Considerations for Visual Impairment When Designing a Behavior Intervention Plan

Authors: Scott Baltisberger, VI Educational Consultant, Outreach Program, Texas School for the Blind and Visually Impaired (TSBVI)

Introduction

A Behavior Intervention Plan (BIP) can be a valuable tool for supporting a student who is experiencing emotional challenges that manifest in difficult, maladaptive or non-constructive patterns of conduct. The origins of a particular student’s emotional distress are as individual and personal as the student themself. 

With any student, a BIP must be personalized for their individual needs, and adhering too closely to any generalizations based on a student’s visual impairment may be problematic. However, it can be helpful to have in mind some general concepts to ensure that the impact of a visual impairment is considered. 

What follows are some general observations and suggestions for educational teams who are developing a behavior intervention plan for a student who is blind, deafblind, or has low vision. The information is organized into five main topics:

1. Impact of visual impairment on social skills acquisition
2. Impact of visual impairment on communication skills
3. Impact of visual impairment on emotional health
4. Impact of visual impairment on academic access
5. Impact of additional disabilities

Social Skills

• A great deal of a student’s early knowledge and skills are a result of incidental learning, which is unintentional learning through primarily visual observation of social interaction and contextual experience, rather than from direct instruction. This includes the acquisition of social skills and cognitive constructs. While people may tend to think of social skills as innate or as arising naturally and universally for everyone, experiences are heavily informed by what is observed visually. A student who is blind may miss important cues for building social skills, most of which are non-verbal, and this can impact how the student interacts with others.
• It is possible that a student’s deficits in social skills could impact interactions with peers and/or adults to such an extent that problems arise. These could be based on either the student’s misunderstanding of typical social interactions, or others may be misinterpreting the student’s atypical actions. 
• The team should consider whether the behavior arises as a result of deficits in social skills or missing concepts resulting from incomplete learning due to the visual impairment. If so, steps should be taken to provide learning experiences which may address the underlying causes of problematic behavior. 
• Proactive strategies in this area often include direct and explicit instruction in “what to do” during usual classroom activities such as lining up for transitions or eating in the cafeteria. 

Communication Skills

• A great deal of communication between people who are sighted relies on non-verbal cues, many of which may not be available to a student who is blind. These can include not only body language, gestures and eye contact but also environmental cues and information. 
• Examples of environmental cues and information are the number of people in the room, the reactions of persons not directly involved in an interaction, whether an utterance is directed to the student or to a completely different person, and identifying the source of a noise.
• If these nonverbal cues are missed, there is potential for miscommunication and misunderstanding, which could harm the implementation of a behavior program.
• Accordingly, staff working with a student who has a BIP must be provided information and training on the specific nature of the student’s visual impairment as well as effective communication and interaction strategies with persons who are blind.
• One effective training activity can be to provide blindness sensitivity training in which sighted staff are blindfolded and tasked to engage in activities and interactions in which vision would typically play an important role. The desired outcome is that staff will have an increased awareness of how they interact with the student who is blind and will modify their own behavior to be more supportive and effective.
• Proactive strategies that support effective communication and reduce distress may include:
  • The use of social stories that aid the student in understanding a particular situation and their role in it.
  • Consistently addressing the student by name and identifying oneself during interactions.
  • Taking time to explain to the student the setting, what is happening, and who is present. 

Emotional Health

• Recently, there has been significant attention, research, and training for educational staff directed towards “trauma-informed instruction”. This approach views a great many maladaptive behaviors as arising from a student’s experience of traumatic events in the past. Behaviors are not viewed as a conscious attempt on the part of the student to achieve a result but as an attempt to achieve safety and stability.
• The focus is not so much on the behavior itself as on the student’s mental and emotional well-being. The goal of the intervention is to support the student in regaining feelings of safety, interpersonal connection and independence. 
• Behaviors are not addressed in isolation but as part of the larger, ongoing relationship shared by the student and the adults in their life. 
• Trauma can be considered “big-T”—major, dramatic, defining events that are easily identified, such as a physical assault or a debilitating illness. Students who are blind or have low vision may have lost their vision as a result of an accident or progressive disease. They may have also experienced extensive medical treatment related to their eye condition. They may still be feeling the effects of this trauma even many years later.
• There are also “small-t” events that are not as dramatic but which occur on an ongoing basis, and their cumulative effect can be the same. Due to their visual impairment or others’ response to it, students who are blind may suffer from real or perceived rejection, isolation, and lack of autonomy.
• When designing or implementing a BIP, it may be helpful to investigate how big-T or little-t traumas may be impacting the student. A focus on fostering safe, supportive relationships between the adult and child is key. Options include:
  • Guidance for Planning Behavior Intervention for Children and Young Adults who are Deafblind or have Visual & Multiple Impairments from TSBVI offers further information and ideas on this approach.
  • Some proactive strategies that may be helpful include:
    • Spend time with the student talking about what is interesting or important in their life.
    • When a student is experiencing distress, reduce demands.
    • Provide opportunities for the student to use self-calming strategies such as movement breaks.
  • “Trust-Based Relational Intervention”, based on the work of Dr. Karyn Purvis, is another approach based on addressing behavior from the standpoint of adult-student relationships. 

Academic Access

• Students who are blind or have low vision frequently require adapted materials and other accommodations to access instructional content. However, teachers sometimes believe that providing auditory access is sufficient. This is simply not the case in most situations.
• Students who do not have sufficient access to instruction and instructional materials may feel confused and disconnected from lessons and learning opportunities in the classroom, which can lead to anxiety and distress. Students may react to these feelings by refusing to complete assignments or engage with instructional activities.
• Proactive strategies to increase engagement include:
  • Consistent provision of adapted materials to allow the student to meaningfully participate in classroom activities.
  • Consistent implementation of the accommodations a student requires for access to instructional materials.
  • Frequent check-ins with the student to ensure they understand lesson content along with the class assignment, especially if the student has materials that, out of necessity, are different from those of peers.

Additional Disabilities

Another aspect to consider is the high percentage of additional disabilities among students with visual impairment. Autism spectrum disorder, intellectual disability, motor impairment, speech/language impairment and auditory impairment, among others, can increase not only the chances that social, communicative and emotional factors are present, but also the severity of their impact. For example, a student who is blind but also has an intellectual disability and motor impairment may have experienced greater isolation due to challenges in connecting and communicating with others. Limited connection and communication can result in increased feelings of isolation and concurrent trauma.

Summary

A behavior intervention plan can be a great tool for supporting a student. However, not all behavior plans are created equally. The quality and effectiveness of a plan are directly dependent on the degree to which it is individualized for a particular student. Applying general strategies that fail to incorporate deep observation and knowledge of the student’s social, communicative and emotional needs will be of only limited success. In the case of a student who is blind, deafblind or has low vision, the possible impact of the visual impairment on each of these areas should be considered. 

Resources

Schultz, M. et al. (n.d.). Guidance for planning behavior intervention for children and young adults who are deafblind or have visual and multiple impairments. Texas School for the Blind and Visually Impaired. https://www.tsbvi.edu/wp-content/uploads/assets/documents/statewide-resources/behavior_guidance.pdf 

Purvis, K. (2005). Trust-Based Relational Intervention. Karyn Purvis Institute of Child Development. https://child.tcu.edu/#sthash.pxYkr1Cw.dpbs