Email Survey for VR Agencies

EMAIL SURVEY FOR VR AGENCIES

VR Agency:

Name:

Title:

Number of Years at Agency:

Phone:

Email:

Date Completed:

1. Are you the staff person at your VR agency who is most familiar with the needs of consumers who are deaf-blind, and with services at the Helen Keller National Center (HKNC)?

 Yes (Answer A)

 No (Answer B)

A. How long (in years) have you been familiar with the needs of consumers who are deaf-blind?

________

Years

B. What is the name and email address of the person at your VR agency who is most familiar with deaf-blind consumers and with HKNC?

Name:

Email:

2. Are you familiar with . . .

YES NO

HKNC services in New York?  

At least one HKNC regional office/regional representative?  

3. Of the consumers who are deaf‑blind and seeking VR services and/or independent living services in your state, does your VR agency serve . . . All, Most, Some, Few, or None of them?

 All

 Most

 Some

 Few

 None

4. In the last 8 years (2000-2008), how many consumers did your agency refer to the HKNC regional office/regional representative for. . .

Number

a. Information and referral ______

b. Assessment and evaluation ______

c. Mobility training ______

d. Training for employment ______

e. Training for independent living ______

f. Use of adaptive technology ______

g. Transition services ______

5. In the past 8 years (2000-2008), has your agency recommended consumers through the HKNC regional representative/regional office for training or services at HKNC in New York?

 Yes

 No (Go to Q7)

A. How many were recommended?

___________

B. How many actually attended?

___________

6. Of those referred by your agency and who attended HKNC in New York in the last 8 years (FYs ), how many:

Don’t
Number know

a. Were able to live more independently after attending HKNC? ______ 

b. Were able to obtain first-time jobs, or better jobs? ______ 

c. Noticeably improved their social skills? ______ 

7. Does your agency receive referrals from HKNC Headquarters in New York? [NOTE: QUESTION 8 ADDRESSES REFERRALS FROM THE HKNC REGIONAL OFFICES].

 Yes (Answer A)

 No

A. How many consumers in the last 8 years (2000-2008) were referred to your agency from HKNC in New York?

___________

8. Does your agency receive referrals from an HKNC regional office?

 Yes (Answer A)

 No

A. How many consumers in the past 8 years (2000-2008) were referred to your agency from an HKNC regional office?

___________

9. In your state, do consumers have access to formal or informal training or services similar to those offered either by HKNC in New York or by the HKNC regional office?

 YES

 NO

A. Is each service listed below available in your state – statewide, only in some areas, or not at all available?

Only in

State- some Not at all Don’t
wide areas available know

Assessment and evaluation    

Training for family members    

Training for professionals    

Information about issues related to deaf-blindness    

Mobility training    

Training for independent living    

Training for employment    

Use of adaptive technology    

Developing social skills    

B. In your opinion, in general, are the training or services available in your state more effective, just as effective, or not as effective as the services provided by HKNC?

State State State
services services services
Not more as not as Don’t
applicable effective effective effective know

Assessment and evaluation     

Training for family members     

Training for professionals     

Information about issues related to
deaf-blindness     

Mobility training     

Training for independent living     

Training for employment     

Use of adaptive technology     

Developing social skills     

10. In the last 8 years (FYs …), has HKNC in New York or a regional office provided formal or informal training to any staff of your VR agency?

 YES (Answer A-C)

 NO

A. If Yes, how many staff have received formal or informal training?

___________

B. Were any staff trained in . . .

YES NO

Communication techniques?  

Orientation and mobility topics?  

Awareness of the deaf-blind community?  

Services for seniors (Confident Living Program) ¨ ¨

Other (Specify)  

C. Was this training very useful, somewhat useful, or not useful?

Not Very Somewhat Not Don’t
applicable useful useful useful know

Communication techniques?     

Orientation and mobility topics?     

Awareness of the deaf-blind community?     

Services for seniors (Confident Living)     

Other (Specify)     

11. How helpful is the HKNC regional representative to the staff in your VR agency in . . .

Very Somewhat Not
helpful helpful helpful

Coordinating services for deaf-blind consumers?   

Assessing the needs of individual deaf-blind consumers?   

12. In your opinion, how can existing HKNC programs or services be improved? If yes, please explain. If no, with which HKNC services is your agency especially satisfied, and why?

13. Are there additional programs or services HKNC should offer to meet the needs of deaf-blind consumers or your VR agency? Please explain.

14. How could the programs or services your VR agency now provides to deaf-blind clients be improved?

15. Is there a program or combination of programs in your state that can substitute fully or partially for the programs at HKNC in New York?

 Yes (Answer A)

 No

A. Name of the program(s) or services offered, and the sponsoring organization. If possible, please compare the program and services to HKNC New York.

16. Please describe the process and criteria by which an individual’s sensory or communicative impairment is recorded in your record keeping systems, focusing specifically on deaf-blindness. Are there state or local policies or regulations that can provide guidance to VR agency counselors in classifying the sensory or communicative impairment of deaf-blind individuals? Are there circumstances where an individual who might be classified as deaf-blind might be alternatively classified as deaf, blind, or using another sensory or communicative impairment for a primary or secondary disability? Do you believe that this classification differs from counselor to counselor in your agency, or is the classification fairly consistent? Please explain.

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