Implementation of Low Vision Rehabilitation Advice for People with Intellectual Disabilities

People with intellectual disabilities are at a very high risk of visual impairment, often due to undiagnosed refractive errors and cataracts. Oftentimes, however, these people are being cared for in facilities that do not have knowledge about low vision, and do not know how to detect it. Low vision centers in the Netherlands take a pretty proactive role in screening for visual impairments in people with intellectual disabilities. However, it doesn’t help much if the advice these centers give, for example for glasses or lighting, is not followed up on by the intellectual disability facilities the people live in.

A recent study by Sjoukes et al. investigated factors influencing the implementation of low vision rehabilitation advice by facilities for people with intellectual disabilities. It was found that many staff at intellectual disability facilities are not sufficiently familiar with the advice given by low vison centers, because it is usually technical: “Beware that acoustic input is important,” just isn’t going to make sense to someone unfamiliar with vision loss, especially if they’re staff with generally only vocational training rather than care specialists. On the other hand, it sounds merely logical to say you should attempt to let the client hear rather than see things.

Implementation of advice given by low vision centers was reasonable to complete in only twenty out of sixty cases studied. Besides the fact that people may not be familiar with the advice, this is also due to the bureaucracy involved in implementing adaptations. If a client, for example, needs specific lighting accommodations, the staff are going to need permission from the management to change the home lighting. I can tell you that in the Dutch system, changing anything about the setting is going to create a lot of hassles.

Besides this, it usually takes at least four months between the initial screening for visual impairment and the advice report. This seems like forever to me, but then again indeed when I was at rehab, there were four months between my admission interview and the day I got my advice report, too.

The authors make the following recommendations to low vision centers to increase the implementation of advice they give:

• Only screen [for visual impairment] when the board of the service provider agrees to support the implementation of advice;
• Reduce the time between screening and advice;
• Write the advice concisely and in an easy to read style;
• Start the advice with a summary of the most important points;
• Offer follow-up by telephone 3-6 months after the advice;
• Make sure that carers are (and stay) familiar with the advice by mentioning it in the updated care plan;
• Make agreements that in case of (re-)building facilities for people with ID the low vision centre will advise on illumination and design to adjust buildings to the needs of people with ID and low vision.

Now let’s hope the intellectual disability facilities will cooperate, too.

Reference

Sjoukes L, Kooijman A, Koot H, Evenhuis H (2010), Rehabilitation of Low Vision in Adults with Intellectual Disabilities: The Influence of Staff. Journal of Applied Research in Intellectual Disabilities, 23(2):186-191. DOI: 10.1111/j.1468-3148.2009.00516.x.