5.11.3 Service Delivery

Scope of Services

Orientation and Mobility (O&M) services include:

  • an initial assessment of the consumer's O&M skills (if any) including strengths, challenges, and existing competency levels;
  • a review of the assessment results and training recommendations with the consumer; and
  • O&M skills training as agreed upon by the consumer, the counselor or case manager, and the O&M provider.


Provider Objectivity

The O&M provider must remain impartial and objective.


Referral Information

Before contacting the consumer, the O&M provider receives referral information from the consumer's DBS counselor or case manager. The DBS counselor or case manager fills out known information on 2897, O&M Referral. The O&M referral form helps the O&M provider prepare and plan before contacting the consumer.


Initial Assessment

Assessments may be conducted using the consumer's functional vision, which is an opportunity for consumers to recognize that their vision may not meet all their travel needs.

The initial assessment includes an evaluation of the consumer's orientation and mobility skills in multiple situations, which may include:

  • the consumer's home and immediate surrounding area;
  • public areas, such as a church, park, or college campus;
  • commercial areas, such as a bank, store, or mall;
  • transit systems, such as paratransit or taxis (if available);
  • local buses and similar public transportation (if available);
  • rural areas (if applicable);
  • residential areas (those with light vehicle and foot traffic and some stop signs);
  • small business areas (those with heavier traffic and simple traffic lights);
  • downtown areas (those with heavy vehicle and foot traffic and complex traffic lights);
  • commercial transportation systems, such as buses, trains, and airplanes (if applicable); and
  • travel using low-vision devices (if applicable).


Post-Assessment Discussion

Following the initial assessment, the O&M provider reviews the results with the consumer and answers any questions that he or she may have about the recommended training. A meeting with the consumer, counselor or case manager, and O&M provider is strongly recommended, so that all parties can agree on the overall O&M training plan.


Documenting the Initial Assessment

Initial assessment reports must be submitted using 2894, Consumer Services Report: O&M Assessment.

The assessment report includes:

  • the O&M provider's observations and comments;
  • recommendations for O&M skills training in each of the areas included in the initial assessment;
  • the number of recommended training hours for each area;
  • the total number of training hours being recommended;
  • the anticipated period (beginning and ending dates) for recommended training;
  • the consumer's acceptance or rejection of the training recommendations;
  • the height of the rigid cane that is most appropriate for the consumer (using the measurement between the consumer's chin and nose when standing up); and
  • a description of all travel aids the consumer uses or would benefit from using.


Training Authorization

After submitting the 2894, Consumer Services Report: O&M Assessment, the O&M provider must contact the consumer's counselor or case manager to discuss the initial assessment and get authorization to provide training services.

The discussion includes:

  • the provider's recommendations for training (if any), including the:
    • orientation and mobility skills needed;
    • proposed completion date; and
    • number of training hours authorized by the consumer's counselor or case manager;
  • anticipated delays in services, if any;
  • special considerations or extended direct training dates, if any;
  • the consumer's readiness to begin nonvisual O&M skills training; and
  • the consumer's understanding of O&M skills training and its potential benefits.


Monthly Progress Reports

After receiving authorization to provide training services, the O&M provider must document each consumer's monthly training progress using 2896, Consumer Services Report: O&M Training.

Monthly progress reports must be submitted within 30 days of the end of each calendar month until the consumer's O&M services are completed or services are no longer recommended by the consumer's counselor or case manager.

Each consumer's monthly progress report must include:

  • the number of training hours provided in each training area;
  • a detailed narrative of each skill area addressed during the reporting period and the training location for each lesson. Training locations include:
    • home (indoors and outdoors);
    • public areas (bank, church, doctor's office, and so on);
    • commercial areas (grocery store, mall, and so on);
    • transit systems (public transportation, paratransit, taxi, and so on);
    • rural areas;
    • residential areas (light traffic and stop signs);
    • small business areas (heavier traffic and simple traffic lights);
    • downtown areas (heavy traffic and complex lights); and
    • commercial travel (trains, planes, and so on);
  • a detailed explanation of anticipated training for the upcoming month;
  • an explanation of deviations from assessment recommendations, if any; and
  • a detailed narrative of cumulative progress if training is complete.


Expectations of Training

All O&M training services for DBS consumers must be conducted using nonvisual (blindfold) techniques and a rigid (nonfolding) cane. All exceptions must be discussed with the consumer's counselor or case manager before training services are begun, and must be fully documented in the provider's required reports. Approval must be fully documented by the case manager in the case notes.

O&M providers discuss the benefits of nonvisual training with each consumer. Role modeling and peer support for nonvisual training are encouraged.

With prior authorization from the consumer's counselor or case manager, visual training may be provided after nonvisual training is completed to transfer skills.

Note: The provider must get written authorization (by email or handwritten note) before providing visual training of any kind. DBS does not reimburse visual training without prior written authorization.


Group Training

DBS encourages O&M providers to coordinate group trainings (of up to three consumers) when it will benefit the instruction process and better meet the needs of the consumers. However, the O&M provider must get approval from each consumer's counselor or case manager before providing group training.


Travel Aids

The counselor or case manager provides one rigid, long, white cane for each consumer for O&M assessment and training, to be distributed by the O&M provider or vocational rehabilitation teacher (VRT).

If a consumer has a guide dog, the consumer is assessed by the O&M provider to ensure that the consumer has proficient cane skills. O&M training can occur with either a cane or guide dog.

The DBS provider must include observations and recommendations of cane skills in the initial assessment. Recommended hours for training must be inclusive of the consumer's travel needs, regardless of the mobility tool (dog or cane). Additional hours are not requested for training with a guide dog.

In addition, O&M providers give cane-purchasing information to each consumer. Consumers are responsible for acquiring all replacement canes, cane tips, back-up canes, and so on.

O&M providers may recommend additional travel aids or other items to the consumer's counselor or case manager; but the decision to purchase additional items rests solely with the counselor or case manager.

DBS does not reimburse O&M providers for any items provided to a DBS consumer by the provider.

DBS encourages consumers to contact the school from which they obtained their guide dog for further assessments and direct training for the guide dog, if needed.


Providing Services

Orientation and mobility training may not exceed the extent of services (type of training and total number of training hours) authorized by the consumer's counselor or case manager.

An O&M provider cannot have more than 25 DBS consumers in active training at any time, and must keep counselors and case managers informed of the total number of consumers in active training. Any consumer who has been provided services, from assessment through completion, is considered to be in active training. The capacity for 25 consumers in active training was determined to allow for group lessons. Priority for training is determined on a case-by-case basis in consultation with each consumer's counselor or case manager.

O&M providers cannot provide more than six hours of training on any given day, even if multiple consumers are served in that day. Lessons are approximately two hours long. Without prior authorization from a counselor, an individual consumer must not receive more than four hours or less than two hours of O&M instruction on any given day.

Consistent and frequent scheduling is recommended to maximize consumer learning. Daily O&M training is considered best practice. For VR consumers, one two-hour lesson a week is the minimum training allowable.

For IL consumers, the IL worker authorizes two to three hours for the initial assessment. If training is recommended, the IL worker allows no more than five hours of training per month. If additional training time is needed (because of safety-related concerns, secondary disability, or a specific consumer request), the O&M provider sends a written request to the IL worker, including the number of additional hours requested and the reason more hours are needed. Requests for additional training are made as part of the initial assessment, when possible.

Transporting consumers does not count toward training time. O&M providers are not reimbursed for time spent in the car, even when a consumer is present.

The O&M provider must notify the consumer's counselor or case manager within 24 hours about all:

  • no-shows, cancellations, or rescheduled appointments;
  • issues, concerns, or circumstances that might impact or delay planned services; and
  • issues that might delay the completion of services.

O&M providers must get written approval from the counselor or case manager before deviating from any of these standards during training (even when based on an individual consumer's needs).


If Services Are Interrupted

If training cannot be completed as planned or if services are postponed indefinitely because of unexpected circumstances, the O&M service provider must notify the consumer's counselor or case manager within 24 hours.