NEW YORK STATE

OFFICE OF CHILDREN AND

FAMILY SERVICES

 

 

 

 

 

 

 

Comprehensive Services Contract Guidelines

 

01/01/2014-12/31/2018

Revised 11/20/15

 

 

 

 

 

Comprehensive Services Contract Guidelines

Table of Contents

 

1.0         General Information

 

1.01    Introduction

1.02    Format

1.03    Information Applicable to All Contract Components

1.04    Assessment Process and Time Frames

1.05    Service Process and Time Frames

1.06    Rejection of Referrals

1.07    Cancellation of Referrals

1.08    Time Frames Reference Guide

1.09    Missed Appointments

1.10    General Documentation, Reporting and Meeting Requirements

1.11    Responsibilities of the NYSCB Counselor

1.12    Responsibilities of the Contractor

1.13    CIS Overview of the Electronic Case Folder (ECF) and Procedures for                                   Contract Outcome Services

1.14    Dispute Resolution

1.15    Quality Assurance

1.16    Recoupment for ALP and Vocational Rehabilitation Cases

1.17    Method of Determining When Payment should Be Recouped and                                             Recouping Payment

1.18    Closure Type Reduction for ALP-2E and ALP-3 Cases

1.19    Providing Written Communications in the Consumer’s Preferred                                              Format

1.20    Communications with Consumers who are Deaf/Blind

1.21    Communications with Consumers Whose Primary Language is                                    Other than English

1.22    Informed Choice

1.23    Confidentiality of Information

1.24    Personnel Standards

 

2.0       Adaptive Living Program (ALP)

2.01    Program Description

2.02    NYSCB and Contractor Responsibilities

2.03    Outreach and Referrals

2.04    ALP Outcome 1

2.05    Definition of Terms Used in Outcome Statement

2.06    Standards for Services Delivery

2.07    Role of NYSCB

2.08    Role of the Contractor

2.09    Criteria for Determining That a Person Has Achieved ALP Outcome #1

2.10    ALP 2, 2E and 3 Outcomes

2.11    Definitions of Terms

2.12    Differentiating ALP Programs

2.13    Services Provided Under ALP-2 and ALP-3

2.14    Standards for Service Delivery for ALP-2E and ALP-3

2.15    Role of NYSCB

2.16    Role of the Contractor

2.17    Criteria for Determining That a Person Has Achieved ALP Outcomes

 

3.0       Vocational Rehabilitation Services

3.01    Description

3.02    Assessments

3.03    VRT, O&M, Social Casework Assessment Outcome Statement

3.04    Terms Used in the Assessment Outcome Statement

3.05    Time Frame for Completing an Assessment and Providing Services

3.06    Integrated Service Delivery

3.07    Service Intensity

3.08    Determining Appropriate Service Levels During Assessment

3.09    Criteria for Determining that a Consumer Has Achieved the                                          Assessment Outcome

3.10    Assessment Documentation/Reporting Requirements

3.11    VRT, O&M, Social Casework Training Outcome Statement

3.12    Scope of Services

3.13    Orientation and Mobility Service Categories

3.14    Vision Rehabilitation Therapy Service Categories

            3.15    Social Casework Service Categories

3.16    Adaptive Equipment

3.17    Criteria for Determining that a Consumer Has Achieved the Service                            Outcome

3.18    Documentation/Reporting Requirements for VRT, O&M and Social                                          Casework Services

3.19    Authorizing Additional Outcome Services

 

4.0       Pre-Employment Skills – Prevocational Skills

4.01    Pre-Vocational Skills for Young Adults

4.02    Pre-Vocational Skills for Young Adults Assessment

4.03    Pre-Vocational Skills for Young Adults Assessment Outcome

4.04    Time Frame for Completing an Assessment

4.05    Conducting the Pre-Vocational Skills for Young Adults Assessment

4.06    Who Conducts the Pre-Vocational Skills for Young Adults Assessment  

4.07    Criteria for Determining that a Consumer has Achieved the Pre-Vocational Skills Assessment Outcome

4.08    Pre-Vocational Skills for Young Adult Outcome Statement

4.09    Pre-Vocational Milestones

Milestone A: Getting Started

Milestone B: Continued Career Exploration

Milestone C: Moving Toward Mastery

4.10    Standards for Service Delivery: Pre-Vocational Services

4.11    Responsibilities of the NYSCB Counselor and the Contractor

 

5.0       Pre-Employment Skills - Academic Instruction

5.01    Academic Instruction Assessment

5.02    Academic Instruction Outcome Statement

5.03    Terms Used in Assessment Outcome Statement

5.04    Time Frame for Completing an Assessment

5.05    Conducting the Academic Instruction Assessment

5.06    Who Conducts the Academic Instruction Assessment

5.07    Criteria for Determining that a Consumer has Achieved the                                           Academic Instruction Outcome

5.08    Academic Instruction Outcome

5.09    Terms Used in Outcome Statement

5.10    Standards for Service Delivery: Academic Instruction Services

5.11    Criteria for Determining that a Consumer has Achieved the                                           Academic Instruction Outcome

 

6.0       Pre-Employment Skills - Vocational Skills Training

6.01    Vocational Skills Training

6.02    Vocational Skills Training Assessment

6.03    Vocational Skills Training Assessment Outcome

6.04    Vocational Skills Training Assessment Standards

6.05    Time Frame for Completing an Assessment

6.06    Conducting the Vocational Skills Training Assessment

6.07    Criteria for Determining that a Consumer has Achieved the                                           Vocational Skills Training Assessment Outcome 

6.08    Vocational Skills Training Outcome

6.09    Terms Used in the Outcome Statement

6.10    Standards for Service Delivery: Vocational Training Services

6.11    Responsibilities of the NYSCB Counselor and the Contractor

6.12    Criteria for Determining that a Consumer Has Achieved the                     Vocational Skills Training Outcome

 

7.0       Pre-Employment Skills – Work Readiness Skills Training and Assessment

7.01    Work Readiness Skills Training and Assessment

7.02    Work Readiness Skills Assessment

7.03    Work Readiness Skills Assessment Outcome

7.04    Time Frame for Completing an Assessment

7.05    Conducting the Work Readiness Skills Assessment

7.06    Who Conducts the Work Readiness Skills Assessment

7.07    Responsibilities of the NYSBC Counselor and Contractor

7.08    Criteria for Determining that a Consumer has Achieved the Work                                             Readiness Skills Assessment Outcome

7.09    Work Readiness Skills Training

7.10    Work Readiness Skills Training Outcome Statement

7.11    Standards for Service Delivery

 

8.0       Pre-Employment Skills - Work Experience 

8.01    Work Experience

8.02    Work Experience Outcome

8.03    Terms Used in the Outcome Statement

8.04    Standards for Service Delivery

8.05    Responsibilities of the NYSCB Counselor and Contractor

8.06    Additional Contractor Responsibilities

8.07    Criteria for Determining that a Consumer has Achieved the Work                                 Experience Outcome

 

9.0       Provision of Additional Services

9.01    Orientation and Mobility Services

9.02    Vision Rehabilitation Services

9.03    Social Casework Services

9.04    Outreach/Case Finding

 

10.0 Forms

 

11.0 Appendices

 

           


 

 

 

 

GENERAL INFORMATION

1.0

 

 

 

 

 

 

 

 

 

 


 

1.01    Introduction

 

These Comprehensive Services Contract Guidelines provide requirements, procedures and other information needed by contractor and NYSCB staff as they implement the Comprehensive Services Contract.

 

1.02    Format of the Comprehensive Services Contract Guidelines

 

The Comprehensive Services Contract Guidelines contain the following sections:

1.      General Information

2.      Adaptive Living Program (ALP)

3.      Vocational Rehabilitation Services (Orientation & Mobility, Vision Rehabilitation Therapy and Social Casework)

4.      Pre-Employment Services (Pre-Vocational Services for Young Adults, Academic Instruction, Vocational Skills Training, Work Readiness, Work Experience)

5.      Additional Services

6.      Forms

 

1.03    Information Applicable to All Contract Components

 

The following apply to all components of the contract, except ALP Services.  ALP Services do not require that assessments or services be authorized by a NYSCB counselor. ALP consumers will have little or no direct involvement with NYSCB during the assessment and service process.  See the ALP section for further information.

 

1.04    Assessment Process and Time Frames

 

When a consumer is referred for a service that requires an assessment, the counselor will first authorize the assessment for that service.  After the assessment, an assessment meeting will be held and a determination will be made regarding authorizing services.  If the consumer has received services previously, the counselor will determine whether a new assessment is needed.

 

1.      The contractor must notify the referring counselor of the acceptance of the referral within 21 days of the receipt of the referral for the assessment.

2.      The assessment must be completed, the assessment report must be submitted to the referring counselor and a start date for services must be provided within 45 days of receipt of the referral for the assessment.

3.      The assessment meeting must be held prior to the authorization of services.  Service goals will not be considered approved and the assessment outcome will not be considered successful until an assessment meeting occurs.


 

4.      The assessment meeting will be scheduled by the contractor and will include the contractor, the counselor and the consumer.  The purpose of this meeting is to review the assessment, gather input from all participants, verify that all areas of training identified will meet the needs of the consumer and support their employment goal and reach agreement on the service intensity and frequency.  This meeting may occur in person or via teleconference.

5.      At the conclusion of the assessment meeting, any necessary revisions to the assessment report will be made by the contractor.  The contractor will include the date of the assessment meeting, a summary of the meeting and the service intensity and frequency in the assessment report. The report will then be submitted to the counselor for approval.

6.      The counselor will approve the assessment report and authorize the agreed upon services.

7.      Extensions of these time frames may be granted with district office supervisory staff approval.  These requests should only be made when absolutely necessary.  The request should be provided in writing and detail the basis of the extension request. District Office supervisors will only grant extension request substantiated by the consumer’s circumstances.

 

1.05    Services Process and Time Frames

 

1.      The contractor must notify the referring counselor of a start date of services within 45 days of the receipt of the referral for the assessment.  The service start date must be within 59 days of the receipt of the referral for the assessment.

2.      Upon completion of services, the contractor will arrange a meeting between the contractor, the counselor and the consumer to discuss goal achievement and any next steps.  This meeting should occur within 21 days of completion and should encompass all levels of each service authorized.  The meeting may occur in person or via teleconference.

3.      Reports for each authorized level of service will be submitted to the referring counselor within 30 days of the completion of services.

 

 

 

1.06    Rejection of Referrals

 

The contractor has the option to reject a referral for services if, in the opinion of the contractor, the referred individual will not benefit from the requested service(s); however, severity of disability is not a reason for rejection. The contractor should notify NYSCB of the rejection as soon as possible, but not longer than 30 days after the completion of the assessment.  If a referral is rejected, the contractor must provide the reason for not accepting the referral, as well as a description of the service(s) the consumer might benefit from as a prerequisite or an alternative to the service(s) requested.

 

 

1.07    Cancellation of Referrals

 

If services do not commence within 45 days of the receipt of the referral for a service, NYSCB may cancel the referral for purposes of obtaining services from another provider. 

 

1.08    Time Frames Reference Guide

 

Within 21 calendar days of the receipt of the assessment referral:

 

Within 45 calendar days of the receipt of the referral for the assessment:

 

Within 59 calendar days of the receipt of the referral for the assessment:

 

Within 21 calendar days of the completion of services:

 

Within 30 calendar days of the completion of services:

 

1.09    Missed Appointments – Vocational Rehabilitation Services

 

Consumers receiving vocational services have been notified by their counselors of their responsibilities to participate in services. Consumers should give notice to the provider as soon as possible if they are unable to keep scheduled appointments. For outcome services provided in the community, when a consumer fails to appear for the appointment, the service provider should notify the counselor that the consumer did not cancel and did not appear and document the date and time in a case note in the progress report.

 

 

 

 

 

1.10    General Documentation, Reporting and Meeting Requirements (additional requirements are included in some of the specific services sections)

 

1.        Contractors are responsible for completing reports accurately and meeting submission deadlines.  Copies of reporting forms are located in the Consumer Information System with instructions where needed.  Print copies of all forms are available at the end of this document.

 

2.        Contractors should note that NYSCB is unable to accept reports or attachments to reports that contain handwritten information as these are not accessible to those using screen reading software.

 

3.        A VR Plan Authorization is used by NYSCB to authorize all vocational rehabilitation services. When the authorization is approved by the NYSCB counselor, a Progress Report is automatically generated in the consumer’s Electronic Case Folder (ECF). The contractor will use the report to accept or reject the referral.

 

4.        After the assessment is completed, the contractor will arrange a meeting with the counselor and the consumer to finalize service goals and service intensity and frequency. This discussion can take place in person or by telephone.

 

5.        At the conclusion of the assessment meeting, the assessment report will be completed and submitted to the referring counselor.

 

6.        During service provision, the contractor will document consumer progress toward goal achievement.  At the conclusion of services, the Progress Report will be submitted to the counselor.  The following information should be included in the comments section of the report: the final results achieved by the consumer, comments about goal achievement, any challenges to goal achievement and other information that will assist the counselor and the consumer in planning for future services and employment.

 

7.        The contractor will arrange a final meeting between the service provider, the counselor and the consumer to discuss goal achievement and finalize the outcome level achieved and discuss any appropriate next steps. This discussion can take place in person or by telephone.

 

 

 


 

1.11    Responsibilities of the NYSCB Counselor (additional responsibilities are included in some of the specific services sections)

 

The NYSCB counselor is the service coordinator for consumers receiving vocational rehabilitation (VR) services. The counselor will work in partnership with the contractor to meet the requirements outlined in these Guidelines.

 

1.         Prior to the referral for an assessment or service, the counselor will discuss the purpose of the assessment and the services with the consumer including the consumer’s responsibility to actively participate in these services. 

 

2.         The counselor will make the referral by completing the VR Plan Authorization to the contractor for the assessment based on the consumer’s needs and vocational plans.

 

3.         The counselor will provide the contractor with all relevant information about the consumer pertinent to the service being referred for. This information may include: work history; education and training history; previous vocational training and competencies; adaptive technology related skills; medical information including low vision reports and information about secondary disabilities; cultural or language issues; education and vocational goals and rehabilitation needs. This information will enable the contractor to provide services and training in accordance with the consumer’s needs and vocational goal.

 

4.         The counselor will actively participate in the assessment meeting set up by the contractor and will let the contractor know if the assessment report and service goals are accepted.

 

5.         At the conclusion of the assessment meeting, the counselor will authorize the agreed upon services.

 

6.         As the service coordinator, the counselor will maintain contact with the consumer and the contractor regarding the consumer’s progress during service provision at least quarterly and will participate in the final meeting held at the completion of services.  During this meeting, the counselor, contractor and consumer will discuss and agree upon the goals achieved and approve any recommended revisions to the goals. The counselor with review the submitted reports and enter a successful or unsuccessful outcome.

 

 


 

1.12    Responsibilities of the Contractor (additional responsibilities are included in some of the specific services sections)

 

The contractor will provide assessments and services in accordance with these guidelines. The contractor will work in partnership with the counselor to meet the requirements outlined in these guidelines.

 

1.            Upon referral of the consumer by the counselor, the contractor will conduct an assessment.  The assessment will determine the consumer’s specific needs within the skill areas identified in the referral.  The contractor will have the consumer demonstrate all of the skills in each level when conducting the assessment and determining goals.

 

2.         The contractor will complete and submit the assessment report, detailing in the comments section of the report the specific needs that were identified during the assessment and the goals that have been established to address those needs.  If services are not recommended, the contractor will document the reason in the assessment report.

 

3.         The contractor will arrange an assessment meeting between the contractor, the counselor and the consumer to finalize training goals and agree upon service intensity and frequency.

 

4.         The contractor will make appropriate revisions to the assessment report and will enter the date the assessment meeting was held and the outcome of the meeting.

 

5.         The contractor will provide services in a timely manner in accordance with the agreed upon goals and level of service intensity and frequency.

 

6.         For those services that have multiple levels, at the beginning of each level of service the contractor will review the goals met previously, reinstruct as necessary and integrate the skills into the current training.  At the conclusion of services, the contractor will review the skills learned and reinstruct as necessary.

 

7.         The contractor will maintain communication with the counselor informing the counselor of achievement, recommended revisions to the service goals and/or problems in the consumer’s service program at least quarterly.

 

8.         The contractor will arrange a final service meeting to include the contractor, the counselor and the consumer at the conclusion of all authorized levels of services.

 

8.    The contractor will complete required forms, reports and other case documentation in accordance with the guidelines and timeframes in these Guidelines.

 

1.13    CIS Overview of the Electronic Case Folder (ECF) and Procedures for Contract Outcome Services

 

Contract outcome services (except for ALP services) are authorized through the Consumer Information System (CIS) used by NYSCB and contractor staff.  When a service is authorized to a contractor, the contractor staff are able to view certain forms in the consumer’s ECF and are able to report progress using Progress Reports that are located in the ECF.

 

Contractor staff are able to view the following forms in the consumer’s ECF:

 

1.        Demographic form

2.        Authorizations to their agency

3.        Service specific progress reports for services authorized to their agency

4.        Vendor referral forms if completed by the NYSCB counselor, and

5.        If low vision services are authorized, the Low Vision Evaluation Form.

 

The following information outlines the authorization, referral and reporting procedures.

 

1.      NYSCB counselors authorize contract outcome services using the VR Plan Authorization form.  These services are typically authorized after an individual has been determined eligible for vocational rehabilitation (VR) services.

 

2.      Some assessments can be authorized using the VR Diagnostic Authorization during the application/intake process, before a determination of eligibility is made.

 

3.      When an authorization is approved by the NYSCB counselor:

a.      An email notification is sent to contract agency staff who have the “contract assignee” role.  The contract assignee will determine who in their agency will have access to the consumer’s ECF.   The contract assignee will need to alert staff who may be serving the consumer of referrals for additional services.

b.      Service specific progress reports will automatically load into the consumer’s ECF.

c.      Contract agency staff will accept or reject the referral by entering the appropriate selection into the Agency Determination field on the Progress report.  The counselor will receive an email notification when the Agency Determination field is completed.

d.      Contract agency staff will enter the documentation specified in the service guidelines in the appropriate sections of the progress report.

e.      Contractors should note that NYSCB is unable to accept reports or attachments to reports that contain handwritten information as these are not accessible to those using screen reading software.

f.       When services are completed, contract agency staff will change the Agency Determination field to Outcome Achieved/Outcome Not Achieved, complete the remaining fields on the first page of the report and enter the Agency Signature Date.  The counselor will receive an email notification alerting them that the report has been submitted for review/approval.

g.      Once agreement is reached and the counselor accepts the report and fills out the NYSCB Determination field, the outcome will be considered successful and will be reflected in the contractor’s Reconciliation Report in CIS.

 

1.14    Dispute Resolution

 

If the provider is unable to come to agreement regarding an outcome of service with the counselor, the provider should first contact the senior counselor to discuss the outcome. If an agreement cannot be reached, the senior counselor or the provider may contact the district manager, who will then investigate the dispute and if necessary, assist in arriving at a resolution.

 

1.15    Quality Assurance

 

NYSCB will conduct quality assurance reviews with all Comprehensive Services Contract providers on a regularly scheduled basis. The reviews will cover all contracted services and will measure provider performance against contractual standards and contract guidelines. The quality assurance review includes an off-site review of randomly selected consumer case files, a consumer satisfaction survey and on-site meetings with direct service staff and administration. A report detailing the results of the review and any recommendations for improvement is shared with the provider and the NYSCB district office(s) in the provider’s catchment areas.

 

1.16    Recoupment for ALP and Vocational Rehabilitation Cases

 

NYSCB will seek to recoup payment for cases that, upon quality assurance review, are found to:

 

1.        contain egregious violations of the Comprehensive Services Contract Guidelines or,

2.        be seriously below NYSCB standards.

 

NYSCB will identify the criteria for determining an egregious violation of contract standards and what constitutes services seriously below standards.

 

The recoupment provision is not designed to address widespread or general performance needing improvement.  The recoupment provision will address only individual outcomes where the problem is most serious.  This could be:

 

1.        Cases where service quality is so poor or lacking that there could be, or was harm to the consumer (e.g. failing to serve a referred consumer).

 

2.        Cases where contract or guidelines were not followed, leading to circumvention, intentionally or not, of the normal contract and payment process (e.g. requesting payment for services prior to completion of services, serving someone who is not eligible for services).

 

1.17    Method of Determining When Payment Should Be Recouped And Recouping Payment:

 

This section outlines the methods for determining payment recoupment.  NYSCB will identify any cases meeting the criteria during quality assurance reviews and will:

 

1.        Notify the agency of the suspected finding at the exit interview and discuss if possible.

 

2.        Submit the details and attendant documentation of the suspected finding to the Director of Field Operations for review and approval of recoupment.

 

3.        Notify the agency in writing of the review findings and the Director of Field Operations’ decision.  If the Director of Field Operations approves the recoupment:

a.        if the case is still in the current year, status will be changed to “unsuccessful”, with no adjustment to outcome target number.

b.        if the case is from a previous year, the fiscal support unit will bill the agency accordingly.

 

4.        Conduct follow-up quality assurance activity within 6 months or less, as warranted. The agency may request an appeal of the decision by writing to the Associate Commissioner within 30 days of receipt of the Director of Field Operations’ decision.

 

1.18    Closure Type Reduction for ALP-2E and ALP-3 Cases:

 

All ALP-2E and ALP-3 cases are reviewed by NYSCB home office staff. It is presumed that all ALP-2 cases will at least meet minimum service delivery standards.

 

NYSCB will downgrade, immediately upon review, the outcome for ALP cases that are found to:

1.        Contain egregious violations of the Comprehensive Services Contract Guidelines,

 

Or

 

2.        Be seriously below NYSCB contract standards.

 

 

1.19    Providing Written Communications in the Consumer's Preferred Format

 

In order to communicate effectively in writing with consumers, it is important that consumers receive written materials in a format that is accessible to them.  The consumer’s preferred format should be entered into the Demographic form in the consumer’s Electronic Case File (ECF).  Once identified, all written communications must be sent to the consumer in this format.

 

1.20    Communications with Consumers Who Are Deaf/Blind

 

In order to communicate effectively with consumers who are deaf/blind, it may be necessary to secure the services of a certified interpreter.  Contractor staff must consider whether or not the services of a certified interpreter are needed in order for a consumer who is deaf/blind to participate in services.  NYSCB will pay for interpreter services for VR cases; it is the responsibility of the Contractor for ALP services.  Consideration of this need should be given during all aspects of the consumer's involvement with the contractor.

 

1.21    Communications with Consumers Whose Primary Language is Other Than English

 

In order to communicate effectively with consumers whose primary language is other than English, it may be necessary to secure the services of a foreign language interpreter.  Contractor staff must consider whether or not the services of a foreign language interpreter are needed for a consumer who does not speak English to participate in services.  NYSCB will pay for interpreter services for VR cases; it is the responsibility of the Contractor for ALP services.  Consideration of this need should be given during all aspects of the consumer's involvement with the contractor.

 

 

1.22    Informed Choice

 

Throughout these guidelines, reference is made to providing consumers with opportunities for informed choice as they develop goals and receive services.  This section provides information about the concept of informed choice and how to apply it during goal development and service provision.

Each consumer who is referred for NYSCB services must be given the opportunity to make informed choices about the selection of their goal, objectives and plan for services and the types of services and service providers.  The opportunity to make informed choices continues throughout the rehabilitation process.

 

Informed choice is a decision-making process in which the consumer is provided with relevant information on potential service providers and goals, and selects, in partnership with the NYSCB Counselor or contractor, a goal, objectives, services and service providers.  Through informed choice, the consumer participates fully in considering and choosing options for training and services to obtain his or her goal.

 

1.23    Confidentiality of Information

 

The Contractor will safeguard the confidentiality of all information relating to all consumers who receive services under the Comprehensive Services Contract, or whose names are provided to the contractor, pursuant to the Master Contract, and shall maintain the confidentiality of all such information in conformity with the provisions of applicable State and Federal laws and regulations.  An individual’s records shall not be released without the written consent of the individual, or as otherwise required pursuant to applicable State or Federal laws and regulations.

 

NYSCB requires the use of a Release of Confidential Information when requesting or providing oral or written information regarding a consumer.  In addition, special releases are required for providing or obtaining oral or written information about consumers with special circumstances (e.g. HIV, substance abuse).  Refer to Section 10.0, Forms, of these Guidelines for associated Release of Confidential Information forms.

 

This provision applies to ALP consumers as well as to individuals in the VR program.

 

1.24    Personnel Standards

 

Contractors should submit credentials for all newly hired service providers to the nearest NYSCB District Manager in accordance with the standards in Appendix C: Personnel Standards, of the Comprehensive Services Contract. The District Manager will forward the credentials to NYSCB Director of Field Operations.

 


 

 

 

ADAPTIVE LIVING PROGRAM (ALP)

2.0

Services

ALP 1 Assessment

ALP 2 Outcome

ALP 2-E Outcome

 

Applicable Forms

ALP Intake Form

ALP Assessment Form

ALP Individualized Service Plan (ISP)

ALP ISP Report


ADAPTIVE LIVING PROGRAM (ALP):  GENERAL INFORMATION

 

2.01    Program Description

 

The goal of the Adaptive Living Program (ALP) is to make a comprehensive package of rehabilitation services available to individuals who are legally blind, over the age of 55 and not seeking or engaged in competitive employment.  The ALP Program includes the evaluation of an individual’s service needs within the framework of their personal goals, abilities, and resources, and the provision of appropriate types and amounts of services to promote individual achievement of rehabilitation goals.  It is the intent of NYSCB that individuals identified and served will achieve the highest level of self-confidence, self‑sufficiency and independence allowed by each individual's life circumstances and interests in accordance with their established goal and NYSCB policy.  Each person's accomplishments will be measured by whether or not the consumer has achieved the goals identified in their Individualized Service Plan (ISP).

 

The Adaptive Living Program consists of four components:

 

ALP-1:         Assessment, eligibility recommendation, and service plan development.

 

ALP-2:         Rehabilitation services provided to an older individual to assist him/her to achieve a greater level of safety and confidence in their living environment.

 

ALP 2-E:     Enhanced rehabilitation services provided to an older individual who requires services in excess of the typical ALP-2 program in order to achieve his/her goals.

 

ALP-3:         Rehabilitation services provided to an older individual who meets eligibility criteria for ALP-2E, has significant needs AND primary responsibility for managing the home.

 

The Contractor is responsible for developing and implementing program strategies that result in the contractually specified number of consumers reaching the identified outcomes.  It is expected that consumers served under this portion of the contract will:

 

1.      Participate fully in planning an individualized program which will help them acquire appropriate services;

2.      Learn new ways to perform specified daily activities;

3.      Be assisted to make use of their residual vision and/or learn to do tasks using other senses such as hearing or touch; and

4.      Obtain access to the available social and community supports needed to enable them to live more satisfying and self‑sufficient lives.

 

2.02    NYSCB and Contractor Division of Responsibilities:

 

Consumers served under this program will have very limited, if any, contact with NYSCB staff; the majority of their interactions will be with contractor staff.  For individuals served under ALP, the contractor determines eligibility for services and develops the individualized service plan.  All outreach, assessment, goal development, and service delivery will be conducted and managed by contractor staff.  Contractors can begin to provide needed services to individuals served under ALP after a referral is made or the contractor reserves the consumer through the NYSCB Consumer Information System (CIS).

 

2.03    Outreach and Referrals

 

If referral numbers are too low to achieve the outcomes, contractors will be expected to conduct outreach efforts to inform potential candidates in the service region about the program and encourage them to apply.  It is anticipated that NYSCB will regularly furnish contractor agencies with information about individuals who are newly identified as legally blind, in order to assist with contractor outreach efforts. 

 

In areas where more than one contractor serves a given region, the contractor must provide the individual with information to choose available agencies.  If a consumer prefers services from another agency, the contractor who made the original contact with the individual must refer the consumer to the preferred agency.

 

NYSCB expects that contractors will contact NYSCB Home Office staff:

 

1.        To discuss problems with a consumer referral.

2.        To develop ways to enhance program quality.

 

2.04    ALP Outcome #1

 

An agreed upon number of consumers will complete an assessment which will provide information necessary for NYSCB to determine eligibility for service and result in a comprehensive, mutually agreed upon written statement of the anticipated outcomes of service participation [Individualized Service Plan (ISP)].

 

2.05    Definition of Terms Used in Outcome Statement

 

Assessment:  A comprehensive evaluation of individual consumer’s needs, interests, abilities, and preferences, which will be consistent among all contractor agencies across the state, and will give all consumers an opportunity to receive services targeted to their specific circumstances.  It is intended to be a pre‑service assessment.  In conducting this evaluation, contractors must, at a minimum, complete the NYSCB ALP Assessment Tool in CIS.

 

2.06    Standards for Service Delivery

 

1.      In addition to evaluating needs, the assessment will evaluate the consumer’s interests, abilities, and preferences.

2.      The assessment will provide the information necessary to determine the level of service for which a consumer is eligible.

3.      The result of assessment will be an individualized plan for service delivery, (ISP), identifying the consumer's goals of participation and the services that will be delivered.

4.      Consumers' informed choice will be reflected in the individualized goals developed as a result of the assessment process.

5.      Individualized plans for service delivery will, when appropriate, integrate the services that the contractor directly provides with appropriate community linkages.

6.      In some cases, a consumer may complete an assessment with one contractor, but choose to receive services from a second contractor.  The assessment results must be shared with the second contractor who will initiate the services and may not repeat the assessment process.

7.      Consumers appropriate for employment services will be referred back to NYSCB.  These individuals, however, cannot be counted as achieving ALP Outcome #1, even if the assessment has already been completed.

 

2.07    Role of NYSCB

 

1.      Refer potentially eligible individuals, who come to the attention of NYSCB, to contractor for assessment and information gathering;

2.      Coordinate the transfer of consumers from the contractor that identified the individual to the contractor selected to provide services.

 

2.08    Role of the Contractor

 

1.      Conduct outreach activities to identify individuals who may be appropriately served under ALP.

2.      Screen individuals referred by NYSCB to rule out those who are clearly not eligible.

3.      Obtain information that documents that the consumer is legally blind. The following methods can be used to obtain documentation of legal blindness.  The contractor should provide assistance to the consumer in obtaining documentation using one of the following methods:

a.         Obtain a NYSCB Medical Eye Report (Form 3451) from an ophthalmologist, or

b.         Obtain a NYSCB Report of Legal Blindness/Request for Information with Part A completed (OCFS 4599) from an ophthalmologist or optometrist, or Obtain a letter from an ophthalmologist or optometrist that states that the individual is legally blind, or

c.         Obtain documentation that the individual is receiving SSDI or SSI because of legal blindness, or obtain school records signed by an M.D. or O.D. that documents that the individual is legally blind, or obtain records from a medical clinic, hospital or other medical facility that documents that the individual is legally blind.

4.      Complete the Demographic Information form found in CIS.

5.      Complete the ALP Intake Form in CIS.  For individuals who will be served under the ALP program, determine if the individual is eligible to receive services using all of the following criteria:

a.        Individuals must be legally blind, age 55 or older, legal residents of New York State and not seeking or engaged in competitive employment.

b.        The individual does not meet the criteria for VR eligibility, but has significant responsibility for caring for him/herself and/or the living environment, although the individual may receive assistance with some tasks.

c.        The assessment has established a need for the individual to achieve a greater degree of safety, confidence, and/or personal independence in his/her daily life activities.

d.        Individuals residing in nursing homes are presumed to have little or no responsibility for caring for themselves and/or their living environments and are therefore not eligible.  Individuals residing in other congregate housing settings may be eligible as long as they meet all of the eligibility criteria and have significant responsibility for caring for themselves and/or their surroundings. Individuals in short term physical rehabilitation programs with the goal of returning to their home environment may be eligible for ALP-2 services.

e.        Individuals may not have received NYSCB services within the previous 24 months, unless a waiver due to exceptional circumstances, such as a change in residence, the loss of a key support person, or a substantial additional loss of vision, is granted by NYSCB Home Office staff.

6.      Using the Assessment Tool for the Adaptive Living Program in CIS, conduct an assessment and gather information needed by NYSCB to determine whether the consumer is eligible for ALP-2, ALP-2E or ALP-3 by assessing the consumer's rehabilitation needs and interests, available supports, the basis for eligibility, and other pertinent information.  If the consumer is not eligible, declines services, or cannot be reached, indicate circumstance in a narrative statement.

7.      Individuals served under ALP-2E need services beyond the typical level of ALP-2 services and these needs must be identified during the assessment. Individuals served under ALP-3 need services beyond the level of ALP-2E services.  To qualify for ALP-3 services, the individual must have significant needs AND primary responsibility for managing the home.

8.      Complete the ALP Individualized Service Plan (ISP) in CIS. Provide a copy of the ISP, in consumer's preferred format, to individuals eligible for services under the ALP program.

9.      Provide services.  At the completion of services, complete the ISP Progress Report in CIS.

 

2.09    Criteria for Determining that a Person has Achieved ALP Outcome #1:

 

In order for a person to be reported as having achieved ALP Outcome #1, each of the following criteria must be met:

 

1.      The consumer has had input into and agrees with the individualized goals which resulted from this assessment.

2.      The consumer's needs, abilities, interests, and preferences have been evaluated and incorporated into the preparation of the ISP.

3.      The person meets the eligibility criteria for services under ALP-2, ALP-2E or ALP-3.

4.      The ISP includes the consumer's goals and the services to be provided.

 

2.10    ALP 2, 2E and 3 Service Outcomes

 

Consumers who meet the definition of eligibility for ALP services will demonstrate, in a manner acceptable to NYSCB, that at the time they complete services they are able to use the skills and/or access supports identified in their Individualized Service Plan (ISP).

 

2.11    Definitions of Terms

 

1.        Eligibility for ALP-2 Services:  The consumer is age 55 or older, a resident of New York State, legally blind, not residing in a nursing home and able to benefit from ALP services.

2.        Eligibility for ALP-2 E (Enhanced) Services:  The consumer must meet the eligibility criteria for ALP-2, and must have an ISP which outlines a need for a lengthier and/or more intensive service program due to either an extensive array of service needs; or disability issues, such as multiple disabilities, that will expand the amount of required services.

3.        Eligibility for ALP-3 Services:  The consumer must meet the eligibility criteria for ALP-2E and have significant needs and primary responsibility for managing the home.

4.        Demonstrate in a manner acceptable to NYSCB:  The specified result is verifiable, based on documentation required by NYSCB.

5.        Individualized Service Plan:  A mutually written individualized service plan, which clearly outlines the goals of program participation upon which the consumer and contractor have agreed to work.

6.        Skills/Supports:  Those abilities and resources which enable individuals to meet their personal goals relating to increased safety, confidence, and/or independence within their communities and living environments.

 

2.12    Differentiating ALP Programs

 

All consumers receiving ALP services will participate in an ALP-1 assessment and will meet, at a minimum, ALP-2 eligibility criteria.

 

For a consumer receiving ALP-2E services, the assessment results shall indicate that the consumer needs and will receive services that are in addition to a standard ALP-2 program in order to achieve the goals identified in his/her ISP.  Services provided under this outcome are intended to have significantly greater intensity and/or variety than those services provided to consumers receiving ALP-2 services.

 

For a consumer receiving ALP-3 services, ALP-2E eligibility will be met and the consumer will have significant needs and primary responsibility for managing the home. Services provided under this outcome are intended to have significantly greater intensity and/or variety than those services provided to consumers receiving ALP-2 and ALP-2E services.

 

2.13    Services Provided Under ALP-2 E and ALP-3:

 

Orientation and Mobility to allow a consumer to travel safely in his/her greater neighborhood (or beyond if capabilities permit) including street crossings, cane travel, etc.

 

Vision Rehabilitation Therapy to achieve either a much broader scope of goals than a standard ALP-2 program would permit, or intensive levels of achievement within a few goal areas.

 

Social Casework Services provided to a consumer to resolve significant needs in the areas of adjustment to blindness, access to community resources, access to health and housing resources, etc.

 

2.14    Standards for Services Delivery for ALP-2 E and ALP-3

 

1.      Services include vision rehabilitation therapy, orientation and mobility instruction, assistive equipment, transportation, low vision exams and devices, community linkages and necessary social casework.

2.      Services and equipment (including low vision exams and devices and assistive equipment items) must directly address the needs identified and prioritized in the ISP.  Assistive equipment refers to those aids, appliances and devices that assist individuals who are blind to perform certain functions or activities. Medical restoration devices (prosthetic or orthotic appliances) are not available under this outcome.

3.      It is expected that consumers who achieve an ALP-2 and ALP-2E outcome will be more secure in their daily routines as a result of training and learning to call upon family, neighborhood, or community resources to assist them.  It is not expected that they will have total self‑direction in going about their daily activities and managing their homes.  Consumers who achieve an ALP-3 outcome will have achieved the skills and abilities needed to independently maintain the home and is functioning in that capacity.  

4.      An ISP may be amended, with the approval of both the consumer and the contractor staff, if it appears that specific goals in the original service plan are no longer appropriate or achievable.  An amended plan should be prepared to account for alternative goals.  The case file should also reflect the reasons for the modification.

5.      A consumer may not receive ALP services for a second time for a period of two years from the date of closure, unless a NYSCB staff member determines that the individual, due to exceptional circumstances, requires training not addressed previously.  Examples of these circumstances include moving to a new home, the loss of a spouse, or significant loss of vision.  A re‑assessment and a new individualized service plan (ISP) are required.  Minor needs, such as marking a new appliance, will not be covered as stand-alone services under this contract.

6.      Individuals whose only need is for community connections may not be counted as achieving this outcome, unless the needs involve substantial intervention and eligibility has been approved by a NYSCB staff member prior to initiation of services.

7.      Individuals whose only purpose in applying is to obtain a low vision exam and appropriate devices are not eligible for services under the ALP program.  The provision of low vision exams and devices must be related to the achievement of specified functional goals or tasks, and provided with accompanying training to integrate the use of the devices into the consumer's daily routine.

8.      Whenever a choice of service provider is available, consumers must be given the opportunity to choose which provider they prefer to access for services.

9.      In the provision of low vision services, devices should be provided by the low vision provider who performs the low vision exam.

10.    Sign language or foreign language interpreter service, and/or transportation must be provided under the ALP program when those services are deemed necessary to achievement of the consumer's goals.

 


 

2.15    Role of NYSCB

 

1.        Review the Individualized Service Plan Progress Report (or Amendment) for all ALP-2E’s and ALP-3 cases.  Factors that may determine an outcome for ALP-2E and ALP-3 cases include:

 

-           Number of service delivery hours;

-           Costs associated with low vision aids and assistive devices;

-           Intensity of service details outlined in the ISP Progress Report.

2.        Determine if exceptional circumstances exist to waive the 24 month requirement required before the consumer is again eligible to receive services.

 

2.16    Role of the Contractor

 

1.      Determine from the ISP what services are needed to assist the consumer to achieve their goals.

2.      Determine whether the consumer meets eligibility criteria for ALP-2, ALP-2E or ALP-3

3.      Notify consumer of anticipated dates of service initiation.

4.      Arrange for and initiate a coordinated set of services.

5.      Monitor services and consumers' progress toward goals.

6.      Maintain individualized case records to document services and equipment delivered and the consumer's progress toward goal achievement.

7.      With consumer participation, determine when goals have been reached and

terminate services.

8.      Complete the ISP Progress Report.

9.      Upon completion of the consumer's services, the ISP Progress Report must include clear documentation of the full range of services provided; including the enhanced services that made it possible for the consumer to achieve his/her individualized goals.

 

2.17    Criteria for Determining That a Person has Achieved an ALP Outcome

 

In order for a person to be reported as having achieved an ALP Outcome, each of the following criteria must be met:

 

1.        The consumer agrees that all original or amended service goals identified in their ISP have been achieved and that no further services or equipment are needed.

2.        The consumer was offered the opportunity to express a choice of service providers, wherever they are available, and those preferences were incorporated into the ISP.

3.        The consumer has not been referred for NYSCB services during the 24 months prior to this referral, unless an exception, due to unusual circumstances, has been approved by a NYSCB staff member.

4.        Documentation exists which shows that the services and equipment delivered enhanced consumer achievement of specific goals as outlined in their ISP.

5.        In addition, for ALP-2E and ALP-3 outcomes, the ISP Progress Report must document the reason for determining that the individual met the ALP outcome criteria.

 

 

 

VOCATIONAL

REHABILITATION

SERVICES

3.0

 

 

 

Services

Applicable Forms

Orientation & Mobility (O&M)

O&M Assessment Report

 

O&M Level 1 Report

 

O&M Level 2 Report

 

O&M Level 3 Report

 

 

Vision Rehabilitation Therapy (VRT)

VRT Assessment Report

 

VRT Level 1 Report

 

VRT Level 2 Report

 

VRT Level 3 Report

 

 

Social Casework (SCW)

SCW Assessment Report

 

SCW Level 1 Report

 

SCW Level 2 Report

 

 

 

 

3.01    Description

 

Consumers with a goal of employment need to develop or improve basic skills that are essential to successfully seeking and maintaining employment.  Failure to acquire these skills seriously undermines the success of vocational training and job placement efforts.  Vision Rehabilitation Therapy, Orientation and Mobility, and Social Casework program services are designed to provide consumers in the vocational rehabilitation program with comprehensive and integrated training in basic life skills to prepare them for participation in training, post-secondary education, work experiences, and competitive or supported employment. 

 

Individuals referred for services must:

 

1.      be eligible for vocational rehabilitation services;

2.      have an ultimate goal of competitive employment or VR homemaker;

3.      have a need to improve basic skills before vocational training is completed or employment can be realistically achieved;

4.      be referred by a NYSCB Counselor; and

5.        participate in an assessment of the requested services

 

Consumers referred will receive assessment and/or training in any or all of the following vocational rehabilitation areas to enable them to successfully function as employed persons: safe travel/orientation and mobility, vision rehabilitation therapy, and social casework.  As a result of training, consumers are expected to achieve and demonstrate competence in those skill areas specified in the referral at a level that will allow them to function independently enough to obtain and maintain employment.

 

3.02    Assessments

 

Prior to receiving Vision Rehabilitation Therapy, Orientation and Mobility Instruction, or Social Casework Services, an individual will participate in an Assessment.

 

The Assessment will:

1.        determine a consumer's readiness for each service

2.        establish a baseline of skill against which future progress can be measured

3.        set goals that have been mutually agreed upon by the consumer, the contractor, and the counselor, and

4.        provide information about the amount of time services may take in order to assist the NYSCB Counselor and the consumer in their vocational planning.

 

The assessment will be completed using the Vision Rehabilitation Therapy, Orientation and Mobility, and Social Casework Assessment Forms.

 

 

3.03    VRT, O&M, Social Casework Assessment Outcome Statement

 

Individuals referred by a NYSCB Counselor will receive separate assessments in the areas of Orientation & Mobility, Vision Rehabilitation Therapy, and Social Casework as specified in the NYSCB referral materials.  The assessments will be conducted by appropriate personnel who meet the contract standards. The relevant assessment form must be used to determine:  (1) The individual’s understanding of the concepts involved in the training; (2) the individual’s desire to participate in training and motivation to achieve the goals set; (3) The individual's present level of functioning; (4) the individual's training needs; (5) the level of service intensity agreed upon; and (6) an estimated length of time to complete the training.

 

3.04    Terms used in the Outcome Statement

 

1.         NYSCB referral materials: Referral information, provided by the NYSCB counselor, that may be wholly contained in the Vendor Referral Form or in supporting documents such as medical or vision reports, reports from previous services, or other background information that will allow the contractor to provide an appropriate assessment.

 

2.         Present level of functioning: skills in which the consumer demonstrates their current ability to function sufficiently to engage in vocational activities.

 

3.         Level of service intensity: Service Intensity refers to the approximate number of hours per session and frequency of training required to achieve the proposed goals – twice weekly is preferred, but no less than once per week.

 

3.05    Time Frame for Completing an Assessment and Providing Services

 

Refer to section 1.07, Time Frames Reference Guide, in the General Information Section of these Guidelines for assessment completion time frames.

 

3.06    Integrated Service Delivery

 

The various service needs of consumers have historically been viewed as related, but separate components, with service delivery typically occurring in traditional, one to one settings between a consumer and either a rehabilitation teacher, orientation and mobility instructor, or a social caseworker.

 

NYSCB Counselors should work with contractors to coordinate and integrate services whenever possible.

 

 

 

3.07    Service Intensity

 

A paramount goal of NYSCB is to enable consumers receiving services in the skill areas of safe travel/orientation and mobility, vision rehabilitation therapy, and social casework Level I to develop these skills as quickly as possible in order to achieve an employment outcome.  Therefore it is expected that consumers will be seen twice weekly but no less than once weekly.  Alternate schedules must be worked out at the time of the assessment meeting.

 

Consumers should be engaged in other services concurrently to allow them to fully participate in the rehabilitation process.

 

3.08    Determining Appropriate Service Levels During Assessment

 

Consumers referred for VRT and O&M should be able to demonstrate all of the skills in Level I and all skills relevant to achievement of their vocational goal in Levels II and III.

 

O&M and VRT goals for youth between the ages of 10 and 13 who are participating in the VR program should be limited to Levels I and II. These levels may be repeated with different goals and greater complexity being added at each advancement.

 

It should be noted that all consumers have entered the VR program with a long-term goal of entering or returning to employment or becoming independent homemakers and need to be able to function as independently as possible. These consumers should have achieved the level of independence required in Level III in both O&M and VRT.

 

3.09    Criteria for Determining that a Consumer Has Achieved the Assessment Outcome

 

A consumer is determined to have achieved the Assessment outcome if the consumer and the NYSCB Counselor agree that the following conditions have been met:

 

1.        The consumer was assessed in the areas identified in the referral materials.

2.        Service goals have been established to meet the consumer's needs.

3.        The consumer had input into the establishment of the goals.

4.        Service intensity and completion timeframes have been established

5.      The required meeting has taken place and the goals and service intensity have been agreed upon.

 

 

 

 

 

 

3.10    Assessment Documentation/Reporting Requirements

 

Refer to Section 1.10, General Documentation, Reporting and Meeting Requirements in the General Information Section of these Guidelines, for documentation and reporting requirements.

 

In addition, for VRT, O&M and Social Casework assessments, the contractor will document the assessment findings, the consumer's goals, and the strategies that will be used to accomplish those goals using the appropriate Assessment Report (VRT, O&M, Social Casework).

 

Achievements, challenges encountered and other information that may be of help in planning vocational rehabilitation services should be fully documented in the comments section of the Assessment report.

 

3.11    VRT, O&M, Social Casework Training Outcome Statement

 

Individuals referred by a NYSCB Counselor will demonstrate that they have acquired adaptive skills in the requested areas, which will assist them to achieve the goals agreed upon in the finalized assessment.

 

3.12    Scope of Services

 

O&M, VRT and Social Casework Services must be of sufficient scope to enable the consumer, upon completion of the service, to be able to function at a level of independence that allows them to be fully engaged in vocational training, post-secondary education, or employment. Each skill in each level of these three services will have been assessed and training will have been provided to allow the consumer to progress smoothly toward achieving their vocational goal.

 

At the completion of training consumers will be able to demonstrate independently all of the skills that were assessed.  It is not expected that all consumers will attain the same level of skill or independence, but that they will have achieved a level that will enable them to reach their vocational goal. 

 

Adaptive equipment and transportation to support the skill areas are to be included as part of these services. (See complete information on purchase of adaptive equipment in section 3.16, Adaptive Equipment.)

 

Orientation and Mobility and Vision Rehabilitation Therapy continue to be divided into three levels. In most cases, services must be provided sequentially. In general, Level I is a prerequisite to receiving Level II services. Level I and II services are prerequisites to receiving Level III services. When a consumer has previously received services and a need specific to a service level is identified by the consumer, the counselor may refer for a specific level only.

 

Social Casework is divided into two outcomes, Social Casework I and Social Casework II, with the latter being a therapeutic intervention based on needs identified during the provision of other services.

 

3.13    Orientation and Mobility Service Categories

 

At the completion of services, the consumer must be able to demonstrate skills in the following areas:

 

O & M Level I Skills

 

1.         Concept Development

a.         Body

b.         Spatial

c.         Directional

d.         Positional

e.         Environmental

 

2.         Sensory Development

a.         Vision Skills

b.         Auditory skills

c.         Olfactory Skills

d.         Haptic Skills

3.         Pre-cane/Safety Skills

a.            Sighted Guide

b.            Protective techniques

c.            Hand trailing

d.            Seating

e.         Stairs, Doorways

f.          Search Patterns

g.         Object Retrieval

h.         Communication Skills

4.         Orientation and Mobility Skills

a.         Use of Landmarks, Clues

b.         Use of Mental/Tactile Maps

c.         Use of Four Types of Orientation Skills

O & M Level II Skills

 

1.         Cane skills

a.         Open and Close the Cane

b.         Utilize appropriate cane techniques

c.         Maintain and Store the Cane

d.         Order Replacement Cane and Parts

 

2.         Community Indoor Travel

a.         School or Workplace

b.         Stores and Places of Personal Importance

c.         Unfamiliar environments

 

3.         Community Outdoor Travel

a.            Street Crossings

b.            Residential Settings

c.            Business Environments

d.            Street crossings

I.              In all weather conditions

 

O & M Level III Skills

 

1.         Independent Access to Various Transportation

a.            Para Transit

b.            Bus/Subway/Trolley

c.            Taxi or Car Service

d.            Private Driver

e.            Combination of Transportation

 

2.       Independently Plan a Route selected by the Instructor.

3.       Consumer demonstrates safe and independent travel to selected location.

 

 4.        ETA/GPS devices

a.         GPS

b.         Smartphone Application

 

5.        Consumer demonstrated ability to independently utilize contingent means of transportation (other public transportation, cab, driver, etc.).     

 

3.14    Vision Rehabilitation Therapy Service Categories

 

At the completion of services, the consumer must be able to demonstrate skills in the following areas:

 

VRT Level I Skills

 

1.           Maximizing functional vision with the appropriate use of prescribed low vision            devices.

 

2.         Self Care Skills

a.         Bathing, showering

b.         Dental care, hair care, nail care, use of antiperspirants, scents

c.         Select clothing

d.         Dressing

e.         Manage basic healthcare needs (bandages, OTC medications)

f.          Identify/differentiate medications

 

3.         Communication Skills

a.         Sign documents and letters

b.         Obtain/Record information (phone numbers, appointments, etc.)

c.         Accessing print (using magnifiers, lighting or other resources to read print)

d.         Make/receive calls (land line or cell)

e.         Deal with emergencies (911, poison control, MD)

f.          Locate and differentiate the position of dots in the Braille cell

     

4.         Organizational Skills

a.         Tel/set time

b.         Record and maintain a calendar

c.         Creating lists

d.         Label items for home and personal use

 

5.         Home Management Skills

a.         Use outlets, change batteries, use keys

b.         Utilize adaptive techniques for basic cleaning tasks (countertops, tables, sinks, spills)

c.         Utilize environmental controls appropriately

6.         Eating Skills

a.         Locating items on table, plate

b.         Cut food

c.         Pouring

d.         Table etiquette       

 

7.         Meal Planning and Preparation Skills

a.         Use a microwave and/or toaster oven

b.         Prepare a hot or cold snack

c.         Prepare hot and cold beverages

d.         Reheat prepared/take out foods

e.         Table setting and food serving       

 

8.         Financial Skills

a.         Identify bills and coins

b.         Writing checks

c.         Use a calculator      

 

 

VRT Level II Skills

 

1.         Self Care Skills

            a.         Manage medications

b.         Monitor weight and blood pressure

c.         Maintain clothing (laundering, ironing, mending, sewing)       

 

2.         Communication Skills

a.         Use recording/playback devices

b.         Manage telephone numbers and contacts (address book, programmable                               phone)

c.         Write and read Uncontracted Braille (Grade 1)

d.         Use a qwerty keyboard to accurately type up to 10 wpm

e.         Use function keys and number pad on a computer keyboard       

 

3.         Organizational Skills

a.         Take notes for personal use, training and/or employment

b.         Record and maintain electronic calendar

c.         Label and locate home and personal items

       

4.         Home Management Skills

a.         Utilize adaptive cleaning techniques throughout residence (dishes, floor,                                 furniture, bed making, toilets, tubs, showers)

            b.         Use of household appliances (vacuum, washer, dryer, etc.)

            c.         Use of tools to perform minor home repairs/projects

 

5.         Meal Planning and Preparation Skills

a.         Access recipes

b.         Create shopping list and obtain items

c.         Cutting, slicing, chopping, spreading

d.         Cook with stove top and oven

e.         Use of small kitchen appliances

f.          Timing, weight, doneness of food       

 

6.         Financial Skills

a.         Create a personal budget   

b.         Organize bills and track payments

c.         Balancing checkbook       

 

VRT Level III Skills

 

1.         Self and Family Care Skills

a.         Prepare formula and/or other special dietary meals

b.         Feed infant, disabled child, adult

c.         Diapering

d.         Bath, dress and groom child or adult

e.         Manage medical needs of family and self

f.          Manage safety needs of self and family

g.         Provide homework help

 

2.         Communication Skills

a.         Begin Contracted Braille (Grade 2)

b.         Use a qwerty keyboard to accurately type up to 20wpm

c.         Use a telephone and computer for business communication

d.         Use Smartphone/tablet for email, texting and creating/maintaining                                            contacts

e.         Use of Smartphone/tablet for notetaking, recording instructions/lectures

 

3.         Organizational Skills

            a.         Establish and maintain an organizational system for the home

b.         Establish and maintain a system for all aspects of financial management                                including ATM, mobile banking, budgeting and savings

c.         Use Smartphone/tablet for scheduling tasks, appointments and reminders

d.         Use Smartphone/tablet applications for identification purposes

 

4.         Meal Planning and Preparation

a.         Meal planning and preparation for self, family and guest meals

b.         Adjusting recipes/portioning

c.         Establish and maintain a system for food storage and labeling

 

5.            Pre-occupational/Worksite Skills

a.         Establish and maintain a system for following an established schedule

b.         Establish and maintain a system for planning and organizing tasks

c.         Label equipment/files

d.         Utilize accommodations/equipment

e.         Select and prepare clothing for an employment interview

f.          Establish and maintain an appropriate work wardrobe

 

3.15    Social Casework Service Categories

 

Social Casework Level 1 services are intended to enable the consumer to utilize resources that will assist in the areas of adjustment to vision loss; finance; health; self-advocacy and participation in activities with family, peers, community and work. Consumers receiving this service should exit with the demonstrated ability to manage all areas of need addressed in the assessment. Consumers referred for Social Casework Level I may have goals in the following areas:

 

1.         Consumer demonstrates ability to seek and obtain services and benefits (housing, financial assistance including social security benefits, food stamps, etc.)        

2.         Consumer is able to use available resources to meet financial obligations and to budget income and expenses.

3.         Consumer demonstrates understanding of and ability to comply with prescribed medical and mental health treatment.

4.         Consumer employs appropriate coping mechanisms in dealing with vision loss.

5.         Consumer can list a system of supports for social or emergency purposes or demonstrates ability to identify, establish, and maintain social supports, including those with peers, with appropriate interpersonal skills and boundaries.

6.         Consumer is able to identify behaviors that adversely affect work readiness.

7.         Consumer understands the concept of self-advocacy and can express ideas and needs assertively.

8.         Consumer is able to identify and access appropriate community referral and resources for on-going, long-term therapeutic services.

 

Social Casework Level II Services– Brief Therapeutic Intervention

 

Through individual, time-limited, in-person services, consumer is able to identify and develop strategies to overcome issues that are interfering with progress toward achieving their vocational goal.

 

Social Casework Level II may be recommended at any time in the vocational rehabilitation process when the counselor and the consumer agree that an immediate, short-term therapeutic intervention is necessary to address behaviors or conditions that are significantly impeding the consumer’s progress toward an educational or vocational goal. This intervention may address mental, social, emotional, behavioral, developmental, and addictive disorders, conditions and disabilities.

 

This service may be recommended in the final report of Social Casework Level I or in a separate communication with the counselor. A recommendation for this service may also result from an indication by a vision rehabilitation professional of a need for therapeutic intervention beyond the scope of Social Work Level I or a need that has arisen during the provision of other services in the vocational rehabilitation process.  Social Casework Level II may not be used to replace adjustment to vision loss services delivered under Social Casework Level I.

 

Social Casework Level II may be authorized when it is expected that the consumer’s needs can be addressed within 6-12 hours over a period of no longer than 12 weeks .

 

A full consideration of comparable benefits should be completed prior to authorizing Social Casework Level II.

 

In all cases, social casework services provided must be explicitly related to the resolution of issues that are interfering with the consumer's achievement of personally defined education and/or employment goals mutually agreed upon between the NYSCB Counselor and the consumer. If the need for long term personal counseling or psychotherapy is identified, the contractor should assist in the transition to these services.

 

3.16    Adaptive Equipment

 

Adaptive equipment refers to those aids, appliances, and devices that assist individuals who are blind to perform certain functions or activities but which are not micro-computer based.  The recommendation of adaptive equipment will be directly related to achievement of the goals specified as a result of an assessment.

 

An item’s cost is not related to the designation of conventional vs. non-conventional equipment.  Non-conventional equipment items are typically electronic or micro-chip based items that may require additional assessment or training.

 

Items considered to be conventional include but are not limited to:

 

1.         Braille writer

2.         White cane

3.         Lock-lid sauce pan

4.         Slate and stylus

5.         Talking clock

6.         Tape or digital recorder

7.         Large print phone

 

Items considered to be non-conventional include but are not limited to:

 

1.         Computerized Braille displays

2.         Portable computerized Braille note takers

3.         Screen enlarging software or hardware

4.         Speech synthesis software or hardware

5.         Closed Circuit Television (CCTV)

6.         Screen reading software packages

7.         One-handed keyboards or specialized input devices

 

 

 

The purchase of conventional adaptive equipment is the responsibility of the contractor.  The contractor should assure that each consumer obtains those standard items that are needed to function at a level of independence that will enable them to engage in activities related to training for or obtaining employment.

 

Non-conventional equipment may be authorized separately if the counselor agrees the equipment is necessary for the consumer to achieve his/her goals and the consumer meets the criteria specified in the NYSCB policy for the purchase of equipment.

 

Low vision and/or audiological services, if needed, will be authorized by the NYSCB Counselor in accordance with NYSCB policy.  NYSCB will make payments for these services directly to the provider.

 

3.17    Criteria for Determining that a Consumer Has Achieved the Service Outcome

 

A consumer is determined to have achieved the service outcome if the consumer and the NYSCB Counselor agree that the following conditions have been met:

 

1.         All goals established in the individual’s assessment or documented revised goals have been met.

2.         The services provided have been consistent with the consumer's interests, capabilities, and needs.

3.         The services have been sufficient to allow the consumer to master the basic life skills he or she needs to seek and maintain employment and/or participate in an educational program.

4.         Adaptive equipment and/or low vision aids provided, if authorized, were consistent with the consumer's needs and goals.

5.         Reinstruction was provided as determined by a review of skills following training.

6.         The services provided met all of the consumer’s needs.

 

 

3.18    Documentation/ Reporting Requirements for VRT, O&M and Social Casework Services

 

Refer to Section 1.10, General Documentation, Reporting and Meeting Requirements in the General Information Section of these Guidelines, for documentation and reporting requirements.

 

For Social Casework Level II, the report should summarize the work done in the sessions, the result of the intervention, and recommendations for transition to long-term community-based services if needed.

 

3.19    Authorizing Additional Outcome Services

 

If a consumer has not completed all levels of vision rehabilitation therapy or orientation and mobility service, they may be re-referred in order to complete the higher level of that service. It is expected that the previously completed assessment will be utilized for this service unless there is a documented change in the consumer’s situation that justifies the need for a new assessment.  For example, if a consumer previously completed Level 1 Indoor Mobility, they can be referred at a later date for Level 2 Outdoor Mobility. Payment will not be made a second time for Level 1 or for a new assessment, without a policy exception which must be approved by the District Manager. However, referral for Level 2 or 3 can be made if the circumstances of the case warrant it.

 

Consumers may require additional time to complete keyboarding and/or Braille training in Level 3. If a consumer has completed all other goals in Level 3 and the counselor has accepted the outcome, the contractor may request a level 3 authorizations if the counselor, the contractor and the consumer are confident that the required level of proficiency can be attained.


 

 

 

Section

Services

Applicable Forms

 

 

 

4

 

Pre-Vocational Skills for Young Adults

Pre-Vocational Skills Assessment Report

 

 

Pre-Vocational Training Skills Report

 

 

 

5

Academic Instruction

Academic Instruction (ESL) Report

 

 

Academic Instruction (ABE/HSE) Report

 

 

Academic Instruction (College Preparation) Report

 

 

Academic Instruction Report

 

 

 

6

Vocational Skills Training

Vocational Skills Training Assessment Report

 

 

Vocational Skills Training Report

 

 

 

7

Work Readiness Skills

Work Readiness Skills Assessment Report

 

 

Work Readiness Skills Training Report

 

 

 

8

Work Experience Training

Work Experience Training Employer Agreement Form

 

 

Work Experience Report

PRE-EMPLOYMENT SKILLS

4.0 – 8.0

 

 

 

 

 

 

 

4.01    Pre-Vocational Skills for Young Adults

 

Pre-Vocational Skills services prepare youth ages 10 through 21 to function more independently in their communities and to eventually enter the workforce. Pre-vocational programs can vary in theme, scope and subject. It is expected that youth will go through different developmental stages as they participate in a variety of pre-vocational skills programs.

 

During their years in transition services, youth will need to master the following skills to become fully prepared to engage in employment:

 

·               Communications (e.g. Braille, keyboarding, knowledge of assistive technology devices, knowledge of note-taking methods)

·               Daily Living/Homemaking (e.g. meal preparation, cleaning, clothing care, bill paying, grooming)

·               Travel Skills (e.g. indoor and outdoor travel skills, knowledge of safety techniques, cane use)

·               Low Vision, (e.g. knowledge and use of magnifiers, low vision aids and techniques)

·               Adjustment to Vision Loss (e.g. emotional and social impact of vision loss)

·               Career Exploration (e.g. knowledge of job search tools and techniques, interviewing skills, including ability to discuss disability in interview settings)

 

The NYSCB counselor will work with agency staff to plan for the individual consumer’s needs.

 

Although pre-vocational services are most often delivered in group settings, it is expected that pre-vocational skills training will meet the needs of the individual consumer.

 

Pre-vocational skills training may occur several times throughout the course of the consumer’s time in transition services as long as new objectives are identified. The counselor and the provider should determine stages at which a new assessment is required.

 

Three milestones have been developed and can be incorporated into pre-vocational training programs to provide a number of opportunities for youth to explore strengths and interests in a systematic manner. Many of the activities included in the milestones can be incorporated into existing pre-vocational programs.

 


 

4.02    Pre-Vocational Skills for Young Adults Assessment

 

Prior to receiving pre-vocational training, an individual will participate in a pre-vocational skills assessment.

 

The Pre-Vocational Skills for Young Adults Assessment will:

 

1.    determine a consumer’s readiness for a pre-vocational training program,

2.    establish a baseline of skill levels against which future progress can be compared,

3.    determine which training milestone the youth should complete, and

4.    provide an estimate of the time needed to complete the training in order to assist the NYSCB counselor and the consumer in vocational planning.

 

4.03    Pre-Vocational Skills for Young Adults Assessment Outcome

 

Young adults (age 10 to 21), referred by a NYSCB Counselor, will be assessed to determine their knowledge of, and skill levels in, vocational clarification, job seeking, and job-related social behaviors.  The assessment must indicate all areas in which knowledge and skills are lacking and define a training program that will address those areas.  The assessment must also gauge the level of parental and family support necessary and available for the attainment of the vocational aspirations of the young adult. A recommendation for the specific milestone in which the child should participate should be included as part of the assessment.

 

4.04    Time Frame for Completing an Assessment

 

Refer to section 1.07, Time Frames Reference Guide, in the General Information Section of these Guidelines for assessment completion time frames.

 

4.05    Conducting the Pre-Vocational Skills for Young Adults Assessment

 

Using the NYSCB Pre-Vocational Skills Training Assessment Report, the contractor will identify individualized objectives for each young adult that can be met by the contractor's pre-vocational program.  The objectives will be determined by assessing the young adult's strengths and needs and their experiences, interests and personal and family factors that may affect future employment outcomes.  The contractor will include a recommendation for a pre-vocational program that addresses specific skills or indicates that a pre-vocational program is not recommended at this time.

 

 

 

 

 

4.06    Who Conducts the Pre-Vocational Skills for Young Adults Assessment

 

The Pre-Vocational Skills Assessment will be performed by the Contractor staff who will conduct the Pre-Vocational Training Program.

 

4.07    Criteria for Determining that a Consumer has Achieved the Pre-Vocational Skills Assessment Outcome

 

In order for a consumer to be reported as having achieved this outcome, each of the following criteria must be met:

 

1.        the consumer's pre-vocational skills training needs have been assessed to determine whether pre-vocational skills training is appropriate, and

2.        the findings and recommendations from the assessment have been discussed with the consumer, the consumer’s parent or guardian and the NYSCB Counselor, and

3.        a Pre-Vocational Skills Assessment Report identifying the type of pre-vocational skills program and milestone the consumer can benefit from or an explanation of why the consumer will not benefit from a pre-vocational skills training program at this time has been provided to the NYSCB Counselor.

 

All pre-vocational skills assessments must be completed prior to scheduling a pre-vocational program and NYSCB must agree that the outcome was achieved.

 

4.08    Pre-Vocational Skills for Young Adults Outcome Statement

 

Young adults (age 10 - 21), referred by a NYSCB Counselor will achieve the pre-vocational skills necessary to seek employment or participate in a work experience or part-time work by the time they reach 21. Pre-Vocational skills are those specific skills necessary for vocational clarification, job seeking, on-the-job behavior and skills, and life-related activities which support the person in securing and retaining a job. The development of pre-vocational skills includes the provision of services to parents to gain their support as their child prepares to go to work.

 

4.09    Pre-Vocational Milestones

 

Three milestones have been developed and can be incorporated into the pre-vocational training programs to provide a number of opportunities for youth to explore strengths and interests in a systematic manner.

 

Although approximate ages have been provided for the milestones, age itself may not be the determining factor of what milestone the individual participates in, but where the youth is on the continuum of skills. Pre-vocational programs may either be repeated or increased in complexity at successive levels.

 

The milestones should include the following elements:

 

Milestone A – Getting Started (approximately ages 10-13)

 

1)        Ability to use appropriate procedures to access community resources and services specifically designed for individuals with visual impairments

·              Knows own personal needs in relation to vision and asks for adult assistance when necessary

·              Spends time with friends in the neighborhood, in homes and in recreational facilities or has been involved in a NYSCB recreation program

·              Visits school and community libraries and uses these facilities for pleasure and to complete school assignments

·              Explains visual needs to unfamiliar adults or peers

·              Shows ability to work with others

 

2)        Ability to manage daily living skills using functional low vision and blindness techniques

·              Can prepare a simple meal for himself/herself (e.g., sandwich, soup and beverage for lunch)-this can be accomplished in a group setting

·              Knows how to use an alarm clock and understands the value of punctuality (takes responsibility for arriving at and leaving places on time)

·              Completes a few basic household cleaning chores (e.g., clearing dishes, making a bed)

·              Has a system and is able to identify coin and paper currency

·              Has had a mobility assessment and possible training

 

3)        Ability to use technology

·              Is aware of the technology used in school and/or accommodations  needed to complete tasks

·              Has regular access to a computer/tablet either at home or at school

·              Uses a land line or cell phone

·              Has basic keyboarding skills

 

4)        Ability to develop the skills and acquire the necessary training that would facilitate job entry, independent living and other life pursuits

·              Takes notes and “reads” own class notes

·              Earns money through an allowance, chores around the home or jobs for neighbors or other adults

·              Actively participates in a group activity

·              Is working to develop assertiveness skills

·              Identifies activities at which they are successful

·              Can discuss what family members and adult friends do at their jobs

·              Identifies several jobs which interest him/her and learns about these jobs through talking with adults, reading books, online

·              Participates in a volunteer position or job shadow experience

·              Has a basic understanding of the vocational rehabilitation process. (What is a feasible vocational goal?  What responsibilities do individuals have in the VR process?)

 

Possible activities:

 

·              Have the students interview workers in a store

·              Encourage job shadowing various jobs

·              Provide opportunities for independent problem solving

·              Have activities that encourage participants to read and follow directions

·              Tour an adaptive technology center with students to discover what types of technology are available

·              Have the students phone the Careers and Technology Information Bank maintained by the American Foundation for the Blind (CTIB) to speak with mentors about their use of technology and see what type of jobs exist

·              As a group, prepare and serve lunch

 

Referrals for Orientation and Mobility Training and Vision Rehabilitation Therapy should be completed when necessary.

 

Milestone B – Continued Career Exploration (approximately ages 14-16 years old)

 

1)        Ability to use appropriate procedures to access community resources and services specifically designed for individuals with visual impairments

·        Has the ability to work through peer conflicts and manage the stress of being a teenager

·        Effectively communicates individual needs/self-advocacy

·        Understands the need for photo identification

·        Obtains working papers

 

2)        Ability to manage daily living skills using functional low vision and blindness techniques (taking care of oneself and one’s possessions)

·        Can draw up a beginning budget

·        Has a bank account for savings and is able to make deposits and withdrawals

·         Writes and reads back a shopping list

·        Understands the importance of making eye contact

·        Has the ability to listen and to respond at the right time

 

3)        Ability to use technology

·        Has knowledge of the technology that is individually used and the reason why it is used (is able to explain their disability)

·        Demonstrates the ability to navigate the internet

·        Can conduct online research when given a specific task

 

4)        Ability to develop the skills and acquire the necessary training that would facilitate job entry, independent living and other life pursuits 

·        Knows how to complete applications and the beginning stages of developing a resume or portfolio

·        Continues with career exploration via job shadowing, mentors, worker interviews, etc., and possible work experiences

·        Participates in mock interviews

·        Conducts research/obtains information about employers/companies

·        Understands (demonstrates?) appropriate interview/work attire

·        Knows how to ask questions/ask for adaptations that they need to do the job

·        Understands the importance of being responsible, dependable (arriving on-time and taking the appropriate length of time for lunches/breaks)

·        Prepares an initial resume

·        Knows how to complete applications

·        Has practiced interview techniques (arriving early, shaking hands, making eye contact, etc.)

·        Has an understanding of transportation that is available to travel independently

·        Practices writing cover letters, thank you notes

·        Completes an interest/values/personal qualities assessment 

 

Possible Activities/Discussion Topics:

 

·        How do the youth plan to access information and express/provide information after they leave high school/when they are at work?  Are there gaps?  Are they proficient in note taking?  Money skills?

·        Are the parents on board?  Is there a need for a parent orientation night?

·        Encourage use of the Careers and Technology Information Bank maintained by the American Foundation for the Blind

·        Obtain picture identification cards at motor vehicle bureau

·        Discuss debit and credit cards and making purchases without cash

·        Discuss on-line grocery services

·        Participate in job shadow opportunities

·        Have the youth practice asking for assistance in stores

 

Milestone C – “Moving Toward Mastery” (approximately ages 16-21)

 

1)        Ability to use appropriate procedures to access community resources and services specifically designed for individuals with visual impairments

·              Demonstrates a proactive approach in researching, obtaining and maintaining community linkages, resources and benefits

 

2)        Ability to manage daily living skills using functional low vision and blindness techniques (taking care of oneself and one’s possessions)

·              Can prepare a simple meal

·              Can do own laundry

·              Travels independently, is able to access areas of need including medical facilities, grocery store, library and other places of interest

 

3)        Ability to use basic technology

·              Has knowledge of the technology that is individually used and the reason why it is used (is able to explain their disability)

·              Uses appropriate technology to complete school work

 

4)        Ability to develop the skills and acquire the necessary training that would facilitate job entry, independent living, college and other life pursuits 

·              Demonstrates independent travel skills – begins to anticipate post high school travel routes

·              Has knowledge of the job searching process

·              Demonstrates job-seeking skills by attempting to find one’s own job or work experience

·              Completes a resume

·              Demonstrates ability to problem solve

·              Sets up and completes a minimum of 2 informational interviews

·              Knows what type of transportation best fits their needs and practices  using it (para-transit, public transportation)

·              Has well developed organization skills ( for managing information and resources at school or work)

o      Personal papers/files

o      Labeling and locating personal items

o      Keeping an appointment calendar and or activity schedule

·               Has demonstrated basic soft work skills during work and volunteer experiences

 

 

 

Possible Activities:

 

·              Create a list of references/resources that the client can use in the future in order to advocate for themselves

·              Encourage youth to write/edit his or her own IPE

·              Practice interviewing/role playing

·              Visit a local college and discuss college requirements

·              Encourage youth to find his or her own work experience

·              Completes a career portfolio (including a vocational evaluation if applicable, summary of all previous work experiences, an outline of goals for after high school graduation including career goals and the steps that are needed in order to reach the goals)

 

4.10    Standards for Service Delivery: Pre-Vocational Services

 

1.      Pre-vocational skills training should be viewed as a normal progression in the vocational development of a transition-aged youth.  Milestone training should be attuned to the developmental level of the consumer.

2.      Pre-vocational skills training programs should develop those work skills which will eventually lead to long term job placement.  They should provide background information (e.g. career information and job leads) and skills (e.g. social and advocacy skills and job seeking skills) which allow the consumer to be successful in a work experience or part-time work.  This component will typically precede Placement I or WET for the transition-age student.

3.      Pre-vocational skills training should address the individual needs of the consumer.  It should be offered as a complement to the consumer's transition goals, as developed by the NYSCB Counselor with the consumer.

4.      Programs should make every effort to build in contact between the consumer and successfully employed blind individuals.

5.      Program effectiveness should be viewed in the context of how well this program prepared students for successful work experiences.

6.        Pre-vocational skills training programs should demonstrate innovative ways of addressing student vocational development, including preparation for work and involvement in community activities.  They should address the needs of students of all work abilities.  The programs should work cooperatively with schools, employers and parents.

7.        All programs are encouraged to incorporate visits to local work sites.

8.        Program components should be offered during hours when the youth and/or parent are available to participate (e.g. after school, evenings, weekends).

9.        All curricula must be pre-approved by the NYSCB Director of Field Operations. Curriculum should be shared with the consumer and their parent or guardian before the program begins.

10.     All youth should complete the Milestone C pre-vocational program with a resume and practice in interviewing skills

 

4.11    Responsibilities of the NYSCB Counselor and the Contractor: Pre-Vocational Skills for Young Adults

 

Refer to Sections 1.11Responsibilties of the NYSCB Counselor and Section 1.12, Responsibilities of the Contractor in the General Information Section of these Guidelines for roles and responsibilities.

 

Counselor

Prior to the referral for pre-vocational skills training, the counselor and consumer will discuss the purpose of training and develop a collaborative, team approach.

 

Contractor

 

1.      Upon referral of the consumer by the NYSCB Counselor, the contractor will interview the referred consumer and family, if appropriate, and clearly describe the assessment process to verify that the consumer wishes to participate and that the parents (or guardian) are supportive.

 

2.      After completion of the assessment report recommend the appropriate milestone program for the consumer. The report must verify that the results of the assessment were discussed with the consumer.

 

3.      Review progress with the consumer, family, if appropriate, and NYSCB Counselor on a regular basis.

 

4.      Provide consumers with opportunities for employer visits, exploration of training opportunities, and contact with individuals who are blind and are successfully employed in a wide variety of occupations.

 

5.      Include information about the consumer’s performance on practice job interviews in the Progress Report if applicable.

 

6.      Attach a copy of the consumer’s resume to the Progress Report.

 

5.01    Academic Instruction Assessment

 

Prior to receiving academic instruction services, an individual will participate in an academic instruction assessment.

 

 

The Academic Instruction Assessment will:

 

1.        determine a consumer’s readiness for Academic Instruction services

2.        establish a baseline of skill against which future progress can be compared, and

3.        provide information about the amount of time services may take, in order to assist the NYSCB Counselor and the consumer in their vocational planning.

 

5.02    Academic Instruction Assessment Outcome Statement

 

Individuals referred by a NYSCB Counselor will be assessed in the specified area(s) of academic skills outlined in the referral material. For those individuals who require academic training, the contractor will develop a plan of service that includes goals, timeframes, and intensity of service needed.

 

5.03    Terms Used in the Outcome Statement

 

1.         Assessment: is an evaluation of the individual’s current level of functioning (baseline), and a recommendation for further instruction, if necessary, in those areas in which mastery is needed in order to achieve the individual’s academic goals.

 

2.         Plan of service: outlines goals to be achieved, including an estimate of the length of service and the frequency/intensity of the service needed to successfully complete the plan.

 

3.         Academic skills: include, but are not limited to: Adult Basic Education, English as a Second Language, High School Equivalency, College Preparatory and/or Academic Tutoring, and Test Preparation (e.g. SAT, exit examinations at Community Colleges, placement examinations.

 

5.04    Time Frame for Completing an Assessment

 

Refer to section 1.07, Time Frames Reference Guide, in the General Information Section of these Guidelines for assessment completion time frames.

 

5.05    Conducting the Academic Instruction Assessment

 

For English as a Second Language, the instructor can determine the appropriate assessment tool.  Some useful assessment tools are: the Gates MacGinitie Reading Test, Wide Range Assessment Test (WRAT), and the Tests of Adult Basic Education (TABE). The assessment tool should cover listening, oral, reading and writing skills, and when possible be administered in the student’s preferred language. The instructor must document the assessment tool used on the assessment report as well as the measurement of progress towards the outcome for that assessment tool.

 

For Adult Basic Education or High School Equivalency, it is preferred that the instructor should use the Tests of Adult Basic Education (TABE) and the TABE Complete Battery.  If another assessment tool is used, the instructor must document the tool on the assessment report.  ABE assessment should also address whether deficits are due to lack of education vs. learning or language disability.  ABE outcomes would include Basic Survival Level – up to 4th grade reading and 3rd grade math levels and Functional Literacy Level – 6th to 8th grade reading and math levels.

 

For the College Preparatory assessment, each item in the assessment guidelines listed in the Progress Report should be reviewed and discussed.

 

Regardless of which assessment a tool is used, the instructor must be sure that the tool provides sufficient information to address all the factors identified in the outcome statement.

 

5.06    Who Conducts the Academic Instruction Assessment

 

The Academic Instruction Assessment must be conducted by a Master’s level teacher unless a waiver of this requirement is given by the local NYSCB District Manager.  The NYSCB District Manager may approve another professional, with or without a Master’s degree, to provide the service if that District Manager believes the person to be qualified to provide the assessment.  The District Manager will send notification of any waivers to the contractor and to the NYSCB Home Office in writing.  Recommendation can also include a request for additional testing if learning or language disabilities are suspected and need to be diagnosed.

 

 

 

 

5.07    Criteria for Determining that a Consumer Has Achieved the Academic Instruction Assessment Outcome

 

For a consumer to be reported as having achieved this outcome, each of the following criteria must be met:

 

1.        The consumer’s academic instruction needs were assessed in order to determine whether academic instruction services are appropriate.

2.        The findings and recommendations from the academic instruction assessment have been discussed with the consumer and the NYSCB Counselor.  Time frames must also be included for length of time anticipated to reach goals.

3.        An Academic Instruction Assessment Report identifying the academic instruction the consumer can benefit from or an explanation of why the consumer will not benefit from academic instruction at this time, was provided to the NYSCB Counselor.

 

5.08    Academic Instruction Outcome

 

Individuals referred by a NYSCB Counselor, will achieve a level of academic competence that enables them to participate in the mutually agreed upon plan of service.

 

5.09    Terms Used in the Outcome Statement

 

1.        Academic instruction may include education programs adapted for individuals who are legally blind in the areas of Adult Basic Education, English as a Second Language, High School Equivalency, College Preparatory and Academic Tutoring to improve, enhance or supplement their academic or educational achievement levels as in a selected or anticipated vocational goal.

2.        Academic instruction does not include any form of college level instruction.

 

New or revised programs must have curricula submitted to NYSCB Director of Field Operations for approval prior to being offered to consumers or NYSCB staff.

 

5.10    Standards for Service Delivery:  Academic Instruction Services

 

1.        Instruction methods and materials must be adapted to individuals who are blind.  This includes providing materials in the consumer’s preferred format.  All programs should include lab opportunities for guided study.

2.        Adult Basic Education programs should include components applicable in a variety of work settings.

3.        English as a Second Language (ESL) programs must ensure that consumers have an opportunity to practice language skills outside of class, especially if a consumer lives in a community where little or no English is spoken. Lab time is a required element, as well as the expectation that guided practice occurs sufficient times during the week and for the number of hours agreed upon by instructor, consumer and NYSCB Counselor at the end of the assessment.  ESL programs should be limited as necessary to assist consumers to achieve an employment outcome.  ESL for successful job interviewing can be an additional element as can instruction to assist the consumer to take part in community-based conversation.

4.        High School Equivalency training will be provided to consumers who have already achieved the prerequisites needed for participation in a high school equivalency program.

5.        College Preparatory programs must be designed to provide sufficient challenge to build independent study skills and knowledge in the use of academic resources, leading to realistic expectation for students entering college.

6.        Academic Tutoring – Tutoring for high school, college or vocational students experiencing academic difficulty must be based on the student’s specific academic curriculum.

7.        Test Preparation must be directly related to the consumer’s stated vocational goal.

 

5.11    Criteria for Determining that a Consumer has Achieved the Academic Instruction Outcome

 

In order for a consumer to be reported as having achieved this outcome, each of the following criteria must be met:

 

1.        The consumer and the NYSCB Counselor agree that a level of academic competence has been achieved that enables the consumer to participate in services toward a selected or anticipated vocational goal.

2.        The consumer has achieved measurable increases in specific academic skills or competencies.

3.        The consumer and the NYSCB Counselor agree that all original or revised goals have been achieved

4.        An Academic Instruction Final Report describing he services provided and the goals achieved by the consumer was provided to the NYSCB Counselor.

 

6.01    Vocational Skills Training

 

Vocational Skills Training prepares consumers to enter competitive employment in an integrated community-based setting. The training may advance consumers’ vocational skills to a level of proficiency that will enable the consumer to attain market-based levels of productivity.  Vocational Skills Training may be of two types: 1) training to acquire competitive proficiencies in areas of communication like keyboarding, Braille, and computer applications or training in foundation skills in a business sector such as office administration, service careers, or manufacturing; 2) training to meet current and future needs of a specific employer/group of employers or a particular business sector.  Business sectors should be identified from data obtained from the NYS Department of Labor on jobs in demand for the geographic area in which consumers expect to obtain employment.

 

Vocational Skills Training is typically provided in a group setting.

 

Curriculum for new vocational skills training programs must be submitted to and approved by the NYSCB Director of Field Operations. Changes to curriculum must also be submitted for approval. No referrals can be made to a program unless it has been reviewed and approved.

 

 

 

 

 

6.02    Vocational Skills Training Assessment

 

Prior to receiving vocational skills training, an individual will participate in a vocational skills training assessment.

 

The Vocational Skills Training Assessment will:

 

1.        determine a consumer's readiness for Vocational Skills Training services,

2.        establish a baseline of skill against which future progress can be compared, and;

3.        provide information about the amount of time services may take, in order to assist the NYSCB counselor and the consumer in their vocational planning.

 

6.03    Vocational Skills Training Assessment Outcome

 

Individuals referred by a NYSCB counselor, will be assessed in the specified area(s) of vocational skills outlined in the referral material.  The assessment must indicate whether the individual possesses those pre-requisite skills necessary to successfully complete a vocational training program leading to employment. If the individual is found to possess those pre-requisite skills, a plan must be developed to complete that training, including an estimate of the length of service and the frequency of service needed to successfully complete the plan.

 

6.04    Vocational Skills Training Assessment Standards

 

1.        The Vocational Skills Training Assessment must include the individual's baseline level of functioning.

2.        For all training programs the assessment must test the hard skills typically required in the occupations for which training occurs.

3.        The assessment must identify both positive and negative characteristics exhibited by the consumer. If remediation is needed prior to or in conjunction with training, the assessment should identify remediation activities.

4.        An approved training assessment instrument should be used to evaluate all referred consumers.

5.        A plan of training must be included as part of any assessment report and must include an estimate of the length of training and the frequency of training needed to successfully complete that program.

 

6.05    Time Frame for Completing an Assessment

 

Refer to section 1.07, Time Frames Reference Guide, in the General Information Section of these Guidelines for assessment completion time frames.

 

 

6.06    Conducting the Vocational Skills Training Assessment

 

The Vocational Skills Training Assessment will be conducted by the staff who provide the vocational skills training.  Currently, the Vocational Skills Training Assessment has been developed to assess a consumer's readiness to enter vocational training leading to employment in clerical/technology related occupations.

 

If a contractor intends to offer vocational training leading to employment in a service or industrial related occupation, the contractor should prepare assessment guidelines and a curriculum for the training and submit both to the NYSCB Director of Field Operations for review and approval.

 

Assessment leading to employment with a particular employer/group of employers or within a specific business sector also should be prepared by the agency conducting the training and submitted for approval.

 

6.07    Criteria for Determining that a Consumer Has Achieved the Vocational Skills Training Assessment Outcome

 

1.        The consumer's readiness to enter vocational training leading to employment has been assessed using NYSCB guidelines or those developed by the agency and approved by NYSCB.

2.        The findings and recommendations from the assessment have been discussed with the consumer and the NYSCB counselor in a three-way meeting or teleconference.

3.        A Vocational Skills Training Assessment Report identifying the type of vocational training the consumer can benefit from or an explanation of why the consumer will not benefit from a vocational skills training at this time, has been provided to the NYSCB counselor.

 

 

 

6.08    Vocational Skills Training Outcome

 

An agreed upon number of individuals, referred by a NYSCB Counselor, will achieve the vocational skills necessary to obtain or maintain employment in the occupation(s) identified in their IPE’s.

 

 

6.09    Terms Used in the Outcome Statement

 

Vocational skills’ training is a hands‑on, experiential learning for occupations that have been identified as in-demand by the New York State Department of Labor.  This training is provided to consumers to prepare them for a specific occupational goal for entry or re‑entry into gainful employment consistent with the individual's interests and capabilities as identified in their mutually agreed upon Individualized Plan of Employment (IPE).

 

 

6.10    Standards for Service Delivery:  Vocational Training Services

 

1.      Prior to the contractor developing a new vocational training program, it is critical to obtain input regarding the development of the program and confirmation of the usefulness of the program from local employers.  The training curriculum must be approved by the NYSCB Director of Field Operations and Implementation.

 

2.      Vocational training programs should have demonstrated evidence of long term placement prospects and strong linkages with employers in the region in order to increase the likelihood of employment after the training has been completed.

 

3.      The intensity of the training program should allow for substantial skill development, but should also allow participants to obtain skills within a reasonable amount of time.

 

6.11    Responsibilities of the NYSCB Counselor and the Contractor – Vocational Training

 

Refer to Section 1.11, Responsibilities of the NYSCB Counselor and Section 1.12, Responsibilities of the Contractor in the General Information Section of these Guidelines for roles and responsibilities.

 

6.12    Criteria for Determining that a Consumer Has Achieved the Vocational Skills Training Outcome

 

In order for a consumer to be reported as having achieved this outcome, each of the following criteria must be met:

 

1.      The consumer and the NYSCB counselor agree that the level of competency in specific vocational skills needed to obtain or maintain employment in service, clerical, industrial or technology-related occupations has been achieved.

2.      The consumer and the NYSCB counselor agree that vocational skills have been developed that are consistent with the consumer's interests and capabilities and the vocational goal as identified in the referral materials.

3.      The consumer has achieved measurable increases in specific vocational skills or competencies.

4.      The consumer and the NYSCB counselor agree that all original or revised plan goals have been achieved.

 

 

7.01    Work Readiness Skills Training and Assessment

 

Certain individuals, at the time they apply to NYSCB or are found eligible for NYSCB services, demonstrate a need to learn basic skills that will assist them in making a successful adjustment to the workplace.  For these individuals, simply getting a job is not enough if they do not have the skills that will allow them to keep the job.

 

The Work Readiness Skills Assessment and Training outcomes have been developed to provide these individuals with assistance in developing the “soft” skills that will enable them to make a satisfactory adaptation to the needs and expectations of any workplace in which they find themselves.

 

Skills learned in Work Readiness Training can be reinforced through a Work Experience following completion of Work Readiness Training.

 

 

7.02    Work Readiness Skills Assessment

 

Prior to receiving Work Readiness Skills Training, an individual will participate in a Work Readiness Skills Assessment.  This assessment will:

 

1.        determine a consumer’s ability to actively participate in Work Readiness Training;

2.        establish a baseline of skill levels against which future progress can be compared; and

3.        provide an estimate of when the training will be completed, in order to assist the NYSCB counselor and the consumer in vocational planning.

 

 

7.03    Work Readiness Skills Assessment Outcome

 

Individuals referred by a NYSCB counselor will be assessed to determine their knowledge of, and skill levels in, strategies that will allow them to successfully balance the demands of a job with necessary activities in their personal lives.  The assessment must indicate any areas in which knowledge and skills are lacking and define a training program that will address those areas.

 

Individuals referred for a Work Readiness Assessment must have discussed the need for this service with their NYSCB counselor, and have been referred for the service by their counselor.  Recommendations from contractors about who may be expected to benefit from this service must be discussed with the NYSCB counselor before discussing the program with the consumer.

 

 

7.04    Time Frame for Completing an Assessment:

 

Refer to section 1.07, Time Frames Reference Guide, in the General Information Section of these Guidelines for assessment completion time frames.

 

7.05    Conducting the Work Readiness Skills Assessment:

 

Using the NYSCB Work Readiness Skills Training Assessment Report, the contractor will identify individualized objectives for each referred individual that can be met by the contractor’s Work Readiness Program.  The objectives will be determined by assessing the individual’s strengths and needs, as well as their experiences, interests, and personal and family factors that may affect future employment outcomes.  The contractor will include a recommendation for a Work Readiness program that addresses specific skills or indicate that a Work Readiness Program is not recommended at this time.

 

7.06    Who Conducts the Work Readiness Skills Assessment

 

The Work Readiness Skills Assessment will be conducted by the Contractor staff who conduct the Work Readiness Training Program.

 

7.07    Responsibilities of the NYSCB Counselor and the Contractor: Work Readiness Skills Assessment

 

Refer to Section, 1.11Responsibilties of the NYSCB Counselor and Section 1.12, Responsibilities of the Contractor in the General Information Section of these Guidelines for roles and responsibilities.

 

In addition, upon referral of the consumer by the NYSCB counselor, the contractor staff will interview the referred consumer and clearly describe the assessment process and expectations for consumer participation.

 

7.08    Criteria for Determining that a Consumer Has Achieved the Work Readiness Skills Assessment Outcome

 

In order for a consumer to be reported as having achieved this outcome, each of the following criteria must be met:

 

1.        The consumer’s Work Readiness Skills have been assessed to determine whether training is required.

2.        The findings and recommendations from the assessment have been discussed with the consumer and the NYSCB Counselor.

3.        A Work Readiness Skills Assessment Report identifying the type of Work Readiness Skills program the consumer can benefit from or an explanation of why the consumer will not benefit from a Work Readiness Skills training program at this time has been provided to the NYSCB counselor.

 

Note:  All Work Readiness Skills Assessments must be completed prior to scheduling a Work Readiness program, and NYSCB must agree that the outcome was achieved.

 

7.09    Work Readiness Skills Training 

 

Work readiness training programs must have a curriculum that is pre-approved by the NYSCB Director of Field Operations and Implementation.  The curriculum must specify the training topics, training schedule, and the staff positions that will be involved in the assessment and delivering the training.  The training program must also include direct involvement by local businesspeople.  Additionally, should the assessment identify individualized work readiness needs for a specific consumer, the results of the assessment must discuss those needs, how those needs will be addressed within and in addition to the training program, and provide an estimate of the time needed to complete the training.

 

7.10    Work Readiness Skills Training Outcome Statement

 

Individuals referred by a NYSCB Counselor will achieve the work readiness skills necessary to obtain and maintain competitive employment in an integrated setting, including but not limited to:  understanding and demonstrating appropriate communication skills for work, understanding employer expectations, understanding how personal issues can affect employment success, demonstrating interviewing skills and developing a basic resume.

 

The curriculum for this program must be pre-approved by the NYSCB Director of Field Operations before individuals can be referred for this service.

 

Individuals referred for a Work Readiness Assessment must have discussed the need for this service with their NYSCB counselors, and have been referred for the service by their counselors.  A suggestion by a contractor about who may be expected to benefit from this service must be discussed with the NYSCB counselor first, before discussing it with the consumer.

 

7.11    Standards for Service Delivery:  Work Readiness Skills Training

 

1.        In order to obtain NYSCB sponsorship of individuals in a Work Readiness Skills Training Program, the contractor must develop a curriculum for the program and obtain the approval of the NYSCB Director of Field Operations and Implementation for the curriculum.

2.        Work Readiness Skills Training programs should develop those work skills that will assist an individual in obtaining and maintaining long-term employment.

3.        Work Readiness Skills Training curricula must include a training schedule that requires trainees to show up on time (preferably in the morning hours), stay for the entire program, and be actively engaged in the training.

4.        The curriculum for each program must include the following components:

 

·        Communication Skills

a.        Listening skills

b.        Non-verbal Communication (body language)

c.        Disability Disclosure

d.        Being an effective team member

e.        Working effectively with others (dealing with conflict, differences of opinion, etc.)

f.          Forms/levels or workplace communication

g.        Learning and understanding workplace culture

 

 

·        Personal Management

a.        Understanding your responsibilities as an employee

b.        Work Ethic (dependability, integrity, honesty, initiative, motivation, etc.)

c.        Balancing work and family/private life

d.        Benefits advisement – understanding impact of earnings on benefits; economic empowerment

e.        Personal Appearance

f.          Self-concept/motivational skills/understanding personal skills and abilities

g.        Conveying a positive attitude

h.        Self-Advocacy

i.          Managing Stress

j.          Goal setting/time management

 

·        Introduction to Job Seeking Skills

a.        Interviewing skills

b.        Development of a basic resume

c.        Mock interviews with hiring managers from local businesses

·        Employer contact – each program must also include an experiential component that brings consumers in contact with real employers with the purpose of developing a real understanding of work settings and employer’s expectations.  These experiences should ideally take place in the employment setting.  NYSCB will also consider mock interviews and informational interviews where the consumer would discuss with the employer skills needed for a specific job, as fulfillment of this requirement.

 

5.        A meeting must be arranged by the contractor to include the counselor, the consumer and the provider to determine if the individual is ready  to move directly to placement services, to discuss a work experience or other training needed before  moving to placement, or to agree that the consumer no longer wants to pursue employment at this juncture.

 

 

 

 

Because of the importance of work readiness skills in enabling an individual to obtain and maintain a job, attendance and punctuality are highly important. Consumers must attend at least 80% of sessions and complete all assignments for the agency to receive the full outcome payment.

 

In general, a training outcome will be considered to be successful if one of the following is true:

1.        The consumer successfully completes the course and is ready to participate in Placement Services.

2.        The consumer successfully completes the course, and areas needing further remediation before Placement Services can be authorized are identified and shared with the consumer and NYSCB Counselor.

3.        The consumer successfully completes the course but informs the NYSCB Counselor that he or she is no longer interested in becoming employed.

 

8.01    Work Experience

 

Work experience is an opportunity for a consumer with little or no work experience, for a consumer who has a substantial gap in employment for a consumer who is changing careers; or for a consumer who has recently completed vocational training or education, to attempt work in the most integrated setting possible. Whenever possible the work experience setting should be appropriate to the consumer’s work goal.

 

Work experience is an opportunity for a consumer to learn and use workplace skills and behaviors. Work experiences should only be of sufficient duration to reach the goals specified by the counselor on the referral form. Work experiences that conclude earlier than the agreed-upon term can be considered successful if the experience provides the counselor with the information sought in the referral.

 

A work experience can be helpful in providing information to the counselor in three areas.

 

1.        Determining whether or not a consumer has chosen an appropriate vocational goal

2.        Determining whether a consumer has the skills or can develop the skills for a particular job

3.        Determining whether or not a particular job can be accomplished with adaptive equipment or reasonable accommodations

 

Work experience may be paid or unpaid. When work experience is paid, remuneration should be at minimum wage. If there appear to be circumstances which warrant a higher wage, the contractor must propose the higher wage to the counselor prior to discussion with the consumer. The District Manager must approve any work experience paid at higher than minimum wage. When work experience is unpaid, the consumer may be reimbursed for reasonable cost of transportation to and from work.  Consumers who have been accepted for placement services may not be referred for Work Experience.

 

8.02    Work Experience Outcome

 

An agreed upon number of NYSCB consumers, referred by a NYSCB counselor, will participate in a time-limited experience which: (1) provides the consumer with an understanding of the work environment, work-related behaviors, and work skills; and (2) provides NYSCB with information on how the consumer performed in the work setting and recommendations for employment or continued work skill building.

 

 

8.03    Terms Used in the Outcome Statement

 

1.         Time Limited:  Duration should be sufficient for the consumer to acquire general work skills and experience, and for others to assess how the consumer performs in a work setting.  A work experience should be of sufficient duration to meet the goals specified by the counselor in the referral documentation.  Work experiences should be for a minimum 20 hours/week, and should not exceed three months.  A senior counselor or district manager may approve an extension of the work experience if information gathered during a three-month period is insufficient to reach a conclusion about the consumer’s abilities or if an extension of the work experience is likely to result in employment at the same work site.  Consumers may require more than one work experience in order to prepare for competitive, community-based employment.  These work experiences should be varied in nature, complexity and/or setting to determine an appropriate job match for the consumer.  The total of all work experiences for a consumer during one case opening may not exceed 1040 hours.

 

            (Exception:  After-school work experiences can be fewer than 20 hours/week).

 

2.         Work environment:  The physical, cultural and psychological aspects of a work setting.

 

3.         Work-Related Behaviors:  Behaviors which impact on the individual's ability to successfully function on a job, including, but not limited to, time management skills, communication skills, organization skills, ability to follow directions, and ability to work collaboratively.

 

8.04    Standards for Service Delivery

 

1.        A Work Experience Agreement will be developed between the contractor and the employer for each consumer served through this outcome.  A copy of the agreement will be sent to the NYSCB counselor when it is finalized. This agreement is required regardless of whether the employer is community-based or the employer is a department within the contractor agency itself. (A sample agreement is included in the Forms section of this document.)

2.        The objective of this outcome is to provide opportunities for the consumer to develop work skills in real-life integrated employment settings. , To this end, the contractor is required to provide the minimum amount of training needed to evaluate the consumer’s ability to adjust, learn and function in a work setting.  The work experience outcome is meant to provide generalized experience in the workplace.  While work experience that matches the consumer’s employment goal is preferred, the work need not be consistent with the individual’s IPE goal.

3.        Consumers are expected to be employed for at least 20 hours/week, unless the NYSCB senior vocational rehabilitation counselor has provided a waiver for fewer hours based on consumer need.

4.        The contractor must visit work site regularly during the course of the work experience to observe and provide feedback to the consumer about their performance along with recommendations for improvement.

 

8.05    Responsibilities of the NYSCB Counselor and the Contractor:  Work Experience

 

Refer to Section, 1.11Responsibilties of the NYSCB Counselor and Section 1.12, Responsibilities of the Contractor in the General Information Section of these Guidelines for roles and responsibilities.

 

Additional responsibilities of the counselor and contractor are listed below:

 

Additional Counselor Responsibilities

 

1.      During the discussion with the consumer of the purpose of a work experience, discuss the types of work experiences the consumer would like to pursue.

 

2.      Include a vendor referral form and a completed Expectations for Work Experience Form identifying specific information the counselor expects to learn as a result of the consumer's participation in a work experience.

8.06    Additional Contractor Responsibilities

 

1.        Upon referral of the consumer by the NYSCB counselor, meet with the consumer to determine the appropriate work experience for the consumer.

2.        Arrange for a work experience, develop a Work Experience Agreement which includes information on how benefits will be covered with the employer, and forward a copy to the NYSCB counselor prior to the commencing the work experience.

3.        Monitor the consumer's progress throughout the work experience, make recommendations for improvement and address any problems that arise with the consumer, the employer and the counselor in a timely fashion.

 

8.07    Criteria for Determining that a Consumer Has Achieved the Work Experience Outcome

 

For a consumer to be reported as having achieved this outcome, each of the following criteria must be met:

 

1.        Each concern or area identified by the counselor in the referral for Work Experience has been assessed.

2.        The work experience established for the individual meets the standards for this service as outlined in these guidelines.

3.        The findings and recommendations from the Work Experience have been discussed with the consumer and the NYSCB counselor and a conference was held to discuss the information as it relates to ongoing vocational planning.

4.        A Work Experience Final Report, which includes required information about the job and the consumer’s performance, and which addresses the initial concerns posed by the counselor, has been provided to NYSCB.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PROVISION OF

ADDITIONAL SERVICES

 

 

9.0

 

 

 

 

Services

1

Orientation and Mobility Service

2

Vocational Rehabilitation Therapy Services

3

Social Casework Services

4

Case Finding/Outreach

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9.01    Orientation and Mobility Services

 

Orientation and Mobility (O&M) as an additional service can be authorized to provide  brief instruction to, from or around a work site, training site or a neighborhood if, without the service, the consumer would find it difficult to participate in that work or training, or to continue functioning as a Homemaker.

 

Consumers receiving this instruction should have already been trained in O&M and demonstrated an understanding of basic O&M skills.  The additional instruction is intended to provide the consumer with an extra measure of safety when traveling a difficult or complicated route on a regular basis.

 

Authorization of additional O&M services will be provided in hourly sessions for a maximum of twenty hours.

 

9.02    Vision Rehabilitation Services

 

Vision Rehabilitation Teaching (VRT) as an additional service can be authorized to provide a time limited service which is necessary to meet an immediate need which develops on a consumer's work or training site or in their home if, without the service, the consumer would find it difficult to participate in that work or training or to continue functioning as a Homemaker.

 

Consumers receiving this service should have already been trained under the Vision Rehabilitation Services, and have successfully completed that training.  The additional instruction is intended to meet a specific and limited need, which could not have been foreseen at the time of the original training.

 

Authorization of additional VRT services will be provided in hourly sessions for an individual NYSCB consumer for a maximum of twenty hours.

 

9.03    Social Casework Services

 

Social Casework as an ancillary service can be authorized by a NYSCB counselor on a fee for service basis only if it is not a part of the service component the consumer is receiving or when it is the only service that a consumer requires.  Social Casework as an ancillary service is meant to provide a time limited service to address a problem in the consumer's life which prevents them from participating fully in either a training program, a job, or from functioning as a Homemaker.  If the problem cannot be addressed within the maximum amount of time allowed, the Social Casework hours authorized should be used to locate and refer the consumer to a community resource which can provide the service.  Social Casework services will not be provided  by NYSCB if the NYSCB counselor is already aware of such a community resource.  Social Casework services can only be provided to address a vocationally related problem.

Authorization of Social Casework as an ancillary service will be provided by NYSCB in hourly sessions for an individual NYSCB consumer for a maximum of twenty hours.

 

9.04    Outreach/Case Finding

 

Individuals of working age (generally 18-55) who are legally blind may be unaware of the vocational rehabilitation services available to them through the New York State Commission for the Blind. These individuals may be eligible for vision rehabilitation, vocational training, and job services that will enable them to enter the workforce and become more active participants in their communities. Entering the workforce will make it possible for them to rely less on benefits and become more independent economically.

 

NYSCB places particular significance on outreach to traditionally underserved populations, as set forth in the Rehabilitation Act of 1973, as amended.

 

To provide this service, the Contractor will engage in outreach efforts to identify individuals who are eligible for Vocational Rehabilitation (VR) services. Payment for Outreach/Case Finding will be made to the contractor upon receipt of the documents listed below when the individual identified is previously unknown to NYSCB, legally blind, eligible to work in the United States and interested in obtaining employment:

 

1.         Completed application for services (including information identifying the agency        submitting the application)

2.         Completed eye report

3.         Any other pertinent information about the individual

4.         A request to issue an authorization for the “Outreach/Case Finding Service.”

 

Upon receipt of these documents, the following must transpire prior to approval of payment:

 

1.         Completion of intake interview with the assigned NYSCB counselor, and

2.         The Consumer is determined eligible for VR services (status 10) by the NYSCB        counselor.

 

In addition, agencies can request payment for Outreach/Case Finding for individuals who meet the criteria for the Job Save Program, are determined eligible for VR services and who have not previously received services from NYSCB.   These individuals are not yet legally blind but are expected to be legally blind within a year, are currently employed and at risk of losing their job due to issues related to their visual impairment and are not currently nor have been served by ACCES-VR.

 

The NYSCB counselor will issue an Authorization for “Outreach/Case Finding Service” after determining the eligibility of the consumer and that they have not previously received services from NYSCB.  After the agency completes their section of the authorization, the counselor will submit the authorization for payment. 

 

 


 

Comprehensive Services Contract Guideline Forms

10.0

Adaptive Living Program (ALP) Intake

Assessment Tool for the ALP

ALP Individualized Service Plan

ALP Individualized Services Plan Progress Report

 

Orientation and Mobility Assessment Report

O&M Level 1 Report

O&M Level 2 Report

O&M Level 3 Report

 

Vision Rehabilitation Therapy Assessment Report

VRT Level 1 Report

VRT Level 2 Report

VRT Level 3 Report

 

Social Casework Assessment Report

SCW Level 1 Report

SCW Level 2 Report

 

Pre-Vocational Skills Assessment Report

Pre-Vocational Training Skills Report

 

Academic Instruction Assessment (ESL) Report

Academic Instruction Assessment (ABE/HSE) Report

Academic Instruction Assessment (College Preparation) Report

Academic Instruction Report

 

Vocational Skills Training Assessment Report

Vocational Skills Training Report

 

Work Readiness Skills Assessment Report

Work Readiness Skills Training Report

 

Work Experience Report

WET Employer Agreement

 

Prohibition on Redisclosure of HIV or AIDS Related Information

Prohibition on Redisclosure of Information Concerning Individuals with a Disability of         Alcoholism or Substance Abuse

New York State Office of Children and Family Services

Commission for the Blind

Intake Form for Adaptive Living Program

 

Consumer:

 

Name: (Last, First, MI)                                                                     Case Number:

 

SSN:                                                                                                   Cycle:

 

Date of Birth:                                                                                     Gender:

 

Person Completing Intake:

 

Referral Information:

 

Source of Referral: 

 

Eye Care Provider (Ophthalmologist, Optometrist)

Physician/Medical Provider                                             State VR Agency

Government or Social Services Agency                        Self-Referral

Family Member or Friend                                                Veteran’s Administration

Senior Center                                                                    Faith-Based Organization

Independent Living Center                                               Other

Nursing Home or Long-Term Care Facility                    Assisted Living Facility

 

First Contact Date:

 

Residential Address:

 

Mailing Address:

 

Telecom

 

Home Phone:                                                                        Cell Phone:

 

TDD(Y/N)?                                                                             E-mail:

 

 

Communication

 

Primary Language (choose 1):       

English                                                       Spanish                             Hindi

African Languages                                   Arabic                                 Italian

Chinese                                                      French                                Japanese

German                                                      Greek                                 Korean

Haitian Creole                                           Hebrew                               Other

Polish                                                         Portuguese                        Russian

Urdu                                                            Vietnamese

 

Other Languages (please choose from options listed above and not the language indicated as primary):

 

Preferred Communication Medium:

Regular Print                                                                    Large Print

Braille                                                                                Taped

E-mail                                                                                Electronic

 

Manual Communication Mode:

Signed English                                                                American Sign Language

Tactile Sign                                                                      Tangible Symbols

Other

 

Race/Ethnicity (Y/N to as many as applicable):

White                                                                     Black or African American                    

Asian                                                                    American Indian or Alaska Native        

Native Hawaiian or Pacific Islander                  Hispanic or Latino

 

 

Other Information:

 

Highest Level of Education Completed:

No Formal Schooling                               Elementary Education (grade 1-8)       

Secondary Education, no high school diploma (grade 9-12)

High School Equivalency Certificate    

Post-Secondary Education (less than Bachelor’s Degree

Bachelor’s Degree or Higher                Master’s degree or higher

 

Type of Living Arrangement at Time of Intake:     

Live Alone

Live with Spouse

Live with Personal Care Assistant

 

Setting of Residence at Time of Intake:

Private (House or Apartment)                            Senior Living/Retirement Community

Assisted Living Facility

 

Major Cause of Visual Impairment as Reported by the Individual:

Macular Degeneration                 Diabetic Retinopathy                  Glaucoma

Cataracts                                     Other

 

Non-Visual Impairments/Conditions at Time of Intake as Reported by the Individual:

Diabetes                           Hearing Impairment                                Cancer

Cardiovascular Disease and Strokes              Depression/Mood Disorder        

Alzheimer’s Disease/Cognitive Impairment      Other Major Geriatric Concerns           

Bone, Muscle, Skin, Joint and Movement Disorders 

 

 

Onset of Significant Vision Loss (when loss began to affect performance of daily activities):

Less than 1year before IL services                    1-3 years              4-6 years

7-9 years                                                              10 years or more

 

Do you have documentation of legal blindness?

Yes                         No

 

 

Blind Registry Number: _____________

 

Services Received

Have Service Been Provided:                                 Yes                        No

For Fiscal Year: ________

 

ILOB Services (HKNC Specialized Senior Services)                              Provided_________

Low Vision screening/evaluation:                                                               Yes            No

Low-Vision:                                                                                                    Yes No  

Orientation and Mobility Training:                                                               Yes            No

Daily Living Skills Training- Financial:                                                        Yes            No

Daily Living Skills Training- Personal:                                                        Yes            No

Daily Living Skills Training- Meal:                                                               Yes            No

Daily Living Skills Training- Home:                                                 Yes No

Daily Living Skills Training- Family Care:                                                  Yes            No

Communications Training:                                                                           Yes No

Counseling:                                                                                                    Yes No

Community Integration:                                                                                 Yes No

Assistive Devices:                                                                                        Yes            No

 

Agency Representative: _________________________

 

Date: ____________


 

New York State Office of Children and Family Services

Commission for the Blind

 

Assessment Tool for the Adaptive Living Program

 

Section I.

 

Name                                                                                     Cycle Number:

 

Address:                                                                                Date of Birth: 

 

Telephone:                                                                              

 

Date of Assessment:                                    Person Completing: 

 

Would you have any difficulty if you needed to contact someone quickly in an emergency?  

 

Describe way of contacting:

 

Emergency Contact Name: 

Phone: 

 

GENERAL BACKGROUND

 

Services are available to help you be safer and more independent in your household activities. In order to determine which program would best meet your needs, we will ask you questions about your household responsibilities. It is also important for us to know if you are working or would be interested in employment.

 

1. a.     Are you currently employed?  

1. b.     If, yes, what kind of work do you do?   

1. c.     Are you having difficulty on the job because of impaired eyesight?     

            Describe:  

 

  

2. a.     If you are not working now, would you be interested in a program which would help you to become employed in the future?  

2. b.     Optional: if the answer to 2.a. is "Yes" - 

            Do you know the kind of work you would want to do?     

2. c.     Optional: if the answer to 2.a. is "Yes" - 

            If you worked in the past, what kinds of jobs did you have? 

   

 

Note: If the person is working, or is interested in working, notify the NYSCB office immediately. The vocational rehabilitation (VR) program provides a range of services necessary for the person to become employed and can include the provision of Rehabilitation Teaching and Orientation and Mobility services to address daily living and mobility skills needs.

 

3. Residence Type:  

 

4. a.     Are you responsible for household activities?

 

4. b.     Does anyone else help with these tasks?

 

4. c.     If yes, who helps you?

What do they do?   

How often?

 

4. d.     Are you satisfied with this arrangement?

 

4. e.     Which of these activities do you want to do on your own?   

 

5.         What is the nature of your eye condition?

        

6.         When did your vision problem(s) begin?

  

7.         When was your last vision examination?

  

8.         What is the name of your eye doctor?  

            Did he/she ever tell you that you are legally blind?

  

9.         Do you know what legal blindness means?

 

10.       Are you currently receiving, or might you soon receive, treatment for your vision that may change your sight?  Describe:   

  

11.       Describe what your eyesight is like now (for instance - no light perception, can only see shadows or vague images, difficulty distinguishing colors, parts of visual field missing, vision changes throughout the day):  

Note to interviewer: If person's vision is NLP in both eyes, check here     

You do not need to ask questions 12 through 16. 

  

12.       Do you have trouble recognizing people or objects at a distance?

Describe:   

  

13.       Do you have problems with brightly-lit areas, dimly lit areas, or glare?

Describe:  

 

14.       Do you have problems reading printed material (newspapers, books, dials, labels, price tags, etc.)?

Describe:  

 

15.       What kind of print is easiest for you to read?

  

16. a.  Do you have any optical devices that you are using to help you see better?

 

16. b.  If yes, when did you get them?

What do you use them for?

 

Personal Care

 

Outcome of Assessment can be indicated by entering a number from 1 - 4 in the first text field. The numbers indicate the following outcomes:

 

1. Training Needed / Goal Set

2. Training Needed / Training Declined

3. No Training Needed

4. Task Not Applicable

 

Task

Outcome of Assessment 

1. Hygiene, such as bathing and brushing teeth

 

2. Grooming, such as nail care, dressing, applying make-up             and shaving

 

3. Medication Management, such as identification,             organization, timing, etc.

 

4. Labeling, such as clothing

 

5. Are there any other needs not listed? If so, please             specify:

 

 

   

 

Communication Skills

 

Outcome of Assessment can be indicated by entering a number from 1 - 4 in the first text field. The numbers indicate the following outcomes:

 

1. Training Needed / Goal Set

2. Training Needed / Training Declined

3. No Training Needed

4. Task Not Applicable

 

 

Task

Outcome of Assessment

1.Handwriting, such as signature

 

2.Time telling, such as having trouble telling the time

 

3.Telephone Use, such as misdialing numbers and difficulty obtaining phone numbers

 

4. Braille Labeling/Instruction

 

5. Note taking, such as making lists, keeping track of appointments and keeping notes

 

6. Electronic Devices

 

7. Are there any other needs not listed?  If so, please specify:

 

 

 

  

Section II: Mobility

 

Outcome of Assessment can be indicated by entering a number from 1 - 4 in the first text field. The numbers indicate the following outcomes:

 

1. Training Needed / Goal Set

2. Training Needed / Training Declined

3. No Training Needed

4. Task Not Applicable

 

Task

Outcome of Assessment

Indoor Mobility 

 

1. Protective techniques

 

2. Emergency Exit

 

3. Home Orientation

 

4. Sighted Guide

 

5. Cane Travel

 

Outdoor Mobility 

 

6. Stairs

 

7. Curbs

 

8. Accessing places of personal importance

 

9. Public Transportation

 

10. Cane Travel

 

11. Street Crossings

 

 

 

 

Section III: Meal Management:

 

Homemaking Core Area 1

Outcome of Assessment can be indicated by entering a number from 1 - 4 in the first text field. The numbers indicate the following outcomes:

 

1. Training Needed / Goal Set

2. Training Needed / Training Declined

3. No Training Needed

4. Task Not Applicable

 

Task

Outcome of Assessment

 

1. Eating meals: 

 

            a. Locating items on table

 

            b. Cutting food

 

            c. Pouring

 

2. Identifying items in refrigerator, cupboards, and drawers. 

 

3. Preparing cold beverage or snack 

 

4. Preparing hot beverage or snack 

 

5. Using microwave and/or toaster oven 

 

6. Using stove and/or oven

 

7. Using small kitchen appliances

 

8. Measuring ingredients 

 

9. Chopping, peeling, slicing 

 

10. Using recipes 

 

11. Are there any other needs not listed?  If so, please             specify: 

 

 

 

 

 

 

Section IV. Home Management:

 

Homemaking Core Area 2

 

Outcome of Assessment can be indicated by entering a number from 1 - 4 in the first text field. The numbers indicate the following outcomes:

 

1. Training Needed / Goal Set

2. Training Needed / Training Declined

3. No Training Needed

4. Task Not Applicable

 

Task

Outcome of Assessment 

1. Light cleanup jobs, such as wiping up spills and dusting 

 

2. Clean sinks, countertops, and bathroom fixtures 

 

3. Sweep, mop, and vacuum 

 

4. Identify and organize clothing items 

 

5. Set controls on washer and dryer 

 

6. Set thermostat    

 

7. Thread needle, mend and sew clothing

 

8. Ironing 

 

9. Use of other household appliances 

 

10. Are there any other needs not listed? If so, please             specify: 

 

 

 

Section V. Financial Management:

 

Homemaking Core Area 3

 

Outcome of Assessment can be indicated by entering a number from 1 - 4 in the first text field. The numbers indicate the following outcomes:

 

1. Training Needed / Goal Set

2. Training Needed / Training Declined

3. No Training Needed

4. Task Not Applicable

 

Task

Outcome of Assessment 

1. Identify coins 

 

2. Distinguish different bill denominations 

 

3. Keep track of bills and other payments 

 

4. Write checks or use other methods to pay bills 

 

5. Balance a checkbook or use other record-keeping system             to keep track of budget and expenditures 

 

6. Handle banking activities 

 

7. Are there any other needs not listed?  If so, please             specify: 

 

 

   

Section VI. Family Care:

 

 

Homemaking Core Area 4

 

These questions are appropriate for persons who take care of a child or children. They are also appropriate for persons who take care of an adult or a child who has a physical or mental disability. Do not complete this section if inapplicable.

 

Describe whom the person takes care of and any special circumstances:

 

Outcome of Assessment can be indicated by entering a number from 1 - 4 in the first text field. The numbers indicate the following outcomes:

 

1. Training Needed / Goal Set

2. Training Needed / Training Declined

3. No Training Needed

4. Task Not Applicable

 

Task

Outcome of Assessment 

1. Prepare formula, baby or pureed food, or other specially prepared food    

 

2. Feed an infant, toddler, disabled child, or adult    

 

3. Diaper an infant, child or adult    

 

4. Dress the child or adult    

 

5. Bathe the child or adult    

 

6. Attend to medical needs    

 

7. Help transfer to toilet or bath    

 

8. Other medical/safety responsibilities not listed?    If so,             please specify: 

 

 

   

 

Section VII: Conclusion

 

1.         Do you want to talk with someone to help you with the vision changes you've experienced?  

 

2.         Would you be interested in a referral to a low vision specialist at this time? 

 

3.         If you are interested in a referral to a low vision specialist, are you also interested in obtaining low vision aids and low vision training?

 

4.         Are you interested in learning about other services and activities available in the community that might assist you in maintaining your independence?  

 

General Resources Applied For:

 

 

Examiner's Observation:

 

Please comment on any noticeable aspects of the consumer's demeanor, home environment, or other factors that might impact upon the rehabilitation process.

(Examples- seems confused, cries easily, home is cluttered, etc.)

 

 

Stimulus Funds Used?  

 

Completed Date:

 


 

New York State Office of Children and Family Services

Commission for the Blind

 

ALP Individualized Service Plan

 

 

Case Number:                                                                                   Cycle Number: 

Consumer:                                                                                         Registry #: 

 

Provider Agency: 

 

Case Manager:                    

 

Projected Start Date:           

 

Goals

 

Goal #1:   Improve personal care skills

Goal #2:    Improve communication skills

Goal #3: Improve independent travel skills

Goal #4: Improve meal management skills

Goal #5: Improve home management skills

Goal #6:    Improve financial management skills

Goal #7:    Improve family care skills

Goal #8: Improve adjustment to vision loss

Goal #9:    Determine the extent of vision loss

Goal #10: Maximize residual vision

Goal #11: Increase involvement in community activities

 

Services

 

Service 1:  Daily Living Skills Training- Personal

 

Detail:   Hygiene Detail:   Grooming

Detail:   Medication Management

Detail:   Labeling

 

This service will contribute to achievement of Goal(s) #:

Service 2: Daily Living Skills Training- Meal

Detail:  Locating Items on the Table

Detail:  Cutting Food

Detail:  Pouring

Detail:   Identifying items in refrigerator, cupboards and drawers

Detail:   Prepare cold beverage or snack

Detail:   Prepare hot beverage or snack

Detail:   Using microwave and/or toaster oven 

Detail:   Using stove and/or oven

Detail:   Using small kitchen appliances

Detail:    Measuring Ingredients

Detail:   Chopping, Peeling, Slicing

Detail:   Using Recipes

Detail:   Other

 

This service will contribute to achievement of Goal(s) #:

 

Service 3: Daily Living Skills Training-Home

Detail:   Lights cleanup jobs, such as wiping up spills and dusting

Detail:   Clean sinks, countertops, and bathroom fixtures

Detail:   Sweep, mop and vacuum

Detail:    Identify and organize clothing items

Detail:   Set controls on washer or dryer

Detail:   Set thermostat

Detail:   Thread needle, mend and sew clothing

Detail:   Ironing

Detail:   Use of other household appliances

Detail:   Other

 

This service will contribute to achievement of Goal(s) #:

 

Service 4: Daily Living Skills Training-Financial

Detail:   Identify Coins

Detail:   Distinguish different bill denominations

Detail:   Keep track of bills and other payments

Detail:   Write checks or use other methods to pay bills

Detail:   Balance a checkbook or use other record-keeping system to keep                                   track of budget and expenditures

Detail:   Handle banking activities

Detail:   Other

 

This service will contribute to achievement of Goal(s) #:

 

Service 5: Daily Living Skills Training-Family Care

Detail:  Prepare formula, baby or pureed food, or other specially prepared                                                food

Detail:  Feed and infant, toddler, disabled child or adult

Detail:  Diaper and infant, child or adult

Detail:  Dress the child or adult

Detail:   Bathe the child or adult

Detail:   Attend to medical needs

Detail:   Help transfer to toilet or bath

Detail:   Other

 

This service will contribute to achievement of Goal(s) #:

 

Service 6:  Communication Skills Training

 

Detail:   Handwriting

Detail:   Time-Telling

Detail:   Telephone

Detail:   Braille Labelling/Instruction

Detail:   Electronic Devices

Detail:   Other

 

This service will contribute to achievement of Goal(s) #:

 

 

Service 7:  Orientation and Mobility Training

 

Detail:   Protective Techniques

Detail:   Emergency Exit

Detail:   Home Orientation

Detail:   Sighted Guide

Detail:   Cane Travel: Indoor

Detail:   Stairs

Detail:   Curbs

Detail:   Accessing Places of personal importance

Detail:   Use of public transportation

Detail:   Cane Travel-Outdoor

Detail:   Street Crossings

Detail:   Other

 

This service will contribute to achievement of Goal(s) #:

 

Service 8: Counseling

            Detail: Counseling

            Detail: Other

 

This service will contribute to achievement of Goal(s) #:

 

Service 9: Low Vision screening/evaluation

            Detail: Low Vision Exam

 

This service will contribute to achievement of Goal(s) #:

 

Service 10: Low-Vision

            Detail: Low Vision Aids

 

This service will contribute to achievement of Goal(s) #:

 

Service 11: Community Integration

            Detail:

 

This service will contribute to achievement of Goal(s) #:

 

Service 12: Assistive Devices

            Detail:

 

This service will contribute to achievement of Goal(s) #:

 

Comments:

 

 

I understand that:

 

NYSCB is sponsoring the services that I will receive from (AGENCY NAME). AGENCY will provide information to NYSCB about my progress toward achieving my goals. If I have questions, I can contact AGENCY at AGENCY PHONE CONTACT. I am not interested in pursuing employment at this time. My progress will be reviewed regularly. I understand that I am required to maintain satisfactory progress in training. My responsibilities are: to cooperate in carrying out this plan; be prepared for lessons; attend scheduled sessions with instructors and service providers; give adequate notice of the need for cancelled appointments and to provide notification of any changes which may affect my program, such as changes in my address, telephone number, health, or vocational interests. I agree that available medical insurance or other benefits will be used to cover the costs of services to which they might apply.

 

A copy of this plan has been provided to me on____________ in _______________ format.

 

 

Level of ALP Services to be authorized:                                        ALP-2

                                                                                                                        ALP-2E

                                                                                                                   □ ALP-3

 

Approval Date: 


 

New York State Office of Children and Family Services

Commission for the Blind

 

Individualized Service Plan Progress Report

 

 

Case Number:                                                                       Cycle Number: 

 

Consumer:                                                                             Registry #: 

 

Projected Start Date: 

 

 

Goals

 

Goal #1:  

           

Achieved:    Yes       □ No

           

Progress notes as of: 

 

Entered by:

 

Attach reports from service providers:

 

Goal #2:  

             

Achieved:    □ Yes              No

 

Progress notes as of: 

 

Entered by:

           

Attach reports from service providers:

 

Goal #3:   

Achieved:    Yes              No

 

Progress notes as of: 

 

Entered by:

 

Attach reports from service providers:

 

Services

 

Service 1: 

 

Detail:  

 

This service will contribute to achievement of Goal #:

 

Completed                        Not Completed                            Deactivated  

 

Progress notes as of: 

 

Entered by:

 

Attach reports from service providers:

 

Number of Training Hours:

 

Service 2: 

 

Detail:  

 

This service will contribute to achievement of Goal #:

 

Completed                       Not Completed                             Deactivated  

 

Progress notes as of: 

 

Entered by:

 

Attach reports from service providers:

 

Number of Training Hours:

 

Service 3: 

 

Detail:  

 

This service will contribute to achievement of Goal #:

 

 Completed                      Not Completed                             Deactivated  

 

Progress notes as of: 

 

Entered by:

 

Attach reports from service providers:

 

Number of Training Hours:

 

Total Amount Spent 

Low Vision Aids:

Assistive Devices:

Audiological Aids:

Room & Board:

Transportation:

 

Number of Goals Achieved:

Number of Services Completed:

Total Number of Training Hours:

 

Program Outcomes/Performance Measures 

  

1) If the individual received Assistive Devices and training and the individual regained or improved abilities previously lost or diminished as a result of vision loss select ''Y''. If the individual did not receive this service, or if they did not experience improvements after receiving this service select ''N''. 

Yes            No

  

 

2)  If the individual received O&M (orientation and mobility) services and the individual gained or maintained their ability to travel safely and independently in their residence or communities as a result of services select ''Y''. If the individual did not receive this service, or if they did not experience improvements after receiving this service select ''N''. 

Yes            No

  

3) If the individual received Communications Skills Training and the individual gained or successfully restored or maintained ability to engage in customary life activities as a result of services select ''Y''. If the individual did not receive this service, or if they did not experience improvements after receiving this service select ''N''. 

 

Yes            No

  

 

4) If the individual received Daily Living Skills training and the individual gained or successfully restored or maintained ability to engage in customary life activities as a result of services select ''Y''. If the individual did not receive this service, or if they did not experience improvements after receiving this service select ''N''. 

 

Yes            No

  

5)  To maintain their current living situation as a result of services, the individual reported feeling that they have: 

   Greater control and are more confident                                      Yes                        No  

   No change in feelings of control and confidence                        Yes             No

   Less control and are less confident                                             Yes                        No

   Experienced changes in lifestyle for reasons unrelated to vision loss   □ Yes        No

  

6) Individual was served and died before achieving functional gain or experiencing changes in lifestyle as a result of services they received. 

 

Yes No

  

Type of Closure:        ALP-2

                                    ALP-2E

                                    ALP-3

 

 

 

Closed Case on:  ___________

 

 

 

 

New York State Office of Children and Family Services

Commission for the Blind

 

O&M Assessment Report

 

Authorization No. 

    

Part I. 

  

Instructions: Complete this section using identifying information from Section I of the Initial Authorization 

 

Consumer Name:

Case No.

Counselor:

NYSCB D.O.

 

Service Outcome

 

 

Agency Determination

Accepted/Rejected

Outcome Achieved/ Outcome Not Achieved

NYSCB Counselor Determination

Successful Outcome/ Unsuccessful

 

Service Period

From

To

Total Hour Units Rendered

 

 

 

  

Agency Name:     ______________________________________________________

  

Agency Signature:   ______________________________________ Date:  _________

 

 

Attachments:

Attachment Notes

 

Part II.

 

OUTCOME KEY  

 

1 – Training Needed/Goal Set

2 – Training Needed/Training Declined

3 – No Training Needed

 

 

O&M Assessment Level I - Basic Skills and Indoor Mobility

 

Instructions: Skills must be assessed in all areas. Enter the numeric code from the Outcome Key to indicate the status of the assessment for each of the guidelines. Provide comments regarding the consumer's abilities and/or level of need in each assessment area.

 

Assessment Guidelines

Outcome Code          Date

 

1.         Consumer demonstrates knowledge of the

            following O&M concepts:

a.         Body

b.         Spatial

c.         Directional

d.         Positional

e.         Environmental

Comments:     

 

2.         Consumer demonstrates ability to utilize senses:

a.         Residual vision

b.         Auditory cues

c.         Olfactory cues

d.         Haptic cues       

            Comments:

 

3.         Consumer is able to demonstrate the following pre-cane/safety skills

a.         Sighted guide

b.         Hand trailing

c.         Protective techniques

d.         Seating

e.         Stairs, Doorways

f.          Search patterns

g.         Object retrieval

h.         Communication skills

Comments:

 

4.         Consumer demonstrates safe and independent travel skills in their home      

            Comments:

 

5.         Consumer demonstrates orientation skills

a.         Use of landmarks, clues

b.         Use of mental/tactual maps

c.         Use of four types of orientation skills       

            Comments:

 

6.         Consumer had input into establishment of goals.      

            Comments:

 

7.         In the comments section below enter:

 

Frequency of training: ____ times per ____

Session length:       

Comments:

 

 

Instructor Name: _________________________________________    

Hours: _________________

 

 

O&M Assessment Level II - Outdoor and Community Access Mobility

 

Instructions: Skills must be assessed in all areas. Enter the numeric code from the Outcome Key to indicate the status of the assessment for each of the guidelines. Provide comments regarding the consumer's abilities and/or level of need in each assessment area.

Assessment Guidelines

Outcome Code          Date 

 

1.         Consumer demonstrates ability to independently

a.         Open and close the cane

b.         Utilize appropriate cane techniques

c.         Maintain and store the cane

d.         Order replacement canes or parts       

Comments:

 

2.         Consumer demonstrates safe and independent indoor travel in community settings

a.         School or workplace

b.         Stores and places of personal importance

c.         Unfamiliar environments       

            Comments:

 

3.         Consumer demonstrates safe and independent outdoor travel in urban, suburban and rural areas

a.         Street crossings

b.         Residential settings

c.         Business environments       

Comments:

 

4.         Consumer demonstrates ability to travel safely and independently in adverse weather conditions.      

Comments:

 

5.         Consumer had input into establishment of goals.      

            Comments:

 

6.         In the comments section below enter:

Frequency of training: ____ times per ____

Session length:       

            Comments:

 

Instructor Name: _________________________________________    

Hours: _________________

 

 

Assessment Level III - Independent Travel for Training

 

Instructions: Skills must be assessed in all areas keeping in mind that training is to be provided for primary and contingent transportation to work/school. Enter the numeric code from the Outcome Key to indicate the status of the assessment for each of the guideline objectives. Provide comments regarding the consumer's abilities and/or level of need in each assessment area.

 

Assessment Guidelines

Outcome Code          Date

 

1.         Consumer is able to demonstrate ability to independently access transportation to and from work, school and activities

a.         Paratransit services

b.         Bus/Subway/Trolley

c.         Taxi or car service

d.         Private driver

e.         Combination of transportation       

            Comments:

 

2.         Consumer demonstrates ability to independently plan a route selected by the instructor.      

Comments:

 

3.         Consumer demonstrates safe and independent travel to the selected location.      

Comments:

 

4.         Consumer demonstrates ability to independently use a GPS device or smartphone application if recommended.      

Comments:

 

5.         Consumer demonstrates ability to independently utilize contingent means of transportation (other public transportation, cab, driver, etc.).      

Comments:

           

6.         Consumer had input into the establishment of the goals.      

Comments:

 

7.         In the comments section below enter:

Frequency of training: ____ times per ____

Session length:       

Comments:

 

 

8.         Indicate the date that the assessment meeting including the consumer and the NYSCB referring counselor was held: __/__/____

 

Summarize the meeting, indicate changes in goals and/or the intensity and frequency of training in the space provided below:       

Comments:

 

 

Instructor Name: _________________________________________    

Hours: _________________

 

 


 

New York State Office of Children and Family Services

Commission for the Blind

 

O&M Level I Report

 

Authorization No. 

    

Part I. 

  

Instructions: Complete this section using identifying information from Section I of the Initial Authorization 

 

Consumer Name:

Case No.

Counselor:

NYSCB D.O.

.

 

Service Outcome

 

 

Agency Determination

Accepted/Rejected

Outcome Achieved/ Outcome Not Achieved

NYSCB Counselor Determination

Successful Outcome/ Unsuccessful

 

Service Period

From

To

Total Hour Units Rendered

 

 

 

  

Agency Name:     ______________________________________________________

  

Agency Signature:   ______________________________________ Date:  _________

 

 

 

Attachments:

Attachment Notes

 

Part II.

 

OUTCOME KEY  

 

1 – Goal Achieved

2 – Goal Not Achieved

3 – Goal Withdrawn/Cancelled

 

 

Part II

O&M Level I - Basic Skills and Indoor Mobility

 

Instructions: Enter the numeric code from the Outcome Key to indicate the status of training for each of the guideline objectives. Training must be provided in all areas identified in the assessment unless the objective is eliminated or withdrawn. Provide comments on the consumer's progress toward the achievement of each objective. If additional needs are identified during training, provide comments in the appropriate guideline section(s).

 

Guidelines

Outcome Code          Date

 

1.         Consumer demonstrates knowledge of the following O&M concepts:

a.         Body

b.         Spatial

c.         Directional

d.         Positional

e.         Environmental

Comments:     

 

2.         Consumer demonstrates ability to utilize senses:

a.         Residual vision

b.         Auditory cues

c.         Olfactory cues

d.         Haptic cues       

Comments:

 

3.         Consumer is able to demonstrate the following pre-cane/safety skills

a.         Sighted guide

b.         Hand trailing

c.         Protective techniques

d.         Seating

e.         Stairs, Doorways

f.          Search patterns

g.         Object retrieval

h.         Communication skills

Comments:

 

4.         Consumer demonstrates safe and independent travel skills in their home      

            Comments:

 

5.         Consumer demonstrates orientation skills

a.         Use of landmarks, clues

b.         Use of mental/tactual maps

c.         Use of four types of orientation skills       

Comments:

 

6.         Other – Enter any additional skills taught during O&M Level I

Comments:

 

7.         Identify equipment purchased in support of these goals (enter information in the comments section below or attach a typed list to this report).

            Comments:

 

Instructor Name: _________________________________________    

Hours: _________________

 

 


 

New York State Office of Children and Family Services

Commission for the Blind

 

O&M Level II Report

 

Authorization No. 

    

Part I. 

  

Instructions: Complete this section using identifying information from Section I of the Initial Authorization 

 

Consumer Name:

Case No.

Counselor:

NYSCB D.O.

 

Service Outcome

 

 

Agency Determination

Accepted/Rejected

Outcome Achieved/ Outcome Not Achieved

NYSCB Counselor Determination

Successful Outcome/ Unsuccessful

 

Service Period

From

To

Total Hour Units Rendered

 

 

 

  

Agency Name:     ______________________________________________________

  

Agency Signature:   ______________________________________ Date:  _________

 

 

 

Attachments:

Attachment Notes

 

 

Part II.

 

 

OUTCOME KEY  

 

1 – Goal Achieved

2 – Goal Not Achieved

3 – Goal Withdrawn/Cancelled

 

 

O&M Level II - Outdoor and Community Access Mobility

 

Instructions: Enter the numeric code from the Outcome Key to indicate the status of training for each of the guideline objectives. Training must be provided in all areas identified in the assessment unless the objective is eliminated or withdrawn. Training will also include a review of the goals previously met and reinstruction should occur when required. Skills learned in previous level should be integrated into this level's training program. Provide comments on the consumer's progress toward the achievement of each objective. If additional needs are identified during training, provide comments in the appropriate guideline section(s).

 

O&M Level II Guidelines

Outcome Code          Date

 

1.         Consumer demonstrates retention of skills learned in Level 1.

            Comments:

 

2.         Consumer demonstrates ability to independently

a.         Open and close the cane

b.         Utilize appropriate cane techniques

c.         Maintain and store the cane

d.         Order replacement canes or parts       

            Comments:

 

3.         Consumer demonstrates safe and independent indoor travel in community settings.

a.         School or workplace

b.         Stores and places of personal importance

c.         Unfamiliar environments       

            Comments:

 

4.         Consumer demonstrates safe and independent outdoor travel in urban, suburban and rural areas.

a.         Street crossings

b.         Residential settings

c.         Business environments       

            Comments:

5.         Consumer demonstrates ability to travel safely and independently in adverse weather conditions.      

Comments:

 

6.         Other – Enter any additional skills taught during O&M Level II.

Comments:

 

7.         Identify equipment purchased in support of these goals (enter information in the comments section below or attach a typed list to this report).

            Comments:

 

Instructor Name: _________________________________________    

Hours: _________________

 

 


 

New York State Office of Children and Family Services

Commission for the Blind

 

O&M Level III Report

 

Authorization No. 

    

Part I. 

  

Instructions: Complete this section using identifying information from Section I of the Initial Authorization 

 

Consumer Name:

Case No.

Counselor:

NYSCB D.O.

 

 

Service Outcome

 

 

Agency Determination

Accepted/Rejected

Outcome Achieved/ Outcome Not Achieved

NYSCB Counselor Determination

Successful Outcome/ Unsuccessful

 

Service Period

From

To

Total Hour Units Rendered

 

 

 

  

Agency Name:     ______________________________________________________

  

Agency Signature:   ______________________________________ Date:  _________

 

 

 

Attachments:

Attachment Notes

 

 

Part II.

 

 

OUTCOME KEY  

 

1 – Goal Achieved

2 – Goal Not Achieved

3 – Goal Withdrawn/Cancelled

 

O&M Level III - Independent Travel for Training

 

Instructions: Enter the numeric code from the Outcome Key to indicate the status of training for each of the guideline objectives. Training must be provided in all areas identified in the assessment unless the objective is eliminated or withdrawn. Training will also include a review of the goals previously met and reinstruction should occur when required. Skills learned in previous level should be integrated into this level's training program. Provide comments on the consumer's progress toward the achievement of each objective. If additional needs are identified during training, provide comments in the appropriate guideline section(s).

 

Assessment Guidelines

Outcome Code          Date

 

1.         Consumer demonstrates retention of skills learned in Levels 1 and II.

            Comments:

 

2.         Consumer is able to demonstrate ability to independently access transportation to and from work, school and activities

a.         Paratransit services

b.         Bus/Subway/Trolley

c.         Taxi or car service

d.         Private driver

e.         Combination of transportation       

            Comments:

 

3.         Consumer demonstrates ability to independently plan a route selected by the instructor.      

Comments:

 

4.         Consumer demonstrates safe and independent travel to the selected location.      

Comments:

 

5.         Consumer demonstrates ability to independently use a GPS device or smartphone application if recommended.      

Comments:

 

 

6.         Consumer demonstrates ability to independently utilize contingent means of transportation (other public transportation, cab, driver, etc.).      

Comments:

 

7.         Other – Enter any additional skills taught during O&M Level III.

Comments:

 

8.         Identify equipment purchased in support of these goals (enter information in the comments section below or attach a typed list to this report).

            Comments:

           

Instructor Name: _________________________________________    

Hours: _________________


New York State Office of Children and Family Services

Commission for the Blind

 

VRT Assessment Report

 

 

Authorization No. 

 

   

Part I. 

  

Instructions: Complete this section using identifying information from Section I of the Initial Authorization 

 

Consumer Name:

Case No.

Counselor:

NYSCB D.O.

 

 

Service Outcome

 

 

Agency Determination

Accepted/Rejected

Outcome Achieved/ Outcome Not Achieved

NYSCB Counselor Determination

Successful Outcome/ Unsuccessful

 

Service Period

From

To

Total Hour Units Rendered

 

 

 

  

Agency Name:     ______________________________________________________

  

Agency Signature:   ______________________________________ Date:  _________

 

 

Attachments:

Attachment Notes

 

 

Part II.

 

Outcome Key

1 – Training Needed/Goal Set

2 – Training Needed/Training Declined

3 – No Training Needed

 

VRT Assessment Level I

 

Instructions: Skills must be assessed and demonstrated by the consumer in all level areas. Enter the numeric code from the Outcome Key to indicate the status of the assessment for each of the guidelines. Provide comments regarding the consumer's abilities and/or level of need in each assessment area.

  

Assessment Guidelines

Outcome 

Code                          Date 

 

1.          Consumer demonstrates the ability to maximize functional vision with the        appropriate use of prescribed low vision devices.

Comments:

 

2.          Consumer demonstrates the ability to manage the following Self Care skills   independently:

a.         Bathing, showering

b.         Dental care, hair care, use of antiperspirants, scents

c.         Select clothing

d.         Dressing

e.         Manage basic healthcare needs (bandages, OTC medications)

f.          Identify/differentiate medications

Comments:

 

3.         Consumer demonstrates the ability to manage the following Communication skills independently:

a.         Signing documents and letters

b.         Obtain/record information (phone numbers, appointments, etc.)

c.         Access print (using magnifiers, lighting or other resources to read print)

d.         Make/receive calls (land line or cell)

e.         Deal with emergencies (911, poison control, MD)

f.          Locate and differentiate the position of dots in the Braille cell

Comments:

 

 

4.         Consumer demonstrates the ability to manage the following Organizational skills independently:

a.         Tell time/set alarm

b.         Record and maintain a calendar

c.         Creating lists

d.         Labeling items for home and personal use (Braille labeler or other means)

Comments:

 

5.         Consumer demonstrates the ability to manage the following Home Management skills independently:

a.         Use outlets, change batteries, use keys

b.         Utilize adaptive techniques for basic cleaning tasks (countertops, tables, sinks, spills)

c.         Utilizing environmental controls appropriately

Comments:

 

6.         Consumer demonstrates the ability to manage the following Eating skills independently:

a.         Locate items on table, plate

b.         Cut food

c.         Pouring

d.         Table etiquette       

Comments:

 

7.         Consumer demonstrates the ability to manage the following Meal Planning and Preparation skills independently:

a.         Use a microwave and/or toaster oven

b.         Preparing a hot or cold snack

c.         Preparing hot and cold beverages

d.         Reheating prepared/take out foods

e.         Table setting and food serving       

Comments:

 

8.         Consumer demonstrates the ability to manage the following Financial skills independently:

a.         Identifying bills and coins

b.         Writing checks  

c.         Use a calculator    

Comments:

 

9.        Consumer had input into the establishment of the goals.   

     a.         Yes

     b.         No  

Comments:

 

10.       In the comments section below enter:

 

Frequency of training: ____ times per ____

Session length: _____

Comments:

 

Instructor Name: _________________________________________   

Hours: _________________________________________________

 

 

 

VRT Assessment Level II

  

Instructions: Skills must be assessed and demonstrated by the consumer in all level areas. Enter the numeric code from the Outcome Key to indicate the status of the assessment for each of the guidelines. Provide comments regarding the consumer's abilities and/or level of need in each assessment area.

  

Assessment Guidelines

Outcome 

Code                          Date 

 

1.         Consumer demonstrates the ability to manage the following Self Care skills independently:

a.         Manage Medications

b.         Monitor Health (including but not limited to weight and blood pressure)

c.         Maintaining clothing (laundering, ironing, mending, sewing)

Comments:

 

2.         Consumer demonstrates the ability to manage the following Communication skills independently:

a.         Use recording/playback devices

b.         Manage telephone numbers and contacts (address book, programmable phone)

c.         Write and read Uncontacted Braille (Grade 1)

d.         Using a qwerty keyboard to accurately type up to 10 wpm

e.         Utilize function keys and number pad on a computer keyboard

Comments:       

 

3.         Consumer demonstrates the ability to manage the following Organizational skills independently:

a.         Take notes for personal use, training and/or employment

b.         Record and maintain electronic calendar

c.         Label and locate home and personal items

Comments:       

 

4.         Consumer demonstrates the ability to manage the following Home Management skills independently:

a.         Utilize adaptive cleaning techniques throughout residence (dishes, floor,

            furniture, bed making, toilets, tubs, showers)       

            b.         Use of household appliances (vacuum, washer, dryer, etc.)

            Comments:

 

5.         Consumer demonstrates the ability to manage the following Meal Planning and Preparation skills independently:

a.         Access recipes 

b.         Create shopping list and obtain items

c.         Cutting, slicing, chopping, spreading

d.         Cook with stove top and oven

e.         Use of small kitchen appliances

f.          Time, weight and doneness of foods

Comments:

 

6.         Consumer demonstrates the ability to manage the following Financial skills independently:

a.         Creating a personal budget

b.         Organizing bills and tracking payments

c.         Balancing checkbook    

Comments:  

 

7.         Consumer had input into the establishment of the goals. 

            Comments:    

 

8.         In the comments section below enter:

 

Frequency of training: ____ times per ____

Session length: 

Comments:     

 

Instructor Name: _________________________________________     

Hours: _________________________________________________

 

 

 

 

 

 

 

 

 

 

VRT Assessment Level III

 

Instructions: Skills must be assessed and demonstrated by the consumer in all level areas. Enter the numeric code from the Outcome Key to indicate the status of the assessment for each of the guidelines. Provide comments regarding the consumer's abilities and/or level of need in each assessment area.

 

1.         Consumer demonstrates the ability to manage the following Self and Family Care skills independently:

a.         prepare formula and/or other special dietary meals

b.         Feed infant, disabled child or adult

c.         Diapering

d.         Bath, dress and groom child or adult

e.         Manage medical needs of self and family

f.          Manage safety needs of self and family

g.         Provide homework help

Comments:  

 

2.         Consumer demonstrates the ability to manage the following Communication skills independently:

a.         Begin Contracted Braille (Grade 2)

b.         Use a qwerty keyboard to accurately type up to 20wpm

c.         Use telephone and/or computer for business communication

d.         Use smartphone/tablet for email, texting and creating/maintaining contacts

e.         Use smartphone/tablet for notetaking, recording instructions/lectures

Comments:       

 

3.         Consumer demonstrates the ability to manage the following Organizational skills independently:

a.         Establish and maintain an organizational system for the home

b.         Establish and maintain a system for all aspects of financial management including ATM, mobile banking, budgeting and savings

c.         Use smartphone/tablet for scheduling tasks, appointments and reminders

d.         Use of smartphone/tablet applications for identification purposes

Comments:

 

4.         Consumer demonstrates the ability to manage the following Meal Planning and Preparation skills independently:

a.         Meal planning and preparation for self, family and guest meals

b.         Adjusting recipes/portioning

c.         Establish and maintain a system for food storage and labeling

Comments:

 

5.         Consumer demonstrates the ability to manage the following pre-occupational/worksite skills independently:

            a.         Establish and maintain a system for following an establish schedule

            b.         Establish and maintain a system for planning and organizing tasks

            c.         Label equipment/files

            d.         Utilize accommodations/equipment

            e.         Select and prepare clothing for an employment interview

            f.          Establish and maintain an appropriate work wardrobe

            Comments:

 

6.         Consumer had input into the establishment of the goals.

Comments:      

 

7.         In the comments section below enter:

Frequency of training: ____ times per ____

Session length:

Comments:       

 

8.         Indicate the date that the assessment meeting including the consumer and the NYSCB referring counselor was held: __/__/____

 

Summarize the meeting, indicate changes in goals and/or the intensity and frequency of training in the space provided below:

Comments:      

 

 

Instructor Name: _________________________________________    

Hours: _________________________________________________

 

 


New York State Office of Children and Family Services

Commission for the Blind

 

VRT Level I Report

 

Authorization No. 

 

   

Part I. 

  

Instructions: Complete this section using identifying information from Section I of the Initial Authorization 

 

Consumer Name:

Case No.

Counselor:

NYSCB D.O.

 

 

Service Outcome

 

 

Agency Determination

Accepted/Rejected

Outcome Achieved/ Outcome Not Achieved

NYSCB Counselor Determination

Successful Outcome/ Unsuccessful

 

Service Period

From

To

Total Hour Units Rendered

 

 

 

  

Agency Name:     ______________________________________________________

  

Agency Signature:   ______________________________________ Date:  _________

 

 

 

Attachments:

Attachment Notes

 

Part II.

 

OUTCOME KEY

 

1 – Goal Achieved

2 – Goal Not Achieved

3 – Goal Eliminated/Withdrawn

 

VRT Level I

 

Instructions:   Enter the numeric code from the Outcome Key to indicate the status of training for each of the guideline objectives. Training must be provided in all areas identified in the assessment unless the objective is eliminated or withdrawn. Provide comments on the consumer's progress toward the achievement of each objective. If additional needs are identified during training, provide comments in the appropriate guideline section(s).

VRT Level I Guidelines

Outcome Code          Date 

 

 

1.            Consumer demonstrates the ability to maximize functional vision with the        appropriate use of low vision devices.

            Comments:

 

2.            Consumer demonstrates the ability to manage the following Self Care skills   independently:

 

a.         Bathing, showering

b.         Dental care, hair care, use of antiperspirants, scents

c.         Select clothing

d.         Dressing

e.         Manage basic healthcare needs (bandages, OTC medications)

f.          Identify/differentiate medications

Comments:

 

3.         Consumer demonstrates the ability to manage the following Communication skills independently:

 

a.         Sign documents and letters

b.         Obtain/record information (phone numbers, appointments, etc.)

c.         Accessing print (using magnifiers, lighting or other resources to read print)

d.         Make/receive calls (land line or cell)

e.         Deal with emergencies (911, poison control, MD)

f.          Locate and differentiate the position of dots in the Braille cell   

Comments:

 

4.         Consumer demonstrates the ability to manage the following Organizational skills independently:

a.         Tell time/set alarm

b.         Record and maintain a calendar

c.         Create lists

d.         Labeling items for home and personal use (Braille labeler or other means)

Comments:

 

5.         Consumer demonstrates the ability to manage the following Home Management skills independently:

a.         Utilize outlets, change batteries, use keys

b.         Utilize adaptive techniques for basic cleaning tasks (countertops, tables, sinks, spills)

c.         Utilizing environmental controls appropriately

Comments:

 

6.         Consumer demonstrates the ability to manage the following Eating skills independently:

a.         Locate items on table, plate

b.         Cut food

c.         Pouring

d.         Table etiquette       

Comments:

 

7.         Consumer demonstrates the ability to manage the following Meal Planning and Preparation skills independently:

a.         Use a microwave and/or toaster oven

b.         Prepare a hot or cold snack

c.         Prepare hot and cold beverages

d.         Reheat prepared/take out foods

e.         Table setting and food serving       

Comments:

 

8.         Consumer demonstrates the ability to manage the following Financial skills independently:

a.         Identify bills and coins

b.         Writing checks   

c.         Use a calculator   

Comments:

 

9.         Other: Enter any additional skills taught during VRT Level I.

            Comments:

 

 

10.       Identify equipment purchased in support of these goals (enter information in the comments section below or attach a typed list to this report).

Comments:

 

 

Instructor Name: _________________________________________    

Hours: _________________

 


 

 

New York State Office of Children and Family Services

Commission for the Blind

 

VRT Level II Report

 

Authorization No. 

 

   

Part I. 

  

Instructions: Complete this section using identifying information from Section I of the Initial Authorization 

 

Consumer Name:

Case No.

Counselor:

NYSCB D.O.

 

 

Service Outcome

 

 

Agency Determination

Accepted/Rejected

Outcome Achieved/ Outcome Not Achieved

NYSCB Counselor Determination

Successful Outcome/ Unsuccessful

 

Service Period

From

To

Total Hour Units Rendered

 

 

 

  

Agency Name:     ______________________________________________________

  

Agency Signature:   ______________________________________ Date:  _________

 

 

Attachments:

Attachment Notes

 

Part II.

 

OUTCOME KEY

 

1 – Goal Achieved

2 – Goal Not Achieved

3 – Goal Eliminated/Withdrawn

 

VRT Level II

 

Instructions: Enter the numeric code from the Outcome Key to indicate the status of training for each of the guideline objectives. Training must be provided in all areas identified in the assessment unless the objective is eliminated or withdrawn. Training will also include a review of the goals previously met and reinstruction should occur when required. Skills learned in previous level should be integrated into this level's training program. Provide comments on the consumer's progress toward the achievement of each objective. If additional needs are identified during training, provide comments in the appropriate guideline section(s).

 

VRT Level II Guidelines

Outcome Code          Date 

 

1.         Consumer demonstrates the ability to manage the following Self Care skills independently:

a.         Manage medications

b.         Monitor weight and blood pressure

c.         Maintain clothing

Comments:

 

2.         Consumer demonstrates the ability to manage the following Communication skills independently:

a.         Use recording/playback devices

b.         Manage telephone numbers and contacts (address book, programmable phone)

c.         Write and read Uncontracted Braille (Grade 1)

d.         Use a qwerty keyboard to accurately type up to 10 wpm

e.         Utilize function keys and number pad on a computer keyboard

Comments:       

 

3.         Consumer demonstrates the ability to manage the following Organizational skills independently:

a.         Take notes for personal use, training and/or employment

b.         Record and maintain electronic calendar

c.         Label and locate home and personal items

Comments:

 

4.         Consumer demonstrates the ability to manage the following Home Management skills independently:

a.         Utilize adaptive cleaning techniques throughout residence (dishes, floor,                                 furniture, bed making, toilets, tubs, showers)

b.         Use of household appliances (vacuum, washer, dryer, etc.)

c.         Use of tools to perform minor home repairs/projects

Comments:

 

5.         Consumer demonstrates the ability to manage the following Meal Planning and Preparation skills independently:

a.         Access recipes

b.         Create shopping list and obtain items

c.         Cutting, slicing, chopping, spreading

d.         Cooking with stove top and oven

e.         Use of small kitchen appliances

f.          Time, weight, and doneness of food

Comments:

 

6.         Consumer demonstrates the ability to manage the following Financial skills independently:

a.         Create a personal budget

b.         Organize bills and track payments

c.         Balancing checkbook      

Comments:

 

7.         Other – Enter any additional skills taught during VRT Level II

Comments:

 

8.         Identify equipment purchased in support of these goals (enter information in the comments section below or attach a typed list to this report).

            Comments:

 

 

 

Instructor Name: _________________________________________    

Hours: _________________

 

 


 

New York State Office of Children and Family Services

Commission for the Blind

 

VRT Level III Report

 

Authorization No. 

 

   

Part I. 

  

Instructions: Complete this section using identifying information from Section I of the Initial Authorization 

 

Consumer Name:

Case No.

Counselor:

NYSCB D.O.

 

 

Service Outcome

 

 

Agency Determination

Accepted/Rejected

Outcome Achieved/ Outcome Not Achieved

NYSCB Counselor Determination

Successful Outcome/ Unsuccessful

 

Service Period

From

To

Total Hour Units Rendered

 

 

 

  

Agency Name:     ______________________________________________________

  

Agency Signature:   ______________________________________ Date:  _________

 

 

Attachments:

Attachment Notes

 

 

Part II.

 

 

Outcome Key

1 – Goal Achieved

2 – Goal Not Achieved

3 – Goal Eliminated/Withdrawn

 

VRT Level III

 

Instructions: Enter the numeric code from the Outcome Key to indicate the status of training for each of the guideline objectives. Training must be provided in all areas identified in the assessment unless the objective is eliminated or withdrawn. Training will also include a review of the goals previously met and reinstruction should occur when required. Skills learned in previous level(s) should be integrated into this level's training program. Prior to the conclusion of training, all skills in all levels should be reviewed and reinstruction should occur when required. Provide comments on the consumer's progress toward the achievement of each objective. If additional needs are identified during training, provide comments in the appropriate guideline section(s).

 

Level III Guidelines

Outcome 

Code                          Date 

 

1.            Consumer demonstrates the ability to manage the following Self and Family Care     skills independently.

a.          Prepare formula and/or other special dietary meals

b.          Feed infant, disabled child, adult

c.          Diapering

d.          Bath, dress and groom child or adult

e.          Manage medical needs of self and family

f.            Manage safety needs of self and family

g.          Provide homework help

Comments:

 

2.         Consumer demonstrates the ability to manage the following Communication skills independently:

a.         Begin Contracted Braille (Grade 2)

b.         Use a qwerty keyboard to accurately type up to 20 wpm

c.         Use telephone and computer for business communication

d.         Use Smartphone/tablet for email, texting and creating/maintaining        contacts

e.         Use of Smartphone/tablet for notetaking, recording instructions/lectures

Comments:

 

3.         Consumer demonstrates the ability to manage the following Organizational skills independently:

a.         Establish and maintain an organizational system for the home

b.         Establish and maintain a system for all aspects of financial management        including ATM, mobile banking, budgeting and savings

c.         Use Smartphone/tablet for scheduling tasks, appointments and reminders

d.         Use of Smartphone/tablet applications for identification purposes
Comments:

 

4.         Consumer demonstrates the ability to manage the following Meal Planning and Preparation skills independently:

a.         Meal planning and preparation for self, family and guest meals

b.         Adjusting recipes/portioning

c.         Establish and maintain a system for food storage and labeling

Comments:

 

5.         Consumer demonstrates the ability to manage the following Job Site skills independently:

a.         Establish and maintain a system for following an established schedule

b.         Establish and maintain a system for planning and organizing tasks

c.         Label equipment/files

d.         Utilize accommodations/equipment

e.         Select and prepare clothing for an employment interview

f.          Establish and maintain an appropriate work wardrobe

Comments:

 

6.         Other – Enter any additional skills taught during VRT Level III.

Comments:

 

7.         Identify equipment purchased in support of these goals (enter information in the comments section below or attach a typed list to this report).

            Comments:

 

 

 

Instructor Name: _________________________________________    

Hours: _________________­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­________________________________

 

 


 

New York State Office of Children and Family Services

Commission for the Blind

 

Social Casework Assessment Report

 

Authorization No. 

    

Part I. 

  

Instructions: Complete this section using identifying information from Section I of the Initial Authorization 

 

Consumer Name:

Case No.

Counselor:

NYSCB D.O.

 

Service Outcome

 

 

Agency Determination

Accepted/Rejected

Outcome Achieved/ Outcome Not Achieved

NYSCB Counselor Determination

Successful Outcome/ Unsuccessful

 

Service Period

From

To

Total Hour Units Rendered

 

 

           

 

  

Agency Name:     ______________________________________________________

  

Agency Signature:   ______________________________________ Date:  _________

 

 

 

Attachments:

Attachment Notes

 

Part II.

 

 

OUTCOME KEY  

 

1 – Training Needed/Goal Set

2 – Training Needed/Training Declined

3 – No Training Needed

 

 

Social Casework Assessment Report

 

Instructions: Skills must be assessed in all areas. Enter the numeric code from the Outcome Key to indicate the status of the assessment for each of the guidelines. Provide comments regarding the consumer's abilities and/or level of need in each assessment area.

 

Assessment Guidelines

Outcome Code          Date

 

1.         Consumer demonstrates ability to seek services and benefits (housing, SSA, food stamps, etc.).

Comments:     

 

2.         Consumer demonstrates ability to use available resources to meet financial obligations and to budget their income.

            Comments:

 

3.         Consumer understands and is able to comply with prescribed medications/ treatment.  Provide detailed medical/ psychiatric history.

Comments:

 

4.         Consumer is able to identify, establish and maintain social supports with appropriate interpersonal skills and boundaries.  Describe family and other social supports.

Comments:

 

5.         Consumer understands self-advocacy and can express ideas and needs.

Comments:

 

6.         Consumer employs appropriate coping mechanisms in dealing with vision loss.  Describe consumer's coping skills with vision loss including issues with impulse control, judgment, insight. What successful coping mechanisms has the consumer used in the past? What challenges remain?

Comments:

 

7.         Consumer is able to identify behaviors that affect work readiness.   

Comments:

 

8.         Consumer is able to identify and access community resources for ongoing therapeutic interventions. Identify/describe current or past therapeutic interventions.

Comments:

 

9.         Recommendations for other interventions/treatment.

Comments:

 

10.       Social Casework Level II is/is not recommended (enter response in the comment section below).

Comments:

 

11.       Consumer had input into the establishment of the goals.  

Comments:

 

12.       In the comments section below enter:

 

Frequency of training: ____ times per ____

Session length:

Comments:

 

13.       Indicate the date that the assessment meeting including the consumer and the NYSCB referring counselor was held: __/__/____

 

Summarize the meeting, indicate changes in goals and/or of the intensity and frequency of training in the space provided below:

Comments:

 

 

 

 

Instructor Name: _________________________________________    

Hours: _________________

 

 

 


 

New York State Office of Children and Family Services

Commission for the Blind

 

Social Casework Level I Report

 

Authorization No. 

    

Part I. 

  

Instructions: Complete this section using identifying information from Section I of the Initial Authorization 

 

Consumer Name:

Case No.

Counselor:

NYSCB D.O.

 

Service Outcome

 

 

Agency Determination

Accepted/Rejected

Outcome Achieved/ Outcome Not Achieved

NYSCB Counselor Determination

Successful Outcome/ Unsuccessful

 

Service Period

From

To

Total Hour Units Rendered

 

 

  

Agency Name:     ______________________________________________________

  

Agency Signature:   ______________________________________ Date:  _________

 

 

 

Attachments:

Attachment Notes

 

 

Part II.

 

 

 

 

OUTCOME KEY  

 

1 – Training Needed/Goal Set

2 – Training Needed/Training Declined

3 – No Training Needed

 

Social Casework Level I Report

 

Instructions: Services must address the needs identified during the assessment. Enter the numeric code from the Outcome Key to indicate the status of the services for each of the guideline objectives. Provide comments on the consumer's progress toward the achievement of each objective.

 

Assessment Guidelines

Outcome Code          Date

 

1.         Consumer demonstrates ability to seek services and benefits (housing, SSA, food stamps, etc.).

Comments:     

 

2.         Consumer demonstrates ability to use available resources to meet financial obligations and to budget their income.

            Comments:

 

3.         Consumer understands and is able to comply with prescribed medications/    treatment.  Provide detailed medical/ psychiatric history.

Comments:

 

4.         Consumer is able to identify, establish and maintain social supports with appropriate interpersonal skills and boundaries.  Describe family and other social supports.

Comments:

 

5.         Consumer understands self-advocacy and can express ideas and needs.

Comments:

 

6.         Consumer employs appropriate coping mechanisms in dealing with vision loss.  Describe consumer's coping skills with vision loss including issues with impulse control, judgment, insight. What successful coping mechanisms has the consumer used in the past? What challenges remain?

Comments:

 

7.         Consumer is able to identify behaviors that affect work readiness.   

Comments:

           

8.         Consumer is able to identify and access community resources for ongoing therapeutic interventions. Identify/describe current or past therapeutic interventions.

Comments:

 

9.         Other – Enter any additional areas addressed during SCW Level I.

Comments:

 

10.       Recommendations for other interventions/treatment.

Comments:

 

11.       Social Casework Level 2 is/is not recommended (enter response in the comment section below.)

            Comments:

 

Instructor Name: _________________________________________    

Hours: _________________

 

 

 

 


 

New York State Office of Children and Family Services

Commission for the Blind

 

Social Casework Level II Report

 

Authorization No. 

    

Part I. 

  

Consumer Name:

Case No.

Counselor:

NYSCB D.O.

 

.

 

 

Service Outcome

 

 

Agency Determination

Accepted/Rejected

Outcome Achieved/ Outcome Not Achieved

NYSCB Counselor Determination

Successful Outcome/ Unsuccessful

 

Service Period

From

To

Total Hour Units Rendered

 

 

 

  

Agency Name:     ______________________________________________________

  

Agency Signature:   ______________________________________ Date:  _________

 

 

 

Attachments:

Attachment Notes

 

 

Part II.

 

 

 

OUTCOME KEY  

 

1 – Goal Achieved

2 – Goal Not Achieved

3 – Goal Withdrawn/Cancelled

 

Social Casework Level II Report

 

Instructions: Enter the numeric code from Key to indicate status of objective. Summarize the work done in the sessions, the result of the intervention and recommendations for transition to long-term community based services if needed.

 

Assessment Guidelines

Outcome Code          Date

 

1.         Summarize the work done in the sessions, the result of the intervention, and recommendations for transition to long-term community-based services if needed.

Comments:

 

 

 

Instructor Name: _________________________________________    

Hours: _________________

 

 

 


 

New York State Office of Children and Family Services

Commission for the Blind

 

Pre-Vocational Skills Assessment Report

 

Authorization No. 

    

Part I. 

  

Instructions: Complete this section using identifying information from Section I of the Initial Authorization 

 

Consumer Name:

Case No.

Counselor:

NYSCB D.O.

.

 

 

Service Outcome

 

 

Agency Determination

Accepted/Rejected

Outcome Achieved/ Outcome Not Achieved

NYSCB Counselor Determination

Successful Outcome/ Unsuccessful

 

Service Period

From

To

Total Hour Units Rendered

 

 

           

 

  

Agency Name:     ______________________________________________________

  

Agency Signature:   ______________________________________ Date:  _________

 

 

 

Attachments:

Attachment Notes

 

Part II.

 

OUTCOME KEY  

 

1 – Training Needed/Goal Set

2 – Training Needed/Training Declined

3 – No Training Needed

 

Instructions: Skills must be assessed in all areas. Enter the numeric code from the Outcome Key to indicate the status of the assessment for each of the guidelines. Provide comments regarding the consumer's abilities and/or level of need in each assessment area.

  

Assessment Guidelines

                                                                                                            Outcome Code          Date

 

1.         Has the student received pre-vocational training in the past? (If yes,where and when and what did they think about the training?)

            Comments:

 

2.         Are the student's self-care skills adequate? Do they have appropriate eating skills? Are hygiene and grooming skills sufficient? Can they prepare a simple cold sandwich or reheatable lunch?

            Comments:

 

3.         Does the student have any travel skills? Can they independently use public transportation or travel in their community or around their school?

            Comments:

 

4.         Can the student describe their visual impairment and any other disabilities as well as functional implications (e.g., tires easily if physical labor is required, works best in good lighting, etc.)

            Comments:

 

5.         Are the student's interpersonal skills adequate? Do they demonstrate the use of acceptable language in different social situations? Do they have the ability to listen and respond at the right time? Does the student require intense group or individual counseling?

            Comments:

 

6.         Does the student possess basic communication skills necessary for schoolwork, including note taking, time management, information retrieval? Have they had any experience in banking and budgeting money? How does the student take notes and complete homework assignments?

            Comments:

 

7.         Is the student computer literate? Have the student describe computer skills including typing skills and adaptations used. Can they use a word processing program? Can they e-mail for personal use? Can they search the internet for personal use?

            Comments:

 

8.         Does the student have vocational goals? If they do have a goal, are they taking any steps to achieve the goal (volunteering, taking courses in school, etc.)? If they have no goal, what types of activities do they think could assist them to further define their goals?

            Comments:

 

9.         Does the student know how to obtain vocational information? Have they ever been exposed to adults who are visually impaired? Can they answer the following questions: What job would you like to pursue? Where would you work? What skills or knowledge would you need? What adaptive equipment would you need to perform the job?

            Comments:

 

10.       Does the student have any knowledge of job seeking skills? Ask the student the process and steps they would take in order to find a job. Have they ever conducted research or gotten information about various employers or companies?

            Comments:

 

11.       Has the student ever earned money? Have they had "jobs" at home? Did they find their own job or get assistance from school, family members or a private agency for the blind?

            Comments:

 

12.       Does the student have knowledge of job appropriate behaviors? Are they aware of the importance of good attendance, punctuality, working cooperatively, following instructions?

            Comments:

 

13.       Does the student know the purpose of a resume? Do they have personal information needed for completing a resume? Do they have a final copy of a resume and have it saved for future changes (if appropriate)? Do they understand the purpose of job applications? Have they ever participated in a mock interview?

            Comments:

 

14.       If the student is under 18, parent or guardian must answer this question: Does the student have any medical or physical conditions?

            Comments:

 

15.       Are the student's parents or guardian supportive of the pre-vocational program and their child's eventual employment? Do they allow the student to travel? Independently?

            Comments:

 

16.       When is the student available for training? After school? Saturdays or Sundays? School vacations? Summer?

            Comments:

 

17.       Does the student want to work this year? Add comment if the student has an             area of interest where they would like to work or what they would like to do.

            Comments:

 

18.       Student had input into the establishment of pre-vocational training goals.

            Comments:

 

19.       Based on the above information, a pre-vocational program is NOT recommended for the student at this time (must provide an explanation in the comment section).

            Comments:

 

20.       Based on the above information, this student should be referred for a pre-vocational program that includes the following milestones.  Identify the recommended milestones in the comment section below:

 

Milestone A: "Getting Started"

Milestone B: "Continued Career Exploration"

Milestone C: "Moving Towards Mastery"      

 

Comments:  

 

21.       Indicate the date that the assessment meeting including the consumer and the NYSCB referring counselor was held: __/__/____

 

Summarize the meeting, indicate changes in goals and/or of the intensity and frequency of training in the space provided below:       

            Comments:

 

Instructor Name: _________________________________________    

Hours: _________________

 

 


 

New York State Office of Children and Family Services

Commission for the Blind

 

Pre-Vocational Skills Training Report

 

Authorization No. 

    

Part I. 

  

Instructions: Complete this section using identifying information from Section I of the Initial Authorization 

 

Consumer Name:

Case No.

Counselor:

NYSCB D.O.

 

 

 

Service Outcome

 

 

Agency Determination

Accepted/Rejected

Outcome Achieved/ Outcome Not Achieved

NYSCB Counselor Determination

Successful Outcome/ Unsuccessful

 

Service Period

From

To

Total Hour Units Rendered

 

 

           

 

  

Agency Name:     ______________________________________________________

  

Agency Signature:   ______________________________________ Date:  _________

 

 

 

Attachments:

Attachment Notes

 

Part II.

 

OUTCOME KEY

 

1 – Goal Achieved

2 – Goal Not Achieved

3 – Goal Eliminated/Withdrawn

 

 

Milestone A – Getting Started

 

Instructions: Enter the numeric code from the Outcome Key to indicate the status of training for each of the guideline objectives. Training must be provided in all areas identified in the assessment unless the objective is eliminated or withdrawn. Provide comments on the consumer's progress toward the achievement of each objective.

 

Milestone A Guidelines

Outcome Code          Date

 

1.         Ability to use appropriate procedures to access community resources and services specifically designed for individuals with visual impairments

 

•           Knows own personal needs in relation to vision and asks for adult assistance when necessary

•           Spends time with friends in the neighborhood, in homes and in recreational facilities or has been involved in a NYSCB recreation program    -Visits school and community libraries and uses these facilities for         pleasure and to complete school assignments

•           Explains visual needs to unfamiliar adults or peers

•           Shows ability to work with others       

Comments:

 

2.         Ability to manage daily living skills using functional low vision and blindness techniques:

•           Can prepare a simple meal for himself/herself (e.g., sandwich, soup and beverage for lunch)

•           Knows how to use an alarm clock and understands the value of punctuality (takes responsibility for arriving at and leaving places on time)

•           Completes a few basic household chores (e.g., clearing dishes, making a bed)

•           Has a system and is able to identify coin and paper currency

•           Has had a mobility assessment and possible training

Comments:

       

 

3.         Ability to use technology:

•           Is aware of the technology used in school and/or accommodations needed to complete tasks

•           Has regular access to a computer/tablet either at home or at school

•           Uses a land line or cell phone

•           Has basic keyboarding skills       

Comments:

 

4.         Ability to develop the skills and acquire the necessary training that would facilitate job entry, independent living and other life pursuits:

•           Takes notes and "reads" own class notes.

•           Earns money through an allowance, chores around the home or jobs for          neighbors or other adults

•           Actively participates in a group activity

•           Is working to develop assertiveness skills

•           Identifies activities at which they are successful

•           Can discuss what family members and adult friends do at their jobs

•           Identifies several jobs which interest him/her and learns about these jobs through talking with adults, reading books, online

•           Participates in a volunteer position or job shadow experience

•           Has a basic understanding of the vocational rehabilitation process. (What is a feasible vocational goal? What responsibilities do individuals have in the VR process?)

Comments:

      

5.         Possible activities:

•           Have the students interview workers in a store, encourage job shadowing at various jobs

•           Provide opportunities for independent problem solving

•           Have activities that encourage participants to read and follow directions

•           Tour an adaptive technology center with students to discover what types of technology are available

•           Have the student’s phone the Careers and Technology Information Bank maintained by the American Foundation for the Blind (CTIB) to speak with mentors about their use of technology and see what type of jobs exist

•           As a group, prepare and serve lunch       

Comments:

 

 

Instructor Name: _________________________________________    

Hours: _________________

 

 

Milestone B – Continued Career Exploration

 

Instructions: Enter the numeric code from the Outcome Key to indicate the status of training for each of the guideline objectives. Training must be provided in all areas identified in the assessment unless the objective is eliminated or withdrawn. Provide comments on the consumer's progress toward the achievement of each objective.

  

Milestone B Guidelines

Outcome Code          Date

 

1.         Ability to use appropriate procedures to access community resources and services specifically designed for individuals with visual impairments:

•           Has the ability to work through peer conflicts and manage the stress of being a teenager

•           Effectively communicates individual needs/self-advocacy

•           Understands the need for photo identification

•           Obtains working papers

Comments:

 

2.         Ability to manage daily living skills using functional low vision and blindness techniques (taking care of oneself and one's possessions):

•           Can draw up a beginning budget

•           Has a bank account for savings and is able to make deposits and withdrawals

•           Has an understanding of transportation that is available to travel independently

•           Understands the importance of making eye contact

•           Has the ability to listen and to respond at the right time

Comments:

    

3.         Ability to use technology:

•           Has knowledge of the technology that is individually used and the reason why it is used (is able to explain their disability)

•           Demonstrates the ability to navigate the internet

•           Can conduct online research when given a specific task

Comments:

 

4.         Ability to develop the skills and acquire the necessary training that would facilitate job entry, independent living and other life pursuits

•           Knows how to complete applications and the beginning stages of developing a resume or portfolio

•           Continues with career exploration via job shadowing, mentors, worker interviews, etc., and possible work experiences

•           Participates in mock interviews

•           Conducts research/obtains information about employers/companies

•           Understands (demonstrates?) appropriate interview/work attire

•           Knows how to ask questions/ask for adaptations that they need to do the job

•           Understands the importance of being responsible, dependable (arriving on-time and taking the appropriate length of time for lunches/breaks)

•           Prepares an initial resume

•           Knows how to complete applications

•           Has practiced interview techniques (arriving early, shaking hands, making eye contact, etc.)

•           Practices writing cover letters, thank you notes

•           Completes an interest/values/personal qualities assessment

Comments:

       

5.         Possible Activities/Discussion Topics:

•           How do the youth plan to access information and express/provide Information after they leave high school/when they are at work?

•           Are there gaps?

•           Are they proficient in note taking?

•           Money skills?

•           Are the parents on board?

•           Is there a need for a parent orientation night?

•           Encourage use of the Careers and Technology Information Bank maintained by the American Foundation for the Blind

•           Obtain picture identification cards at motor vehicle bureau

•           Discuss debit and credit cards and making purchases without cash

•           Discuss on-line grocery services

•           Participate in job shadow opportunities

•           Have the youth practice asking for assistance in stores       

Comments:

 

Instructor Name: _________________________________________    

Hours: _________________

 

Milestone C – “Moving Toward Mastery”

 

Instructions: Enter the numeric code from the Outcome Key to indicate the status of training for each of the guideline objectives. Training must be provided in all areas identified in the assessment unless the objective is eliminated or withdrawn. Provide comments on the consumer's progress toward the achievement of each objective.

 

 

 

 

 

Milestone C Guidelines

Outcome Code          Date

 

1.         Ability to use appropriate procedures to access community resources and services specifically designed for individuals with visual impairments:

•           Demonstrates a proactive approach in researching, obtaining and maintaining community linkages, resources and benefits

Comments:

 

2.         Ability to manage daily living skills using functional low vision and blindness techniques (taking care of oneself and one's possessions):

•           Can prepare a simple meal

•           Can do own laundry

•           Travels independently, is able to access areas of need including medical facilities, grocery store, library and other places of interest       

Comments:

           

3.         Ability to use basic technology:

•           Has knowledge of the technology that is individually used and the reason why it is used (is able to explain their disability)

•           Uses appropriate technology to complete school work

Comments:

       

4.         Ability to develop the skills and acquire the necessary training that would facilitate job entry, independent living and other life pursuits:

•           Demonstrates independent travel skills; begins to anticipate post high school travel routes.

•           Has knowledge of the job searching process

•           Demonstrates job-seeking skills by attempting to find one's own job or work experience

•           Completes a resume

•           Demonstrates ability to problem solve

•           Sets up and completes a minimum of 2 informational interviews

•           Knows what type of transportation best fits their needs and practices using it (para-transit, public transportation)

•           Has well developed organization skills (for managing information and resources at school or work)

•           Personal papers/files

•           Labeling and locating personal items

•           Keeping an appointment calendar and or activity schedule

•           Has demonstrated basic soft work skills during work and volunteer experiences

Comments:

    

5.         Possible Activities:

•           Create a list of references/resources that the client can use in the future in order to advocate for themselves

•           Encourage youth to write/edit their own IPE

•           Practice interviewing/role playing

•           Encourage youth to find their own work experience

•           Completes a career portfolio (including a vocational evaluation if applicable, summary of all previous work experiences, an outline of goals for after high school graduation including career goals and the steps that are needed in order to reach the goals).

 

Comments:

 

 

Instructor Name: _________________________________________    

Hours: _________________

 


 

New York State Office of Children and Family Services

Commission for the Blind

 

Academic Instruction Assessment (ESL) Report

 

Authorization No. 

    

Part I. 

  

Instructions: Complete this section using identifying information from Section I of the Initial Authorization 

 

Consumer Name:

Case No.

Counselor:

NYSCB D.O.

 

 

Service Outcome

 

 

Agency Determination

Accepted/Rejected

Outcome Achieved/ Outcome Not Achieved

NYSCB Counselor Determination

Successful Outcome/ Unsuccessful

 

Service Period

From

To

Total Hour Units Rendered

 

 

  

Agency Name:     ______________________________________________________

  

Agency Signature:   ______________________________________ Date:  _________

 

 

Attachments:

Attachment Notes

 

Part II.

 

 

OUTCOME KEY

 

1 -  LEVEL 1 (Poor to No Understanding)

2 -  LEVEL 2 (Beginning Conversational Skills)

3 -  LEVEL 3 (Intermediate Conversational Skills)

4 -  LEVEL 4+ (See Comments)

5 -  See Comments

6 -  N/A

 

 

Academic Instruction Assessment (ESL)

 

Instructions: Enter numeric code from Key to indicate status of goal. Provide any required explanation in the Comments section.

 

Outcome Code          Date

           

1.         English as a Second Language

Student's current level: (See below)       

            Comments:

 

2.         Student's stated goal

            Comments:

  

3.         Approximate Length of Time to Reach Goal

            Comments:

 

LEVEL 1 - student would be designated at level 1 if during assessment they demonstrated poor to no understanding by inappropriate responses to oral questioning as well as only being able to communicate in their native language.  Training involves basic conversation as it pertains to survival skills, e.g. telling time, travel (bus, subway), and food shopping.  The basic grammar of simple present and past tenses is covered. Basic reading and writing skills are covered, e.g., alphabet, numbers, phone numbers, addresses and simple survival words.     

 

LEVEL 2 - student would be designated at this level if during assessment they were able to demonstrate beginning conversational skills and by responding appropriately to some of the oral questions.  In addition, they demonstrate some basic English reading and writing skills.  Training involves beginning conversational skills.  Grammar covers tenses, complete sentence structure, spelling, reading and writing.  Appropriate Level I skills are reinforces as well.     

 

LEVEL 3 - student would be designated at this level if during assessment they were able to demonstrate intermediate conversational skills and by responding appropriately to many of the oral questions.  Likewise, they demonstrate some English reading and writing skills.  Training covers intermediate conversational skills, guided paragraph writing, answering questions, and general letter writing involving survival skills like job applications.  Appropriate Level 2 skills are reinforced as well.    

 

(NOTE: Consumers who function above Level 3 should be evaluated using an assessment tool. The instructor can determine the appropriate assessment tool. Some useful assessment tools are: the Gates MacGinitie Reading Test, Wide Range Assessment Test (WRAT), and the Tests of Adult Basic Education (TABE).

 

The assessment tool should cover listening, oral, reading and writing skills, and when possible be administered in the student’s preferred language. The instructor must document the assessment tool in the comments section below, used for the assessment report as well as indicate the measurement of progress towards the outcome for that assessment tool.)

 

 

 

Instructor Name: _________________________________________    

Hours: __________________


 

New York State Office of Children and Family Services

Commission for the Blind

 

Academic Instruction Assessment (ABE/HSE) Report

 

Authorization No. 

    

Part I. 

  

Instructions: Complete this section using identifying information from Section I of the Initial Authorization 

 

Consumer Name:

Case No.

Counselor:

NYSCB D.O.

 

Service Outcome

 

 

Agency Determination

Accepted/Rejected

Outcome Achieved/ Outcome Not Achieved

NYSCB Counselor Determination

Successful Outcome/ Unsuccessful

 

Service Period

From

To

Total Hour Units Rendered

 

 

  

Agency Name:     ______________________________________________________

  

Agency Signature:   ______________________________________ Date:  _________

 

Attachments:

Attachment Notes

 

Part II.

 

OUTCOME KEY

1 – L (5/6 = N/A, 7/8 = 0.0-1.9)

2 – E (5/6 = 2.6-4.9, 7/8 = 1.6-3.9)

3 - M (5/6 = 4.6-6.9, 7/8 = 3.6-6.9)

4 - D (5/6 = 6.6-8.9, 7/8 = 6.6-8.9)

5 - A (5/6 = 8.6-12.9, 7/8 = 8.6-12.9)

6 - TABE Score (See Comments)

7 - GED Score (See Comments)

9 - Score Not Available

14 - See Comments

15 - N/A

 

Academic Instruction Assessment (ABE/HSE)

 

Instructions: Enter numeric code from Key to indicate status of goal. Provide any required explanation in the Comments section.

 

Outcome Code          Date

 

           

1.         Adult Basic Education or High School Equivalency

            Current levels (based on TABE)

 

            a.         Total READING Score

            b.         Total MATHEMATICS Score

            c.         Total LANGUAGE Score

            d.         Total BATTERY Score

            e.         Projected GED Score

 

NOTE: Scores should be listed as a grade level. The above scores can be derived from administering the Tests of Adult Basic Education (TABE) and combining content areas to yield a "total score" (i.e., reading vocabulary and reading comprehension, when combined, yield a Total Reading Score). It also assumes that the "TABE Complete Battery" is being administered. (If a test other than the TABE is used or if the Complete Battery is not administered, please indicate in the comments section below along with the name of the alternate test used and the equivalent grade levels and/or points.

            Comments:

 

 

2.         Student’s Stated Academic Goal - Specify whether an overall grade level, competency in a particular area or obtaining a High School Equivalency Diploma.)

Comments:

 

3.         Approximate Length of Time to Reach Goal

            Comments:

 

 

Instructor Name: _________________________________________    

Hours: __________________


 

New York State Office of Children and Family Services

Commission for the Blind

 

Academic Instruction Assessment (College Preparation) Report

 

Authorization No. 

    

Part I. 

  

Instructions: Complete this section using identifying information from Section I of the Initial Authorization 

 

Consumer Name:

Case No.

Counselor:

NYSCB D.O.

 

 

Service Outcome

 

 

Agency Determination

Accepted/Rejected

Outcome Achieved/ Outcome Not Achieved

NYSCB Counselor Determination

Successful Outcome/ Unsuccessful

 

Service Period

From

To

Total Hour Units Rendered

 

 

 

  

Agency Name:     ______________________________________________________

  

Agency Signature:   ______________________________________ Date:  _________

 

 

 

Attachments:

Attachment Notes

 

Part II.

 

 

 

OUTCOME KEY

 

1 -  Yes

2 -  No

 

Academic Instruction Assessment (College Preparation)

 

Instructions: Enter numeric code from Key to indicate status of goal. Provide any required explanation in the Comments section.

 

Outcome Code          Date

 

1.         (For adults returning to school only.)

Does the Student have at least 10th grade Reading skills?

Comments:

 

2.         (For adults returning to school only.)

Does the Student have at least 10th grade Math skills?       

            Comments:

 

3.         (For adults returning to school only.)

Does the student have at least a 10th grade vocabulary?       

            Comments:

 

4.         (For recent High School graduates only.)

Did the student maintain at least a "C" academic average in High School (or numerical equivalent)?

Comments:

 

5.         Does the student have note-taking skills sufficient to identify, organize and retrieve information?      

            Comments:

 

6.         If No, will the College Preparatory Program address these deficits?      

            Comments:

 

7.         Does the student have Writing and Spelling skills sufficient to do college level                        work?

            Comments:

      

8.         If no, will the College Preparatory Program address these deficits?

            Comments:

  

 

9.         Does the student have Basic Keyboarding skills of at least 20 words per minute?      

            Comments:

 

10.       Does the student have Computer skills sufficient to do college level work?

            Comments:

 

11.       If no, will the College Preparatory Program address these deficits?

            Comments:

 

12.       Is the student deficient in any other area that would affect his/her success in college?  (i.e.: term paper writing skills, library research.  Please identify deficits in comments section.)

            Comments:

  

13.       If yes, will the College Preparatory Program address these deficits?

(Please identify deficits in comments section.)

Comments:

           

 

 

 

 

Instructor Name: _________________________________________    

Hours: __________________


 

New York State Office of Children and Family Services

Commission for the Blind

 

Academic Instruction Report

 

Authorization No. 

    

Part I. 

  

Instructions: Complete this section using identifying information from Section I of the Initial Authorization 

 

Consumer Name:

Case No.

Counselor:

NYSCB D.O.

 

 

Service Outcome

 

 

Agency Determination

Accepted/Rejected

Outcome Achieved/ Outcome Not Achieved

NYSCB Counselor Determination

Successful Outcome/ Unsuccessful

 

Service Period

From

To

Total Hour Units Rendered

 

 

           

 

Agency Name:     ______________________________________________________

Agency Signature:   ______________________________________ Date:  _________

 

 

Attachments:

Attachment Notes

 

 

Part II.

 

 

OUTCOME KEY

 

1 – Achieved

2 – Not achieved

 

 

 

Academic Instruction

 

Instructions: Enter numeric code from Key to indicate status of goal. Provide any required explanation in the Comments section.

 

Outcome Code          Date

Comments:

 

 

 

Instructor Name: _________________________________________    

Hours: _________________

 


 

New York State Office of Children and Family Services

Commission for the Blind

 

Vocational Skills Training Assessment Report

 

Authorization No. 

     

Part I. 

  

Instructions: Complete this section using identifying information from Section I of the Initial Authorization 

 

Consumer Name:

Case No.

Counselor:

NYSCB D.O.

 

 

Service Outcome

 

 

Agency Determination

Accepted/Rejected

Outcome Achieved/ Outcome Not Achieved

NYSCB Counselor Determination

Successful Outcome/ Unsuccessful

 

Service Period

From

To

Total Hour Units Rendered

 

 

           

 

  

Agency Name:     ______________________________________________________

  

Agency Signature:   ______________________________________ Date:  _________

 

 

Attachments:

Attachment Notes

 

 

Part II.

 

OUTCOME KEY

1

Yes-The consumer can benefit from training

2

No- The consumer cannot benefit from training

 

 

 

 

Vocational Skills Training Assessment

 

Instructions: These guidelines are intended to be used solely to assess a consumer's readiness to enter vocational training leading to employment in clerical/ technology related occupations.  Enter numeric code from Key to indicate status of goal. Provide any required explanation in the Comments section.

 

Clerical/Technology Related Occupations Guidelines

 

Outcome Code          Date

 

1.         Readiness for Training – Is this consumer ready and available to commit to the training program. Knows the hours and length of time of program. Has addressed transportation, childcare and other personal issues. Has an anticipated goal of employment in the area or occupational field of training.

            Comments:

 

2.      Keyboarding Skills – Does this consumer type at least 20 words per minute as           well as understand the functions and location of keys on a standard computer            keyboard?

            Comments:

 

3.         Note taking – Does this consumer have note taking skills sufficient to identify, organize and retrieve information?  (If yes, please identify method in the comments section).

            Comments:

 

4.         Spelling/Reading – Does this consumer have the spelling and reading skills sufficient to be successful in clerical/technology training? (Please state appropriate grade levels in the comments section).

            Comments:

 

5.         Logical Sequencing – Does this consumer have the ability to follow instructions containing multiple levels of complexity?

            Comments:

 

6.         Other

Comments:

 

Instructor Name: _________________________________________    

Hours: _________________


 

New York State Office of Children and Family Services

Commission for the Blind

 

Vocational Skills Training Report

 

Authorization No. 

    

Part I. 

  

Instructions: Complete this section using identifying information from Section I of the Initial Authorization 

 

Consumer Name:

Case No.

Counselor:

NYSCB D.O.

 

Service Outcome

 

 

Agency Determination

Accepted/Rejected

Outcome Achieved/ Outcome Not Achieved

NYSCB Counselor Determination

Successful Outcome/ Unsuccessful

 

Service Period

From

To

Total Hour Units Rendered

 

 

 

Agency Name:     ______________________________________________________

  

Agency Signature:   ______________________________________ Date:  _________

 

Attachments:

Attachment Notes

 

Part II.

 

OUTCOME KEY

1

Yes-The consumer can benefit from training

2

No- The consumer cannot benefit from training

 

 

 

 

 

 

 

 

 

Vocational Skills Training

 

Instructions: Enter numeric code from Key to indicate status of goal. Provide any required explanation in the Comments section.

 

Outcome Code          Date

 

1.          Comments:

 

 

Instructor Name: _________________________________________    

Hours: ________________


 

New York State Office of Children and Family Services

Commission for the Blind

 

Work Readiness Skills Assessment Report

 

Authorization No. 

    

Part I. 

  

Instructions: Complete this section using identifying information from Section I of the Initial Authorization 

 

Consumer Name:

Case No.

Counselor:

NYSCB D.O.

 

 

Service Outcome

 

 

Agency Determination

Accepted/Rejected

Outcome Achieved/ Outcome Not Achieved

NYSCB Counselor Determination

Successful Outcome/ Unsuccessful

 

Service Period

From

To

Total Hour Units Rendered

 

 

           

 

  

Agency Name:     ______________________________________________________

  

Agency Signature:   ______________________________________ Date:  _________

 

 

 

Attachments:

Attachment Notes

 

Part II.

 

OUTCOME KEY

1 – Yes - the consumer can benefit from training

2 – No - the consumer cannot benefit from training

 

 

 

 

Work Readiness Skills Assessment

 

Instructions: These guidelines are intended to be used solely to assess a consumer's need for work readiness training prior to participating in placement services leading to competitive integrated employment. For each of the areas where the consumer can benefit from training, describe the objective to be met through the work readiness training program in the comments section below. In addition, enter a numeric code from the Outcome Key to indicate status of goal.

  

Communications Guidelines

 

Outcome Code          Date

 

1.         Listening skills      

            Comments:

 

2.         Non-verbal communication      

            Comments:

 

3          Disability disclosure      

            Comments:

 

4.         Being an effective team member 

            Comments:

 

5.         Working effectively with others (conflict resolution)      

            Comments:

 

6.         Forms/levels of workplace communication      

            Comments:

 

7.         Learning and understanding workplace culture       

Comments:

 

 

Instructor Name: _________________________________________    

Hours: _________________

 

 

Instructions: These guidelines are intended to be used solely to assess a consumer's need for work readiness training prior to participating in placement services leading to competitive integrated employment. For each of the areas where the consumer can benefit from training, describe the objective to be met through the work readiness training program in the comments section below. In addition, enter a numeric code from the Outcome Key to indicate status of goal.

  

Personal Management Guidelines

 

Outcome Code          Date

 

 

1.         Understanding responsibilities as an employee      

            Comments:

 

2.         Need for a strong work ethic       

            Comments:

 

3.         Balancing work and family life      

            Comments:

 

4.         Understanding impact of earnings on benefits; economic empowerment      

            Comments:

 

5.         Personal appearance and hygiene      

            Comments:

 

6.         Self-concept/motivational skills      

            Comments:

 

7.         Conveying a positive attitude      

            Comments:

 

8.         Self-advocacy      

            Comments:

 

9.         Managing stress      

            Comments:

 

10.       Goal setting/ time management      

Comments:

 

 

 

Instructor Name: _________________________________________    

Hours: ________________

 

 

Instructions: These guidelines are intended to be used solely to assess a consumer's need for work readiness training prior to participating in placement services leading to competitive integrated employment. For each of the areas where the consumer can benefit from training, describe the objective to be met through the work readiness training program in the comments section below. In addition, enter a numeric code from the Outcome Key to indicate status of goal.

 

Introduction to Job Seeking Skills Guidelines

 

Outcome Code          Date 

 

1.         Presentation- interview skills and disclosure      

            Comments:

 

2.         Development of Basic Resume      

            Comments:

 

3.         Informational interviews with local hiring managers

            Comments:

 

4.         Indicate the date that the assessment meeting including the consumer and the NYSCB referring counselor was held: __/__/____

 

Summarize the meeting, indicate changes in goals and/or of the intensity and frequency of training in the space provided below:

 

Comments

 

 

Instructor Name: _________________________________________    

Hours: _________________

 


 

New York State Office of Children and Family Services

Commission for the Blind

 

Work Readiness Skills Training Report

 

Authorization No. 

    

Part I. 

  

Instructions: Complete this section using identifying information from Section I of the Initial Authorization 

 

Consumer Name:

Case No.

Counselor:

NYSCB D.O.

 

 

Service Outcome

 

 

Agency Determination

Accepted/Rejected

Outcome Achieved/ Outcome Not Achieved

NYSCB Counselor Determination

Successful Outcome/ Unsuccessful

 

Service Period

From

To

Total Hour Units Rendered

 

 

 

  

Agency Name:     ______________________________________________________

  

Agency Signature:   ______________________________________ Date:  _________

 

 

Attachments:

Attachment Notes

 

Part II.

 

OUTCOME KEY

 

1 – Goal Achieved

2 – Goal Not Achieved

3 – Goal Eliminated/Withdrawn

 

 

 

 

Work Readiness Skills Training

 

Instructions: Enter the numeric code from the Outcome Key to indicate the status of training for each of the guideline objectives. Training must be provided in all areas identified in the assessment unless the objective is eliminated or withdrawn. Training will also include a review of the goals previously met and reinstruction should occur when required. Skills learned in previous level(s) should be integrated into this level's training program. Prior to the conclusion of training, all skills in all levels should be reviewed and reinstruction should occur when required. Provide comments on the consumer's progress toward the achievement of each objective. If additional needs are identified during training, provide comments in the appropriate guideline section(s).  

 

Communications Guidelines

 

Outcome Code          Date

 

 

1.         Listening skills      

            Comments:

 

2.         Non-verbal communication      

            Comments:

 

3.         Disability disclosure      

            Comments:

 

4.         Being an effective team member 

            Comments:

 

5.         Working effectively with others (conflict resolution)      

            Comments:

 

6.         Forms/levels of workplace communication      

            Comments:

 

7.         Learning and understanding workplace culture

            Comments:

 

8.         Other - Enter any additional areas addressed related to Communications skills

Comments:

 

 

Instructor Name: _________________________________________    

Hours: _________________

 

 

Instructions: Enter the numeric code from the Outcome Key to indicate the status of training for each of the guideline objectives. Training must be provided in all areas identified in the assessment unless the objective is eliminated or withdrawn. Training will also include a review of the goals previously met and reinstruction should occur when required. Skills learned in previous level(s) should be integrated into this level's training program. Prior to the conclusion of training, all skills in all levels should be reviewed and reinstruction should occur when required. Provide comments on the consumer's progress toward the achievement of each objective. If additional needs are identified during training, provide comments in the appropriate guideline section(s).

 

 

 

Personal Management Guidelines

 

Outcome Code          Date

 

1.         Understanding responsibilities as an employee      

            Comments:

 

2.         Need for a strong work ethic      

            Comments:

 

3.         Balancing work and family life      

            Comments:

 

4.         Understanding impact of earnings on benefits; economic empowerment      

            Comments:

 

5.         Personal appearance and hygiene      

            Comments:

 

6.         Self-concept/motivational skills      

            Comments:

 

7.         Conveying a positive attitude      

            Comments:

 

8.         Self-advocacy      

            Comments:

 

9.         Managing stress      

            Comments:

 

10.       Goal setting/ time management

            Comments:

 

11.       Other - Enter any additional areas addressed related to Personal Management skills

Comments:

 

 

Instructor Name: _________________________________________    

Hours: _________________

 

 

Instructions: Enter the numeric code from the Outcome Key to indicate the status of training for each of the guideline objectives. Training must be provided in all areas identified in the assessment unless the objective is eliminated or withdrawn. Training will also include a review of the goals previously met and reinstruction should occur when required. Skills learned in previous level(s) should be integrated into this level's training program. Prior to the conclusion of training, all skills in all levels should be reviewed and reinstruction should occur when required. Provide comments on the consumer's progress toward the achievement of each objective. If additional needs are identified during training, provide comments in the appropriate guideline section(s).

 

 

Introduction to Job Seeking Skills Guidelines

 

Outcome Code          Date 

 

1.         Presentation- interview skills and disclosure      

            Comments:

 

2.         Development of Basic Resume      

            Comments:

 

3.         Informational interviews with local hiring managers

            Comments:

 

4.         Other - Enter any additional areas addressed related to Job Seeking Skills

Comments

 

 

Instructor Name: _________________________________________    

Hours: _________________

 

 


 

New York State Office of Children and Family Services

Commission for the Blind

 

Work Experience Report

 

Authorization No. 

    

Part I. 

  

Instructions: Complete this section using identifying information from Section I of the Initial Authorization 

 

Consumer Name:

Case No.

Counselor:

NYSCB D.O.

 

 

Service Outcome

 

 

Agency Determination

Accepted/Rejected

Outcome Achieved/ Outcome Not Achieved

NYSCB Counselor Determination

Successful Outcome/ Unsuccessful

 

Service Period

From

To

Total Hour Units Rendered

 

 

  

Agency Name:     ______________________________________________________

  

Agency Signature:   ______________________________________ Date:  _________

 

 

Attachments:

Attachment Notes

 

Part II.

 

OUTCOME KEY

 

1 – Needs further training

2 – Not applicable/not referred for this purpose

 

 

 

 

 

Work Experience

  

Instructions: Enter the numeric code from the Outcome Key to indicate the status of training for each of the guideline objectives. Provide comments on the consumer's progress toward the achievement of each objective. If additional needs are identified during training, provide comments in the appropriate guideline section(s).

  

Work Experience Guidelines

Outcome Code          Date

 

1.         Host company information - enter the following information into the comments section below:

a.         Name

b.         Address

c.         Supervisor

d.         Phone

e.         Fax

f.          Email

Comments:

       

2.         Consumer Job Title and Job Tasks - enter the consumer's job title and the consumer's job tasks in the comments section below:      

Comments:

 

3.         Consumer Work Schedule - enter the consumer's work schedule for each day of the week (see example) in the comments section below:

Sunday - N/A

Monday - 8:30-4:30

Tuesday - 12:00-4:00

Comments:

 

4.         Accommodations/supports required - enter these in the comments section below:

Comments:

 

5.         Consumer wage (justification is required and senior counselor/district manager approval is required for pay rates higher than minimum wage).  Enter the consumer wage in the comments section below:

Comments:

 

6.         Consumer understood and adhered to attendance policies and work schedule:

            Comments:  

 

 

7.         Consumer demonstrated appropriate grooming and dress for the work setting:      

Comments:  

 

8.         Consumer demonstrated ability to plan and organize job tasks for productivity:      

Comments:  

 

9.         Consumer demonstrated ability to learn job tasks with instruction and repetition:      

Comments:  

 

10.       Consumer demonstrated ability to take notes about work tasks:      

            Comments:  

 

11.       Consumer demonstrated ability to identify and use adaptive skills and equipment at work:      

            Comments:  

 

12.       Consumer demonstrated ability to interact with coworkers and supervisors professionally and socially:      

            Comments:  

 

13.       Consumers demonstrated ability to ask for assistance in a positive manner:      

            Comments:  

 

14.       Consumer demonstrated ability to benefit from constructive criticism:      

            Comments:  

 

15.       Consumer learned all hard skills needed to perform job tasks successfully:      

            Comments:  

 

16.       Consumer learned problem-solving, time, management and teamwork skills:      

Comments:  

 

17.       Consumer was able to travel safety to/from/within the work site:      

            Comments:  

 

18.       Consumer demonstrated improvement in other areas identified in referral materials:      

            Comments:  

 

 

 

 

19.       Please elaborate on the trainee’s performance in the areas above, problem areas noted during training, other conclusions, and recommendations for future services:      

            Comments:  

 

 

Instructor Name: _________________________________________    

Hours: ________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

New York State Office of Children and Family Services

Commission for the Blind

Work Experience Training (WET) Agreement

 

WET For:

 

Job Information:

 

Employer: ________________________

Employer Address: _________________

Employer City: ____________________            State: ________       Zip: ____________

Employer Contact: ___________________        Teleconference: __________________

Consumer’s Job Title: ____________________________________________________

JobDuties:_________________________________________________________________________________________________________________________________________________________________­­­­­­­­­­­­­­­­­­­­­­­­­­­­________________________________________

 

Dates of WET:

            Start: ______________________                        End: _____________________

            Total Hours: _________________                        From: ________ to _________

 

Understandings:

 

The employer is not an immediate relative (as identified in the NYSCB On-the-Job training policy) of the NYSCB consumer.

 

The NYSCB consumer will be placed on the employer’s payroll. The employer will pay Worker’s Compensations, Social Security and Unemployment Insurances during the WET period. All New York State Department of Labor Standards for wage, hours and safety will be met.

 

The counselor will make contact with the employer during the WET period.

All personal information regarding the NYSCB consumer will be maintain in a confidential manner and released only in accordance with applicable regulations and guidelines.

 

Any changes to this agreement must be made by mutual agreement on the part of the NYSCB consumer, the employer and the NYSCB counselor.

To be filed out by NYSCB Counselor and/or Designated Agency Representative.

 

NYSCB Counselor: _______________________Counselor Phone: _______________

 

Counselor Signature: ______________________­­­­­­­­­­­­­­­__________Date: _______________


New York State Office of Children and Family Services

COMMISSION FOR THE BLIND

 

Prohibition on Redisclosure of HIV or AIDS Related Information

 

 

NOTE:   This form must be attached to all disclosures of HIV and AIDS Related          information.

 

 

 

This information has been disclosed to you from confidential records which are protected by State law.  State law prohibits you from making any further disclosure of this information without the specific written consent of the person to whom it pertains, or otherwise permitted by law.  Any unauthorized further disclosure in violation of State law may result in a fine or jail sentence or both.  A general authorization for the release of medical or other information is NOT sufficient authorization for further disclosure.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

New York State Office Children and Family Services

COMMISSION FOR THE BLIND

RELEASE OF CONFIDENTIAL INFORMATION

 

 

_______________________________                          ______________________

Consumer Name                                                                   Identification Number

 

I hereby authorize the New York State Commission for the Blind to obtain or release the following information as necessary to effectively plan for and provide vocational rehabilitation services to me.  I can change my mind about this release, except for actions already taken with my permission, by telling NYSCB in writing that I do not want any further information to be given out.  My permission to release or obtain this information is only valid until ______________ and cannot extend beyond one year from the date I sign this form.  This permission will also end if my case is closed by NYSCB.

 

Type of Information: _____________________________________________________

 

_____________________________________________________________________

 

Purpose and reason information is needed: __________________________________

 

_____________________________________________________________________

 

Name, Title, Agency and Address of person releasing this information:

 

_____________________________________________________________________

 

_____________________________________________________________________

 

Name, Title, Agency and Address of person receiving this information:

 

_____________________________________________________________________

 

_____________________________________________________________________

 

I understand that the specified information is privileged and confidential and for the exclusive use of those persons and agencies or facility employees involved in my rehabilitation program.

 

_____________________________________________       _____________________

Consumer Signature (parent/guardian if minor)                            Date

New York State Office of Children and Family Services

COMMISSION FOR THE BLIND

 

 

Prohibition on Redisclosure of Information Concerning Individuals with a Disability of Alcoholism or Substance Abuse

 

 

NOTE:   This form must be attached to all disclosures of information concerning individuals with a disability of alcoholism or substance abuse.

 

 

This information has been disclosed to you from records protected by Federal confidentiality rules (42 CFR Part 2).  The Federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 CFR Part 2.  A general authorization for the release of medical or other information is NOT sufficient for this purpose.  The Federal rules restrict any use to criminally investigate or prosecute any alcohol or drug abuse patient.


 

New York State Office Children and Family Services

COMMISSION FOR THE BLIND

RELEASE OF CONFIDENTIAL INFORMATION

 

__________________­­­­_____________                          ______________________

Consumer Name                                                                   Identification Number

 

I hereby authorize the New York State Commission for the Blind to obtain or release the following information as necessary to effectively plan for and provide vocational rehabilitation services to me.  I can change my mind about this release, except for actions already taken with my permission, by telling NYSCB in writing that I do not want any further information to be given out.  My permission to release or obtain this information is only valid until ______________ and cannot extend beyond one year from the date I sign this form.  This permission will also end if my case is closed by NYSCB.

 

Type of Information: _____________________________________________________

 

_____________________________________________________________________

 

Purpose and reason information is needed: __________________________________

 

_____________________________________________________________________

 

Name, Title, Agency and Address of person releasing this information:

 

_____________________________________________________________________

 

_____________________________________________________________________

 

Name, Title, Agency and Address of person receiving this information:

 

_____________________________________________________________________

 

_____________________________________________________________________

 

I understand that the specified information is privileged and confidential and for the exclusive use of those persons and agencies or facility employees involved in my rehabilitation program.

 

_____________________________________________       _____________________

Consumer Signature (parent/guardian if minor)                          Date


Appendices

11.0

 

 

 

 

 

 

Appendix A: Ancillary Service Standards

 

Appendix B: Rates for Ancillary Services

 

Appendix C: Personnel Standards

 

Appendix D: Children’s Services and Independent Living Services

 

Appendix E: Rates for Children’s and Independent Living Services

 

Appendix F: Contractor Service Delivery Regions

 

Appendix G: NYSCB Deaf Blind Services at Helen Keller National Center

 

NYS Commission for the Blind

Comprehensive Service Contract Guidelines

Appendix A: Ancillary Service Standards

 

 

I.          Low Vision Services 

                    Low Vision Aids & Devices *

 

II.          Psychological Services

 

III.         Physical/Occupational Therapy 

 

IV.        Braille Instruction

 

V.        Interpreter Services 

                  A. Sign Language Interpreter

                  B. Foreign Language Interpreter

 

VI.        Consultation Services 

 

VII.       Job Coaching Services

 

VIII.      Intensive Adaptive Skills Training

 

IX.        Psychological Evaluation 

 

X.        Microcomputer Software Training

 

XI.        Strategic Technical Intervention

 

XII.       Social Casework Services 

 

XIII.      Diabetes Education

 

XIV.     Insulin Device Training

 

XV.      Work Experience Services

 

XVI.     Orientation & Mobility Instruction

 

XVII.    Vision Rehabilitation Therapy

 

XVIII.   Job Save Services

 

* Rates are posted at the Low Vision Fee Schedule On-Line by going to:

Visionloss.ny.gov, choosing the tab on the left titled “Low Vision,” and then choosing, “Click Here for Low Vision Fee Schedule.”

 

 

I. Low Vision

 

 1.1 Program Description: Low vision services are those services designed to maximize a consumer's residual or subnormal vision. The evaluation of a consumer's vision or acuity and the determination of necessary aids is only a part of the low vision service available to consumers. Additional factors that affect the consumer's functioning are considered in evaluating a consumer's need for and acceptance of low vision services.

           

Based on the assessment of the consumer's acuity and other factors the low vision specialist prescribes or recommends optical and non-optical aids and/or appliances to meet the individual needs of a consumer. Low vision services may involve personnel from many fields in rehabilitation: ophthalmologists, optometrists, mobility instructors, nurses, teachers and counselors.

 

1.2 Program Standard: Low vision services include the assessment and identification of factors affecting the provision of those services. Such factors may include but are not limited to the following:

•           visual acuity

•           visual field restriction(s)

•           occupational choice

•           tasks to be performed

•           special lighting required

•           other medical factors or conditions

Optical aids, devices, equipment, and appliances may be recommended/prescribed to meet the particular visual needs of each consumer.

           

Low vision services include the instruction of the consumer in the use of low vision aids, devices, etc., and coordination with mobility and/or rehabilitation teaching activities, including adaptive electronic devices, follow-up on the use of prescribed/recommended aids, or devices.

           

An individual consumer's ability to use low vision aids or devices may vary during periods of extended usages. Rest periods may extend the consumer's endurance to use the aid or device. The low vision assessment shall, in so far as possible, evaluate endurance, i.e. how long a period of time, including necessary rest periods, the consumer is able to use the devices prescribed by the low vision specialist. This is particularly important with regard to expensive electronic devices where cost benefit decisions involving the consumer, the low vision specialist, and the NYSCB counselor must be made.

           

Low vision services may be provided up to four sessions: an initial evaluation and three follow-up visits.

 

1.3 Personnel Standard: Low vision services can only be provided by low vision specialists. Minimum qualifications for specialists include:

•           Ophthalmologists licensed to practice in New York State.

•           Optometrists licensed to practice in New York State and approved by the                               New York State Optometric Association to provide low vision services.

 

 

II. Psychological Services

 

2.1Program Description: Psychological Services are therapeutic services designed to ameliorate a psychiatric or psychological condition. Psychological Services are provided to a consumer who possesses a psychiatric/psychological condition that is stable or slowly progressive. These services must be medically recommended and included as a part of the IPE.

 

2.2 Program Standard: Psychological Services may be provided to appropriate vocational rehabilitation consumers who have a disability that could be removed or substantially modified. The service must be short term in duration (not to exceed 18 months). The specific therapy provided must be based upon recent (within three months) psychiatric or psychological recommendation. Progress must be reported on a monthly basis to the NYSCB counselor.

           

2.3 Personnel Standard: Psychological Service may only be provided by the following practitioners:

 1.  Psychiatrist licensed to practice in New York State.*

                        OR,

2.  Psychologist licensed to practice in New York State.

                           

 In addition, the psychologist must:

•           be currently registered in accordance with Article 153 of the New York                                     State   Education Law, and;

•           have completed three years of supervised experience in clinical                                               psychology; and

•           be currently engaged in professional practice, at least half of which is devoted to providing clinical psychology;

                        OR,

3.  Social worker licensed to practice in New York State and approved by the                            New York State Board of Social Work. 

 *Psychotherapy to alleviate or correct severe emotional trauma, psychotic, or serious neurotic disorders is only to be provided by a psychiatrist under the provisions of Sections 162 and 253 of the New York State Insurance Law.

 

 

III. Physical Therapy and Occupational Therapy

 

3.1 Program Description: Physical Therapy and Occupational Therapy services are those services designed to correct or substantially modify a physical condition. Services may be provided to a consumer who has a physical condition which is stable or slowly progressive. The service must be medically recommended and included in the consumer's IPE.

 

 3.2 Program Standard: Physical Therapy and/or Occupational Therapy may be provided to appropriate vocational rehabilitation consumers to reduce functional limitations resulting from disability. The service must be short term in duration (12 months or less). The specific therapy provided must be based upon current medical recommendation and progress is to be reported on a monthly basis to the NYSCB counselor. Justification for continued treatment beyond the initial term of therapy shall be based upon a written progress statement and recommendation included in a final report to the NYSCB counselor.

           

3.3 Personnel Standard: Physical Therapy can only be provided by a physical therapist licensed by the State of New York. Occupational Therapy can only be provided by an occupational therapist licensed by the State of New York.

 

 

IV. Braille Instruction

 

4.1 Program Description: Braille instruction is provided to individuals or groups of consumers to enable them to, or enhance their ability to, read and write Braille. Braille may be introduced using a slate and stylus or a Braille writer.

           

4.2 Program Standard: Braille instruction may be provided to NYSCB consumers based upon an assessment of the consumers need and ability to read and write Braille. The need for instruction must be documented and include such factors as:

•           Consumer’s current level

•           anticipated achievement levels

•           Medical factors

           

4.3 Personnel Standard: The Braille Instructor must possess, as a minimum, either:

•           Certified/certifiable as a teacher of the visually impaired by the New York                                State Education Department; or

•           NYSCB approval as a Vision Rehabilitation Therapist.

 

V. Interpreter Services

 

A. Sign Language Interpreter

           

5. A.1 Program Description: Sign Language interpreter services are provided to enable NYSCB staff and service providers to communicate effectively with NYSCB applicants and consumers who have a significant hearing loss that prevents adequate speech discrimination. Many consumers who are deaf or hard of hearing and severely visually impaired may require special communication modalities. Depending upon the age of onset of deafness, level of communication and other factors, the communication method is most likely to be one or more of the following:

•           American Sign Language

•           Sign Language Presented in English Word Order

•           Manual Alphabet (Finger Spelling)

•           Tactual Sign Language

•           Print-On-Palm

 

Consistent with the code of ethics of Registry of Interpreters for the Deaf, the interpreter must:

              Keep all assignment related information confidential

              Always convey the content and spirit of the speaker and not edit or delete information

              Refrain from providing advice or interjecting personal opinions

              Only accept assignments for which he/she is qualified

              Only request appropriate and reasonable compensation

 

5. A.2 Program Standard:  interpreter services are only available to allow effective communication with consumers who have severe hearing and visual impairment and who can communicate utilizing one or more of the modalities mentioned in the program description above. The primary purpose of this service is to facilitate the exchange of information between the consumer and counselor and assure the consumer's active participation in the rehabilitation process.

           

5. A.3   Personnel Standard: Interpreter services shall be provided only by a person certified by the Registry of Interpreters for the Deaf (RID).

 

5. B. Foreign Language Interpreter

           

5. B.1 Program Description: Foreign language interpreter services are provided to NYSCB staff to communicate with consumers who do not speak English. This service is provided to enable a consumer to participate in the rehabilitation process and communicate in his/her “native language”. The service will be utilized during the interview process and counseling sessions.

           

5. B.2 Program Standard: Foreign language interpreter services are available to appropriate NYSCB staff to communicate with non-English speaking consumers. These services are provided to enable a consumer to participate in the rehabilitation process.

           

5. B.3 Personnel Standard: Foreign language interpreters must be conversant in both English and the foreign language which they interpret. The interpreter must possess a high school education or equivalent in addition to the conversational proficiency in two languages (English and another).

 

 

VI. Consultation Services

 

6.1 Program Description: Consultation Services are those services which describe issues on blindness, provide training in working with blind persons, provide assessments and recommendations about site-accessibility for blind persons, or provide assessment and recommendations about specialized equipment needed by blind persons. The purpose of this service is to ensure that community training, educational, and employment resources are rendered accessible to NYSCB consumers to the greatest extent possible.

           

6.2 Program Standard: Consultation Services shall be provided by the Contractor to the community resource upon authorization by the NYSCB District Office. The NYSCB counselor, upon determination of need for Consultation Services by a potential service provider shall:

•           Convene a case conference among the consumer, NYSCB counselor,                                    Contractor, and community resource, to identify the goals of the                                                consultation services.

•           Provide for assessment of the community resource site by the Contractor,                              when necessary.

•           Provide for a written consultation plan prepared by the Contractor and                                     agreed to by all parties.

•           Provide for implementation of the plan by the Contractor.

The Contractor will submit a report of the consultation service and of the goals attained, to the District Office within one week of completion of the service.

           

6.3 Personnel Standard: Consultation Services shall be provided only by Contractor staff members with a Bachelor's Degree and two years professional expertise in the field of human services; exceptions are subject to the approval of the Associate Commissioner for the New York State Commission for the Blind.

 

 

VII. Job Coaching Services

 

7.1 Program Description:  Job Coaching is a service option to enhance the ability of individuals, who may not have fared well in traditional rehabilitation and competitive work settings, to learn work-related behaviors and specific job skills in a real job.

           

7.2 Program Standard: Working in conjunction with the rehabilitation counselor, the job coach may appropriately perform the following activities;

1.         conducting intake and assessment(s)

2.         developing a job appropriate to the individual's interests and abilities

3.         assisting in the development of an individual plan for the job site                                               instruction

4.         implementing the instruction plan for specific steps of jobs including:

•           job performance skills such as sequence, quality and quantity

•           job-related skills such as grooming, socializing with co-workers,                                   accepting supervision, and/or managing one's paycheck

5.         providing reinforcement for successful performance of job steps

6.         performing assessments of work quality and quantity according to                                            procedures and criteria established in the individual instruction plan or IPE

7.         providing counseling regarding good work habits, job finding and job                           retention

8.         providing written reports on each consumer's job performance and work                                 related skills

9.         providing training as needed to work site supervisors to facilitate their supervision of persons with disabilities

10.       providing advocacy

11.       providing long-term follow-up for individuals participating in supported                                     employment

 

            Job coaching may be provided to an individual or to small groups (no more than eight individuals). The job coach will submit a written report after the first three (3) weeks of service and on a monthly basis thereafter.

 

7.3 Personnel Standard:  Individuals serving as job coaches must meet the following personnel standards:

•           ability to communicate effectively and to provide meaningful instruction

•           ability to use effectively a variety of instructional techniques including   shaping, reinforcing, and prompting

•           for coaches who will be working with individuals who are deaf and blind                                  and unable to understand most speech, the demonstrated ability to                                                 communicate effectively with the consumer in the consumer's preferred                                   mode and level of communication (sign language, total communication,                              Braille, etc.)

•           possess the following personal characteristics: sensitivity to disability-                        related issues; positive attitude; flexibility; creativity; patience; and sound         judgment.

 

In addition, it is helpful if the individual has demonstrated work experience in the type of job for which they will be providing job coaching. Job coaches who will be working with individuals participating in supported employment must also demonstrate a commitment to the concept of supported employment.

 

 

VIII. Intensive Adaptive Skills Training

 

8.1 Program Description: Intensive Adaptive Skills Training is provided to young adults outside the school environment. The purpose of this service is to provide comprehensive, intensive training in a group setting to insure that young adults acquire the necessary adaptive skills to pursue further education and employment.

           

8.2 Program Standard: Working in conjunction with the NYSCB rehabilitation counselor, the agency will define a specific short term intensive program to address one or more of the following:

•           Spatial orientation

•           Personal/self-care skills

•           Communication skills

•           Use of optical aids, devices

•           Use of electronic & mechanical devices

•           Career exploration/transitional employment

           

8.3 Personnel Standards: Staffing standards will vary depending upon the specific program design. Staff credentials must be submitted to NYSCB Director of Field Operation for approval.

 

 

IX. Psychological Evaluation

 

9.1 The basic purposes for providing psychological testing: To assess an individual's cognitive, learning abilities and intellectual functioning, occupational interests, academic achievement and educational aptitude, perceptual and neuropsychological abilities, motor functioning and mental or emotional status to provide information about rehabilitation needs for the development of the employment plan.

           

The results of these or other related measures are included in a comprehensive psychological assessment to be utilized in planning for appropriate vocational rehabilitation services. The assessment also may contain references concerning adjustment, maladjustment, behavior and or psychological anomalies observed or revealed through testing.

           

9.2 Program Standard: Psychological evaluation must address, as a minimum, the seven areas listed above. The evaluation will include a comprehensive report and recommendations based upon the findings. The report will contain as a minimum, the following:

            1. Specific test and measures used

 2. Objective test results (raw data)

 3. Norms utilized

 4. Interpretation of results

 5. Summary of findings

 6. Recommendation

           

The psychologist must select appropriate testing instruments to address the specific condition of the visually impaired individual from among them and a variety of other measures, using his or her professional judgment to determine the relevancy for the individual consumer.

           

9.3 Personnel Standard: Psychological evaluation shall only be provided by a psychologist licensed by the State of New York. The psychologist must:

•           be currently registered to practice in accordance with Article 153 of the                                   New York State Education Law, and

•           have completed three years of training or supervised experience in test                                  administration, and

•           have a minimum of one year of experience in testing legally blind persons.

 

X. Microcomputer Software Training

 

10.1 Program Description: Microcomputer software instruction is provided to NYSCB consumers who have successfully completed assessment and training at a NYSCB approved Adaptive Technology Center or at another NYSCB approved training source. This training is for the purpose of providing software specific instruction to NYSCB consumers who require a thorough working knowledge of a particular software package for employment or educational purposes.

           

Consumers receiving this service should already be trained on their adaptive equipment configuration, know how to use their computer, perform basic maintenance and assemble/disassemble their equipment.

           

10.2 Program Standard: Microcomputer software training must be provided in hourly sessions to individuals or group of NYSCB consumers. The following defines the expected outcomes for the various types of software training:

 

Word Processing:

 1. Understanding of basic word processing concepts

 2. Ability to create, save, print, edit, insert, delete, center, move

                 underline and bold text

             3. Ability to use a spell checker

 4. Ability to utilize mail merge techniques

 5. Ability to create labels

 6. Ability to create and use a mailing list

 7. Document conversion

 

  Database:

 1. Understanding of basic database concepts

 2. Utilize functions and commands, plan, create and use files

 3. Use sort and index functions

 4. Programming techniques and command files

 5. Debugging and error techniques

            6. Creating and printing reports

            7. Forms generation

            8. Data screen generation

            9. Data verification

 

  Spread Sheet:

1. Understanding of spread sheet concepts

2. Ability to move around the spread sheet

            3. Ability to utilize the command menu

            4. Ability to enter labels, numbers and create formulas

            5. Ability to create and print reports

            6. Ability to create graphics

7. Ability to interface with various database

            8. Ability to work with and define Macros

 

Communications

1. Understanding of basic communications concepts

2. Ability to set up and install software

3. Ability to define and set up systems defaults

4. Establishing communications

5. Ability to develop telephone lists

6. Ability to communicate information

7. Ability to end communications

 

10.3 Reports: If the training exceeds a two week period in duration, a brief written interim report must be submitted to the NYSCB counselor who referred the consumer within three days of the end of the second week of training. A final written report must be submitted within one week of the completion of training.

10.4 Personnel Standard: Instruction in microcomputer software shall be provided by an individual with one year of experience with and thorough knowledge of microcomputers and competency in the following microcomputer software categories:

            1. Word processing

 2. Data base

 3. Spreadsheet

 4. Communications

 

The instructor shall also be proficient in the specific software package for which the consumer is receiving instruction. Additional experience in adaptive technology for visually impaired persons is recommended.

 

XI. Strategic Technical Intervention

 

11.1 Program Description: The Strategic Technical intervention service is meant to provide for supplementary job/education site technical support services. Consumers receiving this service should already be trained on their adaptive equipment configuration and know how to use their computer. Types of technical service covered would include (but not be limited to): new software installation; highly specialized and computer specific job task training; technical trouble-shooting

            NOTE: Before authorizing this service the NYSCB counselor must verify that the        support required is not available through any other contractual mechanism.

 

11.2 Program Standard: Strategic Technical Intervention should be provided in hourly sessions to an individual NYSCB consumer for a MAXIMUM of 20 hours. This type of service may encompass many areas. The following defines the expected outcomes for the examples noted above:

           

New Software Installation (use only when employer support for software installation is not adequate and returning the equipment to a central location for software installation is not an acceptable alternative):

1.         Work with on-site technical liaison when available and assist with product                               integration into local environment

2.         Install and test’ software for viable functionality

3.         Configure adaptive equipment configuration to new software requirements

4.         Provide introduction to basic software functions and features to consumer.

5.         Ensure appropriate product registrations and support are activated.

           

Computer-Specific Job Task Training:

1.         Work with on-site technical liaison when available and assist with product                               integration into local environment.

2.         Provide introduction and assistance in accessing a very specific                                              application or a limited set of program features (such as filling out a data                                entry screen).

3.         Where needed, train job coaches or co-workers to enable continued                           assistance on the job to the consumer after this service is completed.

4.         Ensure appropriate product support is activated.

           

Technical Trouble Shooting

1.         In cases where other technical support options are unavailable (products                                out of warranty, etc.), work with onsite technical liaison when available and                        assist with identifying and correcting error conditions in local environment.

2.         Liaise with manufacturer of adaptive equipment and their technical support                staff as needed.

3.         Assist in providing equipment repair, substitution, and reprocurement                          options, as needed.

4.         Resolve error conditions, provide adaptive equipment reconfiguration or                                 new environment services as warranted, and return consumer to viable                               functionality on-site as expeditiously as possible.

 

 The NYSCB counselor and the contractor's technical staff providing this service should agree on expected outcomes for services not defined above prior to service provision.

           

Reports: A brief written report must be submitted to the NYSCB counselor who referred the consumer, within one week of the completion of service, noting the service provided and the outcomes achieved.

           

11.3 Personnel Standard:  experience with microcomputer software and hardware, thorough knowledge of adaptive technology for visually impaired and legally blind individuals (one year minimum), Braille grades 1 and 2 desirable but not mandatory, experience with local area network hardware and software and mainframe terminal emulations, experience with modems and communication software.

 

 

 

 

 

XII. Social Casework Services

 

12.1 Program Description: Social casework services are a time-limited, short-term service intended to support or supplement the outcome-focused social casework services provided under this contract, or to be used when the longer term services package is not necessary.

           

12.2 Program Standard: Social Casework can be authorized by a NYSCB counselor only if it is not a part of the service component the individual is receiving, or when it is the only service an individual requires. If the problem cannot be addressed within the maximum time defined in the NYSCB referral document, the Social Casework authorized hours should be used to locate and refer the individual to a community resource which can provide the service. Social Casework services will not be provided by NYSCB if the NYSCB counselor is already aware of such a community resource. Social Casework may be provided only to address a vocationally related problem.

           

12.3 Personnel Standard: Social Casework may be provided only by individuals who possess a Master's or Bachelor's Degree in social work (MSW or BSW), or a Bachelor's or Master's degree in a related social/human services field with a minimum of one year of social work or related experience.

 

XIII. Diabetes Education

 

13.1 Program Description: Diabetes Education is an instructional program for NYSCB consumers who have diabetes to improve their ability to manage diabetes as independently as possible, following the guidelines of the American Diabetes Association.

           

13.2 Program Standard: As a result of attending this program an individual must gain the knowledge and skills to enable him or her to manage his or her diabetic condition. At a minimum, the program must address the following:

•           What is diabetes;

•           Path physiology;

•           Self-treatment techniques;

•           Insulin Device Training;

•           Nutritional management;

•           Complications

 

The Contractor must also: (1) identify the primary health care provider of the NYSCB consumer, and (2) prepare a Plan of Continued Self-Care for the primary health care provider to use in assisting the NYSCB consumer to self-manage their diabetic condition upon completion of their participation in the Diabetes Education Program. Copies of the Plan of Continued Self-Care must be provided to the NYSCB consumer, the primary health care provider, and the NYSCB district office.

           

Contractors who wish to provide this service must submit a curriculum of the program to NYSCB Central Office, with a copy to the NYSCB District Office, for approval prior to receiving referrals for this service. The diabetes education program must be accessible to legally blind individuals, and any materials provided to trainees must be in the trainee's preferred mode of communication (Braille, large print, audio tape, or diskette), as identified by NYSCB in the referral documents.

           

13.3 Personnel Standard: Diabetes Education may only be provided by a registered nurse certified as a diabetes educator, or eligible to take the certification exam. Other specialists, such as a Vision Rehabilitation Therapist, may be utilized, if necessary to assist in the presentation of non-medical portions of the program.

 

XIV. Insulin Device Training

 

14.1 Program Description: Insulin Device Training is an instructional program for NYSCB consumers who have diabetes which teaches the proper techniques for self-administration of insulin using a hypodermic syringe.

           

14.2 Program Standard: This training is less extensive than Diabetes Education. It is intended for individuals who already have an understanding of their diabetic condition and who do not need the in-depth training of the Diabetes Education program. At a minimum, this program must address the following:

•           Insulin injection methodology for visual impairment;

•           Sterile techniques and sterilization;

•           Use of lactometer;

•           Guidelines for mixing insulin;

•           How to store insulin;

 •          Disposal of syringes and needles.

           

Contractors who wish to provide this service must submit a curriculum of the program to NYSCB Central Office, with a copy to the NYSCB District Office, for approval prior to receiving referrals for this service. The insulin device training program must be accessible to legally blind individuals, and any materials provided to trainees must be in the trainee's preferred mode of communication (Braille, large print, audio tape, or diskette), as identified by NYSCB in the referral documents.

           

14.3 - Personnel Standard: Insulin Device Training may only be provided by a registered nurse certified as a diabetes educator, or eligible to take the certification exam. Other specialists, such as a Vision Rehabilitation Therapist may be utilized, if necessary to assist in the presentation of non-medical portions of the program.

XV. Work Experience Services

 

15.1 Program Description: Work Experience Services are services provided by the Contractor to support NYSCB consumers in work experience assignment settings identified by the NYSCB District Office at NYSCB Business Enterprise program facilities and other work experience sites identified by the NYSCB District Office.

           

15.2 Program Standard: Work experience sites will be selected by the NYSCB district office and will be identified by NYSCB in the referral materials to the Contractor. The referral will include the following documents: (1) Work Experience Referral Form, (2) US Immigration and Naturalization Service, Employment Eligibility Verification Form (Federal I-9 Form), and (3) IRS Form W-4, Employee’s Withholding Allowance.

           

The Contractor will coordinate payroll review and payments to referred NYSCB consumers, and will provide necessary Worker’s Compensation, Social Security and unemployment insurance coverage.

 

XVI.     Orientation & Mobility Instruction

 

16.1 Program Description: Orientation and mobility services are time-limited, short-term services intended to support or supplement the outcome-focused orientation & mobility services provided under this contract, or to be used when the longer term outcome services package is not necessary. 

           

16.2    Program Standard:  Orientation and mobility instruction may include: basic orientation concepts of body awareness and geometric shapes; use of reference systems to increase safety, independence and confidence; a primary travel system using residual vision, sighted guide, and long cane, prescribed low vision aids or a combination of the above. Where appropriate, the system may integrate the use of a guide dog and electronic vision enhancement systems; effective indoor travel techniques, including self-protective techniques, trailing and room or building familiarization; safe and effective negotiation of outdoor areas including street crossings at various traffic controlled intersections and the use of public transportation. Orientation and mobility training is provided by professional orientation and mobility instructors who meet the qualifications established by NYSCB.

           

16.3    Personnel Standard: Orientation & Mobility (Professional):  Individuals must possess a Master's or Bachelor’s degree with specialization in Orientation & Mobility instruction; or, a Bachelor's Degree and successful completion of instruction of a NYSCB approved program for orientation & mobility instruction professionals which meets nationally accepted standards.

           

16.4    Personnel Standard: Orientation & Mobility (Assistant):  Individuals must possess a minimum of a high school diploma, or equivalent, and satisfactory completion of a NYSCB approved program for orientation & mobility instructor assistants.  Provision of services are subject to the supervision of a professional orientation and mobility instructor, as defined above, who has two years of experience in orientation & mobility instruction.

           

XVII.    Vision Rehabilitation Therapy

 

17.1    Program Description:  Vision Rehabilitation Therapy services are time-limited, short-term services intended to support the outcome-focused vision rehabilitation services provided under this contract, or to be used when the longer-term outcome service package is not necessary.

17.2    Program Standard: Vision Rehabilitation Therapy will include communications training, home management skills, personal management skills and financial management skills.. 

           

Communication training may include braille and or large print or other preferred communication mode; the ability to use the telephone, including number retrieval; skills sin such functions as note-taking, message retrieval, record keeping, typing, labeling, and organizing information; and the ability to use communication devices, including but not limited to typewriter, keyboard, tape recorder, calculator, personal message recorder, or electronic notetaking devices. 

 

Home management will include training in meal planning and preparation, use of appliances and utensils, food storage and organization, and home cleaning, organization and safety.

 

Personal management includes training in personal grooming, clothing selection and care, child care, medication management and the use and care of non-optical and prescribed optical devices.

 

Financial Management includes training in the use of appropriate financial institutions,

personal budgeting and money management.

           

17.3    Personnel Standard Vision Rehabilitation Therapy (Professional):  Individuals must possess a Master's Degree or Bachelor’s Degree with specialization in rehabilitation therapy of individuals who are blind and a knowledge of Grade II Braille; or, a Bachelor’s Degree and successful completion of a NYSCB approved training program for rehabilitation therapy professionals which meet the nationally accepted standards, as well as knowledge of Grade II Braille.

           

17.4   Personnel Standard Vision Rehabilitation Therapy (Assistant):  Individuals must possess a minimum of a high school diploma, or equivalent, and satisfactory completion of a NYSCB approved program for vision rehabilitation assistants, as well as knowledge of Grade I Braille. Provision of services are subject to the supervision of a professional Vision Rehabilitation Therapist, as defined above, who has two years of experience in rehabilitation therapy.

 

XVIII. Job Save Services

 

18.1 Program Description: Job Save Services are time-limited services intended to assist the NYSCB consumer retain an existing job.

           

18.2 Program Standard:  Job Save Services must involve the NYSCB consumer, the NYSCB counselor, and the employer in a collaborative effort to identify the factors which are causing the consumer's job to be at risk and to develop a plan to address and alleviate the obstacle(s) to continued employment. Job Save Services may include recommendations for assistive technology and linkage to assistive technology providers to make print or computer-based information at the job-site more accessible to the consumer.  However, Job Save Services do not include the actual provision of assistive technology.

           

18.3 Personnel Standard:  Job Save Services must be provided by an individual who possesses either of the following:

•           a Master's Degree in Vocational Rehabilitation, OR

•           a Bachelor's Degree, or an equivalent combination of experience and post-secondary study in business, human resources/personnel development, marketing, counselling, education or a related field, from an accredited college or university, AND one year of experience providing employment/job placement services to individuals seeking employment, and working directly with employers, OR, completion of a NYSCB approved training program.   

 

 


 

                                                                   

NYS Commission for the Blind

Comprehensive Service Contract Guidelines

Appendix B: Rates for Ancillary Services

 

 

 

I.          Low Vision Services                                                 $250.00 / examination (initial)

                                                                                                $ 75.00 / follow-up examination

            Low Vision Aids & Devices                                     * please see below

 

II.          Psychological Services       

A.  Psychiatrist                                                          $ 45.00 / hour session

B.  Psychotherapist                                                   $ 30.00 / hour session

 

III.         Physical / Occupational Therapy                             Current NYS Medicaid Rate

 

IV.        Braille Instruction                                                       $ 80.00 / hour session

 

V.        Interpreter Services                                     

Foreign Language Interpreter                      $ 45.00 / hour

Sign language                                               $ 80.00 / hour

 

VI.        Consultation Services                                              $ 55.00 / hour / person

 

VII.       Job Coach Services                                                 $ 45.00 / hour

                       

VIII.      Intensive Adaptive Skills Training                           $ 50.00 / day / person

 

IX.        Psychological Evaluation                                         $286.00 / evaluation

 

X.        Microcomputer Software Training                           $ 50.00 / hour

 

XI.        Strategic Technical Intervention                              $ 80.00 / hour

 

XII.       Social Casework Services                                      $ 80.00 / hour

 

XIII.      Diabetes Education                                                  $ 720.00 / person / program

 

XIV.     Insulin Device Training                                             $ 45.00 / hour / person

                        Group Rate                                                    $ 30.00 / hour / person

 

XV.      Work Experience Services                                      Per NYSCB referral materials;                                                                                                        Not to exceed $ 25.00 / hour

XVI.     Orientation & Mobility Instruction (Professional)                $ 80/hour session

            Orientation & Mobility Instruction (Assistant)                     $ 50/hour session

 

XVII.    Vision Rehabilitation Therapy (Professional)                    $ 80/hour session

            Vision Rehabilitation Therapy (Assistant)              $ 50/hour session

 

XVIII.   Job Save Services                                                               $180/hour

                                                                                                            Not to exceed 10 hours

 

XIX.     Neuropsychological Evaluation                                           $88.00/hour

 

XX.      Case Finding                                                                         $200.00/case

 

Note: For any of the above services add $ 10 per hour for service providers who have ASL certification when working with a deafblind consumer and add $ 10 per hour for bilingual service providers when working with a consumer who needs bilingual services.

 

* Rates are posted at the Low Vision Fee Schedule On-Line by going to:

Visionloss.ny.gov, choosing the tab on the left titled “Low Vision,” and then choosing, “Click Here for Low Vision Fee Schedule.”


 

NYS Commission for the Blind

Comprehensive Service Contract Guidelines

Appendix C: Personnel Standards

 

1.    ALP Coordination:

 

Individuals must possess a Bachelor's Degree in Social Work or, a Bachelor's Degree in a related social/human services field.

 

2.    Assessment Services

 

Individuals must possess the qualifications specified below relevant to the specific area of assessment.

 

3.    Vision Rehabilitation Therapy:

 

Vision Rehabilitation Therapy (Professional):  Individuals must possess a Master's Degree or Bachelor’s Degree with specialization in rehabilitation therapy of individuals who are blind and a knowledge of Grade II Braille; or, a Bachelor’s Degree and successful completion of a NYSCB approved training program for rehabilitation therapy professionals which meet the nationally accepted standards, as well as knowledge of Grade II Braille.

 

Vision Rehabilitation Therapy (Assistant):  Individuals must possess a minimum of a high school diploma, or equivalent, and satisfactory completion of a NYSCB approved program for vision rehabilitation assistants, as well as knowledge of Grade I Braille. Provision of services are subject to the supervision of a professional Vision Rehabilitation Therapist, as defined above, who has two years of experience in rehabilitation therapy.

 

4.    Orientation & Mobility Instruction:

 

Orientation & Mobility (Professional):  Individuals must possess a Master's or Bachelor’s degree with specialization in Orientation & Mobility instruction; or, a Bachelor's Degree and successful completion of instruction of a NYSCB approved program for orientation & mobility instruction professionals which meets nationally accepted standards.

 

Orientation & Mobility (Assistant):  Individuals must possess a minimum of a high school diploma, or equivalent, and satisfactory completion of a NYSCB approved program for orientation & mobility instructor assistants.  Provision of services are subject to the supervision of a professional orientation and mobility instructor, as defined above, who has two years of experience in orientation & mobility instruction.

 

5.    Social Casework Services:

 

Individuals must possess a Master's Degree (MSW) or a Bachelor's Degree (BSW) in Social Work, or a Master's Degree or a Bachelor's Degree in a related social/human services field with a minimum of one year of social work or related experience.

 

6.    Pre-Vocational Skills Training for Young Adults:

 

The Pre-Vocational Skills training instructor must have:

·        a high school diploma or GED;

·        have a varied and successful work history in competitive employment settings;

·        knowledge of employer expectations of employee performance and workplace behaviors;

·        ability to interact effectively with youth;

·        knowledge of NYSCB reporting requirements; and

·        a minimum of two years’ experience in providing vocational services to persons who have disabling conditions or other significant barriers to employment.

 

7.    Academic Instruction:

 

The academic instructor must possess a teaching certificate from the New York State Education Department or must possess the education and experience to meet the New York State Education Department requirement for a certificate.

 

8.    Vocational Training:

 

Vocational training must be provided by an instructor who has the following qualifications:

 

EITHER:

Licensure or certification by the New York State Education Department, OR

Four years of experience as an instructor in the appropriate vocational training area.

 

9.    Work Readiness Services:

 

The work readiness instructor must have:

·        a high school diploma or GED;

·        have a varied and successful work history in competitive employment settings;

·        knowledge of employer expectations of employee performance and workplace behaviors;

·        knowledge of NYSCB reporting requirements; and

·        a minimum of two years’ experience in providing vocational services to persons who have disabling conditions or other significant barriers to employment.

NYS Commission for the Blind

Comprehensive Service Contract Guidelines

Appendix D: Children’s Services and Independent Living Services

 

I.   SERVICE STANDARDS

 

1. Orientation & Mobility Services

 

A.  Service Description:  Orientation & Mobility (O & M) services are individualized comprehensive services to assist a legally blind child or adult to become aware of elements and factors in his/her environment and to move through that environment safely and independently.

 

B.  Assessment:  In order to determine the service needs of a consumer, an O & M assessment must be conducted prior to the start of service.  The assessment must address, but not be limited to, the following:

            (1) the amount and type of travel necessary for the consumer

            (2) the consumer's desire for independent travel skills

            (3) previous training, if applicable

            (4) amount of functional vision

            (5) effects of any secondary disabilities or medical conditions

 

The Contractor must provide NYSCB a written report of the assessment findings including recommendations, in a format acceptable to NYSCB.  These recommendations will be the basis for the provision of further orientation and mobility services.

 

C.  Scope of Services:  O & M Instruction includes, but is not limited to: concept development (i.e., right, left, forward, backward), sensory training, body awareness and geometric shapes, spatial orientation, protective techniques, travel techniques, use of reference systems to increase safety, independence and confidence; a primary travel system using residual vision, sighted guide, long cane, prescribed low vision aids or a combination of the above. Where appropriate, instruction may integrate effective indoor travel techniques, trailing and room or building familiarization; safe and effective negotiation of outdoor areas including street crossings at various traffic controlled intersections and the use of public transportation.  When necessary, instruction must integrate the use of a guide dog and electronic vision enhancement systems, electronic travel aids, and other mobility related equipment.

 

 

 

 

 

2.    Vision Rehabilitation Therapy Services

 

A.  Service Description:  Vision Rehabilitation Therapy services are the training and guidance provided to a legally blind child or adult to assist that person to function more independently in his/her daily activities.

 

B.  Assessment:  In order to determine the service needs of the consumer, a vision rehabilitation therapy assessment must be conducted prior to the start of service.

 

The Contractor must provide NYSCB a written report of the assessment findings including recommendations, in a format acceptable to NYSCB.  These recommendations will be the basis for the provision of further rehabilitation teaching services.

 

C.  Scope of Services:  Vision Rehabilitation Therapy includes, but is not limited to the following areas of training:

(1) Communication training may include braille and or large print or other preferred communication mode; the ability to use the telephone, including number retrieval; skills in such functions as note-taking, message retrieval, record keeping, typing, labeling, and organizing information; and the ability to use communication devices, including but not limited to typewriter, keyboard, tape recorder, calculator, personal message recorder, or electronic notetaking devices.

(2) Home management and orientation includes training in meal planning and preparation, use of appliances and utensils, food storage and organization, and home cleaning, organization and safety.

(3) Personal management includes training in personal grooming, clothing selection and care, child care, medication management and the use and care of non-optical and prescribed optical devices.

(4) Financial Management includes training in the use of appropriate financial institutions, personal budgeting and money management.

(5) Provision of adaptive equipment necessary to accomplish the goals defined in the assessment recommendations.

 

3.  Social Casework Services

 

Social Casework service must be provided according to the standards found in Appendix A, Ancillary Services Standards.

 

4.  Low Vision Services   

 

Low Vision Services must be provided according to the standards found in Appendix A, Ancillary Services Standards.

 

 

II. INTERPRETER SERVICES

 

When necessary to the successful provision of Services, the Contractor agrees to provide the following Interpreter Services, as defined in Appendix A: Ancillary Service Standards, at the rates in Appendix B: Rates for Ancillary Services.

            1.  Foreign Language Interpreter

            2.  Sign Language Interpreter

 

 

III. PROVISION OF SERVICES

 

1. Upon receipt from NYSCB of a referral for service, the Contractor agrees to initiate and provide services in a timely and continuous manner.  The Contractor further agrees that services will be initiated no later than sixty (60) days from the date of referral.

 

2.  The Contractor agrees to provide Orientation & Mobility instruction and Vision Rehabilitation Therapy at a minimum frequency of one one-hour session per week continuously until the total units of services authorized in the Referral have been provided.  Interruption of services for reasons other than consumer health is to be considered extraordinary.  Rationale documenting justification for any such interruption must be entered in the consumer's case record. 

 


 

                                                                                                                       

NYS Commission for the Blind

Comprehensive Service Contract Guidelines

Appendix E: Rates for Children’s and Independent Living Services

 

 

 

 

I.          Orientation & Mobility Instruction (Professional)                            $65.00/hr. session

            Group Instruction                                                                               $28.00/hr. session

 

            Orientation & Mobility Instruction (Assistant)                                 $40.00/hr. session

            Group Instruction                                                                               $22.00/hr. session

 

II.          Vision Rehabilitation Therapy (Professional)                                $65.00/hr. session

            Group Instruction                                                                               $28.00/hr. session

 

            Vision Rehabilitation Therapy (Assistant)                          $40.00/hr. session

            Group Instruction                                                                               $22.00/hr. session

 

III.         Social Casework Services:

            Individual Services                                                                            $65.00/hr/ session

            Group Services                                                                                 $20.00/hr. session

 

IV.        Low Vision Services                                                             $125/initial visit

                                                                                                                        $40/follow-up                                                                                                                                     examination

                                                                                                                        (maximum of three)

 

V.        Interpreter Services:

                        Foreign Language Interpreter                                              $35.00/hr. session

                        Sign Language Interpreter                                                   $65.00/hr. session

 

 

 

 


 

 

NYS Commission for the Blind

Comprehensive Service Contract Guidelines

Appendix F: Contractor Service Delivery Regions

 

 

Contractor                                                                                                      Counties Served

 

Catholic Charities Community Services, Archdiocesan              Bronx

Of New York   (CCCS)                                                                                  Dutchess                                                                                                                                            Kings

                                                                                                                        Queens

                                                                                                                        Richmond

                                                                                                                        New York 

                                                                                                                        Sullivan

Ulster

 

Association for the Blind and Visually Impaired -                          Livingston

            GOODWILL                                                                                       Monroe

            (ABVI – GOODWILL)                                                                       Ontario

                                                                                                                        Wayne

                                                                                                                        Steuben

 

Association for the Visually Impaired         .                                               Orange

            (AVI)                                                                                                   Rockland

 

Association for Vision Rehabilitation and Employment                           Broome

            (AVRE)                                                                                               Chenango

                                                                                                                        Cortland

                                                                                                                        Delaware

                                                                                                                        Otsego

                                                                                                                        Tioga

                                                                                                                        Tompkins

                                                                                                                        Chemung

                                                                                                                        Schuyler

 

Aurora of Central New York                                                             Cayuga

            (Aurora)                                                                                              Cortland (Northern)

                                                                                                                        Onondaga

                                                                                                                        Oswego

 

 

 

 

Central Association for the Blind and Visually Impaired               Herkimer

            (CABVI)                                                                                              Lewis

                                                                                                                        Madison

                                                                                                                        Oneida

                                                                                                                        Fulton and                                                                                                                                          Montgomery

         (Area west of Route30A, including towns of Johnstown,

          Fultonville, Fonda, Gloversville and Charleston)

 

Chautauqua Blind Association                                                                    Cattaraugus

            (CBA)                                                                                                 Chautauqua

 

Elizabeth Pierce Olmsted, M.D.,                                                                 Allegany

            Center for the Visually Impaired                                                      Cattaraugus

            (EPOCVI)                                                                                           Chautauqua

                                                                                                                        Erie

                                                                                                                        Genesee

                                                                                                                        Niagara

                                                                                                                        Orleans

                                                                                                                        Wyoming

 

Glens Falls Association for the Blind                                                          Hamilton

            (GFAB)                                                                                               Saratoga (Northern)

                                                                                                                        Warren

                                                                                                                        Washington

                                                                                                                        Fulton and                                                                                                                                          Montgomery

                                                                    (Area east of Route 30A and north of Route 29,

                including towns of Broadalbin, Mayfield, Northville)

 

Helen Keller Services for the Blind                                                 Kings

            (HKSB)                                                                                               Queens

                                                                                                                        Nassau

                                                                                                                        Suffolk

 

Jewish Guild for the Blind                                                                             Bronx

            (JGB)                                                                                                  Kings

                                                                                                                        Queens

                                                                                                                        New York

                                                                                                                        Richmond

                                                                                                                        Nassau

                                                                                                                        Suffolk

                                                                                                                        Rockland

                                                                                                                        Westchester

                                                                                                           

Lighthouse International                                                                               Kings

            (Lighthouse)                                                                                       Queens

                                                                                                                        New York

                                                                                                                        Bronx

                                                                                                                        Richmond

                                                                                                                        Putnam

                                                                                                                        Nassau

                                                                                                                        Suffolk

                                                                                                                        Orange

 

Northeastern Association of the Blind                                                        Albany

            (NABA)                                                                                               Columbia

                                                                                                                        Greene

                                                                                                                        Rensselaer

                                                                                                                        Saratoga(Southern) 

                                                                                                                        Schenectady

                                                                                                                        Schoharie

                                                                                                                        Fulton and                                                                                                                                          Montgomery

                                                 (Area east of Route 30A and south of Route 29, including

                                 towns of Amsterdam, Fort Johnson, Perth, Hagaman and Minaville)

 

North Country Association for the Visually Impaired                                 Clinton

            (NCAVI)                                                                                              Essex

                                                                                                                        Franklin

                                                                                                                        St. Lawrence

 

VISIONS Services for the Blind and Visually Impaired                             Bronx

            (VISIONS)                                                                                          New York

                                                                                                                        Kings

                                                                                                                        Queens

 

Western New York Center for the Visually Impaired                                 Allegany

            (WNYCVI)                                                                                          Erie

                                                                                                                        Genesee

                                                                                                                        Niagara

                                                                                                                        Wyoming


 

 

 

NYS Commission for the Blind

Comprehensive Service Contract Guidelines

Appendix G: NYSCB Deaf Blind Services at Helen Keller National Center

 

Provisions of Outcome Focused Services

1.       Vocational Services (Outcome-Based) + Room, Board & Support Services (Fee-Based/ Ancillary Services)

2.       Home Community Services (Fee-Based Services/ Ancillary Services)

 

I.              Vocational Services (Outcome – Based Services)

1.   Initial Assessment Outcome

2.  Vocational Assessment Outcome

3.  Rehabilitation Services Outcome

4.  Work Readiness Training Outcome

5.  Work Experience Training Outcome

6.  Job Seeking Outcome

7.  Job Development Outcome

8.  Job Placement – 6-Day (Outcome)

9.  Job Placement/90 Days (Outcome)

10.  Apartment in the Mainstream (AIM) Services Outcome

11.  Assistive Technology Assessment Outcome

12.  Assistive Technology Training Outcome

 

II.            Room, Board, & Support Services (Fee-Based/ Ancillary Services)

1.    Case Management

2.    Independent Living Instruction

3.    Medical Services

 

III.           Home Community Services (Fee-Based Services/Ancillary Services)

1.    Job Development and Job Placement Services

2.    Job-Save Services

3.  Job-Coaching Services

4.  Orientation & Mobility Instruction

5.  Rehabilitation Teaching and Communication Skills Training

6.  Social Casework Services

7.  Assistive Technology: Community-Based Services

8.  Sign Language Interpreter Services

9.  Low Vision and Audiological Services and Equipment

10.  Consultation Services

11.  Transition Services

12.  Benefits Advisement

 

 

IV.          Room, Board, & Support Fee Schedule

 

V.           Home Community Services Fee Schedule

 

VI.          Personnel Standards

 

VII.         Reporting Requirements

 

VIII.       Records

 

 

I. PROVISIONS OF OUTCOME FOCUSED SERVICES

 

The State of New York has determined to participate in the provision of services pursuant to the Federal Vocational Rehabilitation Act of 1973, as amended, and has through its designated State agency, the Office of Children and Family Services,  New York State Commission for the Blind (NYSCB), received approval from the Federal Rehabilitation Services Administration for a comprehensive State Plan for Vocational Rehabilitation and Supported Employment Services as set forth in 34 CFR Part 361, Subpart B, Section 361.10, of the Act.

 

The Contractor agrees to make the following categories of service available to appropriate individuals with deaf-blindness referred from NYSCB:

 

1.    Vocational Services (Outcome-Based) + Room, Board & Support Services (Fee-Based/Ancillary Services)

2.    Home Community Services (Fee-Based)

 

1. Vocational Services (Outcome-Based) + Room, Board & Support Services (Fee-Based/Ancillary           Services)

 

Definition:  Vocational Services + Room & Board Services are outcome-focused, provided at the Contractor’s Sands Point campus, and consist of one or more of the services identified below.  Rooms, Board & Support Services are fee-based and are authorized only in support of On-Campus Vocational Services.

 

(1)  Initial Assessment  

(2)  Vocational Assessment

(3)  Rehabilitation Services

·         Orientation & Mobility Instruction

·         Rehabilitation Teaching & Communication Skills Training

·         Social Casework Services

(4)  Work Readiness Training

(5)  Work Experience Training

(6)  Job Seeking

(7)  Job Development

(8)  Job Placement – 6 Day

(9)  Job Placement/90 Day

(10)    Apartment In the Mainstream Services

(11)    Assistive Technology Assessment

(12)    Assistive Technology Training

 

Provision of Services:  On-Campus Vocational Services must be provided consistent with the NYSCB referral materials and according to the outcome definitions in section II.  The Contractor must meet the annual outcome target goals defined in Attachment B-2.  Room, Board & Board Services must be provided on a fee basis according to the service description in section III, and at the fees identified in section V.

  

2. Home Community Services (Fee-Based Services/ Ancillary Services)

 

Definition:  Home Community Services are fee-based services for deaf-blind individuals who reside inside or outside the Contractor’s catchment region and who (1) do not require the intensive services, nor the residential services, available at the Contractor’s facility, or (2) have successfully completed a service package at the Contractor’s facility and who require services in their home community to enable them to achieve home and community integration, and/or obtain or retain employment in their home community.  Home Community Services are intended to enhance the likelihood of success of the individual in attaining goals identified in his or her Individualized Plan for Employment (IPE) or Individualized Service Plan (ISP).  For individuals who reside inside the Contractor’s catchment region these services are provided primarily as follow-up services to augment services already provided under Section III, 1, above.

 

 

 

 

Home Community (Fee-based) Services consist of one or more of the following:

 

(1)  Job Placement Services ( Job Seeking, Job Development, Job Placement 6-day, Job Placement 90-day)

(2)   Job-Save Services

(3)   Job Coaching Services

(4)   Orientation & Mobility Instruction

(5)   Rehabilitation Teaching Services

(6)   Social Casework Services

(7)   Assistive Technology Services

(8)   Sign Language Interpreter Services

(9)   Low Vision and Audiological Services

(10)  Consultation Services

(11)  Transition Services

(12)  Benefits Advisement

 

Provision of Services:  Home Community Services must be provided consistent with the NYSCB

referral materials and according to the services descriptions in section IV and the fees defined in section

VI.

 

 

II. VOCATIONAL SERVICES OUTCOMES

 

  1. Initial Assessment 

 

For the number of individuals identified in Attachment B-2, referred annually by NYSCB for an Initial Assessment, the Contractor will complete an assessment of their Orientation and Mobility Skills, Rehabilitation Teaching and Communication Skills and/or their Social Casework needs as specified in the NYSCB referral material.  The assessment should be conducted by the appropriate personnel in each area and be comprehensive enough to determine what training, if any, is needed for the NYSCB consumer to reach their optimum level of functioning in those areas.  The assessment should address whether the NYSCB consumer has the potential to live independently.  If training is recommended, the assessment should estimate the length of time that training should last.  The assessment should be conducted after the NYSCB consumer has obtained Low Vision and Audiological services, unless the assessment is scheduled simultaneously with these services.

 

 

   2. Vocational Assessment

 

For the number of individuals identified in Attachment B-2, referred annually by NYSCB, the Contractor will complete a vocational assessment which provides the NYSCB counselor sufficient information to develop a vocational plan with the NYSCB consumer.  The vocational assessment will include, but not be limited to:  an interview with the NYSCB consumer to identify interest areas; assessment of learning ability and academic achievement;  assessment of sensory, physical, and motor skills; assessment of interpersonal, social, coping, and problem-solving skills;  and assessment of work history and work skills. 

  

   3. Rehabilitation Services Outcome

 

The number of individuals identified in Attachment B-2, referred annually by NYSCB, will demonstrate that they have acquired skills in each one of the adaptive skill areas listed below, as specified in the Initial Assessment, and/or as specified in the NYSCB referral materials.

 

Due to the unique population referred for this service, it is expected that each participant receive an individualized training program encompassing a wide and in-depth range of each of the three services categories below. Training programs should be developed from the findings in the Initial Assessment and incorporate a majority of the areas of training identified. Outcomes indicating a deficit in one or more of the three services areas may not receive a successful outcome and will be determined as successful or unsuccessful, on a case by case basis, by the referring NYSCB office.

 

1. Orientation & Mobility Instruction:  Adaptive skills which will assist individuals to travel safely and efficiently negotiate specified environments, and which will assist them achieve the goals identified in the Individualized Plan for Employment (IPE).

 

2. Rehabilitation Teaching and Communication Skills Training:  Adaptive skills which assist an individual to independently function in the following areas: personal care, home management, financial acumen, braille and/or large print use, telephone use and number retrieval, classroom note taking, tape recording, basic skills in typing/keyboard usage and the use of calculators and electronic note-taking devices or similar devices, which will assist them achieve the goals identified in the Individualized Plan for Employment (IPE). 

 

3. Social Casework Services:  Adaptive skills related to the individual’s vision and hearing loss which will result in successful resolution of personal issues (including adjustment to vision loss) specifically related to the move toward education and employment goals; including:  securing appropriate housing, medical care, child care services, accurate benefits information; developing the necessary personal skills and coping mechanisms to overcome the social, familial, and environmental barriers to achieving success in education and employment settings, all of which will assist them achieve the goals identified in an Individualized Plan for Employment (IPE). 

 

Please Note:  In no case, may psychotherapy be provided within the scope of this outcome.

 

 

4. Work Readiness Skills Training

 

Certain individuals, at the time they apply to NYSCB or are found eligible for NYSCB services, demonstrate a need to learn basic skills that will assist them in making a successful adjustment to the workplace.  For these individuals, simply getting a job is not enough if they do not have the skills that will allow them to keep the job.

 

The Work Readiness Skills Training outcomes have been developed to provide these individuals with assistance in developing the “soft” skills that will enable them to make a satisfactory adaptation to the needs and expectations of any workplace in which they find themselves.

 

Skills learned in Work Readiness Training can be reinforced through a Work Experience following completion of Work Readiness Training.

 

5. Work Experience Outcome

 

The number of NYSCB consumers identified in Attachment B-2, referred by a NYSCB Counselor, will participate in a time-limited experience which: (1) provides the consumer with an understanding of the work environment, work-related behaviors, work skills and work experience; and (2) provides NYSCB with information on how the consumer performed in the work setting. Duration should be sufficient for the consumer to acquire general work skills and experience, and for others to assess how the consumer

performs in a work setting. A work experience must not be less than one month, at 20 hours/week, and should not exceed six months at not less than 20 hours/week. Should a work experience last less than one month for reasons beyond the control of the Contractor, it cannot be considered a successful outcome without District Manager approval.

 

 

6. Job Seeking Outcome

 

The objective of services provided in this area is for the consumer to have an appropriate targeted resume(s) and cover letter, be able to successfully submit resumes through various media (print, electronic) and conduct appropriate follow-up activities, be prepared and able to submit job applications, and be prepared to participate in the job interview process. In addition, the objective of job seeking services is to enable the consumer to be actively involved in the job search process, and be able to understand and use various means of identifying potential jobs through review of job listings, social media, networking, cold calls and other means.

 

 

 

7. Job Development Outcome

 

The objective of services provided in this area is to identify and develop job opportunities with employers in the consumer’s chosen job sector, perform job/task analysis of potential positions, identify job accommodations which might be needed, and arrange job carving or restructuring, as needed. During job development the consumer will participate in a minimum of three employer interviews for real jobs consistent with the consumer’s IPE, with the objective of the consumer obtaining a job offer or learning from each interview how they can be more successful in the job interview process.

 

 

8. Job Placement 6-Day Outcome

 

The number of individuals identified in Attachment B-2, referred annually by a NYSCB Counselor, will obtain paid, community-based, non-subsidized employment in an integrated setting following participation in placement activities outlined in a mutually agreed upon job placement plan prepared in consultation with the consumer, the NYSCB counselor and the Contractor’s placement specialist.

 

Placement services must be customized to the needs of the NYSCB consumer.  Services must be:  (1) based on an individualized placement plan, (2) organized to teach the NYSCB consumer the skills necessary to find a job, and (3) actively support and assist the NYSCB consumer obtaining employment.  Individual and group approaches may be used to teach job-seeking skills and how to conduct an active job search.  These approaches may also be used to provide technical assistance in completing applications, developing resumes, and improving interview skills.  Employer contacts, job or task analysis, job restructuring, identifying needed reasonable accommodations, and other services that assist NYSCB consumers achieve successful employment outcomes are included as placement services, as are job development efforts focused on providing information, support, and assistance to employers to facilitate the hiring of individuals who are legally blind. 

 

The NYSCB consumer obtains non-subsidized employment at or above minimum wage, consistent with his/her IPE, in an integrated setting following participation in placement activities outlined in the mutually agreed upon job placement plan prepared in consultation with the NYSCB consumer, the NYSCB counselor and the contractor’s employment specialist; and is employed continuously for 6 work days; and receipt and approval by the NYSCB district office of the placement report.

 

The Contractor must coordinate job placement services with technology services, whether the technology services are provided by the Contractor or by another technology services provider, as defined in the NYSCB referral materials.

 

An integrated employment setting is one in which NYSCB consumers interact with non-disabled individuals (other than non-disabled individuals who are providing services to those NYSCB consumers) to the same extent that non-disabled individuals in comparable positions interact with other persons.

 

Please Note:  (1) Extended employment or supported employment under Title VI does not meet this outcome; and  (2) a qualifying job must pay at least minimum wage and be in a setting in which the individual interacts with non-disabled individuals, other than service providers, to the same extent that non-disabled individuals in comparable positions interact with other persons.

 

 

  9. Job Placement-90 Days Outcome

 

The number of individuals identified in Attachment B-2, referred by NYSCB, who obtained a job following participation in the Work Experience, or in the Job Placement Program, above, will maintain that employment continuously for at least 90 days.

 

The NYSCB consumer who achieved employment under 6 day Placement will have stabilized and maintained that employment continuously for a minimum of 90 days, the job is expected to remain permanent, and receipt and approval by the NYSCB district office of the placement report that documents:

 

a)    The job is satisfactory to the consumer;

b)    The provider maintained contact with the consumer and employer during the 90 day period;

c)    The employer is satisfied with the consumer’s performance in the job;

d)    Any needs for accommodations have been resolved; and,

e)    Any other issues impacting job stability have been resolved.

 

10. Apartment in the Mainstream (AIM) Services Outcome

 

The number of individuals identified in Attachment B-2, referred annually by NYSCB, will demonstrate the capacity to live independently in an apartment in the community for a period of up to six months as participants in the Contractor’s Apartment in the Mainstream (AIM) program. 

 

As specified in the NYSCB referral materials and as identified in the Initial Assessment, NYSCB consumers who demonstrate the potential to live independently will be provided an opportunity to learn and practice the skills needed to live independently in the community.   When necessary, training will first be provided in an on-campus apartment setting.  Under monitoring by the Contractor, the NYSCB consumer will take responsibility for the full physical upkeep of the apartment; all meal and menu planning; household shopping, including arranging for the shopping trips; food labeling and storage; and the safe preparation of all meals.  The Contractor will pay for the costs of all transportation related to these activities.  Upon successful completion of the on-campus phase of the program, NYSCB consumers will reside in one of three studio apartments located in the heart of the Port Washington residential community, approximately two miles from the Contractor’s training campus.

 

The AIM program, in addition to providing independent living instruction and support necessary for the NYSCB consumer to successfully live independently in the community, will provide the consumer with all necessary instruction to support this goal, including but not limited to: communication, orientation & mobility, skills of daily living/personal management, work experience, money management, banking and budgeting, and coordination with the on-going outcome based programming at the Contractor’s campus. 

 

11. Assistive Technology Assessment Outcome

 

For the number of individuals identified in Attachment B-2, referred annually by NYSCB, the Contractor will complete an assessment of the individual’s existing computer skills and knowledge, and of the individual’s capacity to learn to use assistive technological devices.  The assessment will also contain a recommendation of an assistive equipment and software configuration which will best meet the functional needs of the individual in his or her employment, educational, or home setting, and will contain a recommendation for a specific course of training which will assist the individual use the recommended assistive technology configuration in a way which will support the goals in his or her Individualized Plan for Employment (IPE), or Individualized Service Plan (ISP).

 

12. Assistive Technology Training Outcome

 

The number of individuals identified in Attachment B-2, referred annually by NYSCB, will successfully complete the course of training defined in the Assistive Technology Assessment.

 

 

III. ROOM, BOARD & SUPPORT SERVICES (Fee-based/ Ancillary Services)

 

Room, Board & Support Services are fee-based residential and support services for NYSCB consumers who are referred to the Contractor for outcome-based On-Campus Vocational Services.

 

In consultation with the NYSCB counselor, NYSCB consumers will share a room in the on-campus residence with a roommate, or live in individual on-campus apartments, depending upon the individual NYSCB consumer’s training plan.

 

Habilitation Specialists will be on staff 24 hours/day, 7 days/week in the residence to work with NYSCB consumers in creating an environment conducive to their learning and their practice of skills which will help them live as independently as possible.

 

A Recreation Specialist will work with NYSCB consumers to develop and implement leisure-time activities during evenings and weekends.  Emphasis is placed on developing leisure skills, interests, resources and abilities which can be used by a NYSCB consumer in his or her home community.  Additionally, residence staff works with the Coordinator of Volunteer Services to assist NYSCB consumers in locating volunteers who have common interests and can act as Support Service Providers (SSPs).

 

In addition to Room and Board, Support Services may include, but are not limited to:

 

1.    Case Management:  Each NYSCB consumer will be assigned a case manager whose role is:

 

·         Contact with NYSCB:  The case manager is the primary liaison between the Contractor and NYSCB.  The case manager is responsible for providing the NYSCB counselor with progress updates through comprehensive written reports and frequent telephone and e-mail communication.

 

·         Program Planning and Coordination: The case manager will assist the NYSCB consumer in understanding, and adjusting to, the On-Campus Vocational Services training program and, in consultation with the NYSCB counselor, will develop a set of rehabilitation goals in support of the NYSCB consumer’s overall vocational goal.  The case manager will synthesize information from the various departments and will serves as team leader to facilitate coordination of the NYSCB consumer’s program, and consistent communication with the NYSCB counselor.

 

·         Contact with Family/ Coordination of Benefits:  In consultation with the NYSCB counselor, the case manager will facilitate communication between the NYSCB consumer and his/her family.  Also, in consultation with NYSCB, the case manager will assist with obtaining financial and medical benefits for the NYSCB consumer, overseeing the use of personal funds, and arranging for vacations and transportation.

 

 

2.    Independent Living Instruction:  NYSCB consumers referred for On-Campus Vocational

Services will receive instruction in independent living skills in the residential setting which supports the training received through their outcome-based services.  Instructional components include, but are not limited to:

 

·         Organization, orientation and basic safety and self-protective procedures within the kitchen and the home environment.

·         Preparation of simple uncooked foods; basic cooking, advanced cooking and baking skills which incorporate safe, tactual and adaptive rehabilitation work methods.

·         Use of appropriate small and major appliances, including the standard electric and/or gas range, microwave oven, toaster-oven/broiler, electric skillet, hot beverage maker, coffee pot, slow cooker/crock pot, electric mixer, food processor, etc.

 

·         Use of cookbooks, recipes and resource materials in the format of one’s choice.

·         Meal and menu planning, shopping and shopping strategies.

 

·         Organization, labeling and storage of food, supplies, clothing, and personal items.

 

·         Cleaning and housekeeping skills.

 

·         Personal grooming.

 

·         Laundry, wardrobe management, clothing identification and color coordination.

 

·         Dining skills.

 

·         Money management, banking and budgeting.

 

·         Aids and devices to include low vision clocks, tactual wake-up devices and signal alerting systems.

 

·         Community activities.

 

3.    Medical Services:  In consultation with the NYSCB counselor, medical services will be available on as as-needed basis to NYSCB consumers receiving On-Campus Vocational Services, as follows:

 

·         Medical and Nursing Services:  Routine services of a nurse practitioner, ophthalmologist, otolaryngologist, and consulting psychiatrist are available on the premises at regularly scheduled intervals.  Staff nurses are available during the day and in the evening to administer medications and treatments, provide symptomatic nursing care and first aid, assist with medical appointments and provide instruction in health education.

 

·         Health Education Evaluation and Instruction:  Upon authorization of the NYSCB counselor, the Contractor will develop a consumer-specific health education program to provide the NYSCB consumer with a factual frame of reference about the consumer’s health issues.  Areas of instruction include medication administration, basic first aid, nutrition, disease process, diabetic management and sex education.

 

·         Emergency Medical Service:  The Contractor will assume responsibility so that any NYSCB consumer receives emergency medical care as necessary through the use of emergency rooms, local hospital clinics, and private physicians’ offices.  The NYSCB counselor will be notified immediately by telephone, with written notice following, when emergency medical service is required for any NYSCB consumer.

 

·         Physical Therapy/Gym Program:  In consultation with the NYSCB counselor, the gym is available to all NYSCB consumers who have been medically cleared.  Exercise programs are developed for each NYSCB consumer by the recreation therapist, and a physical therapist is available for consultation.  Upon authorization of the NYSCB counselor, individual programs will be developed by the physical therapist for those NYSCB consumers with neurological or orthopedic problems.

 

 

 

 

 

 

IV. HOME COMMUNITY SERVICES (Fee-Based Services/Ancillary Services)

 

1.    Job Development and Job Placement Services

 

Job Development and Job Placement Services are services leading to paid employment in the NYSCB consumer’s home community. The consumer and his/her support team research the consumer’s home community, identify prospective employers, and coordinate community resources in order to obtain paid employment and needed supports. This may include utilizing the Internet, coordinating support from placement agency affiliates, and supported employment programs. Home area canvassing may be conducted as well as job interviews leading to permanent employment.

 

Job Development and Job Placement Services are customized to the needs of the NYSCB consumer.  Services must be:  (1) based on an individualized Job Placement Plan agreed upon by the NYSCB consumer, NYSCB counselor, and the Contractor, (2) organized to teach the NYSCB consumer the skills necessary to find a job, and (3) actively support and assist the NYSCB consumer obtaining employment.  The service is intended to teach job-seeking skills, to conduct an active job search and to provide technical assistance in completing applications, developing resumes, and improving interview skills.  Employer contacts, job or task analysis, job restructuring, identifying needed reasonable accommodations, and other services that assist NYSCB consumers achieve successful employment outcomes are included as placement services, as are job development efforts focused on providing information, support, and assistance to employers to facilitate the hiring of individuals who are legally blind.  The Contractor is expected to provide linkages to technology services but will not be expected to provide technology services themselves

 

2.      Job-Save Services

 

Job Save Services are intervention services, occasionally on an emergency basis, in the NYSCB consumer’s home community which are intended to address the consumer’s potential loss of employment as a result of problems relating to his or her deaf-blindness, and to provide intervention with the employer, consumer training, technology supports, and social supports which result in the retention of the consumer’s job.

 

This service must be based upon a Job-Save Plan agreed upon by the NYSCB consumer, NYSCB counselor, and the Contractor.  The Plan must specify the individuals responsible for identified tasks, describe communication and collaboration strategies with the employer, assess whether assistive technology will ameliorate the situation triggering the potential job loss, and assess whether job coaching services are necessary to assist the NYSCB consumer retain the job. 

 

3.      Job-Coaching Services

 

 Job-Coaching Services are time-limited services intended to enhance the ability of the NYSCB consumer to learn work-related behaviors and specific job skills in new or existing paid employment settings by providing an on-site job coach to assist the NYSCB consumer in work-related tasks.

 

This service must be based upon the NYSCB referral materials and a Job-Coaching Plan agreed upon by the NYSCB consumer, NYSCB counselor, and the Contractor.

 

The Contractor will provide a Job-Coach a work location specified by NYSCB.  The Job-Coach will perform activities which may include, but are not limited to:

 

·         advocacy with the employer;

·         intervention with co-workers and supervisors to address work-site accommodation issues;

·         development of co-worker supports;

·         counseling regarding good work habits;

·         thorough task analysis;

·         intensive on-site skills instruction, including:

·         job performance skills, such as sequencing, quality assessment, speed and endurance, etc;

·         job related skills, such as working with supervision, socializing with co-workers, personal grooming, etc;

·         transition/fading of instructional intervention to increase the independence of the NYSCB consumer in the employment setting;

·         extended services which include monthly contacts with the NYSCB consumer and with the employer to assess job performance and address problems.

 

4.      Orientation & Mobility Instruction

 

As specified in the NYSCB referral materials, this service provides instruction in adaptive skills which will assist the NYSCB consumer travel safely and efficiently negotiate specified environments, and which will assist them achieve the goals identified in their Individualized Plan for Employment (IPE).

 

5.      Rehabilitation Teaching and Communication Skills Training

 

As specified in the NYSCB referral materials, this service provides instruction in adaptive skills which enable an individual to independently function in the following areas: personal care, home management, financial acumen, braille and/or large print use( or another preferred format), telephone use and number retrieval, classroom note taking, tape recording, basic skills in typing/keyboard usage and the use of calculators and electronic note-taking devices or similar devices, which will assist them achieve the goals identified in their Individualized Plan for Employment (IPE).

 

6.      Social Casework Services

 

As specified in the NYSCB referral materials, this service addresses issues related to the NYSCB consumer’s vision and hearing loss in order to achieve a successful resolution of impediments to the consumer’s achievement of education and employment goals, including, but not limited to:  securing appropriate housing, medical care, child care services, accurate benefits information; developing the necessary personal skills and coping mechanisms to overcome the social, familial, and environmental barriers to achieving success in education and employment settings, all of which will assist them achieve the goals identified in their Individualized Plan for Employment (IPE). 

 

Please Note:  In no case may psychotherapy be provided within the scope of this outcome.

 

7.      Assistive Technology: Community-Based Services 

 

Community-Based Assistive Technology Services are intended provide technical support to the NYSCB consumer in the consumer’s home or education site, or work site.  As specified in the NYSCB referral materials, this service includes but is not limited to: software installation, instruction in the use of software, hardware/assistive equipment installation, instruction in the use of hardware/assistive equipment, configuration of the NYSCB consumer’s equipment to be compatible with the system at the education or work site, and technical trouble shooting.

 

8.      Sign Language Interpreter Services

 

Upon authorization from NYSCB, the Contractor will provide sign language interpreter services to assist NYSCB consumers access information needed to ensure the successful attainment of their vocational and rehabilitation goals.  Sign language interpreters must be capable of providing one or more of the following communication methods, depending upon the communication abilities of the NYSCB consumer:

¨        American Sign Language

¨        Sign Language Presented in English Word Order

¨        Manual Alphabet (Fingerspelling)

¨        Tactual Sign

¨        Print-On-Palm

 

Interpreters must be certified by the Registry of Interpreters for the Deaf, or eligible for such certification.

 

9.      Low Vision and Audiological Services and Equipment

 

Low Vision and Audiological Services are services intended to maximize a NYSCB consumer’s residual or subnormal vision and/or hearing.  As specified in the NYSCB referral materials, this service includes an evaluation of the consumer’s vision and/or hearing and the prescription of necessary aids or assistive devices.

 

After prescription of assistive aids or devices for the NYSCB consumer the Contractor must provide instruction in the use of the devices and must coordinate with mobility and/or rehabilitation teaching specialists to provide follow-up services on the consumer’s use of aids or devices.

 

10.    Consultation Services

 

Under this service the Contractor’s staff member, concurrently with the provision of one or more of the above services to a NYSCB consumer in his or her home community, will, according to the referral materials from NYSCB, identify and train a local service provider to continue provision of the service(s), after departure of the Contractor’s staff member. Provision of services to the NYSCB consumer by the local service provider upon conclusion of the training period will be at the discretion of NYSCB, and will require a referral from NYSCB if the provider requires recompense for the services.

 

11.  Transition Services

 

Transition Services are services intended to enhance the NYSCB consumer’s success when returning to the home community.  This Contractor’s case manager for the specific NYSCB consumer, in consultation with the referring NYSCB counselor, will provide one or more of the following services:

 

·         Work with the Contractor’s transdisciplinary team in locating and contacting potential residences and work sites through networking with HKNC regional representatives and affiliates, and other supportive parties

·         Assist the NYSCB consumer with referral and application for pertinent educational and residential opportunities

·         Visit the NYSCB consumer’s home community for the purpose of consumer advocacy, job development, residential placement and in-service orientation for on-site personnel

·         Assist in coordination of a variety of support services to assist the NYSCB consumer live and work successfully in his or her home community

·         Coordinate follow-up services to enhance community transition

·         Provide consultation services to individuals, families and service providers.

 

12. Benefits Advisement

 

Benefits Advisement includes any combination of the following services needed by the consumer:

 

·                  Counseling and Education regarding benefits available and eligibility requirements

·                  Applying for Social Security Benefits, Medicaid, Medicaid Buy-in for Working Adults

      with Disabilities, Medicare, Food Stamps (SNAP), Temporary Assistance

·                  Adjusting Social Security information to include statutory blindness designation

·                  Education and assistance regarding reporting wages to the Social Security

      Administration

·                  Education and assistance with utilizing benefits appropriately

 

 

 

 

 

 

V. ROOM, BOARD & SUPPORT SERVICES:  FEE SCHEDULE

 

 

Service                                                                                                         Fee

 

Room, Board & Support Services (Traditional)……………………………………$400/week

             (Includes incidentals)

 

Room, Board & Support Services (AIM)…………..………………………….……$550/week

                                                                                                            (Includes incidentals)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VI. HOME COMMUNITY SERVICES:  FEE SCHEDULE

 

 

Services                                                                    Fee: Inside Contractor         Fee: Outside Contractor

Catchment Region *             Catchment Region* 

 

1.    Job Development/Job Placement Services…….…..…$ 80/hr.  ………..……..….…$350/day**

 

2.    Job-Save Services...…………………………..………$180/hr.  …………….….…..$350/day**

 

3.    Job-Coaching Services…………………………….….$ 45/hr.  …………………….$350/day**

 

4.    Orientation & Mobility Instruction...…………………...$ 80/hr.  ………………..…....$350/day**

 

5.    Rehabilitation Teaching/Communication Skills….…..$ 80/hr.  …………..…….…..$350/day**

 

6.    Casework Services……………………………………....$ 80/hr.  ……………..….…..$350/day**

 

7.    Assistive Technology Services……………………….…$ 80/hr.  ………………….…$350/day**

 

8.    Sign Language Interpreter Services………………….….$ 80/hr. 

 

9.    Low Vision and Audiological Services

 

            Medical Low Vision Evaluation……………………$250……………………..…….N/A

              Medical Low Vision Services…………………….…$ 75/ visit…………………..….N/A

Low Vision Aids:    Rates are posted at the Low Vision Fee Schedule On-Line by going                                         to: Visionloss.ny.gov, choosing the tab on the left titled “Low                                                Vision,” and then choosing, “Click Here for Low Vision Fee                                                          Schedule.”

                                   

            Audiometric exam (V5000)………………….…….. $100/visit………………………N/A

            Hearing aid evaluation test (V5010)..……….…..... $100/visit………………………N/A

            Impedance testing (Z9509)……………….….……. $ 25/visit………………..….…..N/A

            Tympanometry (Z9510)…………………………… $ 25/visit…..……………….…..N/A

            Acoustic reflex testing (Z9511)……………….….... $ 25/visit………..…………..….N/A

            Dispensing fee, monaural (V5090…………….…..  $150/visit……………..…….….N/A

            Dispensing fee, binaural         (V5160) ………….. $300/visit………..………….…..N/A

 

10.  Consultation Services……………………………………………….………………..….$350/day**

 

11.  Transition Services………………............................. $ 65/hr. ………………………$350/day**

 

12.  Benefits Advisement…………………………………… $ 80/hr.

 

 

*    Contractor’s catchment region includes Long Island, New York City, and Southern Westchester County.

 

** Plus travel, meal, and lodging costs.

 

Note:  All reimbursement for travel, meals and lodging will be at rates approved by the NYS Office of State Comptroller.

 

 

VII. PERSONNEL STANDARDS

 

 

1.    Initial Assessments:

 

Initial Assessments must be conducted jointly by staff members who meet the qualifications for Rehabilitation Teaching & Communications Skills Training, Orientation & Mobility Instruction, and Casework Services, as described below.

 

2.    Rehabilitation Services

 

Rehabilitation Teaching & Communication Skills Training:

 

Professional Rehabilitation Teacher:  A Master's or Bachelor's degree with a specialization in rehabilitation teaching of the blind, knowledge of Grade II Braille, intermediate American Sign Language (ASL) skills, and familiarity with resources available to people with deaf-blindness;  OR, a Bachelor's Degree and successful completion of a NYSCB-approved training program for professionals which meets nationally accepted standards, knowledge of Grade II Braille, intermediate American Sign Language (ASL) skills, and familiarity with resources available to people with deaf-blindness.

 

Rehabilitation Teacher Assistant:  A minimum of a high school diploma, or equivalent, and satisfactory completion of a NYSCB approved program for rehabilitation teacher assistants, as well as knowledge of Grade I Braille, intermediate American Sign Language (ASL) skills, and familiarity with resources available to people with deaf-blindness.  Provisions of services are subject to the supervision of a professional rehabilitation teacher, as defined above, who has two years of experience in rehabilitation teaching.

 

Orientation & Mobility Instruction:

 

Professional Orientation & Mobility Instruction: A Master's or Bachelor's degree with specialization in Orientation and Mobility instruction, intermediate American Sign Language (ASL) skills, and familiarity with resources available to people with deaf-blindness;  OR, a Bachelor's Degree, successful completion of instruction of a NYSCB approved program for professionals which meets nationally accepted standards, intermediate American Sign Language (ASL) skills, and familiarity with resources available to people with deaf-blindness.

 

Orientation & Mobility Assistant:  A minimum of a high school diploma, or equivalent, and satisfactory completion of a NYSCB approved program for orientation and mobility instructor assistants, intermediate American Sign Language (ASL) skills, and familiarity with resources available to people with deaf-blindness.  Provision of services are subject to the supervision of a professional orientation and mobility instructor, as defined above, who has two years of experience in orientation and mobility instruction.

 

Social Casework Services:

 

A Master's Degree or a Bachelor's Degree in Social Work, or a Master's Degree or a Bachelor's Degree in a related social/human services field, intermediate American Sign Language (ASL) skills, and familiarity with resources available to people with deaf-blindness, plus a minimum of one year of social work experience with individuals with deaf-blindness.

 

3.    Vocational Assessments:

 

      Vocational Assessments must be conducted by individuals who possess EITHER

 

-- a Master’s Degree in Vocational Evaluation, or Vocational Rehabilitation, and who have a minimum of one year of experience working with individuals with deaf-blindness, OR

 

-- a Bachelor’s Degree in a human services field, one year of experience providing vocational services to persons with deaf-blindness, and satisfactory completion of course work and training related to assessments of individuals with disabilities.

 

4.    Work Experience & Job Development Services,  Job Placement/90 Days Services, Job-Save Services:

 

A Master's Degree in Vocational Rehabilitation;  OR, a Bachelor's Degree or an equivalent combination of experience and post-secondary study in business, human resources/personnel development, marketing, counseling, education or a related field from an accredited college or university; intermediate American Sign Language (ASL) skills, AND familiarity with resources available to people with deaf-blindness, plus one year of experience providing employment/ job placement services to individuals seeking employment and working directly with employers.

 

 

5.    Sign Language Interpreter:

 

Must be certified by the Registry of Interpreters for the Deaf (RID), or eligible for certification.

 

 

 

6.    Assistive Technology Services:

 

All Contractor staff who provides assessment or training services under the terms of this Agreement must submit their credentials to NYSCB for approval prior to providing services under the terms of this Agreement.  An interview may be required after credentials have been submitted and reviewed by NYSCB.

 

7.    Consultation Services:

 

Dependent upon the nature of the Consultation Service requested by NYSCB, Contractor staff who provides this service must meet the personnel qualifications listed above for the appropriate job title.

 

8.    Transition Services:

 

A Master's Degree or a Bachelor's Degree in Social Work, or a Master's Degree or a Bachelor's Degree in a related social/human services field, intermediate American Sign Language (ASL) skills, and familiarity with resources available to people with deaf-blindness, plus a minimum of one year of social work experience with individuals with deaf-blindness.

 

VIII. REPORTING REQUIREMENTS

 

The Contractor must submit progress reports on each NYSCB consumer referred for service to the referring NYSCB District Office in the format required by NYSCB.  A final report on outcome-based services must also be submitted upon completion of the service describing outcome attainment, or explaining the failure to attain the outcome.  A final report must similarly be submitted upon conclusion of fee-based services.

 

No outcomes will be considered to have been attained by the Contractor unless the final report for the specific consumer’s outcome has been submitted in the proper format and has been received and approved by the NYSCB district office.  Failure to submit a final report on specific outcome-based services will result in a reduction of the number of outcomes attributed to the outcome target for the particular service category.

 

A quarterly roster listing all successful recipients of all outcome-based services must be submitted to the NYSCB Central Office, in a format acceptable to NYSCB, along with the quarterly voucher for outcome services.

 

No fee-based services will be paid without a final report in a format acceptable to NYSCB attached to the payment request voucher.  Reports and vouchers for fee-based services must be submitted to the referring NYSCB District Office.

 


 

 

 

IX. RECORDS

 

The Contractor agrees to maintain accurate, complete and separate accounting and fiscal records identifiable as NYSCB Services to Individuals with Deaf-Blindness, so as to be able to account for all reimbursement received and all activities conducted under this Agreement.  The Contractor agrees to retain such records for a period of six years from the termination date of this Agreement, or until the conclusion of any litigation arising out of this Agreement, whichever is later.  Such records shall be subject to audit by NYSCB, the Office of Children and Family Services, the Office of State Comptroller, or any other party authorized by federal or State law or regulation.