ERIC EJ1114533: Expanding the Frontiers of Orientation and Mobility for Infants and Toddlers in New Mexico and Utah

2015·0.06 MB·English

by  ERIC

ExpandingtheFrontiers theconcepts,skills,andconfidencenecessary
ofOrientationandMobility totravelandexploresafelyandindependently
forInfantsandToddlers in a variety of environments. Early O&M
inNewMexicoandUtah support is critical in helping families and
otherserviceproviderstofacilitatepurposeful
HongPhangiaDewald,CindyFaris,
movement and independence in young chil-
KarenS.Borg,JulieManer,
dren with visual impairments.
LoretaMartinez-Cargo,andMarkCarter
O&M instructors are trained to teach all
E
arly intervention services provide very
age groups; however, many often “lack an
young children, typically aged birth to 3
understanding of early childhood learning,
years, and their families “early and appropri-
which makes them uncomfortable with pro-
ate learning experiences to facilitate the
vidingservicestoveryyoungchildren”(Skel-
child’s learning and development” in their
lenger & Sapp, 2010, p. 200). There is an
natural environment (Chen, 2014, p. 3).
increasing recognition of a need for qualified
Teachersofstudentswithvisualimpairments
O&M specialists in early intervention. O&M
andcertifiedorientationandmobility(O&M)
instructors who wish to work in early inter-
specialists provide vision-related expertise to
vention need to obtain additional training in
families and the early intervention team to
early childhood development and learn strat-
address the vision needs of children. These
egies for working with this special popula-
services are integrated with other early inter-
tion.AstheworkofO&Mspecialistschanges
vention services as part of an individualized toincludemoreinfantsandtoddlers,theroles
familyserviceplan(IFSP).Thiscollaboration ofsuchspecialistswillalsochange(Anthony
enhances the quality of services and informs et al., 2002). Preparing O&M specialists to
families and early intervention colleagues so work appropriately with young children with
they are better prepared to provide adequate visualimpairmentsandtheirfamiliesrequires
recommendations and options for the transi- “more than a shift from the formal O&M
tion into preschool of young children with techniquesandapplicationstoadevelopmen-
visual impairments. tallyappropriateapproach.Thelatterwillde-
Research has shown that children with vi- mand further research and collaboration
sual impairments often experience delays in withinanearlychildhoodspectrumofeduca-
the development of gross motor skills when tion for children with vision loss” (Anthony
compared to their peers who are sighted et al., 2002, p. 404).
(Adelson & Fraiberg, 1974; Ferrell, 1998; This report represents the perspectives of
Troster & Brambring, 1993). Because of the two states that have recognized the need for
significant role vision plays in sensorimotor specialized O&M services in their early in-
development in young children (Rosen, tervention programs for young children with
2010), the lack of visual input is a major visual impairments. New Mexico, with a
contributor to these delays. Vision impair- growing early intervention O&M program,
ment frequently hinders these children from has a successful history of providing these
purposefully reaching out and moving about services throughout the state. Utah, with a
toinvestigateandexploretheirsurroundings. long history of providing early intervention
“O&M, with its emphasis on movement, ac- vision services, but relatively new to the
tually encompasses all development areas” challenge of early intervention O&M, and
(Anthony, Bleier, Fazzi, Kish, & Pogrund, inspired by New Mexico’s success, is striv-
2002,p.327).ThegoalofO&Msupportisto ingtoprovidemoresupportandtrainingfor
help people with visual impairments develop these specialists to work with very young
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JournalofVisualImpairment&Blindness,November-December2015 ©2015AFB,AllRightsReserved
visually impaired children and their visionimpairmentandbestpracticesforearly
families. intervention to help prepare staff members to
provide services for this population.
NEWMEXICO:AGROWINGPRACTICE ThesearchledNMSBVItoUtah’sSKI-HI
Since 2000, the New Mexico School for the Institute and its Vision Impaired InService in
Blind and Visually Impaired (NMSBVI) has America (VIISA) curriculum (Morgan,
been building its early intervention program. 1995). VIISA is a resource-curriculum de-
It began with one teacher of students with signedtosupportprovidersofvisionservices
visual impairments who was tasked to pro- to children aged birth to 5 years (Dennison,
vide services to infants and toddlers in a 2000). The national trainer for the VIISA
center-basedprogramandhasgrowntoastaff projectfromUtahprovidedon-siteinstruction
of 20 individuals who provide services at NMSBVI, the start of a long-term collab-
throughoutthestate.Currently,theNMSBVI oration. NMSBVI staff members were re-
early intervention O&M program includes quired to take the VIISA coursework, and
three specialists and two staff members who many existing NMSBVI staff members were
are currently enrolled in the personnel prep- trained to teach the VIISA coursework to
aration program for O&M at New Mexico facilitate the school’s own training and to
State University. provide training throughout the state to other
NMSBVI has an early intervention pro- early intervention agencies.
gram that is guided by the philosophy that As an offshoot of their in-state training
the “best fit” for providing its services is sessions, NMSBVI staff members began pre-
having staff members who know infant and senting at national conferences in the United
child development and understand the States—at the Western Regional Early Inter-
structureofearlyinterventionandPartCof vention Conference, for example, and those
the Individuals with Disabilities Education of the Association for Education and Reha-
Act (home visiting, family-centered prac- bilitation of the Blind and Visually Impaired
tices, natural environments, team collabo- (AER).StaffmembersfromUtahattendedthe
ration). The program began with a grass- sessionentitled“O&MNewMexicoStyle”at
roots effort to collaborate with the various the AER conference in Seattle in 2012, be-
early intervention agencies around the state ginningUtah’srenewedfocusonaddingspe-
and resulted in integrating vision services cific O&M services to its early intervention
with the other early intervention services services.
provided in New Mexico.
As vision staff members began working UTAH:ADEVELOPINGPRACTICE
withveryyoungchildren,itbecameapparent O&M specialists are few and far between in
that waiting until they were walking and Utah. In 2012, virtually none of them had
ready to use a white cane was not early significant experience with very young chil-
enoughtoreferthemforO&Mservices,since dren. And progress data from the Utah
many of the children were not moving about SchoolsfortheDeafandtheBlind’s(USDB)
andexploringtheirhomeenvironments.Early Parent Infant Program for the Blind and Vi-
intervention teams realized that beginning suallyImpaired(PIPBVI)revealedsignificant
O&M training early would help overall de- lagsingrossmotordevelopment,evenamong
velopment and set the stage for exploration children whose level of disability could not
and movement. As a result, NMSBVI in- account for such delays. These lags created
creased its vision and O&M staff members grave concern among administrators and
and began searching for training materials in educators and spurred their desire to
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©2015AFB,AllRightsReserved JournalofVisualImpairment&Blindness,November-December2015
addressthedeficit.TheinformationPIPBVI A needs assessment was conducted to piece
staff members received from NMSBVI’s together a picture of the children and fam-
AER presentation on O&M for young chil- iliesreceivingearlyinterventionvisionser-
dren,inconjunctionwiththedataindicating vices. The training and needs assessment
need,successfullyresultedinadditionalad- led to the development of a tool to guide
ministrative support for addressing the PIPBVI staff members in making referrals
O&M needs of these children in a more for O&M services. The vision specialist
direct way. fills out the referral form for each child on
The assets that made it possible to include hisorhercaseloadwhomheorshewantsto
O&M in the PIPBVI program include early refer, regardless of the score on the referral
interventionvisionspecialistswhowerewill- instrument.TherespondingO&Mspecialist
ingtoreceiveadditionaltraining,aninforma- also completes the O&M referral tool for
tiontechnologydepartmentwillingtosupport thechildbeingevaluated.Theinstrumentis
the use of distance technologies (Skype or currently being evaluated, and comparisons
FaceTime, for example), O&M specialists of the responses are being reviewed for
willing to implement developmentally ap- interobserver reliability. Although early results
propriate practice for very young children,
are promising, more evaluation is needed.
and a sound structure for delivering home-
The needs assessment indicated that there
based services across the relatively large
are many children and families in PIPBVI
and rural state of Utah. In the past two
who would benefit from O&M services and
years, PIPBVI and the USDB O&M team
instruction. Next steps include training and
have focused on O&M for young children,
educatingtheO&Mstaffmembersonhowto
and qualitative data reveal increased confi-
work more confidently with very young chil-
dence in the O&M process and in imple-
dren and families, increasing referrals from
menting motor interventions.
the PIPBVI vision specialists, and intensify-
The initial development and coordination
ingO&Mservicesforchildrenandfamiliesin
of O&M services for young children and
PIPBVI around the state.
their families in PIPBVI focused on four
areas: conducting a needs assessment, edu-
O&MPRACTICEINEARLYINTERVENTION
cating the staff about O&M, developing a
referral tool to facilitate the referral pro- Introducing O&M as early as possible sup-
cess, and educating the O&M staff about ports the independence, body imagery, and
PartCserviceandpracticesinPIPBVI.One ability of a child with vision loss to move
member of the O&M team was designated purposefully.Itallowsthechildtoventureout
toworkwiththePIPBVIadministrationand pasthisorher“comfortzone.”Proficiencyin
staff members to help initiate O&M service O&M-related skills helps expand the child’s
coordination for PIPBVI. Since none of the world and develop safe travel. The O&M
members of the O&M team had a back- instructor works with the vision specialist to
groundinearlychildhooddevelopment,the understandthevisualfunction,diagnosis,and
PIPBVI administration taught essential challenges the child confronts, then formu-
components of early intervention (for in- lates appropriate interventions and best ap-
stance, Part C processes, principles, and proaches to provide services to each child
best practices) to the O&M team. individually.
Several in-service training sessions were Varioustoolsandstrategiesareincludedin
orchestrated to educate PIPBVI vision staff the services provided. Homemade tools for
members about the O&M referral process. reaching out and activities incorporating a
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JournalofVisualImpairment&Blindness,November-December2015 ©2015AFB,AllRightsReserved
variety of textures, movement, and songs are andpositionalconcepts,spatialconcepts,
utilized. Movement and interaction are en- temporalconcepts,safetyawareness,and
couraged through the use of toys or objects environmental awareness.
that emit sound and light or provide tactual
(cid:129) Developing the other senses, includ-
stimulation.Theuseofaswitchmaypromote
ing hearing, listening, and tactile
purposeful movement and set a foundation
skills. Sound localization, discrimina-
for a possible communication system. All of
tion, and echolocation skills, as well
theseitemsareusefulinexpandingthechild’s
as tactile exploration and discrimina-
repertoire and motivation for exploring the
tion, are foundational to developing
environment.
O&M skills.
The inclusion of family members, the
early intervention team, and the O&M in- (cid:129) Practicing tolerance to movement and
structorininterventioniskeytothesuccess positional changes. A child needs to
of the children, since skills and learning experience typical movement from
environments may be replicated and intro- birth. These experiences include being
ducedwhentheO&Minstructorisnotpres- carriedontheparent’sbody,participat-
ent. Since the children may not be able to
ing in age-appropriate movement play
see the world around them or maneuver
andvariouspositionalchanges(rolling,
withinitefficiently,“incidental”learningis
bouncingonlaps,“flying”movements),
provided via planned outings and learning
and experiencing safe movement in
environments for this group of learners.
space. Early movement will begin to
These learning opportunities are modeled
develop sensory integration, balance,
for family members so that they can be
strength,andcoordination.Theseexpe-
reinforced naturally during daily routines.
Travelinavarietyofenvironments(librar- riences develop transitional move-
ies, parks, or museums, for example) also ments,whicharefoundationalskillsfor
reinforces O&M skills and provides opportu- mobility, and provide a great way to
nitiesforchildrentoexhibitnaturalcuriosity. bond with a child and gain trust while
Theseexperiencesexpandachild’sskills,in- fostering joy in movement, body confi-
cluding trailing, identifying landmarks, at- dence, and a willingness to explore.
tending to surface changes, climbing stairs,
(cid:129) Using play stands and defined play
and entering and exiting a variety of doors.
spacestoencourageindependentmove-
On these outings, families meet other fami-
ment and orientation. Employing short
lies, and this networking helps promote
caneswhilesittinggiveschildrenexpe-
growth in their understanding of their chil-
rience in cane use and teaches them to
dren’sdiagnosesandtheimportanceofO&M
derive environmental information from
skills.
Some guiding principles of early interven- them.
tion O&M practice include: (cid:129) Using active learning strategies to de-
veloppurposeful,meaningfulmovement.
(cid:129) Believing parents are the experts on (cid:129) Introducing a push toy or walker for
their children and should be actively independent standing and safe walking
involved in every lesson. when children are ready for standing
(cid:129) Including orientation concepts in all les- and walking. Using a walker or push
sons. These concepts include locational toy will give children experience with
505
©2015AFB,AllRightsReserved JournalofVisualImpairment&Blindness,November-December2015
independent movement and prepare ture,theexperiencesofNewMexicoandUtah
them for cane use. may help expand the frontiers of O&M for
infants and toddlers in the future.
FINALTHOUGHTS
With the knowledge that early O&M support References
is essential in providing the best opport-
Adelson, E., & Fraiberg, S. (1974). Gross
unity for life-long independence and self-
motor development in infants blind from
determination,UtahandNewMexicoarede-
birth. Child Development, 45, 114–126.
terminedtoprovidetheseservices.O&Msup- Anthony,T.L.,Bleier,H.,Fazzi,D.L.,Kish,
port in the early intervention setting assists D., & Pogrund, R. L. (2002). Mobility
familiesinattainingtheskillsandconfidence focus: Developing early skills for orienta-
necessary to help their children become safe, tionandmobility.InR.L.Pogrund&D.L.
independent travelers. Fazzi (Eds.), Early focus: Working with
New Mexico’s successful development young children who are blind or visually
impaired and their families (2nd ed.) (pp.
and implementation of a statewide early
326–404). New York: AFB Press.
intervention O&M program inspired Utah
Chen, D. (2014). Early intervention: Purpose
to strive to do the same. New Mexico’s
and principles. In D. Chen (Ed.), Essential
efforts have noticeably impacted its chil-
elements in early intervention: Visual im-
dren, families, and staff members as chil-
pairmentandmultipledisabilities(2nded.)
dren transition to preschool. “There is a
(pp. 3–33). New York: AFB Press.
significant improvement in overall spatial Dennison, E. M. (2000). The VIISA Project:
skills and familiarity with the cane in stu- A model national in-service training pro-
dents who have received O&M services as gram for infants and young children with
infants and toddlers. Equally important are visual impairments. Journal of Visual Im-
thepositive,informedattitudesparentstake pairment & Blindness, 94, 695–705.
Ferrell, K. A. (1998). Project PRISM: A lon-
as they learn with their children the advan-
gitudinal study of developmental patterns
tages that are provided and limitations that
of children who are visually impaired. Fi-
maybeovercomethroughearlyexperiences
nal report. (Grant H023C10188, US De-
with white canes and with O&M training”
partment of Education, Field-initiated re-
(C. Quintana, personal communication,
search, CFDA 84.023). Greeley, CO:
May9,2015).Utahhopestoseethefruitof
University of Northern Colorado.
its efforts soon, as it implements and ex- Morgan, E. (Ed.). (1995). Project VIISA: Re-
pands its early intervention O&M program. sources for family-centered intervention
Utah and New Mexico have recognized forinfants,toddlers,andpreschoolerswho
theimportanceofearlyO&Msupportinthe arevisuallyimpaired(2nded.,Vols.1–2).
development of young children with visual Logan, UT: SKI-HI Institute, Utah State
impairments and their families. The two University.
Rosen, S. (2010). Kinesiology and sensori-
states share many early intervention O&M
motor functioning for students with vision
strategies and practices that help support
loss.InW.R.Wiener,R.L.Welsh,&B.B.
thegrowthofthechildrenandfamiliesthey
Blasch (Eds.), Foundations of orientation
serve, including providing additional early
and mobility, Volume I: History and theory
intervention–related training to their staff
(3rd ed.) (pp. 138–172). New York: AFB
members to help them work with families
Press.
comfortably and successfully. As other states Skellenger, A. C., & Sapp, W. K. (2010),
takeaninterestinexploringwaystoincorporate Teaching orientation and mobility for the
O&M into their early intervention infrastruc- early childhood years. In W. R. Wiener,
506
JournalofVisualImpairment&Blindness,November-December2015 ©2015AFB,AllRightsReserved
R.L.Welsh,&B.B.Blasch(Eds.),Foun- 582,000 people living in a geographic
dations of orientation and mobility, Vol- area of 97,093 square miles. Wyoming’s
ume II: Instructional strategies and prac-
sparselypopulatedcitiesandtownsstrug-
tical applications (3rd ed.) (pp. 163–207).
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New York: AFB Press.
and specialist health care (Gantenbein,
Troster, H., & Brambring, M. (1993). Early
motor development in blind infants. Jour- Robinson, Wolverton, & Earls, 2011).
nal of Applied Developmental Psychology, Limited availability of primary care for
14, 83–106. children presents a barrier to the provi-
sion of screening services for potentially
correctable conditions such as amblyopia
HongPhangiaDewald,M.A.,COMS,orientation
and mobility specialist, USDB, 3098 South High- (Kemper & Clark, 2006). Amblyopia is
land Drive, Suite 105, Salt Lake City, UT 84106;
the most common form of unilateral
e-mail: (cid:2)[email protected](cid:3). Cindy Faris,
MAECSE, TVI/L, program coordinator, Infant blindness in children, with an estimated
Toddler Program, NMSBVI, 801 Stephen Moody prevalence of 1–5% (Holmes & Clarke,
Street SE, Albuquerque, NM 87123; e-mail:
(cid:2)[email protected](cid:3). Karen S. Borg, 2006).
M.Ed., TVI, director, Parent Infant Program for To address the need for vision screen-
theBlindandVisuallyImpaired,USDB,742Har-
ing services in areas where primary care
rison Boulevard, Ogden, UT 84404; e-mail:
(cid:2)[email protected](cid:3). Julie Maner, M.A., is limited, the Lions Clubs of Tennessee
COMS, orientation and mobility specialist, established a network of lay screeners
NMSBVI; e-mail: (cid:2)[email protected].
us(cid:3). Loreta Martinez-Cargo, M.A., TVI/L, whoweretrainedtofollowastandardized
COMS,developmentalvisionspecialistIII,orien- screeningprotocol(Donahue,Johnson,&
tationandmobilityspecialist,BirthtoThreePro-
Leonard-Martin, 2000). The success of
grams, NMSBVI; e-mail: (cid:2)loretacargo@nmsbvi.
k12.nm.us(cid:3). Mark Carter, M.A., COMS, the Tennessee program led the Lions
orientation and mobility specialist, NMSBVI; e- Clubs International Foundation (LCIF)
mail: (cid:2)[email protected](cid:3).
to incorporate vision screening into its
Core Four sight preservation initiatives
Practice Report and provide matching funds for Lions
Clubs in various states, including Wy-
oming, to initiate vision screening pro-
ScreeningforAmblyogenic grams (see Donahue et al., 2006, for a
FactorsinaRuralState: review).
ImplementingaStatewide
ChildhoodVisionProject THEPROGRAM
TheWyomingLionsEarlyChildhoodVi-
JoshuaJ.Kemp,LauraLeaMarquardt
Westlake,RebeccaD.Christensen, sion Program (WLECVP) provides chil-
andWilliamE.MacLean dren aged 6 months to 6 years with free
Wyoming is the least populated state in annual vision screening, administered by
the United States, with approximately
knowledgetheWyomingChildDevelopment
Centers and Wyoming Lions Clubs for their
The authors would like to acknowledge Ken ongoing assistance with screening services.
Heinlein for his assistance with the concep- Rebecca Christensen became a contracted
tualization and screening activities for the employee of PlusOptix after preliminary
project. The authors would also like to ac- drafts of this manuscript were written.
507
©2015AFB,AllRightsReserved JournalofVisualImpairment&Blindness,November-December2015