THOUGHT PROVOKER 113

     "Before I introduce our guest speaker for this 113th THOUGHT PROVOKER I need to make a few remarks, in a sense set the stage." I said to the nearly 500 people gathered in the room. We were all members of a discussion forum called THOUGHT PROVOKER and had a common interest in all blindness issues. "Recall that in THOUGHT PROVOKER'S past we have had guest authors, four in all. The first was Dianna Quietwater, with TP67 BECAUSE I LOVE HER. The second was Michael Bullus and TP91 FACING THE NEW WORLD. The third was Sarah Cranston and her TP100 WHEN I HAVE CHILDREN. The fourth and most recent was Nancy Karsten with TP102 ASSISTANCE OR NOT."

     The group was quieting down nicely. With their common interest and unique mix, it was a natural for them to want to visit; the makeup was about 70 percent blind or severely visually impaired individuals, 30 percent who were sighted with about twenty-five percent of the total being professionals within the field of blindness rehabilitation.

     "The woman I am about to introduce to you represents an important group of professionals, individuals who are dedicating their careers to serve the blind. And in this endeavor, she has written me asking for us to help her prepare to lead a discussion with other professionals in the field of blindness rehabilitation. I will say, that her request represents one of several of varying types that I will get within the average year. I of course read and think about any request I receive and look for merit to fit my vision of what THOUGHT PROVOKER is to be. Bottom-line, I felt her request posed an important issue, indeed more than it appears to be upon its surface and thought her need for guidance was worth creating a TP to address. And so with no further ado, please help me to welcome Emilie Meadows."

     "Thank you. I know a THOUGHT PROVOKER is to be brief and so let me get right into it. And for sake of background, I am a clinical social worker, employed by the New Hampshire Association for the Blind, a private non-profit agency that provides free rehab services across our state. I coordinate rehabilitation services, provide individual counseling, facilitate support groups, etc, all with the goal that a person can live fully and independently with vision loss. Soon I will be presenting at a regional conference in Montreal, a workshop for professionals working in the blindness field; rehab teachers, O&M instructors, low vision therapists, social workers and job counselors.

     The THOUGHT PROVOKER I wish to pose is the same question or theme which is being asked of the  workshop participants and it is whether or not environmental factors are important when it comes to adjustment to vision loss and if so, to what extent? For example, family, living situation, availability of public transportation, etc. It would be especially helpful to hear from people who lost vision after childhood, for whom learning to live with blindness was more of a conscious issue, to get an idea of whether or not these factors matter. And if they do, how making changes in the environment might especially help people who are newly blind or visually impaired adjust more easily to this new challenge in their lives." 

**1. Does environment play an important part in adjusting to being newly blind?

  Most certainly, the attitudes and notions of the family around you plays a big part on how one deals with every situation.  I lost my vision at the age of 16 years old and how my family handled the situation played a huge role in how I dealt with my loss.  No one in my town, well no one under the age of 18 had ever lost their vision and attempted to go to the regular schools.  I had to be a pioneer in everything I did, and my family, never having to deal with the situation or ever knowing a blind person naturally had their preconceived stereo-typical ideas.  The education that I received, mobility, orientation, living skills, Braille, counseling, etc., they had to take it also, they had to learn right along with me.  My family was wonderfully open to educating themselves and dealing with every new situation physically and emotionally.  If they were not, it would have made me reluctant to deal with the new situations and to learn.  If my family would have been embarrassed and insecure about dealing with situations, than that way of thinking would have spilled over on to me.    Your neighborhood, the schools, the extended families, the peers, and husbands and/or wives and children have everything to do with acceptance and dealing with it.  Sometimes it is harder for the loved ones to accept things than it is for the actual blind person.    I can only speak from my own experience, but I do think environment has a lot to do with adjusting.  Remember, evolving and growing is both nature and nurture. 

Your friend in Buffalo, 
Maria  

**2. What a great way to open communication among consumers and the people who serve them. As a consumer, I feel fortunate to live in a state (NY) that supports my desire to live fully and independently. I will soon graduate with a master's degree and begin to look for a job. As someone who lost my vision at 28, I feel that my rehabilitation took a back seat to raising my family. I'm not quite sure I'd do it differently if I had the chance to do it over, but I think if I had more support from friends and family, I might have done more for myself. I didn't have any role models. I was alone in my adjustment. If the professionals can make the effort to find mentorship for newly impaired adolescents and adults, there would be less depression, family duress, and probably even less rehab time involved. I say this because of my personal experience as well as my work as a family therapist. Pairing a newly impaired person with a blind person who is willing and able to foster someone in an appropriate manner would be a great way to help an individual. Additionally, at the time of my diagnosis, I didn't know how to tell my family, let alone know how best they could help. I would have benefited from a professional who could visit or meet with my family to educate them about my adjustment. They just didn't know how to approach me so they stayed away. My family pitching in would have been great during my most difficult times.

Regards,
Ann Chiappetta, M.S.
Family Therapist

**3. I have been blind all my life, so I can't discuss the changes which someone goes through, having lost their sight later in life, and trying to adapt.

But, I can tell you that environment definitely makes a difference. I've met several people, lately, who, despite their families, have become independent adults, with good attitudes about blindness. But, they still have the baggage from their family's negative attitudes.

If a family doesn't believe that a person, who is blind, can live independently, hold a job, get married, etc., this attitude is taught to the child, all through their formative years. In some cases, families go further than simply saying that they don't believe the blind child can do certain things. Some have gone as far as telling the blind person that they're stupid, or not as good as siblings. Families can also make the blind person feel as though they're a burden, because they don't want to be bothered providing transportation or other assistance, which might be needed. As far as I'm concerned, this is a form of abuse, especially when it's done intentionally, and not simply out of ignorance.

The transportation issue is the next environmental issue. Blind people who choose to live in large cities may not have as much difficulty as others who live in smaller towns or rural surroundings. To some extent, we have a responsibility to choose the most accessible place, we can, to live. We can't all live in a major city, and wouldn't all want to. But, evaluating the public transit system is extremely important in determining where we can live, independently.

These are just two areas, and I'm sure a much longer discussion could be had on this subject. But, these illustrations, I believe, indicate that environment plays a very large part in our success and independence.

Cindy Handel Willow Street, PA

**4. Hello, with all due respect to the questioner, when are environmental factors    NOT important in any life change, whether planned or not. The question should not be whether environmental factors are important - they shape, mold, delineate, structure, color and often distort a life-altering circumstance.

So, the question in my opinion should be:  Which environmental factors are important, and why?  And probably mine is all too general as well. One environmental factor certainly, would be the attitude of family members about disabilities generally and blindness specifically.  If, for instance, people had traditionally held the view that the blind were somehow inferior, less fortunate, in need of help from the sighted, well, then adjustment to vision loss might be seriously jeopardized.  If, on the other hand, family members held a view that a blind person simply acquired blindness as a characteristic with which he/she should adjust, just as to any other characteristic of, for example aging, adjustment might be easier. Naturally, those knowledgeable about stages in a life cycle might expect a period of anger, grief, or fear, but with professional support, such feelings could be worked out.

This question hits home for me. we recently accepted on our caseload a young man who is now blind due to drowning.  I think he was under water for about 2 minutes.  He fell from a cliff, and the people think the taotao-mana (ghosts of the ancestors) caught him, because he didn't die. Besides this, he's been out of school for a year and now we' looking at Braille, technology; and O&M along with every other adjustment that needs to be made.  But first, no one, including the student, has ever had any kind of counseling to deal with vision loss.  I'm not qualified to do much, though I can certainly offer blindness related info.  I'm wondering how far I'm going to get without the support of professional counselors/therapists (see, I don't even know for sure which support to request - school counselors first, I imagine). To even begin to believe that environmental factors aren't important is, in a sense, quite the denial. By the way, the father of the young man I'm describing here has worked with para-transit for about 15 years.  He's had lots of dealings with capable blind people.  Somehow though I don't think it helps where his son is concerned. 

best, as always to all TP readers,
kat Guam

**5. Having sight most of my life and then becoming blind three years ago the hard part is learning how to let other people help you do things or help you do it.  Now you have do more planning where you are going and when and finding the  the person to take you or arrange transportation.  The other is people offering to do things which you can still do and you let them do it so that you do not hurt they feeling.  Try explaining to person what help you need and you know that they thinking you are blind how does he or she know what they talking about.  Or handling the person whom talk to other person that you with like you do not know how or what you want.

  AT time when you want to yell out I can do it myself.

Dexter

**6. There are so many factors that contribute to how one adjusts to blindness, but I do believe environment can be part of that.

Suitable environments may offer better opportunities, but I believe the person's ability to be a problem-solver plays a very significant role.

I've seen people who have adjusted either very poorly or very well to blindness, but this is a reflection on their personal attitude on how they see themselves in relation to problem-solving, overcoming life's obstacles, whether or not they have to do with blindness, etc.

Judy Jones

**7. The issue of environmental factors, if and how they may effect adjustment and independence of blind people, is one that has been discussed for years.  Depending on who you speak with, some say that we must adapt to the environment, so we have the skill to handle anything that comes up.  Others feel that the environment must change to enable us to be as independent and safe as possible.  Personally, I believe that the solution is somewhere between.  When and where possible environmental factors can and should be altered, but the person must also be able to adapt to situations, at least till changes can be made.  Part of the process should be for the person to learn what needs changing and how to accomplish them.  However, the same person must not come to rely entirely on the presence of an adapted environment.       I feel that the person's environment is quite important, because it can have a tremendous impact on his/her ability to live independently.  For instance,

I once had a client, who completed a program of rehabilitation at a center (she was blind from birth), just to have her family refuse to permit her to be even a little independent.  Frankly, we failed to fully consider the impact that the family would have on her continued adjustment.  As for the person who becomes blind or severely visually impaired after spending many years depending on sight, adjustment, both physical and emotional, won't be easy.  The person has believed that blind people can't do anything.  The adjustment process must include the changing of inappropriate attitudes, as well as development of adaptive skills.  I do agree with those who say that altering the environment to adapt to the needs and abilities of the blind person will enable him/her to acquire the adaptive skills more easily, but at what eventual cost.  Will having audible pedestrian signals at intersections help or hinder the person's ability to learn to cross streets?  Will learning to use a talking microwave   enable the person to prepare foods once he/she is home?  Perhaps the answer is to have the person first experience adapted situations, then introduce him/her to other conditions, once self-confidence is improved.    

I must say that I may not quite fit what you requested.  I've been totally blind from age 8.  However, My career and activities have given me the opportunity to speak with many people with various degrees of blindness and of all ages.  I've been an adjustment counselor, a textbook recording specialist at a university, a supervisor of volunteer services and now about to teach home management skills at an orientation and adjustment center. 

Doug Hall (Daytona Beach, FL)    

**8. Perhaps environment does play a factor in adjusting to vision loss. One could have a supportive family or a sheltering family. One could have a hard time adjusting in a rural community, especially. I don't know how I'd survive on a farm.

Beth NABS NFB listserv

**9. Remember, it is not just those who lose their sight later in life who must consciously choose how they will deal with it. I was born with cataracts, and I struggled while I was growing up with how to deal with my blindness. I had a lot of confusing ideas from everyone. Internally I knew there must be a truly positive way to approach blindness. I found this approach when I joined the National Federation of the Blind. The attitudes within this organization reflected perfectly what I believed and wanted. I was fortunate to find the NFB while I was still in high school. After I graduated, I attended Blindness: Learning in New Dimensions, (BLIND, Inc.), and it solidified my beliefs.

Now I have two blind children. They are being raised in the Federation, but they must also choose how they will deal with their blindness. They have good role models, family support, and a helpful environment. However, there is still that internal element of choice. Just my thoughts.

Kasondra Payne NFB Parents of Blind Children listserv

**10. I have been partially blind for most of my childhood and just recently totally blind because of Retinitis Pigmentosa. In the near future I am planning a move from my home for the past 12 years. We have very limited transportation here. With each milestone in transportation - The bus extended its hours from 9 AM to 7 PM to 8 AM through 7 PM, The bus began running between Nampa and Boise. My husband and I have celebrated. When our daughters began driving our options seemed limitless. We have been on road trips and it was nothing to ask for a ride after hours when the bus stopped running.  Now, Though, a strange feeling of independence have come over me. I want to be able to "catch" a bus when I want to. I want options to go more than just to the doctors or shopping. I want entertainment which I could only get when my daughters drove us. So, in our search for a new home we are determined to find a city where public transportation is readily available.   So for us, one of the environmental factors we look for is public transportation. Nampa was a nice place to raise our daughters, but now we are ready for the city again.

Janet George

**11. I am not in the group you wanted to hear from since I lost my vision at age eight.  However, I did leave home at nineteen and remained independent of family support that is I never returned to the nest again other than for visits.  Most aspects of blindness can be handled with creativity and some forethought.  The most destructive thing to dealing effectively with blindness is a negative attitude from those around you.  Although I am a friendly and by choice, outgoing person, I find dealing with other peoples reaction to my blindness most wearing on my spirit and ability to cope.  Sometimes I get too exhausted to face large groups of strangers because I am just plain tired of being an educator or token blind person.  Yes, it is a good idea to choose a good location to take into consideration things like the availability of transportation etc.  For me at least, it is important to surround myself with people who can accept me as a person who happens to be blind rather than a blind person. 

DeAnna Quietwater Noriega Missouri

**12. I guess I would say that environmental issues are absolutely important in how a person lives, or adjusts, to blindness. I have been blind since birth, and in general I feel I have fairly decent skills. However, the lack of public transportation in my area means that I don’t have the ability to go where I would like to go, at least not independently.

 And other environmental factors also play a role in a person’s adjustment. Whether your family is supportive of you or not changes how much you feel you can do.

None of this is specific to blindness, or even to disabilities. Environmental factors change how everyone lives. But I think it is probably a little more noticeable in someone who is blind.

 Karen Anderson, Omaha, Nebraska

**13. I would agree with much of what has been said so far, that certainly environmental factors greatly influence a newly blind person's ability to successfully adjust to blindness.  The environment, of course, is multi-faceted, including the availability of public transportation and the attitudes of the person's friends and relatives.  I think this is also true for a person who has been blind from birth.  If you are brought up with positive attitudes about blindness from the first or, at least, in a family that recognizes that it needs outside help in determining how best to help you as a blind child, as I was, it can make a world of difference.   

I also want to bring up a couple of other issues, one regarding choice of environment, and one regarding the environment's impact on other relatives.  There was a man I spoke with once who had lost his vision, and chose to live in his isolated, rural area, where there was no public transportation, and he didn't see why he should move to a city or larger town where transportation would be more readily available.  He apparently thought that he should be able to rely on volunteers to drive him everywhere.  That sort of thing would never do with me, and it almost seemed to me as though he was displaying an entitlement mentality, that somehow this ability to rely on volunteers was his due.  This is the kind of situation, I think, in which the newly blind individual has some choice about his/her environment.  Of course, nothing is quite that simple, and there may have been reasons I couldn't even begin to imagine for his choices which seemed to greatly limit his life, and some of these reasons may have had to do with environments that could not so readily be changed.  Maybe he had a family that wanted him to stick around for their own reasons and didn't like the idea that he might move to a big city, further away from their assistance.   

Now, regarding this other point about environmental impacts on other relatives.  I once had a friend who tried to get me to guess who she was by recognizing her voice, before we knew each other well.  She was a victim of the stereotype that we are all so incredibly in tune with voices, that somehow we should be able to always guess who is talking with us, even though we don't necessarily know this person well.  I find it very hard to be patient with such people and, even though we were in public, I gave her quite a tongue-lashing and walked away.  The next day she called me, apologizing but also pointing out some things I was unaware of, in particular that her grandfather had lost his sight when she was a child, and the whole issue was hushed up.  Questions by her and her siblings, very natural questions about his blindness were forbidden by the adults.  Therefore, I would venture to say that she grew up afraid of blindness and of asking questions, and she fell into an erroneous belief system which almost destroyed our friendship.  Fortunately, she was a brave soul who was able to talk to me, and my irritation with her turned to compassion, but also sadness that she, in my mind, was damaged that way as a child.   

So, in conclusion, I would have to say that environmental factors in this situation can be extremely important, although sometimes people do have environmental choices they could make which might improve things.  And I would also say that the environment not only impacts the newly blind individual, but the rest of his/her family in often unforeseen ways.       

Mark Tardif 216-621-1854

**14. This one is a complete no brainer!  Environmental factors have a tremendous and overwhelming impact and should be carefully considered.  While previous research regarding a persons  perception of his or her control over the outcome of a particular task,  "Locus of Control", is all over the place and non conclusive  ,   this theory did not consider environmental factors or the individuals overall  self concept.   As a result simply   forcing success over a task had no overall or lasting effect. On the other hand,             "Attribution theory developed in Canada   carefully    considered several psycho/social factors.  When we tested this theory with blind individual we had  an overwhelming degree of statistical significances. While column and row effects were non-significant, the interaction effects between the variables were highly significant when social and environmental factors were taken into account. 

             Emily May I  also suggest that you carefully examine and utilize Developmental theory to identify and  access secondary issues  as they are related to the various life stages as these issues are important to an individual and will              very across the various life stages of an individual as he or she attempts to integrate  changes into there overall self concept and effect his or her adjustment to vision loss.  While we cant control many environmental factors which impact  our lives we can certainly control our perception of our ability to adjust to these various changes.  For more information regarding the for mentioned research contact me by  phone  

Robert Doulas Lincoln Nebraska

My friends were another big part of the environment that had influence upon me. They felt bad for me and also didn't know what to expect. So, they mostly didn't do anything, they left me alone; some of the closer ones did still interact with me, but too many times I was not asked to join them in some of the things they did because they didn't think I would be able to do what they were doing. After all, they and I have never had a blind person our own age around and not even one a little older that they could learn from. Our town was a small one and mostly any one who was visually impaired was very old like a grand parent and we all didn't see them doing anything out side of the home.

The town mostly thought I would be staying home and living with my parents for the rest of my life. Or, some thought there were schools and places for the blind to go and live, places that had wires stretched from building to building to help you find your way. Or they thought I would become a religious guy, some one closer to god and all based on the loss I was feeling. Or, some even thought I could start learning the piano and become like Stevey Wonder. One thing that was also bad, because I couldn't read print any more, I only had talking books to read and that meant only books and not much daily information to read in order to keep up with current events like my peers. Yes, I had the TV and radio, but that is a different dimension, a some what lesser one. And what I'm saying here is, only listening to the world is different than the more interactive and active participation of engaging the mind through the written word like print or Braille.

And of course I was always stuck at home unless a friend came and picked me up in their car. So here was a major change in life for some one in my environment; I would normally had the option to get my own set of wheels and do all the things teens did back there in my little neck of the world.

I didn't get the chance to work like other teens either; I didn't know what I could do and no one else did either. This also effected me.

And in writing this I can also see that not only did all around me effect and shape me as a newly blinded person, but what I or who I was also came into play. But, wasn't that also a result of what my environment was or had been prior to my blindness? Oh sure, nature or my jeans also played a part, speaking of that old nature and nurture thing.

But what I can say now by looking back, is that some one needed to work with me and my family. Someone also needed to help my peers and the whole town know what was possible for a competent blind person to be able to do; then of course to first push the blind person to go and get the training and the confidence. And then most of the other parts then fall into place for the blind person; you either move to where there is better transportation or learn how to better work what is available and you then also can do more around the house and community for yourself and for others because you have Braille or large print or other skills to do what ever you need to carry on with life.

So I'm saying, don't just work on the blind person themselves. Work on all of the parts that make up the whole.

Marvin

**15. The question was, How does environment play a role? i.e., family and living conditions? This one is unique, in that it is the first one I know of that is not a short story, but strictly scientific in its approach. And, although I am not blind, I think I can offer a worthy perspective.     First of all, I come from a community where I had seen only ONE blind person. (I will explain later.) Woonsocket, Rhode Island is a dead-as-a-doornail community, with absolutely no future. In fact, I dare say the entire STATE is like that. Our General Assembly is so busy trying to get a casino built here that they can't (or won't) accommodate businesses that try to bring legitimate jobs. But, even if they did, Rhode Island's public transportation and highway system are, by far, the WORST in the country. We pay more taxes, and get less in return, than any other state. Therefore, even if there were good jobs for the blind around here, the chances of getting reliable transportation are virtually nil. And, if you should dare to walk, be warned that we also have the worst DRIVERS in America. They will run you down, then yell at you for mussing up their cars. No blind person in his or her right mind would touch this state with a ten-foot cane!   

   Secondly, with regard to "family" reactions, that might be a tough call around here, too. In addition to being the most corrupt, ineptly-run state in the country, Rhode Island also has more than its fair share of unfriendliness and dishonesty. Most of the families I've known in this state are nasty, unfeeling, and downright liars.      On that note, I feel I should make a more personal point. I repeat: I am not blind, though I do tend to have serious bouts of depression. Because this runs in my family, a number of other family members tend to go the "self esteem" route. That is, they try to offer "compliments," in order to make me "feel good." I would bet my bottom dollar that a newly-blind person also goes through this bull. In your case, some well-intentioned (but ignorant) sighted person will try to "cheer you up" with such nonsense as "compensation," or some other blindness-related cliché. Every issue has things like this.      I hate that! If you're facing ANY crisis, regardless of what kind, the least you need is HONESTY from your family and friends. It is not good to bring up your "self-esteem" with FALSEHOODS, especially those you KNOW to be false. I think this is the worst mistake anyone can make.      I often try to imagine what I might do in a crisis like this, especially when dealing with a blind person. But, having never experienced it, the best I can come up with is a theory. If I had a friend or relative who suddenly went blind, I suppose the best thing to do is simply to have an open ear. Let the other person do all the talking, then wait for HIM to ask a question. Then I would answer that question in the best ways I know how: 1) "I don't know." 2) "Please don't be offended." 3) "May I make a suggestion?" Or maybe I'll say something off-the-cuff, but try to be diplomatic. I find that statement #2 has always worked.     The whole thing goes back to one's acquaintances. Personally, I could count on one hand the number of them whom I would trust, and in whom I could confide, and only ONE is a relative. As for that one blind person I'd ever seen in my hometown? That was a diabetic relative. We were never close to begin with. Her entire side of the family is downright cold. Always had been, always will be.      Therefore, if a family is to be any good to a newly-blind relative (or one facing any particular crisis), they had better be close to begin with. They have to have an aptitude for love, joy, peace, honesty, togetherness, and all the other emotions that are essential to strong family relations. Because if they don't already have that, the person facing a crisis will be in for one hell of an uphill climb. 

David Lafleche    

**16. Well, I have been blind from childhood, but still think I have  some  insight into this particular issue.   Incidentally, I am a mental health professional myself. I am blind but work in the sighted mainstream at a private agency in SC.    I believe environment is   a huge factor in someone successfully adapting to vision loss. Even those born blind or who are blind from childhood have to adapt as their   life situations change and they have to take on greater responsibilities as adults.   Ideally, one's environment will allow for the greatest number of options and the greatest  possible amount of personal choice.   What I mean, for example, is that someone who is blind should have the option of relying on friends/family for transportation or taking a bus, DART,  cab, etc.  They should have the option of making their own dinner, walking to a nearby restaurant, or  of  food being delivered.  Such things are very important to a sense of  personal competence and freedom to choose how to manage one's sight loss.    For example, I live  in an apartment high rise in a downtown area.  I prefer this for several reasons.  One is that  I can easily walk to local restaurants, a park,   a convenience store, a nearby church, and even a local  theater and    a couple of places where concerts and other performances are held.  There are  several bus stops near my home and  I can also call cabs or take the  DART bus, if I so choose.  There are  restaurants that deliver to my home.  I can pretty much order in anything I want, if I choose to. I don't always  exercise all these options but I know they are available to me. I grew up in an area  that is very rural and  where I couldn't walk anywhere, take a bus, have anything delivered, etc. so I don't take having such control for granted.  I also am able to have groceries and prescriptions delivered to my home. These services are available to the community as a whole, not just to me as a blind person, so I have no issue  taking advantage of these resources. No one is granting me special accommodations or favors because I am blind. These things are very convenient and helpful, though having groceries delivered does cost more. It saves me a lot of stress, time, and energy, though, and I find it well worth the money. Similarly, for those who have the Internet or access to it,  so many things can be ordered on line now and that  can help a lot with shopping and getting needed  household items and  personal care products, etc., as well as stuff for fun.   I make use of all these things and don't have to worry about someone having time to take me to the grocery store, help me with finding things at  Wal-Mart, etc. I can shop at my own convenience.   Even if someone can't afford their own place, it is always possible to find a reasonably priced apartment and even to get a roommate or room with friends.  This can also be helpful for those transitioning to independent living who  want to  have a sense of security that they won't be living alone. I had roommates for several years before getting my own place. Now, I have several good neighbors I know would help me in a pinch.  They don't come by and check on me or anything but I know I could seek them out if I urgently needed something, if my guide dog was sick, etc. 

  I  believe skills are vital, as well. One can't make optimum use of environment without having the skills to navigate an area,  do some basic cooking and cleaning,   do one's own laundry, etc. Also, if one does not have computer skills, this limits options. Assertiveness skills are  often necessary, as well.  We need to know when and how to ask for, and decline, help. So, those are my thoughts.  

Carmella Broome, Ed.S., LPC/I, LMFT/I Crossroads Counseling Center