The best of both: working together to support children with visual impairment and additional complex needs

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1 Visua impairment and speech and anguage therapy The best of both: working together to support chidren with visua impairment and additiona compex needs A series of eafets exporing ways that the QTVI (Quaified Teacher of Visuay Impaired chidren) and other professionas can achieve an effective working reationship together and ensure the best outcome for chidren with specia requirements. This eafet has been written by Ian Be (Lead Speech and Language Therapist RNIB Pears Centre for Speciaist Learning, formery known as RNIB Rushton Schoo and Chidren s Home) and Judy Be (QTVI and Independent Consutant).

2 The team A chid with a combination of disabiities is ikey to receive continued support from severa agencies, each to address a medica, educationa, therapeutic or socia need. Each supporting professiona wi have their own expertise, priorities, methods of working and aims for the chid. In this series of eafets we ook at the above scenario and expore ways that the QTVI can support effective team work with other professionas. We aim to discover how good communication and joint working can hep to: eiminate seemingy conficting or confusing practice for both professionas and parents avoid, or sove, practica probems co-ordinate working practice, aims and targets to ensure the best possibe outcome for the chid. Other tites in the series incude: Visua impairment and physiotherapy Visua impairment and occupationa therapy Visua impairment and orthoptics (cinica and functiona vision assessment) Visua impairment and specific medica needs and medication. How the speech and anguage therapist and QTVI can achieve the best of both Some practitioners are not aware that speech and anguage therapists (SLTs) have a roe with chidren who have visua impairment and compex needs who may not speak or have any symboic anguage. In fact, SLTs dea with communication in its broadest sense and can make an important contribution to supporting this group of chidren. Many of these chidren have difficuties with eating and drinking and SLTs focus on these issues too. With regard to communication, SLTs work in simiar ways to QTVIs. The roe of the QTVI focuses on the chid s earning and deveopment in reation to visua and non-visua communication. 2 Best of both Visua impairment and speech and anguage therapy

3 The QTVI: has a roe in reducing the impact of VI on communication and in assessing capacity to access visua communication raises the cass team s awareness and knowedge of visua impairment and its impact on chidren with compex needs assesses the chid s functiona vision gives advice on managing the environment assists with the seection of targets assists with devising intervention strategies. The roe of the SLT focuses on maximising communication opportunities. The SLT: supports the cass team s understanding of communication assists with assessing communication gives advice on designing the communicative environment assists with the seection of targets assists with devising intervention strategies. How is communication affected by visua impairment? Having itte or no vision has an impact as soon as a baby is born. A new-born sighted baby is interested in peope s faces. When a sighted baby ooks at her, the mother engages with the chid, responding naturay to what the chid does. A chid who has visua impairment does not give the same signas as a sighted chid, making it much harder for the mother (and others) to respond in hepfu ways: the chid makes itte or no eye contact, smies ater and possiby ess warmy, may starte when picked up and may babbe ess. The cruciay important eary interactive patterns are not easiy estabished. Visuay impaired babies aso tend to be passive; without being abe to see the exciting word around them, they expore ess. Many show itte interest in the word. In turn, this means they have ess to communicate about. A passive chid rarey takes the initiative to spontaneousy communicate what they need or want. This is very disabing. For sighted infants, vision pays an essentia roe in earning to request. At about 10 months of age, an infant who sees something interesting is ikey to ask for it by ooking at the object, then at an adut, back at the object and so on; the chid wi point and vocaise to emphasise that they want the object. With itte or no vision, earning to request is much harder. When the chid has additiona disabiities the difficuties outined above may be compounded by others such as poor attention, imited memory, impaired movement, poor co-ordination, hearing oss, and the effects of issues such as a poor seep pattern, epiepsy and medication. Best of both Visua impairment and Visua speech impairment and anguage and therapy 3

4 In schoo, who has a roe in promoting communication? Everyone does: a staff who come into contact with the chid have a roe. Communication occurs throughout the day, in a situations and with a peope. Everyone must promote it. What has the SLT to offer? Supporting the cass team s understanding of communication This may be through informa training sessions but is more ikey to be embedded in the SLT s reguar work. For exampe, in assisting with assessment, the SLT may outine an aspect of communication deveopment in typica chidren and expain how that might differ in chidren who have vision impairment and compex needs. The cass team s understanding wi aso grow through discussion of the communicative environment and the seection of targets and intervention strategies. Assessment A difficuty for the SLT is not being in reguar contact with the chid. This means their roe is to assist the cass team with assessment. Teachers are required to report against the P Leves so wi need to assess, monitor and record progress of chidren who have vision impairment and compex needs using P Leves. Difficuties may arise because these omit many important visua skis and are not readiy appicabe to chidren who do not foow a typica visua deveopmenta pathway. With their expert knowedge of eary communicative deveopment, SLTs can assist teachers to obtain an accurate assessment of communication. Designing the communicative environment Supporting communication is necessary at a times and requires an appropriate communicative environment to provide chidren with the means, opportunities and reasons to communicate. Means of communication Many chidren who have visua impairment and compex needs require aternative and augmentative communication (AAC) means. Those chidren who have not yet reached the stage of symboic communication or who cannot speak ceary require at east one aternative means for expressive communication. Staff must aso augment their spoken anguage to hep the chid to understand; this is so even if the chid has some understanding of spoken anguage. 4 Best of both Visua impairment and speech and anguage therapy

5 There is a range of both aternative and augmentative means. Possibiities, depending on a range of factors, incude signing, objects of reference, tactie pictures/symbos, enarged visua pictures and symbos, and voice-output communication aids. Routine, music, and even sme can aso be used as aternative means. Seecting aternative and augmentative means is often very difficut and may rey on trying different means to estabish which works best for the chid. The foowing exampe highights the impact of using aternative communication means. Rashid Rashid has some functiona vision, but the SLT was unsure whether this was sufficient to see signing. The QTVI advised that he woud be unabe to see signs ceary uness they were made very cose to him. However, he disikes having someone in his persona space more than very briefy, so on-body signing is inappropriate. The QTVI aso informed the SLT that Rashid enjoys exporing everyday objects by touch. The SLT therefore recommended that staff shoud augment their spoken anguage with objects of reference. Rashid is aso beginning to use objects expressivey as an aternative to spoken anguage. A sma pastic box is kept on a shef just inside the cassroom. When he is not engaged in an educationa activity, Rashid finds this box, takes it to a member of staff, and exchanges it for a arge box containing severa everyday objects he enjoys exporing. Opportunities for communication Cassroom staff must provide chidren with opportunities to communicate. Because chidren who have vision impairment and compex needs require additiona time to process what they experience, and extra time to respond, it is essentia that staff sow down and wait for the chid. The importance of this is evident in the foowing exampes. Charie Before unch Charie is positioned in his wheechair. It woud be very easy for staff simpy to push the tray into pace. However, Charie is given the opportunity to respond to communication and to pay an active part in this. The QTVI advised the SLT that the tray is arge enough for Charie to see if it is hed up in front of him and he is given 30 seconds to process the visua information. The SLT therefore advised the teaching assistant to hod the tray in front of Charie for 30 seconds and then to say Tray. Arms up. and wait. After what can seem ike a ong time, Charie sowy raises his arms, aowing the tray to be fixed. As noted above, many chidren who have vision impairment and compex needs rarey initiate. It is essentia to give them opportunities to do so. The ony way of providing such opportunities is to wait. This is essentia. Kiran Kiran oves the spinning top and dancing bear, but reies on someone ese to set them going. Each time one of the toys stops, the adut waits and observes Kiran. After a pause, Kiran hums quiety if she wants the top, or jigges her eft eg for the bear. The QTVI said that she thought Kiran might have sufficient vision to see the top and bear if they were no more than a metre away. Initiay, Best of both Visua impairment and speech and anguage therapy 5

6 Kiran dispayed no visua interest in the toys. However, because of the QTVI s advice, staff ooked for visua interest. After severa months, it was observed that as we as humming or jigging her eg, Kiran was ooking towards the toy in question. Reasons for communication Chidren communicate for many reasons. For exampe, they request, reject, greet, gain attention, protest and express feeings and emotions such as pain, discomfort and boredom. Schoo staff become skied at knowing what chidren ike and disike. It is easy to fa into the habit of simpy giving chidren their favourite items and never those they disike, but this denies them reasons for communicating. The foowing exampe demonstrates communication through the picture exchange communication (PECS) system. Freddie The SLT considered using PECS to support Freddie. However, being unsure about the most suitabe means of communication, she sought advice from the QTVI. The QTVI informed the SLT that Freddie has sufficient vision to his right to recognise items severa centimetres ong at a distance of up to two metres. The QTVI recommended the use of cutter-free ife-ike pictures on cards 12cm square. Freddie ikes to use the bes in circe time. The SLT therefore recommended that a teaching assistant sits about 1.5 metres from Freddie, on his right, with the bes resting in her ap; she aso recommended that a suitabe picture of the bes be paced on the tabe to Freddie s right. To draw Freddie s attention to the bes, the teaching assistant briefy shakes them. As circe time begins, Freddie picks up the picture, waks to the teaching assistant and hands over the picture, in exchange, Freddie is given the bes. Routines can hep chidren to understand what is happening and predict what wi happen next. Once the chid knows a routine, staff shoud sometimes pause, or introduce a change and wait for the chid to signa awareness or request the next step. Lois Lois participates in dressing: Afza, her teaching assistant, heps her to put on a sock; instead of immediatey putting on her shoe, Afza waits; Lois ifts her foot to ask for her shoe to be put on. Seecting targets Seecting targets can be compex, especiay when assessment indicates severa possibe targets. SLTs can assist in such situations by drawing on their knowedge of how communication deveops. Cassroom staff, who know the chid far better than the SLT, contribute with their knowedge of the chid and what happens during the schoo day. 6 Best of both Visua impairment and speech and anguage therapy

7 Don Don is working within P4 in Speaking: he uses severa singe words, a names of famiiar peope and objects. Mark, his teacher was unsure of which words to target next. The SLT noted that a typica chid at this stage might aso have a few words concerned with actions, such as gone and spash. However, Don has no vision, so woud not see objects disappearing; he aso disikes water. It was therefore decided not to target these words. In contrast, Mark knew that Don reay enjoyed it when Mary, a teaching assistant, capped. The target seected is therefore that Don uses the word cap. Seecting strategies Having seected a target, it is important to specify the strategies for achieving it. Because Don sometimes copies a word he hears, the SLT advised that modeing coud be used. Severa times a day, Mark and Mary take Don to the quiet corner. Mark tes Don who is present and then modes the target behaviour by saying cap. Mary immediatey caps for a few seconds. Again, Mark says cap. Again, Mary caps briefy. This time Mark waits, giving Don the opportunity to say cap. If he does not do so, Mark again says cap. Don is not directy asked to say cap. Many other opportunities are taken to use the word cap. For exampe, whenever a pupi has worked hard, they are given a cap. Thus Don hears the word many times a day. Concusion Everyone who comes into contact with each chid has an essentia roe in supporting and faciitating communication. Different members of the team bring different things to this work. By understanding and respecting each other s work, and that of the schoo staff, the QTVI and SLT support the cassroom team, enabing them to have the best of both. More information Communication is very compex. Therefore, we have provided ony a very brief introduction here. The Compex Needs pages of the RNIB website are a source of further ideas, visit rnib.org.uk/ professionas/education/schoobasedearning/compexneeds/pages/compex_needs.aspx Some chidren who have visua impairment aso have autism. The strategies for supporting such chidren have received itte attention to date. The Visua Impairment and Autism Project is preparing a Resource Pack which wi provide guidance for practitioners. For more information, visit rnib.org.uk/autism Best of both Visua impairment and speech and anguage therapy 7

8 Best of both: other tites in the series To order more copies of this eafet or the others in the series, pease ca , emai or visit rnib.org.uk/shop Visua impairment and speech and anguage therapy (PR12322P) Visua impairment and physiotherapy (PR12319P) Visua impairment and occupationa therapy (PR12320P) Visua impairment and orthoptics (cinica and functiona vision assessment) (PR12321P) Visua impairment, specific medica needs and medication (PR12323P) Visua impairment and orthoptics (cinica and functiona vision assessment) The best of both: working together to support chidren with visua impairment and additiona compex needs A series of eafets exporing ways that the QTVI (Quaified Teacher of Visuay Impaired chidren) and other professionas can achieve an effective working reationship together and ensure the best outcome for chidren with specia requirements. This eafet has been written by Catherine Southwe (QTVI, Woverhampton) and Stevie Johnson (RNIB Eye Cinic Impact Team and Orthoptist) Visua impairment and occupationa therapy The best of both: working together to support chidren with visua impairment and additiona compex needs A series of eafets exporing ways that the QTVI (Quaified Teacher of Visuay Impaired chidren) and other professionas can achieve an effective working reationship together and ensure the best outcome for chidren with specia requirements. This eafet has been written by Catherine Southwe (QTVI, Woverhampton) and Debbie Hunt (Senior Occupationa Therapist, Woverhampton PCT). Visua impairment, specific medica needs and medication The best of both: working together to support chidren with visua impairment and additiona compex needs A series of eafets exporing ways that the QTVI (Quaified Teacher of Visuay Impaired chidren) and other professionas can achieve an effective working reationship together and ensure the best outcome for chidren with specia requirements. This eafet has been written by Catherine Southwe (QTVI, Woverhampton) and Fiona Minion (RN Learning Disabiities, RNIB Rushton Schoo and Chidren s Home) Insight Do you support a chid or young person who is bind or partiay sighted? Insight magazine is packed fu of practica ideas, persona stories and advice from teachers, parents and eading experts to inspire you at home and in the cassroom. in-depth themes such as mobiity, transition and compex needs famiies sharing their experiences knowing your rights and getting support Pus news and reviews and Bitesize our 12 page termy curricuum suppement Subscribe today: one year s subscription (six issues): UK 21 Students and parents 72 Overseas New: Parents can save more by becoming a Member of RNIB. For detais ca quoting Insight offer How to subscribe Ca or rnib.org.uk/shop RNIB Juy 2011 Registered charity number PR12322P

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