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The fundamental vehicle of service delivery to blinded veterans
in the VA system is the Visual Impairment Services Team (VIST)
program. VIST is an interdisciplinary team approach to the delivery
of comprehensive services developed by VA more than 30 years ago.
The program was the result of a pilot project sponsored by BVA,
the American Foundation for the Blind (AFB), and VA. The failure
of blinded veterans to utilize the benefits and services to which
they were entitled precipitated this aggressive outreach effort.
The isolating effects of blindness accompanied by the depression
and feelings of being overwhelmed induced these veterans to remain
in their homes. It is important to note the establishment of a
VIST did not require new resources but only the organization of
existing professional disciplines (already present at the medical
centers) that could deliver essential services to blinded veterans.
As a direct result of this outreach effort,
newly blinded veterans learn that programs and services are available
to assist them in working through the trauma of vision loss. Exposure
to a full range of benefits and services, including rehabilitation,
instills hope for resuming a meaningful and productive life.
The primary reason for the success of this vital
program is the VIST Coordinator. The Coordinator is the key member
of the interdisciplinary team responsible for coordinating the
delivery of comprehensive services. When the program was first
established, the position of Coordinator was part-time and usually
filled by the social worker assigned to the team. Shortly after
its inception, it became evident the Coordinator position would
need to be expanded to full-time in order to manage the increased
workload. It took nearly ten years before VA recognized this need
and provided six full-time centralized VIST Coordinator positions.
Through subsequent years, that number has increased to 93. This
would not have been possible without the intervention of these
Committees to encourage VA to provide more full-time positions.
We have always maintained that any station that had at least 100
eligible blinded veterans on their rolls could support a full-time
VIST Coordinator. Mr. Chairman, this program has been extremely
successful in identifying blinded veterans not previously known
to VA and coordinating the delivery of comprehensive services
to these needy and deserving veterans.
As the program has evolved, a significant body
of knowledge about blindness has been developed and shared among
these professional providers. They have become the subject matter
experts at VA facilities regarding blindness and appropriate services
to assist in coping with the problems associated with vision loss.
Through the years, VIST Coordinators organizationally
have been very vulnerable because they are essentially one-person
services. In the new organizational structure, that vulnerability
has become even more pronounced. There is no consistency throughout
the system with respect to their organizational alignment. Consequently,
they have become targets for cost savings reductions. As I reported
last year, several stations had arbitrarily decided that these
positions were not full-time and VIST responsibilities have been
assigned as collateral duties to existing social work staff. As
VIST Coordinator vacancies developed at these stations, management
could not resist the opportunity to eliminate one full-time FTEE
and withdraw support from this vital program. Only one station
attempted to submit statistical documentation to support the decision,
though the numbers sighted were irrelevant and unrelated to the
purpose of the basic program. The other stations made no effort
and in fact had no data, such as outcome measures or patient satisfaction
surveys, to justify the elimination of the full-time position.
All stations insisted that they would provide the necessary services
and therefore blinded veterans would not experience any reduction
in the level or quality of service. This has not proven to be
the case. Fortunately, as I indicated above, these situations
were reversed on paper. If these reversals are cosmetic, as we
suspect, the appropriate level of quality service will not be
restored.
These examples, unfortunately, are becoming the
rule rather than the exception. In nearly every instance where
a full-time Coordinator position becomes vacant, local management
attempts to either eliminate the position altogether or assign
the duties to other medical personnel as collateral duties. This
behavior only reinforces our contention that centralized management
is required if the integrity of this vital program is to be preserved.
In summary, Mr. Chairman, the VIST Coordinators are the case managers
through which the blinded veteran gains access to the full continuum
of VA health and rehabilitative care. They are involved in the
day-to-day lives of blinded veterans, serving as the catalysts
for delivering the right service in the right place at the right
time.
In the past, the BRC has been the focal point
for the delivery of services to blinded veterans although this
is no longer the case. VIST should be the focal point for lifetime
service delivery. Therefore, VIST should be protected, strengthened,
and expanded rather than diluted.
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