Low Vision Therapy with Rachel Partner, OTR/L, CLVT

Today’s blog is all about the low vision certification, or CLVT! I was very fortunate to get in touch with Rachel Parter, OTR/L, CLVT and have her share about her experiences as a certified low vision therapist. I was lucky to have a professor with her CLVT who taught us a lot about low vision therapy, including assessing vision and interventions. I’m very excited about sharing this interview and talking about low vision therapy because vision can have a major impact on occupational performance, and it is an important thing to assess with any client!

The low vision certification’s origins started in 1975 at the American Association of Workers for the Blind conference in Atlanta, GA. By the late 1980s, development of a specific credential for professionals who incorporated low vision into their practice began. The first low vision therapist certificates were issued in September of 1997. You can read more about the history here.

A CLVT completes a functional low vision evaluation using various instruments to assess visual acuity, visual fields, contrast sensitivity function, color vision, stereopsis, visual perception and visual motor functioning, literacy skills in reading and writing, and various other functional vision skills. That is just the tip of the iceberg when it comes to how CLVTs evaluate, interact, and treat clients with low vision. You can read more about the scope of practice here.

Here is the link for the steps to acquiring the certification, which entails applying for eligibility and scheduling your exam.

Academy for Certification of Vision Rehabilitation & Education Professionals website

Total Estimated Time to Complete Certification: 350+ hours

Total Estimated Cost: $680

Now, let’s meet Rachel, an OT who specializes in low vision therapy!

Rachel Partner, OTR/L, CLVT graduated from Alvernia University in Reading, PA in 2013 with a combined Bachelor and Master of Science degree in OT, and received her post-professional OT doctorate degree in 2016 from Chatham University. Rachel has been practicing general OT for 7 years and during the past 2 years, has been in an optometric practice where she integrates her low vision specialty into her OT plan of care. Rachel currently works in several assisted living facilities and skilled nursing facilities as a per diem staff.

A unique fact about Rachel, is that she was born with bilateral congenital cataracts and nystagmus, which had a huge impact on her life experiences and professional trajectory. Consequently, she became extremely open about her experiences in the hope that her insights will positively affect others. She credits her family for supporting her and pushing her to be the person she is today.

Rachel now lives in central PA and spends most of her time with family and friends, and engaging in various hobbies, including knitting and other fiber arts, reading, making cards and scrapbooking, and playing piano, flute, or singing.

Where did you attend OT school?

I graduated from Alvernia University in Reading, PA in 2013 with a combined Bachelor and Master of Science degree in Occupational Therapy. Alvernia appealed to me because it was a smaller campus and offered a 5-year program, all completed at the same campus. It was also the only college that accepted me into both the college and OT program simultaneously as a freshman. After working as an entry-level OT for several years, I went back to Chatham University in Pittsburgh, PA to obtain a post-professional OT doctorate degree in 2016. Chatham’s online format made it manageable to still work as an OT while completing the required coursework and capstone project, which addressed interprofessional rehab team education about common low vision conditions in the geriatric population.

Why did you choose OT?

The basic answer to this question is because I wanted to help people, a common altruistic reason OT practitioners are drawn to the profession.

The more in-depth answer took me years of reflection to articulate. In high school, I took a job skills survey and the results identified a service-based profession as my best category, with OT at the top of the list. My summer employment that year was supervising a group of special needs adults with basic assembly line tasks, during which I was able to teach a new job to one of the women. She proudly presented me with a finished box my last day, to the astonishment of the staff. I felt so fulfilled in that moment, thinking “if this is the feeling I get when I impact someone else’s life in such a simple way, I should pursue it professionally.” After much research, I decided that OT was an excellent fit for me. I could become a well-rounded, knowledgeable individual. Each day and every interaction as an OT would offer unique experiences and insights, while there would never be a dull moment. I could advocate for my clients, bridging the gap between the medical/professional community and the client/family like I had experienced in countless ways throughout my own life.

Why and when did you choose to become certified in low vision?

Although being an OT was fulfilling, my ultimate goal was to specialize in low vision to pay it forward. Because I grew up with low vision myself, I experienced the positive effects of interacting with professionals in the medical and blindness communities including ophthalmologists, optometrists, OTs, teachers of the visually impaired (TVI), orientation and mobility (O&M) specialists, vision rehabilitation teachers (VRT), and vocational rehabilitation counselors (VRC).

Reflecting on my experiences, I realized I was extremely fortunate. Despite living in a rural community with limited access to low vision resources, my parents sought out the services I needed. They and my brother instilled in me that my vision wasn’t a crutch. I was encouraged to try activities, with the understanding that it would take me additional time, effort, and adaptation as compared to my peers. I had many opportunities my friends with low vision didn’t because of my strong support system, and vice versa. So, after researching the low vision rehab certifications (CLVT, O&M, VRT) during the summer of 2017, I felt the CLVT was the most complementary with my OT degrees and life skills. A CLVT conducts functional low vision examinations to determine the adaptive device, compensatory strategy, and environmental modification needs for daily use by individuals with low vision, providing education and training accordingly as part of the interprofessional team.

What settings have you worked in? Do you have a favorite, and why?

I’ve been lucky to work in numerous settings over the years. My first job was at a continuum-of –care retirement community (CCRC), so I worked in short-term rehab, long-term, outpatient (from both the facility and the community), and home health. Then, after becoming a CLVT, I added private practice outpatient at the optometrist office. While I enjoy working in all of these settings, because each requires a slightly different set of skills and knowledge, the private practice outpatient routine is my favorite by far. In addition to using my OT and CLVT training simultaneously in this setting, it’s nice to have my own stationary workspace with all the devices/equipment at my fingertips. I can work with clients with limited interruptions or distractions and am able to address their most meaningful, desired activities. The successfulness of each intervention I implement is immediately evident. Clients usually have a very apparent reaction about whether it’ll work for them, which enables me to more efficiently adjust my approach.

What does a typical day with clients look like for you?

At the optometrist office, my day typically involved seeing an average of 4 clients for 75 minutes per session. After reviewing any new client medical records and optometric exams, I consulted with the optometrist to obtain her low vision device recommendations. We also discussed current client needs and progress. I completed an OT evaluation on all new clients, introducing them to potential optical devices (high-power spectacles, magnification devices, wearable optical devices, etc.) and adaptive low vision techniques to improve desired occupational performance. Throughout every subsequent client session, I incorporated: education about optimizing remaining vision and other senses to complete activities; training regarding task modifications or adaptations, organizational strategies, and/or environmental modifications; referrals to applicable community and/or federal resources; and facilitation of active problem-solving and critical thinking skills. In addition to addressing the vision-related components, I simultaneously analyzed the physical, social, and cultural barriers present. For example, if a client had arthritis and couldn’t manipulate a hand magnifier easily, what else could we try? Once all goals were met or progress was no longer evident, clients were discharged from my services.

When not interacting directly with clients, I assisted with general office work (inventory and ordering, follow-up calls, coordination of referrals and other rehab services, insurance authorization, etc.), which helped me to better understand the business aspects of an office.

How do you stay client-centered and occupation-based in your practice?

Regardless of the setting or clientele, I try to remain client-centered and occupation-based. I use the Person-Environment-Occupation (PEO) Model to guide my plans of care because it focuses on optimizing occupational performance through the dynamic relationship between the client, the environment, and the occupation being completed. A good fit must exist between the three components with a “just right” challenge to achieve optimum occupational performance, while a poor fit creates dysfunction and minimal occupational performance.

As I observed my clients with low vision at the office, I considered what aspects could be altered to improve their performance. Do we need to look at other low vision devices? Is there a different way to complete the task with the same end result? How can the environment be modified? I presented all the possible options to the client and we collaborated to find the best solution. While I also had an idea of the goals and what interventions I’d provide, I asked clients for the top 3 to 5 activities they wanted to improve, using those activities as a starting point. At the end of my evaluation sessions, I provided a simple recommendation that clients could implement immediately so they could see their own improved activity performance, such as using task lighting or writing with a bold-lined felt-tipped pen.

How often do you use the skills you learned from acquiring this certification in your practice?

I use CLVT principles daily, despite the setting I work in. Similar to ideas such as universal design or energy conservation techniques, adaptive low vision strategies are applicable to everyone to improve performance. Additionally, reduced vision isn’t always physically evident to the observer. I tend to recommend lighting, contrast-enhancement, and glare-reduction principles the most for the clients I see in the SNFs and ALFs because those interventions are fairly simple to implement without expensive equipment. Recommending a low vision device including a magnifier or wearable device happens less often. However, if clients or their families reference a noticeable change in vision, I suggest an eye exam to both them and the facility staff. Conversely, at the optometrist office, I utilized my CLVT skills constantly throughout the day.

What are the steps to acquiring the credentials? Is there a renewal process?

I became a CLVT through the Academy for Certification of Vision Rehabilitation and Education Professionals (ACVREP). Individuals must demonstrate competency about eye anatomy, diseases, and conditions in addition to low vision devices, the low vision rehabilitation process, and relevant policies and procedures. To achieve this, they must complete a minimum of 350 hours providing services to clients with low vision under the guidance of an optometrist and a CLVT mentor while simultaneously reviewing the recommended study materials and textbooks. Applicants then apply and sit for the competency exam, which consists of approximately 100 questions, and a CLVT certificate is issued after ACVREP receives confirmation of a passing test score. Subsequently, CLVT status must be renewed every 5 years by completing 100 hours of ACVREP-approved continuing education and paying a recertification fee. Coincidently, many of the CLVT continuing education courses can be applied toward OT’s license continuing education requirements.

Do you get paid more for having this certification?

I wish I could say I got paid more for having CLVT credentials, but I don’t. The certification does make me more marketable as an OT practitioner, in a better position to negotiate a higher salary, if desired, depending on the setting since I have more training and knowledge in a specific area than many of my peers.

Can you name the various settings that a CLVT can practice?

Ultimately, a CLVT can practice in any setting that serves clients with low vision. While some CLVTs work in an outpatient capacity, others combine outpatient and in-home services. But, it’s extremely beneficial to work collaboratively with an optometrist or ophthalmologist, since these eye care professionals initiate the low vision rehab process. Although private eye care practices can employ CLVTs, the majority of jobs reside with the Veteran’s Administration (VA) and nonprofit organizations such as the Lighthouse for the Blind.

Do you believe acquiring the credentials is worth it?

I believe holding CLVT credentials is worthwhile. It not only demonstrates to other professionals that I’m a specialist in low vision, but it also allows me to be more marketable for certain jobs and with a specific clientele than the majority of my OT peers. I would rather have the extra credentials than not, because obtaining CLVT credentials depends on the employer. For example, some private practice eye care professionals provide on-the-job training about the low vision rehab process instead of requiring CLVT credentials while others will only hire someone with the CLVT qualification. The VA considers only those licensed professionals including OTs who are CLVTs, and nonprofit organizations typically want employees with CLVT training. In addition, although the low vision services I provide as a CLVT are reimbursable by insurance companies because I’m able to incorporate the concepts into my OT plans of care, the CLVT qualification and services aren’t billable independently. Because CLVTs aren’t licensed healthcare practitioners, insurance companies don’t recognize them as providers.

Do you have any other OT interests that you would like to pursue? (other certifications, a specialty area you want to work in, etc.)

I love learning! Since I primarily work with adults, I’m interested in continuing education about aging-in-place and dementia at the moment. I can help clients successfully age-in-place, whether in their own homes or while transitioning through a CCRC (continuing care retirement community) while incorporating my low vision specialty. Because dementia is very prevalent in the settings I work, it makes sense for me to learn as much about it as possible so I can provide quality interventions and properly educate staff and families. Working with students with low vision during their transition between academia settings and the professional world is another area of interest. I’d also like to delve more into education at some point, whether it’s becoming a professor and designing a course around low vision rehab or creating professional continuing education for other healthcare and rehab practitioners about low vision. But, for right now, I’m satisfied with the alphabet soup behind my name, at least until the world recovers more from the pandemic.

Do you have any words of advice for someone wanting to pursue the CLVT credential?

If you’re interested in pursuing CLVT credentials, go for it! Although it’s a challenging and time-consuming process, making a positive impact in the lives of clients with low vision is extremely gratifying and humbling. The knowledge and interventions are versatile across practice settings and clientele of any age. One of my biggest challenges was finding an optometrist willing to help supervise me- it took about 3 months and a dozen letters of introduction before I was successful. Other issues (reimbursement; recognition of my role as an OT with a low vision specialty by other healthcare, rehab, and eye care professionals; documentation requirements; client referrals) also impacted the process. So, because of my experiences and challenges, I’m very open about my CLVT journey, willing to act as a resource for those OT practitioners interested in this low vision specialty.