Visual Impairment Scotland Research

Introduction of a Multi-disciplinary Community Vision Assessment team

A J Blaikie, M Campbell, G Coyle, E Lymburn, M Comerford, J Ravenscroft, M Buultjens, GN Dutton

The 7th International Conference on Low Vision Activity and Participation
July 2002, Göteborg, Sweden

Purpose and Background

Teachers of visually impaired children require up to date, relevant and understandable information on the visual function of children to help develop early intervention strategies and Individualised Educational Programmes (IEP). These interventions aim to give children the best opportunity to access the full curriculum and fulfil their potential.

Dundee City Special Education Service has lacked a reliable and formalised transfer of understandable and relevant information from the Hospital Eye Services, hindering the development of appropriate educational strategies.

The purpose of this study was to improve the transfer of relevant and understandable information from the hospital eye service to special education services by introducing a Multi-Disciplinary Community Vision Assessment Team. This study puts into practice recommendations made in two recent Scottish Executive reports 1,2

Methods

Consultation occurred between special education, community paediatrics and the ophthalmology department. A review of vision assessment techniques was made 3,4,5,6 and members of staff from the three agencies identified to work in the collaborative team. A questionnaire was developed to explore parent’s and teachers opinions of the new service.

37 children have so far been assessed by the new service. 27 of the children assessed have cerebral visual impairment (CVI) with additional disabilities. 2 children have since died and one has moved away. Questionnaires were sent to the parents and teachers of the remaining 34 children.

Results

Feedback from parents
Half (17/34) of the parent’s questionnaires were returned.
All parents who responded felt it was useful to have been given a copy of the report. All parents except one (16/17) said it was the first time that they had ever received a written copy of a vision assessment report. Three quarters of the parents (13/17) claimed that the report had helped them improve their understanding of their child’s vision. All parents considered it important that the same report is also given to their child’s teacher and therapists (more so than their family doctor).
More than half of the parents felt their child was more relaxed (9/17) while waiting for the assessment and less stressed (11/17) by the actual assessment than previous hospital-based vision assessments. Only one parent felt their child was more stressed by the new assessment.

Feedback form teachers
88% (30/34) of the teachers questionnaires were returned
Almost half (14/30) the teachers had no previous written information on the visual function of the child they were trying to teach.

Almost all teachers (28/30) felt the report improved their understanding of their child’s vision with the same number stating the report helped in planning teaching strategies. More than half the teachers (17/30) made a significant change in teaching strategies as a result of receiving the report.
This was most marked in the children with CVI where more than three quarters of teachers (19/25) made a significant change in teaching strategies.

Conclusions

A successful multi-disciplinary community vision assessment team has been established in Child Development Centres and schools in Dundee, Scotland.

Several different pathways of assessment are now employed depending on the age or developmental stage of the child, the level of visual impairment and presence of additional disabilities.

Current, relevant and understandable vision assessment reports are now distributed to all agencies that provide care to the child. In particular teachers now have available information on the visual function of children aiding development of optimal educational strategies.
Overall parents and teachers feel the new vision assessment team has many benefits compared to previous hospital eye clinic appointments.

Recommendations

It is recommended that other health board and local authorities collaborate and develop similar vision assessment teams.

Children with CVI and additional disabilities should be assessed in an environment that is as familiar as possible with the minimum of upheaval to their usual daily routine.

Information on visual function should be ‘translated’ into language that is understood by all agencies that provide care to the child. With parents consent this information should be disseminated to all care giving agencies.

References:
1. Certification and Registration Working Group, Social Work Services for People with a Sensory Impairment, The Scottish Office: May 2001
2. Social Work Inspectorate ‘Sensing Progress’, Social Work Services for People with a Sensory Impairment, The Scottish Office: September 1999
3. Hyvarinen, Lea. Vision testing manual : 1995-1996. Illinois: Precision Vision, 1995,
4. Lindstedt, Eva. How well does a child see?: A guide on vision and vision assessment in children (2nd ed). Sweden: ELISYN, 1997.
5. Sonksen PM, Petrie A, Drew KJ. Promotion of visual development of severely visually impaired babies: evaluation of a developmentally based programme. Dev Med Child Neurol 1991 Apr;33(4):320-35
6. Adoh TO, Woodhouse JM, Oduwaiye KA. The Cardiff Test: a new visual acuity test for toddlers and children with intellectual impairment. A preliminary report. Optom Vis Sci 1992 Jun;69(6):427-3
7. Houliston MJ, Taguri AH, Dutton GN, Hajivassiliou C, Young DG. Evidence of cognitive visual problems in children with hydrocephalus: a structured clinical history-taking strategy. Developmental Medicine & Child Neurology 1999, 41: 298-306

VI Scotland
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