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Focus: Early Intervention
Topic: Professional Collaboration and Development
Ineke van Dijk Marjon T. Vink
orthopedagogue and manager child psychologist
Support, Research & Development dept. Early Intervention dept.
SENSIS BARTIMEUS
St Elizabethstraat 4 Oudenoord 325
5360 AB Grave 3513 EP Utrecht
The Netherlands The Netherlands
+31 486 471003 +31 30 2398239
ivdijk@sensis.nl m.vink@bartiméus.nl
Corry J.van Gendt-van Evert
child psychologist
Child Rehabilitation dept.
VISIO
Poortgebouw Rijnsburgerweg 10
2333 AA Leiden
The Netherlands
+31 71 5251515
In this session we will present an overview of the recent history of early intervention for children with visual impairment. This story, covering over 25 years in this field, will be told by three representatives from the Dutch organizations: Bartiméus, Sensis and Visio.
We will use the metaphor of “developmental processes” to illustrate how E.I. developed in a changing environment with the emancipation process of people with disabilities on the one hand, and how organizations for V.I. people had to provide a stimulating climate for professional growth on the other.
This presentation will cover three time phases:
- Where we started.
- The current state of the field.
- And finally what the future perspective should be.
Using this structure we will start by showing developmental changes from the client’s perspective. We will then reflect on the changing developmental characteristics of organizations and professional expertise.
We are presenting the early intervention story in this way to offer an anchoring point for countries where E.I. is just being introduced. There will be some analogies and it can be helpful to have an idea of the perspectives that could appear on the horizon in the stages ahead. This offers opportunities for anticipating processes and using this knowledge to perhaps gain time and avoid reinventing the wheel.
It is also for this reason that the one of the Dutch centres for V.I. decided to present the book “Looking Forward” during the ICEVI World Conference. The proceedings of a symposium held on the 25th anniversary of E.I. in the Netherlands formed the basis for a transcription, edited by Bartiméus with the help of the original editorial staff.
It is with great pleasure that we invite you to take a look at “Looking Forward - Developments in early intervention for children with visual impairment”, which is being launched at this conference.
An outline of the client´s position during more than 25 years of early intervention involves three distinct stages of characterization. When we talk about clients, we mean everyone within the client system, namely the child, parents and family as well as the professionals involved. Over the course of time, clients were perceived as:
- Handicapped people needing a great deal of care
- In the following stage clients became people with individual competencies to be developed.
- And in recent years clients have been seen as emancipated people making their own choices about what they really need from the professional field.
2.1. This evolution in position can be illustrated by the contemporary social context.
In the initial stages of early intervention history, institutions offered support to the youngest children taking the view that the child was a more or less “congenitally” handicapped person and there was a commitment to education at specialized institutes. Because of lack of understanding about the early development of V.I. children at that time, these institutions were the only places with any concentrated experience and growing insight. Care and support objectives focused on teaching self-help skills and compensation behaviours. This was meant to better prepare children for entrance to a special school.
But after a few years, an increasing number of young children were applying for support. Early detection, progress in the medical care of premature babies and better referrals caused an increase in the E.I. population. More professional information exchange and experience led to more expertise and better support.
Strategies in early intervention moved away from adapting to ‘normal´ standards and focused on a child’s individual competencies and stimulating development in an appropriate way.
2.2. As a result of increased information and exchange of experience, parents became more conscious about their position in society. They started to organize discussions with institutions about mainstreaming and social integration. Parents were asking for support and expertise to handle their own family situation.
The prospect of bringing up children from birth to school age in the home environment began to grow in the ‘80s.
Newly acquired knowledge and experience in the field of early detection and intervention formed the basis for more differentiated diagnoses. The population of children with V.I. appeared to include two thirds of multi-handicapped children. In the ‘90s, CVI was diagnosed in a large number of children whose visual behaviours had been difficult to understand previously.
With this increasing knowledge, it became possible to differentiate between impairment and competence. Instead of focusing on compensating behaviours, the emphasis shifted to reinforcing capacities and competence.
2.3. Nowadays, families of children with visual impairment are able to access information at a highly specialized level. With all these advanced information facilities, clients can select professional help and support on the basis of their own needs and demands.
As well as the empowerment of the individual client, the political climate has changed as well. In recent years our country has been involved in a radical shift in the organization of care and education for people with impairments. The government has pointed out that the demands of the client must be the starting point for assigning the appropriate care. Clients are assisted in “buying” their care using a set personal budget.
Procedures for indicating types and amount of care are now carried out by an institution operating independently of health care organizations.
This move towards client empowerment involves great change and is also a great challenge for our vision rehabilitation centres.
Working on the basis of this precondition, professionals in our highly specialized field have to analyze what new types of demands there are.
Now that the client controls his or her own care budget, what kind of choices will be made? A tentative assumption is that families with a greater burden will opt for relief support in daily life - cheaper, more frequent and still helpful - rather than for an expensive specialized type of professional help. Multi-handicapped families are more likely to choose the latter option. A broad range of affordable home services is needed. These services are offered by professionals specialized in caring for people with an intellectual disability. Moreover, a personal budget creates opportunities to appeal for voluntary help.
In addition, the condition of the “marketplace” raises the question as to whether V.I. Centres have to adapt their care packages and provide more flexible service delivery to children with V.I.
As representatives of this new force - the marketplace principle - management and E.I. workers have to make up the bill.
Client needs will lessen the burden on some services but specialized care and education will still be required. As mentioned earlier the question arises as to whether parents of young children – some still insufficiently diagnosed - will make primary choices for the latter.
With the development of client choice, we as professionals have to signal real risks to timely intervention and prevention.
The next step is to reflect on the consequences for our organizations.
3. Perspective of organizations and professional expertise
According to organizational theory, development can be described in 3 stages:
We can identify these stages for the organization of early intervention in the following account:
- The pioneering stage is characterized by professionals discovering new client needs or creating new methods for better support. Professionals often start with such innovative actions. They are strongly motivated and can be considered the architects of the new organization.
This happened 25 years ago with early intervention in our field. Teachers from primary classes started to visit families in order to prepare toddlers and young children for special school and residential care. They discovered that parents were eager to bring up their child themselves in the setting of their family life. So early intervention was born. Parents were supported according to the ideas and opinions of the time. In the Netherlands the initiatives came from three institutes: Bartiméus, Sensis and Visio. Characteristic of this early stage is that the professional is “his or her own manager”. He or she is operating without standardized methods or control systems. In this case the bottom-up strategy is dominant.
- The differentiation stage is the second stage of organization development. It is characterized by the fact that professionals and management have different tasks. These tasks, responsibilities and boundaries of different professionals are defined. The services, products and costs are established. Besides the educational, social and psychological professionals, medical and paramedical disciplines are introduced: the orthoptist, the ophthalmologist and the physical therapist.
In the Netherlands no professional training programs exist for this field. So organizations have to invest a lot in developing competence and have to train their personnel in specific skills related to early intervention in visual impairment. Managers have to support this professional work by guaranteeing financials, and creating quality and control systems. They also have the task of supporting professional competencies. These are directly related to specific service delivery, for example: assessing development and developmental disorders, assessing visual functioning and determining the needs in terms of vision stimulation, skills in parent guidance etc.
The organization is clear about the strategy, service, caseload and competence needed. This is a top-down approach.
- The integration stage is characterized by growing cooperation between professionals and managers.
New support methods and “products and procedures” are developed corresponding to the new needs and demands as well as new structures for this service delivery. In this stage professionals and managers really interact as partners in a bottom-up and top-down movement. Professional cooperation increases both inside and outside the organization.
Managers and professionals create and participate in the same innovative strategy.
This kind of mutual respect for each other ‘s contributions is a precondition for a flexible client-directed and needs-focused service
4. Planning for the future
Based on the reflections above we have formulated guidelines for the future development of our vision rehabilitation organizations. In this agenda, three perspectives converge: changes in demands, changes in organizations and changes in the need for professional knowledge and skills.
4.1. Planning at client level
As professionals and managers of centres for V.I. children we have to make services and expertise more differentiated. We have to communicate with colleagues and clients about our centres’ high-quality diagnostic facilities and the preventive value of detection and assessment of visual impairments.
Another matter of great concern is creating a clear and effective route for referrals.
Our centres have to position themselves as expertise centres for young children with visual impairment. Based on analyses of client preferences and conclusions from bench marking activities, we have to offer a broad and / or specialized range of services. Care and education should also be affiliated and coordinated with related partners in our national care system. We have to be conscious of, and think critically about, our place in the chain of care. This will mean good communication and a clear presentation of our core business to partners in the health system and last but not least, to our client groups.
4.2. Planning for developing competence and professional skills
As previously stated, the Netherlands has no formal training for workers in the field of V.I. Organizations have to create and transfer professional knowledge. The need for specific professional expertise has grown.
A branch curriculum is now aimed at transferring disability-specific knowledge such as:
- Knowledge and skills in the field of young children with visual impairments: pathology, assessment, and developmental and perceptual psychology.
But this disability-related knowledge is not enough and has to be complemented with other types of knowledge and skills.
- Social and communicative skills, advisory skills and networking skills.
- Organizational knowledge: policy, rules and procedures and costs of services.
- External knowledge. For example: knowledge in the field of community-based early intervention, in research, in changing society and in needs of parents.
4.3. Planning for knowledge creation
Visual rehabilitation centres in the Netherlands focus on the creation of knowledge. Recently there have been two initiatives contributing to this knowledge creation:
- The national forum for curriculum development for workers in this field.
- And a national foundation for research in the field of vision rehabilitation called “In Vision”. Here researchers are annually invited to subscribe to projects. So vision rehabilitation centres work closely with scientific researchers in university programs.
We define knowledge creation as a ‘’social activity’’ that is facilitated by networks in this field. Early education in the Netherlands and the Dutch-speaking part of Belgium has been developed in the last 25 years by a network of early intervention workers.
We now face a new area of European cooperation. There is the Comenius project and the Dortmund cooperation for low-vision services for young children.
- For worldwide sharing and knowledge exchange there is the World Wide Web.
We now have to learn how to make the best use of these technical gains.
To sum up this presentation:
Orientation in terms of changes in needs and demands of young children with visual impairment and those responsible for them must remain the backbone for organizational and professional development. A real dialogue between the different players will redefine our identity and open new perspectives for development.
We have outlined some of them in this lecture.
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