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University of Edinburgh

The Early Years: Strategies and Resources for working with very young visually impaired children

Presented on Friday 12 June

Using the Early Support developmental journal for babies and children with visual impairment

Lorna Hall

The brief

A developmental framework for babies and young children (0-36 months) with severe and profound visual impairment

  • to be held by families
  • used jointly by parents and professionals
  • supporting partnership working
  • underpinned by a scientific developmental framework for VI

The development team

  • Developmental Vision Team (DVT)
  • Great Ormond Street Hospital NHS Trust (GOSH),
  • UCL Institute of Child Health, London
  • Multidisciplinary team
  • Focus on development and vision of children with visual impairment especially 0-5 years

Funded by Department for Education and Skills (DfES, UK)

Core project team

  • Alison Salt - paediatrician - project lead
  • Naomi Dale - psychologist - project lead
  • Jackie Osborne - education consultant/teacher for visual impairment
  • Patricia Sonksen - paediatrician - lead on visual impairment materials

Aims of the developmental journal

  • To support parental understanding of their child's development and progress
  • To identify the small steps underpinning learning
    • stages of readiness
    • appropriate goals
    • sequential learning
  • To develop a shared language and understanding of development (parents and professionals)
  • To provide a common framework for understanding the early development of children with a visual impairment
  • To help professionals gain a more complete picture of what a child is doing, using the observations of parents/carers
  • To highlight vulnerable areas that may need further support
  • To support sharing developmental information with other professionals.

Notes: This slide makes it clear that the brief given to the development team focused on

  • Supporting families' understanding of and
  • Ability to provide for their children's needs.
  • It was not focused on developing something that would be used as a clinical assessment tool for practitioners.
  • The scientific underpinning of the materials gives professionals, services and multi-agency groups a standard format for monitoring and tracking children's development and progress

Findings from practice and research - DVT GOSH

Vulnerable processes:

  • Integrating senses in the first year of life
  • Becoming social and communicative
  • Becoming aware of their movement potential
  • Sharing attention (joint attention)
  • Making their world meaningful
  • Linking language to meaning.;

Developmental opportunities and challenges

  • These can be helped to be overcome with appropriate early developmental guidance and promotion, including vision.
  • Intervention from the earliest days of infancy.
  • Parents and key workers working together.

Notes: The research and clinical experience of the DVT suggest that intervention should be introduced as early as possible, particularly during the first months or year of life, if possible.

Key innovations in the materials

  • Focus on early social and communicative development
  • Focus on 'shared discovery' and joint attention
  • Focus on importance of promoting vision as early as possible.

Introduction booklet

Focus on importance of promoting vision as early as possible.

Flexible use of the developmental journal

  • OK if families complete all or some of the Record - with or without support from the people who work with them.
  • OK if families want to talk about the pages in the Record relevant to their child but not fill in the paperwork.
  • OK if families ask (or give permission to) professionals to complete the paperwork on their behalf.
  • OK if families want to use it more at some times than others.
  • OK if families don't want to use it at all.

Age guide and expectations

Developmental 'stages'

Stages Approx age ('average' child with VI)

  • 1a 0-6 months
  • 1b 4-12 months
  • 2 8-18 months
  • 3 15-24 months
  • 4 21-30 months
  • 5 27-36 months +

Notes: Lots of discussion re inclusion of this in journal, all the way through the consultations. Mixed views majority view was that it was useful to have a yardstick to compare progress. At the same time, parents did not want specific age expectations against each developmental goal. The overlap of age bands takes into account that child of different levels of vision tend to learn or acquire skills at a slightly different rate. Child with most profound levels of visual loss acquiring skills at a slower rate, especially in the early years.

Developmental areas

  • Social and emotional development
  • Communication, language and meaning
  • Play and learning (including using hands)
  • Movement and Mobility
  • Self care.

How do you fill it in? Decision making

  • How do you fill them in?
  • How can they be used ?
  • Decision making
  • Is behaviour there/can a child do something?
  • Possibly?
  • Definitely?
  • Please turn to page 12 of the booklet entitled 'Introduction'


  • Dev goals are in an organised sequence. Can be filled in with possibly or definitely achieving.
  • Examples can be given of what child does in relation to goal.
  • Sequence of progress can help track how quickly child is achieving goals.
  • Parents tick and date the step for each area of dev
  • How would you define possibly or definitely. This is covered in page 12 of intro booklet.

Using the activity cards - activities and ideas

  • Provide suggestions for how to support and encourage achieving developmental goals
  • Outline potentially useful activities and strategies
  • Organised and colour coded in line with the stages of the developmental record.

Which activity card to use

Notes: Each stage has 2 cards, the second a little more advanced than the first. At each stage there are 2  cards for each dev area.

Developmental profile - what it is and who it's for

  • Record where a child is up to in all areas of development on one sheet
  • Makes it easier to compare development across more than one area
  • Family completes, with the support of their key worker/teacher of the child with visual impairment
  • Intervals for completion are recommended in the Introduction 'how to use'.