mainstream classroom is not producing the level of social integration which was expected.

The Texas School for the Blind has an interesting model which seems to be providing some positive results. Children with visual impairments go into the general education classroom and do part of their education there. Then they are brought back to the School for training in braille and other skills. The feeling is that the children develop better if they have time with other children with visual impairments as well as time with children in the mainstream classroom. You can assist in empowering a blind client as well as his or her family by supporting their own investigation of the rehabilitation services in their area. This is why I want you all to visit the service providers in your state.