Visual impairment - assess, plan and strategies

Students with Visual impairments should be encouraged to participate in all classroom activities, physical education and extracurricular activities. Schools should make sure it is easy to move around, good contrast between walls, floors and doors and that bright sunlight is reduced by the use of blinds. It should also be noted, making something bigger for a student with a Visual Impairment is not always best especially if presenting work on larger paper or on a bigger screen.

Students with a Visual Impairment may also feel self-conscious about their condition. They may also be a target for bullying. Vision impairment severely affects quality of life among adult populations. Adults with vision impairment often have lower rates of workforce participation and productivity and higher rates of depression and anxiety.

Visual Impairment can be wide ranging, so consider each student’s needs individually.

Definitions

The International Classification of Diseases 11 (2018) classifies vision impairment into two groups, distance and near presenting vision impairment.

Distance vision impairment:

• Mild –visual acuity worse than 6/12 to 6/18
• Moderate –visual acuity worse than 6/18 to 6/60
• Severe –visual acuity worse than 6/60 to 3/60
• Blindness –visual acuity worse than 3/60

Near vision impairment:

• Near visual acuity worse than N6 or M.08 at 40cm.

What other professionals would be involved at each stage?

• Initial Observations - Class teacher, support staff
• First Concerns 1 - Class teacher, support staff, parents/carers, child or young person, Optician if appropriate
• First Concerns 2 - Class teacher, support staff, parents/carers, child or young person, Optician if not been seen
• SEN Support 1 - SENCo, class teacher, support staff, parents/carers, child or young person, Optician
• SEN Support 2 - SENCo, class teacher, support staff, parents/carers, child or young person, external professional (VI service, Optician – assessments may suggest some concern that needs medical support, Ophthalmologist at the hospital may be able to give further information
  Additional support for mobility from the provider commissioned by the Council)

What assessments would be used at each stage?

• Initial Observations - Reading age assessments
• First Concerns 1 - Reading age assessments
• First Concerns 2 - Reading age assessments
• SEN Support 1 - Reading age assessments, BPVS, simple visual assessment published by boots UK.
• SEN Support 2 - Assessments at this stage would be completed by a specialist teacher
  • Distance Acuity
  • Near Acuity
  • Colour
  • Contrast Sensitivity

First concerns - stage one

- Assess

• Deteriorating handwriting – may be unusually small or large, or letters may be poorly formed
• Difficulty copying accurately either from board or close
• Appears to be unable to see words and pictures on the whiteboard
• When reading may skip letters, lines and words and may cover an eye when reading or performing close tasks
• Shows signs of poor hand eye co-ordination and over and under reaching
• Appears clumsy and may often trip or fall
• May be light sensitive (photophobic)
• May thrust head forward to squint when looking at near/far
• May hold equipment and/or text unusually close or at a strange angle
• When writing or drawing head is very close to the page

- Plan

Class teacher liaises with parents/carers and child/young person on a regular basis – minimum of 3 meetings with parents within a 12-month period.

• Establish whether the child or young person is known to have a visual impairment
• Check to see if all vision checks are up to date and establish if having similar issues at home

- Strategies

Continue with any relevant strategies from initial observation stage, plus:

• Intersperse short spells of visual activity with less demanding activities
• Eliminate inessential copying from the board
• Ensure child is positioned with back to windows, so that the light source streams from behind.
• Ensure safe access to physical and practical activities
• Provide additional time to complete tasks
• Make reasonable adjustments to the learning environment

First concerns - stage two

- Assess

The child or young person has observed ongoing and/or fluctuating difficulties or deterioration in the following areas:

• Deteriorating handwriting – may be unusually small or large, or letters may be poorly formed
• Difficulty copying accurately either from board or close
• When reading may skip letters, lines and words and may cover an eye when reading or performing close tasks
• Shows signs of poor hand eye co-ordination and over and under reaching
• Appears clumsy and may often trip or fall
• seeing different colours on paper or whiteboard
• May be sensitive to light
• May tire easily or easily distracted by precision tasks
• May thrust head forward to squint when looking at near/far
• May hold equipment unusually close or at a strange angle

- Plan

Class teacher liaises with parents/carers and child/young person on a regular basis - minimum of 3 meetings with parents within a 12-month period.

At this time:

• Establish whether the child or young person is known to have a visual impairment
• Check to see if all vision checks are up to date and establish if having similar issues at home
• Discuss concerns/observations with parents/carers
• Obtain and record parental information and views
• Obtain and record child or young person’s views

If available and/or appropriate:

• Examine Early Years Foundation Stage (EYFS) Data and/or previous school records
• Consider past teacher observations and views
• Collate current assessments related to area of concern – qualitative, quantitative and summative
• Discuss concerns with SENCO

- Strategies

Class teacher to discuss finding with the SENCo and plan for interventions

Continue to use the strategies suggested in the initial observations and First Concerns Stage One.

• Try out different paper or Smartboard colours to try to find best contrast
• Intersperse short spells of visual activity with less demanding activities
• Ensure child is positioned with back to windows, so that the light source streams from behind.
• Blinds to be closed to avoid glare on the whiteboard
• Give the child/young person a darker pencil or fibre tip pen
• Try using bold/wider lines for the child/young person to write on

SEN support - stage one

- Assess

The child or young person has observed persistent and moderate difficulties with the following

• Accessing practical activities
• Writing especially cursive script
• Accessing standard text on electronic devices
• Navigating around unfamiliar or hazardous situations
• With reading back own handwriting – may be unusually small, large or letters poorly formed
• Copying accurately either from board or from table top learning materials
• With viewing objects so moving them close or holding them at an angle and/or adopting a noticeable head tilt or position
• With discrepancy between oral responses and written responses.

At this stage, the child or young person could have:

• A recognised visual impairment and/or an assessed visual deficit, which is corrected by glasses/lenses

- Plan

SENCo, Class teacher, parents/carers and child/young person continue to liaise on a regular basis with the SENCo taking the lead, having a minimum of 3 meetings within a 12 month period

At this time:

• Obtain and record updated parents/carers views
• Obtain and record updated child or young person’s views
• Establish whether the child or young person is known to have a visual impairment
• Check with parents to see if all vision checks are up to date
• Complete a SEN Support Plan and review on a regular basis (e.g. at least termly)
• Place child/young person on register as SEN Support (Code K)
• Seek external advice from health professionals such as School Health
• Implement strategies (including targeted support and/or resources) up to agreed financial levels: Universal funding (AWPU) plus up to a maximum of £6,000
• Ensure Class teacher and Teaching assistants receive relevant Continuing Professional Development (CPD). 

If the child/young person has not been assessed by an optician and it is appropriate, the SENCo could complete a simple visual assessment published by Boots UK.

- Strategies

Continue with any relevant strategies from First Concerns stages, plus:

• Provide adaptions to the learning environment
• Withdrawal sessions for individual or small group work may be necessary to:
  • Complete tasks made slower by the visual impairment
  • Prepare child or young person for a class activity/learning experience
  • Reinforce mainstream work
  • Provide additional hands on experience of materials or presentations
  • Provide additional experiences of the environment to remedy a lack of incidental learning
• Child or young person may benefit from using specialist equipment, for example:
  • Sloping reading/writing boards
  • Dark pens/pencils
  • Dark lined books/paper
  • Laptops/tablets

SEN support - stage two

- Assess

At this stage, the child or young person has:

• A recognised visual impairment and/or an assessed visual deficit, which is not fully corrected by glasses/lenses

Observed persistent and moderate difficulties with the following:

• Difficulty with forming or reading back own handwriting – may be unusually small, large or letters poorly formed
• Difficulty copying accurately either from board or from table top learning materials
• When reading may skip letters, lines and words
• Shows signs of poor hand eye co-ordination and over- and under-reaching
• Children or young people may tire easily or be easily distracted from precision tasks
• Move close to items to view them or hold them at an angle
• Adopts a noticeable head tilt or position
• Discrepancy between oral responses and written responses.

- Plan

SENCo, Class teacher, parents/carers and child/young person and any external professionals liaise on a regular basis – minimum of 3 meetings within a 12-month period

Continue to:

• Check with parents/carers to see if all vision checks are up to date
• Obtain and record updated parents/carers views
• Obtain and record updated child or young person’s views
• Complete a SEN Support Plan and review on a regular basis (e.g. at least termly)

At this stage:

• Seek external advice with parental consent discuss /refer to Inclusion Team
• Inclusion Team to carry out specialist assessments, including assessments for specialist equipment
• Implement strategies (including targeted support and/or resources) up to agreed financial levels: Universal funding (AWPU) plus up to a maximum of £6,000
• Ensure Class teacher and Teaching assistants receive relevant Continuing Professional Development (CPD). Liaise with the Inclusion Team regarding possible training opportunities

If necessary:

• Seek external advice from educational agencies such as Educational Psychologist (EP) Clusters
• Seek external advice from health professionals such as School Health
• Carry out and review further assessments as required and/or as advised by outside agencies

- Strategies

Continue with any relevant strategies from First Concerns stages and SEN Support Stage One, plus:

• Provide adaptions to the learning environment, as advised by the Inclusion Team
• Withdrawal sessions for individual or small group work may be necessary to:
  • Complete tasks made slower by the visual impairment
  • Prepare child or young person for a class activity/learning experience
  • Reinforce mainstream work
  • Provide additional hands on experience of materials or presentations
  • Provide additional experiences of the environment to remedy a lack of incidental learning
  • Learn particular skills to improve curriculum access e.g. touch typing or use of magnifiers or other specialist equipment
  • Learn mobility skills
• Provide specialist equipment as recommended by QTVI, for example:
  • Sloping reading/writing boards
  • Magnifiers
  • Dark pens/pencils
  • Dark lined books/paper
  • Large print materials (e.g. reference books)
  • Modified measuring equipment
  • Laptops/tablets
  • Low vision aid
  • Modified Text

• Consider whether some support from a teaching assistant/adult is required
• Consider whether typing tuition needs to be provided
• Consider access arrangements for external tests and exams

Complex

- Assess

The child or young person has observed persistent and significant difficulties with the following:

• Access to standard print and needs modified materials, or alternative formats, e.g. braille
• Learning from demonstrations and activities in lessons
• Recording/retrieving written work efficiently
• Organising learning materials
• Access to incidental learning and concept development
• Moving safely, independently and with appropriate speed

The child or young person will also have one or more of the following:

• A need to use specialist equipment to provide efficient access to the curriculum
• A need for some individualised programmes of learning
• A need for some pre or post tutoring to ensure full access to learning
• Slower work rate/ability to process visual information
• A need for provision of alternate physical activities
• A need for a programme to support  personal, social and emotional development and self-help skills

- Plan

SENCo, Class teacher, parents/carers and child/young person and any external professionals liaise on a regular basis – minimum of 3 meetings within a 12-month period

If EHC Plan is not in place:

• Review SEN Support Plan (at least termly)
• Consider a request for EHC needs assessment (see section on EHC needs assessments)

If EHC Plan is in place:

• Change code on SEN register to indicate child/young person has EHC plan in place (code E)
• Refer to described outcomes and provision and implement
• Continue to plan, do, review against the specified outcomes and provision, using previous SEN Support Plan as ‘EHC Implementation Plan’
• Complete Annual Review of EHC Plan. Specialist Teacher for Visual Impairment from the Inclusion Team to attend Annual Review
• Continue to act on external advice from educational and health agencies as necessary
• Carry out and review further assessments as advised by outside agencies
• Continue to liaise with the Inclusion Team, who will carry out further specialist assessments as required and write reports for annual review of EHC Plan
• Implement strategies (including provision of targeted support and/or resources) up to agreed financial levels: Universal funding (AWPU)
  • plus up to £6,000 (this is equivalent to approximately 12 hours of additional support)
  • plus any additional top-up as detailed in the EHC Plan

- Strategies

Continue with any relevant strategies from First Concerns and/or SEN Support Stages, plus:

• Employ a differentiated/modified curriculum
• Provide support to meet needs as detailed in STVI recommendations, and EHC Plan
• Provide significant modification of materials and presentation to facilitate access to the curriculum
• Will require targeted support from a teaching assistant and/or preparation of modified resources to access the curriculum
• Ensure that specialist equipment is integrated into the inclusive learning practice of the classroom.
• Provide appropriate learning space, storage space and a recharging point for equipment
• Ensure that specialist equipment is kept in good working order and inform QTVI of any
• Provide child or young person with time for pre or post tutoring
• Provide alternative or differentiated physical activities if and when required/advised
• Provide time for joint planning between school staff and QTVI
• Provide sufficient time for school TAs to acquire specialist skills, e.g. Braille
• Actively support the child or young person in using specialist skills as an integral part of the school day

Inclusion Team involvement may be required as follows:

• Specialist Teacher for the Visually Impaired
• Defined and time limited programmes of specialist teaching, g.
  • Use specialist
  • Social skills
  • Ongoing, weekly specialist teaching of Alternative Formats, such as Braille, Moon, Audio.
  • Ongoing specialist teaching for curriculum support
  • Ongoing support around social and emotional aspects of learning
  • Ongoing training for school TAs
• Specialist Teaching Assistant (VI)
  • Support TA training by working alongside school TA to model good practice
• Habilitation Specialist
  • Assess skills in mobility
  • Assess independent life skills
  • Create and implement a programme of work to develop mobility skills and techniques
• Create and implement a programme of work to develop independent life skills

Specialist support

- Assess

Additional to impact at First Concerns, SEN Support and Complex, the child or young person may have one or more of the following:

• Significant cognitive/health/physical difficulties, plus a visual impairment or visual loss
• A very high and complex level of need specifically related to the visual impairment
• Particular and significant social/emotional or vision needs which require sustained specialist provision
• Need for access to appropriate sporting activities and opportunities as an intrinsic part of the curriculum
• Need for individualised programmes of learning due to a combination of special educational needs and visual impairment
• A requirement to be taught within a small group
• A requirement for a high level of mobility and independent life skills teaching as an intrinsic part of the curriculum
• A need for an appropriate peer group to support social and emotional wellbeing
• A need for access to appropriate social activities
• A need for an appropriate peer group to support identity as a person with visual impairment

- Plan

Class teacher, SENCO, parents/carers and child/young person continue to liaise on a regular basis - minimum of 3 meetings with parents within a 12-month period

Continue to:

• Obtain and record updated parents/carers views
• Obtain and record updated child or young person’s views
• Indicate on SEN register that child or young person has an EHC plan in place (code E)
• Refer to described outcomes and provision in the child or young person’s individual EHC Plan and implement

Continue to plan, do, review against the specified outcomes and provision within the child or young person’s EHC Plan

• Complete Annual Review of the EHC Plan. QTVI to attend Annual Review
• Liaise with named local authority 0-25 SEND officer for child or young person if needs change
• Continue to act on advice from internal and external education and health professionals, as necessary
• Carry out further assessments following advice and guidance from outside agencies
• Implement strategies (including provision of targeted support and/or resources) up to agreed financial levels for specialist provision (see finance section)
• Ensure all staff receive Continuing Professional Development (CPD) and training as required

- Strategies

Additional to strategies at First Concerns, SEN Support and Complex:

• Suitable/alternative curriculum, exams, vocational assessments/learning environment
• Daily teaching from a QTVI/Habilitation Specialist