Welcome
I an a professional counselor. My graduate degree is in Social Work. I am licensed as an Advanced Clinical Practioner (MSW-ACP). As a student, I was exposed to the theories of human behavior and counseling. All focused on the same thing, the development of a style of interaction that allowed a therapist to assist and guide an individual through a crisis or through a portion of their life that they felt needed intervention.
When I began working as a VIST Coordinator, I found myself as having a dual role. The veterans I interacted had significant sight loss, and many had additional problems due to factors such as aging, loss of loved ones, substance abuse, homelessness, acute and chronic disease, or other conditions.
In my role as VIST Coordinator, I have to guide clients through the sight loss rehabilitation process. I also have to provide triage services and refer them to other sub-specialties to address other issues that need intervention. Though I am a trained degreed counselor with advanced clinical practice certification, I have to also realize there is other specialist in a rehabilitation team. I feel a large part of my role as a case manager is to ensure veterans are referred to the appropriate care provider.
I feel my own sight loss and having personally gone through the adjustment process allows me to have insights that contribute to effective counseling. Along with my professional training and development, I feel my own life with vision loss as well as my experiences going through VA blind rehabilitation adds credibility to my therapeutic interventions.
I have been a VIST Coordinator for 12 years. I started off as a Part time VIST Coordinator and in 1994 I became full time. I am legally blind since 1970. I have been through the HINES BRC and the Palo Alto BRC. I attended college under VA vocational rehabilitation.I feel all my life experiences have helped to develop me into a VIST Coordinator.
My first exposures to learning techniques related to sight loss were as a student in the Hines Blind Rehabilitation Center. This was an interesting time in the field of blind rehabilitation. I was exposed to the tried and true blindfold technique that is still used in many places today. The thought behind it was the development and reliance on my other senses. This was contrasted with my exposure to low vision services. The concept of maximizing residual vision was relatively new. Sight saving had been a predominant consideration right into the 1960’s. The VA during the time of my initial rehabilitation was pioneering the concept of low vision training. This was further enhanced by the later development of the closed circuit television and the first commercial models available in the 1970’s.
This time period presented a paradox. I was trying to teach individuals to function without sight one period and the next I was trying to maximize their residual vision. BRS seems to have come to incorporate both techniques in the VA, but this continues to be a point of confrontation outside of the VA.
During my rehabilitation, the going theory of vision loss was that it was an inconvenience. A blind person could overcome obstacles with adaptation and go about their previous life. I did not feel that this alone was enough of an adaptation process. Later in my professional life, I was exposed to the grief process as outline by Kubler-Ross. This theory seemed to dominate the view of adjustment to sight loss through the 1980’s and early 1990’s. The process outlined by Tuttle and Tuttle in the mid-1990’s supplanted this. Their model included seven steps; trauma, shock and denial, mourning and withdrawal, succumbing and depression, reassessment and reaffirmation, coping and mobilizing, and self-acceptance and self-esteem.
When I started to analyze this model, my thoughts on the rehabilitation process also changed. I had been very well served when I went to a VA blind rehabilitation center. I had lost sight and was sent relatively quickly. In the process that existed when I became a VIST Coordinator, a veteran was identified and might have to way over a year to attend a blind center. Over time it became apparent to me for the need of local intervention to avoid the veteran from being at risk for regression and depression. Also, while waiting for intervention, individuals were forced to change where and how they lived, and often once these changes were made there was no opportunity of going back to the life they had lived before. An example of this was individuals needlessly forced to leave their homes and go to a nursing home.
Through the late 1990’s these considerations started to shape my view of the rehabilitation process. I did not want to do away with the residential blind center component. I did want to ensure timely intervention. This insight leads to the development of a risk management program. In this program I attempted to stabilize all blind veterans as quickly as possible. I then go on to look at longer-term intervention models. I really feel that this was a precursor to the continuum of care concept that VA Blind Rehabilitation Services now endorses.
Through the use of local services such as low vision examinations, blind rehabilitation outpatient specialist (BROS), state services, and partnering with local service providers I have been able to build a continuum of care and services in south Texas with a focus on risk management. I have attempted to minimize the wait time for basic intervention services. My initial efforts concentrated on self-management of medications and reading in order to help stabilize our veterans’ lives and minimize the effects of depression.
I managed to still incorporate the services of blind rehabilitation centers for many of the veterans. However, I developed services to provide options to veterans unable or unwilling to attend a VA residential blind rehabilitation center. Without these initiatives, those veterans would have gone underserved in regards to basic blind rehabilitation. I have managed to implement this program over a geographic area in excess of 100,000 square miles, representing many different geographic settings.
I have 16 years of clinical experience working with blind and visually impaired veterans and their families. These years of experience have been a training ground for my development as a blind rehabilitation specialist. I feel my 30 years of clinical experience working with all types of disabilities has contributed significantly to my understanding and skills.
The role of VIST and the methods of performing VIST duties have evolved over this time period. I have gone from record keeping by hand using 5 by 8 cards to a sophisticated data base system. A simple annual review has evolved into a triage point in a continuum of care, and the process keeps on evolving.
The demographic of whom I serve have changed dramatically also. Fifteen years ago I had a just retiring World War II population as our major thrust. Many of these people still exist, but they fit into the geriatric category. In South Texas I also have a large agent orange related Vietnam veteran population. I have found that this shift in demographics have forced me to utilize many of my Social Work skills in managing my duties. The World War II population has many social concerns that come with aging and end of life that are equally as important as sight loss. The Agent Orange veterans tend to have numerous co-morbidities that have great bearing on the rehabilitation process. Fifteen years ago I would never have projected the great need I would have to improve my skills and knowledge in the area of Post Traumatic Stress Disorder. Nor, would I have foreseen the need to constantly keep updated in VA, DOD, Government, and Community benefits and resources.
The logistics of South Texas have offered some unique additional challenges. The VIST program covers over 100,000 square miles. In recent year?s health service have become decentralized as the VA has gone to provision of primary care in the veteran?s home community. To adapt to this I have expanded the way I communicate with veterans. This has lead to expanded use of the phone. I use volunteers and work studies to do informational projects. I initiated a newsletter as a secondary form of contact and education on key issues. I feel that our program has pioneered the use of statistics through the use of formal needs assessments to help shape the nature of the service I provide.
As a results of my efforts, the South Texas VIST program has been a vibrant, healthy, growing program. The caseload has grown to close to 700 legally blind veterans who receive a wide range of services in one of the areas of the country that has pioneered the concept of a continuum of care.
Five years ago I initiated our Risk Management model based on the information obtained from a formalized needs assessment. Using this information I focused on regaining the ability to read and manage medications. Follow up needs assessment showed exceptional results from this effort. Concerns about every day reading dropped from an initial 47% to a two year later 3% with similar sample sizes. To accomplish this I needed to utilize identification techniques, timely intervention, and a full spectrum of services.
During the late 1990?s and early 2000?s the South Texas program has led the nation numerous times in total number of referrals to a VA blind rehabilitation center. As there has been a growing emphasis on local services I have attempted to be a leader in this area also. I have gone from using one low vision clinic to using three private agencies, plus, I have developed a strong working relationship with the two military low vision centers in our area. I also have a strong working relationship with other State and community agencies.
In 2000 the team initiated a quarterly newsletter. We looked to this to bridge the distance gap that our coverage area generates. This has been supplemented with special interest projects that have had a unique focus. In 2002 ? 2003 we did a year long Agent Orange project for our Agent Orange veterans. This focused on the benefits, co-morbidities, post traumatic stress disorder, family considerations and other concerns for these veterans. It consisted of a start up survey, 12 installments of a monthly newsletter, and post program report. It was extremely well received by our veterans. We have also completed a joint project with Audiology Service called the Year of the Ear in 2004. The goal is to maximize the use of residual hearing by all VIST veterans.