Early Intervention in Germany for Children
with Visual Impairment

Eberhard Fuchs

ICEVI European Chairperson

The following paper presents a compact overview of the early intervention situation in Germany. It only sketches the contents of early intervention; we would be glad to provide more detailed information to interested readers.

Blindness and visual impairment have complex effects on the entire development of the child, impacting on  all areas of behavior and perception. Children who are blind or partially sighted exhibit specific courses of development and idiosyn crasies in their social behavior, play, and motor development due to their inability, or very reduced ability, to learn through visual impressions.

Interventions on behalf of these children require specialized knowledge about the specific diagnostic methods for assessing their development, their orientation and mobility, and their functional vision. Teaching principles and methods have to be specially adapted by using, for example, tactile and auditory modes with children who are blind and methods that support visual promotion in those who are partially sighted. The purposes of intervention have a markedly different focus compared with those for children with other impairments.

Early intervention is a primarily pedagogical provision. It is oriented toward the family, and it views its major task as perceiving the children as individuals and helping to place at their disposal a life environment that will promote development. The goal is to prevent the potential consequences of a visual impairment in the cognitive, socio emotional, communicative, and psychomotor domain, and, when necessary, to apply appropriate visual training to counteract any earlier failure to exploit residual vision. This is achieved predominantly through intensive cooperation with parents, the social environment, and other professionals engaged in early intervention.

As a result, most care takes the form of a visiting early intervention service which is delivered in the child’s home, typically at weekly or fortnightly intervals.

Over the last two decades, Germany has built up an extensive network of early intervention centers for children with visual impairments who are blind, partially sighted, or multiply disabled. More than 50 early intervention centers, which are mostly based in schools or resource centers for the visually impaired, provide individual promotion for the children and expert counseling for their parents.

In recent years, the screening of children has improved continuously in that it is more comprehensive and carried out at an earlier age. In the state of Bavaria, for example, intervention begins during the first year of life for 40% of  such children  and by the second year at the latest for 60%. This is the outcome of successful public relations work by the early intervention centers, and, in particular, improved cooperation with ophthalmic and pediatric hospitals, early diagnosis centers, and ophthalmologists and pediatricians in private practice. These provide the majority of referrals to early intervention centers—in Bavaria, more than 80%.

In the whole of Germany, there are currently approximately 3,500 children with visual impairments aged 0-6 years receiving specific early intervention. This represents 0.074% of the total population or approximately one-third of all preschool-age children with visual impairments. It can be assumed that just about all those in this group who are blind and more than two-thirds of those who are multiply disabled receive specific early intervention from specialized institutions. A less satisfactory state of affairs, in contrast, is that it is received by only approximately 20% of children with low vision who have no additional disabilities. The reason for this has little to do with difficulties in the early diagnosis of low vision in children. It has far more to do with the continuing widespread belief that it is not worth referring children to early intervention centers when no improvement in vision can be anticipated through intervention measures. There is a need to emphasize more strongly that specialised intervention has enormous potential for both improving functional vision and coping with daily life in general.

A particular feature of the situation in Germany is that because early intervention centers are
often based in schools, almost 60% of the 300 early intervention professionals are teachers. As a result interdisciplinary teams are still an exception rather than the rule. Increasing
efforts are being made to integrate qualified psychologists, orthoptists, and Orientation and Mobility trainers into early intervention teams in order to ensure that the breadth of professional competence needed to meet the wide range of needs in this field is available.

Up to now, there has been no clear legal definition of the role of the early intervention professionals in Germany, and no guidelines for their training and development. In 2002, the VBS Association of Professional Staff established the first nationally available continuing education course (420 hours part-time). This has proved an important step toward professionalizing the field.

One specific feature of early intervention for children with visual impairment in Germany is that in most federal states, children may receive services from generic and specialist early intervention centers at the same time.  Simultaneous care from two intervention centers is problematic in terms of costs, calls for time-consuming coordination of support, and often restricts our ability to offer specialist input for example in the area of low vision training. This, in turn, runs counter to a holistic pedagogical concept designed to integrate all areas of development and daily life.

Summary

In recent decades, Germany has managed to set up an extensive network of modality-specific early intervention centers and thus ensure early care particularly for children who are blind or multiply disabled.

However, there is room for improvement in the assessment of children with visual impairments who are of average or above average ability and in the establishment of early intervention teams which have a more interdisciplinary nature.

Finally, the training, continuing professional development, and the supervision of early intervention staff needs to be expanded. It is necessary to make the recently developed tools for diagnosis, therapy, and, in particular, counseling available to all staff in order to assure the quality of our services.