Survey of World Early Intervention

Prof. Kenneth Koslowe, OD MS FCOVD-A, Director, Professional Services, Eliya.

In order to better understand the best methods of providing early intervention for the blind and visually impaired (VI) infants and children, at ELIYA (The Association for Blind and Visually Impaired Children in Israel) we have undertaken to survey the approaches used in various countries around the world. The following is a summary of this survey. While not every country is included in this summary, it does present all the various strategies and approaches.

United States of America

In the USA, treatment is guided by a law originally passed in 1970 and amended in 1980 and 2004. It is called IDEA (The Individuals with Disabilities Education Act). It originally established to entitle school age children with disabilities a “free and appropriate public education” in the “least restrictive environment”. It was expanded in the 1980’s offering Federal grants for provision of special education services to children from birth to age 3 years.

The early intervention services are voluntary for parents with eligibility determined by each state. The natural environment is taken to mean where the child would be if they had no disability (home, daycare, nursery school). This is referred to as Part C and covers infants from birth through (and including) age 2. Children aged 3 through 21 are covered by Part B which is more extensive. Part B mandates:

  1. Free and Appropriate Public Education
  2. Least Restrictive Environment: If possible, a regular classroom, if not a special class in a regular school and if not, a special school. This is determined by each child’s Individualized Education Program (IEP).
  3. Comprehensive evaluation (full and individual evaluation, FIE):
    1. An eye report from the child’s eye care professional
    2. A functional vision assessment to see how your child uses the vision they have
    3. An Orientation and Mobility assessment
  4. An Individualized Education program (IEP)
  5. Parent’s input into educational decisions
  6. Safeguards to make sure that the local authorities enforce your child’s right to a free and appropriate education.

This law is the basic structure governing the intervention by the various states. Each state has its own variation in how it implements this law. In the age group 6 months to 3 years Florida has a model that is similar to Israel, that is a public supported (alongside private support) nursery and kindergarten program. This is provided in Southern Florida by the 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 training for those who cannot be seen in such a setting. New York (The New York Lighthouse for the Blind), Massachusetts (Perkins School for the Blind) ,  California and Texas (Texas School for the Blind and Visually Impaired)  are mostly home training education with one day/week visits to learning centers by the parents and the children. There are also state -wide programs such as in Texas where it is called the Early Child Intervention Service. The services provided are as follows:

The early intervention system of services for young children, aged birth to three years, is a state and federally funded program through the Individuals with Disabilities Education Act (IDEA), Part C.   In Texas, Early Childhood Intervention, or ECI, is administered by Texas Health & Human Services (HSS).

ECI coordinates with a variety of local agencies and organizations across Texas to bring services to the infant in his or her “natural environment” – usually the home, play group, daycare setting, or Mother’s Day Out program.  Professionals work together with families to:

  • promote development and learning,
  • provide support,
  • coordinate services, and
  • decrease the need for costly special programs.

Shortly after the child turns two, the ECI team begins working with families to help determine the best pre-school programs for the child and ensure a smooth transition to the school system.  During this time, called “transition”, the ECI service coordinator works with families to develop a transition plan that will be part of the child’s Individual Family Service Plan (IFSP).  Children “graduate” from ECI on their third birthday. 

When the child turns three, families may choose from several pre-school options for their child.  One option would be private pre-school.  Another option might be PPCD.  PPCD is the pre-school program for children with disabilities, ages 3-5, that is available through the public school.

Bachelor’s and Master’s Degrees are available in all aspects of early intervention with the Visually Impaired in numerous Universities in the USA.

Hungary 

Center based treatment is the only option available in Hungary. In addition, there are no regional centers in Hungary for early intervention of children with visual impairment. The services are available from birth to age 4.  Hungary regulates early intervention in the frame of the Education Law, and it means that the provision of early intervention and the financial support is under the Ministry of Education. The Hungarian early intervention center is state supported (70% of budget) and serves 87 families with 2 full time and 5 part-time early interventionists (as of 2006). The ratio of children and teachers is 20/1. The service is provided once a week and for some children twice a week. There are training courses provided by Universities in early intervention. While there are no special therapies designed for early childhood intervention of visually impaired children, there are lots of methods and approaches
for treatment, remediation and stimulation of the development which are
used and applied in the center. These include:

  • Low vision therapy
  • Hydro-therapy
  • Senso-motoric therapy
  • Physiotherapy
  • Conductive therapy
  • Music therapy

The treatment team consists of: Early interventionists, Psychologists and Ophthalmologists/Optometrists

Austria

Austria has one state facility and two private institutes. While there is no state legislation each of the nine Austrian provinces has its own regulations coming under health and social services. The services are available from birth to age 7. The two private facilities focus mainly on home-based intervention while the state facility provides more center-based activities for small groups. Three different types of therapies are available in Austria.

In a survey conducted in 2006 the following was reported:

In Tyrol, the organization served 54 families with 7 home visitors on both part-time and full-time basis. One full time early interventionist should deal with 10 children. In Salzburg and its suburb, it was reported that one full time early interventionist works with 10 families and they employ 1 full time and 3 part-time teachers. The frequency of visits is once a week or in two weeks. In Upper-Austria, Linz the center provides services to 90 families with 1 full time and 5 part-time early interventionists. One full time worker serves 30 families with the frequency of once a week, two weeks or month, depending on the needs.

Czech Republic

In the Czech Republic the state covers only 50% of the budgetary needs of the institutes serving the visually impaired children. The laws governing the care are under the Ministry of Social Welfare. One major focus is providing support for the family (parents). The ages covered are birth to age 6. The main service provided is home-based intervention. Assessments are performed at early intervention centers along with family programs (weekends, camps, etc.). The basic therapy provided is low vision therapy along with some physiotherapy.

The number of families receiving service in the Czech Republic is
500 families and 47 early intervention teachers representing about10
children/teacher. But many of the early intervention teachers work part time. There are 25 families for one full time teacher. The frequency of visits is once in two
months. Training of teachers is done through courses at the early intervention centers rather than through academic degree granting programs

Poland

The legislation governing the care of the visually impaired is under the Ministry of Health and also under the Ministry of Education. The age range covered is birth until age 6 and the programs are government funded. The interventions are both home-based and center-based. The Polish Academy of Special Education is responsible for assessments. A complete range of therapies are offered in the Polish centers (Low Vision, Music, Hydro, Sensori-motor, etc.).

In Poland, a survey of the three major institutes found the following. In Warsaw, the Rainbow Foundation serves 120 families with 6 full time and 3 part-time teachers. The ratio of children/staff is 25/1. The frequency of visits is dependent on which area the family lives. If the family lives in Warsaw, they visit them once in every two week and if outside Warsaw, once a month. Early intervention team at the Academy
in Warsaw provides services to 30 families with 1 full time and 3 part-time teachers. The ratio is around 15 children to 1 teacher. They visit families once a month. The third participating Polish organization in Ohorzów serves 155 children and families with 5 teachers. All of them are full time so the ratio is 30 children/teacher with a frequency of weekly visits. Early interventionists, psychologist, ophthalmologist/optometrist, neurologist are available in two Polish centers.

Poland offers both University based and center-based training of staff.

Australia

In Australia, the early intervention program exists within the general program called Vision Australia. In 2004 Vision Australia became Australia’s first national blindness agency. Vision Australia was formed following the merger of the Royal Blind Society (RBS), the Royal Victorian Institute for the Blind (RVIB), Vision Australia Foundation (VAF), and the National Information Library Services (NILS) in July 2004.

The organization was further expanded in December 2006 through the amalgamation of Royal Blind Foundation Queensland and November 2007, Hear a Book, a Tasmanian producer of audio books, also joined.

In July 2008 Seeing Eye Dogs Australia (SEDA) merged with Vision Australia. This made Vision Australia the only national provider of guide dog services.

Vision Australia is a comprehensive program covering the children from birth and their first steps, starting school and discovering their talents to graduating, finding after-school jobs and making the most of adulthood.

In collaboration with the parents, the expertise of an allied health team, professionals and specialist staff to develop strategies that suit the child’s needs.

The child’s support network of specialists includes:

  • Speech pathologists
  • Occupational therapists
  • Physiotherapists
  • Psychologists
  • Orientation and mobility specialists
  • Access technology specialists
  • Orthoptists
  • Early childhood specialist teachers

Various funding options can help to access Vision Australia’s services and support. These include Medicare (such as Better Start Early Intervention and Medicare, Better Access to Mental health, Chronic Disease Management) and the National Disability Insurance Scheme. Vision Australia currently supports over 2,100 children (and 25,000 people overall) nationally. The funding is by a combination of Government support and private donations

 

England

In England there exists a professional organization (VIEW) representing the education workforce supporting children with Vision Impairment (VI). According to this organization there are several key issues facing the treatment of children with VI in England.

Over the past few years, VIEW has observed with increasing concern how a combination of cuts in local authority budgets, changes in funding, and education policy have led to a crisis in specialist educational provision for children with VI. The current system is failing this vulnerable group. A generation of vision impaired young people is at risk of poor outcomes that will seriously undermine their ability to become independent adults.

There are about 25,000 blind or visually impaired children in England. This works out to be about two in every 1,000 (0.2 per cent) children and young people up to the age of 25. This is based on a visual acuity (VA) threshold of 6/18 and does not include children with ‘mild’ VI. Some of these children may have additional difficulties with their vision that have implications for learning and development, particularly when combined with other disabilities/special educational needs (SEN), for example, eye movement problems, or problems with the way that the brain interprets visual information. There is a much higher prevalence (10.5%) of VI among disabled children. In the population of children with learning disabilities (LD) the estimated prevalence is 5.6%, with the risk of VI increasing in line with severity of LD

Although childhood vision impairment (VI) is often grouped with hearing impairment as a sensory disorder, severe early onset VI is more appropriately considered as a major neurodevelopmental disorder, given its impact on multiple developmental processes”. The nature and quality of VI provision in England and the UK is highly variable across local authorities as well as across individual educational settings, leading to a postal code lottery of specialist support.

Babies and young children with VI need to be referred as soon as possible after diagnosis for specialist support – usually this is provided by a qualified teacher of children and young people with VI (QTVI). There is strong research evidence to support the importance of early intervention from a practitioner with specialist knowledge of early years development of babies and children with VI to ensure optimal visual and developmental progress.

Despite the overwhelming evidence about the importance of early specialist intervention for babies and young children with VI and their families, there are still lengthy delays in referral for some babies and children, with consequent delays for early childhood intervention.

  • While the majority (86%) of local authorities have an established arrangement with health for referring babies and children to the VI service, a few LAs appear to have no formal referral arrangements with health
  • Even where there is a local arrangement for referring children from health to education, referrals can still be delayed or fail to be made because:
    – The child is not being treated in their local hospital but, in a hospital where there is no referral arrangement with the VI service in his/her home LA, or in a specialist hospital in another area. Eye Clinic Liaison Officers (ECLOs) in these centers have reported difficulties in obtaining the contact details of the VI service in out of area LAs. While this information should be on the local authority’s Local Offer page, in many LAs this information is either extremely difficult to find, or only gives the contact details of a generic early years or SEND service, which can lead to further delays.
    -If the child is being treated by a consultant ophthalmologist who usually sees adults, or by a pediatrician who is not an eye specialist, the doctor may not be aware of the need to refer to the VI service .
  • In addition, to the above concerns about delays in referral, anecdotal evidence suggests that there is a trend in some LAs towards steering babies and young children with VI towards a generic early years’ service, rather than to the VI service.

The following suggestions have been made to correct matters:

  • The major developmental impact of childhood VI should be officially recognized, and resources and funding provided for intensive, specialist intervention for all babies and early years children with VI and their families.
  • There should be recognition that vision impairment is a lifelong disability and that proactive support from VI specialists is required throughout childhood and early adulthood. It should not be assumed that support is only needed in response to a failure to make good progress against a narrow range of academic outcomes
  • There should be recognition of the key role played by qualified teachers of children and young people with VI (QTVI), and registered qualified habilitation specialists (RQHS), and a commitment to both the quantity and the quality of these professional groups through appropriately funded training and continuous professional development (CPD)

Ireland

The major resource for early intervention in Ireland is an organization named ChildVision (formerly known as St. Joseph’s Centre for the Visually Impaired). This has been functioning for close to 150 years. It is estimated that there are about 224,000 blind or visually impaired people in Ireland and about 1.8% (4,000+) of them are children. ChildVision is the only place in Ireland totally dedicated to the education and therapy needs of blind and multi-disabled children. They look after children from all over Ireland ranging in age from birth to 23 years of age. The treatment team includes speech and language therapists, occupational therapists, teachers, nurses, braille specialists, social care workers, pet and equine therapists as well as a team of maintenance and household staff who work across campus.

The campus consists of a Preschool, Therapies & Nursing, Vocational Education, National Assessment Service, Low Vision Clinic, Eye Clinic, Library, Equine Therapy and Pet Farm, and Swimming Pool. All services are free of charge and the funding is a combination of public and private sources. ChildVision’s income comes from three principal sources, the Health Service Authority (HSE), the Department of Education & Skills and through Corporates, Trusts and Foundations, and public and private donations.  They have preschool locations in Dublin and Cork. The early intervention class is followed by a pre-school, with full nursing care. Children attend between one to five days per week with a preschool bus service (which can transport wheelchairs) picking up children from the surrounds of ChildVision and dropping them home again in the early afternoon.

China

There are an estimated 70,000 school-aged blind children in China – most living in rural areas and villages. The schools which offer special education for VI children are predominantly located in the major cities hundreds or thousands of miles away.

The facilities for early intervention are all state funded and almost all treatment is center based with few if any early home interventions.

Russia

The transitional state of Russian society is reflected in various sectors of the socio-medical sphere, including the imperfection of the system of early detection and correction of deviations in development of children. An important step in the creation of early intervention was the idea of creating a system of early care for children with disabilities advanced by the Ministry of Education of the Russian Federation in the mid 90’s of the last century. This idea included both the quality improvement of early help functioning, and providing each family with available medical and psycho-pedagogical diagnostics in the early stages of child development, defining special psychological and educational needs that would create the conditions for effectively overcoming the deviations in a child’s development, starting with the first days of life

The leading staff of the Institute of correctional pedagogy of RSA developed the state concept of early care for children with developmental disabilities. The key tasks of implementing this system were defined as follows:

  1. The earliest possible identification of special educational needs of children (special educational needs).
  2. The maximum reduction of the gap between the moment of definition of primary violations and the beginning of targeted training of the child, including both nonspecific and specific components.
  3. The mandatory inclusion of parents in the learning process, starting from the first years of a child’s life.
  4. Extension of time limits for special education: lower boundary – the first few months of a child’s life.
  5. The existence of a specialized standard of education, which defines academic achievement together with the level of child’s competence.
  6. More differentiated, step-by-step training, which in most cases is not required in the education of a standard developing child.
  7. Much more profound than in mass education, the differentiation and individualization of the learning process and special organization of the educational environment.

Services of early intervention were opened as a structural unit in:

  • preschool educational institutions of compensating or combined type
  • special (correctional) schools
  • pre-school educational institutions
  • various centers of education: of diagnostics and consulting; psychological, medical and social support; psychological-pedagogical rehabilitation and correction; curative Pedagogy and others.

The aim of early help services is to provide complex psycho-pedagogical and medico-social support to families with babies and toddlers with developmental problems.

Institute of RAE correctional pedagogy of the Ministry of Education of the Russian Federation created the project of Program, a unified state system of the early (from the first months of life) identification and special assistance to children with developmental disabilities. The project entered in-to the Program “Development of practical Psychology in education” (2003-2010) of the Ministry of education of the Russian Federation. The high level of interest of specialists and state structures in the organization of such assistance was proved by the feedback received and expert assessment of the Program during its discussion in the regions of the country.

Today a variety of support services are actively created for families with children of early age with disorders in development in our country. So, the model of early intervention service was created in Great Novgorod, where there is great experience in consulting families in Moscow (Consultative-diagnostic center of the Institute of RAE Correctional Pedagogy, state scientific institution “Center for early diagnostics and special assistance” of the Ministry of education of Russia, psychological-medical-social Centre North district, the Center for curative Pedagogy, Center of early intervention “downside up”, etc.), in St. Petersburg (non-state educational institution “Saint-Petersburg early intervention Institute”, the rehabilitation center of children with visual impairments, etc.). Samara, Rostov region adopted the regional program of early diagnosis and early special assistance, and these programs are financed from regional budgets. Perm region, Kostroma, small cities of the Moscow region are implementing their own models of early rehabilitative assistance to children with disabilities.

Professionals working at public organizations try to solve the problem of help for children with developmental disorders and their families, so in Nizhny Novgorod and Saratov Centers of early intervention for children with visual impairments were created.

In Nizhny Novgorod, a group of short-term stay for Visually Impaired Children operates on the basis of the early intervention Centre, created by members of the Nizhny Novgorod public organization of parents of visually impaired children called “Perspective” (NARDIS “Perspective”). Educational activities for children are held by speech pathologists, physical education instructor, musical director. Work is conducted in close contact with the parents.

In Saratov the early rehabilitative assistance to children with visual impairments began in 2004 on the basis of the Saratov regional public organization “Center for rehabilitation and assistance to children with visual impairments”. In contrast to Nizhniy Novgorod’s colleagues the Saratov experts have developed and tested innovative technology for early intervention via home visits for children with severe visual impairment and their families. In 2012-2013 the developed technology was applied in the practice of the Resource center, operating under a Federal pilot group on the basis of GBSO “Special (correctional) comprehensive boarding school of III-IV type of Saratov”. Since 2014 work in early intervention for children with visual impairment is carried out in two directions: consulting at home (children up to 3 years) and a short-stay group (children 2-3 years). 3 years old children are enrolled in a pre-school group which is a subdivision of a boarding school. Thus, there is continuity in the education of children with vision impairments. Students of the faculty of psychological, pedagogical and special education of Chernyshevsky Saratov State University are involved into work at home with young children with severe visual impairment, as volunteers. Future special education teachers and psychologists learn to develop individual educational routes, conduct studies of cognitive activity and the emotionally-volitional sphere of children, develop synopses of lessons with preschool children, acquire practical skills of work with the blind and visually impaired children, including children with multiple disabilities.

Japan

In Japan there are about 300,000 visually impaired among 2,000,000 physically handicapped population. Education and Resettlement Methodology has been successfully developed to impart education to the blind in existing village schools in rural areas by attaching a Resource/Itinerant Teacher who serves 8 – 10 schools in a cluster of adjoining villages.

There are 65 special schools for students with visual impairments (special school)
in Japan and 171 children attend the kindergarten program of these schools (Nihon 1995; Takahashi 2010). Half of them also attended to regular kindergarten or preschool (Inohira 1992; Takahashi 2010). Special schools for visually impaired children (special school) in Japan remain common and the most appropriate place for providing education and instruction for blind children. Since the principal of inclusion is widely recognized in Japan, many children with visual impairments are attending both regular preschool and special school.

One University based facility exists at the University of Tsukuba called The Special Needs Education School for the Visually Impaired and it is the only national school for the visually impaired.

Their mission statement is as outlined below:

  • – To provide the specialized care needed for visually impaired toddlers, children and students, and also to provide general education in our kindergarten, elementary, junior high, and senior high schools, along with professional occupational training
  • – To cooperate with visual impairment education research of the University of Tsukuba, and also conduct teaching practice and care giving practice for the university’s students
  • – To strive for the further succession and development of our expertise in visual impairment education through everyday practice and research, and to send such results around all of Japan
  • – To provide the necessary educational support to other visually impaired toddlers, children and students not enrolled in our school
  • – To provide assistance in the creation of textbooks for visually impaired toddlers and students. Also, to cooperate in various related activities of the education for the visually impaired in Japan. Such as the development and organization of volunteers for the creation of books and other teaching materials and tools, and, in addition, to implement Braille type university entrance exams and to strive for the acceptance of visually impaired students etc.

Educational Activities and features

  • Kindergarten and elementary departments
  • we accept various children, including those that require special care, on the premise of commuting to school from home. We enhance the learning effect by devising flexible forms of teaching, such as classes based on visual impairment, combined classes, and individual guidance, tailored for the developmental stage.

 

Sources:

  1. https://www.visionaustralia.org/
  2. Key issues for VI education in England Posted on 27th January 2020by VIEW Admin
  3. The 16th World Congress of Rehabilitation International contents> 16th World Congress of Rehabilitation International No.11
  4. IDEA and Vision Impairments by Carmen Willings June 4, 2019 teachingvisuallyimpaired.com
  5. Comparing the situation of early intervention services to visually impaired children and their families in some European Countries: ISaR – Inclusive Services and Rehabilitation Technical University of Dortmund Department Rehabilitation Sciences
    Rehabilitation and Education for the Blind and Visually Impaired Project ISaR
  6. Early Childhood Intervention in China Journal of International Special Needs Education Vol. 18, No. 1 pp. 29–39
  7. Formation and Evolution of Early Intervention for Children with Developmental Delays in Russia and Abroad Journal of Psychological Abnormalities J Psychol Abnorm 2016, S1
  8. Special Needs Education In Japan BY KIRSTY KAWANO NOVEMBER 1, 2016 FAMILIESLIFESTYLE
  9. https://childvision.ie/site/
  10. Vision UK (2018) Key facts about vision impairment in children and young people. https://www.visionuk.org.uk
  11. Salt A and Sargent J (2014) ‘Common visual problems in children with disability’. Archives of Diseases in Childhood 2014;0:1–6.
  12. Nielsen LS, Skov L, Jensen H (2007) ‘Visual dysfunctions and ocular disorders in children with developmental delay. I. prevalence, diagnoses and aetiology of visual impairment’. Acta Ophthalmol Scand 2007; 85: 149–56
  13. Emerson E and Robertson J (2011) The estimated prevalence of visual impairment among people with learning disabilities in the UK. CeDR, Lancaster University/Learning Disabilities Observatory report for RNIB and SeeAbility
  14. Keil S, Fielder A and Sargent J (2017) ‘Management of children and young people with vision impairment: diagnosis, developmental challenges and outcomes”. Archives of Diseases in Childhood 2017;102:566–571 (p566)
  15. Flynn K (2018)) Freedom of Information (FOI) questions on local authority education provision for children and young people with vision impairment in England: 2017. Research briefing RNIB https://www.rnib.org.uk/campaigning-current-campaigns-children-and-education/protecting-local-vision-services-children
  16. VIEW (2018) The RNIB/VIEW VI service Local Offer spreadsheet https://viewweb.org.uk/vi-education-provision-local-offers-england-2017/
  17. DINF: https://www.dinf.ne.jp/doc/english/sp/index_e.html

 

 

 

 

 

 

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