World Review on Early Intervention for Children With Visual Impairment or Early Childhood Blindness

Written by Prof. Kenneth Caszlo, The Professional Director of the Elia Association

In order to better understand the optimal methods of intervention for the advancement of toddlers and children with blindness and visual impairments, the BALA conducted a review of the various intervention approaches that exist in different countries around the world. This document is a summary of our review. Although not all countries are included in this summary, it faithfully represents the various strategies and approaches that exist in the field.

Usa

Treatment in the United States is guided by a law passed in 1970 and has since been amended several times (in 1980 and 2004), called the Individuals with Disabilities Education Act. Originally, the law's intention is to give school-age disabled children 'adequate and free public education', in a 'restrictive environment as little as possible'. In the 1980s, the law was expanded to offer federal grants for special education services for children from birth to age 3.

Early care services are voluntary for eligible parents, whose eligibility is determined by each state. The natural environment is determined to be such that the child would be there if he did not suffer from a disability (home, daycare, kindergarten), under Part C, which covers toddlers from birth to the age of two. Children from 3 to 21 years old are covered under the wider Part B. This part requires:

1. Proper and free public education.
2. An environment that limits as little as possible if a regular classroom, if not, a special education class in a regular school, or not, a special education school. This division is determined by each child's personal educational program (IEP).
3. Full and individual evaluation (FIE):
   1. Vision test by an eye professional.
   2. Functional vision assessment to diagnose how the child is used in the vision he has
   3. Assessment of orientation and mobility.
4. Personal Educational Program (IEP).
5. Considering parents' opinions in educational decisions.
6. Enforcement that will ensure that the relevant local authorities exercise the right of the child to adequate and free education.

This law constitutes the basic structure that determines the specific intervention of each country. Each state has a slightly different policy on how it implements the law. In the 6-month-to-3-year age group, Florida has a model similar to the one that exists in Israel, i.e. a public-supported kindergarten and nursery program (in parallel with private frameworks). In South Florida, this program is provided by Florida Heiken Children's Vision Program of the Miami Lighthouse for the Blind. The children spend most of the day in this facility, along with home care for those who are unable to attend. In New York, Mesut Utd, California and Texas, the system is primarily based on homeschooling, with daily/weekly visits by children and parents to learning centers. There are also state programs, such as in Texas, for example, where it is called the Early Child Intervention Service. The services provided are as follows:

The early care system for young children, from birth to 3 years of age, is a federally funded state program under the IDEA Act, Part C. In Texas, this program (called ECI) is under the state's health care.

This program works with a variety of local organizations and agencies throughout Texas to provide services to a toddler in his 'natural environment', usually at home, in a nursery or as part of the Mother's Day Out program. The professionals work together with the families to promote development and learning, provide support, coordinate services and reduce the need for special and expensive programs.

After the child is two years old, the program team begins working together with the families to determine the best pre-school program for the child, and ensure a smooth transition to the school system. During this period, called Transition, the team works with the families to develop a transition plan that will be part of the Individual Family Service Plan. The children 'finish' and leave the ECI after they are 3 years old.

At age 3, families can choose from a number of optional kindergartens. One option is a private garden, and another option can be PPCD. PPCD is a preschool program for children with disabilities, ages 3-5, available through the public school.

Many U.S. universities offer first and second degrees in various aspects of early treatment for visual impairments.

Hungary

In Hungary, the only treatment option is in designated centers. There are no regional centers in Hungary for early treatment of children with visual impairment. Existing services are provided from birth to age 4. Hungary oversees early treatment under the Education Law, meaning that the provision of their services and funding is the responsibility of the Ministry of Education. The early treatment center is funded by the state (70% of its budget) and serves 87 families through 2 full-time and 5 part-time employees (as of 2006). The children's ratio to teachers is 20 children per teacher. The service is provided once a week, and for some children twice a week. Some universities offer training courses in early treatment. While there are no special treatments designed for early treatment of children with visual impairments, the center uses many methods and approaches to treatment, correction and developmental encouragement. These include hydrotherapy, motion therapy, physiotherapy, music therapy and more. The center's staff includes experts such as therapists, psychologists and ophthalmologists/optometrists.

Austria

Austria has one public institution and two private institutions. While there is no national legislation in the field, each of the state's nine districts has its own legislation within the framework of social services and health. Services are available from birth to age 7. Both private institutions focus primarily on home-based care, while the public mainly provides center-based services in small groups. There are 3 different types of treatments in Austria. A 2006 survey found that:

In Tyrol, the organization serves 54 families with 7 part-time and full-time caregivers. One full-time therapist takes care of 10 kids. In Salzburg and the surrounding area, one full-time caregiver working with 10 families was reported, along with 4 full-time teachers and 3 part-time teachers. The frequency of home visits ranges from one to a week or two. In Upper Austria and Lynch, the center provides services to 90 families, with 4 full-time caregivers and the rest part-time. A full-time employee serves 30 families once a week, two weeks or a month, depending on the specific need of the family.

czech republic

In the Czech State, the state covers only 50% of the budget of institutions serving visually impaired children. The laws regulating the required care are under the Ministry of Social Affairs and Social Services. A main focus is on providing support to the family (for parents) and the covered ages are childbirth until age 6. The main treatment provided is a home-based treatment. Tests and assessments are given in early treatment centers, as well as various family programs (weekends, vacations, etc.). The basic treatment provided is low-vision therapy, plus physiotherapy.

The number of families treated in the CzechOs stands at 500, and 47 caregivers represent a ratio of 1:10. But many of the caregivers work part-time, so the ratio is 25 families per full-time teacher. The frequency of visits ranges from a visit to a month or two. The training of therapists is done through courses in treatment centers, not through academic training programs.

Poland

The legislation regulating the treatment of the visually impaired is under the Ministry of Health and the Ministry of Education. The covered age range is birth to age 6, and the programs are funded by the government. The programs are house and center based, and the Polish Academy of Special Education is responsible for carrying out the evaluations and tests. The various centers offer a wide range of treatments (vision, music, hydrotherapy, movement, etc.).

A survey of three leading institutions found that in Warsaw, the Keshet Foundation serves 120 families through 6 full-time teachers and 3 part-time teachers, with a ratio of 25/1. The frequency of visits depends on the area where the family lives. If the family lives in Warsaw, the visit is done every two weeks, and outside the city once a month. The early care team at the Warsaw Academy provides service to 30 families, with one full-time teacher and 3 part-time, with a ratio of 15 children per teacher. The visit is done once a month. The third organization examined serves 155 children and families through a team of 5 teachers, all full-time, with a ratio of 30 children per teacher with a frequency of weekly visits. In 2 centers examined, the team includes teachers, psychologists, ophthalmologists/optometrists and neurologists. Poland offers training through both universities and treatment centers.

Australia

In Australia, early treatment programs operate under a comprehensive program called Vision Australia. In 2004, this program became the first national agency to treat blindness, following the merger of several agencies. And in 2006 and 2007 it was expanded with the joining of other organizations.

In July 2008, the agency also joined Eye Dog Australia, and is currently the only one in the country that provides guide dog services. Vision Australia is a comprehensive program that covers children from birth to their first steps, starting school, finding work and most of adulthood. In cooperation with the parents, the team develops strategies suitable for the child's needs.The support network includes diverse professionals, including speech therapists, physiotherapists, occupational therapists, movement and orientation experts, technology accessibility experts, orthopedists and teachers who are experts in child development.

There are a variety of sources of funding for families in need of medicare services and a national insurance framework for people with disabilities. The program currently supports over 2,100 children (a total of 25,000 people) nationwide. Funding for the program comes from government and private donations.

England

In England there is a professional organization (VIEW) representing the sector working with children with visual impairments. According to this organization, there are a number of key issues regarding the treatment of children with visual impairments in the country.

In recent years, the organization has watched with concern how a combination of budget cuts, funding changes and teaching countries is leading to a crisis in the care of visually impaired children. This crisis causes real harm to the treatment of this population, in a way that may impair their ability to become independent adults in the future.

There are about 25,000 blind or visually impaired children in England, i.e. 2 children and young adults up to the age of 25 per 1,000 people (0.2%), excluding children with 'mild' vision impairments. Some of these children face additional difficulties that affect their learning and developmental ability, especially combining with disabilities and other limitations, such as eye movement problems, or interference in the way the brain interprets visual information. There is a higher incidence (10.5%) of visual impairments among children with disabilities. In the population of children with learning difficulties, the estimated prevalence is 5.6%, with the risk of visual impairment increasing with the increase in the severity of learning difficulties.

Although childhood visual impairment is sometimes included with hearing impairment as a sensory disorder, early severe visual impairment is mainly considered a severe neurodegenerational disorder, given its effect on many different developmental processes. The nature and quality of treatment of visual disorders in England and the UK varies greatly between different places and different degrees.

Infants and young children with visual impairments need professional assistance as soon as possible after diagnosis– support that usually provides a teacher with specialization in teaching children and young people with visual impairments. Many studies emphasize the importance of early intervention by a professional to ensure optimal developmental and visual progress. Despite the overwhelming evidence regarding the importance of early intervention, there is still a significant delay in referral of some toddlers and children to professional care.

• While 86% of local authorities have a clear arrangement for referring toddlers and children to visually impaired care services, there are still authorities without clear referral arrangements.
• Even when a local referral arrangement is in place, the referral is still delayed for various reasons:
  • The child is not treated at a local hospital, but in a hospital where there is no arrangement with the local authority's care services, or in a specialized hospital in another area. Eye Clinic Liaison officers at these centers reported difficulty obtaining contact information in the visual impairment care services outside the local authority. Although this information should be on the local offer page of the local network, in many cases it is allowed to be found, or includes only details of generic early treatment services.
  • If the child is treated by an ophthalmologist who advises that he or she treats adults, or by a pediatrician who is not an ophthalmologist, that doctor may not be aware of the need to refer the child to the relevant treatment services.
• In addition to the above regarding the delay in referral, anecdotal evidence indicates that there is a trend in some places to direct toddlers and young children with visual impairments to generic 'milk drop' services, not to the treatment services for visual impairments.

In order to address these problems, the following steps were proposed:

• The funding required for intensive and professional interventions and treatments for all toddlers and young children with visual impairments must be recognized and allocated.
• It should be recognized that visual impairment is a lifetime limit, and that proactive support from professionals is essential throughout childhood and early adulthood. It should not be assumed that support is required only in response to a specific difficulty and for progress in a short range of academic results.
• The important role of professional teachers with relevant knowledge (QTVI) and qualified rehabilitation experts must be recognized and maintain the appropriate quality and quantity of these professionals through sponsored training and continuous professional development.

Ireland

The Central Early Treatment Organization in Ireland is called ChildVision (formerly known as the St. Joseph's Center for the Visually Impaired), an organization that has been operating for almost 150 years. An estimated 224,000 people are blind or visually impaired in Ireland, of whom 1.8% (about 4,000) are children. ChildVision is the only place in Ireland devoted entirely to the educational and treatment needs of blind and visually impaired children. The organisation treats children from all over Ireland from birth to 23. The group of therapists includes speech and language clinician, teachers, nurses, braille teachers, social workers and more, as well as housekeeping and maintenance staff.

The campus includes a kindergarten, a treatment center, an education center, the national evaluation service, an eye clinic and low vision, a petting zoo, a horse farm and a swimming pool. All services are offered free of charge and the funding comes from a combination of public and private resources, mainly from three main sources: the Health Services Authority, the Ministry of Education and various corporations and foundations, together with public and private donations. The organisation has kindergartens in Dublin and Cork, which include full support from medical staff. Children arrive at the kindergarten between one and five days a week (via a dedicated transportation that is also suitable for wheelchairs) from the morning until the early afternoon

China

It is estimated that there are about 70,000 school-aged blind children in China, most of whom live in rural and agricultural areas. The schools that offer a special educational framework for the visually impaired are located mainly in the large cities, sometimes thousands of kilometers from the villages. All facilities are funded by the state, and almost all treatment options are center-based, with few of them also available in the child's home.

Russia

The variability of Russian society is reflected in various areas of the socio-medical world, including the treatment system and the identification of developmental disorders in children. An important step in creating a framework for early treatment was the idea of creating a system for early treatment of children with disabilities promoted by the Russian Ministry of Education in the mid-1990s. This idea included both improving the quality of care provided and providing medical and psycho-pedagogical services to each family in the early stages of child development.

The leading team of the Institute of Affirmative Action Pedagogy in Russia developed the national framework for early treatment of children with developmental problems. The main tasks of this system have defined:

1. The earliest identification of special educational needs of children.
2. Maximum reduction of the gap between the definition of the disorder and the beginning of targeted treatment, including specific and specific components.
3. Mandatory inclusion of parents in the learning process, starting from the first years of the child's life.
4. Expanding the time limits for special education, with the low threshold being the first months of the child's life.
5. The existence of a special education standard, which defines academic achievements together with a level of ability.
6. A more directional and gradual education, which in most cases is not required in the educational framework of a child in normal development.
7. Customizing the learning process and special organization of the learning environment.

Early treatment services were opened as a unit in:

• Integrated kindergartens and kindergartens.
• Special education schools facility.
• Various educational centers – diagnosis and counseling, psychological, medical and social support, pedagogical-psychological rehabilitation, affirmative action and others.

The purpose of early assistance services is to provide psycho-pedagogical and soy-medical support to families with toddlers with developmental problems.

The Institute for Remedial Teaching of the Russian Ministry of Education has created a unified national program for early identification and special assistance for children with developmental disorders (starting in the first months of life). Today, a variety of support services are offered to families with young children suffering from various disorders. The initial model was created in Novgorod, where there is extensive experience in the treatment of families in Moscow (where there are several institutes at the national level), in St. Petersburg (a non-national institute), Samara and Rostov, where a provincial program for early-stage diagnosis and treatment was adopted, funded from provincial budgetary sources. Other cities in Russia (e.g. in the Moscow region) adopt their own models for rehabilitative assistance for children with disabilities. Professionals working in public organizations are trying to solve the problem of assistance for children with developmental disorders and their families, and for example, centers have been opened in the cities of Nizhny Novgorod and Sratov for early treatment of children with visual disorders.

In Nijany Novgorod, a group was opened to help children with visual impairment as part of the Early Care Center, a group created by members of Perspective, a public organization that brings together parents of visually impaired children. Educational activities for children are taught by speech clinician, physical training instructors, music director and more, and the work is done in close contact with the parents.

In Saratov, early assistance to children with visual impairment began in 2004 as part of the Rehabilitation and Assistance Center for Visually Impaired Children. Unlike their counterparts in Nijani, the professionals in Saratov developed and tested innovative technology for early treatment through home visits of children with severe visual impairment and their families. In 2012-2013, the technology they developed was implemented in the field and operated as part of a national pilot. Since 2014, assistance for children with visual impairments has been provided in 2 forms– home counseling (for children up to age 3) and a kindergarten group (for children aged 2 to 3 years old). 3-year-olds enroll in a kindergarten group, which operates within the framework of the school and thus maintains an educational continuum for the children. Students in the Faculty of Special Education and Psychology at The University of Serteub integrate into home care as volunteers. Special education and psychology students learn to develop personal learning pathways, conduct studies on cognitive and emotional activity among children, and acquire practical skills in working with the blind and visually impaired, including children with additional disabilities.

Japan

There are about 300,000 people in Japan with visual impairments, out of approximately 2,000,000 people with disabilities. The country has successfully developed an educational methodology to support the blind in existing schools in agricultural areas, through the addition of a teacher serving 8-10 neighboring schools in a particular area.

There are 65 special schools in Japan for visually impaired students, and 171 children are in the kindergarten program of these schools. Half of them also frequently visit a regular kindergarten or nursery. Special schools are also common for children with visual impairments. Since the state sees importance in the principle of integration, many visually impaired children visit both special schools and regular schools.

Tskova University has the only national school in the country for the visually impaired. The school's tasks are:

1. Provide the special assistance required for toddlers, children and visually impaired students, as well as provide general education in the kindergarten system, schools and high schools, combined with professional corrective instruction.
2. Collaborate with the university in the field of research and integrate students into the school's practice.
3. Continue to develop expertise in visually impaired education in research and day-to-day practice and share the findings across the country.
4. Providing essential educational support for visually impaired toddlers and students who are not enrolled in school.
5. Help create textbooks for visually impaired toddlers and students and collaborate in other activities in the field of teaching for the visually impaired in Japan, such as creating textbooks and other teaching materials. In addition, implement braille admissions exams to the university in order to assist students with visual impairment.

Educational activities

• Kindergartens and elementary schools

We accept a variety of students, including those who require special assistance. We improve the learning experience through flexible forms of teaching, such as unique lessons and personal guidance, adapted to the child's developmental stage.

 

Sources:

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   Rehabilitation and Education for the Blind and Visually Impaired Project ISaR
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