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Summer 2001 Table of Contents
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Q & A with Marty

By Marty Murrell, VI Program Administrator, Texas Education Agency

Editor's note: Marty recently received some e-mailed questions about issues related to vision services for young children. Here are the questions and her responses.

For children from birth through 2 years of age, who should make the referral for an orientation and mobility (O&M) evaluation? Can it come directly from one team member or should the referral be an IFSP team decision? What if the services are provided by the education service center?

Services to a child with a disability (birth-2) are provided as a result of a decision by the child's IFSP team. Assessment is considered a service and therefore the IFSP team should determine the need for the assessment.

If the parent, the vision teacher, or anyone else on the team suspects there is a need for an O&M evaluation, then that should be discussed in an IFSP meeting. The team determines if there is, in fact, a need, who will do it, when it needs to occur, etc. If the IFSP team agrees that there is a need, then the ECI program provides the notice to the parents and obtains the parent's consent according to IDEA-Part C requirements. Once the consent is obtained, ECI will follow the previously arranged logistical procedures to provide to the district the appropriate paperwork, including such things as copies of the notice and consent.

According to the ECI/TEA MOU, the district is responsible for providing orientation and mobility services, which include evaluation. If the district relies on O&M evaluation and instruction provided by an education service center (ESC), the district should forward appropriate referral information to the ESC, according to procedures set forth by the ESC.

Sometimes physicians are hesitant to estimate visual acuities for very young children. How should this be documented on the Texas Eye Examination Report?

For most infants, an eye doctor should be able to get a general idea of acuity from direct ophthalmoscopy. Reluctance to give an estimate may be a result of not knowing specifically how the information will be used. Sometimes this can be addressed by providing technical assistance to the doctor. If the doctor indicates that he/she was unable to test and does not give any estimation of visual abilities, then there may be a need for an evaluation by a doctor with more experience and skill with similar children.

If the doctor has had little experience with young children, especially those who are very difficult to assess, there are two excellent videos by Deborah Chen, Ph.D. and Deborah Orel-Bixler, Ph.D., O.D., that can be shared with the doctor to demonstrate effective diagnostic techniques to use with babies. The titles are "Vision Tests for Infants" and "What can Baby See? Vision Tests and Interventions for Infants with Multiple Disabilities." These may be purchased from the American Foundation for the Blind or may be available on loan from your regional education service center or the TSBVI.

When referring children to the eye doctor, parents should be directed to doctors with the expertise to provide the information that is needed to make decisions about the needs of the child.

Sometimes it takes several weeks or even longer to obtain the eye report from the eye doctor. How should we document this? Do you have any suggestions?

For students 3 years or older who need eye reports as part of their special education evaluation, the district can use such things as logs or contact reports to document attempts to get copies of the reports. However, this documentation does not eliminate the district's responsibility to adhere to the required timelines.

Since the cost of the eye doctor evaluation and report is a district responsibility, the district does have the option of choosing who will provide the evaluation and report. If a specific doctor does not respond to reasonable timelines, does not provide the information the district needs, and does not respond to efforts by the district to explain the critical need for timely and quality information, the district should identify doctors who will do these things, and refer students to them. The district may establish a contract with a specific doctor in order to meet its responsibilities under IDEA.

For children under 3 years, obtaining the eye doctor evaluation and report is the responsibility of the ECI program.

Timely eye reports may be an issue that can be addressed effectively through the Regional Plan for Students with Visual Impairments, since the planning group includes the agencies for which this is typically a problem (ECI, TCB, and districts.).

Some strategies that have been suggested by others include visiting with the doctors to share information; inviting doctors to a luncheon meeting; developing informational brochures/packets for the doctors; developing a cover letter to accompany the eye report form explaining the critical need for timely and complete information.

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Last Revision: September 2, 2003