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Spring 2007 Table of Contents
Versión Español de este artículo (Spanish Version)

By Barbara J. Madrigal, Assistant Commissioner, DBS

Abstract: Commissioner Madrigal, upon the celebration of 75 years of services, reviews the history of services to Texans who are blind and anticipates future years of service.

Key Words: DARS Division for Blind Services, anniversary, Commissioner Barbara Madrigal, vocational rehabilitation, employment, blindness, News & Views

On October 17, 2006, DARS Division for Blind Services proudly celebrated 75 years of quality services to blind, visually impaired, and deafblind Texans of all ages. Joining us at this memorable event were some prominent members from various organizations, including TSBVI Superintendent Phil Hatlen.

Services for blind Texans began when the State Legislature authorized the first appropriation for home teachers for the blind. Today, we feel justifiably proud when we look back over our evolution into an organization that provides highly sophisticated vocational rehabilitation and independent living services for blind Texans of all ages and all circumstances.

It is our sincere hope that this year's important milestone will also help recognize the dedication of the many diligent staff who work in partnership with our consumers. This dedication reflects their personal belief that Texans who are blind or visually impaired should have the same opportunities as other Texans to pursue independence and employment.

Historical Perspective

The history of our organization reflects the long-term dedication of our staff as well as our continuous efforts to improve the services we offer.

1930s and 1940s: Vocational rehabilitation for blind Texans was moved from the Texas Department of Education to the new State Commission for the Blind, and the legislature appropriated funds for sight conservation and prevention of blindness in children.

1950s and 1960s: We increased our focus on employment opportunities, worked with employers to increase the types of jobs available to blind Texans, received legislative authorization to establish what we know today as the Business Enterprises of Texas program, and expanded services to blind Texas children.

1970s: The Criss Cole Rehabilitation Center opened in Austin. We were among the first state agencies to install a toll-free line to enhance consumer access, we established consumer advisory committees across the state to encourage consumer involvement in developing and improving program services, and we received one of five national grants to demonstrate a model for enhanced Independent Living services for people who are blind or visually impaired.

1980s and 1990s: The Texas Commission for the Blind adopted an agency-wide consumer as partner philosophy to enhance service delivery and improve outcomes for blind and visually impaired Texans. An innovative Transition Program was established to bridge the gap between children's services and adult services, and we received a federal grant to provide Independent Living services to older Texans with visual disabilities.

The Current Decade

In the current decade, change has been our constant companion. Consolidation and budget considerations have been primary concerns, but we are moving toward the future with full enthusiasm.

VR counselors and teachers in our Vocational Rehabilitation Program assist blind Texans to reach their independent living and employment goals, and we have initiated a comprehensive review of our employment-related services to ensure DBS continues to provide the highest possible level of effective services to Texans seeking productive, gainful employment.

Our Deafblind Program celebrated 15 successful years of a unique program to assist deafblind consumers to live independently in their own apartments and, in 2006, the Criss Cole Rehabilitation Center marked 35 years of services to blind Texans while continuing to receive national recognition as a model program for comprehensive services.

Business Enterprises of Texas (BET) is nationally recognized for successful development of quality employment opportunities for blind Texans in the food service and vending industries.

Our Transition Program bridges the gap between the Blind Children's program and adult Vocational Rehabilitation services, ensures a seamless service delivery system through each stage of the young person's development, and assists Texas youth who are blind or visually impaired to make an effective transition from secondary school to adult life and the world of work.

The Blind Children's Vocational Discovery and Development Program provides a wide range of habilitation services to meet each child's unique needs and circumstances and to ensure our youngest Texans acquire independent, productive, and satisfying lives.

The Independent Living Program provides much needed services to older blind adults - a segment of our population that continues to grow as more older Texans experience vision loss -- to help them acquire the adaptive skills necessary to live independently.

Critical support functions such as Employment Assistance Services, our Vocational Diagnostic Unit, and our Braille Unit support our programs statewide. And our Blindness Training & Development Unit continues to be recognized for its outstanding training programs.

The Future

Through strong partnerships with consumer and advocacy groups as well as organizations such as the Texas School for the Blind and Visually Impaired, the DARS Division for Blind Services maintains active relationships with the blind community to encourage critical input about our services and ways we can improve, and the Texas Confidence Builders philosophy remains at the heart of our service delivery system: consumer independence, competence, and self-confidence. These foundations will serve us well as we continually strive to enhance services.

As we move forward into the new century, we maintain a strong and efficient service delivery system for consumers of all ages -- children, students and young adults, working-age adults, and older Texans -- and staff members in all program areas remain career oriented and committed to providing legendary customer services. Consumer surveys rank DBS staff and DBS services very high, and our organization continues to be recognized at the national level as a premier agency for blind services.

Equally important, DBS is taking steps within our organizational structure to ensure the future continuation of quality, seamless services for blind Texans by establishing a new FUTURES initiative that offers career ladder opportunities for eligible staff while encouraging them to be forward thinking and innovative.

We are proud to celebrate 75 years of quality services to blind and visually impaired Texans, and we're looking forward to many, many more. We're already off to a great start in fiscal year 2007 -- and we're ready to start planning our future 100th celebration.

Spring 2007 Table of Contents
Versión Español de este artículo (Spanish Version)

By Roger Toy, OTR, and Lisa Ricketts, OTR Texas School for the Blind and Visually Impaired, Austin, TX

Abstract: This article describes strategies and equipment that allow students with physical limitations become more independent with daily living skills.

Key Words: Programming, blind, visually impaired, deafblind, adaptive equipment, daily living skills, occupational therapy (OT), physical therapy (PT)

All students have different abilities and unique needs. Students who have physical disabilities in addition to sensory impairments often benefit from a variety of adaptations to routines, materials, and the environment. The following are examples of adaptive equipment and strategies that can be considered in order to help students with physical limitations be more independent with their daily living skills.

Eating Skills

Before considering the use of adaptive equipment to promote a student's ability to eat independently, take a look at basic positioning. The student needs to be as close to the table as possible. This will minimize the amount of food that falls into the lap and can discourage slouching, which can interfere with swallowing.

Therapists commonly recommend that positioning follow the rule of 90 degrees. This incorporates a 90-degree bend at the hip, a 90-degree bend at the knees, and 90 degrees of flexion at the ankle. This means that smaller students may need footstools when they eat in a school cafeteria so their feet don't dangle. This kind of accommodation might not be possible in all places, such as restaurants and outdoor settings, but it is important in school cafeterias, classrooms, and at home in order to develop independent eating skills.

Adaptive Equipment

Consider using some of the following materials and equipment to help promote greater independence when eating:

  • Adapted plates or dishes: HiLo dish, plate (food) guard (clear or metal), a high-sided plate (regular or partitioned), or a scoop plate. Overall, these dishes are good for the visually disabled population because they give them a physical barrier to push their food up against. They are all available commercially at medical supply stores and online.
  • Dycem (a brand name) can help stabilize the plate or bowl on the bottom to prevent it from sliding. It can also be used to stabilize other things, such as books, tabletop projects, etc. We have even used it to keep a child from sliding out of his chair.
  • For students who have physical difficulty holding things in their hands, utensils with built-up handles (foam or manufactured supergrip) and hollow-handled or cuffed utensils may help. Hollow-handled utensils allow a helper to insert a finger into the handle to teach the correct motion of scooping.
  • Adapted utensils might also work with students who have tactile or sensory deficits, coordination problems, or reduced strength. Angled spoons may help students get the food to their mouth more successfully because they require less wrist movement. Weighted utensils are good for students who need more feedback to help them grade their force when scooping food onto the utensil or if they have tremors/unsteadiness in their hands. A rocker knife or T-shaped rocker knife can be helpful for people who have the use of only one hand.

Cooking Skills and Food Preparation

Adaptive equipment can also help students develop more independence with cooking skills and food preparation, especially those who have the use of only one hand.

  • Spread boards can be used to stabilize a slice of bread, so that it does not move when spreading food over it.
  • Two pins on an adapted cutting board will hold food in place during cutting tasks.
  • A one-handed dish scrubber can be suctioned to the bottom or side of the sink to let you wash dishes, bowls, cups, and utensils with one hand.
  • The Pan Holder (suction cups) keeps the pan from turning when cooking on the stove. The suction cups don't work as well, however, when the stove top gets hot.

Dressing Skills

Students with physical or visual impairments can use adaptive equipment to dress themselves more independently.

  • Individuals with limited functional reach to their lower extremities can use a long-handled shoehorn to independently put on and take off their shoes.
  • For students who cannot tie their shoelaces because of physical or cognitive limitations, elastic shoelaces are an option, as are shoes with Velcro closures. Elastic laces turn regular laced shoes into slip-on shoes by letting the tongue of the shoe stretch to accommodate the foot. They come in two different types, Spyrolaces for younger children, and Tylastic (which look like regular shoelaces) for older students who want to look more age appropriate.
  • Reachers work well for an individual in a wheelchair who has some vision. The reacher lets the person pick up items that have dropped on the floor.
  • For some individuals with limited functional reach to their lower extremities, a dressing stick makes putting on and removing socks or pants simpler. Most of the dressing sticks can also be used as a shoehorn, but they may not be as comfortable for this use as the metal shoehorns.
  • For individuals who cannot bend down to touch their toes, the sock aid can help them get the sock over their foot (some coordination is necessary and some vision helps).
  • For the students who lack fine motor coordination or who have the use of only one hand, a button hook or a zipper pull might be useful.
  • Velcro adaptations can be made on clothing for individuals that have difficulty with fasteners, such as those often found on pants.
  • Some students at TSBVI use a device known as a Dressing Bar. A student in a wheelchair that has upper body strength and some coordination in his hands can use the dressing bar to pull to standing and then pull his pants/underwear up or down by himself. Students who have less upper body strength or coordination skills can hold onto the dressing bar while being assisted with their pants/underwear.
  • The Flipfold is a 4-panel device that can assist students with folding shirts, pants, and towels.

Hygiene/Bathing Skills

  • The foam described above for use with eating utensils can also be used on other things, such as toothbrushes, razors, hairbrushes, and pens.
  • Toothpaste dispensers can help individuals with limited finger/hand function or visual impairments put the correct amount of toothpaste on their toothbrush. The main drawbacks to these dispensers are the price (they can be rather expensive) and they only work with Aqua-Fresh 4.3- or 4.6-oz pump toothpaste.
  • Spray-can extenders can help people with decreased movement, control, or strength in their fingers.
  • There are also soap dispensers with single (like the ones you see in the public restrooms) and multiple containers that can be mounted in the shower/bathtub area for easier access for people with limited hand function or use of only one working hand. The drawbacks are that the dispensers that require drilling (for mounting on the wall) might not be possible in some bathrooms, and the dispensers held by adhesives might not hold well.
  • Long-handled sponges allow people with limited reach to wash their backs, lower legs, and feet.

These are only some of the many adaptive devices that are available. The purpose of this article is not to make you an adaptive equipment expert, but to give you a quick look at things that might help the students you work with. If you feel that a student could benefit from adaptive equipment, please contact an occupational or physical therapist in your district or contact us at TSBVI.

Spring 2007 Table of Contents
Versión Español de este artículo (Spanish Version)

TAKS-Alt: The Times&They Are A-Changin' for Assessing Students with Significant Cognitive Disabilities

By Peggy Miller, Deafblind Specialist/ Speech-language Pathologist, Texas School for the Deaf, Austin, TX

Abstract: This article provides an overview of TAKS-Alt, the new statewide assessment in Texas for students with significant cognitive disabilities. It also provides suggestions to help teachers, administrators, and parents prepare for the changes.

Key Words: Programming, blind, visually impaired, deafblind, assessment, TAKS, TEKS, TAKS-Alt, LDAA, NCLB

  • Teacher: TAKS for my students? You are asking me to do WHAT???
  • Parent: I'm thrilled! We're raising the bar for my daughter's education!
  • Administrator: Who will do this? When? Why? How? Will it go away?

The quotes above are from real people who are sharing the adventure of the new statewide assessment for students with significant cognitive disabilities called TAKS-Alt (Texas Assessment of Knowledge and Skills - Alternate). This past November, twelve teachers in the Special Needs Department at Texas School for the Deaf (TSD) completed assessments for the TAKS-Alt Pilot on twelve students, grades 3 through 11 in Reading or English Language Arts (ELA). It was time-intensive, challenging, frustrating, interesting, surprising and more; we made mistakes and called TEA many times for clarification. We are now preparing for more assessments across more subject areas for the TAKS-Alt Field Test to begin this January. This article is written to give a brief overview of TAKS-Alt with some suggestions learned from TSD's participation in the Pilot administration of this test. Our task was made considerably easier by having so many people to support us. Even if you are the sole special educator in your district, please know that you are not alone in this adventure!

Background

These are exciting and challenging times in special education. As Dr. Diane Browder from the University of North Carolina at Charlotte said at a recent workshop in Austin, Nationally, we are being asked to move to a new house and take the best of teaching practices from the past and bring them into a future where we are adding academic content to functional skills curriculums for students with the most significant cognitive disabilities. As part of this move, new assessment practices for these students are required by federal law, specifically, The No Child Left Behind Act (NCLB) of 2001. NCLB requires that all states include students with disabilities in state assessment systems. THIS IS A BIG CHANGE!!!

Texas' state assessment is the Texas Assessment of Knowledge and Skills (TAKS) and the state curriculum is the Texas Essential Knowledge and Skills (TEKS). The Student Assessment division of the Texas Education Agency (TEA) developed the TAKS-Alt to comply with federal law. Beginning in January 2007, more than 1, 000 school districts in Texas will be required to participate in the Field Test for TAKS-Alt. This translates to assessing more than 40,000 students who are receiving special education instruction and who meet all five of the following participation criteria developed by TEA.

The student:

  • requires supports to access the general curriculum that may include assistance involving communication, response style, physical access, or daily living skills, and
  • requires direct, intensive, individualized instruction in a variety of settings to accomplish the acquisition, maintenance and generalization of skills, and
  • accesses and participates in the grade-level Texas Essential Knowledge and Skills (TEKS) through activities that focus on prerequisite skills, and
  • demonstrates knowledge and skills routinely in class by methods other than paper and pencil tasks, and
  • demonstrates performance objectives that may include real life applications of the grade-level TEKS as appropriate to the student's abilities and needs.

The state will no longer be recognizing the functional Locally Determined Alternative Assessments (LDAA) that are traditionally given to students with the most severe cognitive disabilities. Districts no longer have the option to use their own locally determined assessment protocol such as Student Portfolio Assessment, the BRIGANCE, or Student Performance Indicators; schools must follow state standards for assessment. The state will evaluate the results from the TAKS-Alt Field Tests for students with severe cognitive disabilities and set a standard for passing. TAKS-Alt will be fully operational beginning with the 2007-2008 school year and it is definitely with us for the future!

What exactly is TAKS-Alt?

The Alt in TAKS-Alt represents alternate achievement standards. Students with significant cognitive disabilities are mandated to have access to the general education curriculum; in Texas this is the TEKS. These students will be assessed using alternative achievement standards. TAKS-Alt is linked to grade-level TEKS that are reduced or modified to reflect prerequisite skills. TAKS-Alt is not a pencil-and-paper test for students. Instead, it is based on teacher observations that occur during teacher-designed activities that are scored using the TAKS-Alt Rubric. Each activity must relate to an essence statement developed by TEA; these statements summarize the TEKS knowledge and skills statement and student expectations for each TAKS-tested objective. All of the results are entered on-line through the TEA website for TAKS-Alt. That's a lot of new vocabulary to understand!

Here is how it may look for one activity for reading for a 3rd grade student:

  • TAKS Objective: The student will demonstrate a basic understanding of culturally diverse written texts.
  • TEKS Knowledge and Skills Statement: 3.8 The student develops an extensive vocabulary
  • Essence Statement: Expands vocabulary
  • Prerequisite skill: The teacher reviews the links to the TEKS provided by TEA and determines her student can be assessed on this prerequisite skill - use new vocabulary in everyday communication
  • Activity: The teacher designs a specific activity for assessing this skill that must include at least three measurable and observable predetermined criteria. The teacher assesses the student on these criteria, scores performance, offers an opportunity for generalization if appropriate, and enters the results (with supporting data) on-line.

Which subject areas are assessed?

TAKS-Alt follows the same requirements for TAKS testing. Consequently, subject areas are assessed at enrolled grade levels as follows:.

  • 3rd Grade: Reading, Math
  • 4th Grade: Reading, Math, Writing
  • 5th Grade: Reading, Math, Science
  • 6th Grade: Reading, Math
  • 7th Grade: Reading Math, Writing
  • 8th Grade: Reading, Math, Social Studies, Science
  • 9th Grade: Reading, Math
  • 10th Grade: English Language Arts (ELA), Math, Social Studies, Science
  • Exit Level/11th Grade: English Language Arts (ELA), Math, Social Studies, Science

What do teachers need to do to make this happen?

Teachers must complete training modules on-line before administering the test. Modules 1, 2 & 3 are available to anyone interested in TAKS-Alt; parents are encouraged to take a look, too. You can access these through <http://pearson.learn.com>. Module 4 is about the actual on-line assessment tool that is available to teachers conducting the test during the testing window which is January through April 2007 for the Field Test. All data must be finalized on-line during the submission window from April 2 through April 13, 2007.

: the TEKS Curriculum Framework, TEKS Vertical Alignment, and TEKS-Based Examples of Instructional Activities. You can access these directly at this site: <http://tea.texas.gov/student.assessment/resources/taksalt/>.

How many activities are required to assess a student?

Many, many, many! For the Field Test this spring, teachers are required to create four activities per subject area. To give you an idea of this task, a student qualifying for TAKS-Alt testing enrolled in the fourth grade taking the Field Test will be assessed on four activities that the teacher developed in each of these subjects: reading, math and writing (12 total activities). A student in the 10th grade will be assessed on four activities in each of these subjects: ELA, Math, Science, and Social Studies (16 total).

Beginning in the 2007-2008 school year, teachers will be required to assess their students on six activities per subject area linked to state and teacher selected essence statements. That means, for example, that a teacher who has a 10th grade student qualifying for TAKS-Alt will create a total of 24 activities for that one student and assess, record, and score performance using the TAKS-Alt protocol. In reality, we know that many classrooms for students with significant disabilities are multi-age and contain more than one student. Teachers may find that they have to create 50 to 100 activities! Keep in mind that many activities can be used or modified for other students and other subject areas.

How will I, as a teacher, accomplish all of this? Here are some suggestions:

Acknowledge that this first year is a challenge for all of us.

It does get easier after you learn the lingo and go through the process for one activity. Look at what you are already doing through a different pair of glasses and you may find you can link some of what you are teaching your students to a TEKS pre-requisite skill. Expect that this will be the most difficult for students with the most profound disabilities at the presymbolic level. For these students, creative minds need to come together and task-analyze the most basic of skills to link them to grade-level TEKS. Try your best to maintain a positive attitude - take it one TEKS essence statement at a time!

Be prepared.

Become very familiar with the resources TEA provides; these are very valuable. Go back and review the training modules as often as needed. Although the modules state they can be reviewed in 30-35 minutes, our teachers found they needed much more time to access the important links provided for the resources and documents that are used to create and administer the test. Plan and participate in additional trainings, including those offered on TEKS-based instruction. Manage time wisely. The average time teachers in the Pilot said it took to go through the process of creating one activity for one essence statement was three hours, not including the actual time doing the activity with the student. Some districts funded extra, paid workdays this year; we used our full day in-services, after school training times, and planning periods for our teachers. Begin thinking about a plan for next year; you will have a better idea of what is needed after completing the Field Test this spring. The good news is that the essence statements will be available to all districts by the time school begins next fall, so teachers can begin early and have most of the year to complete TAKS-Alt. TSD is looking ahead at who will train new teachers, how to maintain a database of activities created, and how many in-service days will be needed for activity development and review of the important concepts.

Connect with others.

on this topic; check the TEA website for more information at <http://tea.texas.gov/student.assessment/resources/taksalt/>. If you cannot attend the TETN, you can download the presentations from the website. We immersed ourselves in whatever anyone had to offer on the subject and always found something helpful to use.

Don't be reluctant to contact TEA directly.

Pat Otto, Debbie Owens, Janet Borel and the team at the Student Assessment Division are available to answer questions and clarify information. We contacted them many times, and following the Pilot, we invited them to speak to our staff regarding a variety of questions that came up. In a positive, non-critical way, they reviewed some of our activities and helped us to see where there was room for improvement. They can be reached at (512) 463-9536 or through email at <>, <> or <>.

Download the key documents.

We found it helpful to spiral bind separately the Curriculum Framework and Examples of Instructional Activities for each grade level and subject for easier reference; be sure to copy the Essence Statements, too. Our teachers have several binders of TAKS-Alt information. Print the data collection form you want to use and the hierarchy of prompts and cues; keep these with you when you assess your student. Study the rubric carefully before scoring your student. Enlist support from others to print the volumes of information needed; this is costly. Find a system that works for you!

Expect glitches and mistakes to happen, as this is in its infant stages.

Lots of little bugs are being worked out based on suggestions and feedback from the districts that participated in the Pilot. TEA takes the suggestions seriously and makes changes within the constraints of the law that mandates assessing students across the scope and breadth of the general education curriculum. But, no, they are not going to reduce the number of essence statements. They are, however, prepared to provide more examples of activities available to view on-line, and they are encouraging all of us to send them tools, tips and ideas so they can be shared statewide.

And most of all . . .

Focus on the students!

We were surprised by what some of our students were able to do on modified academic tasks. While this is a big challenge and a shift in thinking for many of us who are concerned about our students not getting enough time to learn important functional skills, remember you are not being asked to throw out all the good things that you have been doing for your students. You are being called to set the bar higher and find ways for them to have access to the curriculum taught to their peers. While not an easy task, I do believe special educators are among the most creative and brilliant of educators. By putting our heads together, we can adjust to these changing times and make something good happen for our special students!

Figure 1 - TAKS Requirements for Subject Areas

Grade

ELA

Reading

Math

Writing

Social Studies

Science

3rd


X

X




4th


X

X

X



5th


X

X



X

6th


X

X




7th


X

X

X



8th


X

X


X

X

9th


X

X




10th

X


X


X

X

Exit Level (11th)

X


X


X

X

Winter 2008 Table of Contents
Versión Español de este artículo (Spanish Version)

By Sara Kitchen, Texas School for the Blind and Visually Impaired Outreach educational consultant for students with visual impairment

Abstract: This article describes structuring positive interactions around children and young people's preferences and responses. A description of the structure of an interactive routine to foster communication is included.

Keywords: blind, visually impaired, multiple disabilities, deafblind, communication, routines.

altInteraction is often difficult and scary for youngsters with multiple impairments including visual impairment. It is often unpredictable, in that others enter and leave without warning. Positive interactions help create a bond, establish trust, and foster communication. An adult who is trusted will more likely be successful in drawing out participation in a child. When interacting with a child who has visual and multiple impairments, especially when establishing a bond, it is important to pay attention to the subtleties of the child's personality. Knowledge of this can help develop interaction that the child will enjoy and endeavor to maintain.

Tips to help foster interaction

  • Be quiet (initially). Listen and observe what kind of verbal interaction the child enjoys, for example:
    • Silly voices
    • Singing/Rhyming
    • Quiet soothing babble
    • Slapstick/Homer Simpson sounds
    • Being imitated
  • Observe behavior. Observe the type of sensory experience the child engages in, for example:
    • Rocking
    • Jumping
    • Flapping Hands
    • Head banging
    • Little movements
    • Big movements
  • Create games that are fun for the child and not offensive to their sensory system. Pair auditory and motor behavior to create a simple interactive game that can be played, for example:
    • A child likes singing and rocking: row the boat is a great game which involves singing and rocking. It can be played at various intensities according to the child's needs.
    • A child likes silly voices and jumping: the child holds the adult's hands while jumping on a trampoline (or the floor if there is no trampoline). The adult says, jump, in a high voice when the child jumps high. The adult says ,jump, in a low voice when the child jumps low.
    • A child likes head banging and being imitated: often children who engage in head-banging are craving more deep pressure. This can come in the form of hugs. When the child makes a noise, the adult can make that noise and squeeze the child simultaneously.

alt

  • Wait for the child to signal that he/she wants more. This gives him/her a role; otherwise, it isn't really an interaction! The child may signal for continuation in a variety of ways, for example;
    • They may look at the adult when the adult has paused.
    • They may move their body after the adult has paused.
    • They may make a sound when the adult has paused.
  • Once you have established a fun, positive interaction, make it a routine. Do it often, and do it in the same way. Introduce the game in the same way:
    • Signal to the child that the game will begin by touching them in a particular way.
    • Introduce the interaction by saying their name the way you call them when you're getting ready for a fun interaction.
    • Bring an object if there is one in the game and let the child explore it before beginning.
  • Perform the steps of the game in the same order. Use the same materials (if there are objects included). End it in the same way, for example:
    • Do the same number of turns and then tell them (say or sign) that you are finished.
    • Say bye bye at the end.
    • Put the object that is used away in a container.

Routines provide predictability which decreases stress. Positive interactions establish a bond. When a child feels safe, stress is decreased and learning opportunities are increased. Positive results will follow, and everyone will have fun along the way!

Winter 2008 Table of Contents
Versión Español de este artículo (Spanish Version)

Dr. Natalie Barraga, Professor Emeritus, The University of Texas at Austin

Abstract: This article describes six stages of learning and education students with visual impairment and their families experience as they grow and change. Educational and family issues are discussed.

Key words: blindness, visual impairment, child development, educational issues in vision impairment

Editor's note: Dr. Barraga is an internationally renowned expert in visual impairment. She directed the training program for teachers of the visually impaired at the University of Texas at Austin from 1963 until she retired in 1984 and has stayed active in the field. She was inducted into the American Printing House for the Blind's Hall of Fame in 1992. Read more about her at the APH website: .

From birth and throughout life, babies, children, and youth with visual impairments encounter numerous challenges. Parents along with other team members are responsible for providing opportunities at various stages to identify variables to be considered and decisions to be made as the challenges increase. As progress is made and children become more responsible, the focus gradually changes to the individual for more involvement in educational and personal decisions.

There are six stages in development in which parents and various team members are involved as children grow.

Stage 1. Infants and Parents, from Birth to 2 years

Parents are dealing with emotional issues of shock, trauma, and grief associated with the first diagnosis of visual impairment. Confusion and uncertainty cloud their thinking until they can begin to understand and accept the reality of the situation. By then, they need to seek information though support systems, reading and learning what to do.

Medical and clinical personnel (preferably pediatricians, pediatric ophthalmologists, and low vision specialists) provide knowledge about the eye conditions, possible medical/surgical interventions, and indicated adaptive devices. Regular examinations to monitor the health of the eye and retina are critical.

Teachers of students with visual impairments (TVI's) can establish communication and rapport with parents, provide positive support, interpret clinical information, and try to answer questions honestly or refer to appropriate persons or reading material. They can model teaching techniques for the parents during visits, and leave written instructions for tasks parents can do daily. They will emphasize tactual, visual and auditory stimulation, and encourage talking to infants by naming objects, sounds and actions.

Certified Orientation and Mobility Specialists (COMS) begin to teach infants orientation to touch, sound, and visual objects. They give checklists of activities for parents to follow, and model teaching to reach, learning to sit alone, to crawl, and later to encourage walking. They also teach body parts, body positioning, spatial concepts, and body movements. They may encourage parents to keep a journal of each new voluntary movement and behavior indicating the use of vision.

Other professionals may need to be added to the team, such as a social worker to provide information and help parents secure needed resources; a neurologist in the event of central nervous system anomalies; physical, occupational and/or speech therapists for infants with motor disabilities; and possibly a low vision specialist, to teach parents how to encourage use of vision with appropriate lights, materials, and activities. The VI professionals begin in infancy to perform the functional vision evaluations and the learning media assessments that will guide sensory access decisions throughout the school years. The Early Childhood Intervention program works with the family on an Individual Family Services Plan (IFSP) in coordination with the school district's TVI and COMS to secure the assistance of these needed team members.

Stage 2. Toddlers and Preschoolers, from 2-4 years of age

This is the stage when a child is striving for independence. Parents (or primary caregivers) are still the primary members of the team. The major decision is to determine who gives the regular care during the day; parents, another family member, or day care. One-on-one teaching of skills and language is a necessity. The IFSP team must make decisions about whether there is exclusive home instruction, or a blend of home teaching and center based teaching. In Texas, home based programming is the most prevalent model during the 0-2 year program. At three, the choice of instructional placement is determined by an Admission, Review and Dismissal (ARD) Committee, which includes the family members, and will depend on individual needs. Children may receive instruction in a regular preschool, public school special education in a PPCD classroom, Pre-K general education, or possibly a special class for children with vision impairment.

Preschool teachers begin to be the leaders for learning development and diagnostic assessments and report to parents and therapists. It may best for the student to be placed in a regular classroom with a consulting teacher of students with visual impairments (TVI) or a special classroom, whichever is most appropriate for the child. The challenges are to select and utilize appropriate magnification when needed; focus on development of such major skills as language and story telling; stimulation of all senses; gross and fine motor activities; establishment of concepts; and encouragement of independence and responsibility.

The Certified Orientation and Mobility Specialist (COMS) teaches sensory orientation skills involved in movement, increases the scope of gross motor skills and some fine motor skills such as protective techniques. The COMS may introduce mobility devices for independent movements using push objects and later the cane.

Peers become playmates and important team members; at first they engage in parallel play, then model imitative play and other movement actions. They are actually teachers when engaging in activities such as running, hopping, skipping, and jumping. Language interaction stimulates curiosity and is a motivating force for exploration and engagement of the world beyond tactile and visual reach.

Stage 3. Kindergarten and the Primary Grades, from 5-7 years of age

This stage involves many of the same team members with addition of others as indicated. Parents, in consultation with teachers have important decisions to make in regard to placement and instructional service delivery depending upon the child's readiness for and progress in the general and VI-specific expanded core curriculum. The visual status of the child is not the only determinant in placement. One placement may be appropriate initially but depending on the progress and needs of the individual may change later. If more VI service intensity is needed, increasing local TVI time and/or short or long-term placements at a residential school might be considered.

At home, the parents are challenged to encourage more independence in personal and home activities. Play opportunities with peers are especially critical as is time with parents to talk about incidents of the day. Children often have questions and they should be encouraged to talk freely about them and to receive open and candid answers. They need to know exactly what their visual condition is and be able to explain it to peers and teachers. If they use special devices they should explain how they are helping them do their work (and let others experiment with the device). Children can learn to express their visual needs and ask for help graciously when needed but politely refuse offers of help when not needed.

The TVI works closely with the instructional and assessment staff to assess visual, auditory, tactual concepts; evaluate fine and gross motor coordination; evaluate receptive and expressive language; and note any sensory preferences and their efficiency. The Educational Diagnostician is part of the team to develop educational and cognitive measures as indicated, and share assessment data with parents and teachers to develop the individualized educational program (IEP).

Teachers, TVIs, and parents are in constant communication regarding placement options and educational plans. Special skills may be a part of the school day or scheduled after school or on weekends.

They may include handwriting, selection of primary learning media, proper use of magnification devices, monoculars, and/or other devices for greater independence.

The Orientation and Mobility Specialist teaches travel in the school building or local neighborhood, location in space on playground and safety in cane travel.

Medical/clinical team members receive reports from others and continue to monitor visual condition and appropriate lenses or devices.

Stage 4. Middle to Late Elementary School, from 8-12 years of age

This is a crucial time for students and team members when issues and decisions require communication and cooperation among all members, who have both individual and team responsibilities.

The key challenge is to develop the learning scope and efficiency of the students as a priority to make maximum progress possible. Instructional decisions based upon student achievement will determine the type and amount of VI specialized instruction. Placement changes may be indicated if progress is not satisfactory, such as moving from regular class to a self-contained or resource class or placement in residential school. Ongoing evaluation of the efficiency of the student's primary learning media (visual, tactual or both) supplemented by auditory is critical. As the nature of visual materials the student will need to access changes, the TVI will refine the learning media assessment and determine the efficiency of regular print, magnification, and/or braille. A CCTV may be useful for some specific activities, such as to enhance handwriting skills or to look up words in the dictionary or read shorter passages. New skills to be emphasized are keyboarding for the computer and other technology-related instruction. Social skills are important to enhance communication and interaction with peers and teachers, and as a means to effect natural independence as a prelude to middle and high school.

Stage 5. Middle School and High School, from 12 to 18 years of age.

The early and later teen years indicate the need for additional members of the previous teams to ensure a broader scope of academic, vocational and job-seeking considerations. Rehabilitation counselors and/or job coaches, adults with visual impairments as role-models, and extended family members are valuable members of the team. The following emphases are crucial:

  1. Refinement of academic and personal skills.
  2. Learning to acquire, evaluate, and organize information.
  3. Selecting, using, and maintaining equipment and tools including technology.
  4. Setting personal and vocational goals.
  5. Analyzing and solving problems at school, home, and community.
  6. Developing personal and behavioral values such as honesty about the visual condition related to peer pressure.
  7. Emphasizing job-seeking skills and performing volunteer and/or paid work.
  8. Applying for admission to college or vocational training.

Peers may have a strong influence during these years, but students still need values, standards of behavior, and knowledge about being respectful of parents and other adults when interacting with others. Interactive clubs and sports participation may boost self-esteem and provide a unique identity, helping compensate for being unable to drive a car.

Stage 6. Transition to Adulthood, from 18 years and beyond

The major decisions center around, What now? Where do I live? Where can I work? Should I pursue further education? When an individual has other disabling conditions, these decisions require consultation with team members about the optimal situation for each individual. Some may be unable to live away from home or other protected environments. Creative personal living and working situations, including sheltered or supported employment, may be suitable for those with limited independence. If additional education is indicated, then it may be a trade school for placement as an apprentice related to skills; community college can prepare one to be a teacher's aide or childcare worker or small business employer or owner. University can be a goal for those who have reached a higher level of independence in routine activities, travel, work habits, and mature decision making in relationships, self evaluation and self advocacy, and have realistic future plans.

The ideal goal is for maximum growth of each individual according to their physical abilities and cognitive development.