Training for
Medical
Professionals
Shannon Myers, M.S., Certified Rehabilitation Counselor (CRC)
Employment Specialist
[email protected]
515-242-5746
Overview
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Understand Vision Loss
Resources, Services, and Training
Americans with Disabilities Act (ADA)
Reasonable Accommodations
Vision Loss Etiquette
Myths of Vision Loss
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Individuals who are blind see only darkness
– Only 18% of visually impaired are classified as totally blind.
Persons have better hearing/taste/smell/etc. to compensate for their vision loss
– Many learn to listen more carefully, or remember without taking notes.
Most individuals are proficient in Braille and own a guide dog
– Braille is something that needs to be learned and guide dogs are only effective if person is
proficient using a cane first.
Persons who are blind/ visually impaired cannot work or hold a job
– With proper training and accommodations, individuals can work competitively.
Accommodations on the job are too expensive for employers
– Most accommodations are under $500 and are easy to implement.
People who are blind or visually impaired cannot access print or handwritten materials
– Technology has made nearly all print accessible. Computer software translates print into
speech, magnify screen images, and enlarge text to readable sizes. Human readers take care
of the rest.
(Information obtained from IDBonline.org and afb.org)
How to Interact with Someone
with Vision Loss
• Interact with the person, not their disability.
• Introduce yourself by name, make eye contact, & use usual voice tone.
• When an individual who is blind/visually impaired enters the room,
identify yourself.
• Also, let them you are done with conversation when walking away.
• “See”, “Look”, and “Watch” are common words that should be used in
conversation.
• Be very specific when giving directions.
• Do not grab the arm of the person, offer yours instead.
• Do not interfere with an individual’s cane, and do not pet or feed their
guide dog.
• When in doubt, just ask. Most likely the person will appreciate that
you asked.
(Information obtained from American Foundation for the Blind web site)
Misconceptions
• Unfortunately, and inaccurately, people with disabilities are often
viewed as:
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Victims, or objects of pity
Burdens, either on society or on their family
Threat to comfort and safety of others
Assumed to be unable to do things
Having multiple disabilities
Special, Child-like, or Hero
Disability and Fear
• Reasons why disability is fearful
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Safety threat
Ambiguity, Salience, and Spread/Overgeneralization
Moral accountability for the cause and management of disability
Inferred emotional consequences of disability
Fear of acquiring disability
• Factors that contribute to attitudes
– Environment in which you interact with the individual
– Type of disability
– Your cultural background
Fear Factors
– Inferiority: The individual is seen as a “second-class citizen”.
– Pity: People feel sorry for the person and are patronizing.
– Hero Worship: People consider a person with a disability living independently to be
“special”.
– Ignorance: The individual is dismissed as incapable due to their disability.
– The Spread Effect: People assume that the individual’s disability affects other senses.
– Stereotypes: People make both positive and negative generalizations about disabilities.
– Backlash: People believe the individual is being given an unfair advantage because of
their disability.
– Denial: People may not believe that hidden disabilities are legitimate and therefore do
not need accommodations.
– Fear: People are afraid they will offend a person with a disability by doing or saying the
wrong thing and avoid the person as a result.
Overcoming Fear
• Openness and willingness to understand your biases,
culture, and assumptions
• Education, information, and training
• Exposure to individuals with disabilities
• Understand that learning can only come with interaction
with individuals with disabilities
What is Vision Loss
• Legal (Statutory) Blindness: central vision acuity of 20/200 or less in
better eye with correction or visual field of 20 degrees or less.
– With 20/200 visual acuity, a person can see at 20 feet, what a person with 20/20
vision sees at 200 feet.
• Visually Impaired: Reduction in vision that cannot be correct with
standard glasses or contact lenses.
– Reduces an individual’s ability to function at certain or all tasks.
• Functional Blindness: has barriers in environments and uses many
alternative techniques.
– Examples include reading a newspaper while listening to it.
Types of Vision Loss
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Macular Degeneration
Glaucoma
Cataracts
Diabetic Retinopathy
Cataract
 Clouding of the eye’s lens.
 Most cataracts are related to aging (very common in older adults).
Macular Degeneration
Blurs the sharp, central vision you need for “straight ahead” activities such as reading,
sewing, and driving.
Diabetic Retinopathy
Leading cause of blindness in American adults.
Cause: Blood vessels swelling and leaking fluid. Or abnormal new blood vessels
grow on the surface of the retina.
Glaucoma
Damages the eye’s optic nerve.
If left untreated, vision can be reduced to a narrow area known as “tunnel
vision” and then, total blindness.
Retinitis Pigmentosa
Rare, genetic disorder that involves a breakdown and loss of cells in the retina.
Common symptoms include difficulty seeing at night and a loss of peripheral vision.
Vision Loss Occurs
on a Spectrum
 http://www.eyesiteonwellness.com/eyediseases/?utm_source=Member%2BNewsletter&utm_medium=Email&utm_campaign=Q1%2B201
6%2BMember%2BNewsletter&j=1395662&[email protected]&l=46086_HTML&u
=83723229&mid=6323686&jb=0
Vision Loss
• About 80% of individuals who are blind have some
remaining vision.
• Service Provider/Employer Role: It may be difficult to
understand how and individual with a certain eye condition
can see some things while not seeing others.
• Ask the person to describe their vision loss and barriers in
various environments.
Eye Reports
Visual Acuity Notations and Abbreviations
VA
CC
SC
N
PH
OD or RE
OS or LE
OU
CF or FC
Visual Acuity
With Correction
Without Correction
Near Vision
Pin Hole
Right Eye
Left Eye
Both Eyes (together)
Count Fingers or finger counting
Eye Reports Continued
LP
LP or pro
NLP
F/F
20/40-2
20/50+2
Light Perception
Light Perception with projection
No light perception
Fix/Follow
Missed two letters on the 20/40 line
Read 2 letters on the line following the
20/50 line
Statistics
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56.7 million people
1 in 5 people, 19% of population
450,000 individuals with disabilities in Iowa
69,000 people are visually impaired, and of
that number 10,000 are blind
• 69,000 = Iowa City
• 10,000 = Pella
Loss of Vision Can Impact
• Ability to read
• Ability to drive/get around
• Independence such as setting time on microwave, oven, dials
on washer and dryer, etc.
• Access to service providers and employment
Services
• Vocational Rehabilitation: Vocational Rehabilitation agency for Iowans who are blind, visuallyimpaired, & deaf-blind and wish to become or maintain employment.
• Transition Program: Students aged 14 and up can apply for VR services.
• Independent Living: Iowans with vision loss aged 55+ or with secondary disabilities (nonvocational), provides support groups and vision loss resource fairs.
• Library for the Blind & Physically Handicapped: Materials in alternative formats for those
unable to read print due to vision loss, physical disability, or dyslexia. All available by mail, free of
charge.
• Business Enterprises Program: self-employment in vending or cafeteria business.
Accommodations & Alternative
Techniques
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Reading- Large Print, Braille, Audio, Screen Readers, Magnification
Writing- Wide Lined Paper, 20/20 Pen, slate & stylus, braille note taker
Measuring- Talking Scale/Thermometer/Calculator/Watch/Ruler
Independent Living- Adhesion dots, tactile items such as puff paint
Mobility- Cane Travel and using other senses
Braille/Transportation- hiring a driver, public transportation, car pooling
Computer- screen enlargement, screen reader
Hiring a driver/public transportation
Assistive Technology
• Screen Magnifiers- ZoomText
• Screen Readers- JAWS, NVDA
• Refreshable Braille Displays
• Closed Circuit TV(CCTV) & Video Magnifiers
• Smart Phones- Voice Over and Apps
TapTapSee, knfb Reader, Money Reader
Braille
Refreshable Braille
The Americans with
Disabilities Act (ADA)
Defines a person with a disability as a person who has an impairment
that substantially limits one or more major life activity.
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Types of Disabilities:
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Physical
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Cognitive
Psychiatric
Sensory
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The ADA and Employment
• Applies to employers who have 15 or more employees, including:
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Private employers
State and local governments
Employment agencies
Labor Unions
• Protects qualified individuals with disabilities from discrimination
• Allows individuals with disabilities an equal opportunity to work
• Applies to those applying for a position, interviewing for a
position, and working in the position
Reasonable Accommodations
• According to the Department of Justice government-wide
regulations, section 41.53,
• Reasonable Accommodation:
"A recipient shall make reasonable accommodation to the known physical or
mental limitations of an otherwise qualified handicapped applicant or employee
unless the recipient can demonstrate that the accommodation would impose an
undue hardship on the operation of it program."
Reasonable Accommodations
• A modification or adjustment to a job, the work environment, or the way things
usually are done that enables a qualified individual with a disability to enjoy an equal
employment opportunity.
• An equal employment opportunity means an opportunity to attain the same level of
performance or to enjoy equal benefits and privileges of employment as are available
to an average similarly-situated employee without a disability.
• Most accommodations are under $500 and easy to implement
• The ADA requires reasonable accommodation in three aspects of employment:
– 1) to ensure equal opportunity in the application process,
– 2) to enable a qualified individual with a disability to perform the essential functions of a job, and
– 3) to enable an employee with a disability to enjoy equal benefits and privileges of employment.
Reasonable Accommodations
• The reasonable accommodation must not pose an “undue
hardship” for the employer
• Definition of undue hardship: extensive, substantial, disruptive, or
fundamentally alters the nature or operation of the business
• Factors that determine undue hardship:
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1. Nature and cost of the accommodation
2. Overall financial resources of the employer
3. Overall financial resources of the parent company
4. Impact of the accommodation on the operation
Examples of Reasonable
Accommodations
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Making existing facilities accessible
Job restructuring
Part-time or modified work schedules
Acquiring or modifying equipment
Changing tests/assessments, training materials, or policies
Providing qualified readers or interpreters
Reassignment to a vacant position.
For additional information about reasonable accommodation under the ADA, visit
Reasonable Accommodation and Undue Hardship (EEOC Guidance):
http://www.eeoc.gov/policy/docs/accommodation.html
• Searchable Online Reasonable Accommodations (SOAR): http://askjan.org/soar/index.htm
Enforcement
The Equal Employment Opportunity Commission
(EEOC), the Federal agency that regulates and enforces
other employment discrimination laws, and is
responsible for enforcing ADA employment provisions.
Medical Exams and Disability
Inquiries Pre-Employment
• An employer may not ask or require a job applicant to take a medical examination
before making a job offer.
• Employer cannot make any pre-employment inquiry about a disability or the nature
or severity of a disability.
– An employer may ask questions about the ability to perform specific job functions and may, with
certain limitations, ask an individual with a disability to describe or demonstrate how s/he would
perform these functions.
Post-Offer
• An employer may condition a job offer on the satisfactory result of a post-offer
medical examination or medical inquiry if this is required of all entering employees
in the same job category.
• A post-offer examination or inquiry does have to be job-related and consistent with business
necessity.
• If an individual is not hired because a post-offer medical examination or inquiry
reveals a disability, the reason(s) for not hiring must be job-related and consistent
with business necessity.
• The employer also must show that no reasonable accommodation was available that
would enable the individual to perform the essential job functions, or that
accommodation would impose an undue hardship.
Overview of IDB
• The Department’s main office is in Des Moines, with field staff statewide.
• IDB is nationally recognized as a leading provider of services to individuals
who are blind or visually impaired.
• Providing services since 1925.
• Primarily funded through state and federal tax dollars.
• Iowa ranks 3rd in the nation in the percentage of individuals who are
blind/visually impaired successfully placed, employed and remaining in jobs.
• As of September, 2014, the average hourly wage obtained after completing
IDB’s VR Program was $16.81.
• People who are blind or visually impaired work in a broad variety of jobs and
professions …
Individuals with Vision Loss Work At:
KIRKWOOD COMMUNITY COLLEGE
WELLS FARGO
BICKLES BICYCLE REPAIR
RED CROSS
PIZZA HUT
TABOR MANOR
ROCK ISLAND ARSENAL
A PLUS LAWN AND LANDSCAPE
RUFFALO CODY
DELTA AIRLINES
PRINCIPAL FINANCIAL
PIZZA RANCH
RYAN’S FAMILY STEAKHOUSE
IOWA STATE
SEED SAVERS
VALLEY HIGH SCHOOL
HY VEE
ELECTROLUX
HOME DEPOT
PAPA JOHN’S PIZZA
HARRAH’S CASINO WALMART
YWCA
IOWA CIVIL RIGHTS
MARRIOTT
SKIFF HOSPITAL
DMACC
PDI
ACT
REGIS SALON
MEDIACOM
APAC
EDS
QWEST
NATIONWIDE
OSCO DRUG
JOHN DEERE
DOWLING HIGH SCHOOL
ROCKWELL COLLINS SIOUX CITY SCHOOL
EASTER SEALS
SODEXHO
MCDONALDS
DIAMOND JO CASINO
UPPER IOWA
FAREWAY
KRAFT FOODS
IVRS
And Do the Following Jobs:
ACCOUNTANT
FILE CLERK
COUNSELOR
MEDICAL SOCIAL WORKER
RECEPTIONIST
SCULPTOR
RESTAURANT MANAGER
VET TECH
PROOF READER
ATTORNEY
AUTO CAD OPERATOR
INSURANCE AGENT
COOK
CIVIL RIGHTS SPECIALIST
PASTOR
AEROBICS INSTRUCTOR
CHILD CARE WORKER
ELEMENTARY TEACHER
BAKERS HELPER
ELECTRICAL ENGINEER
LEGAL SUPPORT WORKER
PARKING LOT ATTENDANT
WOODSMITH
GRAPHIC DESIGNER
SPECIAL ED TEACHER
SUPERINTENDANT
ARCADE ATTENDANT
BICYCLE MECHANIC
CHIEF FINANCIAL OFFICER
GREETER
RESTAURANT HOST
COLLECTIONS AGENT
CAR REPAIRMAN
ELECTRICIAN
CHIROPRACTOR
GRAPHIC DESIGNER
COLLEGE PROFESSOR
JANITOR
NUN
BROADCAST ENGINEER
TEACHER ASSISTANT
MISSIONARY WORKER
TECHNICAL ANALYST
SALES REP
CASHIER
CHILD CARE WORKER
COSMETOLOGIST
AUDITOR
MASSAGE THERAPIST
DISHWASHER
CARPENTER
WRITER
CUSTOMER SERVICE REP
LAWYER
Vision Loss Etiquette
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Identify yourself when entering and leaving a room
Provide a tour of a new facility (new employee)
Describe setting, environment, and obstacles
Do not grab their arm to guide
Do not pet or feed a guide dog
Offer to read information
Do not touch or grab, ask or offer assistance
Extend your hand, announce it, if necessary
At the end of a conversation, let the person know when you are walking away
If you hold the door open for a person who is blind, tell them
Be specific when giving directions
When in doubt, just ask
Referrals
• Call and ask for our Intake Specialist: 515-281-1333
• Referral information can be found here:
http://www.blind.state.ia.us/form/referral
• How we receive referrals
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Doctors
Family members, friends
Service Providers
Self
How Can I Learn More?
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Web: www.IDBonline.org
Twitter: http://twitter.com/idbonline
Facebook: www.facebook.com/IowaDeptartmentfortheBlind
YouTube: www.youtube.com/idbonline
Blogs: www.idbonline.org/newsroom/blogs
Take a Tour/Request a Speaker: Contact Tiffany Bickell at (515) 281-1336 or, (800)
362-2587, ext 1-1336, or [email protected].
• Volunteer: http://www.blind.state.ia.us/volunteers/becoming-volunteer
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Support Groups across the State for those experiencing Vision Loss
http://www.iowablindhistory.org/living/support-groups
Resources for parents of children with vision loss: http://www.idbonline.org/resources-parentsblind-children
Famous People with Disabilities
Michael Jordan- Attention Deficit
Hyperactivity Disorder
Stevie Wonder- Retinopathy of
Prematurity/Blind
Ray Charles- Glaucoma/Blind
Albert Einstein- Autism
Tom Cruise- Dyslexia
Charles Schwab- Dyslexia
Ludwig Van Beethoven- Deaf
Ellen DeGeneres- Depression
Leonardo DiCaprio- Obsessive
Compulsive Disorder
Jim Carrey- Depression
J.K. Rowling- Depression
Brad Pitt- Depression
Billy Joel- Depression
Demi Lovato- Bipolar Disorder
Adam Levine- Attention Deficit Hyperactivity Disorder
Elton John- Bulimia
Angelina Jolie- Depression
John Hamm- Depression
David Beckham- Obsessive Compulsive Disorder
Franklin Delano Roosevelt- Vision Impairment
Sir Isaac Newton- Epilepsy
Shannon Myers, M.S., Certified Rehabilitation Counselor
Employment Specialist
[email protected]
515-242-5746