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Stephanie Walker, M. Ed., Educational Consultant, Lead for the State Leadership Services for the Blind and Visually Impaired (SLSBVI) Network, Education Service Center Region 11

Abstract: CVI is a neurologically based visual impairment that may be improved with targeted and specialized interventions. Teachers often feel unprepared to assess and modify for this highly complex condition. It can be frustrating for parents and guardians if they see that the educational team lacks guidance about how to address their child’s vision needs. The Texas CVI Statewide Initiative has been formed to improve educator confidence and competence in addressing CVI around the state and thus improve outcomes for children who have CVI.

Keywords: Texas CVI Initiative, cortical visual impairment, cerebral visual impairment, CVI, neurological impairment, Dr. Christine Roman-Lantzy, Christine Roman, teacher training, university prep programs, Texas Tech University, TTU, Stephen F. Austin University, SFA, CVI Range Endorsement©, Amanda Lueck

Neurological, cortical and/or cerebral visual impairment (CVI) are all terms that are used to describe brain-based visual impairments. This area of the field of visual impairment is expanding rapidly due to new research. As professionals in the field debate names, strategies, assessments, research, and theories, many parents and guardians in the United States are asking for educators to utilize appropriate assessments and interventions across educational settings for students identified with CVI.

In 2018, 19% of students with visual impairment in Texas had a diagnosis of CVI, making CVI the leading cause of visual impairment in Texas. The second leading cause of visual impairment in Texas was retinopathy of prematurity (ROP) at 15%. The percentage of students diagnosed with CVI has been steadily increasing each year. Texas professionals are prepared to answer the call to action from parents and guardians. We are committed to impacting student success where it counts the most, utilizing the most appropriate interventions based on assessments across multiple settings. This begins with assessing the current level of knowledge surrounding CVI and expanding that level throughout the state and across professions.

In order to identify ways to expand the level of expertise within CVI and keep up with the current research, Texas leaders in the field of visual impairment are meeting to assess the support and/or training necessary for professionals to meet the ongoing needs of students with CVI statewide. Participants include: members of the SLSBVI (State Leadership Services for the Blind and Visually Impaired) Network, including the statewide lead, Stephanie Walker; Dr. Shannon Darst and Dr. Rona Pogrund from the Texas universities that prepare students to become Teachers of Students with Visual Impairments, Texas Tech University (TTU) and Stephen F. Austin State University (SFASU); Emily Coleman, Director of Outreach Programs, Texas School for the Blind  and Visually Impaired (TSBVI); two Outreach VI Education Specialists from TSBVI; and an independent consultant from the Houston area, Diane Sheline, who has extensive experience in evaluating children with CVI and has made it a special area of study. Coleman and Sheline have also completed the CVI Range Endorsement©. In the United States, the most common term used is Cortical Visual Impairment, so the group adopted CVI to refer to this condition. This group is called the Texas CVI Statewide Initiative.

The Texas CVI Statewide Initiative identified three levels of knowledge in the area of CVI as well as existing opportunities for training. Level 1, reflection, refers to a basic level of knowledge related to CVI. This can be attained through university coursework at teacher preparation programs, online courses, or in-person trainings with Dr. Christine Roman-Lantzy, Dr. Amanda Lueck, or Diane Sheline. Level 1 trainees would observe someone using the CVI Range© (or another assessment if/when one becomes available) to assess the student’s visual functioning, provide appropriate intervention, and reflect on the student’s response to that intervention. A mentor who is very seasoned in using the tool can provide this experience. In Texas, a year-long process called the CVI Clinic offers attendees an opportunity to observe this process (https://library.tsbvi.edu/Player/18435 for English; https://library.tsbvi.edu/Player/18436 for Spanish). TSBVI is also creating online modules, guided by the newly released (2018) second edition of Dr. Christine Roman-Lantzy’s book, Cortical Visual Impairment: An Approach to Assessment and Intervention, to provide an additional resource for an observer of this process if an experienced mentor in CVI is not available. These online modules could also be used within university coursework to provide Level 1 training. Texas Tech University and Stephen F. Austin State University are developing additional coursework to ensure that new TVIs have a solid base of knowledge in CVI when they enter the field.

The second level, implementation, is what we like to refer to as the “boots on the ground” level. With support, educators will perform an assessment, determine intervention, write reports with relevant information about CVI, develop IEPs, and collect data supporting the selection and effectiveness of interventions. The first step is performing the assessment with the support of a CVI coach or mentor. This can be achieved one-to-one with a mentor well versed in CVI and assessment. Assessment practice can also be accomplished through the CVI Clinic (see above), as the professional participates by gathering information, scoring during all steps of the process, and completing a report on their student. After the clinic, teachers provide follow-up video of their student’s visual behavior after interventions have been put into place. CVI Study Groups offered by TSBVI Outreach can be utilized to grow in the area of implementation, as participants engage in conversations, view student videos, and exchange ideas with a group of colleagues related to students in different phases of CVI. The online modules described above will offer users a second level guided practice, which will require implementation of the CVI Assessment process. This will give participants a chance to practice implementation and may be utilized within university coursework to provide a higher skill level in relation to CVI. Perkins School for the Blind offers a number of more specific web trainings on apps for CVI and literacy for students with CVI (http://www.perkinselearning.org/cvi). Another great, multi-dimensional resource for CVI is offered through the American Printing House for the Blind’s website (https://cvi.aphtech.org/).

A professional may spend a great deal of time at Level 2 (just like our kids may spend a great deal of time in Phase II of the CVI Range) building their skills before they become ready for Level 3, which involves facilitation. Level 3 includes serving as a CVI mentor, leading trainings for those who have less experience, and assisting with CVI Clinics.  An educator at Level 3 might pursue the CVI Range Endorsement©. A professional that is at the facilitation level would be expected to possess the skills to administer an assessment appropriately, be well-versed in implementing a wide range of interventions and strategies successfully, deliver training to educational teams, and continue to expand their knowledge of current research and practices in the area of neurologically based visual impairment.

It is important to the Texas CVI Initiative to ensure that we are addressing the capacity of educators in Texas at all levels, and also to build a strong mentor base that can support additional educators in developing skills related to CVI. CVI is a complex and endlessly fascinating topic. As the Texas CVI Initiative moves forward, we will continue to consult with families of students with CVI to ensure that the continuum of professional learning we are building is addressing the unique needs of this population and that we are taking into account family needs as well. We are committed to providing the best opportunities for all of our students with visual impairment, and we believe a network of support is essential to provide families and educators with the tools necessary to support students with CVI.