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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.
·
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.
·
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).
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.
·
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.
·
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.
·
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..
·
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).
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.
·
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.
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.
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.
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.
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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