There is an increased use of block-based programming environments in K-12 education and computing outreach activities to introduce novices to programming and computational thinking skills. However, despite their appealing design that allows students to focus on concepts rather than syntax, block-based programming by design is inaccessible to people with visual impairments and people who cannot use the mouse. In addition to this inaccessibility, little is known about the instructional experiences of students with visual impairments on current block-based programming environments. This dissertation addresses this gap by (1) investigating the challenges that students with visual impairments face on current block-based programming environments and (2) exploring ways in which we can use the keyboard and the screen reader to create block-based code. Through formal survey and interview studies with teachers of students with visual impairments and students with visual impairments, we identify several challenges faced by students with visual impairments on block-based programming environments. Using the knowledge of these challenges and building on prior work, we explore how to leverage the keyboard and the screen reader to improve the accessibility of block-based programming environments through a prototype of an accessible block-based programming library. In this dissertation, our empirical evaluations demonstrate that people with visual impairments can effectively and efficiently create, edit, and navigate block-based code using the keyboard and screen reader alone. Addressing the inaccessibility of block-based programming environments would allow students with visual impairments to participate in programming and computing activities where these systems are used, thus fostering inclusion and promoting diversity.