An Overview of Services
A tremendous variety of services exists that can meet the needs of people living in the United
States or Canada who are blind or have some degree of visual impairment. Largely as a result of
the way in which they have developed and are funded, however, these varied programs are not
organized into unified national systems. Services are for the most part driven by federal
legislation (in the United States) or provincial legislation (in Canada) and overseen by different
government agencies, and a large portion of services themselves are actually provided by private
agencies. In addition, different systems provide services to children, adults, and older persons,
and coordination of services is frequently lacking. In general, the population of people with
visual impairments is so diverse and their needs so varied that there is no one type of
organization that meets all their needs. Thus, there are numerous national, state or provincial, and
local organizations that offer assistance to people who are blind or visually impaired, but there is
no one simple pathway to find all the services an individual might require. The AFB Directory of
Services for Blind and Visually Impaired Persons in the United States and Canada, therefore,
attempts to capture the breadth of existing services and organize them in a way that allows
people to identify and locate what they need.
This discussion gives a brief overview of how services for persons with visual
impairments are structured in the United States and Canada. For a detailed description of the
types of organizations and services covered in this Directory, as well as an explanation of how to
find particular organizations or services, see "How to Use This Directory." For more
information about the legislation that governs services for people who are blind or visually
impaired, see "A Summary of Major Federal Disability Programs."
What Are Blindness and Visual Impairment?
There are many different definitions of the terms blind and visually impaired that are used for
different purposes. Essentially, the word blind refers to the absence of vision or to the ability to
determine only the existence (not the source) of light (known as light perception.) A visual
impairment is any vision problem that is severe enough to affect an individual's ability to carry
out the tasks of everyday living. In a broad sense, the term visual impairment usually includes
blindness.
People are said to have low vision if they have a severe visual impairment even after the
best possible correction (with eyeglasses, contact lenses, or surgery) but still have some usable
vision. People with low vision are often able to learn to use their vision effectively—that is,
increase their visual functioning—through instruction from professionals from the field of blindness and visual impairment, practice in
visual techniques, and the use of optical devices such as magnifiers or telescopes. They can
benefit from special low vision services that evaluate their vision, prescribe low vision devices,
and train them in the use of devices and techniques to improve visual functioning.
To establish blindness for legal purposes, such as qualifying for government-funded
disability or adult rehabilitation services, the term legal blindness is sometimes used. Legal
blindness is not the same as total blindness. It refers to a visual acuity (the clarity of vision) that
has been measured to be 20/200 or less in the better eye with corrective lenses (eyeglasses or
contact lenses), or a visual field of less than 20 degrees. (A fully sighted person has a visual acuity
of 20/20 with or without corrective lenses and a visual field of 120 to 180 degrees. An acuity of
20/200 means that the individual sees at a distance of 20 feet what the fully sighted person sees at 200
feet.) Definitions of legal blindness are based on clinical and not functional measurements;
that is, they do not consider individuals' ability to use their vision.
Organizations that serve visually impaired people may use these or other terms—such as
visually handicapped or partially sighted—in their name. Regardless of the terms they use, most
organizations serve people with the full range of visual impairment unless particular eligibility
requirements are specified.
People Who Are Blind or Visually Impaired
The population of individuals who have a visual impairment or are blind is as diverse as the
population of the United States and Canada. Visually impaired infants, children, youths, and
working age and older adults live in remote rural areas, towns, suburbs, and cities and represent
all nationalities, ethnicities, cultures, and religious beliefs. In addition, each person's response to
blindness or a severe visual impairment is unique, and therefore individual needs for services are
extremely varied as well.
People who are blind or visually impaired can live productive and independent lives.
With the opportunity to learn techniques to adapt to visual impairment and the assistance of
adaptive equipment and products, they go to school, attend college, participate in all types of
activities, hold all types of jobs, raise families, and enjoy sports and other recreational activities.
In addition to information about organizations that provide various services and instruction in
adaptive techniques, this Directory also provides listings of manufacturers and
publishers that produce adapted materials and products that visually impaired people can use.
Estimates vary, but approximately 10 million people who are blind or visually impaired
live in the United States, and over half of them are elderly. (The population of visually impaired
individuals in Canada is estimated to be smaller.) Indeed, elderly people are the fastest growing
population of individuals with severe visual impairments. Many individuals who are blind or
have low vision also have additional disabilities and will therefore require services from
specialists, agencies, and organizations other than those addressing visual needs.
Where to Begin
Given the diversity of agencies and organizations that exist, it is useful to begin looking for
information about blindness and visual impairment by consulting national organizations in the
field of blindness—regardless of whether one is looking for services for an individual who is
experiencing vision-related difficulties, professional resources, or general facts about visual
impairment. These organizations are knowledgeable about the different types of services that
exist and how to find them. They also can provide important information about the services that
people are entitled to by law, as well as the requirements for those services. For more
information about these organizations, see "National Organizations" for both the United States
and Canada (see "How to Use This Directory"). The web sites
for national organizations are also listed in "A Quick Index to Internet Assistance."
When looking for services and assistance, it is helpful to have an understanding of the different types of services that are
generally offered to people with visual impairments, the government agencies that oversee them,
and the kinds of organizations that offer them. Services are organized differently in the United
States and Canada, so they will be discussed separately.
Services in the United States
Government Policy
The United States government made a clear national commitment to the elimination of
discrimination against people with disabilities in 1990 with the passage of the landmark
Americans with Disabilities Act (ADA) (P.L. 101-336). The ADA prohibits discrimination
against people with disabilities in virtually every segment of society, including employment,
state and local government services, transportation, and public accommodations.
The existence of the ADA influences many aspects of daily life for people with disabilities.
and services and information related to government policy can be obtained from federal agencies.
For more information about this and other federal legislation, see "A Summary of Major Federal Disability Programs."
In the United States, each state or territory has several "lead agencies," government
agencies that oversee certain services related to aging, early intervention, education, instructional
materials, and rehabilitation. "Key State Agencies and Resources" for each state identifies these
agencies. It may be helpful to discuss services by breaking them down into two major categories,
those for children (which includes infants, from birth to age 3; toddlers or preschoolers, ages 3 to
5; and school-age children and adolescents, ages 5 to 21), and those for adults. In addition,
however, some services, such as low vision services, are required by both groups and may be
offered in a variety of systems.
Services for Children
A variety of educational services for children and infants who are blind or visually impaired are
guaranteed as a right by federal legislation in the United States, in particular the Individuals with
Disabilities Education Act (IDEA), P.L. 108-442, formerly P.L. 105-17 as amended (see "A Summary of
Major Federal Disability Programs"). This act establishes the right to a "free, appropriate, public education" that is, an
education appropriate to the needs of the individual child for all children from birth to 21,
regardless of disability. In addition, this education must be provided in the "least-restrictive
environment" appropriate for the child—that is, to the extent possible in the same settings as
children who do not have disabilities—and families must be involved in the planning and
implementation of services for their children. An Individualized Education Program (IEP) is required for
each child eligible for services, as is family participation as part of the child's educational team.
Educational services are also provided under Section 504 of the Rehabilitation Act of 1973; these include
classroom accommodations or adaptations such as the provision of materials in large print or other
accessible formats.
Educational services are overseen by the U.S. Department of Education: Office of the Secretary,
but they are administered at the state level and vary considerably from state to state. To learn about the services that are available and where
they are, start with the State Department of Education, Division for Special Education (listed
under "Key State Agencies and Resources" for each state) and ask for the state vision
consultant or the person in charge of services for children who are blind or visually impaired.
Information is also available from local public school districts, multischool districts or county
special education consortia (such as intermediate units or boards of cooperative education
services), and state or private schools for children who are blind or visually impaired.
Early Intervention Services
Children who are born blind or develop severe visual impairments before the age of 3 need
special attention to their early development. They need to learn about the world just as other
children do, but often through channels other than or in addition to vision. Each state is required
by IDEA legislation to provide early intervention services for infants from birth to age 3 with
disabilities or who are at risk of developmental delays. The services provided typically include
assessment of the child's condition and needs, developmental enrichment, coordination of health
and social services, and an individualized family service plan (IFSP) for both the child and the
family outlining the services to be provided. Services to infants and toddlers are provided mainly
in the home by itinerant (traveling) professionals, although some are offered in organizations or
centers, where a variety of special education and related services are available in the same place.
The supervising agency for early intervention services is listed under "Key State
Agencies and Resources" for each state. These lead agencies may be housed in state
departments of education, health, human services, or rehabilitation, although some are in
agencies outside the state system. These agencies usually provide referrals to local programs. The
local school district may be an additional direct source of information. It is also important to
contact agencies and organizations for people who are blind or visually impaired (either national
or local) and special schools for blind students, which may have more information about early
intervention, nursery, and preschool programs that have specific experience with children who
are blind or visually impaired.
Many blind and visually impaired toddlers and children ages 3 to 5 attend regular day
care, nursery, and preschool programs and receive specialized services from visiting, or itinerant,
professionals such as an early childhood specialist and a certified teacher of children who are
visually impaired. There are also preschool and early childhood programs that specialize in
blindness and visual impairment.
Agencies that provide services for young children who are blind or visually impaired also
provide assistance to the families. For example, they may have counseling or support groups and
social work services in addition to providing information about adapted communication
techniques and developmental stimulation.
Educational Services
As noted earlier, to obtain information about educational services for children of preschool and
school age, families can begin by contacting the office of the state's Department of Education
that oversees education for children with disabilities. The state rehabilitation agency for
blind persons can be contacted; both of these agencies are listed under "Key State Agencies and Resources" for each
state. In addition, the agencies providing the services at the local level, including public school
districts, multischool districts, and state or private schools for children who are blind, are
important sources of information.
The vast majority of students who are blind or visually impaired in the United States and
Canada attend their local community public schools. Most attend regular classes and receive
separate instruction from a teacher certified in the education of children who are blind or visually
impaired and the additional skills unique to blindness or visual impairment that they need to learn.
These skills may include reading and writing in braille, travel skills (known as orientation and
mobility techniques, or O&M), and optimal use of low vision. Children may be taught by an
itinerant teacher who travels to different students at different schools within the school district or
neighboring districts, or a teacher of visually impaired children may be assigned to a resource
room at a given school where he or she meets with several students who are visually impaired
during different periods of the day.
Some children may attend a special school for children who are blind or visually
impaired, either as day students or residential students. Some programs are geared toward
students with single or mild multiple disabilities and emphasize academic programs and an
expanded curriculum. Others may focus on functional lifelong learning programs for children
with severe multiple disabilities, while still others provide a full spectrum of educational
opportunities. It is important for a family to make inquiries about the full continuum of
educational services as well as all the possible educational settings and to find out what types of
services are offered and which children are served at each site before deciding on what is best for
their child.
In addition to the legal requirements of IDEA already noted, this legislation requires that
an IEP be written for all students with disabilities in the
educational system. This plan is developed by an educational team, including teachers, special
educators, a teacher of students who are visually impaired, an O&M specialist and other
professionals as appropriate, family members, and the student him- or herself, if appropriate.
This team assesses the student's abilities, strengths, and needs; determines the most appropriate
educational placement; sets educational goals and objectives for the student; and specifies the
special educational and related services that he or she will receive.
Among the services to be included in the IEP are supplementary aids and services that
enable the student to make the best use of his or her education. For example, a student may need
to have books transcribed into braille, or a student with low vision may need a low vision device
such as a magnifier or a closed-circuit television (CCTV) to complete his or her schoolwork.
Generally speaking, the teacher of visually impaired students will make arrangements for these
services and alert the family to what is needed. However, the Directory also includes resources
for obtaining materials or services that the family might need such as books in formats other
than print (in braille or large-print or on audiotape), low vision services and devices, special
library services, and so forth.
Transition Services
IDEA requires that, beginning at age 14, students receive so-called transition services to prepare
them for life after high school. The student's IEP will incorporate goals and activities to begin
preparing the student for this transition and the services that will be needed, including
preparation for independent living, enrollment in a vocational program or college, career and
vocational planning, and the like. Connections also need to be made to services that students may be
eligible for after school and as adults. For example, rehabilitation services, such as vocational
rehabilitation (described in the next section), may provide financial and other assistance while a
young person attends college or trade school, looks for work, and gets established in a new job.
Services for Adults
Rehabilitation Services
Vision rehabilitation services are generally provided to adults who have recently lost
vision and are adjusting to blindness or visual impairment or are congenitally blind and
may be experiencing difficulty finding work. Rehabilitation also serves young adults who are
making the transition from school to adulthood and older people who are losing vision
and need independent living services. For the most part, rehabilitation services are
ultimately directed toward improving an individual's opportunities for employment
(vocational rehabilitation), with the exception of independent living programs, which
provide training in daily living skills for people, such as older or medically fragile
individuals, who do not have employment as a goal.
In the United States, the authority for training and finding employment for people with
mental, physical, and sensory disabilities is provided by the Rehabilitation Act of 1973
(see "A Summary of Major Federal Disability Programs"), which must be
reauthorized by Congress every five years. Rehabilitation services for people with
disabilities are provided jointly by the federal and state governments, and the way in which
they are delivered varies from state to state. In approximately half the states, services for individuals who
are blind or visually impaired are offered through a separate state vocational rehabilitation
agency for blind persons—such as a division of vocational services or a state
commission for the blind and visually impaired. Individuals have to meet eligibility
requirements to qualify for state rehabilitation services—for example, they may need
to be legally blind and demonstrate that their disability is an impediment to finding
employment to receive vision rehabilitation.
Rehabilitation services may include vocational evaluation, vocational skills or
postsecondary academic skills training, and work site evaluation and modifications;
medical, psychiatric, psychological, and social services; comprehensive assessment;
provision of assistive aids and devices; physical and occupational therapy; O&M services
(training in how to move and travel safely and independently); rehabilitation teaching in
daily living skills such as personal and household management and communication methods;
computer training and the provision of assistive technology (methods of accessing the
environment and printed information using computers); health and low vision services;
supported employment services; and vocational training and placement.
Rehabilitation agencies may provide services in clients' homes, at a facility in the
community, or at a residential rehabilitation center. In some states, assisted living
facilities provide semi-independent living arrangements for blind or visually impaired
individuals. In some places, facility-based employment is available for individuals who
choose to work outside a competitive environment or as a transitional placement to prepare
for community-based jobs.
A good place to start looking for rehabilitation services is the state's general
rehabilitation agency or its special rehabilitation agency for people who are blind or
visually impaired. These are listed under "Key State Agencies and Resources" for each
state. The state rehabilitation agency provides the services it identifies as necessary
for an individual, either directly or by contract with other agencies and service providers.
There is generally a network of local offices to contact for assistance.
In addition to state-sponsored services, there are hundreds of private, nonprofit agencies
for blind people in the United States. Services specifically directed to the needs of
individuals with visual impairments may vary significantly among agencies.
The U.S. Department of Veterans Affairs:
Blind Rehabilitation Service (BRS) also provides eye health care services and rehabilitation training
services to qualified veterans. Each state has at least one Visual Impairment Service Team
(VIST), and there are rehabilitation centers specifically for veterans who are blind or visually
impaired in Alabama,
Arizona,
California,
Connecticut,
Florida,
Georgia,
Illinois,
Puerto Rico,
Texas,
and Washington.
Aging Services
As mentioned earlier, over half of the population of people who are blind or visually impaired
are elderly, and their numbers increase every year. For several reasons, the services needed by
adults in this age group tend to differ from those provided to other individuals who are blind or
visually impaired. Many elderly people begin to lose vision for the first time as they age as a
result of eye conditions that are most common in older persons, such as glaucoma, macular
degeneration, diabetic retinopathy, and cataracts (see "A Glossary of Common Terms"). At the
same time that they need to adjust to vision loss, elderly people are often coping with other
physical and psychological changes that occur during the later years of life. However, vision
rehabilitation services are not generally well integrated with other services provided for older
people, so the Directory provides contact information for general aging services as well. Each
state's lead agency for aging services is listed under "Key State Agencies and Resources" for
each state. These State Units on Aging were created by the 1965 Older Americans Act to
coordinate services for older people in each state, although they go by a variety of designations,
including Department, Division, or Commission on Aging. The State Unit can refer callers to the
nearest Area Agency on Aging, regional agencies that can connect them with specific services in
their local area.
Vision rehabilitation services for older people are also provided by the state rehabilitation
agency in most cases, typically under a separate program, known as Independent Living Services for Older Individuals Who Are Blind. Directed
specifically at people who are over age 55, the Independent Living Program is mandated by Title
VII, Chapter 2, of the Rehabilitation Act. This program provides services similar to those in
more traditional rehabilitation programs, but focuses on training for living independently, not on
job skills. Services include training in daily living skills, O&M, low vision services, provision of
adaptive devices, counseling, and efforts to keep the individual integrated in the community. The
lead agency for the Independent Living Program is also listed under "Key State Agencies and
Resources" for each state. In addition to the state vocational rehabilitation system, however, it is
important to contact national vision organizations and other local rehabilitation agencies for
information about the full range of services for older people who are experiencing vision loss.
Other Services
Low Vision Services
As noted earlier, individuals are said to have low vision when they are severely visually
impaired, even with conventional eyeglasses or contact lenses, but are able to use vision at least
some of the time for some everyday activities. Low vision services assist these individuals,
regardless of age, to make the best use of their vision, with or without the assistance of special
optical devices. These services include a low vision evaluation a specialized examination to
assess the abilities and needs of an individual with low vision; prescription of low vision devices,
such as magnifiers or telescopes, and training in their use; and training in adaptive techniques to
make optimal use of vision.
Ophthalmologists and optometrists typically do not provide low vision services unless
they are specially trained in that area and may not always refer patients with low vision for low
vision services. It is crucial, therefore, that individuals who may have low vision, their families,
and their service providers be aware of such services and be assertive in finding out where to
obtain them.
Low vision services may be located in agencies of and for blind or visually impaired
people, hospitals, VA facilities, private rehabilitation agencies, university settings, and private
ophthalmological and optometric clinics or practices. In addition to the listings of low vision
services in this Directory, referrals may be obtained from national blindness organizations, state
rehabilitation services, agencies or professionals that provide other visual impairment services,
state or national ophthalmological and optometric associations, and nearby universities that train
professionals in the field of blindness and visual impairment.
Additional Services and Products
There are many other forms of assistance, as well as products and services, that people who are
blind or visually impaired may wish to make use of on their own. Although they are likely to
receive information about these services through the educational or rehabilitative systems, the
following list summarizes the range of services available. This includes:
- dog guide schools that train people who are blind or visually impaired to use a dog guide
for independent travel
- libraries that provide special services for disabled readers, including the
National Library Service for the Blind and Physically Handicapped
libraries (local libraries may also provide books in large-print and audio formats)
- radio reading services that provide special broadcasts of news and information
- alternate media providers that make books and other printed matter available in forms
that are accessible to visually impaired people, such as braille, large print, and audiotape,
as well as audio- or videodescribed versions of television shows, films, and other
performances
- computer training in assistive technology that allows people who cannot read print to
access information electronically.
- recreational opportunities
- products that are specially adapted for use by people who are blind or visually impaired
These products and services are further described in "How to Use This Directory,"
and sources of these products and services are listed in this Directory.
Services in Canada
As in the United States, the Canadian government has expressed a strong commitment to the
rights of its citizens who have disabilities. The Charter of Rights and Freedoms contained within
the Canadian constitution guarantees people with disabilities equality and equal protection under
law, and the Canadian Human Rights Act prohibits discrimination based on disability. The
Employment Equity Act was passed in 1986, and the Omnibus Bill of 1992 guarantees a large
number of specific rights (see "A Summary of Major Federal Disability Programs").
As in the United States, government directives are, administered by different departments, such
as Transport Canada, the Library and Archives Canada,
Public Works and Government Services Canada,
Veterans Affairs Canada, and so forth. (See the listings of federal agencies in Canada.)
Although there is a range of disability programs at the federal level, services to people
who are blind or visually impaired in Canada are usually provided either by provincial
governments or private agencies. By and large, the categories of services offered are similar to
those described for the United States (e.g., education or rehabilitation) although the structure is
different.
Education for children with disabilities is under the direction of the provincial department
or ministry of education (see listings in the Directory for each province or territory. Educational
services are usually provided by the local school board. For rehabilitation and other non-
educational services, the provincial department that is responsible for services to people with
disabilities is identified in the Directory. This agency may be a department of social, community,
or family services or a health department
The Canadian National Institute for the Blind (CNIB) is the country's largest private
national organization and has a network of Divisions and District Offices throughout Canada. It
serves as an information resource as well as a direct service provider, and thus is a good place to
begin gathering information on any type of service. CNIB focuses on seven core services:
- counseling and referral,
- rehabilitation teaching,
- library,
- O&M training,
- sight enhancement (vision rehabilitation),
- technical aids,
- and career development and employment.
This summary can provide only a brief overview of the complex array of services,
information, products, and assistance available to people who are blind or visually impaired.
Moreover, legislation and interpretations of laws and regulations are always subject to change.
For this reason, readers are urged to contact the American Foundation for the Blind and other
national blindness organizations for the most up-to-date information about the field of blindness
and services for people who are visually impaired.
AFB Directory of Services, Copyright © 2005 American Foundation for the Blind. All rights reserved.
If you would like to give us feedback on the data in the Directory of Services, or if you know about new organizations, please contact us at afbdirectory@afb.net.
