Vocational Rehabilitation Services Manual C-600: Orientation and Mobility Services

Per 34 CFR §361.48(b)(11), Orientation and Mobility services are available to individuals who are blind.

Per Human Resources Code §91.002(2), "blind" means a person having not more than 20/200 visual acuity in the better eye with correcting lenses or visual acuity greater than 20/200 but with a limitation in the field of vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees.

C-603-1: Role of the Orientation and Mobility Instructor

Orientation and Mobility (O&M) are core skills that help customers who are blind or visually impaired to achieve an effective employment outcome. Both the VR counselor and the O&M instructor should encourage customers who do not travel efficiently and effectively to learn O&M skills.

Independent travel skills are learned non-visually with a white cane so that the customer develops the necessary skills and confidence to travel safely and independently, regardless of available visual information. In rare exceptions, an aluminum cane might be needed to fit nonmetal tips such as a roller tip. Exceptions must be clearly justified and documented in a case note in ReHabWorks.

In all cases, use of a customer's remaining vision may be transferred to training when the O&M instructor believes it would be helpful to the learning process, usually after nonvisual skills are mastered.

O&M instructors may teach customers travel skills, including (list is not inclusive):

• white cane skills;
• compass directions;
• stairs;
• indoor self-familiarization;
• auditory skills;
• grocery, mall, airport, and rural travel;
• sidewalk travel;
• in a residential neighborhood, skills such as
  • recovery techniques;
  • turning at corners;
  • numbering systems;
  • soliciting directions;
  • drop-offs;
  • crossing at stop-sign-controlled intersections;
  • crossing light-controlled intersections with light traffic; and
  • bus travel;
• in a small business area, the following additional skills:
  • analyzing and crossing at light-controlled intersections (four-way plus sign-shaped, three-way T-shaped, and offset) with heavier traffic;
  • advanced recovery skills; and
  • traveling in heavier pedestrian areas and unfamiliar areas;
• problem solving;
• independent travel;
• transportation;
• for downtown travel, in addition to the skills listed above, exposure to a variety of different environments to help build confidence in skills already learned (the sounds of downtown travel are very different from those in small business areas, and the customer must learn them to prepare for travel independence in all areas for employment options); and
• travel at night.

In teaching these skills, O&M instructors may work with:

• VR counselors and other VR staff;
• families;
• educators;
• community providers; and
• others who support the customer's work and independent-living goals.

C-603-2: Orientation and Mobility Employment Outcome Services

Prior to beginning O&M training services, the VR counselor must include O&M services on the customer's IPE. O&M instructor services support the customer's ability to achieve an employment outcome. O&M instructor services must be coordinated with the VR counselor through all phases of the rehabilitation process, including:

• sharing information with the VR counselor regarding the customer's emotional adjustment to visual impairment and acquisition of motivational, problem-solving, organizational, and independent-living skills;
• accompanying the VR counselor to employer contacts or work site tours and assisting with job-travel analysis;
• providing nonvisual skills training based on the customer's known or anticipated job-travel responsibilities and researching travel methods for employment assistance; and
• providing transferable skills so that the customer can apply skills to unfamiliar areas.

C-603-3: Orientation and Mobility Instructor and Vocational Rehabilitation Counselor Staffing Sessions

Staffing sessions purpose is to:

• develop a team approach for services with each customer;
• provide frequent and regular communication between the O&M instructor and VR counselor during the provision of O&M services; and
• ensure that comprehensive O&M services are provided in a timely manner.

Staff sessions focus on:

• cases selected by the O&M instructor and VR counselor;
• customer's training progress;
• any customer issues requiring immediate attention; and
• any changes to the O&M instructor's plan or the customer's individualized plan for employment (IPE).

C-603-4: Customer Referral Process

If a customer requires O&M services, the VR counselor refers the customer to the O&M instructor or a contracted O&M service provider.

Customers who are blind must be referred to the In-House O&M instructor or a contracted O&M service provider for assessment, unless there is pending eye surgery or the customer recently completed training at the Criss Cole Rehabilitation Center (CCRC). Visually impaired customers with severe functional limitations may also be referred if O&M services are needed.

Customers demonstrating immediate critical needs before surgery may be referred to the O&M instructor, depending on availability.

A service record must be created in ReHabWorks to begin the process referring a customer to an O&M instructor.  

C-603-5: Orientation and Mobility Assessment Report

The O&M assessment provides critical information to the VR counselor and customer in the development of the customer's IPE. This information can help determine training needs and the potential length of training. A white cane and blindfold may be used for evaluation purposes.

The O&M assessment focuses on the alternative skills needed to live independently and obtain or maintain employment.

Except for assessment-only requests, O&M services cannot begin before the case is moved into either a Pre-Trial Work Experience or the IPE is completed in RHW.

O&M instructors provide assessments that may include such areas as:

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

When the assessment is completed, the In-House O&M instructor will enter a case note in ReHabWorks by choosing the "O&M" drop-down title and typing "Assessment" in the Add to Topic line.

The O&M assessment must include the following information:

• Customer's current level of travel
• Specific travel skills needs and issues
• Summary of independent travel abilities at the time of the assessment
• Dates of assessments
• Number of training hours recommended

After the O&M assessment is entered into a case note, the O&M instructor determines with the VR counselor if and when training should begin.

C-603-6: Assessment Focus and Employment Outcome

Although the O&M instructor does not determine the customer's employment outcome, the O&M instructor's assessment is completed with independent functional travel as the ideal goal. Travel skills are critical to an employment outcome, but different employment outcomes require different skill levels.

If the assessment is developed before an employment outcome is known, the assessment focus is on independent functional travel and its general application to employment.

C-603-7: Orientation and Mobility Training Process

Based on customer needs and the O&M instructor's input, the range of training services must include:

• training in the use of nonvisual skills;
• employment assistance for independent functional travel needs;
• adaptive supplies for travel, such as a white cane and blindfold; and
• use of problem-solving skills for customers to build confidence in travel and realize an opportunity for independence.

An O&M instructor cannot have more than 25 customers in active training at any time. The O&M instructor must notify by email VR counselors and assigned regional program support manager (RPSM) of the total number of customers in active training monthly. Any customer who is receiving an O&M assessment or is enrolled in O&M training is in active training.

C-603-8: Orientation and Mobility Services Monthly Progress Report

In-House

During active training, the O&M instructor must complete and enter into a case note in ReHabWorks by using the drop-down title "O&M" and typing "Monthly Progress Report" in the Add to Topic line. The monthly progress report must include at least the following:

• Customer's progress for the report month
• Number of hours worked with the customer for the month
• Training dates
• Recommendations for next steps
• Any issues or concerns with training, or changes in initial recommendations

Completion of O&M Services

When O&M services are completed, the O&M instructor completes a "Summary Report" case note in ReHabWorks by using the "O&M" drop-down title, then typing "Summary Report" in the Add to Topic line. The Summary Report must include a description of how O&M services helped the customer reach his or her O&M goals and/or a description of why a goal was not reached.

The O&M instructor will close the service record when the O&M instructor and VR counselor agree that no further services are needed.

C-603-9: Providing Additional Services after Service-Record Closure

In-House

If additional services are needed after the service record is closed, a new RHW service record is required, with the VR counselor specifying what O&M skills are needed.

If services extend beyond 30 days, the O&M instructor must provide a monthly progress report by entering a case note in ReHabWorks using the drop down "O&M" and typing "Monthly Progress Report" in the Add to Topic field until service needs are completed.

O&M Case Services Management and/or Case Notes

The O&M instructor must document all customer contacts and other pertinent information in ReHabWorks case notes by choosing the "O&M" drop-down title, then typing a title of the subject content of the case note in the "Add to Topic" field. Examples of "Add to Topics" include:

• Assessment
• Monthly Progress Report
• Summary Report
• Service Record Closure
• Customer Contact

For detailed information regarding contracted O&M services, see VR Standards for Providers, Chapter 5: Orientation and Mobility Services.

C-603-10: Action List

For more information on searching action lists, see the ReHabWorks User Guide, Chapter 6: Case Actions and Action Lists.

Ordering Rehabilitation O&M Instructor Supplies

For information on ordering O&M instructor supplies, see VRSM D-200: Purchasing Goods and Services.

C-603-11: Recommending Purchase of Equipment

The O&M instructor may recommend the VR counselor purchase equipment that is not immediately available or the O&M instructor may recommend a purchase by:

• creating a service record in RHW for the items; and
• delegating the purchase to the VR counselor.

The O&M instructor must determine before the purchase how the VR counselor would prefer to complete the purchase.

A service justification must be provided for all purchase recommendations unless the case is in employment phase in RHW. If the case is in employment phase in RHW an IPE amendment is required. 

C-603-12: Customer or Staff Purchases from Control Account 40

For information on ordering O&M instructor supplies, see VRSM D-200: Purchasing Goods and Services.

C-603-13: Guidelines for Electronic Travel Aids

Examples of electronic travel aids include the following:

• Laser cane
• Mowat sensor
• Sonic guide
• Global Positioning System
• Talking compasses

C-603-14: Maintaining Inventory Levels in the Local Office

Staff must use the following procedures to maintain inventory in local offices:

• Order in bulk to maintain one month's supply of high-use rehabilitation supplies for the office.
• Order small quantities regularly to maintain stock levels, rather than allowing stock to be depleted and ordering large quantities.

C-603-15: Accountability

Accountability for adaptive supplies and equipment issued to customers is verified by:

• documentation in the O&M instructor case notes;
• review of the case file by the VR Supervisor or VR Manager; and
• maintenance of an established inventory level in the field office.