- Email: [email protected]
Partners in low vision
International Congress Series 1282 (2005) 3 – 6
www.ics-elsevier.com
Partners in low vision Jacqui Armstrong Tameside Social Care and Health, Visual Impairment Stalybridge Resource Centre, Waterloo Road, Stalybridge, Tameside, SK15 2AU Greater Manchester, UK
Abstract. To examine the current level and value of the low vision service in Tameside and Glossop, and to build a model of preferred practice for the future service. It was discovered that: (a) Waiting lists were unacceptably long for assessments and provision of aids. (b) There was an unacceptable level of failure in the use of aids and therefore a high level of dwastageT in devices. (c) dFollow-upT and low vision therapy was patchy and not taking place in the home conditions where devices were to be used. (d) People were having to travel some distance for their appointments and there was a significant instance of missed appointments associated with travelling difficulties. (e) No liaison between medical, optometric and rehabilitation staff. In addition, a local service set in the community involving a multi-disciplinary approach should be initiated. Assessments were undertaken by local optometrists and rehabilitation workers and followup and low vision therapy were provided in the individual’s home by rehab staff. A pilot project of 12 months was undertaken and in the light of that project’s findings the service model was adjusted and the service mainstreamed. D 2005 Elsevier B.V. All rights reserved. Keywords: Partnership; Tameside; Rehabilitation; Consultation; Local
1. Introduction The partners in low vision model of practice for the low vision service in Tameside (a group of towns east of Manchester in the north of England) and Glossop (which is a small town bordering Tameside but which falls under the responsibility of Derbyshire local authority) followed an 18-month research project and a 12-month pilot study undertaken
E-mail address: [email protected]. 0531-5131/ D 2005 Elsevier B.V. All rights reserved. doi:10.1016/j.ics.2005.05.154
4
J. Armstrong / International Congress Series 1282 (2005) 3–6
by the Joint Strategy Group of Tameside MB Social Care and Health and West Pennine Health Authority. The main thrust of the research was consultation with all interested parties and the conclusions drawn reflected the views of professional and service users in equal measure. Whilst attention was paid largely to local opinion, services in other regions of the country were studied and organisations that could be considered to be major players in low vision were also consulted. The research was undertaken in Tameside, the subsequent service provided jointly by Tameside Metropolitan Borough, Social Care and Health and Tameside and Glossop Primary Care Trust and is therefore also available to residents of Glossop or to those who have a GP who practices in Glossop. Derbyshire Social Services department pay 14% of the cost of the low vision worker, based on percentage of population. 2. Historical background Tameside and its constituent towns have been shaped by its industries, agriculture, textiles, coal-mining and hat making, have all been major sources of employment over the last century in the area. At the time of the research the total population of Tameside was 221,270 of whom 40,256 were of pensionable age (this figure had risen by 5.5% (average) over the preceding 5 years). Older pensioners (75 years and over) showed an increase of 14.2% in the same period. They represented 35.9% of the elderly population and 6.5% of the gross population. A total of 1400 people appeared on the local authority registers for blind and partially sighted people. RNIB research, undertaken in 1999 but current at the time of the Tameside research, which suggests approximately 40% under reporting of significant sight loss, was accepted to calculate that in fact 5796 people in Tameside would be eligible for registration, 4396 of whom were unknown to the agencies involved in delivering services to visually impaired people. 3. Referral history There was only one route into the existing service and this was through consultant ophthalmologist referral. Most of these individuals had to visit a neighbouring town for assessment at a specialist optometry practice with a few being assessed in local optometric practices and buying devices privately. 4. Consultation (1) Carers. This presentation to an established Carers Forum met with average interest but no carers felt that they wished to contribute to the research. (2) Visually impaired people. Visually impaired people who met for various groups at the Social Care and Health resource centre were consulted in face-to-face interview. All individuals who had been registered as blind or partially sighted in the previous 2 years and who had been referred for low vision assessment and a random sample of those who had been considered inappropriate for low vision assessment were consulted. 50% were sent questionnaires and 50% received telephone consultations.
J. Armstrong / International Congress Series 1282 (2005) 3–6
5
(3) Professionals: 1. 2. 3. 4.
Members of the Visual Impairment Rehabilitation Team Local Optometrists Head Ophthalmologist Local Optical Committee. (4) Stakeholders group, which became the Low Vision Committee. (5) Residential and nursing establishments for older people.
5. Findings The findings showed that service users and professional shared a high level of dissatisfaction with the current model of practice; U U U U U U U U
A lack of equity in service provision. Long waiting times for appointments and further waiting to receive an aid. Long and time-consuming journeys—no local service. A perception that assessments were rushed and did not treat service users as partners in the procedure. No follow-up training and a low success rate with use of device. Difficulty re-entering the service for re-assessment and no home visits available. Narrow selection of aids available, few monoculars prescribed. No liaison between optometric, medical and rehabilitation staff. An alarmingly low awareness of visual impairment in general and use of magnification aids in particular was also identified in residential and nursing homes for older people in Tameside and this led to a separate piece of work within Social Health and Care. The consensus of opinion suggested that a low vision service should be:
U Local; U Accessible to all regardless of age, registration status and ability to pay; U Have short waiting times for assessment appointments and immediate supply of devices; U Include a functional assessment and offer a choice of aids, free of charge, based on the needs of the service user and not restricted to a single aid; U Have follow-up and easy re-entry to the service; U Promote liaison and co-operation between professionals. 6. The model of practice A local service, consisting of a specialist low vision worker with rehabilitation experience and training in low vision and 5 community optometrists, was set up for a 1year pilot study. The referral route to the service became open, giving visually impaired people various professional options to be referred from and the option to self-refer if they prefer.
6
J. Armstrong / International Congress Series 1282 (2005) 3–6
Service users received a functional assessment from the low vision worker whose recommendations informed a clinical assessment from the optometrists. The service users were supplied with aids following the clinical assessment. Follow-up was given by either the specialist worker or one of the rehabilitation workers from the Visual Impairment Service, all of whom had undertaken low vision training. The involvement of the Visual Impairment Service enabled swift cross referral for people needing rehabilitation input or other services. Service users would be recalled after 2 years if they had not presented in that time for a check up on their abilities with their aids. Unused aids would be reclaimed and re-issued. 7. Changes to the model in the light of the pilot study and subsequent practice The research had estimated an annual referral rate of 88 people based on the registration data available. In the pilot period 293 referrals were received and 239 assessments completed. The model of the specialist worker completing all assessments was therefore quickly abandoned and low vision trained rehabilitation workers also undertook assessments. Thirty-seven percent of assessments take place in the service users home. Aids are prescribed in relation to the task undertaken and service users are not restricted to a single aid. Monoculars are prescribed when necessary. Clinical assessments are not carried out on all service users, a criteria of need was written for guidance of the workers. 8. Ambitions for future service ! A re-evaluation of the effectiveness of the service thus far. ! Smoother re-entry into the service for re-assessment when sight deteriorates. ! Screening visits by non-low vision worker prior to low vision assessment (service users are often distracted by other issues such as travel passes and small aids and cannot focus on the low vision assessment until these are resolved). ! Low vision presence in new Primary Care Trust done-stop shopsT in local areas around the borough. ! Further work to break down inter professional barriers between health and social care staff. ! Regular ongoing service user feedback by personal contact with a knowledgeable interviewer. Acknowledgements The author would like to thank the following: Dr. Christine Dickenson—University of Manchester; Dr. Rob Harper—Manchester Royal Eye Hospital; Mary Bairstowe—Low Vision Consultation Group; Mr. J. Lipton—Tameside General Hospital; Mrs. T. Wood— Tameside and Glossop PCT; The Low Vision Unit RNIB (in particular Andy Fischer); George Mumford—Local Optical Committee; Lynn Reitze—Low Vision Worker; Royal National Institute of the Blind—for statistical information.
www.ics-elsevier.com
Partners in low vision Jacqui Armstrong Tameside Social Care and Health, Visual Impairment Stalybridge Resource Centre, Waterloo Road, Stalybridge, Tameside, SK15 2AU Greater Manchester, UK
Abstract. To examine the current level and value of the low vision service in Tameside and Glossop, and to build a model of preferred practice for the future service. It was discovered that: (a) Waiting lists were unacceptably long for assessments and provision of aids. (b) There was an unacceptable level of failure in the use of aids and therefore a high level of dwastageT in devices. (c) dFollow-upT and low vision therapy was patchy and not taking place in the home conditions where devices were to be used. (d) People were having to travel some distance for their appointments and there was a significant instance of missed appointments associated with travelling difficulties. (e) No liaison between medical, optometric and rehabilitation staff. In addition, a local service set in the community involving a multi-disciplinary approach should be initiated. Assessments were undertaken by local optometrists and rehabilitation workers and followup and low vision therapy were provided in the individual’s home by rehab staff. A pilot project of 12 months was undertaken and in the light of that project’s findings the service model was adjusted and the service mainstreamed. D 2005 Elsevier B.V. All rights reserved. Keywords: Partnership; Tameside; Rehabilitation; Consultation; Local
1. Introduction The partners in low vision model of practice for the low vision service in Tameside (a group of towns east of Manchester in the north of England) and Glossop (which is a small town bordering Tameside but which falls under the responsibility of Derbyshire local authority) followed an 18-month research project and a 12-month pilot study undertaken
E-mail address: [email protected]. 0531-5131/ D 2005 Elsevier B.V. All rights reserved. doi:10.1016/j.ics.2005.05.154
4
J. Armstrong / International Congress Series 1282 (2005) 3–6
by the Joint Strategy Group of Tameside MB Social Care and Health and West Pennine Health Authority. The main thrust of the research was consultation with all interested parties and the conclusions drawn reflected the views of professional and service users in equal measure. Whilst attention was paid largely to local opinion, services in other regions of the country were studied and organisations that could be considered to be major players in low vision were also consulted. The research was undertaken in Tameside, the subsequent service provided jointly by Tameside Metropolitan Borough, Social Care and Health and Tameside and Glossop Primary Care Trust and is therefore also available to residents of Glossop or to those who have a GP who practices in Glossop. Derbyshire Social Services department pay 14% of the cost of the low vision worker, based on percentage of population. 2. Historical background Tameside and its constituent towns have been shaped by its industries, agriculture, textiles, coal-mining and hat making, have all been major sources of employment over the last century in the area. At the time of the research the total population of Tameside was 221,270 of whom 40,256 were of pensionable age (this figure had risen by 5.5% (average) over the preceding 5 years). Older pensioners (75 years and over) showed an increase of 14.2% in the same period. They represented 35.9% of the elderly population and 6.5% of the gross population. A total of 1400 people appeared on the local authority registers for blind and partially sighted people. RNIB research, undertaken in 1999 but current at the time of the Tameside research, which suggests approximately 40% under reporting of significant sight loss, was accepted to calculate that in fact 5796 people in Tameside would be eligible for registration, 4396 of whom were unknown to the agencies involved in delivering services to visually impaired people. 3. Referral history There was only one route into the existing service and this was through consultant ophthalmologist referral. Most of these individuals had to visit a neighbouring town for assessment at a specialist optometry practice with a few being assessed in local optometric practices and buying devices privately. 4. Consultation (1) Carers. This presentation to an established Carers Forum met with average interest but no carers felt that they wished to contribute to the research. (2) Visually impaired people. Visually impaired people who met for various groups at the Social Care and Health resource centre were consulted in face-to-face interview. All individuals who had been registered as blind or partially sighted in the previous 2 years and who had been referred for low vision assessment and a random sample of those who had been considered inappropriate for low vision assessment were consulted. 50% were sent questionnaires and 50% received telephone consultations.
J. Armstrong / International Congress Series 1282 (2005) 3–6
5
(3) Professionals: 1. 2. 3. 4.
Members of the Visual Impairment Rehabilitation Team Local Optometrists Head Ophthalmologist Local Optical Committee. (4) Stakeholders group, which became the Low Vision Committee. (5) Residential and nursing establishments for older people.
5. Findings The findings showed that service users and professional shared a high level of dissatisfaction with the current model of practice; U U U U U U U U
A lack of equity in service provision. Long waiting times for appointments and further waiting to receive an aid. Long and time-consuming journeys—no local service. A perception that assessments were rushed and did not treat service users as partners in the procedure. No follow-up training and a low success rate with use of device. Difficulty re-entering the service for re-assessment and no home visits available. Narrow selection of aids available, few monoculars prescribed. No liaison between optometric, medical and rehabilitation staff. An alarmingly low awareness of visual impairment in general and use of magnification aids in particular was also identified in residential and nursing homes for older people in Tameside and this led to a separate piece of work within Social Health and Care. The consensus of opinion suggested that a low vision service should be:
U Local; U Accessible to all regardless of age, registration status and ability to pay; U Have short waiting times for assessment appointments and immediate supply of devices; U Include a functional assessment and offer a choice of aids, free of charge, based on the needs of the service user and not restricted to a single aid; U Have follow-up and easy re-entry to the service; U Promote liaison and co-operation between professionals. 6. The model of practice A local service, consisting of a specialist low vision worker with rehabilitation experience and training in low vision and 5 community optometrists, was set up for a 1year pilot study. The referral route to the service became open, giving visually impaired people various professional options to be referred from and the option to self-refer if they prefer.
6
J. Armstrong / International Congress Series 1282 (2005) 3–6
Service users received a functional assessment from the low vision worker whose recommendations informed a clinical assessment from the optometrists. The service users were supplied with aids following the clinical assessment. Follow-up was given by either the specialist worker or one of the rehabilitation workers from the Visual Impairment Service, all of whom had undertaken low vision training. The involvement of the Visual Impairment Service enabled swift cross referral for people needing rehabilitation input or other services. Service users would be recalled after 2 years if they had not presented in that time for a check up on their abilities with their aids. Unused aids would be reclaimed and re-issued. 7. Changes to the model in the light of the pilot study and subsequent practice The research had estimated an annual referral rate of 88 people based on the registration data available. In the pilot period 293 referrals were received and 239 assessments completed. The model of the specialist worker completing all assessments was therefore quickly abandoned and low vision trained rehabilitation workers also undertook assessments. Thirty-seven percent of assessments take place in the service users home. Aids are prescribed in relation to the task undertaken and service users are not restricted to a single aid. Monoculars are prescribed when necessary. Clinical assessments are not carried out on all service users, a criteria of need was written for guidance of the workers. 8. Ambitions for future service ! A re-evaluation of the effectiveness of the service thus far. ! Smoother re-entry into the service for re-assessment when sight deteriorates. ! Screening visits by non-low vision worker prior to low vision assessment (service users are often distracted by other issues such as travel passes and small aids and cannot focus on the low vision assessment until these are resolved). ! Low vision presence in new Primary Care Trust done-stop shopsT in local areas around the borough. ! Further work to break down inter professional barriers between health and social care staff. ! Regular ongoing service user feedback by personal contact with a knowledgeable interviewer. Acknowledgements The author would like to thank the following: Dr. Christine Dickenson—University of Manchester; Dr. Rob Harper—Manchester Royal Eye Hospital; Mary Bairstowe—Low Vision Consultation Group; Mr. J. Lipton—Tameside General Hospital; Mrs. T. Wood— Tameside and Glossop PCT; The Low Vision Unit RNIB (in particular Andy Fischer); George Mumford—Local Optical Committee; Lynn Reitze—Low Vision Worker; Royal National Institute of the Blind—for statistical information.