Community Health Report

SECOND SENSE

CHERYL MEGURDICHIAN

65 E. WACKER PLACE #1010

CHICAGO, IL 60601

312-236-8569/info@second-sense.org

Mission Statement

Second Sense inspires individuals to move beyond vision loss and believe in their abilities.  Through client-centered support and training, they learn new skills, build confidence and realize their value in our community.  Together we are changing society’s perception of human potential.

1. Identify the high risk/underserved and/or disadvantaged populations in the community(ies) that you serve and describe specifically the actions you have taken, based on relevant assessment data, to increase their accessibility to health services.

There are an estimated 242,406 adults (107,285 aged 65+) in Illinois with vision loss (CDC figures for 2012).  Studies show that vision loss is associated with higher prevalence of chronic health conditions, falls, depression, anxiety and social isolation.

• While only 4.3% of U.S. adults aged 65 or older live in nursing homes, the rates are significantly higher for adults who are visually impaired (16%) and blind (40%). (Rein, Zhang, et. al. JAMA Ophthalmology, 2006)

• Among older adults without vision loss, 70% reported engaging in physical activity; while only 59% of those with moderate or severe vision loss were physically active. (CDC Report)

• Seniors experiencing vision limitations were found to be twice as likely to fall as those who do not. In addition, fear of falling is common in seniors with vision loss, which can lead to lower self-confidence and a reduction in activities further deteriorating physical capability and quality of life.  (Durquette and Baril, Institut Nazareth & Louis Braille, 2013)

• In a study of 10,500 adults, those with vision loss were found to be 90% more likely to be depressed than those without an impairment. (Zhang, et. al., JAMA Ophthalmology, 2013)

• A study examining the implications vision loss has on everyday life found that vision loss is not only associated with functional problems, it lowers moral, reduces self-esteem, diminishes emotional security and reduces levels of social interaction. (Branch, et.al., Gerontology, 1989)

Vision loss compromises a person’s quality of life by taking away their ability to travel independently by car, public transit or foot.  It limits their ability to participate in favorite activities and to socialize with family and friends. (The State of Vision, Aging, and Public Health in America, CDC)

• Williams and colleagues (JAMA Ophthalmology, 1998) interviewed 86 seniors with age-related macular degeneration (AMD) and found their ratings for quality of life were substantially lower than those of seniors with no visual impairment, including seniors with several chronic obstructive pulmonary disease and seniors with AIDS.

• Comparing those with and without AMD, those with AMD were 8 times more likely to have trouble shopping, 13 times more likely to have difficulty managing their finances, 4 times more likely to have problems with meal preparation, 9 times more likely to report difficulty with light housework and 12 times more likely to have trouble using a telephone. (Alliance for Aging Research, 2006)

• A three-year study looking at how vision loss affects cognitive decline was able to make a link between the number of dropped valued activities and decline. Subjects who relinquished 3 activities were nearly four times as likely to experience dementia as those who dropped no activities.  When the number of relinquished activities increased to 5, the likelihood of dementia was 9.54 times higher.  (Rovner, Casten, et al. Alzheimer’s Dement, Jan 2009)

• Every 7 minutes another American becomes blind or visually impaired. They are so overwhelmed by the prospect of a lower quality of life that they are willing to trade 1 out of every 3 of their remaining years to regain perfect vision.  Those with no light perception are willing to trade 3 out of every 4! (Alliance for Aging Research, 2015)

Loss of vision increases significantly in those over age 65.  With the growing percentage of older adults, the number of seniors facing new vision loss will become a larger proportion of our population.

We provide our clients with the fastest path to begin their new life as an independent adult with vision loss. All of our services are offered free-of-charge to anyone with vision loss: no paperwork, no referrals, and no waiting period. Additionally, we are able to respond quickly and address each client’s immediate needs.

Since 2008 we have increased the number of clients served by 33%, providing direct service to over 500 clients each year and education and professional training to 2,000 individuals.

Our programs are designed to have a direct and immediate impact on the quality of our clients’ lives and to prepare them for more training.  Second Sense empowers our clients, encouraging them to take control of their lives, not become dependent upon our services.

2. Describe specifically the strategies you have used to gather input from high risk, underserved and/or disadvantaged population and their leaders as a basis for program or service development.

In 2003, we held focus groups with service providers and clients and surveyed our target audience to find what vision rehabilitation training they had received and what training they still needed.  We asked about services available in the Chicago area and experiences with other service providers.

We saw a need for client-centered vision rehabilitation training in the Chicago area. There were huge gaps in the training available and the population served.  Low vision optometric or vocational rehabilitation services were the focus of most agencies, with standardized training programs being the norm.  We also found that most vision rehabilitation training was not provided by professionals trained in vision rehabilitation, but rather by individuals with vision loss who were using their personal experience as the foundation for their training.

We developed a five-year strategic plan, changing our service model to focus on vision rehabilitation and provide direct training to our clients.  Second Sense offers both support and training programs to help our clients regain their confidence and independence.  All services are provided by vision rehabilitation professionals and offered individually or in small groups.

Second Sense works directly with our clients to determine their specific needs.  We seek input from them before, during and after training through both informal questions and formal evaluations to inform us during our strategic planning for new programs or services.

3. Describe specific partnerships with other providers and community-based organizations to promote continuity of health care for high risk/underserved and/or disadvantaged populations.

1. Our Vision Exchange program works with community-based organizations to reach seniors with vision loss. Our staff helps start new low-vision support groups and strengthen existing groups through leader training, workshop presentation and resources.  Resources include a section on our website devoted to materials for these group leaders, a manual (available in both large print and electronic formats), quarterly conference calls and an email discussion group.

Our partners include: Peace Village, Friedman Place, Village of Niles, Wheeling Township, Sights Unlimited, Park Ridge Public Library, Illinois College of Optometry, Niles Public Library, BOCOA, Swedish Covenant House, Monarch Landing, Waukegan Township Park Place, Mayslake: MLV Wellness Center, Glenview Vi, Vision Rehab, Presbyterian Homes, Bridgeway Senior Living, Skokie Public Library, the Admiral at the Lake, Breakers, Oak Lawn Tech Group and various Brookdale residences.

1. Second Sense has a partnership with the Veterans Administration to provide in-home technology training to area veterans with vision loss. The VA Blind Rehabilitation Center in Hines provides on-site training, but this requires residency at the Center.  Once vets have gone through this program, they still need ongoing training for new technology or updates to their software/hardware – this is the service we provide.

1. Second Sense has a more informal partnership with Hadley School for the Blind. They refer clients who are seeking direct, in-person training to us and we use and recommend their distance education as a supplement to our braille instruction and as an option for those who cannot get to our training sites.

4. Provide two examples of how you have used the community-oriented approach to program development specified in the attached principles to develop a program of service for high risk/underserved and/or disadvantaged populations specified in the guidelines.

Our first example of how Second Sense used the community-oriented approach to program development is our Vision Exchange program.  This program began by focusing on training and supporting low-vision support group leaders working in the community.  It has now expanded to include individual training for group members in their homes.

Documentation:  In addition to the research summarized above showing the need for seniors with low vision to get rehabilitation training, Second Sense staff has received feedback through personal communications and formal evaluations from both clients and service providers demonstrating this need.

Involvement:  Prior to launching this program, we worked with one client and one service provider who were interested in launching a low vision support group.  We worked closely with each, offering training materials (both our own and programs offered by Hadley School for the Blind) and ongoing support through personal meetings, phone conversations and email.  Over the course of one year, both successfully launched their groups.  We used this experience, including their feedback, to develop the full Vision Exchange program.

During our first two years of Vision Exchange, we received increasing requests for individual training.  We encouraged group members to come to our office, but travelling downtown was a deterrent.

Partnerships:  We developed partnerships with over 35 community agencies (see partial list above) and with other service providers to deliver this program in the community.  We work with the support group leaders at these agencies to improve their facilitation skills and help them integrate vision rehabilitation training into their meetings.  Staff travels to the different support groups to present workshops/training.  The leadership of these groups changes often, requiring ongoing support from Second Sense staff.

For the expansion to individual training, we encouraged group members to follow up the group training with individual lessons.  We current get about 80% of our off-site training clients through these groups.

Continuous Quality Improvement:  We reach out to participants (both support group leaders and group members) to monitor outcomes and resolve any problems.  Support group leaders are in regular contact with staff through personal and group email.  Participants in our individual training have case files open with staff and are asked to complete satisfaction surveys.

Financial Sustainability:  We received two years of funding to launch of this program and will continue to strategically use foundation funding to support the growth of this program.  We are in the third year of a federal grant to support the costs of a new staff person to deliver the offsite training to seniors.

Quantitative Information from FY2018:

Number of clients served:  152 support group leaders/1040 low vision seniors and 116 seniors received individual training.

Total amount budgeted by your organization for the program:  $153,257

Percent that program budget is of total agency budget:  18%

Percent of program budget that is directly reimbursed by third party payers:  59%

Percent of program budget that is covered by public/private grants:  33%

Our second example of how Second Sense used the community-oriented approach to program development is our Orientation and Mobility program.  This program provides training to adults with vision loss on orienting themselves to their environment and actively traveling through that environment to a set destination safely and efficiently.

Documentation:  This was the one training area mentioned most as needed by our clients: both through formal suveys/evaluations and information conversations.  It is also one of the training areas most requested by State counselors from the Department of Rehabilitation Services for their clients.

Involvement:  This service is provided individually.  Each client determines his or her own goals, training environment and training routes.  There is continual interaction between the client and the instructor throughout training, with the client given the ability to change/expand their training goals.

Partnerships: We receive referrals from the Illinois Department of Rehabilitation Training to train their clients and provide training to seniors living in residential facilities through our partnership with community-based support groups.

Continuous Quality Improvement:  Each client receiving training is given an assessment prior to training that examines current mobility and details client goals.  The instructors provide monthly reports to Second Sense staff detailing the training activity and progress made by the client.  The Director of Rehabilitation Services contacts each client six weeks after training begins to track progress, get feedback on the instructor and discuss any changes in goals.  Each client receives ongoing assessment for skills throughout training.  All of this ensures quality training and ensures desired outcomes.

Financial Sustainability:  Second Sense receives referrals from the Illinois Department of Rehabilitation services to provide this training to their clients who have vocational goals. We receive funding from The Stewardship Fund to train clients who qualify for state funding.  In addition, we are in the second year of a federal grant that funds vision rehabilitation training for seniors – including orientation and mobility.

We are seeking funding from new foundations and private individuals to support the expansion of this program.

Quantitative Information from FY2018:

Number of clients served:  96

Total amount budgeted by your organization for the program: $144,879

Percent that program budget is of total agency budget:  17%

Percent of program budget that is directly reimbursed by third party payers:  17%

Percent of program budget that is covered by public/private grants: 58%