Edward Hines, Jr. VA Hospital
Central Blind Rehabilitation Center (BRC) History
On July 4, 1948 the VA celebrated the establishment of Blind Rehabilitation Service’s first Blind Rehabilitation Center (BRC) at Edward Hines Jr. Hospital in the western suburbs of Chicago. From a humble beginning with a nine-bed facility and a staff of nine, VA Blind Rehabilitation Service has grown significantly during the past half century, marked by a continued expansion of comprehensive rehabilitation services to blinded veterans.
There are now thirteen BRCs strategically located throughout the country and Puerto Rico, over 100 full-time Visual Impairment Service Team (VIST) Coordinators, over 20 Blind Rehabilitation Outpatient Specialists (BROS), and the VISOR program, an outpatient intermediate 9-day rehabilitation program located in the Lebanon VA Medical Center in Pennsylvania. VA, through its innovative training programs, education and research, is recognized nationally and internationally for its leadership role as a premier service provider.
President Roosevelt’s Commitment
The roots of VA Blind Rehabilitation Service can be traced directly to the pioneering military rehabilitation programs for war-blinded servicemen of WWII and events surrounding that armed conflict. Early in WWII, the United States government was uncertain whether to pass legislation for a unified rehabilitation program for both disabled war-injured and civilians, or to establish separate programs. In 1942, President Franklin Roosevelt delivered a special address to Congress personally advocating a unified plan serving both civilians and veterans. However, pressure from veteran service organizations resulted in legislation supporting separate programs, and the passing of Public Law 78-16 on March 24, 1943, which authorized VA to provide benefits, including vocational rehabilitation to veterans. Three months later, passing of the Barden-LaFollette bill provided rehabilitation for disabled civilians.
On Jan. 8, 1944, the United States government made an extraordinary commitment to the blinded war-injured with an order under President Roosevelt’s signature declaring “no blinded servicemen from WWII would be returned to their homes without adequate training to meet the problems of necessity imposed upon them by their blindness.”
Army and Navy Programs
To meet this commitment, the Army Medical Corps developed a three-phase program. The medical and surgical treatment of the blinded soldier was to be accomplished at two chief centers. One was Letterman General Hospital, San Francisco, Calf., later transferred to Dibble General Hospital, Menlo Park, Caliph., and the other at Valley Forge General Hospital, Phoenixville, Pa.
While receiving medical care, the blinded servicemen started to receive basic blind rehabilitation training. The second phase was at Old Farms Convalescent Hospital, Avon, Conn., where an 18-week, extensive rehabilitation training and vocational training program was conducted. The Navy operated another special program for sailors and naval officers at Philadelphia Naval Hospital. The final stage of the rehabilitation program was the discharge of the soldier or sailor, at which time VA would provide vocational training and placement. The Army programs were heavily modeled after the St. Dunstan blind rehabilitation program in England and, from 1944 through 1947, provided 1,400 war-blinded servicemen rehabilitation training that many considered superior to existing services in the private sector.
VA Adopts New Mission
With the conclusion of WWII and the probability of the deactivation of the military blind rehabilitation program, the question arose as to which agency would provide remedial and ongoing treatment of the 1,400 war-blinded veterans. In the spring of 1947, the Federal Budget Bureau raised the question of whether VA could legally provide any services beyond vocational rehabilitation. President Harry Truman, on May 28, 1947, settled the issue by signing a Presidential Order whereby responsibility for the social adjustment training of blinded servicemen was transferred from the Army and Navy to VA. In June 1947, the armed services deactivated all wartime rehabilitation programs for blinded servicemen.
Hines Chosen as First Site
On Sept. 15, 1947, VA Administrator Gen. Omar Bradley and VA Chief Medical Director Gen. Paul Hawley appointed C. Warren Bledsoe as VA Coordinator of Blinded Veterans Affairs, charged with the development of a blind rehabilitation program. Hines Hospital was selected as the site of the first VA BRC, due in part to its large and well-functioning Physical Medicine and Rehabilitation Department.
On Feb. 20, 1948, Russell C. Williams, a WWII blinded veteran and former counselor at the Valley Forge Military Rehabilitation Program, was appointed Chief of the new center. A group of three outside consultants— comprised of Kay Gruber, Harry Sparr and Dr. Richard Hoover—were selected to assist Williams in selecting, indoctrinating, and training the nine-member staff.
After four months of intensive staff training, the nine-bed unit admitted the first patient, Naron Ferguson, on July 4, 1948. Williams, himself a product of both the Valley Forge and Old Farms blind rehabilitation programs, provided expert leadership in developing a model program. A well-rounded instructional curriculum was constructed around Williams’ unshakable faith in the capabilities of the blinded veterans.
Orientation and Mobility
The rehabilitation was demanding, with both high expectations and standards. The long cane concept, developed by Richard Hoover at Valley Forge Hospital, was instituted, refined, and expanded by the staff. During the next two decades, a systematic approach to independent travel utilizing the long cane technique became the foundation of the new training in Orientation and Mobility.
Early interest in the new training program and techniques taught became so widespread that other rehabilitation professionals and agencies requested and were granted rudimentary training at Hines BRC. From 1949 to 1960, the Hines Orientation and Mobility staff also conducted more than one dozen workshops for teachers at several universities and schools for the blind in the principles of the new long cane techniques.
BRC During Korean Conflict
During the Korean War in 1951, the beds at Hines BRC were increased to 27, plus an additional 13 beds in the Ophthalmology Ward. The nature of combat in the Korean War resulted in numerous instances of blindness and multiple handicaps. More than 500 servicemen were blinded, accounting for five percent of all casualties, the highest ratio of any American conflict up to that time. During this period, the blind rehabilitation program at Hines treated a substantial number of unique cases including bilateral hand amputees, unilateral arm amputees, unilateral and bilateral leg amputees, neurologically impaired, and brain injured. Many new techniques were created, as well as adaptations to training and prosthetic devices, which later proved to benefit the general population.
In 1953, VA, with the cooperation of the Department of Agriculture, produced a one-hour film entitled The Long Cane, which documented the adjustment process. Utilizing the BRC staff at Hines and featuring a blinded veteran, Lloyd Greenwood (later the Executive Director of BVA), the film was created to promote awareness of the new program within the VA system. During the ensuing years, the film was viewed by not only VA personnel but seen throughout the country and abroad by a variety of organizations as a model training film on blindness and mobility.
University Training Programs
Beginning in 1960, VA assisted in playing a major role in developing university training programs in blind rehabilitation. In 1961 and 1962, VA approved clinical training affiliations with Western Michigan University (WMU) to train Orientation and Mobility specialists and Rehabilitation teachers at Hines. Support for funding the university program was under the sponsorship of the Department of Health, Education and Welfare. Three staff members from the Hines BRC had previously joined the WMU program to administer it and create the Orientation and Mobility training segment. The program at WMU soon became an outstanding model for the many university training programs to follow.
Through the continued support of VA stipends and new university affiliations, VA BRCs have played a major role in preparing teachers in blind rehabilitation. Nationally, over 1,100 specialists in Orientation and Mobility, and Rehabilitation Teaching have received their clinical intern training at a VA BRC. In addition, through a VA-funded Optometric Residency Program, over 100 optometrists have success fully completed residency training at a VA BRC, while over 1000 optometry students have also received training.
New Centers Open
After 18 years with only one VA BRC, a combination of events led to a steady expansion. The Vietnam War—coupled with the earlier inclusion of non-service connected veterans, more low-vision applicants, and a more expansive referral system—increased the demand for additional blind rehabilitation sites.
BRCs were strategically created within the VA system:
- Palo Alto (Calif.) VAMC (1967)
- West Haven (Conn.) VAMC (1969)
- American Lake (Wash.) VAMC (1971)
- Waco (Texas) VAMC (1974)
- Birmingham (Ala.) VAMC (1982)
- San Juan, Puerto Rico VAMC (1986)
- Tucson (Ariz.) VAMC (1994)
- Augusta (Ga.) VAMC (1996)
- West Palm Beach (Fl.) VAMC (2000)
As the number of VA BRCs expands, so does the number of accomplishments and innovations. Research has been conducted in fostering advances and progress in electronic travel aids, reading machines, low-vision devices, and computers. Involvement in prosthetic equipment evaluations directly results in new clinical programs. VA Blind Rehabilitation Service led the nation in incorporating a family training program at all its facilities. The development of new methodology in the blind rehabilitation of the multiply handicapped, the geriatric population, and in program evaluations has continued through the 1970s, ‘80s, ‘90s and into the new millennium.
The multi-disciplinary team approach to treatment was expanded to include not only blind rehabilitation specialists, but also a physician, nurse, optometrist, dietitian, social worker, and psychologist. Regardless of discipline, all team members’ efforts focus on promoting health, developing skills of independence, and improving adjustment to sight loss. Today, VA has 238 beds committed to the ten BRCs staffed by more than 370 blind rehabilitation specialists and support personnel providing a variety of training programs.
The first comprehensive follow-up study of WWII and Korean blinded veterans was conducted from 1952 to 1954, involving 386 VA social workers interviewing 1,949 service-connected blinded veterans. The number represented all but 12 of the war-injured still living. Overall, the final report conclusively substantiated the economic and psychological advantages of rehabilitation. Veterans who received blind rehabilitation rated considerably higher in employment and social adjustment. A smaller follow-up research effort, 851 Blinded Veterans: A Success Story was conducted 10 years later by the American Foundation for the Blind, with technical assistance from the Blinded Veterans Association and VA funding. Again, data clearly demonstrated the long-term value of blind rehabilitation.
One of the findings of the survey was that an alarmingly high percentage of veterans had not had an eye exam in five years, while a substantial number had a hearing loss or neglected health-related problems. The need for a coordinated outpatient program that would monitor blinded veterans’ health on a routine basis was apparent.
VIST is Formed
On Feb. 8, 1967, the VA Department of Medicine and Surgery Manual M-2, Professional Services, included a new section in Blind Rehabilitation, creating the Visual Impairment Service Team—VIST. Formalized and long advocated by Russell Williams, then Chief of the Blind Rehabilitation Section in VA Central Office (VACO), the document charged 71 specific field stations within VA to establish coordinated outpatient services for eligible blinded veterans nationwide. It was initially done without additional funds or positions.
The VIST was to be comprised of a coordinator and representatives from all disciplines available at the facility who could offer a service to blinded veterans. These disciplines included Ophthalmology, Optometry, Audiology and Speech Pathology, Medicine, Podiatry, Nursing, Psychology, Dietetics, Social Work, Library, and Veterans’ Assistance. The VIST was designed as the VA’s frontline diagnostic and treatment agent for blindness. It was a VIST program construct that no adjustment patterns under blindness are fixed or unchanging. The VIST Coordinator ensured that all eligible blinded veterans were routinely informed of VIST services and invited to the local health care facility on a yearly basis for a review of their physical, social and psychological needs, plus a review of benefits. The reviews often resulted in additional services, including referral to a BRC.
During the following years, the VIST has served to strengthen the comprehensiveness of VA Blind Rehabilitation Service with early rehabilitation intervention for veterans in their adjustment to the impact of sight loss.
BROS Positions Established
The latest innovation in strengthening services in VA Blind Rehabilitation Service occurred in 1995 with the establishment of 15 Blind Rehabilitation Outpatient Specialists (BROS) positions. These multiply-trained, blind rehabilitation specialists provide selective rehabilitation training to veterans in their local environment prior to and following participation in a BRC program. In special cases, veterans unable to participate in an inpatient program are eligible for BROS services. BROS work closely with VIST Coordinators and the regional BRC in providing a continuum of care.
History of Leadership
Since 1948, VA has been fortunate in the quality of VA leadership in Blind Rehabilitation Service. Under the direction of only four men—C. Warren Bledsoe (1947-1958), Russell C. Williams (1959-1975), George M. Gillespie (1976-1979) and Don E. Garner (1979-2003)—services for blinded veterans have steadily improved in sophistication and scope. VA continues to examine the quality of its work.
In a joint research effort with the VA Rehabilitation Research and Development Center in Decatur, Ga., Blind Rehabilitation Service began work in 1996 in developing National Outcome Measures to verify the quality and cost-effectiveness of rehabilitation services. In addition, VA was instrumental with the Commission for Accreditation of Rehabilitation Facilities (CARF) in the development of national accreditation standards for VA blind rehabilitation services. Since then, all of the BRCs have been accredited at least once, some twice with a three year accreditation.
Blinded Veterans Association
It is impossible to consider the growth and accomplishments of VA Blind Rehabilitation Service without recognizing the constant support and partnership it has enjoyed with the BVA. The BVA was founded on March 8, 1945, by 100 blinded veterans at Avon Old Farms Convalescent Hospital. During the next few years, the BVA vigorously campaigned for VA to create a BRC. At the second BVA national convention in 1947, the Board of Directors issued three strong recommendations for VA improvement, of which the establishment of a BRC was foremost. Very soon thereafter, VA approved plans for a center at Hines Hospital. Since the inception of Blind Rehabilitation Service, the BVA has continued its active partnership for advocating the highest quality blind rehabilitation programs. On countless occasions, when VA services for the blind were threatened, the BVA rose to the challenge and engaged the highest level of VA management and Congress to seek equitable solutions.
VA Legacy and Future
The VA is again collaborating with the Commission for Accreditation of Rehabilitation Facilities (CARF). This time the team is working on the development of national accreditation standards for Low Vision Programs throughout the country. The VA Blind Rehabilitation Service Strategic Planning Group is also working diligently to enhance the quality of care for Blind Rehabilitation nationally. The group is putting together a national service system which will ensure that all veterans receive the highest quality of training and commitment.