visual conditions and functional vision: early intervention issues early intervention training...

Visual Conditions and Functional Vision: Early Intervention Issues

Early Intervention Training Center for Infants and Toddlers With Visual Impairments

FPG Child Development Institute

The University of North Carolina at Chapel Hill

Working With Families and Eye Care Professionals Session 1

Objectives

After completing this session, participants will

1. compare and contrast the roles of different eye care professionals.

2. describe the components of an eye care examination and information families should expect to receive following the exam.

3. describe strategies that TVIs use to support families who seek to understand their children’s visual diagnoses.

Visual Conditions 1A

Early Intervention Training Center forInfants and Toddlers With Visual ImpairmentsFPG Child Development InstituteUniversity of North Carolina at Chapel HillJune 10, 2004

ObjectivesAfter completing this session, participants will

4. discuss factors such as learning styles and language and cultural barriers that affect families’ abilities to access and understand information and describe strategies for providing support to overcome these barriers.

5. describe strategies for facilitating interactions and communication between eye care specialists and families.

6. describe the role of TVIs when working with eye care specialists and other professionals using the transdisciplinary model.

Visual Conditions 1B


Eye Care Specialists

Different eye care specialists have differentresponsibilities and training.

•Ophthalmologist

•Optometrist

• Low vision specialist

•Orthoptist

•Optician

•Ocularist

TVIs should assist families and other members of the team in understanding the roles of thesedifferent professionals.

Visual Conditions 1C


Components of aClinical Eye Exam

Knowing what to expect may make visits less stressful for families.

1. Gather family and child history

2. Assess external appearance

Visual Conditions 1D


Components of a Clinical Eye Exam

3. Measure visual acuity

4. Observe pupil reaction and movement of eyes

Visual Conditions 1E


Components of aClinical Eye Exam

5. Examine the interior of eye

6. Evaluate child’s need for corrective lenses

Visual Conditions 1F


Expected Results From the Exam

• Explanation of child’s visual condition and prognosis

• Information about secondary visual conditions

• Prescription for corrective lenses, if applicable

• Information about size of objects and materials the child can see Stiles & Knox, 1996

Visual Conditions 1G


Expected Results From the Exam

• Recommendations for

environmental lighting

• Prescription for medication, if necessary

• Information about restriction of physical activity, if applicable

Stiles & Knox, 1996Visual Conditions 1H


Responding to Families

TVIs should be aware of the types of responses they can offer families and how their responses may be received.

• Critical response

• Clarifying response

• Empathy response

• Recommending responseVisual Conditions 1I


Families Need Support

• Emotional support (e.g., demonstrating positiveness and responsiveness to the family)

• Informational support (e.g., providing names and locations of specialists and support groups, books, videos, and pamphlets relating to diagnosed condition)

• Material support (e.g., providing nonoptical devices such as lighting sources, reading stands, dome magnifiers, and sunglasses)

Visual Conditions 1J


How Families Access Information

Individuals have different learning styles—

• global preference: overview of information, followed by individual facts, or• analytical preference: presentation of individual facts first, then the bigger picture.

Information presented in a manner accessible to the family should result in improvedcommunication that enhances early intervention.

Visual Conditions 1K


Strategies for Helping Families Understand the Diagnosis

• Introduce families to another family whose child has a similar visual condition.

• Introduce families to successful adults with visual impairments.

• Provide simulation activities to depict what the child might see (using vision simulators).

Visual Conditions 1L


Cultural Considerations Guidelines for Interpreters and Translators

• Use qualified, bilingual, professional personnel.

• Explain the importance of confidentiality.

• Explain the importance of neutrality and impartiality in interpreting and translating.

• TVIs should monitor interactions between interpreters/translators and families.

Milian & Conroy, 2001

Visual Conditions 1M


Cultural Diversity and Visual Impairment

Some cultures

• believe that caring for the child is more important than teaching independence,

• do not expect adults with visual impairment to hold jobs or expect them to hold only certain jobs,

• value oral communication over written words,

• vary in their gender expectations, and

• ascribe special cultural meanings to specific types of visual impairments.

Erin, 2002 Visual Conditions 1N


Religious Diversity and Visual Impairment

• Many religions still connect the presence of visual impairments with the idea of retribution for sin.

• For some families, religious leaders and heads of the family may be the critical decision makers.

• Many families visit religious healers during their children’s early years.

Erin, 2002 Visual Conditions 1O


Cultural ReciprocityAccording to Harry (as cited by Warger, 2001), professionalsand families must engage in a two-way process to gain understanding and respect for each others’ values. This two-way process is the basis for cultural reciprocity and involves

• identifying cultural values,

• determining whether you and the family are aware of each others’ assumptions and how you differ,

• identifying and respecting cultural differences—explaining and discussing cultural bases of assumptions—and

• determining the best way to adjust recommendations to match family’s values.

Visual Conditions 1P


Cultural InfluencesWhen language or cultural barriers exist,families may have additional obstacles tounderstanding or accepting the diagnosis of a child’s visual impairment.

• Use an interpreter with eye care specialists when English is not the family’s primary language.

• Recognize that different cultures respond differently to diagnosis of visual impairment. This may affect the family’s motivation to treat VI or provide interventions.

Visual Conditions 1Q


Gathering Information

• Ask the family what they were told.

• Review existing reports with the family.

• Take notes while the family talks.

• Ask the family if they have any questions.

• Choose topic discussed and share additional information with the family.

• Identify date and time of the next visit to an eye care specialist.

Visual Conditions 1R


Eye Report Interpretation

TVIs may need to identify and

discuss the following components

of an eye report with families.

• History/background information

• Results of the eye examination

• Implications/treatment plan

Visual Conditions 1S


Preparation for Eye Care Visit

TVIs can assist the family in preparing for the exam by

• formulating questions to ask relating to the child’s etiology, prognosis, and treatment options;

• anticipating questions that the eye care specialist might ask; and

• Helping them develop a portfolio of the child’s medical and intervention information.

Visual Conditions 1T


Role of the TVI During Eye Care Visits

The TVI can offer to accompany the family to an appointment in order to

• provide encouragement to the family,• share additional information about the child’s visual abilities,• interject if communication between the family and the specialist is not going well, and• ask for clarification if the family seems hesitant to do so.

Visual Conditions 1U


The TVI as Liaison toEye Care Specialists

TVIs can provide additional information about how children use their vision in different settings across time that will help eye care specialists to better understand the child’s visual condition.

By working collaboratively and sharing information, TVIs and medical personnel will be more effective in supporting families and children.

Visual Conditions 1V


Initiating Interactions With Eye Care Specialists

The TVI can initiate interactions with eye care specialists through

• letters of introduction,• phone calls, and• electronic mail

in order to establish collaborativerelationships and encourage referrals to early intervention.

Visual Conditions 1W


The TVI as Liaison to Team Members

TVIs collaborate with other team members when providing information or asking for input.

Visual Conditions 1X


The TVI as Liaison to Team Members

• TVIs should share medical information with other team members.

• Professionals from other disciplines collaborate with TVIs to learn more about how a child’s visual impairment may affect growth and development.

Visual Conditions 1Y


Transdisciplinary Team Success

Three elements are necessary for

the successful implementation of a

transdisciplinary team:

• collaboration,

• staff development, and

• role release. Correa et al., 2002

Visual Conditions 1Z


Benefits and Challenges of the Transdisciplinary Approach

• An integrated and holistic approach that facilitates consistency and better communication among families and team members.

• Difficult to sustain due to additional time needed to coordinate and collaborate with other team members, to train members across disciplines, and to monitor role release.

Visual Conditions 1AA


The TVI as Liaison to Families

Some families report negative experiences with eye care professionals because families

• were unable to understand eye exam procedures,

• were devastated by the diagnosis,

• felt rushed during the visit, or

• received contradictory information.

In such instances, TVIs can follow up with the eye care specialist to gather more information.

Killebrew & Corn, 2002Visual Conditions 1BB


visual conditions and functional vision: early intervention issues early intervention training...

Documents

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