FY 200 Visual Impairment Services Team, VIST, Business Plan by kerryisalano


									FY 200 Visual Impairment Services Team, VIST, Business Plan Directions: This is a template, you need to make changes as they fit your station and circumstances.
VIST Coordinator: (Fill in name) Goal: Establishment of a Blind Rehabilitation Outpatient Services, BROS, program. Description: Establishment of an outpatient program for blind rehab services in our medical facility. A BROS provides rehabilitation services to visually impaired individuals serviced by the VIST program. The service may be provided in the medical center, at the veteran’s home, or in other locations in the community. A BROS normally has a background in Blind Rehabilitation with the requisite university preparation. BROS skill areas include; Orientation and Mobility, Activities of Daily Living, and Low Vision Therapy. Rationale: BROS provide critically needed rehab services to veterans enrolled in the VIST program. BROS are highly trained rehab professionals with expertise in various aspects of Blind Rehabilitation. They are a service delivery point within the developing Continuum of Care for Vision Loss. BROS may provide early intervention services that are targeted to reduce risk and negative outcomes. This is a critical consideration in issues such as safe medications management by visually impaired veterans. This aspect of BROS services has recently been brought to greater attention by the emphasis by Joint Commission on medications management. BROS may also intervene as a veteran prepares to attend or return from a Blind Rehab Center, BRC, assuring smooth community reintegration. Many VIST veterans are unable to attend a BRC and in these cases BROS provides critical adjustment services that allow these veterans to function successfully in their current living circumstances. This maintenance aspect of care is an important consideration of BROS services. Finally, BROS may work as an extension of local Low Vision Services. BROS do not prescribe optical blind aids. This is done by an Eye Doctor providing Low Vision services. BROS does provide in home follow up to ensure that aids are being used successfully in real life settings. This often includes the task of functional reading and relates back to issues such as medications management. Even veterans who use non optical methods of managing medications need periodic field evaluation to ensure safe practices. BROS are skilled in the assessment and training in non-visually techniques of marking medication bottles and other adaptive techniques.

VERA Considerations: In FY05 VERA considerations for VIST and BROS program veterans have changed. These veterans are categorized in a new VERA level, one roughly three times the rate of a normal vested veteran. To trigger this higher rate, the veteran must receive the appropriate treatment under the proper coding procedures. VIST and BROS are the service delivery points able to provide the proper coding procedures to invoke the elevated VERA rate. There is an added value in BROS services. A BROS is able to go out into the community to see veterans. This further ensures that veteran in a given year will be seen and maintained at a higher rate of VERA. Personnel Requirement: A BROS is normal a university trained individual at the Masters Degree level in the disciplines of Blind Rehabilitation (Orientation and Mobility Instructor, Rehabilitation Teacher, Low Vision Therapist). If a person from another discipline is recruited for the position, then a university training experience needs to be considered as part of the ongoing training requirements and the direct expense of starting the program. A BROS is in the following skill series: Get numbers of position from your HR department The position is normally recruited at the GS 11 position and promoted to the GS 12 level after the appropriate probationary period. Position Description: See the attached position description. Supervisory Considerations: The following position is recommended as the supervisor of the BROS position (needs to be filled in) Alignment of both VIST and BROS under the same supervisor is a recommended approach to supervision. Physical Plant Requirements: Office Requirements; The BROS office may also double as a teaching area. A space of at least 300 square feet is recommended. The office may be separate from the teaching area. An adequate space to set up workstations and an informal eye lane is required.

Ideally the BROS office and workspace is in close proximity to the VIST office. This assists with the logistics of moving patients. Related Costs/Requirements:   Start up Equipment: A recommended one time allowance of 20,000 dollars is suggested for beginning training equipment and supplies. Vehicle: A full time vehicle needs to be dedicated to the BROS program. This means provision of a vehicle through GAO, they all supply the gasoline and maintenance costs. Training at a Blind Center: This is associated with start up and entails the BROS being assigned to a regional BRC for cross training and other specific training as part of the start of the program. The home station pays for the off station expense. This training may or may not be necessary based on the background and credentials of the individual who is selected for the position. Though some time at the BRC is recommended for the smooth start up of the program. Travel: The position calls for travel and may entail being off station. It is estimated that the BROS will be off station at the rate of two nights per month. This entails lodging at government rates and perdiem. Education: It is encouraged the BROS maintain professional certifications through continuing education and that some ongoing education costs be figured into the budget. Also, it is vital that the BROS be funded for the annual training provided by BRS Central Office every August. Recurring Costs: The BROS program consumes a number of expendable training items and supplies. Also, there is the need to keep up with changes and advancement in technology and equipment for the visually impaired. It is recommended that a BROS Control Point be established with a funding level of at least $2,500 dollars per quarter be established.





Central Office Support: BRS Central Office supplies program guidance and review. A National Consultant will provide periodic program review and report to the Medical Center. Central Office is also responsible for guidance through a BROS Handbook, on going training, and Preferred Practice guidelines. BRS Central Office is willing to assist in recruitment and selection process if desired by the local station. Other Considerations:

BROS often do home visits and are under the same requirements as other VA health care providers who go into the home. This includes things such a CPR training, health screenings, etc. Cost Estimates:


First Year 20,000 GAO 2.500 3,000


Supplies Vehicle Continuing Education Training at a Blind Center Lodging Cost

Recurring Yearly Expense 10,000 GAO 2,500


Per Diem

Estimated at 24 nights per year at gov. rates Estimated at 36 days based on 12 two night travel sessions

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