Presupuestos de las medidas cautelares
A) Exigencia de prestar caución y sus excepciones
Availability of/access to services
A survey carried out in 2002 discussed the type and location of low vision services within the UK, including community-based services (Culham, 2002). Services covered in the study included optical and non-optical aids and appliances and modifications to the visual environment, including the use of new lighting and contrast
enhancement techniques. The provider groups included hospitals with eye departments, social services, opticians/optometry
practices, local societies/voluntary organisations for people with visual impairment, specialist teachers and colleges/universities with optometry/optical dispensing courses.
The study found that only a third of potential providers made an active contribution to low vision services (including the prescribing of low vision aids and/or support, such as counselling or training). The majority either did not offer this service (41 per cent), or simply sold magnifying devices without professional support (33 per cent). The authors note that this is a massive underutilisation of potential resources and suggest that recruitment of professionals with
appropriate expertise, either into the hospital or in close contact with medical ophthalmic care, would contribute to the service.
In terms of the geographical location of service providers, the study showed that services are unevenly distributed across the country with service providers being concentrated in urban areas where population densities are highest, while rural areas are less well served. The authors noted that lack of services in some areas meant that some people had to travel long distances to access services. Travelling could be difficult where mobility is restricted by medical problems. Difficulty in accessing services due to problems
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with transport is also highlighted by other studies. For example, a US study focusing on a community based intervention to older adults in public housing facilities (Chu 2009), reported that only 44 per cent of older adult residents had the opportunity to participate in the community vision seminar. Others had been unable to
participate because of transportation issues. Unclear and
pessimistic expectations of what an intervention can achieve for people with low vision were also identified in Rees 2007 as barriers to participation in low vision self-management programmes.
A report by RNIB, Facing Blindness Alone (Kaye and Connolly, 2013), revealed that between 2005 and 2013, there had been a 43 per cent decline in the number of blind and partially sighted people in England getting council care and support. The report showed that of 128 authorities that responded to the RNIB’s freedom of
information (FOI) exercise across local authorities, ten local authorities said that they did not offer a structured programme of rehabilitation to people who were registered blind or partially sighted or had lost their sight. Of those local authorities who had put in
place a structured programme of rehabilitation, 33 councils did not offer it before community care assessments had been carried out, and 23 councils had restricted rehabilitation support to adults with sight loss who were registered as partially sighted or blind (p.30).
Limited attention to diverse life goals
Despite great importance attached by people with vision impairment to a range of life goals, evidence suggests that vision rehabilitation programmes place more emphasis on basic activities and daily functioning than any other domain. Reporting evidence from a small US based study, Boerner (2005) examined the importance of life goals among working-age adults with vision impairment and the way in which rehabilitation addressed personal life goals. They noted that vision rehabilitation programmes more commonly target functional life domains (such as finances, personal care and work) than relationship related goals (including the partner and family domains). Accomplishing daily tasks, and increasing motivation and emotional adjustment to vision loss are reported as the life goals most effectively addressed by rehabilitation services, whereas life
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goals relating to the work domain are reported as being addressed ineffectively. Reporting findings from the same study, Cimarolli (2006) noted that the poor quality of services and a mismatch between the client’s needs and the goal of the service are the key reasons why rehabilitation services are considered to address life goals ineffectively. Further, the authors suggest that although vision rehabilitation may focus on teaching functional skills, teaching
clients how to apply these skills when pursuing goals may not be adequate.
Based on evidence from another US study mentioned above,
Walter (2007) suggests that vision rehabilitation programmes might target social functions (such as adjustment to loss of independence, control, burdened and stressed social relations, and low self-
esteem) more explicitly.
Staff training, awareness and confidence
A report by the Guide Dogs for the Blind Association estimated that there were just 550 specialised rehabilitation officers operating within adult services across the UK (Guide Dogs for the Blind
Association, 2007). The report also stated that the number of vision rehabilitation officers was declining. To generate a diverse
rehabilitation workforce, the report suggests that OTs could
undertake some tasks currently undertaken by vision rehabilitation officers. However, as mentioned above, evidence suggests that most OTs in the UK would need further education and training to be confident and competent to take on this role.
Findings taken from a single study, reported in two papers (Ward, 2009; Campion, 2010) indicate that a significant proportion of OTs perceive their training as regards sight loss to be insufficient. Ward (2009) report that only two per cent of OTs felt confident to assess and give advice to people with sight loss when they first qualified, despite the fact that most had reported that their undergraduate programme had included sight loss training. Among participants who had undertaken additional training, 88 per cent said that generally they would refer on to a sight-loss specialist team for further assessment or intervention. The authors suggest that the
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OTs’ lack of confidence in working with people with sight loss may have been due to the type of education they had received at
undergraduate level being mainly ‘condition-based’, with low priority given to the types of interventions that they might use with older people who had sight loss to improve their independence.
Furthermore, a small UK based study by Percival (2012) evaluating a programme of assistive technology demonstration projects,
involving interviews with people with VI using sight loss services and focus groups with staff in four centres providing support to people with sight loss, found that the people with sight loss and the support staff had limited knowledge of assistive technology devices. Evaluation indicated that support staff would benefit from increased levels of confidence and training to maximise people’s access to, and appropriate use of, assistive technology.