Whitepaper On Rehabilitation and Training
REHABILITATION AND TRAINING
The American Council of the Blind is an organization of blind people with tens of thousands of members in seventy affiliates with members in every state of this country. At our Board of Directors' meeting on September 24, 2006 the Rehabilitation Task Force was instructed to prepare a White Paper on Rehabilitation and Training of people who are Blind which was to be ready for dissemination by the end of December. It was the Board of Directors' intention that this paper would respond to what we believe is a crisis in rehabilitation. The paper is intended to provide not only background to the current situation but also includes a series of recommendations which can be used by our affiliates and by other interested organizations in formulating their policies and attitudes towards this vital service delivery system which is responsible for the vast majority of adjustment to blindness services and placement endeavors for people who are blind in the United States. Herewith, then, is the paper.
BACKGROUND AND CONCERNS
At the end of the First World War, a large number of Americans who had fought in that conflict returned to this country having suffered significant vision loss. As a result, rehabilitation services were authorized to help these individuals and others with disabilities achieve employment and self-sufficiency. With the influx of huge numbers of additional disabled veterans after the Second World War, these services significantly expanded. The post-war period has been characterized by the gradual emergence of professional training for those in rehabilitation and to an expectation that people serving those with disabilities should be specifically certified. At the same time, the Federal government began the process of monitoring and evaluating the service delivery systems in each state. This has led to the emergence of a widespread belief that agencies ought to be evaluated by independent accrediting bodies. While services delivered by agencies authorized under this legislation have, at times, been custodial and demeaning, the disability rights movement has gradually created a rehabilitation system which recognizes that training and job-seeking are collaborative processes between counselors and customers at the heart of which is the notion of informed choice. This principle asserts that every customer of the rehabilitation process has the right to explore a range of rehabilitative options and that his or her wishes concerning these and other components of the rehabilitative process must be presumed to have merit. The process of developing and implementing rehabilitation plans is a joint activity. Both the agency represented by the counselor and the customer have responsibilities and there are expectations of performance that apply to both partners from the point at which the case is opened through and beyond final placement.
As the rehabilitation service delivery model has evolved, consensus has emerged throughout the blindness community that blind people are best served by agencies at the state level whose only responsibility is to serve those who are visually impaired. This position is based on the assumption that there are a range of services that must be provided to people who are blind which are substantially different from those required by people with other disabilities. Specific instruction in alternative communications approaches, access technology, orientation and mobility, and daily living skills are among the specialized components that are essential elements of the training that will enable a person who is blind to be successful. Over the past half century, public and private agencies have delivered these services in every state. By the 1980s such training services had matured into a model which was dominated by professional counselors who tended to have low expectations of "clients" and who gradually ceased to be innovative or self-critical. The net result was a rehabilitation system which patronized those it was supposed to help and which sought to limit the range of career options available to the blind people it "served". Partially as a result of this closed training model, a series of centers were encouraged and funded through the National Federation of the Blind which claimed to offer a real alternative to what they perceived as the demeaning and limiting services delivered by existing agencies. While the model espoused by such "centers" is still evolving, core components would seem to be emphasis on the need to develop a philosophical adjustment as well as learning adjustment to blindness skills, the need for long stays, the principle that blind people ought to have preference as teachers, the use of blind fold techniques for training all persons with some useable vision, and the gradual adoption of the notion of "structured discovery" learning. (`structured discovery" has, at its core, the principle that you should not tell people what to do or how to do it. Instead, it is expected that the learner will, through analysis and experiment, discover for him or herself how to accomplish the task being taught.) These principles have now begun to move beyond the specific NFB centers and are being adopted by many state-run agencies as well as by many private agencies. With the proliferation of NFB-MODELLED centers whose curricula are inflexible and apply to all who wish to attend, the availability of quality training options which honor the principle of informed choice are shrinking precipitately. Those agencies which have not adopted NFB-CENTERED approaches have tended to offer the "traditional" model of rehabilitation service delivery and still espouse many of the limitations which led to the creation of NFB centers in the first place.
Since 1980, the rehabilitation system which, until then, was essentially a monopoly has been increasingly challenged by two new candidates to deliver the same services. Earliest to emerge were independent living centers which have repeatedly asserted that they are better qualified to deliver rehabilitation services. Many have set up training services and job placement departments. While their notion that people with disabilities are uniquely qualified to help other people with disabilities optimize their adjustment to our society, their emphasis on a solution that applies equally to all disabilities and insistence that categorical services are not appropriate for people who are blind makes that model unacceptable to the blindness community. More recently, the one-stop system of comprehensive service delivery for people who are disadvantaged in various ways has been espoused by the current Federal administration. Despite immense pressure to make "one-stops" central to serving people with disabilities, workers are uncomfortable delivering service to people who are blind and lack the specific training and resources to make them an effective or appropriate service delivery option. As things stand now, all three systems are essentially competing for scarce dollars and for the hearts and minds of people with disabilities. While traditional vocational rehabilitation certainly represents the most appropriate service delivery model, it is seen by many as a failure since it has not significantly impacted the 70 percent unemployment rate among people with disabilities despite the allocation of substantial resources over the past half century.
Throughout its history, the American Council of the Blind has adopted resolutions and policies which have sought to clarify our position on what constitutes appropriate, quality rehabilitation services for people who are blind. The principles and recommendations in this document are based directly on policies previously adopted by this organization.
The American Council of the Blind reiterates our conviction that services should be delivered to blind people by state agencies which are categorical, have discreet budgetary authority, and operate with a separate rehabilitation council.
The American Council of the Blind believes that every blind person applying for services from an agency has the right to expect: to be accorded individual respect for his or her values as embodied in the principle of "informed choice"; to have access to all appropriate materials in accessible formats including, but not limited to, agreement of understandings, rehab manuals, state plans, employment plans, information on alternative rehabilitation options, information on appealing decisions including CAPS program brochures, and information on the Federal and State laws and regulations governing rehabilitation. Correspondence with the client shall also be in accessible format as shall any announcements of public hearings on the adoption of State Plans and public hearings of the state Rehabilitation Council.
The American Council of the Blind categorically asserts our belief that every blind person being served by any agency has the right to be treated with dignity and respect and that such client shall always be deemed as a partner in the rehabilitation process with the ability, at all stages of the rehabilitation process, to make "informed choices".
The American Council of the Blind asserts that people who are blind, like other people, have the right to expect society to make such changes to the built environment and to programs and activities operated by Federal, state and local governments that shall have the effect of forwarding the inclusion of blind people in the main stream of society. Examples of appropriate modifications in the rehab process include, but are not limited to: self-advocacy training which includes detailed instruction about those rights that the rehab act and the Americans with Disabilities Act allow, instruction in a broad range of access technology options, an understanding of braille, large print, taped and computerized information and where it should be made available, and all reasonable alterations in programmatic delivery which will make all communities more accessible to people who are blind. This principle asserts that blind people have the right to be fully included in our society and, to forward this end, public and private entities which serve the public are expected to take steps to assure that people who are blind can fully and, where possible, independently access the services or goods that are being made available to those who are not blind. Public and private agencies providing rehabilitation must be models of accessibility.
The American Council of the Blind categorically asserts that people who have some residual vision have the right to expect training that will optimize their ability to make use of what sight still remains to them. All agencies are expected to develop and implement low vision evaluation programs and to incorporate as core components of their training curricula low vision elements which shall include: training in using visual enlargement techniques to access print and technology, training in the use of low vision aids for reading and for distance vision, orientation and mobility training which will include both visual and non-visual approaches to orientation and way-finding, and, in general, the incorporation of such visual techniques into all aspects of training that will assure that the use of residual vision constitutes the primary means of adjustment to visual impairment.
As an extension of this principle, the American Council of the Blind believes that every person with a visual impairment has the right to be valued positively by training agencies regardless of his or her adjustment to vision loss. Each individual who meets any agency's criteria for services shall have the right to fully participate in the programs offered by that agency. Specifically, this organization believes that all visually impaired people are capable of making informed choices and no agency should be permitted to implement policies which deny access to programs based on a refusal by a person with residual vision to enter into programs whose only instructional components are non-visual.
The American Council of the Blind believes that a core component of every adjustment to blindness training program must be an exploration of the impact that blindness has on the individual adjusting to vision loss. Such training must incorporate an acceptance of partial vision as well as an acceptance of total blindness. It must begin with a rigorous effort to create a capacity for critical thinking in all trainees and must include a discussion of a broad range of philosophical notions rather than a reliance on any specific set of values. It must include a detailed analysis of what blind people can and should expect from society. It must take as a core value the notion that blindness should not be seen as a debilitating condition and must incorporate the widespread inclusion of successful blind people as role models. It must incorporate the notion of positive adjustment to blindness and should inculcate the notion of finding ways to do the things the individual wishes to do rather than focusing on those things blindness prevents people from doing. All programs should enlist the assistance of both the American Council of the Blind and the National Federation of the Blind and should encourage those adjusting to blindness to become involved in both organizations.
The American Council of the Blind believes that every person working in a professional capacity for agencies serving the blind should be specifically trained to serve blind people. The American Council of the Blind will work with universities providing such training to help to assure that their programs are more widely available as distance learning options and to see that they include the core components we believe all professionals must be provided to be effective workers.
The American Council of the Blind believes that all training programs must make access technology an inherent component of all training areas. We believe that computers have a role to play in orientation and mobility, daily living skills, communications, and personal management and that curricula in all these areas must be redesigned to include access technology.
The American Council of the Blind believes that the use of blind folds or sleep shades in the rehabilitation of people who are visually impaired, but not completely blind, may have value. However, we categorically assert that their use must be negotiated by the agency with the client and that they should only be used after the client has been taught to optimize his or her use of residual vision. A trial of sleep shades may be incorporated into the initial evaluation period as one of the potentially available pedagogical methods.
The American Council of the Blind believes that the use of a guide dog as an effective mobility aid is a legitimate choice for a person who is blind or visually impaired. Since the concept of "informed choice" is a meaningful component of the rehabilitation process available to people who are blind, it is essential that the agencies providing rehabilitation services and training conduct their programs in a manner that acknowledges that one legitimate result of informed choice for a person who is blind or visually impaired may well involve the use of a guide dog. Training facilities must be willing to remove barriers that discourage individuals who have made the choice and successfully completed training to use guide dogs from participating in their rehabilitation programs, including the stigmatizing of guide dog handlers. Gide dogs may be barred from participating with their handler during orientation and mobility lessons specifically aimed at improving cane technique. However, during all other agency activities, including orientation and mobility lessons, the dog and handler shall be trained as and treated as a team. The American Council of the Blind acknowledges that rehabilitation facilities should not be expected to be experts at training guide dogs. However, we believe that the principles of orientation and mobility are the same whether the visually impaired person is using a dog, an electronic travel aid, a white cane, or low vision aids. Thus, we believe that dog-users can benefit from and should receive orientation and mobility training with their dog. The American Council of the Blind believes that adjustment to blindness training will be effective only when training at a center is combined with careful, ongoing and monitored training once the customer has returned to his or her home community.
The American Council of the Blind believes that all agencies should encourage those who work there to participate in consumer organizations of blind people. We also believe that attendance at meetings and conventions of these organizations ought to be mandatory for professionals.
The American Council of the Blind believes that every agency, public or private, must set up meetings at least twice per year with the major consumer organizations so that ideas can be regularly shared.
The American Council of the Blind believes that every state should develop and implement a blindness caucus which will include legislators, consumers, professionals, and family members of those who are blind whose purpose will be to implement an ongoing comprehensive approach to meeting the needs of all blind persons in the state.
The American Council of the Blind believes that one of the first priorities of such a state caucus must be the expansion of service availability to older persons with vision loss who are woefully underserved at this time.
The American Council of the Blind believes that every state should have an early intervention program designed to serve babies and children with visual impairments. Each state program shall serve children up to the point where they can be seamlessly integrated into the rehabilitation program.
The American Council of the Blind believes that the rehabilitation of every person who is blind should be seen as a holistic process. Adjustment to blindness, training in the use of access technology, the provision of post-secondary education, where appropriate, and adjustment to living independently in a community must be seen as core components to such training. We believe that only when attention is paid to all of these components will the long-term unemployment rate of blind people significantly change.
The American Council of the Blind believes that insufficient attention is currently being paid to the specific needs of blind people with additional disabilities including those who are deaf and blind. We believe that the Rehabilitation Services Administration (RSA) should require the inclusion of specific State Plan components for these populations.
The American Council of the Blind believes that agencies operated under the auspices of National Industries for the Blind are currently playing an invaluable role in the rehabilitation of people who are blind. We believe that the regulations implemented by RSA to limit employment closures for individuals served by such agencies must be reviewed and repealed. Regardless of what is done, we believe that RSA and state agencies must work closely with such agencies to assure that the widest range of rehabilitation choices continue to be available for people who are blind.
The American Council of the Blind remains convinced that the Randolph-Sheppard program constitutes an effective and appropriate career option for people who are blind and urges RSA, state agencies and state rehabilitation councils to seek to expand available locations throughout the country and to encourage blind people to consider this career option.
The foregoing principles constitute a statement of the collective belief of the American Council of the Blind about rehabilitation. They are intended to guide our affiliates in their interaction with state and private agencies. It is also believed that these principles are at the heart of effective rehabilitation of the blind. As such, we will encourage other organizations and agencies to adopt these principles along with ACB. At their core is our belief that every blind person is valuable and has a right to expect to receive services that are delivered in a respectful and cooperative environment. We adopt these principles understanding clearly that they create responsibilities for blind people as well. Blind people must recognize that it is up to us to conduct ourselves in a manner that will lead to our full inclusion in society. Each of us must commit to be as independent and self-sufficient as we can. The American Council of the Blind believes that a society that fully engages and includes those Americans who are blind will be enriched and strengthened! Let us weave blind people into the tapestry of our nation through our rehabilitation system so that we can truly say that our society welcomes the immense talents and potential that blind people have to offer!