19205

Prepared by the North Dakota Legislative Council staff for the Budget Committee on InstitutionalServices February 2000

VISION SERVICES SUMMARY

This memorandum summarizes the estimated number of individuals with moderate or severe vision impairments in the state, the types and locations of vision services provided in North Dakota, funding and FTE positions providing vision services, the number of individuals being served, and possible barriers to accessing vision services.

NUMBER OF VISUALLY IMPAIRED PERSONS - MODERATE OR SEVERE IMPAIRMENT

The schedule below presents the estimated number of persons with moderate or severe visual impairments in each region of the state. The numbers are based on information available from the North Dakota State Data Center at North Dakota State University, the Department of Public Instruction, and the School for the Blind.

						Percentages in Each Region
No.	Region	Ages 0 to 21*	Ages 16 to 54*	Ages 55 and Over	Total	Visually Impaired Persons	Total Population**
1	Northwest - Williston	16	248	475	739	4.7%	4.4%
2	North Central - Minot	23	813	1,388	2,224	14.0%	13.8%
3	Lake Region - Devils Lake	27	399	912	1,338	8.5%	6.9%
4	Northeast - Grand Forks	33	952	1,212	2,197	13.9%	14.5%
5	Southeast - Fargo	34	1,545	1,934	3,513	22.2%	24.5%
6	South Central - Jamestown	20	460	1,186	1,666	10.5%	9.6%
7	West Central - Bismarck	83	1,190	1,840	3,113	19.7%	20.2%
8	Badlands - Dickinson	31	339	662	1,032	6.5%	6.1%
	Total	267	5,946	9,609	15,822	100%	100%
* The North Dakota Data Center estimates that 11 persons with visual impairments may be shown in both the 0 to 21 age category and the 16 to 54 age category. ** Based on 1998 population estimates.

SERVICES

The schedule below presents the vision services provided by the School for the Blind and the Vocational Rehabilitation Division of the Department of Human Services. Unless noted, the services are offered in all regions of the state:

School for the Blind

Department of Human Services - Vocational Rehabilitation

American Printing House - Administration of federal quota funds that provide educational materials to eligible students. National Library Service Talking Book Machine Lending Agency - Administration of talking book machines to persons who are unable to read or use standard printed materials. Braille production - Preparation of textbooks, newsletters, election ballots, etc., in alternative formats (Braille, disk, audio, large print) utilizing technological equipment. Consumer/professional libraries - Fiction and nonfiction books, brochures, and pamphlets and professional books, videos, assessments, and resource materials. Descriptive videos for loan - Home videos with audio descriptions for persons who are blind or have low vision. Toy/adaptive equipment lending library. Store - Adaptive aids for sale. Technology - Demonstrations, consultations, instruction, and evaluations for consumers, professionals, and interested persons; loaning of software and hardware; and service delivery data base. Parent/infant - Consultation, instruction, and evaluations assisting parents and family members to understand the impact of visual impairments on early childhood development and implementation of effective individualized techniques for infants and toddlers. Braille support groups - Support groups to persons enabling them to write and read the Braille code; meets on a regular basis in Minot, Fargo, Bismarck, and Grand Forks. Summer adventure - Summer camp at the School for the Blind for students with opportunities in career awareness, Braille, music, daily living skills, recreation, technology, and orientation and mobility. Athletic programs - Hosting of a goalball tournament in Grand Forks and participation in goalball tournaments at the South Dakota and Minnesota Schools for the Blind; Ski for Life participation in Rapid City, South Dakota. Vision activity day - An activity day for students to share in recreational and educational activities. Specific skills - One-week sessions at the School for the Blind for students in grades 1 through 12 offering instruction in the areas of daily living skills, orientation and mobility, technology, Braille, Braille music, careers, and personal development with local followup. Independent living program - Three-week summer session at the School for the Blind for students in grades 11 and 12 in the areas of vocational/careers/job shadowing and daily living skills. Compensatory skills - Teaching of vision compensatory skills for grades 1 through 12. Time is based on the individualized needs - Provided at the School for the Blind with local followup. Postsecondary - Independent living training for young adults - Provided at the School for the Blind with local followup. LEAP - Life Experiences Advance People - Instruction of vision-specific skills through experiential living in vision-specific skills - Provided at the School for the Blind with local followup. Speakers bureau - Presentations and awareness given by professionals to a variety of groups on vision-related topics. Inservice training - Training provided to parents, teachers, paraeducators, and any interested persons in the home, school, or jobsite. Annual workshops are provided, plus additional training is available upon request. Vocational evaluation - Comprehensive Vocational Evaluation System (CVES) - Designed to evaluate the essential abilities of persons who are blind or visually impaired to determine the level of vocational functioning, programming priorities, interest areas, etc. Functional vision evaluation - Evaluation of the level of functional vision, adaptations, and specific vision-related activities, curriculum adaptations, interventions, and environmental recommendations. The School for the Blind does not charge a fee for the services it provides to visually impaired individuals 21 years old or younger and their families. For visually impaired individuals over the age of 21, the school does charge for center-based training services and ongoing training services. These services are generally paid by the Vocational Rehabilitation Division for the individual. If the individual is not eligible for vocational rehabilitation services funding, the person would still be charged the fee. The school provides a number of other vision services such as consultations, training, and evaluations for other adults for which no fee is charged.

Community integration - Involving older visually impaired persons in community activities. Examples would be church activities, senior center activities, etc. Transportation - Transportation of and for clients to destinations such as doctor's offices. Readers and guides - On a short-term basis, arrange for individuals to read important documents and act as sighted guides. Clients ultimately assume this role for themselves. Referral to other agencies - When necessary or requested by the client, referrals are made to home health agencies, senior meals programs, etc. Initiate and promote support groups - Establish, assist in maintaining, and refer newly blind persons to peer support groups. Individual, family, and peer counseling - Help the client and significant persons in their lives adjust to vision loss. Evaluate/teach communication skills - Training in Braille, handwriting, typewriting (keyboarding), or other means of communicating. Vocational rehabilitation general services - Evaluation, training, and placement activities. Assistive technology aids/devices - Low-vision aids such as magnifiers, cassette player/recorders, writing guides, writing instruments, etc. Orientation and mobility - Instruction in traveling safely with a white cane, sighted guide, or dog guide. Daily living skills - Training to perform activities such as meal preparation, identifying coins and currency, selection of clothing, housecleaning, etc., with reduced or no vision. Use of adaptive aids - Teach people to use the low-vision aids they require. Recreation/leisure - Teach adaptive skills which allow clients to continue participating in their choice of recreation activities. Evaluate functional vision - Determine client's ability to do common everyday tasks and develop a plan to help the client function with poor or no vision. Vocational/career exploration - Help client review occupational options including paying for a vocational evaluation. Telephone consultations - Respond to a variety of inquiries regarding vision loss from clients, referral sources, family members, etc. Vocational training - Training in a specific vocation or profession. Job placement assistance - Assist client with activities related to finding a job. Information/education activities - Disseminate information about vocational rehabilitation services to visually impaired, potential referral sources, etc. All services provided by the Vocational Rehabilitation Division to visually impaired individuals who meet its eligibility requirements are provided at no cost to the individual. If a specific device or aid is needed for the individual to be employed, based on a sliding fee scale, the individual may be asked to participate in the cost of the device or aid.

FUNDING

The schedule below reflects funding provided for these services for the 1999-2001 biennium:

School for the Blind		Department of Human Services - Vocational Rehabilitation - Vision Services
Salaries and wages - 28 FTE	$2,391,456	Salaries and wages - 10 FTE	$723,498
Operating expenses	678,059	Operating expenses	210,961
Equipment	70,500	Equipment	7,925
Capital improvements	51,790	Capital improvements	830
		Grants	155,407
Total all funds	$3,191,805	Total all funds	$1,098,621
Less estimated income	1,002,577	Less estimated income	868,004
Total general fund appropriation	$2,189,228	Total general fund appropriation	$230,617

VISION SERVICES-RELATED FTE POSITIONS

The schedule below presents the number of vision services-related FTE positions of the School for the Blind and the Department of Human Services:

		Number of Vision Services-Related FTE Positions			Percentages in Each Region
No.	Region	School for the Blind	Department of Human Services	Total	FTE Positions	Visually Impaired Persons	Total Population
1	Northwest - Williston	0.0	0.0*	0.0*	0.0%	4.7%	4.4%
2	North Central - Minot	1.5	1.0*	2.5*	6.5%	14.0%	13.8%
3	Lake Region - Devils Lake	1.0	1.0	2.0	5.3%	8.4%	6.9%
4	Northeast - Grand Forks	22.5	2.0	24.5	64.5%	13.9%	14.5%
5	Southeast - Fargo	1.0	1.0	2.0	5.3%	22.3%	24.5%
6	South Central - Jamestown	1.0	1.0	2.0	5.3%	10.5%	9.6%
7	West Central - Bismarck	1.0	2.5	3.5	9.2%	19.7%	20.2%
8	Badlands - Dickinson	0.0	1.5	1.5	3.9%	6.5%	6.1%
	Total	28.0	10.0	38.0	100%	100%	100%
* The Department of Human Services contracts with a vision services provider for services in the Northwest and North Central regions.

NUMBER OF VISUALLY IMPAIRED PERSONS SERVED EACH YEAR

The schedules below present the number of individuals served by the School for the Blind and the Vocational Rehabilitation Division in each region of the state and the percentage of visually impaired individuals being served each year in each region:

Individuals Served - By Age
		Ages 0 to 21*			Ages 16 to 54*			Ages 55 and Over*
No.	Region	School for the Blind	DHS	Total	School for the Blind	DHS	Total	School for the Blind	DHS	Total
1	Northwest - Williston	2	0	2	1	10	11	0	62	62
2	North Central - Minot	20	0	20	30	34	64	0	88	88
3	Lake Region - Devils Lake	27	0	27	5	5	10	0	98	98
4	Northeast - Grand Forks	21	0	21	37	32	69	3	82	85
5	Southeast - Fargo	26	0	26	17	32	49	3	81	84
6	South Central - Jamestown	20	0	20	3	23	26	0	71	71
7	West Central - Bismarck	36	0	36	5	32	37	0	168	168
8	Badlands - Dickinson	10	0	10	0	13	13	1	45	46
	Total	162	0	162	98	181	279	7	695	702
Individuals Served - Total
No.	Region	School for the Blind	DHS	Total
1	Northwest - Williston	3	72	75
2	North Central - Minot	50	122	172
3	Lake Region - Devils Lake	32	103	135
4	Northeast - Grand Forks	61	114	175
5	Southeast - Fargo	46	113	159
6	South Central - Jamestown	23	94	117
7	West Central - Bismarck	41	200	241
8	Badlands - Dickinson	11	58	69
	Total	267	876	1,143
* Although 16- to 21-year-olds appear to be reflected in two categories, there is no duplication of individuals since the individuals in this age group are served either by the School for the Blind or by the Department of Human Services. NOTE: The numbers on this schedule reflect services provided to individuals who are moderately or severely visually impaired. These agencies may provide additional services to less impaired individuals that are not reflected on this schedule.

Percentage of Visually Impaired Persons Served Each Year
No.	Region	Ages 0 to 21*	Ages 16 to 54*	Ages 55 and Over	Total
1	Northwest - Williston	12.5%	4.4%	13.1%	10.1%
2	North Central - Minot	87.0%	7.9%	6.3%	7.7%
3	Lake Region - Devils Lake	100.0%	2.5%	10.7%	10.1%
4	Northeast - Grand Forks	63.6%	7.2%	7.0%	8.0%
5	Southeast - Fargo	76.5%	3.2%	4.3%	4.5%
6	South Central - Jamestown	100.0%	5.7%	6.0%	7.0%
7	West Central - Bismarck	43.4%	3.1%	9.1%	7.7%
8	Badlands - Dickinson	32.3%	3.8%	6.9%	6.7%
	Total	60.7%	4.7%	7.3%	7.2%
* Although 16- to 21-year-olds appear to be reflected in two categories, there is no duplication of individuals since the individuals in this age group are served either by the School for the Blind or by the Department of Human Services. NOTE: The numbers in this schedule reflect services provided to individuals who are moderately or severely visually impaired. These agencies may provide additional services to less impaired individuals that are not reflected on this schedule.

OTHER VISION SERVICES

State Library

The State Library provides information services to visually impaired individuals. Services include books on tape, large print books, and a radio reading service called Dakota Radio Information Service. The talking book program is available to visually impaired persons in any region of the state. The program serves approximately 2,400 individuals. The Dakota Radio Information Service broadcasts live daily programs that provide information from local newspapers. The Dakota Radio Information Service is available in the majority of the Northwest, North Central, South Central, West Central, and Badlands regions. It is not available in the Lake Region, Northeast region, or Southeast region. The Dakota Radio Information Service has 570 listeners.

The schedule below presents the funding provided for the 1999-2001 biennium for vision services of the State Library:

State Library - Blind and visually impaired services
Salaries and wages - 4 FTE	$208,128
Operating expenses	19,000
Total all funds	$227,128
Less estimated income - Federal funds	156,880
Total general fund appropriation	$70,248

School Districts

Special education units provide vision services for visually impaired students attending public schools. The following types of services are provided to these students based on the individual student's needs:

• Orientation and mobility training - White cane travel, routes around home, and residential and commercial travel needs.
• Literary, Nemeth mathematics code, and music Braille instruction.
• Vision efficiency training - Training of eye motor skills for efficient focusing and reading.
• Concept development - Teaching concepts such as around, up, over, left, right, next, etc., without sight.
• Keyboarding instruction and computer operation - Keyboarding instruction in early elementary grades along with speech access and enlarging adaptation to computers.
• Social skills training - Facial expressions, manners, friendships, and how to handle frustration.
• Daily living skills training - Cooking, cleaning, shopping, handling money, dressing, etc.
• Parent training - Expectations of child, Braille, mobility, and how to include child at home.
• Training in gross and fine motor skills - Running, skipping, cutting, and signatures for blind.
• Evaluations - Functional vision and others.
• Teacher consultation - Train teachers on students and adaptations needed.
• Support group for students and parents - Students and parents meet as peer group.
• Mass and selective vision screenings - Vision testing in kindergarten and third and sixth grades in all schools.
• Training in organizational skills - Strategies are taught for organization in all aspects of life.
• Material adaptations - Materials need to be adapted into Braille, tactual, large print, audio.
• Provide low and high tech assistive technology- Assist in adapting computer technology for child.
• Liaison among medical profession, parents, and school.
• Vocational training - Work experiences, mentoring, job shadow, summer employment.
• Collaborating with outside agencies for transitions.

For fiscal year 1998, special education programs spent $484,129 on services for the visually impaired. Of this amount, an estimated $304,130 is provided by the local school districts, $138,558 from the state, and $41,441 from federal funds.

The schedule below presents the vision services-related FTE positions located in the school districts in each region of the state:

No.	Region	FTE Positions
1	Northwest - Williston	.50
2	North Central - Minot	1.00*
3	Lake Region - Devils Lake	1.30*
4	Northeast - Grand Forks	1.68
5	Southeast - Fargo	2.70
6	South Central - Jamestown	1.00
7	West Central - Bismarck	4.30
8	Badlands - Dickinson	.86
	Total	13.34
* These FTE positions serve in special education units that extend into more than one region.

Department of Human Services - Infant Development Program

From birth through age 2, a child who is blind or visually impaired may receive early intervention services through the Department of Human Services by participating in the infant development program. Services offered by this program include in-home assistance, parent training, occupational therapy, physical therapy, and speech therapy. The infant development program serves children with a number of development issues, one of which may be vision-related. However, if a child's only issue is vision, the infant development program generally refers the child to the School for the Blind, which then provides needed services to the child and family. The Department of Human Services provides infant development program services in all eight human service regions. The department contracts for services in the North Central (Minot), Lake Region (Devils Lake), West Central (Bismarck), and Badlands (Dickinson) human service regions. The department provides the services directly in the other four regions of the state. The 1999-2001 biennium budget for the infant development program totals $3,250,507, $2,187,792 of which is from the general fund.

Independent Living Centers

Independent living centers provide services to individuals with disabilities, including the visually impaired. Core service categories include:

• Independent living skills training.
• Peer counseling.
• Information and referral.
• Self-advocacy and systems advocacy.

A number of specific services are provided under each of these general categories based on each person's service need.

Independent living centers are located in Minot, Grand Forks, Fargo (with an outreach office in Jamestown), and Bismarck (with an outreach office in Dickinson). Funding for the centers is provided through the Vocational Rehabilitation Division of the Department of Human Services. For the 1999-2001 biennium, funding for the centers is estimated to total $945,245, $346,347 of which is from the general fund and $598,898 of federal funds.

The centers serve approximately 7,000 people each year. Because of the cross-disability nature of the independent living services, clients are not identified by specific disability.

BARRIERS THAT MAY RESTRICT ACCESS TO VISION SERVICES

The items listed below have been identified by representatives of the Department of Human Services, the School for the Blind, and the North Dakota Association of the Blind as barriers that may restrict individuals with visual impairments from accessing services:

1. Lack of health insurance coverage for vision rehabilitation services.
2. Fiscal disincentives for visually impaired individuals to seek employment.
3. Lack of awareness of the availability of vision services.
4. Lack of funding to provide additional needed services.
5. Time delays in determining an individual's eligibility for services.
6. Vocational rehabilitation employment program requires individuals to be seeking employment in order to access services.
7. Difficulties in reactivating cases that may have been closed.
8. Travel required to access certain services.
9. Fees required to access certain services.
10. Eligibility requirements associated with the level of vision loss needed to access services.
11. Fragmentation of services for adults because two agencies are involved in providing vision services.
12. Confusion regarding the appropriate service provider to contact.
13. Individuals may deny that they need services or may feel they would be unable to learn necessary changes.

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