Posted by VisionAware
Alan R. Morse is President and Chief Executive Officer of the New York- and New York State-based Lighthouse Guild, which provides a full spectrum of integrated vision + healthcare services helping people with vision loss, including those with multiple disabilities or chronic medical conditions. His professional interests include the influence of vision loss on health care utilization, functional implications of vision loss, and communication issues in patient-centered care delivery.
Dr. Morse is an Adjunct Professor in the Department of Ophthalmology, College of Physicians and Surgeons of Columbia University; a trustee of the Healthcare Association of New York State; and a member of the Advisory Panel on Addressing Disparities of the Patient-Centered Outcomes Research Institute. He serves on the Editorial Board of Ophthalmology, the journal of the American Academy of Ophthalmology, and recently has been appointed to the Academy’s Vision Rehabilitation Committee.
He is an ad hoc peer reviewer for more than a dozen publications, a current or past director of numerous healthcare organizations, and a regular participant on government panels, work groups, and committees. Dr. Morse received his B.A. from Franklin College, M.S. from Indiana University, J.D. from Pace University and Ph.D. from Fordham University.
Maureen Duffy: Hello Dr. Morse. Thank you very much for agreeing to speak with our VisionAware readers. To begin, can you tell us about your background? I’m interested to learn more about where you grew up, your schooling, what you studied, and how you got to this point in your life.
Alan Morse: I grew up in New York, in Wantagh, on Long Island. I went to Levittown Public Schools and from there I went on a little detour. I ended up at Franklin College in Indiana where I studied psychology. From Franklin, I went to Indiana University to study rehabilitation counseling on a federal grant. After finishing at Indiana, I came to New York to work at the former Jewish Guild for the Blind for two years, again on a federal grant. I ended up staying at the Jewish Guild, and finished my Ph.D. in counseling at Fordham University, also in New York. A few years later, I went to law school at night. I’ve been at The Guild, now Lighthouse Guild, ever since then.
[Editor’s note: In 2013, Jewish Guild Healthcare and Lighthouse International announced plans to combine as one organization. In 2014, the combined organization, called Lighthouse Guild, officially launched. You can read more about the long and distinguished histories of both organizations at Our History on the Lighthouse Guild website.]
MD: What drew you to study psychology?
AM: Well, I was debating between psychology and law. And I was going back and forth about it. Pre-law wasn’t really a defined major, not nearly as well defined as pre-med. And you could major in almost anything and call it pre-law. While I was looking for a major, I wasn’t particularly fascinated by history, and political science – both common pre-law majors – didn’t really intrigue me.
Philosophy had some interest for me, but I wasn’t sure I was smart enough to do that, so I ended up in psychology. Later on, my daughter was a philosophy major and used to call me up with arcane questions and I thought, Boy, I’m glad I didn’t major in philosophy!
MD: What about law? How does that fit into the whole picture for you? When I saw you had a law degree, I found that to be very interesting.
AM: That was really by chance. My work at the Guild involved a lot of law – a lot of contracts and negotiations – so I was reading an awful lot of documents. In the middle of one of our negotiations, we were using outside counsel. I asked him a question and he said, “Well, you wouldn’t understand because you’re not a lawyer.” And that’s all it took for me to decide to go to law school. Now I use it all the time in my work. It’s great preparation and provides great discipline.
MD: Speaking about planning (or not planning) things, what did you know about blindness when you first came to the Jewish Guild?
AM: I didn’t know anything about blindness when I came to the Jewish Guild. It was a work assignment. My only experience with anyone blind was with a fellow grad student at Indiana University and I didn’t have a lot to do with him because he was always in study groups with other people who were blind. So my first real experience was when I came here. I hadn’t read anything about blindness, other than the textbook chapter I read in my Medical Aspects of Disability course. I had to learn very quickly on the job.
MD: I’m interested to know more about your innovative work in identifying and treating depression at Lighthouse Guild. In the July 18, 2016 issue of Mental Health Weekly, Dr. Goldie Dersh, Vice-President of Behavioral Health Services, was interviewed about your Behavioral Health programs at Lighthouse Guild. I thought the article’s opening paragraph was perceptive and very true:
“The grief that often accompanies a considerable loss of vision can result in depression and a host of other problems. When the individual also has to address another serious medical issue, it becomes critically important to provide comprehensive and coordinated care. Few mental health provider organizations ever encounter a sufficient number of visually impaired patients to develop an expertise in meeting their needs.”
In the interview, Dr. Dersh says this: “Vision loss is often experienced as a loss of part of one’s self. These life changes are permanent. [People] experience difficulty doing the things they did in the past and often feel worthless.” I think many of our readers can relate to her observations. Can you tell us more about the Lighthouse Guild Behavioral Health program?
AM: Sure. First, let me expand all these quotes a little bit. One thing that often gives us problems is that many professionals have the impression that we at Lighthouse Guild regard mental health disability as something that occurs with blindness. We don’t think that. And we also don’t want to give the impression that we believe people have deep-seated, serious mental health problems because they are blind. That’s also not true. But for many people, loss of vision is accompanied by loss, sometimes by feelings of inadequacy or loss of self-sufficiency, and sometimes by depression. Having vision loss doesn’t mean you can’t also have other issues.
So we want other professionals who work with people with vision loss to be aware that when you have a patient with low vision – in an ophthalmologist’s or optometrist’s chair, for example – it’s not inappropriate to have some discussion back and forth, such as “How are you?” and “How are you doing?” This is normal “small talk” that people often have when they are at the doctor. And the doctor should be alert to indications that maybe this person could be feeling depressed or have other issues. We certainly don’t want – or expect – the doctor to deal directly with depression or other mental health issues. They are usually not equipped to do that. But the doctor should know how to refer the person to appropriate services.
Back in the 1950s, when the clinic here began, it was originally a full psychiatric unit. That’s how long the Jewish Guild has had its behavioral health interest. It was staffed, much as it is now, by psychiatrists, psychologists, and social workers. And people from other departments at the Guild were involved if the person had, or was perceived as having, related medical or rehabilitation issues.
As our practice and our clinic evolved and became wider in scope and more outward looking, we began encountering people – even people who were congenitally blind – who hadn’t been exposed to many other blindness services and training. Professionals from other departments within the Guild now had a chance to see something, to identify something, and to make referrals to behavioral health. We consider the behavioral health program to be integral to our offerings here. When people in our other programs, such as Vision Rehabilitation, Medical Services, or Education, have issues, we have a way to deal with them without having to look outside the organization for services.
MD: I’m not sure that all physicians are completely comfortable with that, though – with even asking the question.
AM: They’re not comfortable, but they need to be. It’s no longer appropriate anywhere in medicine, or anywhere in health care, to be talking about a patient as a disease entity. It has never been appropriate, but many physicians do it and have done it. Rather than talking about the nice man in Room 452 with a gall bladder problem, they’ll talk about the gall bladder in 452. That happens with blindness and vision loss also.
Oftentimes, when people who have vision loss are seen in health care, they are not recognized as being the same as, or similar to, other patients because vision loss is seen as a different kind of problem. Frankly, it’s something that the health care community has not dealt with very well, but needs to deal with well, because if they understand the implications of vision loss on what they are doing, it will give them better access to their patients, allow them to provide better care and, surprisingly, will find that better care will end up costing less.
MD: I agree with you. What are your thoughts on how to change this thinking and physician training?
AM: I have been invited to sit on a number of boards, work groups, and committees, and have had other professional opportunities, such as joining the editorial board of the journal Ophthalmology and the advisory panel on disparities of the Patient-Centered Outcomes Research Institute, so I get a chance to share these viewpoints with people who are far more expert than I am in a lot of things. They are ophthalmologists, physicians, specialists in other areas of healthcare, for the most part.
But they don’t deal with patients in the same kind of environment, in the same kind of setting that we do at Lighthouse Guild, so their viewpoints are quite different. They tend to see patients for a brief period of time for episodic care – every six months or every year or every other month for treatment. They don’t want to, they don’t have the time, and they don’t have the skill set, frankly, to start going beyond that. And that’s the reason why our behavioral health services are so important.
Also, we are working with the ophthalmology residency programs on a training program in vision rehabilitation that will be available across the country. The learning modules will include a range of topics, from how to tell your patients they shouldn’t be driving any longer, to identifying depression, to helping ophthalmologists understand what a low vision device or low vision assistive equipment is. We also want to help them understand state agencies and services and how that system works. In other words, we want to make them more knowledgeable about the world of blindness, not just the world of eye disease.
We expect to have the modules done in the next few months. We have the learning platform up and we are now starting to populate that. Certainly by this time next year it should be on the web and accessible to ophthalmology residents. What we hope is that when they have a patient with vision loss, they no longer have to say, “There’s nothing more I can do. I’ll see you in six months.”
MD: Here’s a final question for you as we wrap up our discussion. Could you talk about the importance of integrating vision and health care services? I know that integration of these services is a concept you support strongly and I’d like our readers to learn more about your thoughts on this.
AM: I think one of the things that so often happens – and this is not because of vision loss, it just happens in health care – is that it’s become so specialized. My view of the world tends to be through a health care lens, whereas other people’s might be through an education lens or a rehabilitation lens. So my health care lens very much shapes my thinking about this topic.
Here’s one example of how medical specialization affects integration of services. If I were in a car accident and had some broken bones and a brain injury that resulted in vision loss, my doctors would deal with the brain injury and the broken bones. But they would send me someplace else for vision rehabilitation to treat my vision loss. Why?
Why does it take an organization like Lighthouse Guild to provide that needed vision rehabilitation service when we’re only a few blocks away from many world-class hospitals, all of which have outpatient rehabilitation departments and all of which are working with people who have had strokes, for example? Thirty percent of stroke patients have vision loss, but these outpatient rehabilitation departments don’t see them as vision loss patients; instead, they see them as stroke patients.
In New York State we have about 18 full-service agencies for individuals with vision loss. There are many times that number of hospitals. Wouldn’t it be nice if every one of those hospitals could provide vision rehabilitation? People sometimes say that I’m “medicalizing” vision loss – but it’s just that most blindness or vision loss comes from a medical or health care condition. Something caused it, so you’re going to have interaction with the health care delivery system at some point. It would be good if that system could address your needs in a more medically comprehensive way. It can be done!
MD: Dr. Morse, I’ve very much enjoyed talking with you and learning more about your point of view. We thank you for your support of VisionAware, your innovative work, and your longstanding research and practice on behalf of blind and visually persons worldwide. It has been a pleasure to speak with you.