How One Blindness Agency Successfully Pivoted in Providing Essential Services in the Midst of a Global Pandemic

The Vision Loss Alliance of New Jersey is a nonprofit, founded in 1943, and is located in the state of New Jersey, approximately 35 miles northwest of New York City. The organization employs a small staff governed by a board of trustees. We employ 20 adjunct instructors who have expertise in providing blind rehabilitation skills training in different areas of practice. Our mission is to empower individuals with vision loss to live engaged, productive, and independent lives. We do this by providing support, education, skills training, and assistive technology to adults of all ages.

Leading up to March 2020, the Vision Loss Alliance of New Jersey was serving approximately 200 individuals through a variety of programs and outreach. We offer the following programs:

A Mobile technology program, teaching individuals to utilize the built-in accessibility features of iPhones and iPads.

A Better Health and Wellness program, which provides a holistic approach to vision loss that addresses the physical and psychosocial needs of people with vision loss.

An Introduction to Low Vision and Blindness Rehabilitation Skills, a one-day program designed for those adjusting to vision loss and their family members. The program includes a basic introduction to orientation and mobility, activities of daily living, assistive technology, home safety, and an overview of our other program offerings.

Low vision occupational therapy services for individuals who have limited vision to learn how it can assist them with performing daily living activities.

Effect of COVID-Related Shut Downs on Service Provision

In early March, as our programs were thriving, we were preparing to introduce a new pilot program for teaching computer accessibility using screen reading software. We began hearing about COVID-19 cases arising in the New York–New Jersey area. By mid-March, life as we knew it came to a halt, as the number of COVID cases began to rise dramatically. We witnessed businesses close, parks and recreation areas forced to shut down, and educational institutions close their doors. On March 13, 2020, within a matter of hours, a decision was made by our board of trustees to cancel all programs until further notice.

Statewide services for individuals with vision loss were also shut down indefinitely by the government, which included in-home instruction provided by the New Jersey State Commission for the Blind and Visually Impaired. There was no access to independent living or orientation and mobility training services in individuals’ homes and communities. Transportation options also became limited, as several counties and local paratransit services were suspended indefinitely. Individuals who relied on these vital services were no longer able to navigate the community to acquire basic needs. Due to recommendations by the Centers for Disease Control and Prevention, essential businesses were advised to implement strategies to enforce the six-foot social distance guidelines. These guidelines created additional challenges for individuals with vision loss due to the use of visual signage, highlighting where to stand in a line or marking the direction of travel in an aisle fears of contracting the virus were also a reality.

Creation of Virtual Classes and Programs

Our organization quickly pivoted to working remotely to discuss and design a series of virtual classes and programs that would recreate a sense of our in-person offerings. We selected the Zoom videoconferencing platform after researching several options, since it offers greater accessibility features for people who have low vision or blindness. We immediately launched a selection of virtual classes that were previously offered through our Better Health and Wellness Program, facilitated by our instructors, who are skilled in providing services to individuals with vision loss.

Since that time, our class offerings have continued to grow. We now offer 11 different classes throughout the week to keep individuals engaged and connected to each other, while addressing their physical and socio-emotional well-being. The topics of these classes include peer support, yoga, meditation and mindfulness, self-advocacy, Tai Chi, healing rhythms, and a variety of fitness classes.

Living Independently for Tomorrow (LIFT) Program

With the challenges of the ongoing pandemic and lack of rehabilitation services available, especially for individuals new to vision loss, we created a new program called Living Independently for Tomorrow (LIFT). The goal of LIFT is to provide individuals adjusting to vision loss and their family members with education, adaptive skills, strategies, and techniques to perform daily living activities safely, confidently, and independently.

Components of the LIFT program include:

Activities of daily living: pouring and measuring, labeling items, stovetop, and oven safety, cutting techniques, and kitchen safety basics.

Low-tech communications aka “simple solutions”: Using templates for writing, 20/20 pens, dialing a telephone, bump dots, creating tactile markings, identifying currency, and an introduction to helpful apps for daily living.

Introduction to orientation and mobility: Demonstrating and discussing human guide technique; upper- and lower-body protective techniques; using landmarks, cues, and clues efficiently; navigating doorways, steps, and uneven surfaces.

Introduction to low vision rehabilitation: Importance of lighting and contrast; use of handheld magnification, electronic magnification, optical character recognition-based technology; and a description of what low vision rehabilitation entails.

Service Delivery Model: A Transition From Live Instruction to Virtual Training

Traditionally, instruction for individuals with visual impairments (i.e., those who are blind or have low vision) is hand-under-hand, and it was out of necessity that LIFT was designed with heightened verbal descriptions to compensate for the lack of tactile availability. In developing the curriculum, our goal was to provide detailed descriptions to accommodate individuals having different levels of vision loss. This step-by-step process became necessary to help the student create a mental or conceptual image of the skill or item we were demonstrating.

Daily Living Activity Exercise Examples

To illustrate how certain daily living activity techniques were verbally described, the next section includes step-by-step instructions for measuring dry and liquid ingredients.

Measuring Dry Ingredients

The tools required for this technique are as follows:

A set of nested measuring cups. We recommend having a light and dark-colored set on hand to provide contrast for those individuals who have low vision.

Measuring cups and spoons that have been on the handles, using braille, large print labels, or HI-Mark pen.

A tray that serves as a work surface, to capture spillover.

During our instruction, we use white rice with dark measuring cups to illustrate contrast and demonstrate the actual skill of measuring in the following two steps:

Scoop the measuring cup into the bowl and fill the cup.

Use a knife to slide it across the top of the cup, pushing away the excess to assure an exact measurement.

When measuring spices, a person can put the spice in the palm to feel the amount. If using a spoon to measure, it may be helpful to use a wide-mouth container, which can be labeled for ease of identification (Duffy, 2016).

Measuring Liquids

The tools required for this technique are as follows:

A measuring cup designed for liquids, which helps with accuracy in measurements. We recommend using a glass Pyrex measuring cup with a one-cup capacity, which can be refilled, as necessary.

A Hi-Mark pen will allow you to create tactile marks on the measuring cup at different intervals.

For clients with low vision, measuring cups with large bold prints can be used.

When instructing individuals on how to pour liquids, we offer different solutions:

When pouring liquids into the measuring cup, feel for the opening of the container to ensure it is placed over the rim of the cup.

Listen to the sound when pouring to estimate the amount.

Hold the outside of the measuring cup to keep it stable and feel the change in temperature (Duffy, 2016).

We use videos from Hadley, with permission from the school, for reinforcement of more detailed topics, such as knife safety (Hadley, n.d.). These teaching strategies are further supported by family members, who can attend from wherever they reside, to reinforce these new concepts.

The format of the program is designed to provide instruction in each of the previously mentioned topics in two-hour segments over the course of four consecutive weeks. At the conclusion of each four-week LIFT program, participants are requested to complete an evaluation form to capture their opinions and feedback to determine the efficacy of our program. The evaluation form, available through Survey Monkey, consists of a mix of questions to elicit short answers and open-ended responses. It is vital to obtain feedback from our participants to make ongoing adjustments to the LIFT program and pursue funding for our program through grant requests.

Outcomes

When developing the outcomes for LIFT, it was important to capture how the program was perceived by the participants using the Zoom platform, as well as how the program was received overall:

How do we specifically measure the effectiveness of this program?

Have we achieved our goal of teaching individuals with vision loss adaptive strategies, skills, and techniques to create a sense of regained independence?

Have we accomplished this via the Zoom platform, using heightened detailed verbal description?

As of April 2021, the LIFT program has been virtually attended by a total of 29 participants ranging in age from 30 to 90 years of age. To date, 79% of participants felt they accomplished their goal by attending the four-week program, and 78% of participants were likely to recommend the program to their peers.

In regard to the question, “How can we improve your learning experience via Zoom?” the primary response was, “You provided a very clear description. The ideas and strategies came across well over Zoom.”

Additional feedback included the following:

“Organizing in the home, using labels, colors, bump dots, rubber bands, I had no idea there were so many resources out there to help.”

“This organization is unique in that it offers a combination of knowledgeable professionals who convey warmth and compassion to the participants.”

“So many things were learned, but the most important thing is the sense that I’m not alone, and that there's a caring community who is there for you and able to walk this path with you.”

For many individuals, the adjustment process to vision loss can be a complex journey. Although rehabilitative training skills tend to be a primary focus initially, learning how to be a self-advocate and communicate effectively is also a necessity. Self-advocacy can be a beneficial asset when navigating relationships with friends and family members. Identifying this need, gave rise to the development of a unique program, called STRIVE, which we launched in January 2021.

Strength Through Relationships, Insights, Values, and Education (STRIVE)

The STRIVE program, was designed to complement the LIFT program by providing individuals with vision loss, friends, and family members a platform to facilitate effective communication, and a mutual understanding and respect of each other's needs and values. STRIVE serves as a vehicle to create awareness, provide education, and offer helpful insights to strengthen relationships.

The STRIVE program is offered monthly and provides a combination of education and psychosocial support through presentations and group discussions, facilitated by a panel of individuals living with visual impairments. Our panel members bring different experiences into the group, by sharing their own personal journeys in how vision loss has had an effect on their own lives. One panel member is congenitally blind with light perception only, and the other three panel members have significant vision loss.

Topics covered in STRIVE include the most common eye conditions leading to vision loss, understanding the components of a low vision eye exam, and the various providers and specialists in the field. In addition, the group serves to provide a source of peer support to the members as they learn to adapt to living life with vision loss. The group is further enhanced by having mental health professionals serve as guest speakers, who offer coping strategies to help participants move toward acceptance and a sense of self-empowerment. The average attendance of this program is currently 12–15 individuals with vision loss and their family members.

These programs were conducted under the Ethical Principles for Medical Research Involving Human Subjects, as outlined by the World Medical Association Declaration of Helsinki. All subjects (aka participants) provided informed consent to these authors in participating in this article.

Discussion

The LIFT program has fulfilled an unmet need by providing participants with an introduction or a refresh of adaptive daily living skills to facilitate their adjustment to vision loss. It has also supported participants in functioning more safely and confidently in their home in completing daily living tasks. At the conclusion of the LIFT program, participants can move on to other programs and services. We provide them with a comprehensive resource guide that lists other agencies, services, and helpful products. We direct them toward the STRIVE program for ongoing learning opportunities and avenues to connect with others that are in the process of adjusting to vision loss. We also offer a wide selection of virtual weekly classes that support physical health, mental well-being, and a sense of community. These opportunities are currently provided at no charge to our program participants, as we have been awarded funding through grants and the generosity of individual donors.

The ongoing socioemotional effect of the isolation people have experienced during the COVID-19 pandemic is still being realized. Individuals experiencing vision loss as the pandemic started have had no access to services to facilitate their adjustment, both physically and emotionally. Although it is indisputable that nothing can replace face-to-face services, the virtual education and skills-based training our organization provides have been able to fill an important unmet need. It has offered people the opportunity to minimize feelings of loneliness and isolation, giving them a sense of reassurance. We have observed how these programs have positively influenced the lives of our participants, both in providing education in adaptive skills, and facilitation of their emotional adjustment to vision loss.

Various research studies are currently in process to evaluate the impact and effectiveness of participating in virtual learning opportunities during the pandemic. A recent study conducted in Israel, measured the efficacy of using the Zoom platform to address the potential ill effects of the COVID-19 pandemic on a sample of 82 adults, ranging in age from 65 to 90 years. It was found that the intervention provided through Zoom was beneficial in ameliorating the effects of loneliness in this group, although the discussion in the article references that further studies need to be explored (Shapira et al., 2021).

Conclusion

The COVID-19 pandemic has inspired us to rethink our strategies in how we design and deliver programs. In providing virtual programming, our participants are no longer restricted by transportation or distance limitations, which has allowed those outside our service area opportunities to join our programs. Although we do look forward to the time we will be able to open our doors to resume live programming, we have gained much experience in this unique situation that has affected so many aspects of daily life for which most individuals were not prepared. We are confident knowing that we have met the needs of the people we serve during this pandemic. We are planning to offer concurrent in-person and virtual programs going forward. As we look ahead and take this time to reflect on our experiences during the pandemic, we are hopeful to move forward, creating a revitalized future for our organization.