CNIB Programs & Services Committee (PSC) teleconference meeting held on Monday, February 11, 2013.
Present: Cheryl Crocker - Chair, Sharlyn Ayotte, Donna Cookson-Martin, Lezlee Cribb,Andrew Daley, Penny Leclair, James Officer, Ann MacCuspie, Patricia Pardo,Luke Small, Donald Walls, Jane Beaumont – Board Chair (ex-officio)Regrets: Zahra Sheraly
Staff:Len Baker, John Rafferty – President & CEO (ex-officio), Shampa Bose, Deborah Gold, Biljana Zuvela
1. Welcome and Introductions
Dr. Crocker welcomed everyone to the meeting.
2. Minutes of March 5, 2012 - for approval
It was moved by Mr. Daley and seconded by Ms. Cookson-Martin, that the minutes of the meeting held on October 27, 2012 be accepted as presented.
3.Staffing Realignment: Rationale and Update
Mr. Rafferty informed the committee that in response to significant financial challenges in the current fiscal year, management took some important steps to place CNIB on a more sustainablefinancial footing going forward.
Bequest income, traditionally one of CNIB’s largest and most stable sources of funding, has fallen more than $3 million behind expectations so far this year. There has also been a $4 million year-over-year decrease in funding from Canada’s federal and provincial governments. As a result CNIB has fallen well off-pace from its original budgetary projections for the current fiscal year.
Immediate action was taken when CNIB began to see the warning signs including pulling back on filling vacant staff roles, and containing operational costs to the greatest possible extent through the forecasting and budgeting process. With that in mind, the restructuring that took place on January 16, 2013 was essential in assisting our efforts to balancing the budget in the coming fiscal year, and helping ensure the future sustainability of the organization.
There was a staff reduction of seven per cent nationwide, across a range of disciplines and geographic areas. In making decisions about each individual role, it was required to balance the need to contain costs with the priority of preserving appropriate service levels for the clients. Service managers were actively involved in the decision-making process.The new structure will allow CNIB to continue to deliver the best possible services to the clients and while minimizingthe impact on them directly.
4.Pathways to Service
Mr. Baker informed the committee that in follow up to discussions at the previous Committee meeting and subsequent Board Meeting, his team has been working on a service delivery framework that will effectively and efficiently serve clients based on the severity of vision loss. The current “open-door” approach to rehabilitation is neither sustainable nor optimal in meeting client needs. 32% of new clients have an acuity of better than 20/70 which is widely used as the acuity level in the definition of low vision. These clients receive exactly the same scope and breadth of services as those with more significant vision loss. His team has been working on a Service Pathways plan that will differentiate between those that require professional vision rehabilitation services and those that can be served effectively through a non-rehabilitation approach. In this new model, no person living with vision loss will be turned away, but how we assist them will change based upon acuity, field loss, cause of vision loss and the need for service identified by the referring physician.
Rehabilitation service will be provided to those who qualify for it. An eye examination by an eye doctor and a refraction must have been conducted (and eye report completed) within the last 12 months. Exceptions to the visual acuity and peripheral vision loss rule will occur.
Those with functional vision worse than 20/70 or with compromised visual fields or a progressive form of vision loss such as RP will have a short twenty minute assessment and then be referred directly to low vision services if appropriate to meet their goals.The Low Vision Specialist (LVS) role will shift slightly to include determining if other services are required and then referring those clients to a care coordinator who will complete a more thorough assessment and coordinate the delivery of other rehab services. There will be acceptable wait times for service. “Borderline” clients, if unsure whether rehabilitation will be a benefit, will be referred to their regional office for a Low Vision Assessment.
Clients with no functional vision will not be referred for a low vision assessment. They will be referred directly to the care-coordinator and connected with the required services in an organized manner based upon their most pressing needs.
Those who come to CNIB without an eye report will be directed to the non-rehabilitation path to service until an eye report is received. The non-rehab path will include access to peer support and education sessions, Shop-CNIB, CNIB’s e-learning programs and other community supports.
For current clients, if no service has been received in the past 12 months, a new intake (no new I.D. number) and a new eye report will be required. A new “episode” will be opened in EVRR. This procedure will remain in effect in the new system.
For those who have severe vision loss and need to re-engage with CNIB will not come in through the low vision model. Instead they will go directly through case coordinator’s approach whereby services will be identified to meet their new goals.
Dr. Small suggested that the Low Vision Specialists be involved in the process. He suggested CNIB providing the expertise to clients who needs technical help. Mr. Baker informed that CNIB has started a conversation with the University of Waterloo and School of Optometry and the University of Montreal School of Optometry as to how optometry can be better integrated with low vision and to identify best practices low vision.
Dr. MacCuspie suggested having the information on the website under ‘vision loss and aging’ which would give people list of tips about how to improve the quality of life by doing things. Ms. Pardo suggested having ‘did you know’ phone number where client can call and request for information in their format of choice such as Braille or large print.
Dr. Gold will be working alongside Mr. Baker on Service Pathways; Ms. Zuvela will work on the outcome models and Ms. St. Jean on the children’s model. This will be implemented over the next twelve months of which certain aspects will be piloted first to avoid any negative outcome.The initial assessment with the clients will be much shorter. The target is to implement the model fully by April 2014.
Ms. Hartin questioned if deafblind people will go to the case manager’s directly. Mr. Baker clarified that deafblind clients are included in the pathway model as well. During the comprehensive assessment it will be determined if deafblind intervention is required. Dr. Gold informed that CNIB is devising a common intake tool which will be put together with the eye report in order to determine the pathway. This will capture the additional disability around blindness which will influence the client’s needs from CNIB.
Ms. Pardo wanted to know how the service pathways will be applied to the clients who are already registered. Mr. Baker said that nothing will change for them but where appropriate, they may be asked to provide with an updated eye report if they have not received CNIB services within the last year. Dr. Gold added that clients should be encouraged to see their optometrist regularly so that their refraction is up-to-date.
5.New Service Models
All the teams are working in developing the pillars and best practices to meet the needs of the clients in each age group. Due to financial constraints we will not be hiring a lead for the service model for older adults but will instead be incorporated within the scope of work currently underway in building the working-age service model. Dr. Fok will be the lead person on both the age groups. Appropriate expertise will be brought onto the working group to inform decisions pertaining to service delivery for older persons.
With regards to progress in each age group - the professional development conference is taking place next week which will focus on two of the main pillars of the Child, Youth and Family Services age group vis-à-vis family support and skill acquisition. Ms. St. Jean has worked with the advisory team to develop internal documents and templates for early intervention services which will include components and questions to measure program impact on the families. April 1 is the launch date.
As for Working Age and Employment Services - the January timeline for the logic model for the three life circumstances has been completed which are school to work transition, looking for work and late onset. The expertise of the employment steering committee needs to be broadened to include older adults. The model will be ready by June.
6.Service Measures and Quality
Mr. Baker discussed in detail the report that was posted on the portal prior to the meeting. The formatting was in-line with the President’s report. There are some numbers that are comparatively lower than last year under Group Programs. The reports have been sent to the divisions for clarification. The reason for the drop in the numbers could be due to the fact that some programs that took place last year did not happen this year during the same quarter.
Wait times were then discussed.In the past the wait time would end if the client was contacted to arrange an appointment. That approach wasn’t accurately capturing the time it took for clients to actually receive service. A new approach based on when the client was visited has been implemented. Ms. Ayotte wanted to know if the wait times varied due to the level of functional vision and Mr. Baker said a report can be produced based on functional vision but that shouldn’t be the reason for longer wait times as in most cases, people go straight into the queue. There is no systematic screening in place, but there will be in the new Pathways model. Ms. Cribb asked if there was a way to track the wait time from the time when the client asks for service to the time he/she meets a service person of CNIB. Mr. Baker indicated that could be interpreted as the measure time between assessment to the provision of service(which is currently how wait time is calculated). However, if in order to measure wait time from the moment CNIB is informed by the client that a service is required (eg, through a phone call) then we currently do not have a systematic way of tracking that. Len will discuss with the service quality team.
7.Braille Promotion
CNIB has a new National Coordinator for Braille Promotion, Ms. Debbie Gillespie. Ms. Gillespie is a fierce advocate for braille and in her role she will make certain that CNIB remains current in all matters pertaining to braille access, braille technology and braille instruction and will serve as CNIB’s day to day liaison with the Canadian Braille Authority (CBA) and other organizations that seek to support and promote the use of braille and tactile media. She will keep CNIB abreast with technology and help guide the implementation of the Unified English Braille (UEB) Code in Canada. She will also help with CNIB’s Braille Conference which will take place in September 2013. Members felt that this was an excellent move towards braille promotion. There will be a site dedicated to Braille on CNIB’s website. Ms. Ayotte mentioned that there are other organizations involved in promoting Braille, so there is opportunity for collaboration with those outside the Not for Profit sector.
8.e-Learning
Ms. Vicki Mains is the new Director, e-Learning Project. In her new role Ms. Mains will be providing leadership in the development, implementation and evaluation of CNIB’s e-learning programs. Efforts will be made to ensure that the e-learning program is relevant and beneficial to staff, volunteers, consumers and the general public.
The e-learning initiatives were supported by the National Board in using the funds of Robertson Estate. CNIB has also applied for additional funding from two foundations and federal government.
9.Mohawk Program
In November 2012, the Mohawk’s Board approved the cancellation ILS and O&M training programs. The current class of students will be the last to graduate from the Mohawk Program in June 2013. Student internships will continue as planned for the current year. Students who are enrolled part-time and who did not plan to graduate in June will be accommodated in order to achieve their diploma.
In the meantime, Mr. Baker and Dr. Gold met with Dr. Olga Overbury of the School of Optometry at the University of Montreal who has confirmed that there are definite plans for the University to expand its current vision rehabilitation program into English (as well as the French program) both of which will be offered at the Master’s level. Students will have an opportunity to do two field placements with CNIB or other agencies. The program is expected to commence in September 2014. CNIB will help promote this program and will distribute information to staff and clients who may be interested in pursuing a career in that field.
10.IDs
CNIB generates approximately 5700 cards (new and renewal.) The card provides a means of identification to identify themselves as being eligible for certain concessions (eg. a TTC pass). There is a cost associated with producing these cards and there is no funding for it. CNIB is considering the idea to implement a fee for the ID card. For example by paying $25 a client can get an ID card valid for 5 years without any charge for a replacement card if stolen or damaged. The committee members had a mixed reaction towards the cost. Some members thought that the cost could have a negative impact on the clients and others thought that since there are more advantages than disadvantages; clients will not hesitate to pay. Mr. Baker will develop a draft plan for implementing a cost recovery program and solicit feedback prior to implementing. The program is voluntary, so a client is not required to have a card. As well, any program would ensure that a client was not denied a card based on the inability to pay.
11.Adjournment
The meeting was adjourned at 2.00pm.