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Developing Effective Practice in the Use of LVAs by Children who have Multiple Disabilities and Visual Impairment in the United Kingdom

 

Focus Area: School Years

Topic: MDVI

 

Mike McLinden, Ph.D.

Lecturer in Education (Visual Impairment)

 

Graeme Douglas, Ph.D.

Research Fellow

 

Steve McCall, Ph.D.

Lecturer in Education (Visual Impairment)

 

Chris Arter

Lecturer in Education (Visual Impairment)

 

Visual Impairment Centre for Teaching and Research

University of Birmingham

School of Education

Edgbaston

Birmingham

B15 2TT

United Kingdom

 

Tel: 0121 414 6733

Fax: 0121 414 4865

Email: victar-enquiries@bham.ac.uk

 

ABSTRACT

 

This paper reports the findings of a one year project designed to investigate the use of Low vision Aids (LVAs) with children who have multiple disabilities and a visual impairment (MDVI). The aims of the project were:

 

·        to investigate the current range of uses of Low Vision Aids (LVAs) with children aged 5-16 with multiple disabilities and a visual impairment (MDVI)

·        to identify factors that can be linked to effective practice in the use of LVAs across different age bands and different types of educational provision with children in the population

·        to develop and disseminate material that promotes the effective use of LVAs with children in the population.

 

The results of the study showed that of those children supported by the VI schools and services responding to the survey, over one third (36%) were described as having MDVI. Of these children, 6% were reported as using ‘optical’ LVAs (ie CCTVs, dome magnifiers) and 10% as using non-optical LVAs (ie reading stand, task lighting etc). No consensus on the criteria that were used to assess, monitor and/or evaluate an LVA programme was found, and a series of recommendations was devised for developing more effective proactive in this area.

 

BACKGROUND

 

Despite increasing recognition of the educational needs of children with MDVI, the application of LVA technology for use with these children is still in its infancy. Research investigating the current and potential use of LVAs for children in the population, with a view to developing more effective practice in the field, was considered therefore to be both relevant and timely.

 

The study was designed to build upon the research undertaken by Mason and Mason (1998) at the University of Birmingham which investigated the use of LVAs in mainstream schools by pupils with a visual impairment. Although the focus of this research did not include use of LVAs for children with multiple disabilities, dissemination of the findings at training days and conferences revealed a considerable unmet demand for additional guidance relating to their effective use with these children.

 

JMETHODOLOGY

 

The research study was divided into four broad phases.

 

Phase 1            Months 1-2

·        review of literature in the area;

·        semi-structured interviews with a sample of professionals in the field to clarify broad themes for the research focus;

·        preliminary contact with Heads of VI Services and Schools  in the UK to alert them to the forthcoming research project and request their co-operation.

 

Phase 2          Months 3-6

·        A questionnaire was developed and sent to all VI Advisory Services in the UK and specialist schools for children with a visual impairment (N=160). The questionnaire requested information about the use of LVAs with children in the population including:

 

            rationale for use (or non-use) of LVAs,

            categories for use of LVAs, eg for access to print, mobility etc,

            personnel involved in assessment, monitoring and evaluation of LVAs,

            criteria used to judge effective use of LVAs.

 

The schools and services were also asked to provide brief case study information in relation to children with multiple disabilities and their ‘use’ or ‘non-use’ of LVAs.

 

Phase 3            Months 7-9

·        On the basis of the responses to the questionnaire 17 VI services and/or schools were selected for follow-up research. Selection criteria included: type of reported visual impairment, (eg cortical or ocular); type of educational setting, (eg special school for VI, SLD or PD); age of child; different contexts of use, (eg for curriculum access or mobility etc).

 

·        Semi-structured interviews were carried out with the teachers to gather further information concerning:

 

description of child including visual function and nature of additional difficulties,

            rationale for use of LVAs with different children being supported,

            examples of work undertaken,

details of IEPs and records,

role and extent of involvement of other professionals.

 

Where appropriate, observations using video recordings were undertaken of these children using LVAs. In addition, a sample of services were interviewed to establish why LVAs are not being used (or are no longer used) with  children in the population.

 

Phase 4            Months 10-12

The final phase of the study involved:

 

            continued analysis of the data,

            production of the final report,

            dissemination of information through conferences and papers to be as well as the RCEVH/VICTAR website (see below for details).

 

MAIN FINDINGS OF RESEARCH PROJECT

The intended outcomes of the research project included:

 

·a report on the current use of LVAs with children who havewith MDVI in the UK in a range of educational settings. This report provides information relating to how many children in the population are making use of LVAs; where LVAs are being used; how effectively they are being used; the different contexts of their use;

 

·examples of factors that could be linked with effective practice in the use of LVAs through selected case studies;

 

·published material which would offer guidance to practitioners concerning the use of LVAs with children in the population and help them to

 

-identify the children who can benefit from LVAs;

-incorporate LVAs appropriately into teaching programmes;

-monitor and evaluate the progress of children using LVAs;

-determine the next stage of progression for children in the use of LVAs;

 

·information disseminated through journals, conferences and training workshops which can inform professionals working with children in the population;

 

·recommendations for further research in this area.

 

The main findings of the project are summarised below. The term ‘QTVI/QTMSI’ is used to refer to teachers who have undertaken a specialist mandatory qualification in teaching children with a visual impairment and/or multi-sensory impairment. ‘Low Vision Professional’ is used to refer to professionals with expertise in low vision assessment and includes optometrists, orthoptists and/or ophthalmologists.

 

 

PHASES 1 AND 2

 

Population of Children with MDVIChildren who have MDVI

 

·        Of 160 questionnaires sent out, 51 were returned, a response rate of approximately 30%. Of these responses 35 (22%) were  considered to be ‘quality’ responses in that they contained data on LVA use/non-use which could be included in the project. The remaining 16 responses were not able to be included in the data collection.

 

·        The VI schools and services responding to the survey supported 1669 children with a visual impairment. Over one third of this population (36%) were described as having MDVI.

 

·        Of those children described by respondents as having MDVI, 16% were reported as using optical or non-optical LVAs. Of this group, 6% were reported as using ‘optical’ and 10% as using ‘non-optical’ LVAs.

 

Use of LVAs by Children who have MDVI

 

·        The most commonly used ‘non-optical’ LVAs with children who have MDVI were reported to be reading stands and task lighting. The leastLess commonly used ‘non-optical’ LVAs were reported to be tinted lenses and torches.

 

·        The most commonly used ‘optical’ LVAs with children who have MDVI were reported to be CCTVs and dome magnifiers. The leastLess commonly used ‘optical’ LVAs were reported to be binoculars/monoculars and bar magnifiers.

 

·        Optical LVAs were reported to be most commonly used for ‘near vision’ tasks which included ‘reading’ and ‘looking at pictures/photos’. They were reported as being least less commonly used for ‘distance vision’ tasks.

 

 

Reasons given for ‘non-use’ of optical LVAs by teachers could be broadly grouped into ‘professional’ factors (ie lack of appropriate training/expertise) and ‘child’ factors (ie childschild’s difficulties served as barrier to LVA use).

PHASES 2 AND 3

On the basis of the responses to the questionnaire, all the teachers from VI schools and/or services who had reported using LVAs with children who have MDVI, and had given permission to be contacted, were selected for the semi-structured interviews (N=17). In addition, 2 respondents were selected for interview to establish why LVAs were not being used (or were no longer used) with children in the population. A summary of the findings of these interviews is presented below.

 

Criteria Adopted for Assessment

 

·        No commonly used criteria were reported for assessing a child with MDVI for LVA use were found. Teachers reported using a range of criteria including those which could be broadly recategorised lated as to ‘literacy’, ‘physical’, ‘visual’, ‘behavioural’ or ‘cognitive’ aspects of a child’s level of function.

 

·        Reference to how a child engages with symbols as part of early ‘literacy’ activities was reported to be the most common consideration used by teachers when deciding on assessment for LVA use. No clear criteria emerged however concerning how how the child’s engagement with symbols symbols were used by teachers when should trigger making decisions regarding assessment for LVA use.

 

·        The next most commonly referred to consideration concerned ‘physical’ aspects of the childschild’s function. However, there was no common consensus on how physical aspects of a child might affect any decisions made regarding assessment for LVA use.

 

Role of QTVI/MSI in Assessment of Need

 

·        The QTVI/MSI hads a central role in the initial assessment of need for children who have MDVI. In particular, the QTVI/MSI working in an advisory role often served as the main ‘gatekeeper’ for the referral of children with MDVIchildren who have MDVI for assessment for LVA use.

 

·        The role of the advisory QTVI/MSI in the initial assessment of need of children with MDVIchildren who have MDVI is was varied and is was dependent on a range of factors, including the educational placement of the child, availability of LV clinic and , available resources etc.

 

·        Decisions concerning assessment for use of CCTVs were frequently made by the QTVI/MSI (class or advisory teacher) with little or no input from other low vision professionals. In comparison contrast, assessment for other types of optical LVAs often included input from low vision professionals, usually through referral by the advisory QTVI/MSI to a Low Vision Clinic.

 

Role of Low Vision Professionals

 

·        The Low Vision Clinic hads a central role in the assessment of children with MDVIchildren who have MDVI for optical LVAs (excluding CCTVs), with referral usually made either directly or indirectly by the advisory QTVI/MSI supporting the child.

 

·        Different Varying levels of collaboration were reported between Low Vision Clinics and VI advisory services when assessing children with MDVIchildren who have MDVI for LVAs. When referral to a Low Vision Clinic was not possible, it was reported that other low vision professionals (ie optometrist or orthoptist) may be involved with the advisory QTVI/MSI in assessing the child for optical LVAs at school..

 

Role of Parents

 

·        Although parents were included in the decisions made about assessment for LVAs, they were only infrequently invited to a clinical assessment of a childschild’s visual function.

 

·        In the majority of cases optical LVAs were prescribed exclusively for school use. In a minority of cases children had access to an LVA at both home and school, although . iIt was noted by one respondent that the home environment might provide more natural opportunities for LVA use.

 

·        It was reported that a number of parents had been successful in acquiring additional LVAs for home use, either through private resources (CCTV) or through a formal request to the Low Vision Clinic (dome magnifermagnifier).

 

School/Service Policy

 

·        There was wide variation in the extent to which the needs of children who have MDVI were explicitly addressed within School/Service policies on LVAs, with a minority of respondents from schools and services reporting that their written policy on LVAs explicitly included children who have MDVI.

 

 

 

There was wide variation in the extent to which the needs of children with MDVIchildren who have MDVI were explicityexplicitly addressed within School/Service policies on LVAs.

 

 

 

 

A minority of respondents from schools and services reported that their written policy on LVAs explicityexplicitly included children with MDVIchildren who have MDVI. Each of these policies made clear reference to access to a low vision professional in carrying out an assessment of need.

 

A number of respondents reported unwritten ‘policies’ which were used to guide assessment of need. These included referral to a Low Vision Clinic for all children once they are beyond the ‘symbol stage’ in literacy, and ‘experimenting’ with different LVAs.

 

LVA Practice

 

·        Of  the respondents who reported LVA use with children who had MDVI the the majority of respondents reported described the use of these LVAs for near vision tasks. Only one respondent described use of an LVA for distance vision (monocular). This was used for a range of tasks within class (ie view the white-board and classroom displays) and out of class (assemblies, school outings etc).

 

·        The most commonly used LVAs for used for near vision tasks were CCTVs, and dome magnifiers and hand-held magnifiers. Only one LVA was reported as being used for distance vision (monocular). This was used for a range of tasks within class (ie view the white-board and classroom displays) and out of class (assemblies, school outings etc).

 

·        For children who could engage with print, the range of tasks described for use of the CCTV were mainly to access print through different types of literacy and/or numeracy activities.

 

·        Other uses of the CCTV were reported for those children who could were not access engaging with print including, viewing real objects; as a distance vision aid; to develop awareness of their own body image.

 

 

Monitoring and Evaluating Practice

Those QTVI/MSI’s working in advisory roles supported children with MDVIchildren who have MDVI using LVAs in a wide range of educational settings, including special schools and mainstream contexts. Not all the respondents reported working directly with the child, and a number were involved in training other staff to work with the child.

 

·        The majority of those interviewed worked in advisory roles and reported working closely with the child’s class teachers rather than directly with the children. Those QTVIs working as class teachers in VI special schools reported working directly with the child and emphasised the close involvement of other professionals (ie headteacher, school vision coordinator) in monitoring and evaluating LVA practice within the school.

 

·        There was no consensus on the criteria that were used to monitor and evaluate an LVA programme for children with MDVIchildren who have MDVI. In the absence of appropriate materials for use with children who have MDVI, a number of respondents reported developing their own schedules for monitoring an LVA programme or adapting those developed  for children using LVAs in mainstream contexts.

 

DISCUSSION

 

 

 

The analysis of the questionnaires revealed that of the children described as having MDVI, approximately 16% were reported as using LVAs (Figure 4.2). When the results are broken down into use of ‘optical’ and ‘non-optical’ aids, it was found that only 6% and 10% of the children who have MDVI were reported as using optical and non-optical aids respectivelyaids. This finding provides support for the work in the literature which suggests that the use of LVAs for these children may not be being sufficiently exploited. In particular, they concur with the RNIB report (Walker et al 1992) which highlighted that LVAs are mostly being used with children who have no additional disabilities, questioning whether ‘additionally handicapped children are being sufficiently challenged, and encouraged, to use whatever sight they may have to assist in their learning’ (p 5).

 

The CCTV and dome magnifier were the most commonly used optical LVAs with children who have MDVI, the least commonly used optical LVAs being binoculars/monoculars and bar magnifiers. Although no comparison of this finding can be made with other studies in the literature, it is perhaps not surprising that the CCTV is reported as being in relatively common use with children who have MDVI.  A significant advantage of the CCTV is the ability to readily vary the illumination and contrast of the image produced to meet the needs of an individual child (Bennett 1997). Further, CCTVs offer the facility to provide a higher degree of magnification than can be obtained from other optical LVAs. In addition, as the results of the semi-structured interviews illustrate, teachers using CCTVs with children who have MDVI rarely involved other professionals in the decision making process. Thus, in the majority of cases, no low vision specialist was involved in deciding on whether a CCTV should be used with a particular child. In comparison, the results of the semi-structured interviews show that use of the other commonly used optical aids (ie dome/hand magnifier) invariably involved professionals with expertise in low vision assessment in the decision making process. A series of recommendations have been made in response to the main findings of the study with a view to developing more effective practice in the area. These recommendations can be viewed on the VICTAR website.

 

ACKNOWLEDGEMENTS

 

The Research Team is grateful to the Viscount Nuffield Auxiliary Fund for funding this research study (project grant reference VANF/99/11).

 

but also how these activities might be cross-referenced to a ‘broader’ developmental view of literacy

The findings of the study highlighted the central role that QTVI/MSI has a central role in the initial assessment of need for children who have MDVI. In particular, the QTVI/MSI working in an advisory role often served as the main ‘gatekeeper’ for the referral of children with MDVIchildren who have MDVI for assessment for LVA use. A recommendation is made therefore that an initial assessment of need for LVA use by a child with MDVI should be embedded within an appropriate functional vision assessment (FVA) carried out by a QTVI and/or QTMSI. Where appropriate, the results of the FVA should be used to inform clinical visual assessments carried out by Low Vision Professionals when assessing a child for LVA use.

 

Although parents were involved in decisions made regarding LVA use they were only infrequently included in the initial assessment of need. In developing greater collaboration with parents, it is recommended that parents be more closely included within the assessment process and be invited, where possible, to attend clinical assessments.

 

Monitoring and Evaluating Practice

 

The QTVI/MSI working either in an advisory role or as a class teacher has a central role in monitoring and evaluating LVA use with children with MDVIchildren who have MDVI. The findings of the study showed there was no consensus on the criteria that were used to assess and plan an LVA programme for children with MDVIchildren who have MDVI. A recommendation is made therefore that a framework be developed for this purpose, using observable and measurable criteria to develop, monitor and evaluate an LVA programme which is developmentally appropriate to the child’s needs, and enables decisions regarding LVA use to be recorded and made accessible to both professionals and parents.

 

The findings of the study revealed that in the majority of cases optical LVAs were prescribed exclusively for school use, and only in a minority of cases did children have access to an LVA at both home and school. Given the possibilities afforded by LVAs in the home environment, it is recommended that schools/services and/or LV professionals explore how LVA practice can be extended to the home environment for children who have MDVI. Where appropriate this may entail separate LVAs being made available for home and school use, with the necessary training provided for parents/families.

 

Continuing Professional Development

 

The knowledge, understanding, attitudes and skills required by the QTVI will need to be responsive to the needs of the increasing proportion of children with MDVIchildren who have MDVI. It is recommended that specialist training programmes for teachers of children with visual and/or multi-sensory impairments incorporate components which focus on assessment, monitoring and evaluation of different types of LVAs for children who have MDVI, as well as the possibilities afforded by their use.

 

Learning Support Assistants (LSAs) have an increasingly central role in supporting children who have MDVI, particularly in special schools for children with SLD/PD. A recommendation is made that specialist training courses for LSAs include appropriate components which are aimed at developing their own knowledge, understanding and skills in order to work effectively with children who have MDVI using different types of LVAs.

 

Further Research

 

1.The main focus of the research study was on VI schools/services supporting children who have MDVI. Future research is required which focuses on the LV clinics to which the children are referred for assessment. In particular the research will need to explore the extent to which the clinics feel equipped to assess children across the spectrum of MDVI; the links established with VI schools/services, and the additional training required to develop the knowledge, understanding and skills of the professionals working in the LV clinics. Given the central role of the Low Vision Clinic in the assessment of children for optical LVAs, such research should also explore the extent to which closer collaboration between a school/service and LV clinic is possible and/or desirable, particularly regarding policy development, collaborative assessment and reciprocal staff training.

 

·The research methods adopted for this study did not provide the opportunity to monitor and evaluate a child’s progress in using an LVA over a period of time. It is recommended therefore that a future study incorporates longitudinal case studies monitoring LVA use with a sample of children over a period of time with a particular focus on:

 

-criteria adopted by teachers and/or LV professionals for assessment of    need;

-how the needs are met within the school environment, ie how much    additional time is required to incorporate training in LVA use in the    curriculum, how to meet the needs of an individual within a group    environment, training of the staff supporting the child etc;

-how the child’s needs are met within other environments, including    home;

-criteria adopted to monitor and evaluate LVA use with a child in different    environments and by different professionals.

 

The Research Team is grateful to the Viscount Nuffield Auxiliary Fund for making this research possible. The desired outcomes of the study have been largely achieved and it is anticipated that the information summarised in this report should be of value to a range of professionals working with children who have MDVI, including VI services, schools, visual impairment course providers and policy makers. As highlighted in Section 2, there is increasing recognition that children who have MDVI have distinct educational needs, and the findings of the study should provide a valuable foundation upon which to build further research in order to most effectively meet these needsREFERENCES

 

 

BENNETT, D. (1997).  “Low Vision Devices for Children and Young People with a visual impairment.”  In: Mason, H., McCall, S., et al. (Eds) Visual Impairment Access to Education for Children and Young People with a Visual Impairment.  London: David Fulton.

 

BOZIC, N., MURDOCH, H. (1996).  Learning Through Interaction.  London: David Fulton.

 

MASON, H., MASON, B. (1998).  The Use of LVAs in Mainstream Schools by Pupils with a Visual Impairment.  Report to the Viscount Nuffield Auxiliary Fund.  The University of Birmingham.

 

WALKER, E., TOBIN, M., McKENNALL, A. (1992).  Blind and Partially Sighted Children in Britain: the RNIB Survey, Volume 2.  London: HMSO.

 

A more detailed report of the project findings and recommendations can be viewed on the Visual Impairment Centre for Teaching and Research (VICTAR) website at the School of Education, University of Birmingham: http://www.education.bham.ac.uk/research/VICTAR/


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