kentucky career center kentucky office for the blind

Comprehensive Needs Assessment (CSNA) of Blind and Visually

Impaired Kentucky Residents

Kentucky Office for the Blind December 2011

18BACKNOWLEDGEMENTS

The Kentucky Office for the Blind would like to thank the following groups and individuals for their invaluable contributions to the Comprehensive Statewide Needs Assessment (CSNA) process:

Staff members of the Kentucky Office for the Blind, Kentucky School for the Blind and members of the State Rehabilitation Council who participated in interviews, focus groups, meetings and conversations, compiled data and most importantly, contributed their time and support throughout the data gathering process;

Gateways conference staff and the Visual Impairment teachers who participated in focus group sessions and shared their insights with researchers;

Community Rehabilitation Partners (CRPs) who generously offered their time to speak with us for interviews;

The Ophthalmologists and Optometrists who participated in the Provider Survey;

Kentucky’s employers, both individual and corporate, who have hired blind or visually impaired workers through the Office for the Blind or OFB’s Community Rehabilitation Partners and who contributed their time and insights through interviews

Consumers who participated in focus groups and survey interviews in order to provide data that will help improve services and programs for others;

The many other teachers, students, staff and volunteers who contributed time and resources to this effort.

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TABLE OF CONTENTS

TAcknowledgementsT ................................................................................... i

TExecutive SummaryT .....................................................................................1

TMethodologyT ..............................................................................................16

TKentucky Population Statistics and ProjectionsT .........................................20

TPopulation Trends Regarding Visually Impaired and Blind ResidentsT ..........................................................................................25

TConsumer SurveyT ......................................................................................29

TService NeedsT............................................................................................32

TMobilityT ...................................................................................................32

TRecreational ActivitiesT ............................................................................33

TPersonal CareT ........................................................................................34

TTransportationT ........................................................................................35

TAdaptive TechnologiesT ...........................................................................36

THousingT ..................................................................................................40

TEmployment ServicesT.............................................................................41

TEmployment OutcomesT ..........................................................................44

TBarriers to EmploymentT..........................................................................45

TIncreasing Quality Employment OutcomesT ............................................46

TInformation NeedsT ..................................................................................51

TCommunity Rehabilitation Partners (CRPs)T...............................................53

TEmployersT ..................................................................................................57

TOptometrists and OphthalmologistsT...........................................................62

TConclusionsT ...............................................................................................67

TAppendix A: Consumer Focus Group GuideT.............................................68

TAppedix B: Staff Focus Group GuideT ........................................................74

TAppendix C: Consumer Interview GuideT ....................................................78

TAppendix D: Employer Interview GuideT .....................................................93

TAppendix E: Optometrists and Ophthalmologists Interview GuideT ..........................................................................................95

TAppendix F: Community Rehabilitation Partners (CRPs) Interview GuideT ..........................................................................................99

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0BEXECUTIVE SUMMARY

19BINTRODUCTION

The Kentucky Office for the Blind helps Kentucky individuals with visual disabilities develop the capacity to become more independent and productive in their homes, schools, workplaces and communities. The purpose of this Comprehensive Statewide Needs Assessment (CSNA) is to assist in that effort, by providing a base of evidence on which priorities, goals and strategic planning can be developed.

The Rehabilitation Act of 1973, as amended, mandates that each State and its State Rehabilitation Council (SRC) conduct a comprehensive statewide assessment every three years. This study examines the rehabilitation needs of Kentucky residents who are blind, legally blind or visually impaired. In addition, we seek to clarify the needs of individuals with the most significant disabilities, minorities, and individuals who have been unserved and underserved.

Kentucky’s Office for the Blind, in response to the requirements for a CSNA, contracted with Analytic Insight, LLC to conduct the Statewide Comprehensive Statewide Needs Assessment (CSNA).

20BMETHODOLOGY

This project followed the guidelines established for a Comprehensive Statewide Needs Assessment and the Vocational Rehabilitation Needs Assessment Guide established by the Rehabilitation Services Administration. As specified by the guidelines, a number of data sources were used for this report. Primary data collected for this project includes:

1. Interviews with staff at OFB and stakeholder agencies;

2. Survey of 450 OFB consumers;

3. Focus groups with consumers, family members in Lexington and Louisville, INSIGHT students, VI Teachers and OFB program staff.

4. Survey of 25 Ophthalmologists and 25 Optometrists;

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5. Interviews with 4 employers of blind or visually impaired workers who were referred through the OFB;

6. Interviews with 11 Community Rehabilitation Partners.

7. The Office for the Blind and Vocational rehabilitation provided MIS data related to program activities and outputs.

Several reports and publications created by the State of Kentucky and the Office for the Blind provided overall direction for the research and the development of this report. In particular, the documents and links compiled by the Kentucky State Rehabilitation Council Special Project Committee in conjunction with Office for the Blind staff. These included:

1. 2009 Comprehensive Statewide Needs Assessment (State Rehabilitation Council and Kentucky Office for the Blind)

2. State Plan 2010

3. 2010 Annual Report

4. 2007-2011 Strategic Plan

In order to provide some context to our analysis of the needs of blind and visually impaired Kentucky residents, this CSNA also examines a number of statistics and estimates provided at the state and national levels. These include:

1. 2008 Disability Status Report: Kentucky

2. 2009 and 2010 American Community Survey (ACS)

3. 2009 Current Population Survey (CPS)

4. 2007 KY Behavioral Risk Factor Surveillance Survey (BRFSS)

21BFINDINGS

52BPopulation Projections for Kentucky's Blind and Visually Impaired Populations

Understanding the demographics of the overall population of the state of Kentucky gives a more complete context for the needs of the visually impaired and blind population within the state. Relative trends for blind and visually impaired Kentuckians, and disparities among services and

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resources for subgroups of disabled populations, are more clear when couched in this statewide context.

71BAnAgingPopulation

As the population ages, the prevalence of blindness and visual impairment is also expected to rise. In addition, a higher percentage of Kentucky residents age 65 and over are below the Federal Poverty Level.

Vision impairment and blindness are more common among older adults. Almost one in ten (8.3%) of adults over age 65 with a disability in Kentucky have some type of vision difficulty, compared to 6.9% nationally. By contrast, vision impairment and blindness occur in 2.9% of individuals with a disability between ages 18 and 65, compared to 1.7% nationally.

72BEthnicMinorities

Based on a decade of growing ethnic minority populations within the state of Kentucky, and expected trends continuing through the next several decades, there will continue to be an increasing need for outreach into and services for unserved and underserved minority groups.

According to Prevent Blindness America statistics, vision difficulties are most prevalent among Hispanic populations, and blindness is most frequent among Black populations. In Kentucky, 92.4% of individuals age 40 and over with a visual impairment are White, 5.8% are Black, 0.6% are Hispanic, and 1.1% are another raceFP

1PF.

73BHealthandAccesstoHealthcare

More Kentuckians have rated their health fair or poor compared to the rest of the nation since 2000FP

2PF. Certain health conditions, some of which may

eventually lead to vision-related problems (other than AMD) are disproportionately distributed among the population.

More Kentuckians report being over-weight or obese compared to the rest of the nation, and weight is an issue that also disproportionally affects Kentuckians by race/ethnicity. About 4 out of 5 (82.3%) of Black respondents reported being overweight, compared to 68.1% of White

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P P

P

2P Kentucky BRFSS, 2007

1 Prevent Blindness America, 2008

respondents. The prevalence of diabetes has also been increasing since 2000, according to the BRFSS. The prevalence is slightly higher in Kentucky (9.9%) compared to the nation (8.1%).

Not all areas of the state have equal access to healthcare and health-related resources. Eighty-eight counties are designated as medically underserved or as having health provider shortages. Of these, 27 are so designated because of low-income populations who are at risk for lacking medical services due to a provider shortage, and 17 of these are so designated because of a lack of access in rural areas.

74BEmploymentandPoverty

Given the current high rate of unemployment and the current economic climate, providing access to stable and adequate employment is a major challenge for all subsets of the population. Training, coaching and advocacy for the disabled populations of Kentucky are especially critical at this time.

Based on these expected shifts in the population, issues for all aging Kentuckians will continue to rise through the next few decades. There will be an increasing demand for services for aging adults, especially for smaller and underserved subgroups of the aging population, such as individuals who are visually impaired and living in poverty.

The employment rate for people ages 21 to 64 without a visual disability is 73.1% in the US, and 68.2% in KentuckyFP

3PF. For individuals with a visual

disability, the rate is roughly halved for the US and more than halved for Kentucky: the employment rate is 38.7% within the US, and 29.3% within the state of Kentucky.

Even for adults who are working full-time, the gap is notable. The median annual earnings of Kentuckians without a visual disability, working full-time, is $36,000, however the median income for Kentuckians with a visual disability is $29,000. The rate of people living below the poverty line is almost tripled among persons with a visual disability in Kentucky; only 15.7% of persons without a visual disability live below the poverty line, compared to 40.0% of individuals with a visual disability.

P

3P American Community Survey (2009)

75BGapsinEducation

The rates of educational attainment differs between Kentuckians with a visual disability and persons without a visual disability. 13.2% of Kentuckians have attained less than a high school education, however this rate is more than doubled among Kentuckians with a visual disability; 36.1% have less than a high school educationFP

4PF.

The largest gap in educational attainment is for persons who have attained a Bachelors degree or more. 22.7% of adults without a significant visual disability have a college degree or more education, whereas just 5.6% of those with a visual disability have a college degree or moreFP

5PF.

22BCONSUMER PROFILE

The consumer survey, as well as the MIS data examined, included all cases served. This included open and closed cases.

Most respondents were visually impaired (45%) or legally blind (44%). About one in ten described themselves were Blind (11%).

Over half of the survey respondents were 55 years of age or older (56.2%) and over half reported that they had a physical disability other than blindness or vision impairment (54.2%).

A substantial percentage reported that they also had issues related to mental illness (9.2%), developmental disability (7.4%) or alcohol or other drug dependency (4.9%).

Almost half the respondents had been told by a doctor or other health professional that they had cataracts (45.5%). Glaucoma (18.5%), diabetic retinopathy (15.4%) and macular degeneration (14.3%) were also prevalent.

About half of respondents reported an annual household income of less than $15,000. Almost one in ten (7.9%) had a household income over $75,000. Over a third of consumers reported receiving SSDI and about one in three (33.8%) received income from a job.

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P P

P


4 American Community Survey (2009)

23BSERVICE NEEDS

53BEducation

One in three consumers (34%) said that they need educational support such as help obtaining a GED. One in ten (11%) are receiving those services; thus 31% of consumers who need educational assistance are currently receiving it. This service delivery measure is relatively high among the vocational needs of consumers. About a quarter (26%) of consumers needed help with resume writing or interview skills, and about 17% of those consumers are receiving that type of assistance.

Educational assistance and resume/interviewing assistance have the highest percentage of service delivery to those who need them compared to all other service needs.

54BEmployment Services

The majority of the consumers surveyed (58%) had received vocational services from the Office for the Blind within the past year.

Four out of five consumers surveyed (83%) said that they wanted to find a job, either immediately (54%) or within the next 6 months (29%). Over half of consumers said they had been actively looking for a job within the past 6 months, however most of those looking for work (64%) had not sought the help of any vocational services.

Among those who did seek vocational services, most went to the Kentucky Office for the Blind. 12.8% of respondents who sought vocational services in the past year said they did not know where to look.

The most needed job service was help finding job openings. Almost half of the consumers surveyed (45%) said they needed this service.

Help with on the job training was needed by 38% of consumers and on-the-job support or coaching was needed by 32% of consumers. About 30% of consumers surveyed were employed part or full-time at the time of the survey, and this need was expressed by the majority of those who are employed. During interviews with Community Rehabilitation Partners, on the job training was also mentioned as a need of many CRP clients.

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55BJob Placement

Overall, satisfaction with job placement was moderately positive; on a scale of 1 (very dissatisfied) to 4 (very satisfied), consumers' ratings had an average of 2.65. This score is closest to "somewhat satisfied" and the majority of consumers (61%) described themselves as either very satisfied or somewhat satisfied. Among those who were dissatisfied with job placement assistance, more than two thirds (69%) are consumers who needed services but were not currently receiving them. In contrast, 69.5% of those who received job placement services were at least somewhat satisfied with the services.

Given this information, it seems that the major barriers to job placement is that many who need that type of assistance are not receiving it. In fact, almost half (43.8%) of consumers say they need help with job placement services, but only 5.3% are receiving those services. In other words, 12.2% of those who need job placement assistance are currently receiving it. Underscoring the urgency of the need for these services for a larger percentage of the visually impaired population, almost 8 in 10 (84%) of the consumers who are seeking vocational services want a job either immediately (48%) or within the next 6 months (36%).

Several of the Community Rehabilitation Partners said in interviews that they would welcome referrals for job placement assistance. The major impediment, as perceived by the CRPs interviewed was their need for training in placement of blind and visually impaired clients.

56BOn-The-Job Assistance

On-the-job support or coaching is needed by about a third of consumers (31%), compared to 5% who are receiving these services.

Similarly, over one third (36%) expressed a need for on the job training, but only 3.1% were receiving those services. In other words, of those who need either service, 15% are receiving on the job support or coaching, and 9% are receiving on the job training.

Most of the consumers who need on the job support, but are not receiving it, are blind (54%) or legally blind (31%) consumers.

Several CRPs also mentioned the need for on-the-job support once a client is placed in a new job.

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57BIncreasing Quality Employment Outcomes

Among consumers, there are a variety of vocational needs, including job placement assistance, on the job supports, educational services, and resume and interview skills. These are all important components to employment, and to overall quality of life, but they are not all being met for all consumers. In fact, when asked to identify the most significant unmet needs related to their visual impairment, consumers mentioned a number of employment-related needs. One in ten (10.2%) cited a lack of income or money as the most significant unmet need at this time. Another 13.8% stated that employment was their primary unmet need.

The major barriers to employment for individuals with a visual disability appear to be related to services that are needed, but not delivered. This was found to be caused by a number of issues:

Consumers who reported needing vocational services did not always seek vocational rehabilitation services. Among consumers in need of job placement assistance, over half (55.3%) had not sought vocational rehabilitation in the last year.

Among consumers who were successfully placed in an employment setting, there was a significant relationship between how long the case had been open and the wage of the consumer. The longer a consumer's case was open, the lower their wages were likely to be when the case was successfully closed (r = -0.12, p<0.01). Consumers who are on hold for longer periods of time may be more difficult to place and less able to perform skilled jobs. In that case, identifying low-skill consumers early and referring them to educational or skill development opportunities may be useful.

Educational opportunities and assistance with job placement were rated very high by consumers in terms of importance; relative to other topics, these were rated as some of the most important, and were only rated less important than access to medical care, transportation, and assistive technology. Overall, one in three consumers (34%) said that they need educational support such as help obtaining a GED, however just one in three consumers who need educational assistance are currently receiving it.

58BAdaptive Technologies

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Scanners and bank note readers were rated as the most important pieces of adaptive equipment affecting consumers' quality of life. This includes those who have access to the equipment and those who do not. All respondents, whether visually impaired, blind or legally blind, rated screen reader programs and scanners as being most important to their quality of life.

Although the scanner was rated as most important to their quality of life by those familiar with it, the OCR scanner was also unfamiliar to the highest percentage of respondents (39%).

In general, the adaptive equipment items that were rated as most important to the quality of life for blind or visually impaired people, the less common the knowledge of the item. This may be partly because more sophisticated items such as the OCR scanner or screen reader programs are also newer technological developments in comparison to a talking watch, for example. There is however, an opportunity for educating the blind and visually impaired about important developments that may favorably impact their quality of life.

About half of legally blind respondents (47%) and three-fourths of Blind respondents (78%) said they had access to a screen reader program. Almost one in three visually impaired respondents said they had access (29%). The screen reader was the most commonly accessible of all the adaptive equipment items, followed by the talking watch.

59BRecreational Activities

Recreational and athletic activities were used by a high percentage of respondents. Overall, half or more said they had participated in a recreational activity in the past six months, and a substantial percentage of respondents said that they would participate in additional recreational activities if they were available.

Over one in four respondents said they would have participated in a sports or exercise program in the past six months if help were available (28.5%). Over half (60.2%) had participated in social activities in the past 6 months, and an additional 23.9% of respondents said they would have if assistance were available. The majority of respondents (78.8%) had participated in an outdoor activity in the six months preceding the survey and 13.5% said they would participate if help were available.

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60BMobility

One in five respondents (22.2%) reported that they need help in navigating community environments. Almost as many respondents (17.7%) reported that they currently receive such help.

The greatest gap between those needing assistance and those receiving assistance was in using or obtaining a guide dog. Just 3.1% of respondents said they are currently receiving assistance with using or obtaining a guide dog, although 10.3% said they were in need of assistance.

61BPersonal Care

Help with shopping was the personal care item needed by the largest percentage of respondents. One in five (21%) said they needed help with shopping. An additional one in five (18%) said they currently have help with this task.

About one in four respondents either get or need help with food preparation and banking. Approximately half of those who require help with these tasks currently receive it.

62BTransportation

A friend or family member (45%) was most frequently mentioned as the form of transportation respondents use most often. About one in four (28%) had their own car, and one in ten respondents (9%) said the bus was the form of transportation they use most often.

One in four respondents (25.5%) need low cost door to door transportation and 15.4% are currently receiving it. Additionally, one in four respondents said they need assistance using public transportation (23.5%), whereas just 17.5% report currently receiving this service.

63BHousing

The majority of respondents live with family members (67%). About one in five (21%) lives alone. Most consumers (71%) live in a single family home or apartment (15%). Over half of consumers own their own homes (55%). Just 15% of all consumers surveyed receive rental assistance from the state of Kentucky.

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The vast majority of consumers are very or somewhat satisfied (92%) with the accessibility of their residence. 3% are very dissatisfied.

Among those who are dissatisfied with the accessibility of their residence, half said the reason for their dissatisfaction was the lack of physical accessibility (such as the need for a ramp) and 14% said that the location was not convenient to major transportation routes. Although affordable housing is a concern to many, just 6% mentioned cost as the reason for dissatisfaction with their current residence.

64BInformation Needs

About one in four consumers (23%) said they do not have access to books, online newspapers or Internet content. Although additional help is needed by many consumers, many are currently receiving these services. In particular, one in three consumers (33%) currently receives help in using the library services.

During focus groups and interviews, consumers expressed concerns about the cost of assistive technology. The Bluegrass Council for the Blind in Lexington operates a popular lending library where consumers can 'try out' a piece of technology before deciding whether or not to purchase the equipment.

24BCOMMUNITY REHABILITATION PARTNERS (CRPS)

The majority of CRPs interviewed (55%) said they have not received any referrals from the Office for the Blind in the past year.

Although most had training specific to serving the blind and visually impaired, four CRP respondents out of the 11 interviewed had no training. One of these four had placed a blind individual in the past, however that was not through a referral from OFB.

Training was most often mentioned as the thing that CRPs felt OFB could do to assist them in placing blind and visually impaired consumers into jobs.

The Community Rehabilitation Partners interviewed had varied ideas about the greatest unmet need for blind and visually impaired people looking for work. Educating employers about the abilities of blind and visually impaired workers was suggested by one CRP, who said "Getting their foot

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in the door is the hardest part, and just getting an opportunity. I even had people who would not let this person volunteer."

In addition, once employed many workers need additional services to be successful at their job. "Ongoing follow-up is needed. Someone to make sure they have what they need to be able to do their work. Just a magnifier or something simple like that can make all the difference, but there needs to be someone who goes back to make sure after they've been in the job, that they have what they need."

25BEMPLOYERS

Employers interviewed said that the OFB and other stakeholders provide a wide variety of trainings and information with respect to hiring blind or visually impaired employees. One of the employers knew exactly who in the OFB to call if he had any questions or concerns while on-boarding a new employee with vision-related needs. However, this employer still wanted more information regarding the programs through the OFB, citing she wanted "more familiarity with the program."

One employer had not hired anyone in the past year with any visual impairments, but had done so in the past and was anxious to do so in the future. This employer strongly valued the diversity and value that working with the OFB has brought to their site in the past.

When asked for feedback about their relationship with the Office for the Blind, one employer stated that they were "great at getting equipment out [to the work site]" and that they had all the necessary resources and information to hire individuals with visual impairments.

26BOPTOMETRISTS AND OPHTHALMOLOGISTS

Just 10% of the practices surveyed work with a low vision rehabilitation specialist. 82% refer their patients to rehabilitation providers outside of their offices.

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When asked to whom they refer patients, one in three (34%) did not know, and about one in four (27%) refer to the Office for the Blind. When asked what services are offered by the Office for the Blind, assessment services were named by almost half of the providers surveyed (44%). Although some providers had a higher rate of patients with low vision needs, these

providers were no more knowledgeable about OFB services than their peers.

When asked what percentage of those who need low vision rehabilitation services receive them, half of the providers surveyed (52%) said that less than 25% receive needed low vision rehabilitation services.

Financial needs were perceived to be the greatest unmet eye care need by 58% of the providers surveyed. Together, routine medical exams and preventive care were mentioned by one in four providers (25%).

Two-thirds of the providers surveyed (68%) said that low income residents were unserved or underserved in the area of low vision rehabilitation services. One in five (18%) named people living in rural areas.

27BUNMET NEEDS

Among consumers, 'employment' was the most frequently mentioned response (14%) to the question "For you personally, what is the most significant unmet need in your life at this time relating to your vision loss?" Lack of income or money was mentioned by an additional 11% of consumers.

Almost half of blind, legally blind and visually impaired consumers said that they are active members of their communities and are able to participate as fully as they choose (47%). Just over one in three (38%) said that they are able to participate, but could do more if help were available.

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1BCONCLUSIONS AND RECOMMENDATIONS

Based on the information gathered for this Comprehensive statewide Needs Assessment, the State of Kentucky can anticipate that the population of blind and visually impaired residents will continue to grow. The demand for services will likely increase along with that growth. At this time, despite growing demand, funding is being cut nationwide for social services and programs. In these circumstances, prioritization is often key to maintaining service delivery.

28BPRIORITIZATION

Consumers place a high priority on transportation, job placement and affordable housing, yet satisfaction with these areas is relatively low.

29BSEQUENTIAL DEVELOPMENT

Although services are available, they are often underutilized. Individuals move through stages of development: personal living skills, mobility and transportation, education to job placement. Increasing emphasis on this developmental path, choosing training and educational opportunities that are appropriate to an individual's current skills, interpersonal abilities and motivational levels may help them move efficiently through the sequence.

30BASSISTIVE TECHNOLOGY AND ADAPTIVE DEVICES

Some individuals who would benefit from assistive technologies are unaware of recent developments in available devices. Information outreach to inform individuals of what is available is needed. In addition, lending libraries that let people try out a new technology before purchasing, or seeking financial assistance to purchase, is an efficient way of limiting unnecessary expenditures.

31BRIGHTING SOCIAL INEQUITIES

Education and access to mainstream education settings was a high priority for consumers, and is an efficient and beneficial way of closing the gap

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between sighted and visually impaired residents in terms of educational outcomes, employment and income inequities.

32BCOMMUNITY PARTNERS

Educational outreach is needed for CRPs and medical providers. CRPs consistently discussed a need for training in the needs and abilities of visually impaired and blind clientele. Medical providers, including both ophthalmologists and optometrists, were largely unaware of the specific services offered by the Office for the Blind and its stakeholders.

Educating local service providers and employers about the broad capabilities and particular needs of blind and visually impaired Kentuckians will help improve access to assistive technology, health services, educational opportunities and employment prospects for many residents.

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2BMETHODOLOGY

This project followed the guidelines established for a Comprehensive Statewide Needs Assessment and the Vocational Rehabilitation Needs Assessment Guide established by the Rehabilitation Services Administration.

33BOVERVIEW

A number of data sources are used in this report. The primary data collected for this project includes:

1. Interviews with staff at OFB and stakeholder agencies; 2. Survey of 450 OFB consumers; 3. Focus groups with consumers in Lexington and Louisville, INSIGHT

students, OFB Staff 4. Survey of 25 Ophthalmologists and 25 Optometrists; 5. Interviews with 4 employers of blind or visually impaired workers who

were referred through the OFB; 6. Interviews with 11 Community Rehabilitation Partners.

The Office for the Blind provided MIS data related to program activities and outputs.

Several reports and publications created by the State of Kentucky and the Office for the Blind provided overall direction for the research and the development of this report. In particular, the documents and links compiled by the Kentucky State Rehabilitation Council Special Project Committee in conjunction with Office for the Blind staff. These included:

1. 2009 Comprehensive Statewide Needs Assessment (State Rehabilitation Council and Kentucky Office for the Blind)

2. State Plan 2010 3. 2010 Annual Report 4. 2008-2010 Strategic Plan

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In order to provide some context to our analysis of the needs of blind and visually impaired Kentucky residents, this CSNA also examines a number

of statistics and estimates provided at the state and national levels. These include:

1. 2008 Disability Status Report: Kentucky 2. 2010 American Community Survey (ACS) 3. 2009 Current Population Survey (CPS) 4. 2007 KY Behavioral Risk Factor Surveillance Survey (BRFSS)

34BRESEARCH QUESTIONS

The Office for the Blind’s 2008 CSNA found that the most frequently mentioned needs among consumers surveyed were employment, transportation, assistive technology and education. In that study, staff cited medical restoration, job placement and assistive technology as the most requested services. These topics provided the primary focus points for this study. The lines of inquiry also included:

Employment Transportation Assistive technology and adaptive devices Education and access to mainstream education settings Medical restoration Job placement Housing Independent Living

35BDATA COLLECTION METHODS

The interview guides for each of the data collection efforts are offered as Appendices to this report.

65BInterviews

Interviews were conducted among Kentucky Office for the Blind staff from programs and services including Independent Living and Vocational Rehabilitation field staff, McDowell Center and Kentucky Business Enterprises. In addition, there was representation from the State Rehabilitation Council, the Kentucky School for the Blind, the National

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Federation of the Blind, the American Council for the Blind and the Blue Grass Council for the Blind.

These interviews helped shaped the methodological plan and informed the subsequent research.

In addition to the project planning interviews, key informant interviews were conducted with a sample of 10 community rehabilitations partners and four human resources staff at companies that have employed graduates of Kentucky School for the Blind programs.

66BQuantitative Surveys

A telephone survey was conducted of 450 blind or visually impaired Kentucky residents who had utilized the services of the Office of the Blind and for whom contact information was available.

In addition to the consumer survey, a telephone survey of 25 optometrists and 25 ophthalmologists was conducted.

67BFocus Groups

Focus groups were conducted with consumers and staff in both Louisville and Lexington. A focus group was also held with visual impairment teachers who attend the group, presented as a for-credit session at a professional conference held at the 2011 Gateways to Independence Professional Development Opportunity at the Kentucky School for the Blind.

In order to include the transition experience, a focus group was conducted among transition students that included current and former INSIGHT students, as well as other students listed on counselor caseloads who have chosen not to participate in INSIGHT.

36BDATA LIMITATIONS

Each information source has its own strengths and limitations for use in the CSNA. This underlies the strategy of using a number of data sources and types in the CSNA. Although each has unique strengths and weaknesses, together they provide a balanced portrait of the available services and service gaps in the state.

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The following table shows the strengths and limitations associated with each of the data sources used in this report.

Source Strength Limitations

Population Statistics

Generalizeable and reliable quantitative assessment

Broad definition of disability

Categories with no indicators of blindness or visual impairment.

State MIS data Reliable indicators of process measures

Includes only those participating in OFB or VR registries

Focus Group and Interviews

Rich, qualitative data direct from consumers

Non-random sampling does not provide reliable error estimation. Potential sampling bias.

Consumer Survey Quantitative, generalizeable data

Includes only those participating in OFB or VR registries (listed sample).

Ophthalmologist and Optometrist Surveys

Generalizeable and reliable data from randomly sampled complete listing of licensed providers in KY.

Survey taken by office manager due to time restrictions on access to actual providers.

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3BKENTUCKY POPULATION STATISTICS AND PROJECTIONS

Understanding the demographics of the overall population of the state of Kentucky gives a more complete context for the needs of the visually impaired and blind population within the state. Relative trends for blind and visually impaired Kentuckians, and disparities among services and resources for subgroups of disabled populations, are more clear when couched in this statewide context.

2010 2015 2020 2025 2030

Age 65+ 578,227 676,669 787,067 902,753 998,094

Percentage of Total Population 13.30% 15.00% 16.80% 18.70% 20.20%

Age 18‐64 3,761,140 3,832,760 3,885,687 3,917,637 3,953,094

Percentage of Total Population 86.70% 84.90% 83.20% 81.30% 79.80%

TAGE

The 2010 US Census indicated that the population of Kentucky has risen 7.4% since the last enumeration, to a total of 4,339,367 people. Males and females are represented roughly equally (49.2% versus 50.8%) in the population. Over three quarters (76.4% or 3,315,996) of the population is over the age of eighteen, and more than one in ten of the total population is over age 65 (13.3% or 578,227). The percentage of the aging population will steadily increase over the next several decades, and is projected to grow faster than the rest of the adult population of Kentucky. This trend is projected to occur for the United States, and Kentucky's percentages and rates of increase will closely reflect the national trends. According to the 3-year estimates of the American Community Survey, 13% (+/-0.4% margin of error) of Kentucky residents age 65 and over are under the poverty line. This is higher than the national average of 9.7% (+/-0.1% margin of error).

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The distribution of this age group is not equal among all counties. The statewide average is 13.3%, but most counties exceed that rate by more than 1 percent. The ten counties with the highest rates of residents age 65 and over are listed below.

County Percent of Residents over age 65

Owsley 21.9%

Lyon 19.5%

Elliott 19.4%

Hickman 19.1%

Cumberland 18.9%

Marshall 18.5%

Carlisle 18.3%

Caldwell 18.0%

Trigg 18.0%

Fulton 17.9%

Based on these expected shifts in the population, issues for all aging Kentuckians will continue to rise through the next few decades. There will be an increasing demand for services for aging adults, especially for smaller and underserved subgroups of the aging population, such as individuals who are visually impaired and/or below the poverty line.

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TRACE AND ETHNICITYT

Page 22

Approximately 87.8% of the population is White, 7.8% of the population is Black, 3.1% is Hispanic, and 1.4% of the population is of another race (2010 US Census Bureau). According to the 2010 US Census, the population of White adults aged 18 and over increased by 3.8% from 2000 to 2010. The population of Black adults increased by 13.4%, from 293,639 to 333,075 individuals and the Hispanic adult population increased by 121.6%, from 59,939 to 132,836 individuals. Although state-by-state projections of population growth by race/ethnicity are not currently available, the national trend indicates that the expansion of ethnic minorities will continue. Based on a decade growth of minority populations within the state of Kentucky, and expected trends continuing through the next several decades, there will continue to be an increasing need for outreach into and services for unserved and underserved minority groups.

TEMPLOYMENT

Current labor statistics show that the unemployment rate is 9.5% in Kentucky, with 90.5% of the total labor force currently

employedFP

6PF. The most recent projections indicate that a 7.5% increase in

the available employment by 2018FP

7PF. However, given the current high rate

of unemployment and the current economic climate, providing access to stable and adequate employment is a major challenge for all subsets of the population. Training, coaching and advocacy for the disabled populations of Kentucky are especially critical at this time. Some predominantly rural areas of the state are disproportionately affected by high unemployment rates.

THEALTH

An April 2011 Kentucky Health Care Poll found that 1 in 4 adults are currently uninsured, and 1 in 3 adults have been without insurance at some point within the last 12 months. Nearly half (46%) of adults living in households with an income below 100% of the federal poverty guidelines (FPG) reported being currently uninsured, compared to 16% of those living above 200% FPG. According to the 2007 Kentucky BRFSS, more Kentuckians had rated their health fair or poor compared to the rest of the nation since 2000. The difference between ratings among the age groups was statistically significant. Almost half (45%) of adults age 65 and older report having fair or poor general health compared to a small number (3.7%) of those aged 18-24, and just over 1 in 10 (12%) of those aged 24-34. A greater proportion of Kentuckians (17.4%) report cost as a reason for not seeing a doctor compared to the rest of the nation (12.5%). The difference in rates of cost as a barrier to seeing a doctor between males and females is statistically significant. One in five (20.1%) females report cost as a barrier to seeing a doctor compared to 14.5% of males.

Certain health conditions, some of which may eventually lead to vision-related problems (other than AMD) are disproportionately distributed among the population. More Kentuckians report being over-weight or obese compared to the rest of the nation, with almost 4 out of 5 (79.8%) of males reporting being overweight or obese compared to just over half (58.6%) of females. Weight is an issue that also disproportionally affects Kentuckians

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P P

P

7P Source: Workforce Kentucky, accessed on 10-06-11.

6 Workforce Kentucky, accessed on 10-06-11

by race/ethnicity. About 4 out of 5 (82.3%) of Black respondents reported being overweight, compared to 68.1% of White respondents. The prevalence of diabetes has also been increasing since 2000, according to the BRFSS. The prevalence is slightly higher in Kentucky (9.9%) compared to the nation (8.1%).

Not all areas of the state have equal access to healthcare and health-related resources. The Health Resources and Services Administration of the Department of Health and Human Services creates designations for areas of the country that are medically underserved. The information is tracked according to whether an area has an adequate number of healthcare providers (e.g., 3,500 to 1 primary care physicians to residents), whether the area has a large proportion of medically underserved populations (e.g., low income, Medicaid-eligible, elderly), among other indicators of health disparities. Eighty-eight counties are designated as medically underserved or as having health provider shortages. Of these, 27 are so designated because of low-income populations who are at risk for lacking medical services due to a provider shortage, and 17 of these are so designated because of a lack of access in rural areas.

In addition to tracking which areas are at risk for health disparities, data are also available regarding the distribution of federal and state funds for individuals with disabilities. Caution should be used when looking at these data for a specific population, as the OASDI does not include data between types of disabilities; blind populations are tallied along with other disabled populations in the totals. The number of recipients by eligibility category is listed in the table below.

4BPOPULATION TRENDS REGARDING VISUALLY IMPAIRED AND BLIND RESIDENTS

Within the context of known statewide demographics, it is easier to understand the relative needs of the visually impaired and blind population of Kentucky. According to the 2010 American Fact Finder (American Community Survey 1-Year Estimates), 2.9% (or about 125,800) of Kentucky residents are experiencing some type of vision impairment or blindness, compared to 3.4% of the U.S. population.

37BAGE

Vision impairment and blindness are more common among older adults. Almost one in ten (8.3%) of adults over age 65 with a disability in Kentucky have some type of vision difficulty, compared to 6.9% nationally. By contrast, vision impairment and blindness occur in 2.9% of individuals with a disability between ages 18 and 65, compared to 1.7% nationally.

In people age 40 and older, vision impairment and blindness are more common among women (about two thirds or 67.3% of vision impairment and blindness) than among men (less than one third, or 32.9%).

38BRACE AND ETHNICITY

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According to Prevent Blindness America statistics, vision difficulties are most prevalent among Hispanic populations, and blindness is most frequent among Black populations. In Kentucky, 92.4% of individuals age 40 and over with a

visual impairment are White, 5.8% are Black, 0.6% are Hispanic, and 1.1% are another race (Prevent Blindness America, 2008).

According to the 2009 CSNA, 98% of the visually impaired or blind individuals who were being served were White. This indicates a disproportionate distribution in services, such that minority populations are unserved or underserved, as Black, Hispanic and other races comprise 7.5% of the visually impaired or blind population in Kentucky. Men and women were fairly equally represented in the study (42% and 58%, respectively).

High need areas across all data sources were the areas of job placement, on the job training, job search assistance and soft skills acquisition for the areas of resume writing, identifying job openings, interviewing skills and making employer contacts. Educational Supports for individuals was an area of need given that forty-six percent (46%) of the respondents reported having a High School Diploma or below. This also indicates a need for early intervention and counseling supports for students.

T EMPLOYMENT

According to the 2009 American Community Survey, the percentage of people ages 21 to 64 without a visual disability who were employed is 73.1% in the US, and 68.2% in Kentucky. For individuals with a visual disability, the rate is roughly halved for the US and more than halved for Kentucky: the employment rate is 38.7% within the US, and 29.3% within the state of Kentucky, for individuals with a visual disability. The median annual earnings of persons without a visual disability, working full-time, is $36,000 for Kentuckians. However, the median annual earnings of persons with a visual disability is $29,000. The rate of people living below the poverty line is almost tripled among persons with a visual disability in Kentucky; only 15.7% of persons without a visual disability live below the poverty line, compared to 40.0% of individuals with a visual disability.

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With a Visual Disability

Without a Visual

Disability Percentage Employed 29.30% 68.20%

Percentage Below Poverty Line 40.00% 15.70%

Median Annual Income (Full-time) $29,000 $36,000

Data from American Community Survey, 2009.

THEALTH

An April 2011 Kentucky Health Care Poll found that nearly half (46%) of adults living in households with an income below 100% of the federal poverty guidelines (FPG) reported being currently uninsured, compared to 16% of those living above 200% FPG. The American Community Survey found that about 19.6% of Kentuckians without a visual disability are uninsured, and that 23.0% of Kentuckians with a visual disability are uninsured. One in four (24.5%) Kentuckians with a visual disability received Supplemental Security Income (SSI) benefits in 2009, which is higher than the national average of 18.0%.

Not all counties have equal access to healthcare and providers. This inequity has the potential to impact visually impaired and blind Kentuckians, given the existing discrepancies of income and employment for this population, their transportation needs and the inherent dangers of isolation.

TEDUCATION

The rates of educational attainment differs between Kentuckians with a visual disability and persons without a visual disability. 13.2% of Kentuckians have attained less than a high school education, however this rate is more than doubled among Kentuckians with a visual disability; 36.1% have less than a high school educationFP

8PF.

Page 27 P


Roughly equal rates of Kentucky residents with and without visual disabilities have attained a high school degree or equivalent; 32.4% and 33.8%, respectively. The percentage of persons with some college is 30.3% for individuals without a visual disability, and 25.9% for individuals with a visual disability.

The largest gap in educational attainment is for persons who have attained a Bachelors degree or more. 22.7% of adults without a significant visual disability have a college degree or more education, whereas just 5.6% of those with a visual disability have a college degree or more. Because the base population of individuals with and without visual disabilities is very different, the rates are displayed along with the breakdown by base population below.

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Educational Level With a Visual Disability

Without a Visual Disability

Percent Number of Persons (Base

Population 71,300)

Percent Number of Persons (Base

Population 2,429,100)

Less than HS education 36.10% 25,739 13.20% 320,641

HS diploma or equivalent 32.40% 23,101 33.80% 821,035

Some college or Associates 25.90% 18,467 30.30% 736,017

Bachelors or higher 5.60% 3,993 22.70% 551,406

Data from American Community Survey, 2009.

The largest gap in

educational

attainment is for

persons who have

attained a Bachelors

degree or more.

5BCONSUMER SURVEY

Consumers are the main focus of the activities of the Office for the Blind and its stakeholders. The efforts to improve access to services, vocational rehabilitation and employment ultimately are judged by the impact on consumers’ lives. Therefore, understanding the outcomes of these activities in terms of their quality of life and potential for contributing to the community and the State of Kentucky is critical to this Comprehensive Statewide Needs Assessment.

Several data sources were utilized. Existing data sources include census data, KY Office for the Blind and Office of Vocational Rehabilitation each contributed data on internal processes and consumer outcomes. Focus groups were conducted with consumers, as well as staff having direct contact with consumers and visual impairment teachers.

39BCONSUMER PROFILE

The average of the consumers surveyed was 43. About one third of the consumers surveyed were under the age of 35 (34.5%). The average age at which consumers lost their vision was 26 years old. One in four consumers (25.3%) was over the age of 45 when he or she began to lose vision.

Most respondents were visually impaired (45%) or legally blind (44%). About one in ten described themselves as Blind (11%).

Over half of the survey respondents were 55 years of age or older (56.2%) and over half reported that they had a physical disability other than blindness or vision impairment (54.2%).

A substantial percentage reported that they also had issues related to mental

illness (9.2%), developmental disability (7.4%) or alcohol or other drug dependency (4.9%).

Almost half the respondents had been told by a doctor or other health professional that they had cataracts (45.5%). Glaucoma (18.5%), diabetic retinopathy (15.4%), macular degeneration (14.3%) and retinitis pigmentosa (12.6%) were also frequently mentioned.

68BDemographics

About half of respondents reported an annual household income of less than $15,000. Almost one in ten (7.9%) had a household income over $75,000.

Over a third of consumers reported receiving SSDI and about one in three (33.8%) received income from a job.

Those who were visually impaired were most likely to report receiving income from a job (59.4%) compared to those survey respondents who were blind (4.2%) or legally blind (36.4%).

Income from a

job SSDI SSI Housing

Assistance Food

StampsVisually impaired 59.4% 27.7% 35.7% 41.7% 35.2% Blind 4.2% 17.6% 17.0% 25.0% 14.8% Legally Blind 36.4% 54.7% 47.3% 33.3% 50.0%

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6BSERVICE NEEDS

40BMOBILITY

One in five respondents (22.2%) reported that they need help in navigating community environments. Almost as many respondents (17.7%) reported that they currently receive such help.

About one in ten respondents surveyed said they need help using a cane (12.3%), obtaining or using a guide dog (1.3%) or navigating home environments (9.8%).

The greatest gap between those needing assistance and those receiving assistance was in using or obtaining a guide dog. Just 3.1% of respondents said they are currently receiving assistance with a guide dog, although 10.3% said they were in need of assistance with these skills.

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41BRECREATIONAL ACTIVITIES

Recreational and athletic activities were used by a high percentage of respondents. Overall, half or more said they had participated in a recreational activity in the past six months.

A substantial percentage of respondents said that they would participate in additional recreational activities if they were available.

Over one in four respondents said they would have participated in a sports or exercise program in the past six months if help were available (28.5%). Half of all respondent (49.2%) had participated in a sports or exercise program in the past six months.

Over half (60.2%) said they had participated in social activities in the past 6 months, and an additional 23.9% of respondents said they would have if assistance were available.

The majority of respondents (78.8%), or four out five respondents had participated in an outdoor activity in the six months preceding the survey. 13.5% said they would like to participate if help were available.

42BPERSONAL CARE

Help with shopping was the personal care item needed by the largest percentage of respondents. One in five (21%) said they needed help with shopping. An additional one in five (18%) said they currently have help with this task.

About one in four respondents either get or need help with food preparation and banking. Approximately half of those require help with these tasks currently receive it.

Laundry or home chores and personal grooming help were needed by comparatively fewer survey respondents. A substantial portion of our sample however, said they currently need help with laundry or home chores (9.8%) or personal grooming (4.7%).

43BTRANSPORTATION

A friend or family member (45%) was most frequently mentioned as the form of transportation respondents use most often.

About one in four (28%) had their own car, and one in ten respondents (9%) said the bus was the form of transportation they use most often.

One in three respondents (33.4%) said they currently need free door to door transportation and 5.6% currently are receiving this service.

One in four respondents (25.5%) need low cost door to door transportation and 15.4% are currently receiving it.

One in four respondents said they need assistance using public transportation (23.5%), whereas just 17.5% report currently receiving this service.

Approximately 60% or just under two-thirds of survey respondents said they do not have a need for any of these three transportation services.

44BADAPTIVE TECHNOLOGIES

Among consumers surveyed, scanners (3.4) and bank note readers (3.3) were rated as the most important pieces of adaptive equipment affecting their quality of life. This includes those who have access to the equipment and those who do not. A screen reader program, note taker (or Braille writer) or iPhone were also rated as being between somewhat and very important (3.1 average).

Although the scanner was rated as most important to their quality of life by those familiar with it, the OCR scanner was also unfamiliar to the highest percentage of respondents (39%).

In general, the adaptive equipment items that were rated as most important to the quality of life for blind or visually impaired people, the less common the knowledge of the item. This may be partly because more sophisticated items such as the OCR scanner or screen reader programs are also newer technological developments in comparison to a talking watch, for example. There is however, an opportunity for educating the blind and visually impaired about important developments that may favorably impact their quality of life.

All respondents, whether visually impaired, blind or legally blind, rated screen reader programs and scanners as being most important to their quality of life.

Computer aided keyboard and CCTV were rated as less important by those who are blind, as compared with respondents who described themselves as legally blind or visually impaired.

About half of legally blind respondents (47%) and three-fourths of Blind respondents (78%) said they had access to a screen reader program. Almost one in three visually impaired respondents said they had access (29%). The screen reader was the most commonly accessible of all the adaptive equipment items, followed by the talking watch.

In general, Blind respondents had the greatest access to adaptive equipment. The exceptions to this included the CCTV and iPhone.

A focus group was held with visual impairment teachers. One theme from this focus group was accessibility in all its various forms. Consumers' access to buildings, information, employment, and learning opportunities were all mentioned by participants. In particular, one participant mentioned that, "everything seems to be available in print, but they're not always in a format that's accommodating to someone that's visually impaired or blind out in the community." One of those items mentioned was job applications; in fact, there was a general impression that many employers now want applications completed online, often including a pre-test as part of the application. "Most employers don't want to help you fill out the application," one participant stated.

The consumer survey asked respondents to rate the importance of a number of issues. Later in the survey, respondents were also asked to rate how satisfied they are with the way these same services are provided in the state. The answers to both sets of questions are presented in the graph below. The horizontal (up and down) axis shows how satisfied respondents were, on the average, with each service. An answer of very satisfied is scored as '4', satisfied as '3', dissatisfied as '2' and very dissatisfied as '1'. Note that the highest average rating is for Independent Living, 3.3 and the lowest satisfaction rating is for Job Placement, at 2.65.

The vertical (left-right) axis shows the importance ratings. Transportation, access to medical care and assistive technology were among the most important issues. As with satisfaction, very important equals a rating of 4 and not at all important equals a rating of 1.

Those issues that are considered very important, but which receive low satisfaction ratings are often considered high priorities for service improvements. Those items appear in the lower right section of the graph. Transportation, job placement and affordable housing were each rated as highly important, yet they are of low current satisfaction levels.

45BHOUSING

The majority of respondents live with family members (67%). About one in five (21%) lives alone.

Among those who live with family, over half live with a spouse (56%), 27% live with parents, 7% live with adult children and 3% reported that they live with siblings. 7% of respondents named some other family member with whom they currently live.

Most consumers (71%) live in a single family home or apartment (15%).

The vast majority of consumers are very or somewhat satisfied (92%) with the accessibility of their residence. 3% are very dissatisfied.

Among those who are dissatisfied with the accessibility of their residence, 47% cited physical accessibility (such as the need for a ramp) and 14% said that the location was not convenient to major transportation routes. 6% mentioned cost as the reason for their dissatisfaction.

Over half of consumers own their own homes (55%).

15% of all consumers surveyed receive rental assistance from the state of Kentucky.

46BEMPLOYMENT SERVICES

Four out of five consumers surveyed (83%) said that they wanted to find a job, either immediately (54%) or within the next 6 months (29%).

Over half of all consumers (56%) said they had been actively looking for a job within the past 6 months, however most (64%) had not sought the help of any vocational services.

Among those who did seek vocational services, most went to the Kentucky Office for the Blind. 12.8% of respondents who sought vocational services in the past year said they did not know where to look.

Where did you look for vocational services? Number PercentOffice for the Blind 49 30.80%Did not know where to look

20 12.60%

State Office of Employment and Training

17 10.70%

Other 11 6.90% McDowell Center 10 6.30% Technical School/Vocational Training

8 5.00%

Temporary Job Placement Agency

5 3.10%

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College/Community College

4 2.50%

Other 35 22.00%

Jobs services are normally of a fairly short duration, so at the time of the survey, a small percentage of consumers reported that they were currently receiving jobs services.

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The most needed job service was help finding job openings. Almost half of the consumers surveyed (45%) said they needed this service.

Help with on the job training was needed by 38% of consumers and on-the-job support or coaching was needed by 32% of consumers. About 30% of consumers surveyed were employed part or full-time at the time of the survey, and this need was expressed by the majority of those who are employed.

During interviews with Community Rehabilitation Partners, on the job training was also mentioned as a need of many CRP clients.

Educational needs (24%) and help with resume-writing and interview skills (22%) are also needed by a sizeable number of consumers.

The majority of the consumers surveyed (58%) had received vocational services from the Office for the Blind within the past year.

Vocational Services Received in the Past Year Responses

Percent of Cases

Office for the Blind 261 58%Office of Vocational Rehabilitation 36 8%Independent Living Center 14 3%One Stop System 12 3%Some Other service 170 38%Total 493 109.60%

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47BEMPLOYMENT OUTCOMES

Consumers were asked a number of questions about their employment status, vocational rehabilitation experiences, and what services they need or are lacking. A large percentage of the consumers are currently unemployed (38.9%), and more than one in ten (15.1%) are unable to work. About one third (32.2%) are employed, whether full-time (17.8%), part-time (11.3%) or self-employed (3.1%). Just over one third (35.3%) of all consumers have sought vocational rehabilitation services in the last year.

Among those who are unemployed, over half (56.3%) have actively been searching for a job within the last 6 months. A smaller percentage of unemployed consumers, 39.2% have sought vocational rehabilitation services in the last year, and only a small percentage of consumers seeking vocational rehabilitation

services did not know where to look for them (1.8%). This finding is encouraging, because almost all of the consumers knew where to go to find the services they needed while searching for employment.

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48BBARRIERS TO EMPLOYMENT

Overall, satisfaction with job placement was essentially positive; when consumers were asked whether they were very satisfied (4.00), somewhat satisfied (3.00), somewhat dissatisfied (2.00), or very dissatisfied (1.00), consumers' ratings had an average of 2.65. This score is closest to "somewhat satisfied;" 60.5% of the consumers rated themselves as either very satisfied or somewhat satisfied. More than two thirds (68.97%) of those who are dissatisfied or very dissatisfied with job placement assistance are consumers who need the service but are not currently receiving the service. By contrast, 69.5% of those who received job placement services were at least somewhat satisfied with the services. Given this information, it seems that one of the major barriers to job placement is that many who need that type of assistance are not receiving it. In fact, almost half (43.8%) of consumers say they need help with job placement services, but only 5.3% are receiving those services. In other words, 12.2% of those who need job placement assistance are currently receiving it. Underscoring the urgency of the need for these services for a larger percentage of the visually impaired population, almost 8 in 10 (83.9%) of the consumers who are seeking vocational services want a job either immediately (48.3%) or within the next 6 months (35.6%).

69BOn-The-Job Assistance

Almost a third of consumers (31.3%) responded that they were in need of on-the-job support or coaching but that they are not receiving those services at this time, compared to 4.7% who are receiving these services. Over one third of consumers (36.2%) of consumers expressed a need for on the job training, but only 3.1% mentioned receiving those services. In other words, of those who need either service, 14.8% are receiving on the job support or coaching, and 9.4% are receiving on the job training. Of those that need services, half (54.2%) identify as legally blind; almost a third (31.9%) identify as blind; and about one in seven (14.9%) identify as visually impaired. Most of the consumers who need on the job support, but are not receiving it, are blind or legally blind consumers. Half (49.6%) of the consumers who stated they need on the job support but are not receiving it are also unemployed.

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70BEducational Needs

Just over one third (34.0%) of consumers stated that educational supports, such as obtaining a GED, were needed. Just over one in ten (10.7%) are receiving those services, a percentage which translates into 31.4% of consumers who need educational assistance are currently receiving it. This ratio of service delivery is extremely high among the vocational needs of consumers. About a quarter (25.7%) of consumers needed help with resume writing or interview skills, and about 17.2% of those consumers are receiving that type of assistance. Compared to all the service needs of consumers, educational assistance and resume/interviewing assistance are the most delivered.

49BINCREASING QUALITY EMPLOYMENT OUTCOMES

Among consumers, there are a variety of vocational needs, including job placement assistance, on the job supports, educational services, and resume and interview skills. These are all important components to employment, and to overall quality of life, but they are not all being met for all consumers. In fact, when asked to identify the most significant unmet needs related to their visual impairment, consumers mentioned a number of employment-related needs. One in ten (10.2%) cited a lack of income or money as the most significant unmet need at this time. Another 13.8% stated that employment was their primary unmet need. Although a much smaller number of respondents answered in the following way, their concerns echo these employment-related themes: 2.4% of consumers cited education as their biggest unmet need, and 3 consumers stated that "all of the above" were major concerns. Taken together, these responses represent over a quarter, or 27.1%, of all consumers. The major barriers to employment for individuals with a visual disability appear to be related to services that are needed, but not delivered. This was found to be caused by a number of issues.

Consumers who reported needing vocational services had not always sought vocational rehabilitation services. Among consumers in need of job placement assistance, over half (55.3%) had not sought vocational rehabilitation

in the last year. The trend was similar among other needs; 56.0% of those needing on the job support had not sought VR, 55.8% of those needing on the job training had not sought VR, and 54.3% of those in need of educational assistance had not sought VR in the past year. Similarly, about half of the consumers who were receiving the necessary services had not sought VR. Overall, 61.6% of consumers reported that they had not sought vocational services in the past year. However, educational opportunities and assistance with job placement were rated very high by consumers in terms of importance; relative to other topics, these were rated as some of the most important, and were only rated less important than access to medical care, transportation, and assistive technology. Education and employment were rated as highly as independent living. Among all the needs impacting the visually impaired and blind population, increasing employment opportunities is extremely important.

Data from the Office for the Blind on employment outcomes also sheds some light on useful areas to focus on increasing successful outcomes. Among successful outcomes, that is, consumers who sought VR and were successfully placed in an employment setting, there was a significant relationship between how long the case had been open and the wage of the consumer. The longer a consumer's case was open, the lower their wages were likely to be when the case was successfully closed (r = -0.12, p<0.01). This could be because consumers who are on hold for longer periods of time are more difficult to place and less able to perform skilled jobs. While the causality cannot be determined from this type of statistical test, the relationship is worth examining as more data become available. Additionally, unsuccessful closures gave some insight about why employment outcomes were not always successful. The longest durations for cases being open were for individuals who passed away (average of 1136 days), followed by consumers who moved away and were unable to be contacted (878 days). The wait for consumers with unsuccessful outcomes were over or nearly one year, except for those who had no disabling condition, had no impediment to employment, or who did not require vocational rehabilitation. The average number of days these cases were open was 52 to 105 days. The averages for all recorded reasons for unsuccessful closure are listed in the chart to the right.

Consumers with unsuccessful closures had a variety of visual impairments, and the length of time between opening their case and closing their case unsuccessfully varied. Those with some "other visual impairment" (unspecified in the data provided) waited the longest before closure, at an average of 1022 days.

In the focus group held with visual impairment teachers, it became clear that there are many challenges involved in placing consumers into suitable employment. Some of the difficulty is on the part of the potential employer, but some is also on the part of the consumer. One skill that was mentioned as lacking in current programs is the "selling" of one's skills as assets to potential employers. "They really have to be an advocate for themselves.. when the employer doesn't understand the needs of that individual with a disability, they really go to the bottom of the totem pole... no matter how experienced they are." Participants of the focus group mentioned that their classes currently offer training for consumers on interviewing, researching the job, and being an advocate for themselves in a job interview. Additional challenges remain, however, "especially with congenitally blind individuals... there's a lack of exposure to what the job looks like... and they don't have high expectations of what they can do and what's available out there, so everyone wants to come in and answer the phone" when there may be more that they can do with their own unique skill set. Part of the challenge lies in helping consumers see their own potential, and part of the challenge is for counselors to recognize the needs and experiences of each consumer. "People who have been blind from birth are going to have a different skill set from someone who is 40 and going blind and is scared out of their mind."

The focus group participants also discussed the needs and challenges of helping consumers transition into employment or higher education. While there are a great deal of useful and worthwhile classes available for consumers who need help transitioning into different situations, there was a general concern about the lack of consistency in the type and quality of the outcomes that lead to graduation. In the notes from instructors, one

Page 49

participant mentioned, "9 times out of 10 [the consumer is] thinking they can do things they can't... I want to see 'consumer demonstrated' not 'consumer reported' [in the instructors' notes]... consumer demonstrated the ability to successfully write a check... sign their name with this type of check or this type of receipt." Participants wanted to know that consumers not only felt they could do these important tasks, but that instructors were ensuring that consumers could demonstrate those skills in class before graduation. Another concern was the current lack of a basic required curriculum. "As of 3 or 4 years ago... students had to go through all the classes during the 4 week evaluation... but that seems to have gone to the wayside... that gave them exposure to all the classes... and how it would benefit them." Lastly, one participant also mentioned that there was no current plan for assistive technology during transitional periods for consumers going from high school to higher education or to employment settings. "It would be wonderful if in all classes there were an equipment transition... where they could be allowed to acquire that equipment... and that equipment would transition with them."

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50BINFORMATION NEEDS

About one in four consumers (23%) said they do not have access to books, online newspapers or Internet content.

Consumers often answered more than one answer, so the total of the percentages does not equal 100%.

Computer (16%), mobile phone (11%) and talking book library (8%) were also frequently mentioned.

During focus groups and interviews, consumers expressed concerns about the cost of assistive technology. The Bluegrass Council for the Blind in Lexington operates a popular lending library where consumers can 'try out' a

piece of technology before deciding whether or not to purchase the equipment.

One in three consumers (36%) need help learning to use computer equipment for personal needs like email, Facebook or the Internet. In addition, one in three (35%) need help learning to use computer equipment for work purposes.

A substantial percentage also need help in choosing effective AT equipment (27%), for access to books, magazines and newspapers (25%), library service (19%) and a talking book service (19%).

Although additional help is needed by many consumers, many are currently receiving these services. In particular, one in three consumers (33%) currently receives help in using the library services.

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7BCOMMUNITY REHABILITATION PARTNERS (CRPS)

A total of eleven (11) community rehabilitation partners were interviewed by telephone for this CSNA. Among those interviewed, nine provide community employment services for blind or visually impaired consumers, one provides testing for vocational rehabilitation clients and one does not currently provide services because they do not currently have any blind or visually impaired consumers.

The majority of CRPs interviewed (55%) said they have not received any referrals from the Office for the Blind in the past year.

Although most had training specific to serving the blind and visually impaired, four CRP respondents out of the 11 interviewed had no training. One of these four had placed a blind individual in the past, however that was not through a referral from OFB.

One of the CRPs interviewed had 15 years of training history that included sensitivity training, training at the McDowell Center and 5 years with the VA. Staff at that office had also recently attended training at the McDowell Center. Several respondents mentioned certified rehabilitation counselor through the University of Kentucky and Kentucky Rehabilitation Association. Goodwill and other organizations’ in-house training were also mentioned. Several CRPs said they would like to receive additional training.

Training was most often mentioned as the thing that CRPs felt OFB could do to assist them in placing blind and visually impaired consumers into jobs.

The figure above is a “word cloud” of the verbatim answers to the question of what OFB could do to help CRPs place blind and visually impaired consumers. The word cloud gives greater prominence to words that appear more frequently. In the above word cloud, the word “training” was clearly the most frequently mentioned word. Some of the responses included:

Continue to work as a team, some of the counselors are very good at that, also the OJT is very good. Continue to offer training, because training play a critical role.

The sensitivity training was great, they included aspects of visual impairment, cerebral plays and being in wheelchair. It was very hands on and they let you know two people see the world and what they go through. I would love to have my staff go through a training like that again. Of all my years of training that was the tone that touched me the most. It was one whole day.

I have a lot of new staff on board, so training would be really useful.

Some more training in working with people who are blind. We've had a couple of clients who were visually impaired rather than totally blind, and we were able to place them without problem. I did have one client who was completely blind, and I wasn't able to place him, it was just very, very difficult. This gentlemen had to be led around by the arm to get into the workplace. We did get him a couple of interviews, but mobility was the main thing that was a problem for us.

What we did for this individual, is setting up opportunities for interaction in his community, so he could have references, so he could have experience to put on his resume. That's what we see more and more. I did find a job for him, but what I found working with this person was people were most worried about legal liability. So what helped was getting him around people who could see that he was perfectly capable of operating a lawnmower, for example. And that he could do things that they assumed he couldn't do, and he could do them faithfully.

I think for this population, what they need is more socially valued roles within the community really goes a long way in trying to decrease the stereotype about what an individual who has a diagnosis of blindness or low vision can do.

Set up regular meetings. We consistently have openings that we could fill it they would send us referrals and work with us.

I would like to participate in a training.

The Community Rehabilitation Partners interviewed had varied ideas about the greatest unmet need for blind and visually impaired people looking for work. Educating employers about the abilities of blind and visually impaired workers was suggested by one CRP, who said "Getting their foot in the door is the hardest part, and just getting an opportunity. I even had people who would not let this person volunteer." In addition, once employed many workers need additional services to be successful at their job. "Ongoing follow-up is needed. Someone to make sure they have what they need to be able to do their work. Just a magnifier or something simple like that can make all the difference, but

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there needs to be someone who goes back to make sure after they've been in the job, that they have what they need." CRPs expressed a few concerns about serving blind and visually impaired people looking for work.

I think my experience really illustrated the need for support across the community. More partnerships between non-profits, schools, employers and people willing to give people an opportunity to see what they can do. And that means that maybe we don't jump straight to job development. Maybe we need to do some other things that will help eventually with job development.

An employer expressed to me concern about if the person needs adaptive equipment, getting that in a timely manner. Sometimes it might be two or three weeks or more before the adaptive equipment could be brought in. They'd like to see it happen a bit quicker if they need some accommodation.

I have never actually done a work evaluation on a person who is completely blind. Bringing them in and using props and things of that nature is something that I have not experienced and I believe training would be very helpful.

8BEMPLOYERS

Four employers were interviewed for this needs assessment. Employers were asked questions regarding their involvement in placing visually impaired employees in collaboration with the Office for the Blind. They were asked how many blind or visually impaired employees were hired in the last year; what training the employer had specific to employing this population; what challenges existed in hiring this population for that employer; what training was needed to aid in employing this population; and what the OFB could do to help this employer place consumers into jobs.

The employers who were included in the list of potential interviewees were provided by the Office for the Blind. One employer has 10 current employees that were placed through the Office for the Blind; this company had 5 employees in a previous year. The remaining employers in the sample either did not track that information, hadn't had a potential employee who met the requirements for the job, or weren't sure where to find that information.

An encouraging finding was a general perception that emerged from the interviews that the OFB and other stakeholders provide a wide variety of trainings and information with respect to hiring blind or visually impaired employees. Half of the respondents spontaneously made such comments. One of the employers knew exactly who in the OFB to call if he had any questions or concerns while on-boarding a new employee with vision-related needs. However, this employer still wanted more information

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regarding the programs through the OFB, citing she wanted "more familiarity with the program."

One employer had not hired anyone in the past year with any visual impairments, but had done so in the past and was anxious to do so in the future. This employer strongly valued the diversity and value that working with the OFB has brought to their site in the past. One of the interviewees was a Human Resources specialist for their company, but served in this capacity in one division that required vision "correctable to 20/20 [for aircraft operations]" in keeping with FAA guidelines. Accordingly, this employer (in this division) hadn't had much experience hiring with the OFB but could foresee hiring employees with assistive technology if it allowed them to meet the minimum criteria per federal regulations. This employer had also attended trainings and informational meetings sponsored by the OFB in an effort to be fully prepared in the event of future placement of an employee with visual impairment ("I would say I have had a lot of training"). When asked for feedback about their relationship with the Office for the Blind, one employer stated that they were "great at getting equipment out [to the work site]" and that they had all the necessary resources and information to hire individuals with visual impairments.

The Office for the Blind also provided information related to where hiring occurred after successful closures. A list of occupations was provided, and are represented in the Wordle below.

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This visual representation of the data shows which words occurred most often in the list, and nearby words indicate relationships between words that occurred together. "Workers" appeared most often in the list. The types of "workers" that were hired varied a great deal, indicating a wide range of employment opportunities available for individuals with different levels of experience and education.

In the Wordle, it is clear that "Cleaners" were also frequently-appearing jobs. These included Janitors and Cleaners (Except Maids and Housekeeping Cleaners), for a total of 8 employees; and Maids and Housekeeping Cleaners, for a total of 11.

The entry "Managers" also appeared frequently in the list of occupations, and were also varied in the field of the occupations. These included Managers of Retail Workers, of Office and Administrative Support Workers; Agricultural Managers; Construction Managers; Food Services and Sales Managers; General and Operations Managers. When counting all types of managers, there were 28 total.

One entry in the Wordle is misleading at first glance, but further analysis sheds light on another aspect of employment trends. Most of the weight for this word came from 'special' codes listed in the data (e.g., "Special RSA code") and therefore did not indicate a part of the job title. However, many titles included "Specialist" (e.g., Customer Support, Diesel Engines, Computer Support, etc.). Special Education was also a contributor to the

appearance of "special" in the Wordle; however, at times this was because the title indicated the special education was excluded from that particular job opportunity. The presence of "special" in the Wordle should be interpreted cautiously, if at all, due to the variety of mutually exclusive and unrelated forms it took in the jobs list.

The types (and frequencies) of "workers" were as follows:

Position Number of Consumers Hired

1. Child Care Workers 6 2. First-Line Supervisors/ Managers of Retail

Workers 4

3. Food Preparation and Serving Workers 3 4. Landscaping and Groundskeeping Workers 3 5. Production Workers 3 6. Drivers/Sales Workers 2 7. Food Processing Workers 2 8. Maintenance Workers/Machinery 2 9. Office and Administrative Support Workers 2 10. Production Workers 2 11. Farmworkers and Laborers 2 12. Door-to-Door Sales Workers 1 13. Healthcare Support Workers 1 14. Installation/Maintenance/Repair Workers 1 15. Laundry and Dry-Cleaning Workers 1 16. Logging Workers 1 17. Reinforcing Iron and Rebar Workers 1 18. Sales and Related Workers 1 19. Social Workers 1 20. Structural Iron and Steel Workers 1 21. Textile/Apparel/Furnishings Workers 1

These job titles represent a wide variety of occupations, and demonstrate the ability of the OFB to place consumers in jobs that fit with a broad range of backgrounds and experiences.

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9BOPTOMETRISTS AND OPHTHALMOLOGISTS

The Comprehensive Statewide Needs Assessment included a survey of fifty eye care providers, including 25 optometrists’ offices and 25 ophthalmologists’ offices. In order to gather information without disrupting the offices, and to ensure a high response rate, office managers were interviewed whenever possible.

Optometrist and Ophthalmologist offices were similar in terms of number of doctors in the practice and the number of years the office had been in practice.

There were no significant differences between the levels of awareness of OFB services between the groups. Due to the lack of statistically significant difference between optometrists' and ophthalmologists' practices, the two groups' responses were analyzed together as one group of providers.

Just 10% of the practices surveyed work with a low vision rehabilitation specialist. 82% refer their patients to rehabilitation providers outside of their offices.

When asked to whom they refer patients, one in three (34%) did not know. About one-fourth (27%) refer to the Office for the Blind.

The offices were in practice an average of 21.3 years. The newest practice was in practice for 2 years, and the longest for 60 years. Practices had 1 to 10 doctors in their office; more than half (60%) consisted of a single doctor, and about a fifth (18.6%) had two doctors.

There was a great deal of variety in the number of patients seen by each office; ranging from 45 to 2,000 patients per month. The greatest number of practices (36.1%) saw between 200 and 400 patients per month.

Most of the optometry practices interviewed were general practices (23 out of 25 Optometry practices surveyed). Ophthalmologist practices included a number of specialized practices, including two retina specialists, plastic surgery of the eye, glaucoma, pediatrics and others.

51BAWARENESS OF SERVICES

Assessment services were named by almost half of the providers surveyed; 44% of those who mentioned a service mentioned it first. "Cataracts/Cataracts surgery" was the second-most mentioned service; a total of 3 providers spontaneously provided this response to the question.

Providers were asked to name what services they were aware of that are provided by the Office for the Blind. Ophthalmologists' offices were slightly more aware of the range of services offered in comparison to optometrists, but this was not statistically significant. Half of the providers were able to name at least one service; half were unable to name any service at all.

In order to see if providers with the most familiarity with low vision patients had greater knowledge of OFB resources, providers were split up into two groups: those with the lowest rate of low vision patients (below 25%), and those with the highest rate (25% or more). It is interesting to note that although some providers had a higher rate of patients with low vision needs, these providers were no more knowledgeable about OFB services than their peers.

Almost nine out of ten providers (44 out of 50, or 88%) said that less than one quarter of their patients need low vision

rehabilitation services.

When asked what percentage of those who need low vision rehabilitation services receive them, half of the providers surveyed (52%) said that less than 25% receive needed low vision rehabilitation services.

Financial needs were perceived to be the greatest unmet eye care need by 58% of the providers surveyed. Together, routine medical exams and preventive care were mentioned by one in four providers (25%).

Two-thirds of the providers surveyed (68%) said that low income residents were unserved or underserved in the area of low vision rehabilitation services. One in five (18%) named people living in rural areas.

10BUNMET NEEDS

Among consumers, 'employment' was the most frequently mentioned response (14%) to the question "For you personally, what is the most significant unmet need in your life at this time relating to your vision loss?" Lack of income or money was mentioned by an additional 11% of consumers.

Almost half of blind, legally blind and visually impaired consumers said that they are active members of their communities and are able to participate as fully as they choose (47%). Just over one in three (38%) said that they are able to participate, but could do more if help were available.

11BCONCLUSIONS

The input from consumers, providers, and community partners demonstrates the breadth and quality of the assistance programs available for blind and visually impaired Kentuckians. Ratings of consumers' satisfaction with the services provided are positive. However, there is, of course, always room for improvement; this report has identified several areas that could be considered a focus for future program expansions or improvements. Overall, consumers, staff, vision care specialists, and community partners provide a strong network of communication, information, and assistance. Changes that could be made to address unmet needs and underserved groups will only strengthen the success of the OFB.

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12BAPPENDIX A: CONSUMER FOCUS GROUP GUIDE

My name is Amy and I’m the moderator for this focus group today. I'm going to tell you a little bit about what the group is about, then we'll introduce ourselves, then we'll get started. Our group is going to be discussing the needs of the blind and visually impaired communities. The Kentucky Office for the Blind is conducting a needs assessment, and they will be using your feedback. I do not work for the State or the Office for the Blind. I am an independent researcher who is hired to gather your opinions. Everything you say here is confidential. Your name will not be used in any reports or materials. I do tape record the groups so that I can go back and review the tapes while I am writing the report. After I'm done, the recordings are deleted. In order for the recording to work it's important that we each speak one at a time, and that you speak up at least as loudly as I’m speaking now. If you have a cell phone with you, now would be a good time to turn that off so that we won’t be interrupted, and I’ll go ahead and do that too. If you get the urge to say something to your neighbor or make a side comment of some kind, that’s fine, but please speak up and tell it to the whole group, because sometimes those are the best comments and I’d like to be able to include that sort of thing in my reporting. I need to hear from everyone at least once and I’d like to have everybody’s opinion on all the major issues that come up. If I call on you to ask your opinion it isn't because I want to put you on the spot, I just want to make sure everyone's opinion is heard. In the same way, if I interrupt you or cut you off, please don't be offended, I don't mean to be rude, I just have a list of questions and issues to get through and I need to get them all in.

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The reason we have a focus group with a lot of different people in it, is that we want to get a range of opinions. If you agree with what someone else says, I’d like to hear that because it's important to know that more than one person thinks that way. We don’t have to come to an agreement though, and if you disagree with what someone else thinks, I’d like to hear that too. What I’m looking for is an idea of the range of opinions. To start out the group, I’d like for us to introduce ourselves. If you would tell us your name, how long you've lived in the Louisville (Lexington) area and your favorite piece of technology. I'll start.....

TIssue Exploration

Purpose: Establish rapport and participation, understand survey ratings which included transportation as least important issue.) First, I’d like to discuss some of the issues facing the Blind and Visually Impaired community today. What do you think are the most important issues?

Note: Make sure list includes: Access to assistive technology Transportation Mainstream educational opportunities Affordable housing Access to medical care Home assistance services Mobility needs Socialization opportunities Independent living Job placement Vocational training

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Now let's go through the list. Who thinks _______ is very important? What makes it important? Who thinks that __ is less important than some of the other issues? What are your reasons?

TNavigation

Purpose: Understand needs related to navigating home and community environments. Next I'd like to talk a little about how you get around and navigate different places. Are you comfortable in your home environment? Probe for: How did you come to learn? What help would you have liked? What services are you aware of? What services would be useful now? What about getting around in the community where you live? Probe for: How did you come to learn? What help would you have liked? What services are you aware of? What changes to the community would help you? What services would be useful now?

THousing

Purpose: Understand housing needs.

Let's talk a little about housing. How did you find your current place? Did you encounter any discrimination trying to rent or buy? Did you need to make any adaptations or changes when you moved in? Are there any services available to help with that? What services are available when it comes to finding a place to live? Adapting a place to your needs? Are more services needed?

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What do you think are the most critical areas of need in regards to housing? What supportive services would help you live more independently in your home? In your community?

TAdaptive Equipment and Devices

Purpose: Understand needs related to adaptive equipment. When it come to adaptive equipment and devices, what adaptive equipment has made the biggest impact on your quality if life? What would you like to have, but do not have access to? Probe for how many have/need/want and why:

Screen reader programs Talking or low vision watch Computer aided or enhanced visibility keyboard Scanner (OCR Scanner) Note Taker or Braille Writer IPhone E-book reader like Kindle or iPad Bank note reader CCTV (Closed circuit television)

TMainstream Education

Purpose: Understand attitudes and beliefs regarding public schools and unmet educational needs. Let's talk about education and the public schools. What are your thoughts about the public schools system? What kind of a job do they do meeting the needs of the blind and visually impaired?

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What do they do well? What gaps are there in the services they offer? What services need to be improved?

TEmployment

Purpose: Understand attitudes and beliefs regarding working, experience of discrimination, perceptions of opportunities and needs in the next 5 years. Tell me about your experience with employment. First, if you work or have worked, tell me about the experience of finding a job. Probe for: Discrimination in hiring Help received Barriers to finding employment Difficulties in training/learning job Discrimination in the workplace Opportunities for advancement If you are not currently working, would you like to be working? What services would help you find a job or keep a job? What services or help have you received, either in finding a job or for job training? Were they helpful? What could they improve?

Probe for: State Office of Employment and Training Technical School/Vocational Training Temporary Job Placement Agency Independent Living Center Veteran’s Administration School Transition Program Vocational Rehabilitation

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Everyone, whether they are working or not, has goals for the future. What are your future goals when it comes to your work? Where do you see yourself in 5 years?

TOpen Ended Discussion Questions

What do you think are the primary concerns facing individuals who are blind and visually impaired over the next five (5) years? What could the Office for the Blind do to improve services in your community? That is all the question I have for you today. Thank you for participating!

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13BAPPEDIX B: STAFF FOCUS GROUP GUIDE

My name is Amy and I’m the moderator for this focus group today. I'm going to tell you a little bit about what the group is about, then we'll introduce ourselves, then we'll get started. Our group is going to be discussing the needs of the blind and visually impaired communities. The Kentucky Office for the Blind is conducting a needs assessment, and they will be using your feedback. I do not work for the State or the McDowell Center. I am an independent researcher who is hired to gather your opinions. Everything you say here is confidential. Your name will not be used in any reports or materials. I do tape record the groups so that I can go back and review the tapes while I am writing the report. After I'm done, the recordings are deleted. In order for the recording to work it's important that we each speak one at a time, and that you speak up at least as loudly as I’m speaking now. If you have a cell phone with you, now would be a good time to turn that off so that we won’t be interrupted, and I’ll go ahead and do that too. I need to hear from everyone at least once and I’d like to have everybody’s opinion on all the major issues that come up. If I call on you to ask your opinion it isn't because I want to put you on the spot, I just want to make sure everyone's opinion is heard. In the same way, if I interrupt you or cut you off, please don't be offended, I don't mean to be rude, I just have a list of questions and issues to get through and I need to get them all in. The reason we have a focus group with a lot of different people in it, is that we want to get a range of opinions. If you agree with what someone else says, I’d like to hear that because it's important to know that more than one person thinks that way. We don’t have to come to an agreement though,

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and if you disagree with what someone else thinks, I’d like to hear that too. What I’m looking for is an idea of the range of opinions. To start out the group, I’d like for us to introduce ourselves. If you would tell us your name, how long you've lived in the Louisville (Lexington) area and your favorite piece of technology. I'll start.... TIssue Exploration Purpose: Establish rapport and participation, understand survey ratings which included transportation as least important issue.) First, I’d like to discuss some of the issues facing the Blind and Visually Impaired community today. On your handout, please write what you believe the top 3 issues are, and then when everyone is ready we will discuss them. What do you think are the most important issues to consumers? Note: Make sure list includes: Access to assistive technology Transportation Mainstream educational opportunities Affordable housing Access to medical care Home assistance services Mobility needs Socialization opportunities Independent living Job placement Vocational training Let's discuss the top 3. First, ____________. What examples have you encountered of consumers in need of _______.

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Is that a common or uncommon situation? What services exist? What needs go beyond existing services? TConsumer Needs Purpose: Understand gaps in services, consumer requests that are not realistic or any challenges adapting existing services to consumer needs and wants.) My next question is related, but it's a little different. What are the top 3 services requested by individual consumers? (If you don't have contact with individuals, or you don't have an answer to this question, please leave it blank.) How are these similar to the top issues, and how are they different? (Probe for requests that do not match available services, are beyond scope of services, etc.) TMainstream Education Purpose: Understand attitudes and beliefs regarding public schools and unmet educational needs. Let's talk about education and the public schools. What are your thoughts about the public schools system and how it deals with blind and vi students? What kind of a job do they do meeting the needs of the blind and visually impaired? What do they do well? What gaps are there in the services they offer? What services need to be improved? Note: Include transitional students. Community Rehabilitation Providers

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Purpose: Explore relationships with CRPs, perceptions of quality of services.) Next, let's talk about Community Rehabilitation Providers. How would you describe the services provided to consumers through Community Rehabilitation Providers? I'm not asking what specific services they provide, I'm asking you to describe the manner in which they provide services. Please write down 3 words that come to mind, and then we'll discuss them. Probe for: Quality of services Comprehensiveness Flexibility Motivation TOne Stop How would you rate the level of services provided to consumers through the local One Stop? What services available do your consumers access or take advantage of? TOpen Ended Discussion Questions What do you think are the primary concerns facing individuals who are blind and visually impaired over the next five (5) years? What could the Office for the Blind do to improve its services? That is all the question I have for you today. Thank you for participating!

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14BAPPENDIX C: CONSUMER INTERVIEW GUIDE

Hello, may I please speak to _____________.

Hi, my name is __________ and I’m calling on behalf of the Kentucky Office for the Blind. They are interested in understanding more about the needs of Blind and visually impaired people in Kentucky.

All of the information you provide will be kept strictly confidential. Your answers will be combined with other people’s answers without your name or phone number.

Your participation will help improve services for blind and visually impaired people.

Do you have a few minutes to answer some questions for me?

ANSWERS TO RESPONDENT QUESTIONS, AS NEEDED:

How long will it take? The survey should take about 10 minutes.

How did you get my number? Your telephone number was selected at random from those who have had some contact or experience with the Office for the Blind.

Did the Office for the Blind (OFB) give out my number? The Office for the Blind (OFB) wants to understand its customers better, so they are conducting this survey. They hired us to do the calling.

How do I know this is a legitimate survey? If you would like to check on the legitimacy of the survey, please call Cora McNabb of the Office for the Blind at (502) 564-4754 or your vocational rehabilitation or independent living counselor.

I would like to know more about the purpose of the survey or specific survey questions. If you have questions about the survey, you can call Dr. Amy Flowers of Analytic Insight at 1- 800-996-2545.

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Are you changing my enrollment/program/service? Will this impact my services? No. We are just a survey company trying to learn about people’s needs and experience with the programs and services that are available. We do not have the ability to make any changes, and whether or not you decide to take the survey will have no impact on any services you receive.

TIntroductory Questions

1) Which of the following best describes you? 2) Visually impaired 3) Blind 4) Legally Blind

Sighted (THANK AND TERMINATE. “FOR THIS STUDY, WE JUST NEED TO TALK TO BLIND AND VISUALLY IMPAIRED PEOPLE. THANK YOU FOR YOUR HELP.”)

Next, I’m going to read a list of issues facing the Blind and Visually Impaired community today and for each one please tell me how important you feel the issue is to people with a vision impairment.

Here's the (first/next) one: ________. Do you think this issue is very important, somewhat important, not too important or not at all important?

Very

Importa

nt

Smwht

Importa

nt

Not

Very

Importa

nt

Not At

All

Importa

nt DK/NA

Access to assistive technology 1 2 3 4 9

Transportation 1 2 3 4 9

Mainstream educational opportunities 1 2 3 4 9

Affordable housing 1 2 3 4 9

Access to medical care 1 2 3 4 9

Home assistance services 1 2 3 4 9

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Mobility needs 1 2 3 4 9

Socialization opportunities 1 2 3 4 9

Independent living 1 2 3 4 9

Job placement 1 2 3 4 9

Vocational training 1 2 3 4 9

TMobility and Personal Care

I’m going to read you a list of services related to mobility. For example, the first one is ____.

Do you get ________, need ______ or don’t need this service? (FOR EACH REPEAT, DO YOU GET___, NEED___ OR NOT NEED ____.)

Gets Needs

Does not need DK/NA

Help navigating community environments 1 2 3 9

Help navigating your home environment 1 2 3 9

Assistance obtaining or using a guide dog 1 2 3 9

Help using a cane 1 2 3 9

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In the past six months, have you participated in ….

(IF NO, THEN ASK “WOULD YOU HAVE IF ASSISTANCE WERE AVAILABLE?”)

Yes No Would have

Did not and Would not have used DK/NA

Outdoor activities 1 2 3 4 9

Sports or exercise programs 1 2 3 4 9

Social activities like support groups, social groups or parties

1 2 3 4 9

Next, I’m going to read you a list of services related to personal care. For each one, please tell me if you receive the service, need it or don’t need the service. The first one is ____. Do you get ________, need ______ or don’t need this service.

Gets Needs

Does not need DK/NA

Help with shopping 1 2 3 9

Help with banking 1 2 3 9

Help with personal grooming 1 2 3 9

Help with laundry or home chores 1 2 3 9

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Help with food preparation/cooking 1 2 3 9

TTransportation

My next questions are about transportation. Do you get, need or not need…

Currently Receiving Needs

Does not need DK/NA

Assistance using public transportation 1 2 3 9

Low cost door to door transportation 1 2 3 9

Free door to door transportation 1 2 3 9

What form of transportation do you use most often? (READ LIST ONLY IF NEEDED.)

1) Friend or family member 2) Own Car 3) Transit/Paratransit 4) Walk 5) Paid Driver 6) Taxi 7) Bus 8) Bicycle

9) Other ________________

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TAdaptive Equipment

Next, I am going to read you a list of adaptive equipment items. If you are not familiar with it, just tell me. If you are familiar with it, even if you’ve never owned one, please tell me how important you think each one would be to your quality of life. If you are familiar with a _____, would a ______ be very important, somewhat important, not very or not at all important to your quality of life?

Very Important

Somewhat Important

Not very important

Not at all important

Not familiar with it

DK/NA

Screen reader programs 1 2 3 4 5 9

Talking or low vision watch 1 2 3 4 5 9

Computer aided or enhanced visibility keyboard 1 2 3 4 5 9

Scanner (OCR Scanner) 1 2 3 4 5 9

Note Taker or Braille Writer 1 2 3 4 5 9

IPhone 1 2 3 4 5 9

E-book reader like Kindle or iPad 1 2 3 4 5 9

Bank note reader 1 2 3 4 5 9

CCTV (Closed circuit television) 1 2 3 4 5 9

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Do you have access to a …. (READ LIST, CHECK ALL THAT APPLY.)

Yes No DK/NA

Screen reader programs 1 2 9

Talking or low vision watch 1 2 9

Computer aided or enhanced visibility keyboard 1 2 9

Scanner (OCR Scanner) 1 2 9

Note Taker or Braille Writer 1 2 9

IPhone 1 2 9

E-book reader like Kindle or iPad 1 2 9

Bank note reader 1 2 9

CCTV (Closed circuit television) 1 2 9

(IF Q1=b - LOW VISION ONLY)

Have you ever had a low vision evaluation to determine aids that can help you make use of remaining vision?

1) Yes 2) No

9) DK/NA

THousing

Do you live….?

1) Alone

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3) In Assisted living 4) With family UPlease specify: 5) Spouse 6) Parents 7) Siblings 8) Adult children (DO NOT INCLUDE MINOR CHILDREN.) 9) Other _______

99) DK/NA

How would you describe the building where you live. Is it…

1) A single family home 2) Duplex 3) Townhouse or Condominium 4) Apartment 5) Shared housing or group home 6) Other __________

How satisfied are you with the accessibility of your residence?

1) Very satisfied 2) Somewhat satisfied 3) Somewhat dissatisfied 4) Very dissatisfied

(IF SOMEWHAT OR VERY DISSATISFIED, ABOVE:)

1) Why are you dissatisfied? 2) Cost 3) Noise 4) Location – Inconvenient to major transportation 5) Location – Other than transportation 6) Accessibility (Needs ramp, etc.) 7) Other ___________

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Do you own or rent?

1) Own 2) Rent

9) DK/NA (INCLUDE GROUP HOME, ASSISTED LIVING HERE.)

(IF RENTS, ABOVE:)

1) Do you receive rental assistance from the State of Kentucky?

2) Yes 3) No

9) DK/NA

TEmployment

What is your employment status?

1) Employed Full-time 2) Employed Part-Time 3) Unemployed 4) Student 5) Retired 6) Unable to work 7) Other ______

(IF UNEMPLOYED, ABOVE) Do you want to find a job?

1) Yes, immediately 2) Yes, within the next 6 months 3) No

9) DK/NA

Have you actively been looking for a job within the past 6 months?

1) Yes 2) No

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9) DK/NA

Have you sought any vocational services in the past year?

1) Yes 2) No

9) DK/NA

(ASK IF Q10=Yes) Where did you go?

1) State Office of Employment and Training 2) Technical School/Vocational Training 3) Temporary Job Placement Agency 4) Independent Living Center 5) Veteran’s Administration 6) School Transition Program 7) Vocational Rehabilitation 8) Did not know where to look 9) Other __________________________________

99) DK/NA

Next I’m going to read you a list of services related to jobs and employment. For each one, please tell me if you get, need or don’t need…

Currently Receiving services

Needs Services

Does not need services DK/NA

Help with resume writing or interview skills 1 2 3 9

On-the-job training 1 2 3 9

Help finding job openings 1 2 3 9

Educational needs such as GED or college 1 2 3 9

On the job support or job coaching 1 2 3 9

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Within the past year, have you received vocational services from… (READ LIST, CHECK ALL THAT APPLY.)

1) Office for the Blind 2) Office of Vocational Rehabilitation 3) Independent Living Center 4) One Stop System 5) Other ____________________

TInformation Needs

How do you currently access information such as books, online newspapers, and other Internet content? (READ ONLY IF NEEDED, CHECK ALL THAT APPLY.)

1) Text-to-speech conversion device 2) Mobile phone 3) Screen Reader Software like JAWS/WINDOW EYES/ZOOMTEXT 4) Refreshable Braille device (BrailleNote) 5) Newsline 6) Central Radio Eye 7) Talking Book Library 8) Other _______ 9) Does not access 99) DK/NA

Next I’d like to know about your information needs. Do you have, need, or not need…

Has Needs

Does not need DK/NA

Talking book service 1 2 3 9

Library service 1 2 3 9

Access to books, magazines, newspapers 1 2 3 9

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Help choosing effective Access Technology equipment 1 2 3 9

Help learning to use computer equipment needed for work purposes 1 2 3 9

Help learning to use computer equipment needed for personal needs like email, Facebook or the internet 1 2 3 9

TOther

For you personally, what is the most significant unmet need in your life at this time relating to your vision loss? (DO NOT READ LIST, CHECK ONLY ONE.)

1) Transportation 2) Employment 3) Ability to Read 4) Self–Sufficiency 5) Social Isolation 6) Home Management 7) Lack of income or money 8) Other _________

Overall, are you satisfied or dissatisfied with ____ in Kentucky? (AFTER RESPONSE TO QUESTION, ASK “Is that VERY OR SOMEWHAT?”)

Very Satisfied

Smwht Satisfied

Smwht Dissatisfied

Very Dissatisfied

DK/NA

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Access to assistive technology 1 2 3 4 9

Transportation 1 2 3 4 9

Mainstream educational opportunities 1 2 3 4 9

Affordable housing 1 2 3 4 9

Access to medical care 1 2 3 4 9

Home assistance services 1 2 3 4 9

Mobility needs 1 2 3 4 9

Socialization opportunities 1 2 3 4 9

Independent living 1 2 3 4 9

Job placement 1 2 3 4 9

Vocational training 1 2 3 4 9

Thinking of all the services, supports and programs that are available to you, which statement best describes you …

1) I am able to be an active member in my community and participate as fully as I choose.

2) I am able to participate in the community on occasion, but I could do more if help were available.

3) I am not able to participate in community life as I would like because the help is not available.

I just have a few more questions. My last questions are about you.

Are you a veteran?

1) Yes 2) No

Page 90 Which, if any, of the following apply to you? (READ LIST.)

1) 55 years of age or older 2) Have a physical disability other than blindness or vision impairment 3) Have a developmental disability 4) Have a mental illness 5) Have alcohol or other drug dependency issues

Have you ever been told by a doctor or health professional that you had….

Yes No

DK/NA

Age-related macular degeneration, or AMD 1 2 9

Cataracts 1 2 9

Glaucoma. 1 2 9

Diabetic retinopathy 1 2 9

Macular degeneration 1 2 9

Retinitis Pigmentosa 1 2 9

Toxoplasmosis 1 2 9

Optic Nerve Hypoplasia 1 2 9

A stroke or TIA. 1 2 9

What is your age (years?) _______ (999= DK/Refused)

At what age did you begin to lose your vision (years?) _______ (ENTER 0 FOR “FROM BIRTH”, 999=DK/Refused)

What is your race/ethnicity? (DO NOT READ LIST, SELECT ALL MENTIONS.)

1) White or Caucasian 2) Black or African American

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3) Asian 4) American Indian or Alaska Native 5) Native Hawaiian or Other Pacific Islander 6) Other _________________________________ 7) Hispanic or Latino 9) Refused

What was your household’s income last year?

1) Less than $15,000 2) $15,000 to less than $30,000 3) $30,000 to less than $49,000 4) $50,000 to less than $75,000 5) $75.000 or more 9) DK/NA

What sources do you personally receive? (READ LIST. CHECK ALL THAT APPLY.)

1) Income from a job 2) SSDI or Social Security Disability Income 3) SSI or Social Security Income 4) Housing Assistance 5) Veteran’s Disability 6) Financial help from family or friends 7) TANF or Temporary Assistance for Needy Families 8) Food Stamps 9) Other _______

What is your home zip code? _____ (99999=refused)

Thank you for taking the time to talk to me today. Your responses will be used to improve and strengthen the services offered to blind and visually impaired people in Kentucky.

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15BAPPENDIX D: EMPLOYER INTERVIEW GUIDE

Hello, my name is __________ and I’m calling on behalf of the Kentucky Office for the Blind. May I please speak to _______________?

The Office for the Blind is conducting a Comprehensive Statewide Needs Assessment and is interested in understanding more about the needs of optometrists in serving Blind and visually impaired people in Kentucky.

The survey will take less than 3 minutes. Do you have a few minutes to answer some questions for me?

How many blind or visually impaired employees have you hired in the past year?

None _________________________

What training have you had specific to working with and employing the blind and visually impaired?

None _________________________

What concerns did you have in employing this population?

_________________________

Were they overcome?

_________________________

What training would be helpful to you?

_________________________

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What benefits are there to you as an employer, hiring this population?

_________________________

What could the OFB do to assist you in placing blind and visually impaired consumers into jobs?

___________________________

Those are all the questions I have for you. Thank you so much for your participation.

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16BAPPENDIX E: OPTOMETRISTS AND OPHTHALMOLOGISTS INTERVIEW GUIDE

Hello, my name is __________ and I’m calling on behalf of the Kentucky Office for the Blind. May I please speak to the office manager?

The Office for the Blind is conducting a Comprehensive Statewide Needs Assessment and is interested in understanding more about the needs of optometrists in serving Blind and visually impaired people in Kentucky.

The survey will take less than 3 minutes. Do you have 3 minutes to answer some questions for me?

TANSWERS TO RESPONDENT QUESTIONS, AS NEEDED:

How long will it take? The survey should take about 3 minutes.

How do I know this is a legitimate survey? If you would like to check on the legitimacy of the survey, please call Cora McNabb of the Office for the Blind at (502) 564-4754.

I would like to know more about the purpose of the survey or specific survey questions. If you have questions about the survey, you can call Dr. Amy Flowers of Analytic Insight at 1- 800-996-2545.

What is the survey about? The survey asks some general questions about your clinical practice, like what kinds of low vision rehabilitation services you provide, what referrals you make to low vision therapists outside of your office and the types of patients you treat.

You would have to speak to the doctor/I’m not the person you need to talk to. I’d be happy to speak to the doctor. What time should I call?

First, do you have a low vision rehabilitation specialist working with you in your practice?

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1) Yes 2) No 9) DK/NA

Do you refer your patients to rehabilitation providers outside of your office?

1) Yes 2) No 9) DK/NA

(IF YES ABOVE) To whom?

1) KY Office of the Blind 2) Other _________ 9) DK/NA

What services are you aware of that are provided by the Office for the Blind? (DO NOT READ LIST. CHECK ALL THAT APPLY.)

1) Vocational Counseling and Guidance 2) Assessment Services 3) Referrals and Assistance to other agencies 4) Job search and Placement 5) Vocational or Rehabilitation Training 6) Physical and Mental Restoration 7) Orientation and Mobility Services 8) Assistive Technology 9) Independent Living Services 10) Bioptic Driving 11) Rehabilitation counseling 12) Orientation and mobility training 13) Technology training 14) Independent living supports 15) Other________

16) None 99) DK/NA

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I have just a few more questions about your practice. What best describes your practice type:

1) Optometry - General 2) Optometry-Low vision specialty 3) Optometry - Other specialty ____________________ 4) Ophthalmology - General 5) Ophthalmology – Retina specialty 6) Ophthalmology – Low vision specialty 7) Ophthalmology – Other specialty ____________________

1. Is yours a… 1) Private solo practice 2) Group practice 3) Hospital or medical center 4) Other clinical setting 5) Other ____________

2. How many years has your office been in practice?

1) ___ (0-98) 99) DK/NA

3. About how many patients does your office see per month?

(PROMPT AS NEEDED: I only need an approximate number, roughly how many patients do you see each month?)

1) ___ (0-998) 999) DK/NA

4. Roughly, what percentage of the patients in your practice need low

vision rehabilitation services? (READ, AS NEEDED) 1) Less than one-fourth 2) One-fourth to less than half 3) Half to three-fourths 4) More than three fourths

5. Among those who need them, roughly, what percentage of the

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patients who need low vision rehabilitation services receive them? 1) Less than one-fourth 2) One-fourth to less than half 3) Half to three-fourths 4) More than three fourths 9) DK/NA

6. What groups do you think are unserved or underserved in the area of

low vision rehabilitation services? (DO NOT READ LIST. CHECK ALL THAT APPLY.)

1) Low income 2) Black or Hispanics 3) Rural areas 4) Other ________ 9) DK/NA

Lastly, what do you consider to be the greatest unmet eye care needs in your community? (DO NOT READ LIST. CHECK ALL THAT APPLY.)

1) Financial Needs 2) Routine Exams or Medical care 3) Preventive care 4) Assistive Technology, aids or devices 5) Mobility Training 6) Home care 7) Education 8) Other ________ 9) DK/NA


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17BAPPENDIX F: COMMUNITY REHABILITATION PARTNERS (CRPS) INTERVIEW GUIDE

Hello, my name is __________ and I’m calling on behalf of the Kentucky Office for the Blind. May I please speak to _______________?

The Office for the Blind is conducting a Comprehensive Statewide Needs Assessment and is interested in understanding more about the needs of our partners and stakeholders in serving Blind and visually impaired people in Kentucky.

The survey will take less than 3 minutes. Do you have a few minutes to answer some questions for me?

1. Does your organization provide community employment services for blind or visually impaired consumers?

1) Yes 2) No

2. How many consumer referrals have you received from the Office for the Blind within the past year?

1) None 2) _________________________

3. (IF YES ABOVE) What training have you had specific to serving the blind and visually impaired?

1) None 2) _________________________

4. What could the OFB do to assist you in placing blind and visually impaired consumers into jobs?

___________________________ Page 99

5. What do you consider to be the greatest unmet need for blind and visually impaired people looking for work? ________

6. What concerns do you have in serving this population?

________


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