Chapter 2: Independent Living (IL) Training Service Models

The Department’s IL program service models include:

• I. Regional Cluster Service Training Model;
• II. Community-Based Training Model (group); and
• III. Independent Living (IL) Integration Training Model/Senior Orientation (group).

I. Regional Cluster Service Training (RCST) Model

In 2017, an RCST Model was piloted in Iowa. This pilot allowed for staff to provide individualized or group IL skills training over a period of three to four consecutive weeks within each identified service area cluster. Repeat sessions were provided if needed in the next service-delivery cycle. This model was found to be successful when compared to the results for clients who participated in a non-regional cluster model. The results when this model was employed included:

• A. clients retaining information between training or service visits;
• B. clients achieving objectives more quickly;
• C. clients experiencing greater satisfaction with the service delivery model; and
• D. contributions made toward managing finite program human and financial resources.

II. Community-Based Training (CBT)

A CBT is generally a six-hour group training (i.e., one day or split into two three-hour sessions) that provides Iowans experiencing vision loss or blindness an opportunity to learn basic non-visual independent living skills. The hands-on training is structured to boost individual self-confidence and often inspires participants to learn more. A CBT scheduled for less than six hours of training requires program administration approval.

Finally, the CBT provides participants an opportunity to meet other Iowans who are blind or losing their vision; gives them the opportunity to exchange information with each other as well as share experiences and provides opportunity for participants to learn from one another.

III. IL Integration

IL Integration is a group-training model sponsored by the Iowa Department for the Blind’s Blindness Empowerment & Independence Center (the Center) in partnership with the IL program. While somewhat similar to the SO model, there are some subtle differences. Some of the differences and benefits are summed up as follows:

• A. Where available, each IL program client is assigned to a Center student who has demonstrated a positive attitude about blindness and is willing to serve as a role model for others;
• B. Through the weeklong Center training exposure, IL clients have an opportunity to consider the Vocational Rehabilitation (VR) and Blindness Empowerment & Independence Center (the Center) program training and services;
• C. IL clients may network with other blind students who also use Center services and attend an integrated training session of the Business of Blindness class. This
  opportunity helps to broaden each participating IL client’s prospective related to skills and attitudes of blindness.
• D. This program frees up IL program human resources to allow most IL division staff to remain working in the field while program services are delivered primarily by
  Center staff.
• E. In the event that IL Integration is not available, SO will be made available and has the availability to host one week of training for program clients at the Department in Des Moines. It is designed primarily for individuals age 55+. Clients are given the opportunity to meet others who are going through similar experiences as a result of vision loss or blindness. Clients travel to Des Moines and spend a week devoted to learning and building non-visual skills that will help them adjust to their vision loss/blindness and build their confidence. IL division staff plan, coordinate, and deliver these program services related to this training model.

The Scope of IL & IL-OIB Core Training Services

Core training services include:

#1 Core Service: IL Adjustment to Blindness Counseling

Adjustment to blindness counseling services help people learn to manage feelings of anxiety, depression, anger, grief, and isolation and break the seemingly insurmountable into small steps according to their individual IL goals and objectives. Once people find they can accomplish one small task at a time, they begin piecing their successes together into a skill set for living life to the fullest in a new, happier way. In addition to individual adjustment to blindness counseling, family counseling may be provided when it is deemed necessary for improvement of the client’s ability to live independently.

#2 Core Service: IL Skills Instruction & Training Using Alternative Techniques

A. Mobility means the physical and psychological ability to travel to and from destinations in the community. This also includes orientation, meaning the ability of the individual to know where he/she is, where he/she wants to go and how to get there, as well as the ability to adapt and adjust to new environments;

This training is facilitated by using a long white cane and learning shades.

Communication includes the ability to effectively exchange information through spoken or written words, sign, Braille concepts, gestures, via assistive technology, aids or devices, or any other means. Training includes:

• Braille literacy to include reading and writing braille;
• Ability to place labels and meaning to objects, actions and concepts such as who, what, where, when, and how;

Assistive technology (AT) service and training may include:

• Learning about the long white cane and techniques in using the long white cane.
• Slates and styluses;
• Health management device information and training including talking scales;
• Talking thermometers, Frequency Modulation (FM) systems;
• Adaptive cooking items, writing guides, talking clocks, audio devices;
• Recorders, and phone amplifiers;
• Technology training to include:
  • Computers:
    • Using Talking Typer or Talking Typing Teacher;
    • What is Windows Narrator and NVDA;
    • How to turn on Narrator and train basic navigation;
    • Installing NVDA and train basic navigation;
    • Turning on Windows Magnifier;
    • Basic Windows low-vision accessibility settings.
  • Smart Device (iPhone, iPad, Android phone):
    • Overview of accessibility settings;
    • Making phone calls;
    • Adding contacts;
    • Setting calendar appointments;
    • Setting reminder;
    • Emailing
    • Texting
    • Voice assistant (Siri and Android equivalent)
    • BARD
    • Apps:
      • Seeing A.I./Android Equivalent
      • Be My Eyes
      • One Grocery Shopping App
      • ScripTalk
  • Provide Closed Circuit Television (CCTV) vendor referral, such as Easter Seals
  • Echo Devices and Google Home:
    • General instructions on how to use device to do such things as:
      • Make phone calls
      • Make grocery list
      • Order groceries
      • Calendar appointments
      • How to set up recipes
      • How to set alarms, timers, and tell time
      • How to access games

Daily living includes activities of daily living (ADL). The following are some routine activities where clients may be assessed to determine training assistance:

• Home-management including the ability to manage one’s own home living situation. Some basic training needs might include:
  • Meal planning and preparation;
  • Labeling household items;
  • Using home appliances;
  • Identifying clothing;
  • Telling time;
  • Managing personal finances;
  • Using a telephone;
  • Managing the laundry;
  • Threading a needle for sewing;
• Medication & health management systems:
  • Medication dispensing solutions;
  • Talking devices such as talking glucometer, blood pressure monitor, etc.
  • Accessible drug labels such as ScripTalk, a Quest Bar Code Reader; etc.
  • Talking scale for weight management.
• Leisure skills:
  • Iowa Library for the Blind & Physically Handicapped Services including completing an application, delivery of and instruction in the use of library equipment, and instruction related to ordering and returning materials;
  • Introduction and training on how to use Iowa Reading Radio Information Services (IRIS) for the Blind and Print Handicapped;
  • Introduction to and training on how to use National Federation of the Blind (NFB) Newsline;
  • Introduction to adaptive games or crafts.
• Transportation:
  • Identify public and private transportation options;
  • Identify volunteers to assist with transportation service support, if needed;
  • Identify financial options that would allow for access to public and private transportation, if needed.
  • How to use public transportation system; and
  • Cost of transportation and who is responsible to cover costs.
• Self-care, the ability to manage one’s own living situation, thereby allowing participation in training or other life activities:
  • providing information and referrals to other agencies or
    organizations to assist with self-care services not provided under the agency’s IL program;
  • guidance related to management of safety needs including available alert devices, emergency contact numbers and plan, etc.;
  • Secondary disability provision of available information or medial facts related to the disability, instruction in alternative techniques to address independent living that is non-medical in nature. When medical intervention is needed to address the secondary disability, the program staff shall talk with the client about service provider options and if appropriate make a referral. Document the discussion and referral.
• Self-direction training:
  • the ability to plan, initiate, problem-solve and carry out goal-directed daily living activities;
• Interpersonal skills training:
  • the ability to make and maintain personal, family and community relationships;
  • Information & Referral (I&R) includes the provision of information on available community resources and as necessary, assistance with the application process (and after application, where applicable)
  • Release & Exchange of Information will be obtained before information is obtained/exchanged.
  • When information is shared and/or referrals are made to other outside agencies where the individual is requested to make direct contact with the agency (i.e., not made directly by the IL division staff) and the individual can be located within the IDB/IL case management system (CMS), IL program staff should apply the following steps:
    • Attempt to reach out to the individual by phone, email, text message, or other preferred methods within a month of providing that referral or information.
    • Document if the individual was able to obtain the information needed from the source provided (i.e., outcome of the referral/information).
    • Document if other referrals/information is needed.
    • In the case where the individual is unreachable by phone, email, text message, or other preferred methods; IL division staff will document attempts to reach individual at least three times within a one-month time frame or less from the information/referral and add each attempt to the CMS. This shall be considered staff’s diligence to reach the individual for follow-up purposes.

Group Training Opportunities:

• CBT training model as defined under IL Training Service Model section.
• IL Integration as defined under IL Training Service Model section.
• ILSO as defined under IL Training Service Model section.

#3 Core Service: Independent Living Advocacy Training:

Personal advocacy training supports and promotes the individual’s right and ability to benefit from services, participate in activities, and develop new skills. This may also include learning to self-advocate for civil and human rights on a local, state, and federal level; and

In situations where an individual is unable to self-advocate, referrals could potentially be made to the appropriate agency. Some potential options may include, but are not limited to:

Iowa Disability Rights 400 E Court Ave #300, Des Moines, IA 50309. Phone: (515) 278–2502

Iowa Client Assistance Program (ICAP) 321 E 12th St, Des Moines, IA 50319.
Phone: (515) 281–3957

Office of the State Long-Term Care Ombudsman,
510 E 12th St., Ste. 2, Des Moines, IA 50319.
Phone: (515) 725–3333 or (866) 236–1430 |
Fax: (515) 725–3313

Iowa Olmstead Task Force at http://olmsteadrealchoicesia.org/.
This task force works on systems advocacy and addresses key priorities in the disability community such as:

• Ongoing enforcement of the Americans with Disabilities Act (ADA);
• Availability of home and community based services;
• Accessible housing;
• Public transportation;
• Managed health care services.

#4 Core Service: Peer Support Groups & Peer Counseling Peer Support Groups

The Department’s IL program assists to promote and facilitate the start-up of statewide support groups. While support groups are responsible for their own governance, membership, organizing meetings, agendas, and attendance, etc.; the IL program when requested will provide the support group’s leadership with information to help promote membership interest and ideas to increase attendance.

As invited and able to organize, the ILR teacher may attend support group meetings to present and/or as time permits to have a presence at regular meetings and meet new potential members who may be blind or losing their vision.

The IL program, with verbal and/or written approval from the support group leadership will partner to maintain an active listing on the Department’s website to provide information about the support group, contact information, meeting dates, time, and meeting location.

The IL program and its ILR teachers should:

Make a referral of individuals who have expressed interest in attending a support group in order to promote interaction with others experiencing vision loss or blindness.

Assist the individual to attend one of the closest; that is, in relationship to the client’s home, blind support group meetings in Iowa when identified under the client’s plan as a service need and when no other transportation service option can be immediately secured. When the closest support group is located outside of State of Iowa borders, should the ILR teacher need to attend the support group meeting that supports blind Iowans, steps must be taken to secure approval for out-of-state travel as follows:

Complete the Travel Department Authorization (TDA) as required by the State Accounting Enterprise.

Assist individual to identify transportation options or alternative options that would allow for future engagement to attend if desired (ex. FaceTime; conference call, etc.).

Peer Counseling:

The ILR teacher will make efforts to connect IL clients with a support group or experienced peer to promote adjustment to blindness or other disabilities. Release/Exchange of Information (ROI) is required to be in the client’s case file.

#5 Core Service: Transition Services From Nursing or Assisted Living Facility:

The IL program will continue work with individuals who have their own authority to transition from institutional settings to community living.

In addition to the IL training plan which should outline IL non-visual skills training need, IL program staff will assist these individuals with the following:

Pre-transition plan:

• Establish a support system (examples: nursing home staff, family member, friend, ombudsman, transition coordinator).
• Develop a realistic budget plan with the individual.
• When possible and if needed, counsel the client to interview the home care aides while still in the nursing home and look for aides that the client feels comfortable with and who have a schedule that would fit with their needs once they have transitioned.
• Identify housing:
  • Review types of housing;
  • Review locations of housing;
  • Get on a waiting list if needed;
  • Prepare furniture, household supplies, etc.; and
  • Identify community or other resources.
• Find out the discharge date. Many places cannot deliver furniture or medication until the new living situation is established.
• Identify local public and private transportation services as well as costs as soon as possible. If necessary and where available, apply for “paratransit.”
• Collect and organize important documents: birth certificate, Social Security card, state identification card, Medicaid and Medicare cards.
• Notify the postal service of the change of address. This can be done for free by filling out a change of address form from your local post office. You can also call 1–800-ASK-USPS (1–800–275–8777).
• if needed, apply for food stamps and/or food delivery, such as Meals on Wheels or senior centers where meals are served generally at no cost.
• Remind the nursing home that they should supply enough medication for 30 days at the time of the move. Make sure to have a list of current prescriptions prior to discharge.
• Locate a primary care doctor and if desired, set up medications so they may be delivered to the new home.
• Identify if employment is a goal. Whenever this is expressed, program staff must make an immediate referral to the VR program the Department’s VR
  Program where an application for services can be taken and a VR counselor assigned to meet with the individual. Contact the Department’s RS to make
  the referral at 800–362–2587 or 515–281–1333, then choose option #1.

Post-Transition:

• Assigned program staff will work in partnership with the client to determine if any post-transition IL training skill services and support systems are necessary;
• All services must be defined within a new or amended IL plan if changes are needed following the transition.