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Responding to Dr. Renate Walthes and Marilda Bruno

Nurit Neustadt-Noy, Rehabilitation and Consultation Services for Blind and Visually Impaired Persons. Israel.  nuritnoy@macam.ac.il

As Dr. Walthes suggested “Early Intervention” has many aspects and can be looked at from more than one point of view.  I agree with her approach and wish to emphasize what I heard “in between the lines” of her speech, and add to it some of my thoughts.

The phrase “Early Intervention,” as you heard is linked to conditions that compose a wide spectrum.  Aside from the geography, economy, cultural values and beliefs, the term may tie to it a dynamic ongoing sensory enhancement that is critical to children who are blind or visually impaired.  It is important to intervene at infancy to construct the base of skills and self-confidence for optimal development.

Along with parents of visually impaired children, early intervention is the “business” of specialists including: General Practitioners, eye doctors, pediatricians, educators, rehabilitologists specializing in: assessments, low vision, vision stimulation, skills teaching, concept development, orientation and mobility, activities of daily living, communication including pre-Braille and Braille skills, group treatment managers, kindergarten and school teachers and ….  the community at large.

In other words, early intervention is provided by a multidisciplinary team which assesses the child's strongest and weakest abilities and his or her special needs. The interdisciplinary team enhances the parents’ power to develop the child’s best potential.

They coordinate language and social skills programs; sensory stimulation, support and psychological counseling, using specialized services, books and materials in the appropriate media, as well as specialized equipment and technology, to assure equal access to the core and specialized curricula to enable the visually impaired child to most effectively compete with their peers in kindergarten, at school, and ultimately in society.

Early intervention activities should result in an improved foundation for the child to integration into the school and community environments. Early intervention involves individualized and group programs of instructions and therapy, for infants, toddlers, preschoolers and school age children who have visual deficiencies, sometimes accompanied with developmental delay and other disabilities. The early intervention experiences at various levels of education continue to affect the life experiences in later stages of youth and adulthood.  Early Intervention programs may be offered in a segregated environment, as well as within a community based, mainstreamed or inclusive circumstances.

I remember an experience I had many years ago when I managed a support group of parents of blind and visually impaired children. The parents were in the stage where they had to make a choice between a few educational models. Based on information about the local educational options these parents decided as a group.

At the time three options were available to them.

The first choice was Integration where all visually impaired children were driven to one selected school in one of the city's neighbourhood, there,   a full- time specialized teacher provided the extra curricular support service in a resource class. Many times, the children spent 3 hours round trip on the road.

The second choice was inclusion in the neighbourhood schools, where each of the children received up to six weekly extra curricula support hours provided by an itinerant teacher, under the Ministry of Education, and a weekly session by a rehabilitation instructor in O&M, ADL Communication and Social Skills under the Ministry of Social Affairs.

In both options, the extra curricular classes were offered, overlapping with other class activities and caused the children to miss part of the regular classroom activities. Activities such as sports, art and social interaction were, in most cases, the “missed classes.” Needless to say, the children missed as much as they gained with this set up.

The third alternative was to send the children at a segregated residential school for the blind. This was the less desirable option.

Although most parents chose to register their children at home-based schools, they quickly learned that each of the alternatives had its up sides and down sides.  They learned that they had to continuously advocate for their children’s specialized intervention.  They learned that there was no one best solution and that there are no two children alike. In addition they learned that, at each stage in life, the child may benefit best in a different model of intervention.

Years went by and I never stopped believing in the support I gave to that first group of parents in making their choice.   In a very short time the regional integrated school model resolved itself, when the group of visually impaired children attending it, graduated, and the inclusive model became dominant.

I was and remain a strong supporter of inclusive education.  But a few years ago, after having read Dr. Mike Bina’s address to The National Federation of the Blind's annual convention, I had a new insight. 

Dr. Bina articulates educators of visually impaired children who strongly support full inclusion as “hypocrites.”  He compares the special needs of the visually impaired child in education to the special needs of the very talented child.  He compares needs to develop skills in math, science, dance, computers, arts, etc, to the need to develop special skills using alternative senses to vision.  He suggests that just as we refer talented 'special needs' children to specialized programs for children like themselves, in  “magnet programs” as he names it, so we need to refer the visually impaired children to specialized magnet programs namely - residential schools for the blind.

Just as magnet programs are designed to enhance talented children’s abilities to their full potential among children who have similar abilities like them, by specialized staff, best tools and best suiting environment, so are the schools for the blind.

Bina further stated that “Residential schools do not segregate or restrict in discriminatory manner, but rather positively and purposefully bring together children as do science, math and music management schools which consolidate students with special interests and aptitudes.”

He also claims that “meaningful integration is very possible in segregated settings, and just because the child lives at home, attends a neighbourhood school, and is in physical proximity to non-handicapped children, it does not necessarily mean that they are truly integrated.   We all are aware of students who are isolated islands in the mainstream….

But critics do not call it inappropriate isolation segregation”.

Based on this concept, it may be time for educators to re-examine early intervention options for visually impaired children. We may need to look at concentrated teaching of the  other senses to complement the missing visual skills, to look at this “special talents”, that need the best, specialized support to be developed to full potential.

This should not necessarily be done at Schools for the Blind, but may be based at specialized Resource Centres that offer an array of services supporting the children and their parents and preparing them for the future.

Some general thoughts….

It is very obvious that we need to develop, world wide, better early intervention programs. They may be in an inclusive, segregated or resource center models.   Information about the prevalence of visual impairment and multi handicapped children should be collected in a consistent systematic way.

As it is now, agencies that do collect data, utilize differing criteria. This results in conflicting and widely disparate estimates of the population of children with visual impairments.  Data are particularly lacking for children between birth and preschool age, where changes in the incidence rate of visual impairment and multi handicaps are firmed after final diagnoses are made.

These diagnoses have important implications for program development, evaluation, personnel preparation, in-service training and funding.  The role that vision plays in learning has been well-documented. Data emerging from the largest study of young children with visual impairments and multi-handicaps, in the last 50 years, suggests that the developmental experience of young children who are visually impaired is significantly different from that of children without disabilities.

The impact of a visual impairment cannot be minimized, particularly in the presence of additional disabilities. Unfortunately, it is children with visual and multiple disabilities who are often either un-served or in-appropriately served by early intervention systems.

The emphasis on developing early intervention services necessitates that accurate, dependable, and consistent data be collected. So far, no international data system  exists that identifies characteristics,  unique to blind and visually impaired children - such as; incidence of specific eye conditions, ethnicity, geographical distribution, socioeconomic status and presence of additional disabilities.  If this information were available, it would allow decision makers to identify trends that have important implications for the future in: preventative medicine, education, teacher training, funding, and service delivery.

Such information would globally improve early intervention, special education services and policy development. It will progressively document the needs of young children and their families, and project the future needs of early intervention programs for children with visual impairment.


Bina M, (1993) Pierce B, Editor:  The Braille Monitor, Mainstreaming, schools for the blind, and full inclusion: what shall the future of education of the blind children be.

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