The Vision and Living Skills Research Project:

A flexible approach to teaching daily living skills to children and adolescents

with severe vision impairment

School Years: Living Skills

Presenter: Additional Authors:

Helen Lunn Project Team:

Manager Christine Johnston

Child and Family Services Rosemary Flavel

Royal Blind Society With:

PO Box 176 Stephanie Kain

Burwood NSW 2134 Australia Natalie Kaine

Tel:+61 (0)2 93343120 Meagan Fairnham

Fax:+61 (0)2 93343126 Emma Steele

Email:helen.lunn@rbs.org.au Anna McCauley

This paper supports a poster presentation which describes the development of a teaching package “Do It Yourself: Encouraging Independence in the Child who is Blind ”. The package focuses on daily living skills for children and young people from pre-school age to young adulthood.

Background

Royal Blind Society provides services to children, their families and communities across the state of New South Wales (NSW) and the Australian Capital Territory (ACT), Australia. NSW is the size of France and the United Kingdom combined. It has a population of 6.5 million, 74% of whom are concentrated in three coastal cities. Because of the low incidence of vision impairment in children and the consequent geographic scatter of referrals, services are provided from a head office in the main coastal city, Sydney.

In 1996, Royal Blind Society surveyed the needs of client families who had children aged 5 to 12 years. The data obtained from 122 families spread across metropolitan and rural NSW and the ACT pointed strongly to parents’ concerns about their children’s ability to cope with the skills of daily living. This finding is in line with similar overseas findings (Canadian National Institute for the Blind, 2000(a) and (b); Walker, Tobin & McKenney, 1992) on the development of children with vision impairment and areas of parental concern.

In addition, it is recognised that competence in daily living skills increases the likelihood of independent living, employment and meaningful community participation in adulthood (Beach et al.,1995; Dodds,1989; Halpern,1993).

If these needs are to be met in the context of limited human and financial resources, there are a number of challenges for the agency:

Children with vision impairment are widely scattered across urban, regional and rural communities.

Families are generally choosing inclusive education, where the regular academic curriculum is the prime focus. Regular classroom teachers generally do not have the skills or opportunities to teach daily living skills. Specialist itinerant teachers are frequently concentrating their efforts on the more academic aspects of the “expanded core curriculum” so that the student can keep pace with their sighted peers.

There are few professionals with specialist vision impairment expertise in rural and regional areas and there are difficulties of recruitment to generic health and disability teams.

Parents/carers therefore have chief responsibility for teaching living skills.

Living skills are best learned and practised in natural environments.

Regular individual home-based services to areas up to 1000 kms from the agency base are impractical and unduly costly.

Group programs, such as residential camps, have limited impact because of the short-term nature of the intervention and the difficulties of transfer and generalisation of skills to home and community environments.

In response to these challenges, The Vision and Living Skills (VaLS) Research Project, a collaboration of Royal Blind Society and The University of Sydney, was established to investigate:

factors affecting the acquisition of independent living skills

the relationship between these skills and self-esteem

possible service delivery models, particularly for rural and remote families

As part of the project, the “Do It Yourself” package was developed as a tool for service delivery through a range of models.

The package aims to:

empower families/carers by providing information on:

ways to help their child to learn specific independence skills

how to develop the underlying skills and abilities needed to learn these skills

strategies which can be used in teaching any skill

· maximise the opportunity for the learner to practise skills, by encouraging the use of natural learning environments in the home and community

· motivate families and professionals to encourage independence in children and young people by:

providing positive examples of independent children, young people and adults

emphasising the importance of independence skills for participation in community life

provide generic professionals and para-professionals, particularly those in rural and remote areas, with intervention approaches for a low-incidence group

develop a tool for training within blindness agencies, particularly for staff whose primary role is not teaching independence skills

Developing the Package

The target group for the package was those children and young people considered most “at risk” for difficulties in acquiring daily living skills. This group was identified from the clinical experience of the agency team, the project findings and literature search. In looking at the overall development of pre-school children with vision impairment, Hatton, Bailey, Burchinal & Ferrell (1997) found that there appeared to be a threshold effect, with children whose visual functioning is 20/800 (6/240) or worse being significantly different from those with better vision. Hatton et al. speculated that “Visual function of 20/500 or better may be the level necessary for making eye contact and recognizing nonverbal social cues, thus facilitating responsive interactions. These factors may account for the lower mean level of performance and slower rate of growth observed in the personal-social domain. Visual function of 20/500 or better may also be sufficient for visual imitation, a likely factor in the motor domain.” (p.801). Our findings in regards to daily living skills in subjects from 3 to 18 years (Flavel, Lunn & Johnston, 2002) are consistent with the broader developmental results of Hatton et al.. The target group for the package was thus established as students who, because of the severity of their vision impairment, could not learn through observation and modelling. They therefore needed different teaching and learning strategies from their sighted peers and those with milder vision impairment.

The format of the package was guided by information from focus groups of adults with vision impairment and families regarding preferred intervention methods. Some families commented that they liked to have written and other material to use at their own pace within everyday routines, rather than trying to fit professional appointments into already busy school and after–school activity schedules.

The skill and readiness sheets and the section on teaching and learning strategies were developed collaboratively between experienced occupational therapists from Royal Blind Society and the university team with special education and psychology backgrounds.

The package does not, however, provide comprehensive material on the full range of daily living skills. The skills targetted were identified from service referral patterns and a staff survey of areas of particular concern. There was also consideration given to the availability of other curriculum materials with an attempt to fill identified gaps.

Package Content

(1) Videos

There are two videos in the package. The first, “Do It Yourself”, presents the perspectives of children and adults who are blind and their families on the importance of daily living skills. It also shows:

the range of settings in which skills can be taught, from pre-school to young adulthood

teaching strategies, including equipment and environmental modification, physical guidance and specific verbal instruction

The second, “Ways to teach - a closer look”, consists of four specific segments - Tying shoelaces, Using a spoon, Using a fork and Using a microwave - showing, in more detail, effective teaching approaches for these skills.

(2)Illustrated Skill Sheets

The sheets are organised into the areas of Domestic and Community Activities, Dressing, Mealtime Skills and Personal Care and cover the following skills:

(A)Domestic and Community Activities

Folding clothes

Making the bed

Managing money

Organising clothes

Setting the table

Using coat hangers (clip)

Using coat hangers (triangular)

Using a dishwasher

Using a microwave

Using taps

Washing up

(B)Dressing

Managing buttons

Managing zips

Putting on a jumper

Putting on pants

Putting on shoes

Putting on socks

Tying shoelaces

(C)Mealtime Skills

Eating at the table: Knowing where things are

Finding food on the plate

Pouring hot and cold drinks

Using a fork

Using a knife and fork together

Using a knife to cut

Using a knife to spread

Using a spoon

(D)Personal Care

Brushing teeth

Using a towel

Washing hair in the shower

The sheets have a consistent format:

“Children are probably ready to learn this when they…” - the skills and abilities noted are cross-referenced to sheets of activities to promote readiness
“Getting started” - equipment and environmental considerations
“How to help your child with learning” - practical teaching approaches
“Taking away your help” - strategies to reduce adult assistance
“What if…” - possible solutions to common difficulties
“What else can we do to practise” - suggestions for fun activities which utilise the same skills e.g. for “Using a Fork”, doing ‘block’ printing with textured paint, where the block (piece of apple, etc.) is held with a fork to push against the paper

(3) “Getting Ready to Learn” activity sheets

These sheets are designed to promote readiness for learning of independence skills and are cross-referenced to the skill sheets. They are organised in sections:

Building strength in hands and shoulders
Developing awareness and control of body position
Encouraging hand skills
Understanding concepts

They include information on typical development, issues for children who are blind and activities for a range of ages and stages of development. They provide useful intervention suggestions for early childhood and school programs.

The activity sheets address skills and abilities frequently noted by the agency’s occupational therapists as areas of underlying difficulty in acquiring daily living skills for learners who are blind. The following are examples of their observations of the consequences for children who lack these underlying skills and abilities:

most arm movements are executed in a palm down orientation (i.e. forearm in pronation) - this can lead to ‘winging’ of the elbows when using cutlery
excess movement at the knuckle joint closest to the fingernail (i.e. hypermobility of the distal interphalangeal joint) - this can be seen when pulling a zipper, buttoning, etc.
limited movement of the thumb to meet the fingers (i.e. limited thumb opposition) - this can be seen in lack of involvement of the thumb grasping items such as a toothbrush
decreased shoulder stability and strength, leading to the child’s needing to lean on the basin while cleaning teeth, or the table when using cutlery

It has been argued that some of these poor movement patterns are a result of lack of common early developmental experiences such as time spent in the prone position, visually guided reaching and pointing and use of play tools such as balls and pencils (Strickling,1998). It is therefore critical for young children who are blind to be exposed to a range of experiences and activities to develop these early skills and abilities. They not only underpin daily living skills but are also essential for other skills such as accessing braille and keyboard technology.

(4)Teaching and learning strategies section

This section was included as it was recognised that most parents’ experience of teaching daily living skills was the relatively effortless approach required with their sighted children, who learn largely through observation and imitation. Most parents do not have any understanding of the basic principles of teaching and learning or the adaptive techniques useful with children who are blind, with or without additional disabilities.

The section comprises ‘parent-friendly’ material on:

· Readiness to learn

· General principles of teaching and learning

· Specific teaching techniques, such as task analysis and chaining

· Effective and practical approaches for learners who are blind including:

· Use of specific verbal instruction

· Use of touch

· Equipment modification, such as marking

· Environmental organisation

· Orientation to the room and the task equipment

· Fading adult assistance

How is the package being used?

Use of the package is currently only in the preliminary stages but the skill sheets are being used, in part or full, as an adjunct to individual intervention with families and generic service providers, such as classroom aides. We have also advertised their availability in our newsletter and, as a result, we have received requests from parents and Itinerant Support Teachers (Vision). These will be used without the direct support of agency staff. The video has been used for in-service training and in a seminar presentation for parents and professionals.

Where to from here?

The following avenues are being explored:

Further distribution of the package and individual skill and pre-requisite activity sheets

Evaluation of the skill and activity sheets and the whole package as an intervention strategy with families/carers and generic professionals

Publication of the skill sheets on the agency’s website and investigation of the possibility of interactive capacity

Development of more video material demonstrating the teaching of particular skills, and further skill sheets, taking into account client need and evaluation data.

Conclusion

Agencies must utilise the full range of teaching/learning techniques and resources available if they are to be effective in the teaching of daily living skills. This will include individual intervention, intensive courses and distance education methods utilising written materials, video, tele- and video-conferencing and computer-based learning. Successful training programs must take account, not only of the characteristics of the individuals at whom the training is aimed, but also of their families, the communities in which they live and the resources and support systems available to them. The package developed as part of The Vision and Living Skills Research Project aims to strengthen and support families and communities to nurture and teach children and young people who are blind. It provides curriculum materials which can be used in a range of service delivery models. It emphasises the importance of early childhood intervention from the perspective of building readiness skills and abilities and starting young with expectations of growing independence. The materials are also suitable to be used with primary and secondary aged learners to develop skills for home and community life. They are appropriate for use in transition programs from school to post-school options, such as tertiary study or employment, recognising that independent living skills are a critical component of full community participation.

References

Beach, J.D. (1995). Self-esteem and Independent Living Skills of Adults with Visual Impairments. Journal of Visual Impairment and Blindness, Vol. 6, pp. 531-540.

Canadian National Institute for the Blind (2000(a)). The impact of vision loss on the development of children from birth to 12 years: A literature review. Toronto, Canada: Author.

Canadian National Institute for the Blind (2000(b)). The impact of vision loss on the development of children from birth to 12 years: Preschool age survey findings and summary. Toronto, Canada: Author.

Dodds, A.G. (1989). Motivation Reconsidered: The Importance of Self-Efficacy in Rehabilitation. British Journal of Visual Impairment, Vol. 7, No. 1, pp. 11-15.

Flavel, R., Lunn, H. & Johnston, C. (2002). The Vision and Living Skills Research Project: Determining the effects of personal and family characteristics on the development of independence in 3 to 18 year olds. In Proceedings of the 11^th World Conference of the International Council for Education of People with Visual Impairment. Noordwijkerhout, The Netherlands. July-August.

Halpern, A.S. (1993). Quality of Life as a Conceptual Framework for Evaluating Transition Outcomes. Exceptional Children, Vol. 59, No. 6, pp. 486-498.

Hatton, D.D., Bailey, D.B., Burchinal, M.R. & Ferrell, K.A. (1997). Developmental Growth Curves of Preschool Children with Vision Impairments. Child Development, Vol 68, No 5, pp. 788-806.

Royal Blind Society of NSW (1996). Report on Child and Adolescent Services: Survey of families of primary aged vision impaired children. Unpublished. Burwood, NSW: Author.

Strickling, C. (1998). Impact of Vision Loss on Motor development: Information for Occupational and Physical Therapists Working with Students with Visual Impairments. Texas School for the Blind and Visually Impaired: Austin, Texas.

Walker, E., Tobin, M. & McKenney, A. (1992). Blind and Partially Sighted Children in Britain: The RNIB survey. Royal National Institute for the Blind, London.